Expert opinion on emerging drugs
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Major depressive disorder (MDD) remains a major public health concern, and one that continues to suffer an incompletely-met need for effective and acceptable treatments. The development of antidepressants, to date, has focused primarily on increasing monoamine neurotransmission with increasing efficacy while minimizing adverse effects. Medications currently recommended as 'first-line' are far more tolerable than the older medications they replaced, but as many as 70% of patients continue to suffer significant depressive symptoms after treatment with one of these agents, and as many as 50% will discontinue a trial due to issues with acceptability. This review will summarize antidepressants that have recently entered the market as well as those still in development to help characterize the current state of antidepressant development. ⋯ The past decade has not yielded a large number of new antidepressants and, with the possible exception of agomelatine, none of the newer medications that have been introduced have decisively addressed the several unmet needs in this area of therapeutics. Among the various novel strategies that are being evaluated, results of several small studies of ketamine suggest that drugs that modulate glutamatergic neurotransmission may hold the greatest promise for exerting rapid and large antidepressant effects in patients who have not responded to SSRIs or SNRIs.
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The tuberculosis epidemic continues in much of the developing world fueled by the concurrent HIV epidemic. Due to the emergence of multidrug and extensively drug-resistant isolates of tuberculosis, there is a critical need for new drug regimens for the treatment of this disease. Currently, five new compound classes are in various stages of clinical development for tuberculosis. ⋯ The challenge in antituberculosis drug development is to make available to patients highly effective regimens which present substantial barriers to resistance development in an affordable formulation. Shortening the length of therapy from the current 6 to 3 months or less is a goal for the newly developed regimens. For the first time in many years, there are bright prospects for improving regimens for the therapy of tuberculosis.
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Cystic fibrosis (CF), one of the major respiratory diseases, is caused by mutations in a gene encoding for a chloride channel. Abnormal transepithelial ion transport leads to a reduced volume of the airway surface liquid layer and reduced mucociliary clearance. ⋯ CF drug therapy is moving rapidly from symptomatic therapy to treatment of the underlying pathophysiology.
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Fibromyalgia syndrome (FMS) is currently perceived by rheumatologists and pain physicians alike as representing the classic condition of central sensitization. This term has come to denote a condition in which chronic, widespread pain is attributed mainly to an increase in the processing and handling of pain by the CNS. Thus, effective treatment of the pain of FMS must be directed at the function of the CNS. Over recent years, the pharmacological industry has focused increasing attention on this syndrome, leading to the recent approval of three first medications specifically indicated in the treatment of FMS (i.e., pregabalin, duloxetine and milnacipran). Nonetheless, treatment of FMS remains challenging and in many cases incompletely successful. Issues with drug compliance and side effects, as well as limitations of intrinsic effectiveness, hamper the outcome in many cases. Thus, FMS continues to pose a significantly unmet medical need. ⋯ Following the introduction of three medications specifically indicated in the management of FMS over the last 4 years, additional research is actively leading towards the introduction of new drugs aimed at improving symptoms related to pain and sleep in FMS. Physicians involved in the treatment of FMS patients are required to keep up-to-date on these promising avenues of progress and to be ready to incorporate them into clinical use.
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Atopic eczema (AE) is a chronic relapsing inflammatory skin condition and one of the most common, potentially debilitating diseases with increasing incidence. ⋯ Existing treatment modalities such as barrier repair therapy, topical immunosuppressive agents, antiseptic treatment as well as systemic treatment options are discussed. The review aims to summarize the most recent findings of more innovative treatment approaches such as modulation of cytokines or chemokines, modulation of T-cell responses or anti-IgE therapy.