Justyna Putek, Andrzej Jaworek, Jacek C Szepietowski
{"title":"The evolving landscape of phosphodiesterase inhibitors in atopic dermatitis management.","authors":"Justyna Putek, Andrzej Jaworek, Jacek C Szepietowski","doi":"10.1080/14656566.2026.2715709","DOIUrl":"10.1080/14656566.2026.2715709","url":null,"abstract":"<p><strong>Introduction: </strong>Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease associated with recurrent flares, impaired quality of life, and significant psychological burden. Despite therapeutic progress, important unmet needs remain, particularly for steroid-sparing treatments that are safe for long-term use, suitable for sensitive areas, and applicable in pediatric patients. Phosphodiesterase-4 (PDE4) inhibitors represent a targeted anti-inflammatory approach through modulation of intracellular cAMP signaling.</p><p><strong>Areas covered: </strong>This narrative review summarizes current evidence on topical and systemic PDE4 inhibitors in AD. A literature search was performed using PubMed/MEDLINE and ClinicalTrials.gov for studies published up to March 2026. Approved agents such as crisaborole, roflumilast, and difamilast demonstrate moderate efficacy and favorable safety, mainly in mild-to-moderate AD. Emerging therapies, including apremilast, orismilast, and lotamilast, show variable results and remain under investigation.</p><p><strong>Expert opinion: </strong>PDE4 inhibitors have a stable but limited role in AD management. Their main advantages include good tolerability, long-term safety, and suitability for proactive treatment and sensitive skin areas. However, their efficacy is generally lower than that of biologics and JAK inhibitors. Their future role will likely depend on use as adjunctive or personalized therapies rather than replacement of high-efficacy systemic treatments.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1251-1261"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766107","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}
Alessia Romano, Giovanna Fernanda Vazzana, Claudio Romano
{"title":"Pharmacotherapeutic interventions for pediatric ulcerative colitis.","authors":"Alessia Romano, Giovanna Fernanda Vazzana, Claudio Romano","doi":"10.1080/14656566.2026.2695982","DOIUrl":"10.1080/14656566.2026.2695982","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric ulcerative colitis (UC) is a chronic, immune-mediated inflammatory disease of the colon, characterized by dysregulated immune response. This condition significantly impacts growth, development, and quality of life, highlighting the need for effective therapeutic strategies.</p><p><strong>Areas covered: </strong>This report reviews current pharmacologic treatments for pediatric UC, including conventional (aminosalicylates, corticosteroids, immunomodulators) and advanced therapies (biologics, small molecules). It discusses their mechanisms, efficacy, and safety, highlights challenges such as inadequate response and the need for precision medicine, and summarizes emerging therapies, ongoing pediatric trials, and novel agents under development. A comprehensive literature search of PubMed, Embase, and Cochrane Library databases (1987-2026) identified 100 studies: 67 pediatric-specific and 33 adult studies. The review included randomized controlled trials, observational studies, systematic reviews, and clinical practice guidelines (ECCO-ESPGHAN, NASPGHAN).</p><p><strong>Expert opinion: </strong>Optimal management of pediatric UC requires a personalized approach that balances efficacy and safety while anticipating long-term outcomes. Integration of novel biologics, targeted therapies, and precision medicine strategies holds promise for improving disease control, minimizing adverse effects, and enhancing quality of life in affected children.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1075-1084"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360104","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}
Yookyeong Baek, Hsiangkuo Yuan, Stephen Silberstein
{"title":"Pharmacotherapy for chronic migraine prevention: a narrative review.","authors":"Yookyeong Baek, Hsiangkuo Yuan, Stephen Silberstein","doi":"10.1080/14656566.2026.2715707","DOIUrl":"10.1080/14656566.2026.2715707","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic migraine (CM) is a disabling neurological disorder with evolving diagnostic criteria that have influenced how we interpret the evidence base for preventive treatment. Affecting 1-2% of the population, CM imposes substantial individual and societal burden.</p><p><strong>Areas covered: </strong>This narrative review summarizes the evidence for CM prevention. Literature was identified through PubMed and Google Scholar through April 2026. We review traditional oral preventives, onabotulinumtoxinA, calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies, gepants, and emerging therapeutic targets, emphasizing CM-specific efficacy, safety, and outcomes in patients with medication overuse and prior treatment failures.</p><p><strong>Expert opinion: </strong>Although traditional oral preventives remain widely used in CM, most lack CM-specific trial data under current diagnostic criteria and their use largely reflects extrapolation from episodic migraine. Therapies targeting migraine pathophysiology, including CGRP-targeted agents and onabotulinumtoxinA, offer more robust CM-specific evidence, although effect sizes are modest and comparative efficacy data against established oral preventives remain limited. Despite guidelines endorsing CGRP-targeting therapies as first-line, access barriers limit real-world implementation. Incomplete response and the lack of predictive biomarkers, reflecting disease heterogeneity, pose major challenges in CM management. Future progress may lie in strengthening the evidence for combination therapy, expanding therapeutic targets, and developing clinically actionable biomarkers for individualized care.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1279-1292"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864276","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}
Victoria McGuirt, Dillon Razler, Savannah G Moore, Steven Feldman
{"title":"Evaluating zasocitinib as an oral therapy for moderate to severe plaque psoriasis.","authors":"Victoria McGuirt, Dillon Razler, Savannah G Moore, Steven Feldman","doi":"10.1080/14656566.2026.2714835","DOIUrl":"10.1080/14656566.2026.2714835","url":null,"abstract":"<p><strong>Introduction: </strong>Psoriasis is a chronic inflammatory disease with a significant physical and psychosocial burden. Although biologic therapies targeting IL-17 and IL-23 are highly effective, their cost, injection burden, and variable response highlight the need for convenient oral alternatives. TYK2, a key mediator of the IL-23/IL-17 axis, represents a promising therapeutic target. Our objective is to evaluate the pharmacology, clinical efficacy, safety, and potential role of zasocitinib in plaque psoriasis.</p><p><strong>Areas covered: </strong>This review evaluates preclinical and clinical studies of zasocitinib, focusing on early-phase trials and comparisons with existing therapies. Zasocitinib is a highly selective oral TYK2 inhibitor that modulates IL-12, IL-23, and interferon signaling. Adverse events were generally mild to moderate, with no major safety signals or laboratory abnormalities.</p><p><strong>Expert opinion: </strong>Psoriasis varies widely, but management is generally guided by disease severity and treatment response. Although better treatment options are still needed, especially for mild disease, new drugs like zasocitinib may have a role but will likely face competition from highly effective, established therapies.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1367-1373"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673088","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":"Evaluating mitapivat for the treatment of alpha or beta thalassemia.","authors":"Antonis Kattamis, Konstantinos Bistas, Vangelis Mitros, Efthalia Faidra Agiomavriti Stefanopoulou, Polyxeni Delaporta","doi":"10.1080/14656566.2026.2705347","DOIUrl":"10.1080/14656566.2026.2705347","url":null,"abstract":"<p><strong>Introduction: </strong>Thalassemia is a group of diverse genetic disorders with worldwide distribution that affects hemoglobin synthesis. Until recently, the therapeutic approach to thalassemia was symptomatic, relying on red blood cell transfusions, treatment of comorbidities and of disease-related complications. However, novel therapeutic agents have recently been developed and are gradually being integrated into routine clinical practice.</p><p><strong>Areas covered: </strong>One of the most promising agents is mitapivat (AG348), an oral pyruvate kinase activator that enhances the erythrocytic adenosine triphosphate (ATP) production. After series of preclinical and clinical studies, mitapivat has been suggested to be a safe and effective disease modifier for thalassemia. Large double blind randomized clinical trials have indicated that mitapivat may increase baseline hemoglobin levels, reduce transfusion burden, control ineffective erythropoiesis and hemolysis and improve quality of life.</p><p><strong>Expert opinion: </strong>Mitapivat presents as a potential game-changer in the management of patients with both α- and β-thalassemia, regardless of transfusion dependency. However, further post-marketing evidence is required in order to evaluate mitapivat profile under real‑world conditions and routine clinical practice.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1045-1052"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520392","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}
Simone Ferrero, Irene Gazzo, Umberto Perrone, Francesca Olcese, Silvia Ottonello, Francesco Paolo Rosato, Valerio Gaetano Vellone, Fabio Barra
{"title":"GnRH antagonists for the treatment of fibroids and adenomyosis, current evidence and future perspectives.","authors":"Simone Ferrero, Irene Gazzo, Umberto Perrone, Francesca Olcese, Silvia Ottonello, Francesco Paolo Rosato, Valerio Gaetano Vellone, Fabio Barra","doi":"10.1080/14656566.2026.2695094","DOIUrl":"10.1080/14656566.2026.2695094","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine fibroids and adenomyosis are common estrogen- and progesterone-dependent disorders associated with heavy menstrual bleeding, pelvic pain, anemia, and impaired quality of life. Although surgery remains widely used, there is an increasing demand for effective uterus-preserving medical therapies. Oral gonadotropin-releasing hormone (GnRH) antagonists have recently emerged as a novel therapeutic option, allowing rapid, reversible, and dose-dependent suppression of ovarian steroidogenesis.</p><p><strong>Areas covered: </strong>This narrative, based on a targeted PubMed/MEDLINE literature search and review of major guideline documents published up to May 2026, summarizes the pharmacological properties, mechanisms of action, and clinical evidence regarding GnRH antagonists (elagolix, relugolix and linzagolix) in uterine fibroids and adenomyosis. Evidence from randomized controlled, extension studies, and emerging literature was critically reviewed, focusing on control of heavy menstrual bleeding, pain reduction, quality of life, safety, and the role of add-back therapy.</p><p><strong>Expert opinion: </strong>GnRH antagonists represent a major advance in the medical treatment of uterine fibroids and are highly effective in controlling heavy menstrual bleeding. Their role in adenomyosis appears promising, although evidence remains limited. These agents should currently be considered suppressive rather than curative therapies, as symptoms often recur after discontinuation. Long-term integration into individualized treatment strategies will require further safety and comparative effectiveness data.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1163-1178"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338330","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}
Csaba Matta, Roland Takács, Eun-Jung Jin, Zsuzsanna Helyes, Ádám István Horváth, Krisztián Zoltán Juhász, Balázs István Tóth, Ron Ellis, Ali Mobasheri
{"title":"The rise and fall of TRPV1-targeted analgesia in osteoarthritis: a critical appraisal.","authors":"Csaba Matta, Roland Takács, Eun-Jung Jin, Zsuzsanna Helyes, Ádám István Horváth, Krisztián Zoltán Juhász, Balázs István Tóth, Ron Ellis, Ali Mobasheri","doi":"10.1080/14656566.2026.2696489","DOIUrl":"10.1080/14656566.2026.2696489","url":null,"abstract":"<p><strong>Introduction: </strong>Transient receptor potential vanilloid 1 (TRPV1) has been pursued as a therapeutic target in osteoarthritis (OA) pain for over two decades. Both systemic antagonism and localized agonism advanced into clinical development, supported by mechanistic rationale and preclinical data.</p><p><strong>Areas covered: </strong>We critically appraise TRPV1-targeted drug development in OA, examining the biological basis of the target, translational trajectories of antagonist and agonist programs, and clinical trial outcomes that define the current landscape. Literature was identified through a PubMed search for peer‑reviewed articles on TRPV1 and OA over the past 5 years, followed by manual selection of key references. We review why systemic TRPV1 antagonists were abandoned, and why intra-articular TRPV1 agonists, despite expedited regulatory designations, failed to meet primary endpoints in Phase III trials.</p><p><strong>Expert opinion: </strong>TRPV1-targeted therapy in OA has completed a full translational cycle without yielding regulatory approval. The mechanistic rationale remains valid; what failed was clinical translation. Key contributors include over-reliance on preclinical models poorly capturing central sensitization, lack of stratification by peripheral versus central pain phenotypes, and use of composite pain endpoints in phenotypically mixed populations. The TRPV1 experience offers lessons for peripheral analgesic development in OA: patient phenotyping and enrichment must precede pivotal trials.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1179-1196"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351304","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":"Pharmacological treatment of anhedonic depression: the role of dopaminergic and anti-inflammatory mechanisms.","authors":"Daniel Lindqvist","doi":"10.1080/14656566.2026.2702389","DOIUrl":"10.1080/14656566.2026.2702389","url":null,"abstract":"","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1041-1043"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411075","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":"Evaluating linaclotide for the treatment of irritable bowel syndrome with constipation in children and adolescents.","authors":"Manuel Linares, Miguel Saps","doi":"10.1080/14656566.2026.2702388","DOIUrl":"10.1080/14656566.2026.2702388","url":null,"abstract":"<p><strong>Introduction: </strong>Irritable bowel syndrome with constipation (IBS-C) is a common pediatric disorder of gut - brain interaction (DGBI) characterized by constipation-related bowel dysfunction and recurrent abdominal pain. Despite multimodal management, pharmacologic options specifically evaluated for pediatric IBS-C have historically been absent. Linaclotide, a guanylate cyclase-C agonist with local intestinal activity, has emerged as a mechanism-based therapy for this phenotype.</p><p><strong>Areas covered: </strong>This review summarizes the pharmacology, pharmacokinetics, clinical efficacy, safety, and regulatory status of linaclotide in pediatric IBS-C. Preclinical data support dual effects on intestinal secretion and visceral nociceptive signaling. Adult efficacy is supported by a mature clinical trial program showing consistent benefit across bowel and abdominal symptom endpoints. Pediatric evidence includes a published dose-ranging trial, real-world data, and a confirmatory regulatory trial that contributed to U.S. Food and Drug Administration (FDA) approval in patients aged 7 years and older.</p><p><strong>Expert opinion: </strong>Linaclotide represents an important addition to the pediatric IBS-C therapeutic landscape, particularly for children who remain symptomatic despite optimized conventional care. Its main conceptual advantage is addressing both bowel dysfunction and abdominal pain simultaneously. However, its role in practice will depend on full publication of confirmatory pediatric data, long-term safety experience, and access within multidisciplinary care pathways.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1065-1074"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420113","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}
Guido Gembillo, Chiara Casuscelli, Alberto La Spada, Ylenia Di Pietro, Giulia Cipressa, Domenico Santoro, Claudia Lo Re
{"title":"Angiotensin system modulation in focal segmental glomerulosclerosis: pharmacological basis and clinical implications.","authors":"Guido Gembillo, Chiara Casuscelli, Alberto La Spada, Ylenia Di Pietro, Giulia Cipressa, Domenico Santoro, Claudia Lo Re","doi":"10.1080/14656566.2026.2706076","DOIUrl":"10.1080/14656566.2026.2706076","url":null,"abstract":"<p><strong>Introduction: </strong>FSGS is a histological convergence point for biologically distinct conditions: primary immune-mediated, genetic, and secondary adaptive forms, each with its own pharmacological logic. ACE inhibitors and angiotensin receptor blockers have anchored its management for three decades on evidence drawn predominantly from non-FSGS populations.</p><p><strong>Areas covered: </strong>Experimental and clinical literature from PubMed/MEDLINE, Embase, and Web of Science through 30 January 2026, covering angiotensin II-mediated podocyte injury, RAAS pharmacology across FSGS subtypes, and emerging strategies that extend or layer upon the RAAS backbone, including dual AT1/endothelin-A blockade, SGLT2 inhibition, and mineralocorticoid receptor antagonism, with additional podocyte-targeted and genotype-guided approaches.</p><p><strong>Expert opinion: </strong>The clinical benefit of RAAS blockade appears to vary across FSGS subtypes. It likely targets a key pathogenic mechanism in secondary adaptive forms, while serving mainly as supportive antiproteinuric therapy in immune-mediated and genetic disease. Nonetheless, it remains a cornerstone of care.Emerging therapies, including dual AT1/endothelin-A antagonism (sparsentan) and podocyte-targeted approaches (apecotrep), show promising proteinuria reductions but have not yet demonstrated clear benefits on hard renal outcomes. Biomarker-driven strategies (e.g. anti-nephrin antibodies, APOL1 genotyping) may enable more tailored treatment, although their clinical impact remains to be established.</p>","PeriodicalId":12184,"journal":{"name":"Expert Opinion on Pharmacotherapy","volume":" ","pages":"1293-1308"},"PeriodicalIF":3.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618998","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}