Sitagliptin

Sitagliptin, an oral dipeptidyl peptidase-4 (DPP-4) inhibitor, improves glycaemic control by inhibiting DPP-4 inactivation of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide. This increases active incretin and insulin levels, and decreases glucagon levels and post-glucose-load glucose excursion. In large, well designed phase III trials in patients with type 2 diabetes mellitus, sitagliptin 100 or 200mg once daily alone or in combination with other antihyperglycaemics was associated with significant improvements relative to placebo in overall glycaemic control and indices for insulin response and beta-cell function. Improvements from baseline in mean glycosylated haemoglobin (HbA(1c)) were significantly greater with sitagliptin monotherapy than with placebo in patients with type 2 diabetes. As add-on therapy in patients with suboptimal glycaemic control despite oral antihyperglycaemic treatment, sitagliptin improved HbA(1c) to a significantly greater extent than placebo when added to metformin or pioglitazone and was noninferior to glipizide when added to metformin. Sitagliptin was well tolerated when administered alone or in combination with other antihyperglycaemics, with an adverse event profile similar to that shown with placebo. The incidence of hypoglycaemia with sitagliptin was similar to that with placebo and, in combination with metformin, lower than that with glipizide. Sitagliptin had a generally neutral effect on bodyweight.     

Somewhat more than a splinter

International Journal of Clinical Pharmacy -     

Pharma now needs more than mergers

Fluoroquinolones, such as ciprofloxacin and ofloxacin have recently gained wide acceptance for use in the treatment of respiratory tract, skin/soft tissue, sexually transmitted diseases and urinary tract infections. The broad spectrum activity and good oral absorption characteristics of these antimicrobials promotes their use in both community and hospital settings. Despite these favourable properties, ciprofloxacin and ofloxacin have limited potency against some clinically important organsims, such as Streptococcus pneumoniae, enterococci and anaerobes including Bacteroides fragilis and many methicillin-resistant staphylococci. In addition, occasional clinical isolates of Enterobacteriaceae and Pseudomonas aeruginosa have emerged resistant to these compounds following their introduction. In an effort to expand upon the clinical utility of the existing fluoroquinolones, several new agents of this class have been identified and are in various stages of development. Some of these newer fluoroquinolones have significantly improved antimicrobial potency against the organisms mentioned above and/or possess pharmacokinetic characterisitics in humans that suggest they could be dosed less frequently than ciprofloxacin. This review will summarise the antimicrobial and human pharmacokinetic properties of sparfloxacin, clinafloxacin, PD-131628, PD-138312, PD-140248, Q-35, AM-1155, NM394, T-3761, rufloxacin, levofloxacin, CP-99,219, OPC-17116 and DU-6859a, which appear to be among the most interesting new fluoroquinolones currently in development. An attempt will be made to distinguish the most important characterisitics of these new agents, based upon the available preclinical data and results from single dose pharmacokinetic studies in humans. The data suggest that several of these fluoroquinolones possess properties that could translate into significant clinical advantages over the currently available compounds in this class.     

Homeopathic pathogenetic trials produce more specific than non-specific symptoms: results from two double-blind placebo controlled trials

We conducted two parallel, blinded homeopathic pathogenetic trials conducted at two different sites to determine whether symptoms reported by healthy volunteers were significantly different for homeopathic remedies than for placebos. Study 1 used a two-armed design, testing ozone against placebo. Study 2 used a three-armed design, testing ozone and iridium against placebo. We found significantly more remedy-specific symptoms in provers taking ozone or iridium than in provers taking placebo in the three-armed trial and in both trials pooled for ozone and placebo. We, therefore, conclude that homeopathic remedies produce more symptoms typical for a remedy than non-typical symptoms. The results furthermore suggest a somewhat non-classical pattern because symptoms of one remedy appear to be mimicked in the other trial arm. This might be indicative of entanglement in homeopathic systems.