Drugs of today
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Pixantrone (BBR-2778) is a novel aza-anthracenedione anthracycline derivative developed by Cell Therapeutics Incorporated, WA, USA. Pixantrone is similar in structure to the anthracenedione mitoxantrone but lacks the 5, 8-dihydroxy substitution groups implicated in mitoxantrone-induced cardiotoxicity. The PIX301 phase III single-agent trial of pixantrone for patients with relapsed or refractory aggressive non-Hodgkin's lymphoma randomized patients to receive either pixantrone or another single agent of the investigators' choice. ⋯ There is evidence that pixantrone is well tolerated when substituted for anthracyclines in combination regimens for aggressive non-Hodgkin's lymphoma with comparable rates of complete remission. Pixantrone has also been used for the treatment of indolent non-Hodgkin's lymphomas and the combination of pixantrone and rituximab has been shown to be superior to rituximab alone in relapsed or refractory disease in the phase III PIX302 study. On the basis of these data, the United States Food and Drug Administration is considering pixantrone for use in adult patients with relapsed or refractory aggressive and indolent non-Hodgkin's lymphoma on a fast-track basis.
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Neuropathic pain (NP), in view of its non-nociceptive component, is not caused by physiological lesions but by problems in the nervous system itself, whether in the central nervous system (CNS) or peripheral nervous system (PNS). This particular action mechanism makes NP a very difficult-to-treat condition, resistant to most of the commonly used analgesic drugs. A recent study stated that NP has an incidence of 1.24% over the general population, and this percentage increases if we consider acute radiculopathies and some recurrent neuropathies, frequently considered not only neuropathic pain but also nociceptive. ⋯ Thus, pregabalin opened the door to a new approach to NP. Other pain societies, such as the Canada Pain Society, have also included pregabalin in the first line treatment of NP. In fact, gabapentin and pregabalin are the current standard care in most of NP-associated diseases.
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Neuropathic pain is a difficult to diagnose condition. The definition changes have tried to clarify the confusing consequences about including the word "dysfunction". However, diagnosing problems are not only a definition issue, but also a technical problem. ⋯ Nevertheless, because only pharmacological-based therapies cannot control disease symptoms and there are still diagnostic problems, it is important to perform a multidisciplinary approach to neuropathic pain to balance these issues. Thus, some studies have investigated different non-pharmacological approaches to treat neuropathic pain, such as intensive exercise, hydrotherapy, transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, motor imagery programs (MIP), supportive psychotherapy, and cognitive behavior therapy. To perform these non-pharmacological therapies, a multidisciplinary team focused on individualizing pain management is needed.
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Pain is a subjective condition and, thus, difficult to measure. The best tools to assess pain are the pain evaluation questionnaires, which provide either diagnostic, pain evolution or pain intensity information. To provide information which could help differentiate between nociceptive pain and neuropathic pain is one of the most important functions of these questionnaires. ⋯ Two of such quality of life questionnaires are SF-36 and NHP. Sleep evaluation questionnaires include quantitative features such as the number of sleep interruptions, sleep latency or sleep duration as well as qualitative characteristics such as rest sensation, mood and dreams. One of the most used sleep evaluation questionnaires is PSQI, which includes patient questions and bed-partner questions, providing information from two points of view.
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Dabigatran etexilate (Pradaxa) is the orally available prodrug of dabigatran, a potent compound belonging to the new class of nonpeptide direct thrombin inhibitors (DTIs). Following oral administration, dabigatran etexilate reached peak plasma concentrations within 2 hours, showed linear pharmacokinetics across a wide dose range, a linear relationship between ecarin clotting time (ECT) and international normalized ratio (INR), and no significant food or drug interactions. ⋯ The safety profile of dabigatran etexilate was similar to that of enoxaparin with comparable rates of major bleeding, liver enzyme elevation and acute coronary events. Oral availability of dabigatran etexilate, together with a rapid onset and offset of action and predictable anticoagulation response, makes this compound an attractive alternative to traditional anticoagulant therapies for the prevention of VTE.