{"title":"New and emerging drugs for the treatment of invasive fungal infections.","authors":"Ryan C Maves, Madeline N Fowler","doi":"10.1080/14656566.2025.2568547","DOIUrl":"10.1080/14656566.2025.2568547","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of invasive fungal infections (IFI) is increasing globally, with approximately 6,500,000 cases of IFI per year and 3,800,000 deaths. Most IFI deaths are attributable to opportunistic mycoses, such as Aspergillus and Candida. However, changes in climate and travel are leading to rising rates of endemic mycoses. Compounding this burden is the rise of antifungal drug resistance, requiring the development of new agents.</p><p><strong>Areas covered: </strong>Data were identified using PubMed searches for the terms 'antifungal,' 'olorofim,' 'SUBA-itraconazole,' 'ibrexafungerp,' 'rezafungin,' 'fosmanogepix,' and 'encochleated amphotericin B.' Approved agents include ibrexafungerp, an oral triterpenoid inhibitor of 1,3-β-D-glucan synthase; rezafungin, a long-acting echinocandin with weekly dosing; and SUBA-itraconazole, a reformulation of itraconazole with more consistent absorption. Other investigational agents include: olorofim, an inhibitor of dihydroorotate dehydrogenase with activity against invasive molds and Coccidioides; fosmanogepix, an inhibitor of mannoprotein cell wall attachment, with broad activity against yeasts and molds; encochleated amphotericin B, an oral formulation of the long-established intravenous agent; and nikkomycin Z, a chitin synthase inhibitor under development since 1992.</p><p><strong>Expert opinion: </strong>Despite improvements, gaps remain in treatments for severe IFI, particularly given increasing resistance. These agents represent significant advances, but further research is needed to define their use in patient management.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victor M Samperio, Ruba Alchaikh Hassan, Constantin A Dasanu
{"title":"Optimizing outcomes in chronic myelomonocytic leukemia: sequencing approved therapies and new prospects.","authors":"Victor M Samperio, Ruba Alchaikh Hassan, Constantin A Dasanu","doi":"10.1080/14656566.2025.2571151","DOIUrl":"10.1080/14656566.2025.2571151","url":null,"abstract":"","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-4"},"PeriodicalIF":2.7,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A review of safe and effective pharmacotherapies for paediatric and neonatal septic shock.","authors":"Mahima Chandrasekhar, Simon Nadel","doi":"10.1080/14656566.2025.2571144","DOIUrl":"https://doi.org/10.1080/14656566.2025.2571144","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a clinical syndrome that occurs due to dysregulated host response to infection. Septic shock is the presence of cardiovascular dysfunction in the context of sepsis. Pediatric septic shock is an important cause of morbidity and mortality globally. Early recognition and prompt treatment has been shown to improve outcomes.</p><p><strong>Areas covered: </strong>A comprehensive literature search was conducted using PubMed and Embase. Key search terms included 'Paediatric,' sepsis,' 'shock,' 'neonatal,' 'antimicrobial' and 'adjunctive therapy' from 1965 to date.</p><p><strong>Expert opinion: </strong>The primary focus underlying management of neonatal and pediatric septic shock is rapid recognition and timely antibiotic and fluid therapy, with initiation of supportive treatments. Disappointingly, this management paradigm has not significantly changed in the last 20 years, despite efforts to develop novel adjunctive therapies.What has changed is the recognition that 'bundles of care' including rapid diagnosis, appropriate antibiotics, fluid resuscitation and initiation of supportive care can significantly improve outcomes.Molecular diagnostics have significantly improved the ability for effective antimicrobial stewardship. Initiatives such as the Surviving Sepsis Campaign have highlighted evidence-based practice. However, few new adjunctive therapies have been translated from research into clinical practice, but there are several potential advances in treatment modalities that will be discussed.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Potential treatments for attention-deficit/hyperactivity disorder: a focus on Phase III trials.","authors":"Hurşit Ferahkaya, Ayhan Bilgic","doi":"10.1080/14656566.2025.2566257","DOIUrl":"10.1080/14656566.2025.2566257","url":null,"abstract":"<p><strong>Introduction: </strong>Stimulant medications, such as methylphenidate and amphetamine derivatives, and non-stimulant medications, such as atomoxetine, guanfacine, clonidine, and viloxazine, are considered the cornerstones of pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). However, a significant number of individuals respond partially to these treatments or are concerned about side effects. This creates a need for new treatment strategies that target alternative neurobiological mechanisms and offer improved tolerability and efficacy profiles.</p><p><strong>Area covered: </strong>This review examines pharmacological agents currently in phase III clinical development or recently completed trials for the treatment of ADHD. We highlight four promising candidates: centanafadine, solriamfetol, CTx-1301, and NRCT-101SR. We discuss their pharmacological mechanisms, clinical efficacy, safety profiles, and regulatory status, with an emphasis on how these agents may address existing therapeutic gaps and the potential clinical implications. A literature search was conducted using PubMed and ClinicalTrials.gov databases for articles published between January 2018-July 2025.</p><p><strong>Expert opinion: </strong>Recent advances in ADHD pharmacotherapy suggest that approaches targeting monoaminergic systems beyond dopamine and noradrenaline reuptake inhibition may provide therapeutic benefits. Additionally, multi-phase extended-release formulations may improve adherence and enhance symptom control throughout the day. As phase III data become available, these agents have the potential to redefine ADHD treatment paradigms.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Metabolic dysfunction-associated steatohepatitis treatment: spotlight on the latest hepatoprotective drugs.","authors":"Eda Kaya, Yusuf Yilmaz, Naim Alkhouri","doi":"10.1080/14656566.2025.2566258","DOIUrl":"https://doi.org/10.1080/14656566.2025.2566258","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major public health concern. Recently, the development of liver-targeted pharmacologic therapies has gained momentum, culminating in the conditional approval of resmetirom which has generated renewed optimism for the management of MASLD. In addition, several other investigational agents have shown promising results in clinical trials.</p><p><strong>Areas covered: </strong>In this review, we summarize the data on recent pharmacologic developments in the treatment of MASLD, with a particular focus on agents targeting the more progressive form - at-risk metabolic dysfunction-associated steatohepatitis (MASH). These therapies act through a variety of direct and indirect pathways within the liver.</p><p><strong>Expert opinion: </strong>The approval of liver-targeted therapies for MASH marks the beginning of a new era in disease management, offering promising outcomes even for advanced stages such as cirrhosis. The rising prevalence of obesity and T2DM suggests that new treatment options that can treat multiple comorbidities - including GLP1 receptor agonists, dual, and multi-agonists - are likely to play a significant role in the management of MASH. The availability of effective pharmacologic treatment options highlights the need for effective screening strategies in high-risk populations and call for the engagement of policymakers to develop coordinated plans at a global level.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Vega Brizneda, Deepali Boothankad Sharath, Thomas J Rust, Zachary A Yetmar
{"title":"The current role of maribavir for treatment of cytomegalovirus in transplant recipients.","authors":"Maria Vega Brizneda, Deepali Boothankad Sharath, Thomas J Rust, Zachary A Yetmar","doi":"10.1080/14656566.2025.2564327","DOIUrl":"10.1080/14656566.2025.2564327","url":null,"abstract":"<p><strong>Introduction: </strong>Cytomegalovirus (CMV) is one of the most common infections after solid organ or hematopoietic stem cell transplantation. Typically, ganciclovir or valganciclovir have been used for first-line therapy, with foscarnet and cidofovir being used for resistant or refractory infections. Maribavir was recently approved as a novel CMV therapeutic for transplant recipients.</p><p><strong>Areas covered: </strong>We examine published studies of maribavir for posttransplant cytomegalovirus infection and summarize the current understanding of its pharmacology, clinical efficacy, toxicity, and risk of treatment-emergent resistance.</p><p><strong>Expert opinion: </strong>Maribavir is generally the preferred therapy for CMV infection that is resistant or refractory to valganciclovir/ganciclovir treatment or transplant recipients who are intolerant of first-line treatment. It is well-tolerated overall without significant myelosuppression or nephrotoxicity, a stark difference from traditional CMV antivirals. However, there are high rates of treatment-emergent maribavir resistance, particularly among patients with high baseline CMV viral loads. Some UL97 mutations impart resistance to both maribavir and ganciclovir, though high-grade cross-resistance is rare. Transplant recipients who receive maribavir require close monitoring as resistance can develop even after an initial therapeutic response. Maribavir is an effective and well-tolerated addition to the CMV armamentarium, though it has important caveats that require consideration by infectious disease and transplant practitioners.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1-7"},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging pharmacotherapies for brain metastases: a spotlight on angiogenesis inhibitors.","authors":"Abdullah H Ishaque, Mary Jane Lim-Fat, Sunit Das","doi":"10.1080/14656566.2025.2557457","DOIUrl":"10.1080/14656566.2025.2557457","url":null,"abstract":"<p><strong>Introduction: </strong>Brain metastases represent a major cause of morbidity and mortality in cancer patients and are challenging to manage due to the protective blood-brain barrier and the aggressive nature of intracranial disease. Angiogenesis, particularly mediated by vascular endothelial growth factor (VEGF) and integrin pathways, plays a critical role in the growth and progression of brain metastases. Inhibiting angiogenesis has emerged as a therapeutic strategy to control tumor progression, reduce edema, and improve clinical outcomes.</p><p><strong>Area covered: </strong>This review summarizes the biological mechanisms underpinning angiogenesis in brain metastases, with a focus on VEGF and integrins as therapeutic targets. The role of bevacizumab, a monoclonal anti-VEGF antibody, is discussed in detail, particularly its established use in managing radiation necrosis. The review further explores FDA-approved angiogenesis inhibitors, emerging therapies targeting alternative pathways such as angiopoietin-2 and integrins, and the latest clinical trials assessing their efficacy. Combination strategies, particularly with immune checkpoint inhibitors and radiation, are highlighted as promising avenues for improving intracranial disease control.</p><p><strong>Expert opinion: </strong>Anti-angiogenic therapies, while already well integrated into the management of radiation necrosis, are poised to expand into active treatment paradigms for brain metastases. Future advances are likely to focus on biomarker-driven patient selection, novel drug delivery technologies, and rational combination regimens. Angiogenesis inhibitors are expected to become a standard component of multimodal treatment approaches, moving beyond symptomatic control toward improving progression-free and overall survival in patients with brain metastases.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1433-1439"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment options for immune thrombocytopenia (ITP) in pregnancy and postpartum.","authors":"Lauren E Merz, Annemarie E Fogerty","doi":"10.1080/14656566.2025.2557448","DOIUrl":"10.1080/14656566.2025.2557448","url":null,"abstract":"<p><strong>Introduction: </strong>Immune thrombocytopenia (ITP) treatment goals vary by gestational period. In the first 8 months of gestation, treatment is not indicated unless platelets are <20,000/uL or for clinically significant bleeding. The platelet goal is >70,000/uL for epidural administration and delivery.</p><p><strong>Areas covered: </strong>We review the data on efficacy and safety of medications used to treat ITP in pregnancy, including the associated risks and optimal timing of administration of the first-line treatments of corticosteroids and/or intravenous immunoglobulin (IVIG). We also discuss second-line treatment options.</p><p><strong>Expert opinion: </strong>The differential diagnosis of thrombocytopenia in pregnancy is broad. When ITP is the most likely diagnosis, the decision to treat versus monitor only will depend on the platelet nadir, gestational week, and signs of clinically significant bleeding. Many patients will not require treatment in the first 8 months of gestation. Starting at 34-36 weeks gestation, enhanced therapies may be required to prepare for labor and delivery. We recommend starting with prednisone 20-60 mg daily. If prednisone alone is insufficient, IVIG 1-2 g/kg should be added. Combined prednisone and IVIG will yield the desired platelet response in ~ 80% of cases. Approach to second-line therapy is complicated, but we consider TPO receptor agonist use in the peripartum period.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1441-1449"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sunish Shah, Sahil Angelo, Brandon J Smith, Ryan K Shields
{"title":"Novel beta-lactamase inhibitors with cefepime: where do they fit in clinical practice?","authors":"Sunish Shah, Sahil Angelo, Brandon J Smith, Ryan K Shields","doi":"10.1080/14656566.2025.2558990","DOIUrl":"10.1080/14656566.2025.2558990","url":null,"abstract":"<p><strong>Introduction: </strong>Enmetazobactam, taniborbactam, and zidebactam are novel β-lactamase inhibitors that have been combined with cefepime in an effort to overcome common and emerging mechanisms of antimicrobial resistance.</p><p><strong>Areas covered: </strong>We performed a literature review of articles written in English using MEDLINE, PUBMED, and EMBASE, using the search terms 'Cefepime-enmetazobactam,' 'cefepime-taniborbactam,' and 'Cefepime-zidebactam' between January 2015 and May 2025. This review summarizes the <i>in</i> <i>vitro</i>, animal, and clinical data for cefepime-enmetazobactam, cefepime-taniborbactam, and cefepime-zidebactam to forecast their potential role in clinical practice.</p><p><strong>Expert opinion: </strong>Cefepime-enmetazobactam and cefepime-taniborbactam are among the newest additions to an expanding antibiotic armamentarium; however, their precise role in clinical practice remains to be defined given that their <i>in</i> <i>vitro</i> activity overlaps with current treatment options. On balance, the <i>in</i> <i>vitro</i> activity of cefepime-zidebactam fills critical gaps for the most challenging Gram-negative pathogens, including those that harbor metallo-β-lactamases with or without mutations in penicillin-binding proteins. For each of these agents, clinical data and real-world evidence generation are needed to better define their therapeutic niche, potential for resistance selection, and potential benefits compared to currently available antibiotics.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1451-1465"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renato de Filippis, Ettore D'Onofrio, Gaspare Liparota, Andrea Scaramuzzino, Andrea Aguglia, Andrea Amerio, Gianluca Serafini, Pasquale De Fazio
{"title":"The place of risperidone in situ microparticles (ISM®) among long-acting injectable antipsychotics in schizophrenia treatment.","authors":"Renato de Filippis, Ettore D'Onofrio, Gaspare Liparota, Andrea Scaramuzzino, Andrea Aguglia, Andrea Amerio, Gianluca Serafini, Pasquale De Fazio","doi":"10.1080/14656566.2025.2551636","DOIUrl":"10.1080/14656566.2025.2551636","url":null,"abstract":"<p><strong>Introduction: </strong>A key challenge in managing schizophrenia is ensuring adequate adherence to antipsychotic treatment. Long-acting injectable (LAI) antipsychotics play a crucial role in improving adherence, yet certain clinical needs remain unmet, including a rapid symptom control and satisfactory efficacy/tolerability balance.</p><p><strong>Areas covered: </strong>Main pharmacokinetics and pharmacodynamics properties as well as the effectiveness and safety profile of risperidone in situ microparticles (ISM®) are described. The aim of this narrative review is to explore how this innovative risperidone LAI formulation may be utilized in schizophrenia treatment.</p><p><strong>Expert opinion: </strong>Risperidone ISM® employs innovative in situ microimplant technology for biphasic drug release, achieving immediate and sustained therapeutic plasma concentrations without the need for oral supplementation or loading doses. Indeed, it is characterized by a fast-acting release, reaching active risperidone moiety levels within 12 hours that are comparable to steady-state concentrations observed with oral risperidone (mean concentration of 38.63 ng/mL). The resulting plasma levels ensure consistent dopamine D<sub>2</sub> receptor occupancy above 65% over the full 28-day dosing cycle - an established benchmark for antipsychotic efficacy. In the short-term, risperidone ISM® enables a rapid and sustained symptoms reduction among adults with acute schizophrenia exacerbations, eliminating the need for initial loading doses or concurrent oral supplementation.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1379-1397"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}