The Journal of the Association of Physicians of India最新文献

{"title":"Early Initiation and Dose Optimization of Mineralocorticoid Receptor Antagonists in Heart Failure.","authors":"Sunip Banerjee, Rajeeve Rajput, Chetan Shah, B K Raghunandan, Abhishek Gupta, Sumit Chatterjee, Krishna Prasad Anne, Ashok Veer, Abhijeet Joshi, Arvind Raghuvanshi, R Kedarnathan, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1299","DOIUrl":"https://doi.org/10.59556/japi.74.1299","url":null,"abstract":"<p><p>Guidelines recommend that the foundation four guideline-directed medical therapy (GDMT), which includes mineralocorticoid receptor antagonists (MRAs), should be initiated early in the treatment paradigm of heart failure due to mortality benefits and reduction in hospitalization for heart failure. However, the practical implementation of these guidelines in the real-world clinical scenario is lacking. Delay in initiating MRA is common, and patients often do not receive the optimum dose of MRA. The clinical considerations and guideline recommendations for early initiation and optimum dosing of MRA in HF can form the scientific basis for improving the correct usage of MRA in HF in real-world settings.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Delaying or Omitting Mineralocorticoid Receptor Antagonists in Heart Failure.","authors":"Mohan Lal, Manoj Kumar, Rajesh Kancharla, Sanjay Singh, Atul Kumar, Mitesh Sutaria, Bhavesh M Patel, Harsh B Maniar, S V Haris, Bharat Maheshwari, Shiladitya K Singh, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1300","DOIUrl":"https://doi.org/10.59556/japi.74.1300","url":null,"abstract":"<p><p>Despite strong class I, level A recommendations from major clinical guidelines, the early initiation and optimization of mineralocorticoid receptor antagonists (MRAs) in heart failure (HF) with reduced ejection fraction (HFrEF) remain suboptimal. MRAs, including spironolactone and eplerenone, provide significant morbidity and mortality benefits, particularly when introduced early in high-risk scenarios such as acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF). Evidence from landmark trials and real-world registries underscores that early MRA therapy reduces cardiovascular events, prevents adverse ventricular remodeling, and lowers sudden cardiac death risk. Delaying or omitting MRAs, even by a few weeks, is associated with increased mortality, recurrent hospitalizations, and irreversible cardiac damage. Clinical evidence demonstrated that early aldosterone blockade exerts rapid and sustained benefits, often within days of initiation. Early initiation and aggressive optimization of MRAs must be prioritized in HFrEF management to fully realize their life-saving potential.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"40-42"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mineralocorticoid Receptor Antagonists: An Overview of History and Evolution.","authors":"B C Kalmath, Mangesh Tiwaskar, Gattu R Kumar, Hemant Khemani, Amit Singh, Rajeev Kishore, Arvind Chouhan, B L Harikrishnan, Sarita Choudhary, Manish Goyal, Arun Pradhan, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1293","DOIUrl":"https://doi.org/10.59556/japi.74.1293","url":null,"abstract":"<p><p>Mineralocorticoid receptor antagonists (MRAs) have significantly evolved since the introduction of the first steroidal MRA, spironolactone, in the 1950s. Initially discovered for treating hypertension and heart failure (HF), the clinical applications of MRAs have been expanded to chronic kidney disease (CKD) and diabetic nephropathy. Steroidal MRAs, such as spironolactone and eplerenone, effectively suppress mineralocorticoid receptor activation but are associated with side effects like hyperkalemia and endocrine abnormalities. Current research aims to optimize MRAs further for broader therapeutic applications, including nondiabetic kidney and cardiovascular diseases, and to improve safety profiles. In this review, we reflect on the historical development, classification, evolution, major clinical trials, and future prospects of MRAs.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pharmacological Properties and Safety Profile of Mineralocorticoid Receptor Antagonists in Heart Failure with Reduced Ejection Fraction.","authors":"Dharmesh Solanki, Rajesh Badani, Mangesh Tiwaskar, S Sandeep, Neeraj Bhalla, Mohd Nadeem, Vineet Garg, P K Reddy, Sheetal Kamat, P K Joshi, A Ganesh Raja, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1295","DOIUrl":"https://doi.org/10.59556/japi.74.1295","url":null,"abstract":"<p><p>Among the established mineralocorticoid receptor antagonists (MRAs), spironolactone and eplerenone have demonstrated significant clinical utility in managing conditions such as chronic heart failure, resistant hypertension, and hyperaldosteronism. Spironolactone, the first steroidal MRA, is known for its broad receptor affinity, contributing to both therapeutic benefits and endocrine-related side effects. Eplerenone, a more selective agent, offers improved tolerability with reduced hormonal adverse effects. This review explores the pharmacokinetic and pharmacodynamic profiles of these agents, highlighting their mechanisms of action, receptor-binding characteristics, and clinical implications. The safety considerations associated with long-term use, particularly hyperkalemia and renal function impairment, are also discussed to provide a comprehensive understanding of their therapeutic roles.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"19-21"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dean ICP's Message.","authors":"Kamlesh Tewary","doi":"10.59556/japi.74.1284","DOIUrl":"https://doi.org/10.59556/japi.74.1284","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Director PRF's Message.","authors":"A Muruganathan","doi":"10.59556/japi.74.1285","DOIUrl":"https://doi.org/10.59556/japi.74.1285","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mechanism of Action of Mineralocorticoid Receptor Antagonists in Heart Failure with Reduced Ejection Fraction.","authors":"R R Mantri, Agam Vora, Asif Hasan, Abhishek Raval, R S Kumar, Sachin K Gupta, Subhamoy Chatterjee, S V Srinivas, Kailash Chandra, S Krishnamoorthy, Khizer H Junaidy, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1294","DOIUrl":"https://doi.org/10.59556/japi.74.1294","url":null,"abstract":"<p><p>Mineralocorticoid receptor antagonists (MRAs) are one of the guideline-directed medical therapies for patients with heart failure and chronic kidney disease due to their anti-inflammatory and antifibrotic effects. MRAs regulate mineralocorticoid receptor (MR) signaling by inhibiting aldosterone binding to MR. MRAs are classified into steroidal and nonsteroidal categories based on their molecular interactions and clinical applications. Steroidal MRAs have been widely used in clinical practice and have demonstrated significant efficacy. Continuous advancements in the field have led to the development of nonsteroidal MRAs with greater receptor selectivity and better safety profile.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Utilization of Mineralocorticoid Receptor Antagonists in India and the Benefits of GDMT in Heart Failure.","authors":"Nilesh Gautam, Parijat D Chowdhury, Akash Batta, Rajeev K Gupta, Nishant Kannodia, K Krishna Prabhakar, Karthik Munichoodappa, Mihir Shah, Kaustubh Durve, Mohammed Nadeem, Vamsie Mohan, Febin Francis, Amarnath Sugumaran, Senthilnathan Mohanasundaram","doi":"10.59556/japi.74.1297","DOIUrl":"https://doi.org/10.59556/japi.74.1297","url":null,"abstract":"<p><p>Early initiation of guideline-directed medical therapies (GDMTs) in heart failure (HF) and their uptitration to the target dose confer mortality benefits and reduce the risk of readmission. GDMT nonuse is a significant predictor of mortality in HF patients. However, GDMT prescription and adherence in India are low. Of the GDMTs, mineralocorticoid receptor antagonists (MRAs) are the least prescribed. There are multilevel gaps [healthcare professional (HCP)-related, patient-related] in the adoption and use of MRAs in HF. There is an unmet need to identify these gaps and formulate mitigation strategies to close them. This can improve or enhance GDMT adoption in the HF treatment paradigm.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"27-31"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Real-world Study to Assess Safety, Tolerability, and Effectiveness of Imeglimin among People with Type 2 Diabetes Mellitus Who are Intolerant to Metformin (PRISM Study).","authors":"Prabhat Kumar Agrawal, Ketan K Mehta, Abhisekh Raha, Rajesh Agarwal, Amit Varshney, Amitabh Biswas, Kiran Sharadchandra Shah, Aravinda Jagadeesha, Sher Singh Dariya, Bharat Saboo, Prabhakar Damodar Gokhale, Sandeep Suri, Kumar Prafull Chandra, Ashish Gautam, Harish Kumar B, Sonika Lamba, Prahlad Chawla, Nikhil Pursnani, Soumyaranjan Mohanty, Ruchika Garg","doi":"10.59556/japi.74.1306","DOIUrl":"10.59556/japi.74.1306","url":null,"abstract":"<p><strong>Background: </strong>Metformin has been the cornerstone of type 2 diabetes mellitus (T2D) pharmacologic management, but gastrointestinal (GI) intolerance limits its use in a significant subset of patients. In India, alternative therapies for metformin-intolerant subjects are needed given the high diabetes burden and early disease onset. Imeglimin, a novel oral antidiabetic agent with a distinct mitochondrial mechanism of action, has shown efficacy and tolerability but lacks large real-world evidence in Indian subjects unable to tolerate metformin.</p><p><strong>Materials and methods: </strong>This 6-month, prospective, multicenter, observational study was conducted across 19 clinical sites in India to evaluate the effectiveness and safety of imeglimin in a real-world setting. The study population comprised adult patients with T2D who were identified as intolerant to metformin. Following enrollment, subjects were initiated on treatment with imeglimin, administered either as monotherapy or as add-on therapy to existing regimens. The primary effectiveness endpoint was the change from baseline in glycated hemoglobin (HbA1c) at 6 months and the assessment of safety and tolerability.</p><p><strong>Results: </strong>Among the 722 analyzed subjects, the mean age was 53.1 years, and the mean baseline HbA1c was 8.5%. Imeglimin therapy produced sustained improvements: Mean HbA1c decreased by 1.26% at 6 months (<i>p</i> < 0.001). Imeglimin performed well as both monotherapy (reduction of 0.77% at 6 months, <i>p</i> < 0.001) and combination therapy [with two oral antidiabetic drugs (OADs), a reduction of 1.15%, <i>p</i> < 0.001; and with three or more OADs, a reduction of 1.86%, <i>p</i> < 0.001]. The treatment was well tolerated, with no serious adverse events reported. Overall, 29.7% of participants experienced side effects, most commonly GI symptoms (15.3%), followed by urinary or genital tract infections (5.0%), nausea or vomiting (5.1%), headache (7.1%), and hypoglycemia (1.1%).</p><p><strong>Conclusion: </strong>Imeglimin demonstrates clinically meaningful glycemic efficacy in a real-world setting among metformin-intolerant patients. Its high efficacy, even in complex combination regimens, combined with a favorable safety profile and a low risk of hypoglycemia, establishes imeglimin as a highly valuable and effective alternative for patients who cannot tolerate metformin.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1E","pages":"e1-e7"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizing Secretary Message.","authors":"Kamlesh Tewary","doi":"10.59556/japi.74.1310","DOIUrl":"https://doi.org/10.59556/japi.74.1310","url":null,"abstract":"","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"74 1","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}