Ulcer Drug Research Articles

Preventive effect of insect tea against reserpine-induced gastric ulcers in mice.

The aim of the present study was to determine the preventive effect of insect tea against reserpine-induced gastric ulcers in ICR mice. A high (800 mg/kg) dose of insect tea reduced the serum levels of the proinflammatory cytokines interleukin (IL)-6, IL-12, tumor necrosis factor (TNF)-α and interferon (IFN)-γ compared with those in mice treated with a low (400 mg/kg) dose and the control mice. The serum levels of somatostatin (SS) and vasoactive intestinal peptide (VIP) in mice treated with insect tea were higher compared with those in the control mice; however, the serum levels of motilin (MOT) and substance P (SP) were lower in mice treated with insect tea than in the control mice. Gastric ulcer inhibitory rate of the insect tea treatment group of mice were much lower compared to the control mice, and the high concentration treated mice were similar to the ranitidine treated mice. The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in mice treated with insect tea were higher compared with those in control mice, and similar to those in normal mice and ranitidine-treated mice. The nitric oxide (NO) and maleic dialdehyde (MDA) levels of mice treated with a high concentration of insect tea compared with the normal group were close. Using quantitative polymerase chain reaction (qPCR) assays, the present study revealed that insect tea significantly induced inflammation in the tissues of mice by downregulating the expression of nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, and upregulating the expression of nuclear factor of κ light polypeptide gene enhancer in B-cells inhibitor α (IκB-α). These results suggest that insect tea is as effective at preventing gastric ulcers as the gastric ulcer drug, ranitidine and it can be used as medicine.

Is combined use of SSRIs and NSAIDs associated with an increased risk of starting peptic ulcer treatment?

De Jong et al. [1] reported that the combined use of nonsteroidal anti-inflammatory drugs (NSAIDs) with selective serotonin reuptake inhibitors (SSRIs) synergistically increased the risk of initiating a treatment course with peptic ulcer drugs as a proxy for gastrointestinal adverse effects. In an attempt to limit confounding by indication, tricyclic antidepressant (TCA) users were used as a control group. As the observed association was not adjusted for potential differences between TCA and SSRI users [1], unmeasured confounding may have affected the estimation of the adverse effects. We therefore addressed the association using another pharmacoepidemiological study design, a so-called prescription sequence symmetry design [2]. The main advantage of this design is that it controls for time-invariant (unmeasured) confounding, because the patient population serves as its own control group. We used data from the same pharmacy prescription database (IADB; http://www.IADB.nl) that de Jong et al. [1] used and applied similar inclusion and exclusion criteria. When assessing the association between initiating treatment A and B, the sequence ratio (SR) is calculated by dividing the number of individuals starting treatment A first and treatment B second by the number of individuals starting treatment B first and treatment A second. For the primary analysis, only patients with a time span between both incident prescriptions between 2 and 28 days were included to limit time-variant confounding. We adjusted for prescription time trends by dividing the crude SR by a null ratio, i.e. the SR obtained assuming no association between both drugs, based on overall prescription rates of both drugs in the total IADB population. We estimated 95% confidence intervals (CIs) of SRs using exact confidence intervals for binomial distributions using STATA 12 software (StataCorp LP, College Station, TX, USA). In total, 50 350 adult patients who initiated SSRI treatment were identified between July 1994 and December 2011. A peptic ulcer drug treatment course was started in 277 of them within a 4 week period of SSRI therapy initiation; 126 (45%) started SSRI therapy prior to peptic ulcer drug treatment, while 151 (55%) patients first started peptic ulcer drug treatment [adjusted (a)SR, 0.83; 95% CI, 0.65–1.06; Table ​Table1].1]. Concurrent use of SSRIs and NSAIDs was associated with a statistically nonsignificant increase in the risk of starting peptic ulcer drug treatment (aSR, 1.48; 95% CI, 0.90–2.49), which did not exceed the risk estimated for NSAID treatment alone (aSR, 2.50; 95% CI, 2.27–2.76). Similar results were obtained for TCA treatment alone and concurrent use of TCAs and NSAIDs (Table ​(Table11). Table 1 Symmetry analysis of selected drug therapy initiation within 4 weeks of peptic ulcer drug therapy initiation using a drug-free run-in period of half a year Given that we used the same database and similar inclusion and exclusion criteria as de Jong et al. [1], the main difference between their study and ours is that we used an alternative design that reduces time-invariant (unmeasured) confounding. In accordance with our results, Dall et al., who applied a case–control design in which they controlled for various potential confounders including alcohol abuse, did not observe an increased risk of uncomplicated peptic ulcers associated with combined use of SSRIs and NSAIDs [3]. As we restricted our analyses to relatively short time spans to reduce the potential influence of time-variant confounding, we could not detect a risk that develops later in the course of treatment. However, de Jong et al. found an increased risk for concomitant use of SSRIs and NSAIDs during an average follow-up of 21 days [1]. In addition, Dall et al. found that the risk of uncomplicated peptic ulcers is greatest during the first 30 days of SSRI treatment [3], indicating that our time span of 4 weeks should be long enough to capture potential drug-related increases in peptic ulcer drug prescribing. We could not capture peptic ulcer drug courses prescribed during hospitalization, measure gastrointestinal adverse effects that required hospitalization or measure over-the-counter NSAID and peptic ulcer drug use. However, de Jong et al. did previously find an increased risk in patients concurrently using SSRIs and NSAIDs, while coping with the same limitations [1]. Therefore, the lack of an increased risk associated with SSRI use, whether used concurrently with NSAIDs or not, is likely not to be related to these potential limitations. In conclusion, our results suggest that the observations reported by de Jong et al. [1] might, at least partly, be attributed to unmeasured confounding. Although comparison with a drug that is used to treat the same indication does limit confounding, it does not eliminate all potential confounders. Therefore, when limited data on potential confounders are available, a self-controlled design can have added value, because it eliminates all time-invariant confounders [4].

Nrf2-inducing anti-oxidation stress response in the rat liver--new beneficial effect of lansoprazole.

Lansoprazole is a potent anti-gastric ulcer drug that inhibits gastric proton pump activity. We identified a novel function for lansoprazole, as an inducer of anti-oxidative stress responses in the liver. Gastric administration of lansoprazole (10–100 mg/kg) to male Wistar rats produced a dose-dependent increase in hepatic mRNA levels of nuclear factor, erythroid-derived 2, -like 2 (Nrf2), a redox-sensitive transcription factor, at 3 h and Nrf2 immunoreactivity (IR) in whole hepatic lysates at 6 h. Conversely, the levels of Kelch-like ECH-associated protein (Keap1), which sequesters Nrf2 in the cytoplasm under un-stimulated conditions, were unchanged. Translocation of Nrf2 into the nuclei of hepatocytes was observed using western blotting and immunohistochemistry. Expression of mRNAs for Nrf2-dependent antioxidant and phase II enzymes, such as heme oxygenase 1 (HO-1), NAD (P) H dehydrogenase, quinone 1 (Nqo1), glutathione S-transferase A2 (Gsta2), UDP glucuronosyltransferase 1 family polypeptide A6 (Ugt1a6), were dose-dependently up-regulated at 3 h. Furthermore, the levels of HO-1 IR were dose-dependently increased in hepatocytes at 6 h. Subcutaneous administration of lansoprazole (30 mg/kg/day) for 7 successive days resulted in up-regulation and nuclear translocation of Nrf2 IR in hepatocytes and up-regulation of HO-1 IR in the liver. Pretreatment with lansoprazole attenuated thioacetamide (500 mg/kg)-induced acute hepatic damage via both HO-1-dependent and -independent pathways. Up-stream networks related to Nrf2 expression were investigated using microarray analysis, followed by data mining with Ingenuity Pathway Analysis. Up-regulation of the aryl hydrocarbon receptor (AhR)-cytochrome P450, family 1, subfamily a, polypeptide 1 (Cyp1a1) pathway was associated with up-regulation of Nrf2 mRNA. In conclusion, lansoprazole might have an alternative indication in the prevention and treatment of oxidative hepatic damage through the induction of both phase I and phase II drug-metabolizing systems, i.e. the AhR/Cyp1a1/Nrf2 pathway in hepatocytes.

Evaluation of Efficacy of Cabbage Juice (Brassica Oleracea Linne) As Potential Antiulcer Aggent and Its Effect on the Haemostatic Mechanism of Male Albino Wistar Rats.

Ulcers are usually identified by abdominal pain, but this can be accompanied by vomiting red or black blood, blood in stool, unexplained weight loss and appetite changes (Corriher, 2010). Evaluation of efficacy of cabbage juice (Brassica oleracea linne) as a potential antiulcer agent and its effect on the haemostatic mechanism of male albino wistar rats was studied using 42 male albino wistar rats. The randomly selected animals of average weight were distributed into 3 groups (A, B, C). Groups B and C were systematically induced with peptic ulcer before they were gavaged with the cabbage juice (Group B) and the standard ulcer drug (Group C). Result of the study showed that cabbage juice healed ulcer fasted within 15 days compared to the standard cimethidin ulcer drug (28 days; Table 2). The bleeding and clotting times of test rats administered with cabbage juice were shorter than those on the standard ulcer drug and the corresponding control (Table 3). The result also indicated that cabbage juice does not significantly affect on the haemapoietic systems since the results of all the complete blood count, carried out remained normal after at the end of extract feeding. It could be deduced that cabbage juice contains some antiulcer principles that prevents further breakage of the lining of gastroduon denal system,

Preventive Effect of Polysaccharide of Larimichthys crocea Swim Bladder on Reserpine Induced Gastric Ulcer in ICR Mice.

This project's aim was to determine the reserpine-induced gastric ulcer preventive effect of polysaccharide of Larimichthys crocea swim bladder (PLCSB) in ICR mice. The anti-gastric ulcer effects of polysaccharide of Larimichthys crocea swim bladder was evaluated in mice model using morphological test, serum levels assay, cytokine levels assay, tissue contents analysis, reverse transcription-polymerase chain reaction (RT-PCR) analysis and western bolt assay. High concentration (50 mg/kg dose) of PLCSB reduced IFN-γ as compared to low concentration (25 mg/kg dose) and control mice. SS and VIP serum levels of PLCSB treated mice were higher than those of control mice, and MOT and SP serum levels were lower than control mice. Gastric ulcer inhibitory index of PLCSB treatment groups mice were much lower than control mice, and the high concentration treated mice were similar to the ranitidine treated mice. The SOD and GSH-Px activities of PLCSB treated mice were higher than control mice, close to normal mice and ranitidine treated mice. PLCSB treated mice also showed the similar contents of NO and MDA to normal group. By RT-PCR and western blot assay, PLCSB significantly induced inflammation in tissues of mice by downregulating NF-κB, iNOS, and COX-2, and upregulating IκB-α. These results suggest that PLCSB showed a good gastric ulcer preventive effect as the gastric ulcer drug of ranitidine. Polysaccharide of Larimichthys crocea swim bladder may be used as a drug material from marine products.

Freeze-Dried Highly Porous Matrix as a New Gastroretentive Dosage Form for Ecabet Sodium: In Vitro and In Vivo Characterizations

AbstractThe aims of the present study were to prepare hydroxypropylmethyl cellulose-based matrix tablets prepared using the freeze-drying method for gastroretentive delivery of ecabet sodium (ECS), a locally acting antigastric ulcer drug, and to perform in vitro/in vivo characterizations.The freeze-dried gastroretentive tablets (FD-GRTs) had porous structures, while they had good friability as a pharmaceutical dosage form. The porous structures lowered the tablet density, allowing the tablet to float without any lag time. Buoyancy of FD-GRT was maintained until they were entirely disintegrated during an in vitro release study. Release rate of ECS could be controlled by the amount of ethylcellulose (EC) in FD-GRT. As amount of EC in the composition was increased, there was a decrease in both release rate and erosion rate of FD-GRT. When administered to a miniature pig, FD-GRT remained in the stomach for more than 12h, which was significantly longer than a conventional sustained release tablet. The new FD-GRT do not contain any excipients for buoyancy and do not require any lag time for buoyancy, consequently it could be considered to be safer and more effective than conventional floating-type GRT.

Protective Effect of Tragopogon Graminifolius DC Against Ethanol Induced Gastric Ulcer

BackgroundGastric ulcer is a serious digestive system problem and affects 5% to 10% of people during their life. Chemical antigastric ulcer drugs have side effect, cannot prevent recurrence of ulcer and also show drug interaction with many other medicaments. Tragopogon graminifolius DC.(TG) is a herb which is widely used in the west of Iran and traditionally consumed for the treatment of gastrointestinal disorders. TG was introduced as one of the most beneficial plants for digestive ulcer in Iranian traditional medicine.ObjectivesThe aim of the present study was to determine the acute toxicity and protective effect of hydroalcoholic extract of TG (HeTG) against ethanol induced gastric ulcer.Materials and MethodsMale Wistar rats were divided into five groups (n = 7). HeTG at the doses of 50, 100, and 150 mg/kg were administered orally for 15 days and gastric ulcer was induced by pure ethanol (1 ml/200gr body weight). Ulcer index and protective rate were calculated and histological changes were determined.ResultsHeTG was nontoxic up to 2000 mg/Kg. Ulcer index decreased in extract groups significantly. Protective rates of HeTG were 48.94%, 46.39%, and 43.99% in 50, 100, and 150 mg/kg extract, respectively. 50 mg/kg HeTG group had higher protective effect. There was relatively normal cellular arrangement in HeTG groups.ConclusionsTG showed protective effect against ethanol induced gastric ulcer. This study confirmed traditional medicine claims of TG.

Acid-suppressive drug use in pregnancy and the toddler's asthma risk: A crossover, case-control study

Acid-suppressive drug use in pregnancy and the toddler's asthma risk: A crossover, case-control study

Prescribing Practices and Cost of Drugs for Peptic Ulcer in a Primary Health Center in Pulau Penang, Malaysia

Purpose: Description of the prescribing patterns of gastric acid suppressant treatment in peptic ulcer disease and the cost analysis in a tertiary health center in Malaysia Methods : A cross sectional retrospective study was conducted at a Universiti Sans Malaysia (USM) Health Center, Clinic, Malaysia. Convenience sampling was used to include 100 peptic ulcer patients. Results: Sixty three percent of the patients were male and 37 % female. The majority of the patients were Malay (71 %) and mean age was 46 ± 9.7 years. The most frequently prescribed monotherapy antiulcer drugs were ranitidine (83 %) and omeprazole (17 %), while for combination therapy (with antacids), it was ranitidine (85 %). The average cost of anti-ulcer drug therapy was 15.54 Ringgit Malaysian (RM), i.e., (USD 4.98) for omeprazole and RM 4.62 (USD 1.48) for ranitidine. Conclusion: The practitioners in this study preferred to prescribe ranitidine much more frequently than omeprazole. Considering the cost burden of proton pump inhibitors (PPIs) and their relatively more adverse effects, this may be a cost-effective strategy, but the benefits of ranitidine in terms of therapeutic efficacy need to be ascertained. Keywords : Peptic ulcer, Gastric acid suppressant, H2 receptor antagonist, Proton pump inhibitor

Self-disproportionation of enantiomers of prazoles via achiral, gravity-driven silica gel column chromatography

(R)-Lansoprazole, (S)-pantoprazole, and (R)-rabeprazole are commonly used drugs for peptic ulcers. The self-disproportionation of the enantiomers of these prazoles in regular column chromatography is described herein. When non-racemic mixtures of the prazoles were eluted under achiral, gravity-driven silica gel column chromatography conditions, enantiomeric enrichment occurred in the first fractions, while enantiomeric depletion occurred in the last fractions. The pure enantiomers of all prazoles can be prepared from non-racemic starting materials using a simple procedure (achiral chromatography). Thus, a new method for obtaining a sample with very high enantiomeric purity was established. These results suggested that caution is required to avoid enantiomer fractionation during the purification of the asymmetric synthesis products by chromatography.

Comparative evaluation of anti-gastric ulcer activity of root, stem and leaves of Thalictrum foliolosum DC in rats

Anti gastric ulcer activity of root, stem and leaves of Thalictrum foliolosum DC, was studied against ethanol, hydrochloric acid, indomethacin, stress and pyloric ligation induced gastric ulceration in albino rats. Omeprazole was used as standard anti gastric ulcer drug. Significant anti gastric ulcer activity was noted in root, stem and leaves of Thalictrum foliolosum DC. Root of the plant, however, showed highest activity, which was comparable to that of omeprazole.Â

Synthesis and Pharmacological Evaluation of Some Novel Imidazole Derivatives for Their Potential Anti-hypertensive Activity

Benzimidazole, which is a heterocyclic nucleus, plays an important role in various medicines. A number of therapeutic agents such as H1 antihistaminic agent clemizole, a potent opioid analgesic etonitazene, nonnucleoside antiviral compound enviroxime, for promotion of excretion of uric acid irtemazole, non sedating antihistaminic agent astemizole, anti ulcer drugs omeprazole and pentoprazole, antihelmintic thiabendazole, antinematodal nocodazole etc. are based on benzimidazole heterocyclic nucleus. The synthesis of various benzimidazole derivatives by the reaction of ortho phenylene diamine I with various organic acids to yield 2-substituted benzimidazole derivatives II which on further treatment with nitric acid and sulphuric acid yielded 5-nitro-2-substituted benzimdazoles III. Coupling of this compound with halogenated beta picoline V yielded the title compounds. The structures of synthesized compounds were elucidated mainly by spectral evidence. All the compounds were screened for their anti-hypertensive activity. The compounds exhibited moderate to signiicant activities.

Drug utilization study in the otorhinolaryngology department in a tertiary care hospital

Background: Drug utilization is defined by the World Health Organization (WHO) as the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. The aim of this study was to evaluate the pattern of prescription and then drug utilization in outpatient (OPD) of the Department of Otolaryngology in a tertiary care teaching hospital. Methods: This was a retrospective study conducted at the A.C.S. medical college and hospital, Chennai for a period of 7 months. All the patients who attended the Ear Nose and Throat (ENT) OPD were included. The total number who attended the OPD was 10,249 which include 6,956 new cases and 3313 old cases. Results: The antibacterials commonly used were β Lactams (56%), macrolides (14%), fluoroquinolones (12%), aminoglycosides (8%). Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (27%), in cephalosporins was cefixime + clavulanic acid (19%). Aminoglycosides include gentamycin in refractory cases. Fluoroquinolones include ciprofloxacin and levofloxacin. Others Drugs like antihistamines and mucolytics were prescribed in 27%, anti- ulcer drugs in 36% cases, analgesics in 33% cases and herbal medicines in 4%. The average number of drugs used in each prescription was 3.20. All the drugs were prescribed with brand names. The average cost per prescription per day for OPD patients is 37 Rupees. Conclusions: β Lactams were commonly used antibacterials in the otorhinolaryngology department.

Evaluation of The Healing Effects of Aqueous Extracts of Musa Paradisiaca (Unripe Plantain) And Brassica Oleracea (Cabbage) on Peptic Ulcer.

Background: Peptic ulcer results from an imbalance between ulcer promoting factors (gastric acid, pepsin secretion) and ulcer preventing factors (gastric mucosa, prostaglandins). Unripe plantain and cabbage when used individually were effective in the treatment of peptic ulcer in folkloric medium. This hereby paved way for this research that involved the co-administration of aqueous extracts of Musa paradisiaca (plantain) and Brassica oleracea (cabbage) in the treatment of peptic ulcer. Objectives: To evaluate the healing effect of the aqueous extracts of Musa paradisiaca (plantain) and Brassica oleracen (cabbage) on peptic ulcer in rats, and the possible effect of these materials as prophylaxis against peptic ulcer. This could pave way for the production of anti-peptic ulcer drugs for use in clinical medicine. Methodology: A total of 45 rats of both sexes weighing 200-250g were used for this study. In the prophylactic study, 15 adult albino wistar rats were used. The animals were grouped into 5 groups of 3 animals each and were starved for 24 hrs before the experiment. Group 1 received 0.3ml of distilled water, group 2 received 100mg/kg of cimetidine, group 3 received 100mg/kg of Brassica oleracae extract, group 4 received 100mg/kg of Musa parasidiaca extract and group 5 received a combination of Musa paradistaca and Brassica oleracea extracts at the dose of 50mg/kg+ 50 mg/kg. I hr post treatment, peptic ulcer was induced in all the animals by a single oral administration of 30mg/kg of Indomethacin. 8 hrs after ulcer induction, each animal was sacrificed and the number of lesions in the stomach was counted. In the curative study, a total number of 30 rats were used. They were grouped into 5 groups of 6 animals each. The animals were denied access to food and water for 24hrs. Ulcer was induced in all the groups by single oral administration of 30mg/kg indomethacin. 8 hrs post ulcer induction, 2 animals from each group were sacrificed and the number of ulcer counted. The remaining animals in each group received treatment as follows: group 1 received 0.3ml of distilled water, group 2 received 100mg/kg of cimetidine, group 3 received 100mg/kg of Brassica oleracea extract, group 4 received 100mg/kg of Musa paradisiaca extract and group 5 received 50mg/kg combination of Musa paradisiaca and Brassica extract. They received the treatment for three days, then another 2 animals from each group were sacrificed and their number of ulcers counted. The remaining animals contained to receive treatment for another three days before their ulcer index were determined. The LD 50 test was carried out using the Lorke’s method. The phytochemical analysis was conducted using the trease and Evans method. Results: It showed that the co-administration of aqueous extract of Musa paradisiaca and Brassica oleracea possessed peptic ulcer healing activity, and had more of prophylactic effect than curatve effect. It also showed that the separate dose of Musa paradisiaca extract and Brassica oleracea possesses more curative anti ulcer action when used individually than when co-administered. Conclusion: The extracts of Musa paradisiaca and Brassica oleracea has peptic ulcer healing activity. This could find some relevance in the treatment of peptic ulcer disease. Clinicians and pharmacologists will find this study highly relevant with a view to actually formulating a medicament from the extracts for use in the treatment of peptic ulcer disease in man.

PHP19 Consumption of Drugs for Peptic Ulcer and Gastroesophageal Reflux Disease: Striking Differences Between Serbia and Norway

PHP19 Consumption of Drugs for Peptic Ulcer and Gastroesophageal Reflux Disease: Striking Differences Between Serbia and Norway

Lessons from Lipitor and the broken blockbuster drug model

Pfizer's LDL cholesterol-lowering atorvastatin (Lipitor) defines what it means to be a blockbuster drug. Patented in 1997, it has raked in around US$130 billion for Pfizer during its 14 years on the market, making it the world's bestselling drug of all time. Indeed, Pfizer's business model has relied on the huge profits from Lipitor and a few other blockbuster drugs. But things are set to change. The patent for Lipitor expired on Nov 30.Pfizer will undoubtedly feel the loss of Lipitor sales. It has been planning for this schismatic change for several years. In the past, the company has claimed that it can maintain huge research and development expenditures despite the increasing rarity of new blockbuster drugs. But this year it has already announced closure of its research site at Sandwich, Kent, UK, let go of most of its 2400 staff, and plans a decrease of $1·5 billion from its proposed 2012 research and development spend.The trouble Pfizer finds itself in is a lesson well taken by the drug industry. No company today has the capacity for the aggressive marketing of a few blockbuster drugs as well as substantial research and development. The blockbuster business model is broken, and it has been for some time. The industry has a history of over-reliance on patented drugs with inadequate investment in the drug pipeline. SmithKline, for example, failed to reinvest the proceeds of its successful stomach ulcer drug Tagamet (cimetidine) in research and was forced to merge with Beecham in 1989.A new business model for industry must mean much closer collaboration with universities and academic medical science. The collaboration promoted in the UK Government's new £180 million strategy to boost innovation in the life sciences announced this week is one example. This model of partnership drove drug discovery in the 1970s and 1980s, but the great success of pharma induced industry leaders to lose their collective memory. The difficulties industry now faces are an opportunity to put the leadership of big pharmaceutical companies back in the hands of scientists who understand that business success comes not from aggressive and sometimes unethical sales and marketing, but from judicious exchange between scientists in different sectors and a greater sense of solidarity with the societies they serve. Pfizer's LDL cholesterol-lowering atorvastatin (Lipitor) defines what it means to be a blockbuster drug. Patented in 1997, it has raked in around US$130 billion for Pfizer during its 14 years on the market, making it the world's bestselling drug of all time. Indeed, Pfizer's business model has relied on the huge profits from Lipitor and a few other blockbuster drugs. But things are set to change. The patent for Lipitor expired on Nov 30. Pfizer will undoubtedly feel the loss of Lipitor sales. It has been planning for this schismatic change for several years. In the past, the company has claimed that it can maintain huge research and development expenditures despite the increasing rarity of new blockbuster drugs. But this year it has already announced closure of its research site at Sandwich, Kent, UK, let go of most of its 2400 staff, and plans a decrease of $1·5 billion from its proposed 2012 research and development spend. The trouble Pfizer finds itself in is a lesson well taken by the drug industry. No company today has the capacity for the aggressive marketing of a few blockbuster drugs as well as substantial research and development. The blockbuster business model is broken, and it has been for some time. The industry has a history of over-reliance on patented drugs with inadequate investment in the drug pipeline. SmithKline, for example, failed to reinvest the proceeds of its successful stomach ulcer drug Tagamet (cimetidine) in research and was forced to merge with Beecham in 1989. A new business model for industry must mean much closer collaboration with universities and academic medical science. The collaboration promoted in the UK Government's new £180 million strategy to boost innovation in the life sciences announced this week is one example. This model of partnership drove drug discovery in the 1970s and 1980s, but the great success of pharma induced industry leaders to lose their collective memory. The difficulties industry now faces are an opportunity to put the leadership of big pharmaceutical companies back in the hands of scientists who understand that business success comes not from aggressive and sometimes unethical sales and marketing, but from judicious exchange between scientists in different sectors and a greater sense of solidarity with the societies they serve.

Utilización de medicamentos en España y en Europa

ObjectiveTo compare the Spanish prescription drug consumption with that of European countries. DesignA review of the literature and data sources for prescription drug consumption. SettingEuropean countries; last three decades. ParticipantsIncluded therapeutic groups where the available information allowed a comparison of the consumption in Spain with that of other European countries. MeasurementsStudies, reports, or data sources were included in which the consumption was expressed in DHD (DDD/1000 inhabitants per day). ResultsIt was possible to compare 18 therapeutic groups: drugs for peptic ulcer (A02B), glucose lowering drugs (A10), antithrombotic agents vitamin K antagonists (B01AA), antihypertensives (C02), diuretics (C03), peripheral vasodilators (C04), beta-blocking agents (C07), calcium channel blockers (C08), agents acting on the renin-angiotensin system (C09), lipid-lowering drugs (C10), antibacterials for systemic use (J01), antiinflammatory & antirheumatic products non-steroids (M01A), opioid analgesics (N02A), antipsychotics (N05A); anxiolytics (N05B), hypnotics & sedatives (N05C), antidepressants (N06A) and drugs for obstructive airway diseases (R03). With regard to the European average (100), the Spanish consumption of these therapeutic groups was: N02A, 37; C07, 40; B01AA, 41; C03, 70; N05C, 72; C10, 75; C08, 76; N05A, 77; TH01, 97; N06A, 98; C09, 104; M01A, 101; R03, 101; C02, 107; A10, 114; N05B, 137; A02B, 150 and C04, 234. ConclusionsThe Spanish consumption of most of the therapeutic groups was very close to the average of the group of the countries where it was possible to compare it, or clearly below average, with the exception of the consumption of drugs for peptic ulcer, anxiolytics and peripheral vasodilators, which considerably exceeded the average of the group.

Finding the repurpose

A Stanford spinout called NuMedii will use a new computational approach to look for drug repurposing opportunities. The university's team already has in vivo data to support two opportunities: the anticonvulsant topiramate for inflammatory bowel disease and the ulcer drug cimetidine to treat lung adenocarcinoma.

Therapeutic and cost effectiveness of proton pump inhibitor regimens for idiopathic or drug-induced peptic ulcer complication

Peptic ulcer (PU) disease has a high rate of occurrence and recurrence in Korean and the selection of drug for treatment is diverse. In this study, the therapeutical effectiveness of regimens including proton pump inhibitors (PPI) was compared with the single PPI therapy. The clinical data were collected from 1,658 patients having idiopathic or drug-induced PU complication from a Medical Center in Daegu, Korea, and analyzed retrospectively based on the results of endoscopic examination, the drug history and the therapeutic cost depending on drugs used. The comparison of complete healing rate and recurrence rate showed no significant differences between the single PPI groups and the combination group with antacids, prokinetic agent or mucosa protectants. However, the combination therapy of PPI with mucosa protectants gave a slightly better therapeutic outcome than single PPI treatment in gastric ulcer patients. Comparatively, the combination of PPI with antacids significantly reduced the therapeutic effectiveness in duodenal ulcer patients. The analysis of cost-based therapeutic effectiveness reveals that any economic benefits in PU treatment were not gained by the combination of other class of ulcer drugs. Even though the rapidity of healing rate was not considered, it can be concluded that the PPI combination therapy might be not desirable in PU treatment. Particularly triplet or quartet combination therapy in PPI regimen was absolutely economically ineffective therapy in spite of the increase of medication costs.

Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly

Background Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs. Methods We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations. Results Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI = 1.26 (1.18–1.34), p = .0001) or discharge (OR 95% CI = 1.11 (1.05–1.18), p = 0.0003). Conclusions Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD.