Self-reported adverse reactions associated with topical ophthalmic medication use: a cross-sectional survey

The aim of this study was to investigate self-reported adverse reactions associated with the use of topical ophthalmic medications. A cross-sectional survey, involving 500 ophthalmic patients recruited from three eye care facilities in the Central Region of Ghana was conducted. A structured questionnaire was administered to participants to collect data on demographics, name of drug, dosage form, and dosing frequency of ophthalmic medications used, as well as adverse reactions experienced. The pHs of frequently prescribed ophthalmic medications to the patients were measured. The prevalence of reported adverse drug reaction [predominantly burning sensation (55%), blurry vision (22%) and itching (13%)] was 44.8%. More Females reported adverse drug reactions than males (χ2=26.24, P<0.001). The aged reported more adverse reaction than others (P<0.01). Patients using cream ophthalmic medications reported more adverse drug reactions than those using other dosage forms (χ2=8.80, P=0.024). The pHs of the commonly prescribed ophthalmic medications measured ranged between 4.44-7.37 (desired: 6.6-7.8). There is a high prevalence of reported symptoms of adverse drug reactions among this clinical population attributable to the acid/base status of the drug agent.

Intracellular delivery of NF-κB small interfering RNA for modulating therapeutic activities of classical anti-cancer drugs in human cervical cancer cells

Cervical cancer is the second most common cancer and fourth leading cause of cancer-related deaths among women. Advanced stage of the disease is treated with radiation therapy and chemotherapy with poor therapeutic outcome and adverse side effects. NFκB, a well-known transcription factor in the control of immunity and inflammation, has recently emerged as a key regulator of cell survival through induction of antiapoptotic genes. Many human cancers, including cervical carcinoma, constitutively express NF-κB and a blockade in expression of its subunit proteins through targeted knockdown of the gene transcripts with small interfering RNAs (siRNA) could be an attractive approach in order to sensitize the cancer cells towards the widely used anti-cancer drugs. However, the inefficiency of the naked siRNA to cross the plasma membrane and its sensitiveness to nuclease-mediated degradation are the major challenges limiting the siRNA technology in therapeutic intervention. pH-sensitive carbonate apatite has been established as an efficient nano-carrier for intracellular delivery of siRNA, due to its strong electrostatic interaction with the siRNA, the desirable size distribution of the resulting siRNA complex for effective endocytosis and the ability of the endocytosed siRNA to be released from the degradable particles and escape the endosomes, thus leading to the effective knockdown of the target gene of cyclin B1 or ABCB1. Here, we report that carbonate apatite-facilitated delivery of the siRNA targeting NF-κB1 and NF-κB2 gene transcripts in HeLa, a human cervical adenocar- cinoma cell line expressing NF-κB, led to a synergistic effect in enhancement of chemosensitivity to doxorubicin, but apparently not to cisplatin or paclitaxel.

Evaluations about the physico-chemical stability of docetaxel and irinotecan pre-diluted and diluted solutions: pharmaco-economic perspectives

Several clinically used anticancer drugs are well-known as far as their pharmacologic properties are concerned, but scarcely ever the interest towards their physico-chemical characteristics in solution led to practical acknowledgement in their management. Thanks to the Units for Centralized Anticancer Drug Handling, the importance to evaluate the concentration of saturation (physical stability) or the possible transformations undergone by a drug in solution (chemical stability) has become the starting point for avoiding useless wasting drugs and economic resources. By HPLC experiments we have demonstrated that the solutions of two drugs, docetaxel and irinotecan, are particularly stable at different concentrations and times of analyses in our experimental conditions. The best mobile phase for docetaxel was water/methanol/acetonitrile in 42/32/26 volumetric ratio: for halving concentrations (0.72-0.36-0.18-0.09 mg/mL) in NaCl 0.9%, the highest value gave a six-day and the three lower concentrations a fourteen-day stability, when storage occurred at room temperature and light protected. Elution of irinotecan was possible through an analysis in mobile phase gradient: at t0 a 20% ammonium acetate 10 mM and 80% methanol mixture, and after 5 min, a 80% ammonium acetate 10 mM and 20% methanol mixture. The physico-chemical stability was showed for five days, for any concentration of analysis when storage occurred at 2-8°C and light protected.

Development of a drug safety ePlatform for physicians, pharmacists, and consumers based on post-marketing adverse events

Rigorous clinical trials under the watchful eye of regulators remain the cornerstone of drug safety. However, the emergence of serious and life-threatening Adverse Events (AEs) across best-selling drug classes [sometimes many years after winning Food and Drug Administration (FDA) approval] underscores the limitations of current clinical trial processes and reinforces the need for careful post-approval pharmacovigilance. The FDA’s sizeable repository of patient case reports linking AEs to approved drugs is the Adverse Event Reporting System (FAERS). We believe that open and user-friendly access to the millions of case reports in FAERS would help advance the field of post-marketing pharmacovigilance. However, FAERS data are virtually inaccessible to most physicians, pharmacists, and consumers. Accordingly, we have recently launched a big data platform (www.AdverseEvents.com) that, unlike previous efforts, provides on-demand, user-friendly, and high-impact access to FAERS data. Bringing the power of big data to regular users, such as clinicians, pharmacists, and patients, is the logical next step in the transformation of health care to a model of shared decision making between consumers and the system.

Exploring prospects of β3-adrenoceptor agonists and inverse agonists for colon mobility control

Inverse agonists are useful active ingredient of drugs clinically used to treat diseases mainly involving receptors endowed with non-endogenous agonist induced activity (constitutive or basal activity). SP-1e and SP-1g are the first two potent and highly selective β3-adrenoceptor inverse agonists [EC50=181 nM (IA=- 64%) and 136 nM (IA=-73%), respectively], which their peculiar activity seems due to the absolute configurations of the two stereogenic centres present in each molecule. Rat proximal colon motility measurements allowed their further pharmacological characterization and pA2 values determination by Schild analysis (7.89 and 8.16, respectively). The purpose of our work is a further characterization of our novel β3-adrenoceptor agonists (SP-1a-d, SP-1f,1h) and inverse agonists (SP-1e and SP-1g) on rat proximal colon motility and a confirmation of their inverse agonist nature in a more complex system like the functional test on rat proximal colon. Male Wistar rats segment of the proximal colon were placed in organ baths containing Krebs solution. Muscle tension was recorded isotonically. Cumulative β3-AR agonists doses experiments were performed for each test compound: isoprenaline, BRL37344, SP-1a-d, SP-1f and SP-1h were dissolved in Krebs. The EC50 values of each agonists and pA2 of inverse agonists were determined. SP- 1a-d, SP-1f and SP-1h in rat colon have a muscle relaxing effect thus confirming their partial agonist activity found in CHO-K1 cell line. SP-1e and SP-1g behaved as antagonists with pA2 values of 7.89 and 8.16, respectively. In conclusion, experiments carried out by using isolated rat proximal colon allowed us to determine the pA2 values of the two β3-AR inverse agonists and add knowledge on the behavior of a novel set of compounds and their possible value as agents useful whenever is necessary to also control the colon motility.

From big data to bedside decision-making: the case for AdverseEvents

<p>Evidence-based medicine has gained mainstream popularity, but it requires a delicate balance between clinical evidence, physician skills, patient preferences, and costs. Facing the individual patient, even a simple decision such as which antithrombotic agent should be prescribed becomes complex. There are several reasons for this conundrum, but one of the foremost is the limited external validity of pivotal randomized trials, with their extremely restrictive selection criteria. Post-marketing reporting of adverse events is a very useful and democratic means to appraise the risk-benefit profile, but to date such reports were not organized or available. The development of the Food and Drug Administration (FDA) venue for such task, the FDA Adverse Event Reporting System (FAERS) has substantially improved data collection. However, analysis of this extensive relational database remains complex for most but few companies or agencies. AdverseEvents is a novel online platform enabling updated and user-friendly inquiry of FAERS. Given its ease of use, flexibility and comprehensiveness, it is likely going to improve decision making for healthcare authorities and practitioners, as well as patients. This is clearly testified by the precise and informative comparative analysis that can be performed with AdverseEvents on novel antithrombotic agents.</p>

Formulation, development and evaluation of injectable formulation of Aspirin

The objective of this study was to develop and manufacture a stable parenteral formulation for Aspirin, a non steroidal anti-inflammatory agent. The solubility and stability of the drug was determined. Solubility studies suggested that Aspirin exhibited poor aqueous solubility but showed appreciable solubility in non-aqueous solvents. Based on the preformulation studies, a lyophilized parenteral formulation containing 25 mg/mL of Aspirin was prepared in a solvent system containing of 80% v/v water and 20% v/v polyethylene glycol-400 (PEG-400). Rubber closures, filter membranes, and liquid transfer tubing were selected on the basis of compatibility studies. The formulation was subjected to accelerated stability studies. After reconstitution with sterile water for injection, Aspirin injection was stable for a period of 8 hr at 2°C to 8°C. Accelerated stability studies suggested that the lyophilized product should be kept at controlled room temperature for longterm storage. The proposed non-aqueous solvent concentration used, are known to safe hence, toxicities/safety related issues may not raise. The proposed techniques would be economical, convenient and safe. Thus, the study opens the chances of preparing lyophilized formulation of poorly-water soluble drugs.

Guinea-pig ileum as ex vivo model useful to characterize ligands displaying Imidazoline I2 and Adrenergic alpha2 mixed activity: a preliminary study

The lack of an effective analgesic treatment makes pain a clinical challenge and the need of a novel approach to identify new agents is urgent. In this scenario I2-ligands can be considered an alternative strategy in pain therapy. The development of an <em>ex vivo</em> model useful for the evaluation of functional activities at both a2 and I2-IBs (imidazoline binding sites) is an important task in pharmacological sciences since several I2 ligands display activity also towards a receptors. The present study aims to develop an <em>ex vivo</em> model for estimating the activity of I2-IBs ligands in a biological sample where a1 and a2 adrenergic receptors are present. For this purpose the imidalzoline endogenous ligand, harmane, reference compounds, 2BFI and BU224, and imidazoline derivatives 1-3 have been selected taking into account their in vitro activity towards IBs and adrenergic receptors. All compounds have been tested <em>ex vivo</em> in guinea pig-ileum where a2A-ARs are prejunctionally and I2-IBS postjunctionally localized. Adrenergic component has been identified by the studying the interference of compounds on the electrically-evoked contraction while I2-IBs activity by testing the ability of compounds to inhibit the carbachol-evoked contractions in the presence of prazosin to mask the a1 adrenoceptors. Compounds 1 and 2 were found I2-IBs antago nists (pIC50=4.2 and 4.0, respectively) whereas compound 3 was I2-IBs agonist (EC50=0.38 mM); All ligands were a2 adrenergic agonists. This paper suggests guinea-pig ileum as the first <em>ex vivo</em> approach for establishing both the intrinsic activity of I2-IBs ligands and the physiological correlation between IBs and adrenergic system.

Effective re-induction therapy with dasatinib and clofarabine in relapsed Philadelphia chromosome positive acute lymphoblastic leukemia

This case discusses a 10 year old female patient with a late relapse of Ph-chromosome positive B-cell precursor acute lymphoblastic leukaemias (ALL) who had previously been treated with chemotherapy and allogeneic stem-cell transplantation. Treatment for relapse consisted of single-agent dasatinib, followed by 2 blocks of a combination of dasatinib and clofarabine as consolidation therapy. Using this schedule both morphological and cytogenetic complete remission were obtained. This regimen was well tolerated, and no major toxicity concerns occurred. Subsequently, the patient received a 2nd stem cell transplantation from a matched unrelated donor. Unfortunately, the child died after complete molecular remission at day +104 post-transplantation, due to a disseminated adenoviral infection. We conclude that dasatinib and clofarabine combination therapy was safe and effective in this patient, and should be further explored as a salvage regimen in relapsed/refractory Philadelphia chromosome positive ALL patients.

Anti-drug antibodies

Biological pharmaceuticals are increasingly used in modern medicine and give remarkable improvements for many different patient groups. Unfortunately, for several of these compounds, undesirable immune reactions are induced against the drug. The resulting anti-drug antibodies modify the pharmacokinetic and pharmacodynamic properties of the drug and, by blocking the drug-target interaction, reduce the effects of the treatment. Anti-drug antibodies may also increase the risk of hypersensitivity reactions by the formation of immune complexes. Furthermore, by cross-reacting with the endogenous homolog of the drug, the anti-drug antibodies might impair important physiological functions even after treatment cessation. As a consequence, anti-drug antibodies need to be taken in account when estimating the benefit-burden ratio of a treatment for an individual patient, but also when calculating the value of therapeutics on a socio-economic level. In this review we give an overview over the current understanding of the immunogenicity against drugs, exemplified for patients with hemophilia A, multiple sclerosis, rheumatoid arthritis and Crohn’s disease. We discuss known and potential risk factors for anti-drug antibody formation and finally outline suggested strategies for prediction and prevention.