Clinical Pharmacology : Advances and Applications最新文献

{"title":"Cardiovascular and Metabolic Outcomes of Hormone Replacement Therapy in Women Aged 65 Years and Older: A Systematic Review of Randomized Clinical Trials.","authors":"Taraneh Mousavi, Md Fitrat Hossain, Fadia T Shaya, Wanda Hill, Stephen N Davis","doi":"10.2147/CPAA.S581397","DOIUrl":"10.2147/CPAA.S581397","url":null,"abstract":"<p><strong>Background: </strong>The cardiovascular, kidney, and metabolic effects of hormone replacement therapy (HRT) in postmenopausal women, particularly those who initiate treatment after age 65, remain incompletely characterized. The objective of this systematic review was to evaluate evidence on these outcomes, with a focus on women aged 65 years and older.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, and the Cochrane Library were searched for studies published between January 1, 2021, and February 28, 2026. Eligible studies included randomized controlled trials and secondary or post-trial analyses evaluating HRT in postmenopausal women, particularly women aged 65 years and older. Outcomes included cardiovascular, renal, and metabolic endpoints. Risk of bias was assessed using RoB 2 where applicable, and evidence was synthesized narratively. The review protocol was registered in PROSPERO (CRD420261338310).</p><p><strong>Results: </strong>Of 1701 records identified, 6 reports met the inclusion criteria, all derived from three parent trials: the Women's Health Initiative Hormone Therapy Trials (WHI-HT), Early versus Late Intervention Trial with Estradiol (ELITE), and Kronos Early Estrogen Prevention Study (KEEPS). HRT effects varied by regimen and timing. In WHI-HT analyses, conjugated equine estrogens (CEE), alone or with medroxyprogesterone acetate (MPA), lowered low-density lipoprotein cholesterol (LDL-C) but increased triglycerides and systolic blood pressure; CEE plus MPA had a less favorable coronary profile than CEE alone. ELITE supported less favorable vascular effects with later initiation, while KEEPS showed neutral long-term findings. No trial was designed specifically for women aged ≥65 years, and evidence in this age group was limited to subgroup analyses of broader postmenopausal women. Additionally, no studies included renal outcomes.</p><p><strong>Conclusion: </strong>Future prospective studies should evaluate cardiovascular, kidney, and metabolic outcomes across HRT regimens and timing in older postmenopausal women to guide individualized treatment decisions.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"581397"},"PeriodicalIF":2.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Parkinson's Disease-Related Psychosis.","authors":"Natalia P Rocha, Karina Lucia Moreira Sassi, Erin Furr Stimming, Antonio L Teixeira","doi":"10.2147/CPAA.S575991","DOIUrl":"10.2147/CPAA.S575991","url":null,"abstract":"<p><strong>Purpose: </strong>To provide an updated, clinically oriented overview of therapeutic strategies for Parkinson's disease-related psychosis (PDP), integrating current evidence on risk factors and available pharmacological and non-pharmacological treatments.</p><p><strong>Patients and methods: </strong>This is a narrative, non-systematic review summarizing findings from targeted searches of PubMed, Embase, and Scopus, focusing on clinical trials, observational studies, consensus guidelines, and high-quality reviews addressing the epidemiology, pathophysiology, and management of PDP. Evidence was analyzed qualitatively, with emphasis on consistency of findings, clinical applicability, and areas of ongoing uncertainty.</p><p><strong>Results: </strong>PDP affects a substantial proportion of individuals with Parkinson's disease and is associated with cognitive decline, increased caregiver burden, higher rates of institutionalization, and elevated mortality. Management begins with the identification of reversible triggers, environmental optimization, and rational adjustment of antiparkinsonian medications. When antipsychotic therapy is required, pimavanserin and clozapine demonstrate the strongest evidence for efficacy. However, pimavanserin availability remains limited and long-term data are scarce. Quetiapine is widely used despite inconsistent evidence from randomized trials, largely due to its favorable safety profile and ease of use. Acetylcholinesterase inhibitors may provide benefit in selected patients, particularly those with concomitant cognitive impairment.</p><p><strong>Conclusion: </strong>Current therapeutic strategies allow symptom control in many patients, yet important gaps in the evidence base persist, particularly regarding long-term outcomes. Future research should prioritize mechanistically informed therapies, standardized outcome measures, and the identification of predictors of treatment response.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"575991"},"PeriodicalIF":2.1,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances and Emerging Pharmacotherapeutic Approaches for Central Hypersomnolence Disorders.","authors":"Katyayini Aribindi, Tanwe C Shende, Timothy E Albertson","doi":"10.2147/CPAA.S574714","DOIUrl":"10.2147/CPAA.S574714","url":null,"abstract":"<p><p>Pharmacological management has been the backbone of treatment for disorders of central hypersomnolence despite challenges in drug administration due to intolerable side effects, development of tolerance, and addiction potential. Recent advances in drug therapies for central hypersomnolence disorders, namely sodium oxybate and orexin agonists, have either changed or increased the potential to significantly improve the quality of life of individuals with narcolepsy and idiopathic hypersomnia. Mechanisms of action, pharmacodynamics and pharmacokinetics of previously and commonly used medications, along with the evidence behind their use, are discussed. In addition, oveporexton, an orexin receptor 2 agonist (OX2R) will be discussed as it marks an important first step in directly counteracting the pathology behind narcolepsy with cataplexy and has completed Phase 2 trials with Phase 3 underway. Early clinical data is promising; however, its long term efficacy and safety data is insufficient to garner US Food & Drug Administration approval, though additional trials are ongoing in narcolepsy with cataplexy, and non-orexin deficient central hypersomnolence disorders as well. Regardless, new drug developments may lead expanded treatment options and may have the potential to decrease or potentially eliminate the need for polypharmacy in the treatment algorithm for narcolepsy and idiopathic hypersomnia.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"574714"},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lenacapavir at the Spatiotemporal Limit: Tissue Pharmacokinetics, Pharmacokinetic Tail Dynamics, and the Emergence of Capsid Resistance in Long-Acting HIV Prevention.","authors":"Hans Chinomso Chris-Uchendu, Gerald Olwit, Arnold Atuhaire, Isaac Matovu, Hope Nakakande Kirumira, Patrick Kambale Sasiita, Leo Odongo, Andrew Mutekanga, Jacob Nkwanga","doi":"10.2147/CPAA.S622588","DOIUrl":"10.2147/CPAA.S622588","url":null,"abstract":"<p><strong>Background: </strong>Lenacapavir (LEN), a first-in-class HIV-1 capsid inhibitor administered subcutaneously twice yearly, has demonstrated near-perfect efficacy in Phase 3 trials, generating justified enthusiasm for its potential to reconfigure HIV prevention. However, its revolutionary success obscures critical spatiotemporal vulnerabilities. We critically examined the protective envelope of LEN, specifically focusing on the gap between systemic pharmacokinetics (PK) and mucosal distribution, the dynamics of the prolonged PK tail, and the clinical emergence of capsid resistance.</p><p><strong>Methods: </strong>A systematic narrative synthesis was conducted through April 2026. We integrated screening and data parameters from the PURPOSE and CAPELLA trials alongside advanced PK-PD modeling and structural biology datasets to comprehensively map the spatiotemporal parameters of lenacapavir-based PrEP.</p><p><strong>Findings: </strong>We characterize the Limitations of Systemic Surrogacy, highlighting that no published empirical data exist characterizing LEN concentrations in human mucosal sanctuary sites; the sole registered tissue distribution trial (Pro00043856) remains unpublished four years post-registration. While modeling baseline assumptions establish a wild-type 95% preventive plasma concentration (EC₉₅) of 5.8 ng/mL, the terminal absorption-limited elimination phase creates a definitive 106-235 day Mutant Selection Window (MSW) following drug discontinuation. Based on the 58 studies included in the full synthesis, falling sub-therapeutic drug concentrations during this tail phase exert selective pressure that favors high-fitness capsid substitutions (eg, Q67H), lowering the genetic barrier for complex, high-level resistance mutations (eg, N74D). Clinical breakthrough infections observed across the CAPELLA trial (19%) and rare PURPOSE infections (0.07 per 100 person-years) validate this corridor of vulnerability, highlighted by a recorded seroconversion occurring 16 months post-injection.</p><p><strong>Conclusion: </strong>Optimizing the public health impact of lenacapavir requires transitioning from simple serum-based monitoring toward tissue-informed clinical stewardship. Unlike conventional oral PrEP, twice-yearly lenacapavir involves an extended pharmacological commitment of nearly 12 months, requiring pre-planned clinical protocols for bridging therapy during drug discontinuation. Implementation requires the evaluation of high-sensitivity viral surveillance tools (<i>LOD ≤ 10</i> copies/mL) and global access reconfigurations to resolve the economic and licensing barriers separating low-cost generic synthesis from international list prices, protecting the long-term viability of the capsid inhibitor class across all implementation sectors.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"622588"},"PeriodicalIF":2.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic Modulation of Inflammasome-Related Genes Following Metformin Administration in Breast Cancer Patients with Paclitaxel-Induced Neuropathy.","authors":"Alireza Malayeri, Mehdi Etemad Nezhad, Farrokh Ramesh, Hossein Karimpourian, Mohammad-Reza Mahmoudian-Sani","doi":"10.2147/CPAA.S582439","DOIUrl":"10.2147/CPAA.S582439","url":null,"abstract":"<p><strong>Introduction: </strong>Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of paclitaxel therapy. The inflammasome complex, including apoptosis-associated speck-like protein containing a CARD (ASC), Caspase-1, and NOD-like receptor family pyrin domain-containing 3 (NLRP3), is implicated in inflammatory signaling pathways related to neuropathy. This study aimed to evaluate transcriptomic changes in genes involved in the inflammasome pathway in breast cancer patients, with a specific focus on metformin treatment initiated after the onset of neuropathy.</p><p><strong>Materials and methods: </strong>A total of 51 breast cancer patients receiving paclitaxel were included (26 controls, 25 metformin). Metformin was initiated following the clinical onset of neuropathy. Plasma samples were collected at baseline, cycle 6, and cycle 12. Expression levels of ASC, Caspase-1, and NLRP3 were quantified as fold-change. Statistical analyses included normality testing (Shapiro-Wilk), temporal comparisons (Friedman or repeated-measures ANOVA), group comparisons (Mann-Whitney <i>U</i>-test), correlation (Spearman), and Receiver Operating Characteristic (ROC) analysis.</p><p><strong>Results: </strong>No significant baseline differences were observed between groups. In the control group, ASC expression increased over time (p = 0.0005), while Caspase-1 and NLRP3 showed no significant temporal changes. In neuropathic patients, ASC (p < 0.0001), Caspase-1 (p = 0.0007), and NLRP3 (p = 0.04) expression levels were higher in the metformin group. ROC analysis demonstrated moderate discriminatory ability for ASC (AUC = 0.74) and Caspase-1 (AUC = 0.70), whereas NLRP3 showed weaker performance (AUC = 0.62). Correlation analysis revealed positive associations between ASC and Caspase-1, suggesting coordinated gene expression. These findings reflect transcriptomic modulation rather than functional inflammasome activation.</p><p><strong>Conclusion: </strong>Metformin administration after neuropathy onset was associated with transcriptomic changes in genes involved in the inflammasome pathway. However, these findings should be interpreted cautiously, as plasma RNA may not reflect protein activity or neural tissue processes, and further validation studies are required.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"582439"},"PeriodicalIF":2.1,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors of Chemotherapy-Induced Nausea and Vomiting Among Adult Cancer Patients at Mbarara Regional Referral Hospital: A Prospective Study.","authors":"Patrick Kitheka Muasya, Tadele Mekuriya Yadesa, John Isiiko, Julius Kyomya, Joel Oenga, Abubakar Amina, Godwin Nimusiima, Sebisaalu Joel, John Martin Tumwebaza, Kabera Radiana Makuza","doi":"10.2147/CPAA.S600792","DOIUrl":"10.2147/CPAA.S600792","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy-induced nausea and vomiting (CINV) remains a significant and distressing adverse effect of cancer treatment, adversely affecting patients' quality of life. Despite well-established international guidelines for antiemetic prophylaxis, variability in CINV incidence and guideline adherence persists across different regions and healthcare settings, particularly in low- and middle-income countries (LMICs).</p><p><strong>Objective: </strong>This study determined the incidence and associated factors of chemotherapy-induced nausea and vomiting (CINV) among adult cancer patients at Mbarara Regional Referral Hospital.</p><p><strong>Methods: </strong>A prospective observational study was conducted among 237 adult cancer patients receiving chemotherapy at the Mbarara Regional Referral Hospital. The MASCC Antiemesis Tool (MAT) was used to assess acute nausea and vomiting (≤24 hours) and delayed nausea and vomiting (>24 hours to 5 days), as well as any chemotherapy-induced nausea and vomiting (CINV; nausea and/or vomiting). A 5-day follow-up using the MAT tool for acute (≤24hours) and delayed (>24hours-5 days) CINV was conducted.</p><p><strong>Results: </strong>Among 237 participants, 66 (27.8%) and 136 (57.4%) experienced acute and delayed nausea, and 53 (22.4%) and 101 (42.6%) experienced acute and delayed vomiting; 67 (28.3%) and 136 (57.4%) had combined acute and delayed nausea and vomiting. Antiemetic prophylaxis guideline adherence was 73.4%, with 26.6% receiving non-guideline-compliant regimens. Independent associated factors for CINV were female sex (AOR = 2.0, 95% CI: 1.1-3.8; p = 0.026), moderate- (AOR = 21.2, 95% CI: 9.1-49.0; p < 0.001) and high-emetogenic chemotherapy (AOR = 22.6, 95% CI: 8.6-59.2; p < 0.001), and prior CINV (AOR = 6.1, 95% CI: 2.8-12.9; p < 0.001).</p><p><strong>Conclusion: </strong>Over half of the participants experienced delayed chemotherapy-induced nausea and vomiting, while nearly one-third experienced acute CINV. Adherence to guidelines for antiemetic prophylaxis was high at 73.4%. Key identified associated factors included female gender, moderate to highly emetogenic potential of chemotherapy regimens, and a history of CINV in this study population.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"600792"},"PeriodicalIF":2.1,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent/Refractory Multidrug- and Pre-Multidrug-Resistant <i>Pseudomonas aeruginosa</i> Infection Cases Maintained by Long-Term, Low-Dose Macrolide Administration.","authors":"Masafumi Seki","doi":"10.2147/CPAA.S600235","DOIUrl":"10.2147/CPAA.S600235","url":null,"abstract":"<p><p>Multidrug-resistant <i>Pseudomonas aeruginosa</i> (MDRP) is usually induced by inappropriate use of broad-spectrum antibiotics, and pre-multidrug-resistant <i>Pseudomonas aeruginosa</i> (pre-MDRP) is defined as resistance to any two of three antibiotics, such as carbapenems, fluoroquinolones, and aminoglycosides. Two cases of infections with such organisms are reported. Case 1 was a 78-year-old man with esophageal cancer who had pneumonia, treated by meropenem (MEPM) for two weeks because <i>P. aeruginosa</i>, which showed good susceptibility to most antibiotics, was isolated. He improved, but his inflammation status and chest X-ray findings worsened on day 21. MDRP was isolated, and he was treated using tazobactam/ceftolozane (TAZ/CTLZ) for 10 days. After improvement, clarithromycin (CAM) 200 mg once per day was then started as long-term, low-dose macrolide therapy. His condition has remained stable for more than six months. Case 2 was a 5-year-old girl with congenital heart abnormalities. She had pneumonia due to <i>P. aeruginosa</i> that showed good susceptibility to antibiotics and was treated by MEPM for 10 days. However, MDRP was isolated, and then ciprofloxacin (CPFX), to which MDRP showed good susceptibility, with only intermediate susceptibility to levofloxacin (LVFX), was started. Ten days later, her pneumonia improved, and half-dose (5 mg/kg) CAM three times per day was started as long-term, low-dose macrolide therapy. Her condition has remained stable for more than six months. These two cases, one adult MDRP infection and one pediatric pre-MDRP infection, that were maintained by long-term, half-dose macrolide administration, which might have affected pathogen colonization and host immunomodulation, are presented.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"600235"},"PeriodicalIF":2.1,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior Efficacy and Deep Molecular Remission with Venetoclax Plus Hypomethylating Agent in Elderly Acute Myeloid Leukemia: A Real-World Comparative Cohort Study.","authors":"Chen Luo, Yuhan Jiang, Huiling Yan, Kan Sun, Wentao Li, Mengqing Cao, Lijun Zhu, Xing Hu, Juan Tong, Changcheng Zheng","doi":"10.2147/CPAA.S596901","DOIUrl":"10.2147/CPAA.S596901","url":null,"abstract":"<p><strong>Background: </strong>Treatment of elderly acute myeloid leukemia (AML) remains challenging, and intensive chemotherapy is often poorly tolerated in elderly patients due to comorbidities and frailty, thereby necessitating low‑intensity alternatives. This study compared the efficacy and safety of venetoclax combined with a hypomethylating agent (VEN-HMA) against HMA plus low-intensity induction chemotherapy (HMA-LIIC) and low-intensity induction chemotherapy alone (LIIC) in a real-world elderly AML cohort.</p><p><strong>Methods: </strong>In this retrospective study, 136 newly diagnosed elderly AML patients (≥60 years) were categorized into three groups: VEN-HMA (n=45), HMA-LIIC (n=38), and LIIC (n=53). LIIC was defined as low‑dose cytarabine ‑based regimens given without a concomitant VEN or HMA. Key endpoints included morphologic response, measurable residual disease (MRD) negativity, early mortality, and overall survival (OS).</p><p><strong>Results: </strong>The VEN-HMA group demonstrated a significantly higher overall response rate (82.2%) than the HMA-LIIC (39.4%) and LIIC (54.7%) groups (p=0.010). While the complete remission (CR) rate was comparable across groups, the VEN-HMA group had a notably higher CR with incomplete hematologic recovery (CRi) rate (33.3% vs 10.5% vs 11.3%) (p=0.007). The MRD negativity rate was significantly superior in the VEN-HMA group (65.5%) compared to HMA-LIIC (18.8%) and LIIC (41.7%) (p=0.010), an advantage particularly pronounced in intermediate-risk patients (68.8% vs 12.5% vs 30.8%, p=0.021). The VEN-HMA group also had a numerically lowest 30-day early mortality (4.44% vs 7.97% vs 17.0%). With a median follow-up, the median OS was 11.0 months in the VEN-HMA group, 7.2 months in the HMA-LIIC group, and 10.1 months in the LIIC group. The VEN-HMA group showed a numerically higher 1-year OS rate (55.0%) than the HMA-LIIC group (35.0%) and comparable to the LIIC group (47.9%) (p=0.153).</p><p><strong>Conclusion: </strong>In this real-world analysis, VEN-HMA demonstrated superior response rates and deeper molecular remissions (MRD) compared to HMA-LIIC and LIIC in elderly AML patients, further supporting its use as an effective and feasible frontline option for this population, especially in the intermediate-risk group.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"596901"},"PeriodicalIF":2.1,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for a Prospective, Multicenter Cohort Study on the Treatment of Chronic Cardiorenal Syndrome with Qishen Yiqi Dropping Pills.","authors":"Guohua Shi, Yiming Zuo, Yuxiao Cao, Lu Fan, Xuezheng Liu, Shichao Lv","doi":"10.2147/CPAA.S590664","DOIUrl":"10.2147/CPAA.S590664","url":null,"abstract":"<p><strong>Background: </strong>Chronic Cardiorenal Syndrome (CRS types 2/4) involves the mutual exacerbation of heart failure and chronic kidney disease, with over half of heart failure patients affected by renal impairment that increases mortality and rehospitalization. Despite advances in management, prospective evidence for Traditional Chinese Medicine in chronic CRS is lacking. Qishen Yiqi Dropping Pills (QSYQ) have proven safe in cardiovascular care, but their concurrent renoprotective effects remain unconfirmed. Based on preliminary cardiorenal protective findings, this study evaluates QSYQ combined with standard therapy on symptoms, function, biomarkers, and outcomes in chronic CRS.</p><p><strong>Methods: </strong>This is a prospective, multicenter, observational cohort study. Patients will be stratified into two groups based on whether or not they receive QSYQ treatment: an \"Exposure Group\" (standard background pharmacotherapy plus QSYQ; n=60) and a \"Non-exposure Group\" (standard background pharmacotherapy alone; n=60). The study duration is 270 days, with the exposure period set to the initial 90 days. Follow-up assessments will be conducted at baseline, and on days 90, 120, 180, and 270. The primary outcome measure is the 6-Minute Walk Test (6MWT). Secondary outcome measures include the New York Heart Association (NYHA) functional classification, N-terminal pro-B-type natriuretic peptide (NT-proBNP), serum creatinine (Cr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), trimethylamine N-oxide (TMAO), major adverse renal and cardiovascular events (MARCE), the Veterans Specific Activity Questionnaire (VSAQ), and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Throughout the entire study period, adverse events will be recorded to facilitate safety assessments.</p><p><strong>Discussion: </strong>This study will comprehensively assess QSYQ's clinical utility for chronic CRS, evaluating functional capacity, quality of life, biomarkers, and long-term outcomes to provide prospective evidence for integrating Traditional Chinese Medicine into chronic CRS management.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"590664"},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pain in Elderly Patients: Pathophysiology, Pharmacologic and Non-Pharmacologic Therapies, and Interventional Management.","authors":"Ankur Jain, Eliot Sadik, Alejandra Cardenas-Rojas, Krithika Mahesh, Preston Ooi, Vahid Grami, Paul Christo","doi":"10.2147/CPAA.S506172","DOIUrl":"10.2147/CPAA.S506172","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic pain is a debilitating condition faced among the geriatric population, contributing to reduced mobility, impaired daily function, and increased dependence on healthcare services. This review explores the current landscape of chronic pain in the elderly, providing a comprehensive overview of treatment options, with the goal of exploring more effective, individualized care.</p><p><strong>Patients and methods: </strong>This narrative review draws on a range of studies and clinical publications accessible through the National Center for Biotechnology Information (NCBI) database. The literature reviewed includes research on the underlying mechanisms, diagnostic challenges, and treatment strategies for chronic pain in older adults. Clinical relevance and practical approaches were explored, where risks and benefits of pharmacologic, non-pharmacologic, and interventional therapies were explored.</p><p><strong>Results: </strong>Chronic pain in the elderly is often undertreated, likely due to unaccounted comorbidities and age-related changes in drug metabolism. While acetaminophen remains the recommended first-line agent, the use of NSAIDs and opioids in this population carries significant risks and demands careful consideration. Adjuvant medications such as SNRIs and gabapentinoids offer additional options for neuropathic pain, but may require dose adjustments or close adverse effect monitoring. Non-pharmacologic interventions-such as physical therapy and cognitive behavioral therapy- often are underutilized despite a strong safety profile and evidence of benefit. In cases refractory to conservative measures, interventional procedures including epidural steroid injections, radiofrequency ablation, and spinal cord stimulation may offer meaningful relief for select patients.</p><p><strong>Conclusion: </strong>Managing chronic pain in older adults requires a thoughtful, individualized approach that balances effectiveness with safety. As the population ages, there is a growing need for more inclusive research, better integration of non-drug therapies, and greater access to interdisciplinary care. Tailoring treatment to individual goals can help improve outcomes and preserve independence and function in this vulnerable group.</p>","PeriodicalId":10406,"journal":{"name":"Clinical Pharmacology : Advances and Applications","volume":"18 ","pages":"506172"},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}