Improving the Quality of Substance Dependency Treatment with Pharmacotherapy

This article provides an overview of current pharmacological treatments for alcohol, opioid, cocaine, and nicotine use disorders. Guidelines for a “patient-treatment” matching framework to physicians working with various “substance-abusing” patients are presented, as well as recommendations regarding when to initiate and discontinue pharmacotherapy. Standard and newer pharmacological treatments for substance dependence are reviewed, as well as therapies that may be especially useful when treating the patient with comorbid substance dependency and psychiatric disorders. To maximize the therapeutic benefits of substance dependency treatment, patients should be individually assessed and provided adjunctive medications as clinically indicated. Specific areas for future laboratory and/or clinical research are recommended.     

Pharmacotherapy of obesity

The growing recognition of the health risks of obesity coupled with the difficulties in treating it successfully by lifestyle modification predicates a need for effective drug treatment. The history of drug treatment in the second half of the 20th century is, however, one of disappointment and concern over drug toxicity. However, the advances in our understanding of the mechanism of weight control, together with improved ways of evaluating anti-obesity drugs, has resulted in two effective compounds, sibutramine and orlistat, becoming available for clinical use. Sibutramine has actions on both energy intake and expenditure and had been shown to enhance weight loss and weight maintenance achieved by diet, in simple obesity as well as when accompanied by complications of diabetes or hypertension. About 50-80% of patients can achieve a >5% loss, significantly more than if patients receive the same lifestyle intervention with placebo. Orlistat, which acts peripherally to block the absorption of dietary fat, has had similar results in clinical trials; a recent study (XENDOS) has just reported results which show that the enhanced, albeit modest, weight loss achieved with orlistat delays the development of diabetes over a 4-year period. A number of other compounds are expected to complete or enter clinical trials over the next decade. There is considerable optimism that we will soon have the pharmacological tools needed to make the treatment of obesity feasible.     

卒中后失语的药物治疗

卒中是引起失语的最常见病因.传统的言语-语言治疗仍是失语的主要治疗手段,但是其疗效并不肯定.尽管已开展了许多研究观察药物在治疗失语中的作用,但结论并不一致.文章就卒中后失语的药物治疗状况进行了综述.     

Actoxumab + bezlotoxumab combination: what promise for Clostridium difficile treatment?

Introduction: Clostridium difficile infection (CDI) is the most common healthcare-associated infection worldwide. As standard CDI antibiotic therapies can result in unacceptably high recurrence rates, novel therapeutic strategies for CDI are necessary. A recently emerged immunological therapy is a monoclonal antibody against C. difficile toxin B.

Areas covered: In this review, the authors summarize the available pharmacological, preclinical, and clinical data for the CDI treatment based on anti-toxin A (actoxumab) and anti-toxin B (bezlotoxumab) human monoclonal antibodies (HuMabs), and discuss about the potentiality of a therapy that includes HuMab combined administration for CDI.

Expert opinion: Although only bezlotoxumab is indicated to reduce recurrence of CDI, experimental studies using a combination of HuMabs actoxumab and bezlotoxumab have shown that bolstering the host immune response against both the C. difficile toxins may be effective in primary and secondary CDI prevention. Besides neutralizing both the key virulence factors, combination of two HuMabs could potentially offer an advantage for a yet to emerge C. difficile strain, which is a steady threat for patients at high risk of CDI. However, as actoxumab development was halted, passive immunotherapy with actoxumab/bezlotoxumab is actually impracticable. Future research will be needed to assess HuMab combination as a therapeutic strategy in clinical and microbiological cure of CDI.     

雷诺嗪:抗慢性心绞痛药物新成员

雷诺嗪是哌嗪类衍生物,多个临床试验证实其有确切的抗心绞痛作用和良好的耐受性及安全性,而对血流动力学无影响,2006年已被批准与其它抗心绞痛药物联合治疗慢性心绞痛,其作用机制可能与部分抑制脂肪酸氧化、抑制晚钠电流从而减轻细胞内钙超载有关。现综述了雷诺嗪的药代动力学特征、可能的作用机制及治疗心绞痛的相关临床试验。     

认知行为治疗联合药物治疗强迫症疗效的meta分析

目的:通过对随机对照试验的数据进行meta分析,比较药物联合认知行为治疗(CBT)与单纯药物或CBT治疗对强迫症的疗效,为临床实践提供选择依据.方法:检索PubMed、Embase和Central数据库,收集比较药物联合CBT与单纯药物或CBT治疗强迫症疗效的随机对照试验,选取联合治疗组与单纯治疗组的耶鲁-布朗强迫量表测量数据并采用均差作为效应量,应用RevMan5软件进行meta分析.结果:共纳入7项符合标准的研究,合计样本量468人.排除可能引起异质性的1组数据后,3组数据比较了药物联合CBT与单纯药物治疗的疗效且无异质性(Q=0.48,P＞0.1),结果显示联合治疗组对强迫症状的改善优于单纯药物组(MD =6.46,Z=5.03,P≤0.05);7组数据比较了药物治疗联合CBT与单纯CBT的疗效且无异质性(Q=9.08,P＞0.1),结果显示联合治疗组与单纯CBT组对强迫症状的改善没有差别(MD =0.87,Z=1.22,P＞0.05).结论:鉴于目前结果,推测对于强迫症状的改善,药物治疗联合CBT优于单纯药物治疗而与单纯CBT相当,但仍需进一步研究证实.     

Drug treatment of chronic subdural hematoma

ABSTRACT

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.

Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.

Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.