Efficacy Of Medications Research Articles

Review Article: Pathways to Precision: Advancing the Understanding of Drug Administration Methods

This review explores various routes of drug administration, discussing their advantages, limitations, and applications. It emphasizes the importance of choosing the appropriate route based on pharmacokinetics, patient condition, and the nature of the drug, aiming to provide an in-depth understanding of the current landscape in drug delivery. The route of drug administration plays a pivotal role in determining the efficacy, onset, and overall therapeutic outcome of medications. This review comprehensively explores the diverse pathways through which drugs are introduced into the human body, highlighting their mechanisms, advantages, limitations, and applications. Broadly categorized into enteral, parenteral, and topical routes, each method is tailored to specific clinical needs based on factors such as the physicochemical properties of the drug, patient condition, and desired therapeutic goals. Innovations in drug delivery, including transdermal systems, inhalation devices, and targeted delivery techniques, have further expanded the scope of administration, enhancing precision and minimizing adverse effects. The review also emphasizes the importance of patient compliance, bioavailability considerations, and the impact of administration routes on pharmacokinetics and pharmacodynamics. By delving into traditional methods such as oral and intravenous routes alongside emerging technologies like nanocarriers and implantable devices, this paper aims to provide a holistic understanding of drug administration. The insights presented herein offer valuable perspectives for clinicians, researchers, and pharmaceutical developers, fostering advancements in drug delivery systems to optimize therapeutic outcomes and improve patient care.

Study on the Efficacy of a Novel Sedative Medication Based on Wilcoxon Rank-Sum Test and Multiple Machine Learning Models

This study investigates the efficacy of a novel sedative medication compared to an existing drug using the Wilcoxon Rank-Sum test and multiple machine learning models. The Wilcoxon Rank-Sum test revealed statistically significant differences in petco200, petco2005, IPI005, and moaas005 indicators, primarily within the first 1 to 3 minutes post-induction. Basic information between the novel and existing drug groups was comparable, suggesting effective variable control and attributing differences to the novel sedative. Subsequently, various evaluation metrics including MSE, RMSE, MAE, MAPE, and R² were employed. Exploratory predictions using the Random Forest (RF) model yielded suboptimal results. After comparing the performance of RF, XGBoost, CatBoost, LightGBM, and SVR, a combination of the RF model and logistic regression was selected for regression predictions based on data type. Visualization of results demonstrated good predictive performance and mitigated overfitting.

Optimizing the Efficacy of Anti-Obesity Medications: A Practical Guide to Personalizing Incretin-Based Therapies

Optimizing the Efficacy of Anti-Obesity Medications: A Practical Guide to Personalizing Incretin-Based Therapies

Exploring the Therapeutic Efficacy of Ethanolic Extract of Benincasa hispida in Alloxan Induced Diabetic Rats

Since the dawn of civilization, humans have used herbal medicine to treat medical ailments. This study seeks to evaluate the efficacy of Benincasa hispida as an anti-diabetic agent and its impact on lipid profiles. We assessed the efficacy of the anti-diabetes medication using the alloxan-induced diabetic model. Only the 900 mg/kg dosage exhibited statistically significant antidiabetic effects (p < 0.05) when compared to the 300 and 600 mg/kg dosages. Notwithstanding a slight reduction in these parameters, no groups demonstrated statistically significant results regarding HDL, LDL, and total cholesterol. The triglyceride value of 97.70 ± 7.50* yielded statistically significant results (p < 0.05). Conversely, SGPT and SGOT exhibited no statistically significant effects at dosages of 300, 600, or 900 mg/kg. Group 5 exhibited statistically significant results (p < 0.05) in the kidney function test in case of urea, with a value of 93.24 ± 9.23* after the administration of an extract at a dose of 600 mg/kg. No statistically significant results were seen in any groups concerning creatinine levels.

A Narrative Review of the Interplay Between Carbohydrate Intake and Diabetes Medications: Unexplored Connections and Clinical Implications

This narrative review examines the dynamic interplay between carbohydrate intake and diabetes medications, highlighting their combined molecular and clinical effects on glycemic control. Carbohydrates, a primary energy source, significantly influence postprandial glucose regulation and necessitate careful coordination with pharmacological therapies, including insulin, metformin, glucagon-like peptide (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Low-glycemic-index (GI) foods enhance insulin sensitivity, stabilize glycemic variability, and optimize medication efficacy, while high-GI foods exacerbate glycemic excursions and insulin resistance. Continuous glucose monitoring (CGM) offers real-time insights to tailor dietary and pharmacological interventions, improving glycemic outcomes and reducing complications. Despite advancements, gaps persist in understanding nutrient–drug interactions, particularly with emerging antidiabetic agents. This review underscores the need for integrating carbohydrate-focused dietary strategies with pharmacotherapy to enhance diabetes management. Future research should prioritize clinical trials leveraging CGM technology to explore how glycemic index, glycemic load, and carbohydrate quality interact with newer diabetes medications. Such studies can refine evidence-based recommendations, support individualized care plans, and improve long-term outcomes. Addressing systemic barriers, such as limited access to dietitians and CGM technology in underserved regions, is critical for equitable care. Expanding the roles of community health workers and training healthcare providers in basic nutrition counseling can bridge gaps, promoting sustainable and inclusive diabetes management strategies. These efforts are essential for advancing personalized, effective, and equitable care for individuals with diabetes.

Intraventricular Medication with or without Ventricular Shunt for Leptomeningeal Metastases with Different Intracranial Pressure: A Single-Center, Large-Scale Retrospective Study.

To evaluate the efficacy and prognosis of intraventricular medication (IVM) administered via the reservoir of Ommaya or ventricular shunt (VS) system to control leptomeningeal metastases, with or without VS based on intracranial pressure, in combination with postoperative systemic therapy. Between April 2021 and December 2022, 125 patients with leptomeningeal metastases were managed in our department who underwent Ommaya reservoir placement and/or VS and subsequently received IVM postoperatively. The extent of symptom amelioration and survival, as well as the determinants influencing prognosis, were evaluated. The 3-, 6-month, and 1-year survival rates and mOS of the patients were calculated by the Kaplan‒Meier method, and survival and prognostic analyses were performed using the log-rank test, one-way analysis of variance, and the Cox proportional hazards model. Symptoms were significantly alleviated among the 113 leptomeningeal metastases with intracranial hypertension who underwent VS placement. The median survival time of 112（89.6%）cases who received medication regularly was 9.0months, and significantly prolonged by 2-4months compared with that of other studies not involving IVM in the literature. Cox multifactorial analysis revealed that postoperative administration of IVM and the number of IVM times independently influenced the efficacy of leptomeningeal metastases treatment. For leptomeningeal metastases, VS not only significantly alleviates symptoms caused by intracranial hypertension but also avoids sudden death for those with severe intracranial hypertension. However, VS placement only does not improve overall survival. IVMs controls effectively leptomeningeal metastases, significantly prolongs survival, enhances quality of life.

Exploring Predictors of Treatment Response to GLP-1 Receptor Agonists for Smoking Cessation.

Understanding predictors of smoking cessation medication efficacy facilitates the ability to enhance treatment effectiveness. In our pilot trial, exenatide, a glucagon-like peptide-1 receptor agonist, adjunct to nicotine patch improved smoking abstinence compared to nicotine patch alone. This secondary analysis explores potential baseline characteristics associated with differential treatment response to exenatide. The parent trial randomized (1:1) 84 smokers with prediabetes and/or overweight to once-weekly placebo or exenatide, 2mg, subcutaneously. All participants received nicotine patch (21mg) and brief smoking cessation counseling, with biologically confirmed 7-day point prevalence abstinence at week 6 (end-of-treatment) deemed the primary outcome. Bayesian generalized linear modeling explored differential response to treatment as a function of baseline patient characteristics, including demographic, psychosocial, clinical, smoking related, and genetic factors. Posterior probability (PP)≥75% that an effect exists was taken as a minimum threshold of evidence in favor of model effects. Exenatide showed stronger benefit versus placebo in participants that smoked >20 cigarettes per day (PP=81.7%) and in those without prediabetes (PP=76.0%) or obesity (PP=94.4%). Exenatide's efficacy was observed only in individuals with no/minimal depression symptoms but not in those with symptoms (PP=91.2%). Finally, exenatide was more efficacious than placebo only in those with the CHRNA rs16969968 GG genotype (PP=88.6%). The effect of exenatide on abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger prospective investigations are needed to confirm and extend these findings. Understanding predictors of smoking cessation medication efficacy enhances the ability to improve treatment effectiveness. In our pilot trial, extended-release exenatide, a GLP-1 receptor agonist, adjunct to nicotine patch, improved smoking abstinence in smokers with prediabetes and/or overweight. The current post-hoc analysis found that the effect of exenatide on smoking abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger investigations are needed to confirm and extend these findings.

Pharmacogenetics of opioid medications for relief of labor pain and post-cesarean pain: a systematic review and meta-analysis.

Several studies have attempted to identify genetic determinants of clinical response to opioids administered during labor or after cesarean section. However, their results were often contrasting. A systematic review and meta-analysis was conducted to quantitatively assess the association between gene polymorphisms and clinical outcomes of opioid administration in the treatment of labor pain and post-cesarean pain. A comprehensive search was performed up to December 2023 using PubMed, Web of Knowledge, Cochrane Library, and OpenGrey databases. The clinical endpoints of interest were pain score after opioid treatment, total opioid consumption, patient's analgesic satisfaction, and incidence of opioid side effects. Random-effects meta-analyses were conducted when data were available in at least three studies. Twenty-six studies enrolling 7765 patients were included in the systematic review. Overall, a total of 12 candidate polymorphic genes (OPRM1, COMT, CYP2D6, CYP3A4, ABCB1, ABCC3, UGT2B7, CGRP, OPRK1, OPRD1, KCNJ6, KCNJ9) were considered by the included studies, among which the most investigated variant was OPRM1 rs1799971. Overall pooled results indicated that individuals carrying the G allele of OPRM1 rs1799971 required higher opioid doses for pain management in comparison to rs1799971 AA subjects (standardized mean difference: 0.26; 95% CI: 0.09-0.44; P = 0.003). Such an association was confirmed in the subgroups of patients with labor pain and post-cesarean pain. The present meta-analysis provides strong evidence of an association between OPRM1 rs1799971 and opioid dose requirement for relief of labor pain or post-cesarean pain. However, given the insufficient evidence for other polymorphic gene variants, large studies are still needed to investigate the impact of genetic variability on the efficacy and safety of opioid medications for relief of labor pain and post-cesarean pain (INPLASY Registration No. 202410040).

The Efficacy and Safety of Non-Biologic and Biologic Treatments in Palmoplantar Pustular Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis.

Palmoplantar pustular psoriasis (PPPP), or palmoplantar pustulosis (PPP), is a type of psoriasis that affects the skin on the palms and soles. It is characterised by dermatosis and small sterile pustules and is considered a significant burden on patients' quality of life, as there is currently no gold standard treatment or cure. This network meta-analysis (NMA) compares the efficacy and safety of biologic and non-biologic medications for PPPP and PPP. Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. The efficacy and safety of all medications were assessed through a frequentist NMA using a random-effects model. Treatments were ranked using the net rank function, yielding P scores. Fourteen RCTs with 1056 participants were included. Guselkumab 100 mg was the most effective for improving PPPGA scores (p = 0.72, RR = 1.31, CI: 0.31-5.57). Guselkumab 100 mg was ranked the highest for achieving PPPASI-75 (RR = 5.4, CI: 1.26-23.2, p = 0.023). Oral cyclosporine 1 mg/kg/day was ranked the highest for PPPASI-50 (RR = 2.10, CI: 0.65-6.82). Etretinate 1 mg/kg/day had the highest rate of adverse events (RR = 1.78, CI: 0.92-3.44). Secukinumab 300 mg was associated with the highest rate of serious adverse events (RR = 1.58, CI: 0.21-12.02). Based on the P-scores from our NMA, guselkumab 100 mg was the most effective for PPPGA improvement, guselkumab 100 mg for PPPASI-75, oral cyclosporine 1 mg/kg/day for PPPASI-50, etretinate 1 mg/kg/day had the most adverse events, and secukinumab 300 mg was associated with the highest rate of serious adverse events. TRIAL REGISTRATION: PROSPERO registration number: CRD42023460842.

Cost-Effectiveness of Semaglutide in Patients With Obesity and Cardiovascular Disease.

Randomized clinical trials have shown that semaglutide is associated with a clinically relevant reduction in body weight and a lower risk of adverse cardiovascular events in those who are overweight or obese with a history of cardiovascular disease but no diabetes. The objective of this study was to assess the cost-effectiveness of semaglutide for this indication. A decision analytic Markov model was used to compare the lifetime benefits and costs of semaglutide 2.4-mg subcutaneous weekly vs standard care in a hypothetical cohort of patients who were overweight or obese with preexisting cardiovascular disease (and no diabetes) from the health care payer perspective. Our model included ischemic stroke, heart failure hospitalization and/or urgent visit or myocardial infarction, and death over monthly transition cycles. Model outcomes included costs (2023 CAD$), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Base case analysis showed that the incremental cost-effectiveness ratio for semaglutide compared with standard care was $72,962 per QALY gained with a 14% likelihood of cost-effectiveness adopting a $50,000 per QALY gained willingness to pay threshold. Factors with the greatest influence on cost-effectiveness were medication efficacy on mortality and medication cost. When the price of semaglutide was reduced by 50%, it was economically attractive at $37,190 per QALY gained with an 80% likelihood of cost-effectiveness at a $50,000 per QALY threshold. Semaglutide might be a cost-effective option for the publicly funded health care system contingent on initial pricing. Considering the candidate population-patients who are overweight or obese with preexisting cardiovascular disease-policymakers should consider the budget effect of funding semaglutide and weigh it against other ways scarce health care dollars might be used.

SiRNA-based therapy for overcoming drug resistance in human solid tumours; molecular and immunological approaches.

RNA interference (RNAi) is a primordial biological process that protects against external intrusion. SiRNA has the potential to selectively silence disease-related genes in a sequence-specific way, thus offering a promising therapeutic approach. The efficacy of siRNA-based therapies in cancer treatment has gained significant recognition due to multiple studies demonstrating its ability to effectively suppress cancer cells' growth and multiplication. Moreover, siRNA-based medicines have shown considerable promise in enhancing the sensitivity of cancer cells to chemotherapy and other treatment methods by suppressing genes that play a role in the development of drug resistance. Exploring and identifying functional genes linked to cancer cell characteristics and drug resistance is crucial for developing effective siRNAs for cancer treatment and advancing targeted and personalized therapeutics. Targeting and silencing genes in charge of resistance mechanisms, such as those involved in drug efflux, cell survival, or DNA repair, is possible with siRNA therapy in the context of drug resistance, especially cancer. Through inhibiting these genes, siRNA therapy can prevent resistance and restore the efficacy of traditional medications. This review addresses the potential of siRNAs in addressing drug resistance in human tumours, opening up new possibilities in cancer therapy. This review article offers a non-systematic summary of how different siRNA types contribute to cancer cells' treatment resistance. Using pertinent keywords, sources were chosen from reliable databases, including PubMed, Scopus, and Google Scholar. The review covered essential papers in this area and those that mainly addressed the function of siRNA in drug resistance. The articles examined in connection with the title of this review were primarily published from 2020 onward and are based on in vitro studies. Furthermore, this article examines the potential barriers and prospective perspectives of siRNA therapies.

Inhibition of monoamine oxidases by heterocyclic derived conjugated dienones: synthesis and in vitro and in silico investigations.

A total of 18 heterocyclic derived conjugated dienones (CD1-CD18) were evaluated for their potential monoamine oxidase (MAO)-A/-B inhibitory activity. Among the analyzed molecules, CD11 and CD14 showed notable inhibitory potentials against MAO-B, with half-maximal inhibitory concentration (IC50) values of 0.063 ± 0.001 μM and 0.036 ± 0.008 μM, respectively. In contrast, CD1, CD2 and CD3 showed comparable inhibitory activities toward MAO-A, with IC50 values of 3.45 ± 0.07, 3.23 ± 0.24, and 3.15 ± 0.10 μM, respectively. Derivatives of thiophene (CD13-CD17) exhibited selectivity indices greater than 250 for MAO-B. Both lead compounds exhibited similar potencies to safinamide and were more potent than pargyline. According to kinetic analysis, CD11 and CD14 exhibited competitive inhibition of MAO-B activity, with K i values of 12.67 ± 3.85 nM and 4.5 ± 0.62 nM, respectively. Furthermore, the reversibility test results indicated that the inhibitions were reversible. Molecular docking and molecular dynamics simulation studies can provide insights into the probable binding interactions of CD11 and CD14 with MAO-B. CD11 demonstrated a bipartite contact with Tyr326 and Phe343, whereas CD14 showed contact with Pro102 and Tyr435 via aromatic hydrogen bonds. These results indicated that both compounds have high-affinity binding interactions ( -10.13 and -9.90 kcal mol-1, respectively) at the active site of MAO-B. Furthermore, we used SwissADME to estimate ADME, and both lead compounds demonstrated blood-brain barrier penetration. The study results indicated that all the compounds evaluated demonstrated potent inhibition of MAO-B activity, which was comparable to the efficacy of reference medications. It is necessary to do further investigations on the lead molecules to see whether they may be used to treat different neurodegenerative illnesses.

Medication Management Process: Some Key Challenges and the Way to Address Them

Abstract Medications are essential in the patient healing process within hospital settings; however, their management is fraught with challenges that can lead to adverse outcomes when not handled properly. This study delineates the key phases of medication management—selection and procurement, storage, prescribing, dispensing, administration, and monitoring—while emphasizing the complexities and potential pitfalls within each phase. Major obstacles identified include a lack of accountability across departments, improper storage conditions, and the prevalence of medication errors and near misses. Effective strategies to mitigate these risks are proposed, such as establishing a prescription audit team, minimizing verbal orders, and ensuring thorough reviews of patient medication charts by specialists. This research advocates for a multidisciplinary approach involving collaboration among healthcare professionals, particularly the pharmacy team, to enhance medication safety and efficacy. By fostering clear roles and responsibilities within the medication management process, healthcare organizations can significantly reduce the incidence of medication-related errors, ultimately improving patient care outcomes.

Physician's Attitudes Toward Patients With Opioid Use Disorder and Use of Medications for Opioid Use Disorder Vary by Training.

This study compared whether different addiction treatment educational experiences were associated with physicians' attitudes toward patients with opioid use disorder (OUD) and perceived efficacy of medications for opioid use disorder (MOUD). Ohio physicians (n = 2757) with and without a waiver to prescribe buprenorphine (Drug Addiction Treatment Act 2000 [DATA 2000] waiver) were surveyed regarding their attitudes toward treating patients with OUD and on the effectiveness of MOUD. We divided physicians into 3 groups: physicians with DATA 2000 waivers, non-waivered physicians with experiential training, and non-waivered physicians without experiential training. We defined experiential training as educational experience directly working with individuals with OUD including those in recovery. Analysis of variance was used to detect statistically significant group differences. We found significant main effect differences in attitudes toward patients with OUD and perceived efficacy of MOUD between groups (P ≤ .01) for all but one attitude. Post hoc comparisons revealed waivered physicians had the most favorable attitudes. Among physicians without a waiver, those with experiential training had significantly more favorable attitudes toward treating OUD and perceived MOUD to be more effective, including items such as "OUD are treatable illnesses" and "medication assisted treatment is a crucial part of treatment for OUD." The results suggest that physicians with DATA 2000 waiver and experiential training, as compared to physicians without either a waiver or experiential training in OUD, are associated with less stigmatizing views of treating patients with OUD and prescribing MOUD. While legislation in December 2022 eliminated DATA 2000 waiver training requirement, these findings suggest an ongoing need for training opportunities.

A scoping review of protein biomarkers for schizophrenia: State of progress, underlying biology, and methodological considerations.

Schizophrenia is characterized by symptoms such as delusions, hallucinations, and avolition. The diagnosis is clinical, based on interviews and the main treatment involves antipsychotics. Currently, given the lack of clinically applicable biomarkers for schizophrenia, there is no molecular test based on its biological mechanisms to assist psychiatrists either in the prediction or diagnosis of the disorder, nor to measure medication efficacy. This scoping review assessed original articles in English about protein biomarkers for schizophrenia with samples that could be used in a clinical context, classifying them into diagnosis, prognosis, therapeutics, risk for psychosis, and side-effects. The search was conducted on PubMed and key findings were inserted on a summary table. We discussed the methodologies used in these papers, suggested protein panels for validation in longitudinal research, and proposed a hypothesis to explain the observed variability in results. This heterogeneity is explored in light of the debated validity of this construct, applying recent discussions and the disorder's history. Our data suggest that there is insufficient evidence to integrate protein biomarkers into clinical psychiatry for schizophrenia, not due to study quality, but possibly due to flaws in the current diagnostic system. We propose exploring alternative categorization systems.

Assessment of Antiretroviral Therapy Adherence Among HIV/AIDS Patients at Jugel Hospital, Harar, Ethiopia. 2021

Background: HIV/AIDS remains a major global health concern, significantly impacting not only health systems but also economic development and social fabric; it reduces life expectancy, exacerbates poverty, and contributes to food insecurity. While the introduction of Highly Active Antiretroviral Therapy (HAART) has improved the lives of people living with HIV, strict adherence to treatment regimens is crucial to maintain its effectiveness and prevent the development of drug resistance. Objective: To assess ART adherence among HIV/AIDS patients at Jugol Hospital, Harar, Ethiopia. Method: A cross-sectional descriptive study design was employed using a quantitative approach to determine the status of ARV adherence among HIV patients at Jugel Hospital from February 20, 2021, to March 10, 202. A convenience sampling technique was used to select the study subjects. The study covered all consecutive patients who attended the ART at Jugel Hospital for medication refills over the study period. Results: Of the total 210 HIV-infected patients, the largest number were females, 62%, and belonged to the 26-35 age group, 112 (53.4%). Out of the 210 respondents, the majority, 129(61.4%), used cell phone alarms/watch bells for memory aids to take their medication on time. Most respondents thought that for more Adherence to ART, people need family and other support, education about the importance of medication and schedule aids, an understanding of the importance of adhering, and a belief in the efficacy of medication. Of the total, only 34 respondents had a history of missed doses after they had started ART. The main reasons for missed doses were forgetting 14(41.2%), being busy 9(26.3%), run out of pills 4(11.7%), fear of taking medication in front of others 5(14.7%) and side effects 2(5.9%). The main reasons that made the patients not follow and attend their clinical appointments regularly were forgetting 12(48%), being away from home 7(28%) and being busy 6(24%). Conclusion: In our study, the self-reported adherence rate was higher than in industrialized nations. Regular patient follow-up, raising patients' understanding of ARV adverse effects, and enhancing patients' confidence, trust, and happiness with their caregivers are all goals of programs and clinical initiatives to promote drug taking in study setups.

Colchicine combination therapy increases treatment tolerance in patients with arthritis: A systematic review and meta-analysis.

Arthritis seriously affects people's quality of life, and there is an urgent clinical need to improve the efficacy of medications as well as to reduce the adverse effects induced by treatment. Combined colchicine therapy is gradually being embraced in clinical care, but the evidence remains insufficient. English databases were searched from the establishment to September 4, 2024. Eleven eligible Randomized controlled trials (RCTs) were included. The quality of the literature was assessed by the risk of bias tool in the Cochrane Handbook. Relative risk (RR) and Cohen's d (SMD) were used for categorical and continuous variables, respectively, at 95% confidence interval (CI), and Stata 17.0 software was used for statistical analysis. Sensitivity analyses were used to verify the stability of the analyzed results, and heterogeneity analyses were used to explore the sources of heterogeneity in the studies. Funnel plots and Egger's test were used to assess publication bias. Eleven eligible RCTs were included in this study. Compared with conventional treatment, combined colchicine treatment improved patient's global assessment results (SMD = 1.24, 95% CI [0.01, 2.47], P = 0.05, I2 = 0]), stiffness (SMD = -0.81, 95% CI [-1.43, -0.19], P = 0.01, I2 = 63.91%]) and did not increase adverse effects (RR = 0.79, 95% CI [0.31, 1.27], P = 0.36, I2 = 0.00%). However, combined colchicine treatment did not improve visual analog scores (VAS) (SMD = -0.96, 95% CI [-2.85, 0.93], P = 0.13, I2 = 97.99%]), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain (SMD = 0.01, 95% CI [-0.24, 0.27], P = 0.91, I2 = 0]), WOMAC function (SMD = -0.01, 95% CI [-0.36, 0.16], P = 0.44, I2 = 0]), Total WOMAC scale (SMD = -0.05, 95% CI [-0.33, 0.22], P = 0.70, I2 = 0]), physician 's global assessment (SMD = 0.36, 95% CI [-2.27, 3.00], P = 0.79, I2 = 97.04%]) and Modified Clinical Health Assessment Questionnaire (ModHAD) (SMD = -1.72, 95% CI [-4.90,1.45], P = 0.29, I2 = 99.11%]). Compared with colchicine alone, combination therapy improves patients' quality of life without increasing the incidence of adverse events.

Infliximab and adalimumab in the treatment of fistulizing Crohn's disease: a propensity score-matched analysis from the prospective Persistence Australian National IBD Cohort (PANIC4) study.

There are spare data on comparative medication efficacy in fistulizing Crohn's disease (FCD), particularly with immunomodulator co-therapy. Persistence is a unique way to assess real-world outcomes. The persistence of all dispensed biological agents were analysed from the Australian Pharmaceutical Benefits Scheme (PBS) registry data 2005-2021 for FCD. Propensity score matching was performed to account for baseline cohort imbalance. There were 5,739 lines of therapy in 4,466 patients over the 16-year period with 17,144 patient-years of follow-up; via therapy 2,605/5,739 (45.4%) used adalimumab and 3,134/5,739 (54.6%) used infliximab; 1,697/5,739 (29.6%) used thiopurine co-therapy at induction, whilst 242/5,739 (4.2%) used methotrexate. As a first-line biologic (biologic-naïve), infliximab showed superior overall- and corticosteroid-free persistence to adalimumab (P=0.0002 and P=0.0021 respectively). Used after first-line (biologic-exposed), there was no difference between agents for overall persistence (P=0.064) though infliximab showed greater corticosteroid-free persistence (P=0.030). Co-induction with thiopurine was associated with improved overall- and corticosteroid-free persistence (P=0.0002 and P=0.045 respectively). After propensity score matching, infliximab showed superior overall and corticosteroid-free persistence compared to adalimumab in bio-naïve (P<0.0001 and P=0.0016 respectively), not in bio-exposed patients (P=0.12 and P=0.074 respectively). Thiopurine was associated with superior overall- and corticosteroid-free persistence use, though no difference was seen with methotrexate. The PANIC cohort with real-world data of non-hierarchical prescribing of biological agents supports the superiority of infliximab over adalimumab in bio-naïve FCD patients, but did not show a therapeutic difference in bio-exposed FCD. Thiopurine co-therapy was independently associated with improved biological agent persistence in FCD.

Efficacy of antiobesity medications for weight reduction in older adults: a systematic review.

The objective of this study was to examine weight reduction and adverse events associated with use of antiobesity medications (AOMs) in older adults ages ≥65 years. Seven databases were searched for studies evaluating weight reduction of Food and Drug Administration (FDA)-approved AOMs. Studies had to include adults ages ≥65 years with obesity (BMI ≥ 30 kg/m2 or ≥27 kg/m2 with one weight-related condition), with independent analysis of weight reduction for adults ages ≥65 years. Two coauthors extracted and evaluated studies for risk of bias using standardized forms. Six experimental studies (five secondary analyses of randomized clinical trial data and one single-arm trial) and two observational studies met inclusion criteria. Seven medications were studied. Sample size of older adults ranged from 13 to 6728. Experimental studies predominantly included patients with concurrent prediabetes or cardiovascular disease. All studies found statistically significant weight reduction between intervention and placebo groups or compared with baseline weight. Few studies reported on adverse events. Limited evidence suggests weight reduction of AOMs in older adults, with the best current evidence for the use of semaglutide in older adults with obesity and cardiovascular disease. Larger, more inclusive studies of older adults are needed to guide clinical care and determine the tolerability of AOMs for older adults.

Breath and Beyond: Advances in Nanomedicine for Oral and Intranasal Aerosol Drug Delivery.

Designing and standardizing drug formulations are crucial for ensuring the safety and efficacy of medications. Nanomedicine utilizes nano drug delivery systems and advanced nanodevices to address numerous critical medical challenges. Currently, oral and intranasal aerosol drug delivery (OIADD) is the primary method for treating respiratory diseases worldwide. With advancements in disease understanding and the development of aerosolized nano drug delivery systems, the application of OIADD has exceeded its traditional boundaries, demonstrating significant potential in the treatment of non-respiratory conditions as well. This study provides a comprehensive overview of the applications of oral and intranasal aerosol formulations in disease treatment. It examines the key challenges limiting the development of nanomedicines in drug delivery systems, formulation processes, and aerosol devices and explores the latest advancements in these areas. This review aims to offer valuable insights to researchers involved in the development of aerosol delivery platforms.