Comparative efficacy of various treatment regimens for androgenetic alopecia in men

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.     

Antimikrobielle Effekte des in vitro simulierten Ketoconazol-Kantharidinblasenflüssigkeitsspiegel-Profils bei Candida albicans*,**/Antimicrobial Effects of Ketoconazole Concentration Profiles in Cantharidin Blister Fluid,Simulated in Vitro,on Candida albicans

Zusammenfassung: Candida albicans (Isolat Nr. 5125/85) wurde zum einen in Sabouraud-Glukose-Bouillon, zum anderen in einem flüssigen synthetischen Aminosäuremedium gegenüber ständig schwankenden Konzentrationen von Ketoconazol exponiert. Zugrundegelegt wurden die Profile der freien wie die der Gesamtkonzentrationen, die beim Menschen nach einmaliger oraler Gabe von 200 mg in kutaner Kantharidinblasenflüssigkeit gefunden wurden. Parallel zu jedem Versuchsansatz mit Ketoconazol wurde jeweils ein Ansatz ohne Wirkstoff mitgeführt. Bei Verwendung des ersteren, die Hefeform begünstigenden Mediums fand sich nur eine relativ geringe Wachstumshemmung. In dem die Pseudomyzelform begünstigenden synthetischen Medium war demgegenüber — konzentrationsabhängig — ein deutlicher antimikrobieller Effekt zu erkennen (Keimdichtenzunahme in Gegenwart der Gesamtkonzentration auf das 2, lfache, im Kontrollversuch auf das 15, 3fache). Die größere Wirksamkeit von Ketoconazol auf die Pseudomyzelform von Candida albicans wird wiederum bestätigt, zugleich wird die geringere Sicherheitsmarge bei der systemischen Behandlung mit Azolen gegenüber der antimikrobiellen Chemotherapie mit Antibiotika deutlich. Untersuchungen vom vorliegenden Typ — wie sie in der klinischen Bakteriologie schon öfter durchgeführt wurden — könnten auch bei der Untersuchung neuer Antimykotika zunehmend an Bedeutung gewinnen. Summary: Candida albicans was exposed to continously changing concentrations of Ketoconazole in, on the one hand, Sabouraud Dextrose Broth and, on the other hand, a liquid synthetic amino-acid medium. The profiles of the free and total concentrations found in cutaneous cantha-ridin blister-fluid in humans after a single oral dose of 200 mg were used as basic information. For every experiment with ketoconazole, an identical experiment without addition of an antimycotic was carried out Using the first, yeast-promoting medium, only a relatively small growth-inhibition was evident. Using the synthetic amino-acid medium, which promotes the pseudomycelial form, however, a marked, concentration-dependent, antimicrobial effect was observed. (The colonial density of Candida albicans increased 2.1 times in the presence of the total ketoconazole concentrations, compared with 153 times in the control experiment.) The greater effectiveness of ketoconazole against the pseudomycelial form of Candida albicans is again confirmed. At the same time, the smaller safety margin associated with systemic treatment with azoles as compared with anti-microbial therapy with antibiotics, is apparent. Investigations of the present type, which have often been carried out in clinical bacteriology, may also gain significance in the investigation of new antimycotics.     

二阶导数分光光度法测定复方酮康唑软膏中酮康唑含量

本文采用二阶导数分光光度法直接测定酮康唑的含量。实验结果表明：本法简便、正确、重现性好。在16～48μ/ml浓度范围内线性良好。r=0．9994，RSD=0．65％。     

The prognostic factors of effective ketoconazole treatment for metastatic castration-resistant prostate cancer: who can benefit from ketoconazole therapy?

We investigated the prognostic value of some variables of effective ketoconazole treatment for metastatic castration-resistant prostate cancer (mCRPC). In total, 163 patients with mCRPC were eligible, receiving ketoconazole 200–400 mg three times daily with replacement doses of prednisone. Progression-free survival (PFS) was calculated from the beginning of the ketoconazole therapy to the onset of disease progression. The prognostic value of different variables for PFS was assessed by Cox regression analysis. The median PFS was 2.6 months (0.5–8.6 months) for these patients. The serum testosterone level changed during therapy, which decreased when the prostate-specific antigen (PSA) declined; the serum testosterone level increased as the levels of PSA relapsed. The median PFS values for patients associated with different factors were the following: 1.4 and 3.5 months for a nadir PSA of ≥0.2 and <0.2 ng ml⁻¹, respectively (hazard rate (HR)=4.767, P<0.001); 3.1 and 1.6 months for a baseline testosterone of ≥0.1 and <0.1 ng ml⁻¹, respectively (HR=2.865, P=0.012); 2.8 and 1.9 months for a baseline haemoglobin of ≥120 and <120 g l⁻¹, respectively (HR=1.605, P<0.001); and 3.0 and 1.9 months for a PSA doubling time (PSADT) of ≥2.0 and <2.0 months, respectively (HR=1.454, P=0.017). A risk model was constructed according to the four factors that divided patients into three subgroups of low risk (0–1 factors), moderate risk (2 factors) and high risk (3–4 factors) with PFS values of 3.6, 3.0 and 1.4 months, respectively (HR=1.619, P<0.001). A nadir PSA of ≥0.2 ng ml⁻¹, a baseline testosterone of <0.1 ng ml⁻¹, a baseline haemoglobin of <120 g l⁻¹ and a PSADT of <2 months were associated with a poor PFS. This risk model could provide evidence to predict the survival benefit of ketoconazole therapy.     

Effects of Ketoconazole on the Pharmacokinetic Properties of CG100649, A Novel NSAID: A Randomized,Open-Label Crossover Study in Healthy Korean Male Volunteers

Background

CG100649, a novel selective cyclooxygenase-2 inhibitor that also inhibits carbonic anhydrase I/II, is expected to reduce the cardiovascular risk typical of other NSAIDs. Concurrent medications may influence the activities of the cytochrome P450 (CYP) 3A enzyme through which CG100649 is metabolized.

Objectives

This study was designed to evaluate the influence of ketoconazole, a known strong inhibitor of CYP3A, on the pharmacokinetic properties of CG100649.

Methods

This randomized, open-label, 2 × 2 crossover study was conducted in healthy Korean male volunteers. Each subject received the following 2 treatments in a randomly allocated sequence, separated by a washout period of 42 days: single oral dose of CG100649 6 mg, and concurrent dosing of CG100649 6 mg and ketoconazole 400 mg followed by ketoconazole 400 mg/d over 4 days. Blood samples for pharmacokinetic analysis were collected at 0 (predose), 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 24, 36, 48, 72, 96, 120, 144, 240, 384, and 480 hours after dosing of CG100649 in each sequence. Tolerability assessments were performed throughout the study.

Results

Thirty subjects participated, and 26 subjects completed the study. Seventeen adverse events (AEs) were reported in 10 subjects, and all AEs were recovered without any sequelae. No serious AEs were reported. Six subjects receiving the single dose of CG100649 had 9 AEs, and 7 subjects receiving the combination of ketoconazole and CG100649 had 8 AEs. The C_max of CG100649 with CG100649 only and with concurrent administration of CG100649 + ketoconazole were similar (10.7 and 11.0 ng/mL, respectively). The CG100649 AUC_last with concurrent ketoconazole was 1.29-fold greater than that with CG100649 only (2074.0 and 2685.8 ng · h/mL) and demonstrated a statistically significant difference (P < 0.05). However, there were no statistically significant differences in vital signs, clinical laboratory test results, ECGs, or AEs between treatments.

Conclusion

Although the AUC of CG100649 increased by 29% with the concurrent medication of ketoconazole, it is considered that concurrent administration of CG100649 with ketoconazole would not change the safety profile of CG100649. ClinicalTrials.gov identifier: NCT01154764.     

酮康唑β-环糊精包合物的制备

 目的 探讨应用β-环糊精包合技术提高酮康唑溶解度和稳定性的方法。方法 采用混合搅拌法制备酮康唑β-环糊精包合物,经薄层色谱、X-衍射及差热分析图谱等鉴定,确证为包合物。结果 制备包合物的最佳主客分子摩尔比为1∶1,最佳搅拌时间为5 h,6批包合物包合率在71.59%～73.63%之间。结论 酮康唑β-环糊精包合物可提高酮康唑的溶解度和稳定性。     

高效液相色谱法检测家兔血浆中酮康唑浓度

目的　建立家兔血浆中酮康唑(ketoconazole)浓度的高效液相色谱检测法。方法　采用HypersilODSC18柱,以甲醇 水 三乙胺(79:2 0 :1)为流动相,紫外检测波长2 4 1nm ,安定为内标,乙醚提取,浓缩后进样。结果　酮康唑与内标分离良好;血浆酮康唑浓度在0 .5～10 0 .0 μg/ml范围内线性良好,r =0 .9996 ;最低检测浓度为0 .2μg/ml;0 .5、5 .0、5 0 .0 μg/ml三种浓度的平均回收率分别为91.2 %、96 .9%和98.7% (n =5 ) ;日内和日间RSD <10 %。结论　该方法操作简便、可靠、取血量少,适用于酮康唑的血药浓度测定和临床生物利用度的研究。