Pharmacotherapy Of Diseases Research Articles

Significant Publications on Infectious Diseases Pharmacotherapy in 2023.

Purpose: To provide a summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2023. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2023. Article nominations included those pertaining to general ID and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. Out of the 31 articles nominated by HIDN members, 22 pertained to general ID pharmacotherapy, and 9 pertained to HIV/AIDS pharmacotherapy. To aid selection of the most notable articles of 2023, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 153 SIDP members who participated in the survey, there were 118 recorded votes for the top 10 general ID pharmacotherapy articles and 55 votes were recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: Advances in antimicrobial stewardship and infectious disease states continue to occur. Sustained growth in the publication of ID-related articles over the past year contributed to this review's aim to aid clinicians in remaining current on potentially practice-changing ID pharmacotherapy publications from 2023. This review provides a summary of recently published ID literature, including emphasis on antimicrobial stewardship, appropriate treatment durations, new antimicrobials, and drug-resistant organisms.

Reply: “Continuing the Chat: How Can we Improve the Performance of an Artificial Intelligence Chatbot in Answering Clinical Infectious Diseases Pharmacotherapy Questions?”

Reply: “Continuing the Chat: How Can we Improve the Performance of an Artificial Intelligence Chatbot in Answering Clinical Infectious Diseases Pharmacotherapy Questions?”

Advancing Alzheimer's disease pharmacotherapy: efficacy of glucocorticoid modulation with dazucorilant (CORT113176) in preclinical mouse models.

Exposure to chronic stress and high levels of glucocorticoid hormones in adulthood has been associated with cognitive deficits and increased risk of Alzheimer's disease (AD). Dazucorilant has recently emerged as a selective glucocorticoid receptor (NR3C1) modulator, exhibiting efficacy in counteracting amyloid-β toxicity in an acute model of AD. We aim to assess the therapeutic potential of dazucorilant in reversing amyloid and tau pathologies through the inhibition of glucocorticoid receptor pathological activity, and providing additional evidence for its consideration in AD treatment. The efficacy of dazucorilant was evaluated in two transgenic mouse models of amyloid pathology. The slowly progressing J20 and the aggressively pathological 5xFAD mice. Behavioural analysis was conducted to evaluate welfare, cognitive performances and anxiety levels. The activity of the glucocorticoid receptor system, neuroinflammation, amyloid burden and tau phosphorylation were examined in hippocampi. In both AD models, chronic treatment with dazucorilant improved working and long-term spatial memories along with the inhibition of glucocorticoid receptor-dependent pathogenic processes and the normalization of plasma glucocorticoid levels. Dazucorilant treatment also resulted in a reduction in tau hyperphosphorylation and amyloid production and aggregation. Additionally, dazucorilant seemed to mediate a specific re-localization of activated glial cells onto amyloid plaques in J20 mice, suggesting a restoration of physiological neuroinflammatory processes. Dazucorilant exhibited sustained disease-modifying effects in two AD models. Given that this compound has demonstrated safety and tolerability in human subjects, our results provide pre-clinical support for conducting clinical trials to evaluate its potential in AD.

P-954. Integration Station - The Train Stops Here: Measuring Effectiveness of Integration of Medicinal Chemistry and Clinical Practice Content in a Required Infectious Diseases Pharmacotherapy Course for Pharmacy Students

Abstract Background Pharmacy school accrediting bodies require curricular integration with medicinal chemistry, pharmacology and practice in the curriculum. No studies discuss how to execute that integration effectively. Two pharmacy faculty (one from pharmaceutical sciences and one from pharmacy practice) developed an innovative method to integrate their content in a required ID course. The goal was to determine if exam scores improved. Methods Two faculty at one school of pharmacy developed an innovative method to deliver integrated content in a required ID pharmacotherapy course. They utilized methods of backward design and in-class application during the 2024 course delivery. Objectively, exam scores were compared to prior years (both overall scores and individual content questions such as pharmaceutical science and pharmacy practice) to assess effectiveness of content delivery. Results All of the infectious diseases content was assessed on two exams (exam 3 and 4) in the required course. The exam 3 average from 2024 was 71% and average scores from the three years prior were 72% (2023), 73.3% (2022), and 65.8% (2021). The exam 4 average from 2024 was 80.4%, and past average scores were 68.4% (2023), 69.3% (2022), and 67.1% (2021). Individual content between pharmaceutical sciences and pharmacy practice content from the exam scores from 2024 were higher than all previous exam scores, with a range of 1.6-14% points better in practice content, and 1.6-12.2% points better in science content. Conclusion While there may not have been a dramatic increase in exam scores from the 2024 iteration compared to the previous years, it can be noted that there were some improvements with the newly implemented method of integrated content delivery. Despite the fact that the overall exam 3 average did not increase in 2024 compared to 2023/2022, it is important to note that the content of the exam was weighted differently. There was 1.5x the amount of medicinal chemistry content on the 2024 exam vs previous exams. Students tend to perform worse on medicinal chemistry content. With improved exam scores, this method of integrated science and practice content appears to have been delivered more effectively than in past years. Disclosures All Authors: No reported disclosures

The administrative prevalence and pharmacotherapy of chronic inflammatory bowel diseases, 2012–2020

The administrative prevalence and pharmacotherapy of chronic inflammatory bowel diseases, 2012–2020

Hepatic thyroid hormone receptor-β signalling: Mechanisms and recent advancements in the treatment of metabolic dysfunction-associated steatohepatitis.

The pharmacotherapy of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, the metabolic dysfunction-associated steatohepatitis (MASH), remains a hot topic in research and a largely unmet need in clinical practice. As the first approval of a disease-specific drug, resmetirom, was regarded as a milestone for the management of this common liver disease, this comprehensive and updated review aimed to highlight the importance of the hepatic thyroid hormone (TH) receptor (THR)-β signalling for the treatment of MASH, with a special focus on resmetirom. First, the genomic and non-genomic actions of the liver-directed THR-β mediated mechanisms are summarized. THR-β has a key role in hepatic lipid and carbohydrate metabolism; disruption of THR-β signalling leads to dysmetabolism, thus promoting MASLD and possibly its progression to MASH and cirrhosis. In the clinical setting, this is translated into a significant association between primary hypothyroidism and MASLD, as confirmed by recent meta-analyses. An association between MASLD and subclinical intrahepatic hypothyroidism (i.e. a state of relatively low hepatic triiodothyronine concentrations, with circulating TH concentrations within the normal range) is also emerging and under investigation. In line with this, the favourable results of the phase 3 placebo-controlled MAESTRO trials led to the recent conditional approval of resmetirom by the US FDA for treating adults with MASH and moderate-to-advanced fibrosis. This conditional approval of resmetirom opened a new window to the management of this common and burdensome liver disease, thus bringing the global scientific community in front of new perspectives and challenges.

Lipoprotein(a), atherosclerosis and cardiovascular risk

At the end of the 20th century, the contribution of hyperlipoproteinemia (a) to early development and severity of coronary, cerebral and peripheral artery atherosclerosis was established, and its association with the development of aortic valve stenosis was shown. The results of epidemiological studies allow us to consider lipoprotein(a) (Lp(a)) as a new target for the diagnosis, prevention and pharmacotherapy of atherosclerotic cardiovascular diseases. The atherogenicity of Lp(a) is 6 times higher than that of low-density lipoproteins and can be the cause of early and rapid progression of atherosclerosis. The 2022 European Atherosclerosis Society statement stated that the threshold value of Lp(a) for "excluding" the risk of atherosclerotic cardiovascular diseases is less than 30 mg/dL. The range of Lp(a) values between 30 mg/dL and 50 mg/dL creates the so-called "grey zone" when the possible risks associated with Lp(a) and other cardiovascular risk factors should be considered. At Lp(a) values >180 mg/dL, the risk of cardiovascular diseases is equivalent to the risk of patients with heterozygous familial hypercholesterolemia. This review will discuss the genetic and pathophysiological properties of Lp(a), and the epidemiological data demonstrating its effect on cardiovascular morbidity. Extracorporeal methods for removing excess Lp(a) from blood serum are currently the only proven option to correct this dyslipidemia. Cascade plasmafiltration helps reduce LDLcholesterol and Lp(a) levels by more than 60%, as well as to decrease the level of oxidized phospholipids in plasma. It should be noted that according to 2023 domestic recommendations, the criteria for extracorporeal treatment are Lp(a) >50.0 mg/dl. The review provides recommendations for screening and treatment of patients with elevated Lp(a) levels, as well as a range of pharmacotherapeutic drugs being developed to reduce its level in the blood.

Treatment of Alzheimer Disease.

Symptom-oriented treatment has been the mainstay of Alzheimer disease (AD) pharmacotherapy for decades. This article reviews the evidence basis for symptomatic treatments for AD and the emerging data on amyloid-lowering therapies with possible disease-slowing effects. Amyloid-lowering monoclonal antibody therapies entered clinical use in 2021. In July 2023, lecanemab became the first of these to gain full US Food and Drug Administration (FDA) approval and limited Medicare payment coverage. Donanemab gained similar approval status in July 2024. The approved agents remove amyloid plaque from the brain and appear to slow clinical disease progression but can produce significant adverse events known as amyloid-related imaging abnormalities with cerebral edema or effusion and with cerebral hemorrhages. Extensive safety monitoring is therefore required, including scheduled MRI scans. Also in 2023, brexpiprazole became the first agent specifically approved by the FDA for agitation associated with AD. Suvorexant, an orexin receptor antagonist, previously was approved for the treatment of insomnia in people with mild and moderate AD. There is robust evidence for the use of acetylcholinesterase inhibitors for patients with mild, moderate, and severe dementia due to AD, including outcomes beyond changes in cognitive screening test scores. More limited studies support the use of memantine in moderate and severe stages. These agents have a primary effect of delaying decline in cognition and function and postponing the emergence of adverse behaviors. Pharmacotherapy for behavioral and psychological symptoms is less predictable, and most clinical trials have had negative results. Anti-amyloid therapies provide the first FDA-approved option to alter AD pathology, but an understanding of overall utility and value to patients remains in its infancy.

The methodology for developing modified release granules based on phytoextracts for the treatment of mastopathy

Aim. To substantiate the scientific and methodological approach to the development of the composition and technology of granules based on phytoextracts with modified release of active substances for the complex treatment of mastopathy. Materials and methods. The research was conducted by processing electronic and paper sources of information on the etiopathogenetic factors of mastopathy, the concept of developing medicinal products with modified release of active pharmaceutical ingredients (APIs), the market analysis of medicines and dietary supplements (DS) for the treatment of mastopathy. Results. An information search has been conducted to study the etiology, pathogenesis, clinical manifestations and pharmacotherapy of breast diseases. The article presents and substantiates the stages of experimental research on the development of a medicinal product in the form of granules based on phytoextracts with a modified release of active substances, including marketing and statistical research methods of electronic and paper sources of information on the prevalence and consequences of mastopathy, development of granules based on phytoextracts with a modified release of APIs, standardization, preclinical studies of the medicinal product developed. Conclusions. The scientific and methodical approach to the development of the composition and technology of granules based on phytoextracts with a modified API release for the complex pharmacocorrection of mastopathy and prevention of the appearance of malignant neoplasms in breast tissues has been substantiated.

Research Progress of Traditional Chinese Medicine in Treating Central Nervous System Diseases by Modulating Ferroptosis.

A newly proposed form of programmed cell death, ferroptosis, is distinct in cellular morphology, biochemical characteristics, and genetic characteristics from apoptosis, autophagy, and necrosis. Its mechanisms primarily encompass iron overload, lipid peroxidation, and amino acid metabolisms. Extensive research confirms that ferroptosis is linked to the onset and progression of various diseases that pose a threat to the central nervous system (CNS), offering new directions and targets for the mechanistic study and pharmacotherapy of CNS diseases. Traditional Chinese Medicine (TCM), encompassing herbal medicines (extracts, compound formulations, injections, etc.), acupuncture, and moxibustion, boasts advantages over other treatments, such as multi-pathway and multi-target approaches and high safety. TCM has also demonstrated good efficacy in treating CNS diseases. Numerous studies indicate that TCM can modulate ferroptosis to treat CNS diseases, showing promising research prospects. This paper briefly outlines the pathways and mechanisms of ferroptosis and systematically summarizes the current status and progress of TCM in regulating various CNS diseases through the ferroptosis pathway, providing new insights and directions for future TCM treatments of CNS diseases.

Assessing Associations of Nurse-Managed Hypertension Care on Pharmacotherapy, Lifestyle Counseling, and Prevalence of Comorbid Cardiometabolic Diseases in All Patients With Hypertension That Are Treated in Primary Care in Stockholm, Sweden.

The aim was to study if nurse-managed hypertension care was associated with differences in pharmacotherapy, lifestyle counseling, and prevalence of comorbid cardiometabolic diseases among patients receiving care at primary health care centers. To assess the extent of nurses' involvement in the hypertension care, a questionnaire was distributed to all primary health care centers in Region Stockholm. Age-adjusted logistic regression models were used to analyze the results, odds ratios with 99% confidence intervals. Data was acquired from VAL, the administrative databases of Region Stockholm in Sweden, encompassing all individuals 30 years or older with a registered hypertension diagnosis who attended to the primary health care center they were registered at. Our analysis comprised 119267 patients diagnosed with hypertension registered in one of the 224 included primary health care centers. Of the 81 primary health care centers that responded to the questionnaire, 54 reported having nurse-managed hypertension care. Nurse-managed hypertension care was not significantly associated with differences in pharmacotherapy or patients' comorbidity, except for diabetes. Primary health care centers with nurse-managed hypertension care had a 10% greater adherence to national guidelines for lifestyle counseling (33.5%) compared to those without nurse-managed hypertension care (22.5%). Regardless of the organizational form of hypertension care management, more men received lifestyle counseling according to guidelines compared to women. In-house routines for hypertension care, with designated nurses, and booking systems were associated with more lifestyle counseling, which has been associated with signs of better hypertension care.

Promising cell systems for targeted delivery of nano- and microcarriers loaded with drugs or biomolecules (review)

Introduction. Cellular systems for targeted delivery of drug and biological molecules (drug delivery systems, DDSs) are currently considered as a promising solution to the problems of nano- and micro-sized drug carriers.Text. The review briefly examines fundamental and applied issues in the development of cellular DDSs, the morphofunctional diversity of which theoretically makes it possible to solve the problems of pharmacotherapy of various diseases. Sources are presented summarizing clinical protocols for the use of cellular DDSs, which are, however, limited to antitumor and anti-inflammatory therapy. The advantages, as well as particular and general disadvantages of using certain cells (blood cells, immunocytes, stem cells) as promising platforms for translation into clinical practice of delivery vehicles for various drugs (antibiotics, cytostatics, monoclonal antibodies, enzymes, etc.) loaded into nano- and micro-sized DDSs.Conclusion. Despite the obvious and impressive successes of fundamental and applied research in this area, a difficult path lies ahead in optimizing the processes of targeted delivery and controlled release of drug and biological molecules using cellular DDSs.

MODERN USE OF DRUGS IN BRONCHOPULMONARY PATHOLOGY

Objective: This study aims to evaluate the rational pharmacotherapy for bronchopulmonary diseases in children with recurrent bronchitis, focusing on treatment effectiveness and safety. Methods: A retrospective analysis of 28 children aged 1.5 to 10 years, diagnosed with acute bronchitis, recurrent bronchitis, and pneumonia, was conducted. The patients were treated at a pulmonology department and underwent clinical, laboratory, and radiological assessments. Treatment regimens included third-generation cephalosporins, glucocorticoids, and antihistamines, administered according to age-based standards. Results: The study revealed that all patients exhibited moderate symptoms upon admission, with many presenting coexisting conditions such as chronic ENT diseases and iron-deficiency anemia. Clinical laboratory tests indicated iron deficiency anemia and mild leukocytosis across all groups, suggesting impaired oxygen delivery and ongoing inflammation. The pharmacotherapy was generally well-tolerated, with notable improvements in respiratory function and recovery in most children. Novelty: This study highlights the importance of personalized pharmacotherapy in managing recurrent bronchitis in children, particularly considering comorbid conditions. It emphasizes the role of comprehensive treatment protocols integrating antibiotics, glucocorticoids, and antihistamines for effective management.

Let's Have a Chat: How Well Does an Artificial Intelligence Chatbot Answer Clinical Infectious Diseases Pharmacotherapy Questions?

It is unknown whether ChatGPT provides quality responses to infectious diseases (ID) pharmacotherapy questions. This study surveyed ID pharmacist subject matter experts (SMEs) to assess the quality of ChatGPT version 3.5 (GPT-3.5) responses. The primary outcome was the percentage of GPT-3.5 responses considered useful by SME rating. Secondary outcomes were SMEs' ratings of correctness, completeness, and safety. Rating definitions were based on literature review. One hundred ID pharmacotherapy questions were entered into GPT-3.5 without custom instructions or additional prompts, and responses were recorded. A 0-10 rating scale for correctness, completeness, and safety was developed and validated for interrater reliability. Continuous and categorical variables were assessed for interrater reliability via average measures intraclass correlation coefficient and Fleiss multirater kappa, respectively. SMEs' responses were compared by the Kruskal-Wallis test and chi-square test for continuous and categorical variables. SMEs considered 41.8% of responses useful. Median (IQR) ratings for correctness, completeness, and safety were 7 (4-9), 5 (3-8), and 8 (4-10), respectively. The Fleiss multirater kappa for usefulness was 0.379 (95% CI, .317-.441) indicating fair agreement, and intraclass correlation coefficients were 0.820 (95% CI, .758-.870), 0.745 (95% CI, .656-.816), and 0.833 (95% CI, .775-.880) for correctness, completeness, and safety, indicating at least substantial agreement. No significant difference was observed among SME responses for percentage of responses considered useful. Fewer than 50% of GPT-3.5 responses were considered useful by SMEs. Responses were mostly considered correct and safe but were often incomplete, suggesting that GPT-3.5 responses may not replace an ID pharmacist's responses.

Analysis of methotrexate use practice in patients with rheumatoid arthritis and psoriatic arthritis

Background. Pharmacoepidemiological studies play a key role in optimizing pharmacotherapy for various diseases. In particular, significant progress in the treatment of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) necessitates a detailed analysis of the consumption of disease-modifying antirheumatic drugs. The modern therapeutic concept for these conditions focuses on achieving and maintaining long-term remission, which positions methotrexate (MTX) as a first-line agent, characterized by high effectiveness, safety and advantageous pharmacoeconomic profiles.Objective: to investigate the characteristics of MTX use in real clinical practice among patients with RA and PsA during outpatient medical care.Material and methods. The study comprised two parts: a retrospective cross-sectional analysis of MTX consumption dynamics in 2018, 2020, and 2023 via ATC/DDD (Anatomical Therapeutic Chemical classification, ATC; defined daily dose, DDD) methodology, and a longitudinal non-interventional pharmacoepidemiological study conducted in 2023 using the medical information system “BARS. Healthcare”.Results. The ATC/DDD analysis demonstrated a significant increase in MTX consumption among patients with RA and PsA: from 302,428.6 to 319,114.3 DDDs per 1,000 patients per year for RA, and from 28,157.1 to 310,771.6 DDDs per 1,000 patients per year for PsA in 2018 and 2023, respectively. The most frequently prescribed dose of MT was 15 mg/week. The primary therapeutic combination for 55.8% of patients was “MT + nonsteroidal anti-inflammatory drugs”, with 32.7% of patients also receiving glucocorticoids (GCs) as part of this combination. The study identified a high frequency of prescriptions for proton pump inhibitors, GCs, and cholecalciferol, highlighting the activity of diseases under consideration, potential complications, and the necessity for the prevention of clinically significant drug interactions.Conclusions. The conducted study confirmed that MTX remains the main drug for the treatment of RA and PsA. The ATC/DDD analysis demonstrated a significant increase in MTX consumption in recent years, correlating with its therapeutic effectiveness and accessibility. The high frequency of concomitant prescriptions underscores the complexity of treating RA and PsA and the need for an interdisciplinary approach to ensure safety and efficacy of the therapy.

Current issues of using metronidazole in clinical practice. Effects and directions of clinical application

Metronidazole is an important drug in clinical and outpatient practice due to its broad antibacterial and antiprotozoal properties. Metronidazole is effective against anaerobic bacteria and some protozoa such as Trichomonas vaginalis and Giardia lamblia. This makes it indispensable in the treatment of infections of various etiologies. The review article contains current information about the clinical pharmacology of metronidazole and its place in the pharmacotherapy of infectious diseases. General and specific issues of the use of metronidazole in the practice of GPs, surgeons, obstetrician-gynecologists, and other specialists are considered. Information is provided on the possibilities and indications for the use of metronidazole in the eradication of Helicobacter pylori, in radiation therapy for cancer patients, dermatovenereology, dentistry, treatment of protozoal infections, as well as in alcoholism. Metronidazole is often used in combination with other antibiotics to enhance the antimicrobial effect, especially in cases of mixed infections or when it is necessary to cover a wider range of pathogens. In surgical practice, metronidazole is used to prevent infectious complications after operations on the abdominal and pelvic organs, where the risk of anaerobic infection is high. In an environment of increasing antibiotic resistance, metronidazole remains an effective treatment against many anaerobic pathogens, highlighting its place in modern practice.

Evaluation of self medication practices and prescription patterns in patients of chronic kidney disease: A cross-sectional, questionnaire based study.

Pharmacotherapy of chronic kidney disease (CKD) consists of prescribing myriad of drugs such as antihypertensives, antidiabetics, and phosphate binders to delay disease progression and control the comorbidities, resulting in inherent variability in prescriptions. In addition, tendency to self-medicate may further aggravate the condition. Hence, the present study was planned to assess self-medication practices and variability in prescription patterns in CKD patients. A cross-sectional, questionnaire-based study approved by the ethics committee was conducted in CKD patients attending the nephrology outpatient department. The prescription details which included drug name, dosage form, dose, frequency, duration, and dosage instructions were recorded and prescription completeness was checked. To assess the tendency of CKD patients to self-medicate, each patient was administered a prevalidated [Content Validity Ratio (CVR) = 0.76] 8-item questionnaire which had dichotomous responses "Yes" and "No" and was scored as 2 and 0, respectively (total score 16). Three hundred CKD patients (150 on hemodialysis and 150 nondialysis) yielded 300 prescriptions with 1272 drugs. It was evident that 33% of patients did self-medicate themselves with analgesics, and the mean score (7.81 ± 3.01) of self-medication practices was perceived significantly higher in the nondialysis group (8.41 ± 3.46). The most common classes of drugs prescribed in CKD patients were calcium channel blockers (41%), antidiabetic drugs (39%), diuretics (35%), gastrointestinal drugs (35%), and multivitamins (27%), with the average number of drugs being 5.84 ± 0.51. Nearly one-third of CKD patients were self-medicating with paracetamol, nonsteroidal anti-inflammatory drugs; more in the nondialysis group emphasizing reinforcement of patient education programs. The most common drugs prescribed were amlodipine, followed by metformin, and the average number of drugs was less in our setting, indicating vigilant dose prescribing in CKD patients.

Targeting Adenylate Cyclase: A Novel Concept for Stimulation of Neurogenesis and Pharmacotherapy of Alzheimer's Disease.

The low effectiveness of existing pharmacotherapy strategies for Alzheimer's disease (AD) makes it necessary to develop a new concept for the treatment of this type of dementia. This search is promising to be carried out within the framework of the paradigm of targeting intracellular signaling pathways in Regenerative-Competent Cells (RCCs). The purpose of the research is to study the impact of adenylate cyclase (AC) inhibitor on disorders of the psychoemotional status in aged male C57BL/6 mice, as well as on the dynamics of the content and functioning of RCCs nervous tissue. We examined the effect of the AC inhibitor (2',5'-Dideoxyadenosine) on conditioned reflex activity, behavioral and emotional profile in a mouse AD model (16-month-old (aged) male C57BL/6 mice), as well as the functioning of neural stem cells (NSCs), neuronal-committed progenitors (NCPs), and neuroglial cells in the subventricular zone of the cerebral hemispheres (SVZ). In aged C57BL/6 mice, we found impairments in exploratory behavior, emotional reactivity, and memory, which are the characteristics of senile dementia. Therapy based on AC inhibition led to an increase in the number of NSCs and NPCs in the SVZ due to an increase in their proliferative activity. These changes were more pronounced in NCPs. At the same time, a decrease in the specialization intensity was recorded in NSCs. These phenomena developed against the background of increased secretion of neurotrophic growth factors by oligodendrocytes and microglial cells. The neuroregenerative effects of 2',5'-dideoxyadenosine correlated with the correction of age-related disorders of the psychoemotional status in aged mice. The results provide the basis for the development of targeted drugs based on AC inhibitors to stimulate neurogenesis as an approach for the effective treatment of AD.

Assesment of adherence to therapeutic recommendations among patients with hypertension

Abstract Hypertension is a multifactorial condition involving environmental and genetic factors along with risk behaviors. Data from the National Health Fund show that nearly 10 million adult Poles have hypertension. The main goal of drug therapy is to effectively lower blood pressure to normal or near-normal values, and the basic prerequisite for effective pharmacotherapy of chronic diseases is patient adherence to pharmacological recommendations. Objectives The aim of this study was to determine the level of adherence to treatment recommendations among patients with hypertension with regard to sociodemographic and medical variables. Methods This survey-based study included 200 patients with hypertension, hospitalized in the Department of Cardiology with the Intensive Cardiac Care Unit of an Independent Public Clinical Hospital. The author’s questionnaire and The Adherence to Refills and Medication Scale (ARMS) were used as research instruments. Results The study demonstrated the effect of age and place of residence on adherence to treatment recommendations (the older the age, the worse the adherence). The overall level of non-adherence to recommendations (ARMS total score), and the level of non-adherence to taking medications or refilling prescriptions were significantly higher in patients with than without diabetes, and in patients without heart failure than in those with this condition. Conclusion Adherence among patients diagnosed with hypertension was at a good level. Age, employment status, place of residence, and diagnosed diseases (diabetes, heart failure) significantly affected adherence to treatment among the subjects.Table1

Pharmacotherapy of autoimmune rheumatic diseases – from monoclonal antibodies to CAR T cells: 20 years later

Autoimmunity is a pathological process associated with a violation of immunological tolerance to normal structural components of the body (autoantigens), associated with the predominance of active (adaptive) immunity and manifested by hyperproduction of autoantibodies. Systemic autoimmune rheumatic diseases (SARDs) are among the most common and severe nosological forms of this pathology associated with autoimmunity. Problems of pharmacotherapy of SARDs are the subject of intensive research. At the beginning of the 21st century, more than 20 biologic agents were developed for the treatment of rheumatoid arthritis – monoclonal antibodies (mAbs) and recombinant proteins that control inflammation associated with the overproduction of “pro-inflammatory” cytokines, the use of which has dramatically improved the results of pharmacotherapy. However, much less research has been devoted to studying the possibilities of pharmacotherapy aimed at selective suppression of the “autoimmune” component of the pathogenesis of SADRs associated with uncontrolled activation of B cells and restoration of immunological tolerance to autoantigens. In the spectrum of drugs whose mechanism of action is associated with the suppression of pathological activation of B cells, the leading place is occupied by rituximab (RTM). It is noteworthy that 20 years ago (2004), a group of researchers led by prof. J.C. Edwards first demonstrated the effectiveness of RTM in patients with RA, which was soon successfully repositioned to treat a wide range of SARDs. A major achievement in the pharmacotherapy of SARDs is associated with the use of CAR (сhimeric antigen receptor) T cell therapy, developed for the treatment of refractory hematological tumors. The main component of CART-cells is a genetically engineered T-cell receptor that recognizes the target antigen without the participation of the major histocompatibility complex. Although limited, extremely impressive data regarding high remission rates have been obtained by adapting CD19 CART-cell therapy to treat patients with severe systemic lupus erythematosus (SLE) and other SARDs refractory to standard immunosuppressive medications. The article discusses the results of the use of CART-cell therapy in SLE and other SARDs and prospects for further research.