Expert opinion on emerging drugs
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Expert Opin Emerg Drugs · Mar 2007
ReviewEmerging drugs for acute and chronic heart failure: current and future developments.
Heart failure continues to be a major public health issue. Although angiotensin-converting enzyme inhibitors and beta-adrenergic blockers have been broadly used as evidence-based therapies in heart failure, morbidity and mortality remains high. ⋯ This review provides a broad overview of some of the novel compounds under investigation for the treatment of heart failure. Novel strategies include drugs that aim to alleviate congestion and improve hemodynamics, drugs that preserve renal function, drugs that reduce arterial and myocardial stiffness, drugs that module myocardial contractility, drugs that affect metabolic and hormonal balance, and drugs that act on existing and novel physiologic targets.
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Pulmonary arterial hypertension (PAH) is a life-threatening disease characterised by a progressive pulmonary vasculopathy with ensuing right heart failure if left untreated. In the 1980s, prior to the current treatment era, idiopathic PAH carried a very poor prognosis, with a median survival of 2.8 years from the time of diagnosis. Since then, continuous intravenous epoprostenol has been used for the treatment of severe PAH with tremendous success, improving haemodynamics, quality of life, exercise capacity, functional class and even survival. ⋯ A better understanding of how the currently available agents work together is essential to optimise the long-term care of patients with PAH. Ultimately, additional agents that target the underlying pulmonary vasculopathy and endothelial abnormalities are necessary to cure this fatal disease. This comprehensive review of the currently available and emerging novel therapies provides insight into future management of PAH patients.
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Expert Opin Emerg Drugs · May 2006
ReviewTuberculosis vaccines: current status and future prospects.
There is an urgent need to develop more effective tuberculosis vaccines as chemotherapy and Bacille Calmette-Guérin (BCG) have failed to control the current epidemic. BCG does have some protective effect in childhood, so using a second vaccine to boost BCG would be the most ethical and logistically feasible strategy. ⋯ As more vaccines enter into early clinical trials, there is an urgent need for the identification of correlates of protection to aid decisions about which vaccines should go forward into efficacy testing. Research efforts that focus on reducing the cost and risk of conducting clinical trials will be of direct benefit to tuberculosis vaccine development.
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Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient risk factors (female gender, younger age, no alcohol consumption, history of motion sickness) are the major risk factors for CINV. The use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, but delayed nausea and vomiting remains a significant clinical problem. ⋯ There are a number of 5-HT3 receptor antagonists and NK-1 receptor antagonists currently in Phase II and III clinical trials. Revised antiemetic guidelines for the prevention of CINV are reviewed. Future studies may consider the use of palonosetron and aprepitant with current and other new agents (olanzapine, gabapentin) in moderately and highly emetogenic chemotherapy, as well as in the clinical settings of multiple-day chemotherapy and bone marrow transplantation.
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Septic shock still places a major burden on the healthcare system, although recent years have been marked by the demonstration that corticosteroids and activated protein C may substantially improve survival in selected populations. This review discusses the current management of septic shock and the potential development of new therapeutics following impressive advances in the pathomechanisms of septic shock.