Ibrahim El-Haffaf, David Williamson, Van Dong Nguyen, Alexandre Duong, Virginie Williams, Marc-André Smith, Martin Albert, Hugues Blain, Nicolas Goettel, Bianca Beloin-Jubinville, François Lamontagne, Amélie Marsot
{"title":"Population pharmacokinetic modeling of piperacillin in critically ill adult patients: consideration of sex-based differences during model development.","authors":"Ibrahim El-Haffaf, David Williamson, Van Dong Nguyen, Alexandre Duong, Virginie Williams, Marc-André Smith, Martin Albert, Hugues Blain, Nicolas Goettel, Bianca Beloin-Jubinville, François Lamontagne, Amélie Marsot","doi":"10.1080/17512433.2026.2620530","DOIUrl":"10.1080/17512433.2026.2620530","url":null,"abstract":"<p><strong>Background: </strong>Piperacillin population pharmacokinetic models reportedly perform poorly for critically ill females compared to males. We aimed to explore potential methods that may better adjust for female data during model development.</p><p><strong>Research design and methods: </strong>Total piperacillin concentrations were used from a prospective observational study in NONMEM v7.5.1. Two models were developed following different approaches: classic stepwise approach and sex-specific approach. Relationship between covariates and estimated parameters were explored by statistically and graphically assessing their performance on males and females separately. Dosing regimen simulations were also performed separately by sex.</p><p><strong>Results: </strong>A one-compartment model based on data from 70 critically ill patients (49/21 males/females) with 233 concentrations best fit the data with both approaches. Creatinine clearance was the most significant covariate for the classic approach model, while creatinine clearance was best for male patients and estimated glomerular filtration rate was best for female patients with the sex-specific approach. Dosing recommendations were different between male and female patients with the sex-specific model.</p><p><strong>Conclusion: </strong>This study is the first to consider sex-specific covariates during the modeling process for piperacillin in critically ill patients. This approach may help reduce differences in model predictions between males and females in model-informed precision dosing strategies.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"69-83"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009605","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}
Emily Francis, Samantha Paylor, Cindy Van, Bindu Mathews, Millad J Sobhanian, Daniel Z Mansour, George Hennawi, Nicole J Brandt
{"title":"Review of anti-amyloid-beta (Aβ) monoclonal antibodies for the treatment of Alzheimer's disease.","authors":"Emily Francis, Samantha Paylor, Cindy Van, Bindu Mathews, Millad J Sobhanian, Daniel Z Mansour, George Hennawi, Nicole J Brandt","doi":"10.1080/17512433.2025.2556122","DOIUrl":"10.1080/17512433.2025.2556122","url":null,"abstract":"<p><strong>Introduction: </strong>Alzheimer's disease (AD) remains a major public health challenge, with growing prevalence and limited treatment options that modify disease progression. Recent advances have led to the development and approval of Anti-amyloid-β (Aβ) monoclonal antibodies, which represent a paradigm shift from symptomatic management to targeted disease modification.</p><p><strong>Areas ccovered: </strong>Agents such as lecanemab and donanemab selectively bind aggregated forms of Aβ and have demonstrated modest but statistically significant slowing of cognitive and functional decline in early AD. However, these therapies are associated with amyloid-related imaging abnormalities (ARIA), particularly in individuals carrying the APOE ε4 allele, necessitating close monitoring and individualized risk assessment. Implementation challenges, including high treatment burden, cost, and real-world applicability, have limited broad clinical adoption. This review examines the mechanistic differences, clinical trial outcomes, and safety considerations of Aβ monoclonal antibodies, while also highlighting emerging therapies and the need for inclusive, precision-guided approaches.</p><p><strong>Expert opinion: </strong>As research continues to evolve, balancing clinical benefits with safety and accessibility will be critical in defining the role of anti-amyloid-β therapies within the broader landscape of AD care.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1063-1078"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052654","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}
Noor E Eden, Ammara Zamir, Hamid Saeed, Faleh Alqahtani, Muhammad Fawad Rasool
{"title":"Clinical pharmacokinetics on canagliflozin: a systematic review of <i>in-vitro</i> and <i>in-vivo</i> studies.","authors":"Noor E Eden, Ammara Zamir, Hamid Saeed, Faleh Alqahtani, Muhammad Fawad Rasool","doi":"10.1080/17512433.2025.2597512","DOIUrl":"10.1080/17512433.2025.2597512","url":null,"abstract":"<p><strong>Introduction: </strong>Canagliflozin (CFZ), is a commonly used sodium-glucose cotransporter-2 inhibitor drug for the management of type 2 diabetes mellitus (T2DM). This review comprehensively compiles existing research studies regarding the clinical pharmacokinetic (PK) behavior of canagliflozin, primarily focusing on exploring effects of different disease conditions, potential drug interactions, and genetic polymorphism.</p><p><strong>Areas covered: </strong>A comprehensive review of scholarly literature was conducted by using leading databases, i.e. Google Scholar, Science Direct, PubMed, and Cochrane, to identify clinical PK studies of CFZ. The comprehensive literature search identified 25 articles that met the inclusion standards. A linear relationship was observed between the administered doses and PK parameters such as area under the curve from time 0 to infinity (AUC<sub>0-∞</sub>) and maximum plasma concentration (C<sub>max</sub>). The findings from T2DM patients with moderate renal impairment displayed a 27% increase in AUC<sub>0-∞</sub> of canagliflozin. Furthermore, co-administration of CFZ with rifampin in humans reduced Cmax by 28%, while with telmisartan in rats, CL/F decreased 31.1% initially, but increased 62.9% after 7 days.</p><p><strong>Expert opinion: </strong>This review integrates all significant human PK parameters of CFZ by combining findings from existing studies, allowing researchers to develop and evaluate PK models for recommending model-based dose optimization.</p><p><strong>Protocol registration: </strong>CRD420251054714.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1079-1094"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631249","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}
Chiara Sepulcri, Francesca Saluzzo, Daniele Roberto Giacobbe, Antonio Di Biagio, Daniela Maria Cirillo, Matteo Bassetti
{"title":"Recent advances and unmet needs in the treatment of drug-resistant tuberculosis.","authors":"Chiara Sepulcri, Francesca Saluzzo, Daniele Roberto Giacobbe, Antonio Di Biagio, Daniela Maria Cirillo, Matteo Bassetti","doi":"10.1080/17512433.2025.2606982","DOIUrl":"10.1080/17512433.2025.2606982","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-resistant tuberculosis (DR-TB) still represents a critical global health threat despite recent therapeutic advances. The shift from long, injectable-based regimens to shorter, all-oral regimens has improved outcomes, yet substantial challenges remain in ensuring efficacy, safety, and equitable access.</p><p><strong>Areas covered: </strong>We reviewed recent literature (2020-2025) searching PubMed, Medline, Google Scholar, clinicaltrials.gov, WHO guidelines, conference abstract books focusing on recent policy-changing, or knowledge-advancing Phase II/III clinical trials assessing novel DR-TB drugs/regimens.We reported the persisting issues of drug toxicity and acquisition of drug resistance, reviewing evidence from trials, surveillance data, and real-life studies. We provided an overview of new compounds and regimens in the pipeline and underlined the critical role of drug-susceptibility testing.</p><p><strong>Expert opinion: </strong>The availability of multiple short, all-oral regimens offers unprecedented therapeutic opportunities for drug-resistant tuberculosis. At the same time, the rise in bedaquiline resistance hampers the efficacy of these regimens and represents a global health threat. A promising rich pipeline of new compounds under development holds an important transformational potential in TB treatment; however, integrated drug-diagnostic development is needed to avoid past mistakes. Global advocacy for equitable access to TB treatment is fundamental to pairing scientific progress with concrete impact.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1037-1051"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773864","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}
Vincenzo Giosuè Giambusso, Martina Rafanelli, Robert S Sheldon
{"title":"Progress in the pharmacological management of vasovagal syncope.","authors":"Vincenzo Giosuè Giambusso, Martina Rafanelli, Robert S Sheldon","doi":"10.1080/17512433.2025.2596875","DOIUrl":"10.1080/17512433.2025.2596875","url":null,"abstract":"<p><strong>Introduction: </strong>Vasovagal syncope is a frequent problem affecting nearly half the population. The symptom burden is wide, ranging from once to hundreds of times. It reduces quality of life and causes injuries. Physicians, particularly front-line physicians such as family doctors, need a simple, practical approach.</p><p><strong>Areas covered: </strong>We provide context on syncope frequency, competing diagnoses, and natural history, usually characterized by improvement and remissions. Quality of life is reduced and accompanied by anxiety and improves with care. Injuries are common but serious injuries are rare. Treatment begins with advice on salt and fluid intake and physical maneuvers. Fludrocortisone, midodrine, and 2 serotonin-specific reuptake inhibitors are effective, and beta blockers should not be used. Atomoxetine is under investigation. Pacemakers and ablation must be reserved for the rare patient who has not responded to more conservative treatments.</p><p><strong>Expert opinion: </strong>Patients usually do well and respond to ongoing support and simple dietary advice and physical tips. Some benefit from fludrocortisone, midodrine, or serotonin-specific reuptake inhibitors. Almost all patients eventually stop fainting, and invasive treatments should be used last and for the very few highly afflicted patients who do not improve with safer measures.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"977-988"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631300","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}
Brenna Champlin, Katherine Keefe, Andrew C Birkeland, Shiruyeh Schokrpur
{"title":"The importance of specificity of drug treatment in head and neck cancer: current developments in personalized medicine to improve safety and tolerability.","authors":"Brenna Champlin, Katherine Keefe, Andrew C Birkeland, Shiruyeh Schokrpur","doi":"10.1080/17512433.2025.2600408","DOIUrl":"10.1080/17512433.2025.2600408","url":null,"abstract":"<p><strong>Introduction: </strong>Head and neck squamous cell carcinoma (HNSCC) remains a treatment challenge, with frequent recurrences following localized disease and guarded outcomes in recurrent/metastatic (R/M) settings. While cytotoxic therapy and immune checkpoint inhibitors (ICIs) have produced incremental survival benefits, many patients still exhibit limited response or acquire resistance to treatment, highlighting a critical need for more personalized and novel therapeutic strategies.</p><p><strong>Areas covered: </strong>This review discusses personalized therapy approaches in HNSCC from 2020 to 2025, focusing on immune checkpoint blockade and newer therapeutic modalities. Additionally, this review highlights key biomarkers that are currently being evaluated for predictive and prognostic value in HNSCC. The literature was sourced through PubMed, Google Scholar, and conference abstracts from ASCO, ESMO, and AACR, covering publications from January 2020-June 2025, with a focus on peer-reviewed trials and translational studies in human subjects.</p><p><strong>Expert opinion: </strong>The future of HNSCC treatment lies in the development of novel treatment combinations integrating immunotherapy using immune checkpoint blockade with newer therapeutic approaches. Understanding which agents to use, and when in the course of treatment, stands as a challenge that will shape the future of precision therapy for HNSCC, with integration of biomarkers promising to guide this transition.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1005-1017"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12777937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there a link between cholesterol-lowering medications and atopic dermatitis?","authors":"John Tetteh, Zenas Z N Yiu","doi":"10.1080/17512433.2025.2606262","DOIUrl":"10.1080/17512433.2025.2606262","url":null,"abstract":"<p><strong>Introduction: </strong>Cholesterol-lowering medications (CLMs) are used globally. Cholesterol is a key stratum corneum lipid that helps maintain epidermal barrier integrity. Barrier dysfunction contribute to pathogenesis of atopic dermatitis (AD). Clarifying whether CLMs impact AD has implications for dermatology and cardiology.</p><p><strong>Areas covered: </strong>We synthesized evidence from experimental, clinical, and genetic epidemiology through targeted literature searches and expert selections. It focuses on 1) skin barrier biology and epidermal cholesterol metabolism, and 2) potential effect of CLMs on AD. We discuss findings from experimental studies comparing topical versus systemic statins; population-based observations of AD among CLM users; and Mendelian randomization analyses of CLMs.</p><p><strong>Expert opinion: </strong>Effect of CLMs on AD is biologically plausible but clinically unproven. Signals of concern are most consistent for 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and Niemann-Pick C1-Like 1 (NPC1L1) inhibition, whereas Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition appears protective in some populations. Current studies are limited by confounding, heterogeneous outcomes and sparse ancestry-specific analyses. Until robust causal and pharmacoepidemiologic studies across ancestries are available, clinicians should prioritize established cardiovascular benefit of lipid reduction while monitoring for new or worsening dermatitis after therapy initiation. Future work should triangulate Mendelian randomization with pharmacoepidemiology designs in large, diverse datasets to deliver definitive guidance.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"969-976"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767687","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}
Jack C Stromatt, Anika T Chowdhury, Kevin M Huang, Shuiying Hu, Alex Sparreboom, Sharyn D Baker, Eric D Eisenmann
{"title":"Drug-drug interactions in targeted cancer therapies: a focus on tyrosine kinase inhibitors.","authors":"Jack C Stromatt, Anika T Chowdhury, Kevin M Huang, Shuiying Hu, Alex Sparreboom, Sharyn D Baker, Eric D Eisenmann","doi":"10.1080/17512433.2025.2606258","DOIUrl":"10.1080/17512433.2025.2606258","url":null,"abstract":"<p><strong>Introduction: </strong>Tyrosine kinase inhibitors (TKIs) have significantly improved outcomes for cancer patients. However, TKIs have a narrow therapeutic window, impact a high-risk population, and are frequently combined with additional medications, each of which increases the risk of drug-drug interactions (DDIs). As polypharmacy becomes more common, especially in older and higher-risk groups that are prescribed TKIs, there is an increased risk for harmful DDIs.</p><p><strong>Areas covered: </strong>TKI-related DDIs can lead to toxicity or reduced efficacy, which worsens patient outcomes and quality of life. In this review, we utilized the Drug Interaction Database (DIDB), FDA labels, and PubMed TKI DDI/ADME queries to outline the mechanisms underlying both pharmacokinetic (PK) and pharmacodynamic (PD) DDIs with TKIs. Pharmacokinetic DDIs involve changes in the absorption, distribution, metabolism, and excretion (ADME) of a molecule (victim) caused by another drug (perpetrator). These DDIs may involve direct inhibition, post-translational modification, or transcriptional regulation. Pharmacodynamic DDIs involve overlapping mechanisms resulting in additive, synergistic, or antagonistic effects when two medications are combined.</p><p><strong>Expert opinion: </strong>Understanding the mechanisms underlying DDIs facilitates a better grasp of TKI clinical pharmacology and will help in the development of strategies to optimize drug dosing and avoid DDIs.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1019-1035"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hira Bakhtiar Khan, Pragnitha Chitteti, Mehwash Nadeem
{"title":"Botulinum toxin in focus: evolution, pharmacology, and its expanding clinical impact.","authors":"Hira Bakhtiar Khan, Pragnitha Chitteti, Mehwash Nadeem","doi":"10.1080/17512433.2025.2594489","DOIUrl":"10.1080/17512433.2025.2594489","url":null,"abstract":"<p><strong>Introduction: </strong>Botulinum toxin (BoNT), recognized for its distinctive pharmacological properties, has become a highly effective therapeutic agent with a wide range of clinical applications. Among its serotypes, botulinum toxin A (BoNT A) is the most extensively used, with established roles in conditions such as limb spasticity, overactive bladder, and neuropathic pain. Despite its broad utility, careful consideration is required to minimize adverse outcomes, underscoring the importance of multidisciplinary collaboration to ensure patient safety.</p><p><strong>Areas covered: </strong>This expert review is developed through the evaluation of experimental studies and systematic reviews, which were integrated to generate a practice-oriented expert perspective. Although we have provided an overview of all BoNTs, our primary focus has been BoNT A. We have particularly focused on key considerations for the use of BoNT, including immunogenicity and its utility in special populations such as pregnant patients, individuals with pulmonary compromise, older adults, and children.</p><p><strong>Expert opinion: </strong>Despite the practical challenges of prescribing BoNT A, it is generally regarded as an effective therapy. Its use requires careful risk vs benefit evaluation and strict adherence to guidelines to reduce adverse outcomes. Non-response and immunogenicity remain important barriers, although ongoing research and engineered toxins point toward a future with more precision-based applications.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1053-1062"},"PeriodicalIF":3.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563303","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}