Clinical therapeutics
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Clinical therapeutics · Mar 2014
ReviewFrom bench to bedside: An overview of rotigotine for the treatment of restless legs syndrome.
Restless legs syndrome (RLS) is a common chronic neurologic disorder. Symptoms are most prevalent during the evening and at night, although daytime symptoms may emerge as the disease progresses. Dopamine agonists are currently considered first-line therapy for moderate to severe idiopathic RLS. Most dopamine agonists have short half-lives and are administered in the evening, shortly before the onset of RLS symptoms. Rotigotine is a non-ergot dopamine receptor agonist that has been specifically developed as a transdermal patch to provide continuous drug delivery over a 24-hour period. ⋯ Findings from clinical studies have suggested that rotigotine is efficacious in improving RLS symptoms and is generally well-tolerated. The risk of developing clinically significant augmentation appears to be low. As such, rotigotine represents an important addition for RLS treatment.
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Clinical therapeutics · Mar 2014
ReviewMethotrexate in rheumatoid arthritis: optimizing therapy among different formulations. Current and emerging paradigms.
Methotrexate (MTX) is currently considered the drug of choice, among the disease-modifying antirheumatic drugs, for the treatment of rheumatoid arthritis (RA) because of its favorable risk/benefit ratio, good safety profile, and low costs. Despite MTX's widespread use and large experience accumulated over the many years since its introduction into clinical practice, specific guidelines have not been published. ⋯ Although MTX treatment can be initiated by using the oral administration route, parenteral administration of MTX is indicated in those patients with poor compliance toward the oral form. The subcutaneous route seems to be more effective than the oral route for MTX administration based on the results of several studies, and this route may be preferred because of better usability and absence of pain at the infusion site.
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Clinical therapeutics · Mar 2014
Historical ArticleOverview of local, state, and national government legislation restricting trans fats.
Trans fats, also known as partially hydrogenated oils, have long been associated with cardiovascular disease. In 2003, the Food and Drug Administration mandated that trans fat content of ≥0.5 g be listed on food labeling; the next year, the World Health Organization released a recommended daily limit on trans fat intake. ⋯ The advancement of these parallel processes suggests an emerging best practices phenomenon, integrating public health, law, and the food industry. With both legislation and markets seemingly favoring a limitation on trans fat content in foods, attention has once again shifted to the Food and Drug Administration for a ruling on the safety of trans fats.
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Clinical therapeutics · Mar 2014
ReviewTrans fatty acids: are its cardiovascular risks fully appreciated?
The goal of this article was to review the causal link between trans fatty acids (TFA) produced from partially hydrogenated vegetable oil (PHVO) and cardiovascular disease (CVD) risk and its likely mechanisms. The potential risk of TFA from ruminant dairy and meats, which are currently the major sources of dietary TFA, is also discussed. ⋯ Two key challenges to the health industry arise from this evidence. They must first determine whether a small intake of TFA from PHVO is safe and what constitutes a safe amount. They must also determine whether TFA from ruminant fat in currently consumed amounts represent limited cardiovascular risk that is balanced by the nutritional benefits of dairy products.
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Clinical therapeutics · Mar 2014
Randomized Controlled Trial Clinical TrialA randomized, placebo-controlled study of a new sublingual formulation of fentanyl citrate (fentanyl ethypharm) for breakthrough pain in opioid-treated patients with cancer.
Oromucosal fentanyl is currently used for the treatment of breakthrough pain (BTP) in opioid-treated cancer patients. Ethypharm developed a sublingual formulation of fentanyl suprabioavailable to oral transmucosal fentanyl citrate with a higher early systemic exposure and a shorter Tmax. ⋯ This newly developed galenic formulation with a higher early systemic exposure and a shorter Tmax compared with oral transmucosal fentanyl citrate makes FE a particularly suitable formulation for the management of BTP in opioid-treated cancer patients due to the very rapid onset of action. FE provided significant improvement in pain intensity of BTP compared with placebo as early as 6 minutes' postadministration with a sustained effect over 60 minutes. FE was well tolerated by patients. ClinicalTrials.gov identifier: NCT 01842893.