Recent Advances in Treating Multiple Sclerosis: Efficacy, Risks and Place in Therapy.

Recent advances in treating multiple sclerosis: efficacy, risks and place in therapy.

Filed under: Drug and Alcohol Rehabilitation

Ther Adv Chronic Dis. 2013 Jan; 4(1): 45-51
Jeffery DR

The development of new pharmacologic agents for the treatment of multiple sclerosis (MS) and advances in testing for exposure to the JC virus have led to changes in the treatment of MS. In addition several new agents are in late stage development for MS and their entry onto the market will provide additional treatment options. In 2012 and in early 2013, it is likely that both terifunomide and BG-12 will be approved by the United States Food and Drug Administration (FDA) for the treatment of relapsing forms of MS. The therapeutic environment has already changed and is likely to change rapidly over the next several years. Fingolimod was the first oral agent approved for the treatment of MS and this agent is now widely used in patients intolerant of injections and the side effects associated with the older platform therapies. In many settings it is also used a first-line agent. Owing to the risk of progressive multifocal leukoencephalopathy, natalizumab had previously been reserved for patients with active disease who were intolerant of first-line agents or patients who were worsening despite standard therapy. With the availability of JC virus antibody testing, natalizumab is now being used as a first-line agent in patients negative for JC virus antibodies. Teriflunomide and BG-12 will become available in the next year. Both agents have suitable efficacy and a favorable safety and tolerability profile. There are advantages and disadvantages associated with all of the oral agents. In this article we summarize the clinical trial results regarding the efficacy and safety of the oral agents and discuss the changes that are already taking place in the therapeutic landscape for MS.
HubMed – drug

Tocilizumab in rheumatoid arthritis: efficacy, safety and its place in therapy.

Filed under: Drug and Alcohol Rehabilitation

Ther Adv Chronic Dis. 2013 Jan; 4(1): 15-21
Kaneko A

Tocilizumab is a humanized antihuman interleukin-6 (IL-6) receptor monoclonal antibody. It was developed in Japan as the first biological disease-modifying antirheumatic drug targeting IL-6 receptors. Many large-scale global studies have demonstrated its efficacy and safety, and in April 2008 it was approved in Japan for use in the treatment of rheumatoid arthritis, sooner than in other countries. In this paper, I review the efficacy and safety of tocilizumab in the light of front-line clinical data and data from large-scale studies, and I consider the place of tocilizumab treatment in real clinical practice.
HubMed – drug

Drug treatment developments in schizophrenia and bipolar mania: latest evidence and clinical usefulness.

Filed under: Drug and Alcohol Rehabilitation

Ther Adv Chronic Dis. 2012 Nov; 3(6): 287-300
Johnsen E, Kroken RA

Schizophrenia and bipolar disorder are often highly debilitating with chronic courses, and psychotropic drugs represent cornerstones in the treatment. The primary aim of the review was to summarize the latest evidence with regards to the efficacy and effectiveness of drug treatment of schizophrenia and the manic phases of bipolar disorder. Schizophrenia systematic reviews conclude that antipsychotic drugs are effective in treating overall symptoms of psychosis and in preventing relapse. Some of the newer agents, the second-generation antipsychotics (SGAs), have demonstrated superiority compared with the older first-generation drugs and other SGAs but side-effect differences among the drugs are of a greater magnitude than effect differences. The pragmatic randomized trials of effectiveness have shown a longer time until treatment discontinuation for olanzapine compared with other antipsychotics. Cohort studies have found superiority for the long-acting injection formulations compared with the oral formulations of the drugs, and lower total mortality risk in users of antipsychotics compared with non-users. In bipolar mania SGAs have shown superior antimanic efficacy compared with other mood-stabilizing drugs. In conclusion antipsychotics, in particular some of the SGAs, seem to be drugs of first choice for both schizophrenia and bipolar mania. This perspective review focused on mean effects but the group means may not always be particularly useful as schizophrenia and bipolar mania are biologically heterogeneous disorders with large inter-individual variations in drug response and tolerance. In patients with a prior drug history the different pharmacological and clinical profiles may be exploited in subsequent choices of drugs.
HubMed – drug

Latest evidence on gout management: what the clinician needs to know.

Filed under: Drug and Alcohol Rehabilitation

Ther Adv Chronic Dis. 2012 Nov; 3(6): 271-86
Burns CM, Wortmann RL

Until recently, the last drug approved for the treatment of gout by the United States Food and Drug Administration was allopurinol in 1966. Since 2008, two new drugs for the treatment of gout, febuxostat and pegloticase, have been approved in the US. Febuxostat has been approved in the EU and pegloticase approval is anticipated. A new single-ingredient colchicine preparation is available in the US, and the treatment recommendations for the use of colchicine in acute gout have evolved, now favoring a low-dose regimen. Several other exciting drugs are in development. Herein, we review some of basic principles in the diagnosis and staging of gout. We then examine current treatment principles, with particular attention to febuxostat and pegloticase, offering suggestions as to where they might fit into a modern therapeutic algorithm for gout treatment. We then present available data on several exciting new agents in development, including interleukin-1 inhibitors, and relate them to advances in our understanding of gout pathogenesis. We conclude with some important nonpharmacologic principles for optimal management of this ancient and eminently treatable disease. Dedicated gout research, going on quietly in the background of other breathtaking advances in rheumatology, is now paying off. This comes at a time when the number of patients affected by gout continues to rise, mainly due to an epidemic of obesity. An effort to improve lifestyle choices as a society and better management of the disease by clinicians should have a positive impact on gout incidence and outcome in our lifetimes.
HubMed – drug

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