References of "Expert Opinion on Pharmacotherapy"
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See detailMiconazole , a pharmacological barrier to skin fungal infections.
Pierard, Gérald ULg; Hermanns-Le, Trinh ULg; Delvenne, Philippe ULg et al

in Expert Opinion on Pharmacotherapy (2012), 13(8), 1187-94

Introduction: Miconazole (MCZ) is a time-honored antifungal of the imidazole class. MCZ exerts a multipronged effect on fungi. It inhibits the cytochrome P450 complex, including the 14alpha-demethylase ... [more ▼]

Introduction: Miconazole (MCZ) is a time-honored antifungal of the imidazole class. MCZ exerts a multipronged effect on fungi. It inhibits the cytochrome P450 complex, including the 14alpha-demethylase enzyme required for ergosterol biosynthesis, in fungal cell membranes. In addition, intracellular accumulation of toxic methylated sterols occurs and the synthesis of triglycerides and phospholipids is altered. Disturbances in oxidative and peroxidative enzyme activities lead to an intracellular toxic concentration of hydrogen peroxide. As a result, intracellular organelle destruction then leads to cell necrosis. Farnesol synthesis stimulated in Candida spp. prevents the yeast-to-mycelium formation. MCZ is further active against Gram-positive bacteria. Areas covered: This review aims at revisiting the MCZ antifungal activity in dermatomycoses. Expert opinion: MCZ's wide spectrum of activity appears noteworthy. The full pharmacological profile of MCZ indicates its fungistatic profile through its effect on ergosterol biosynthesis. In addition, it exhibits a fungicidal effect against a number of fungal species, due to hydrogen peroxide accumulation. MCZ is characterized by high safety, efficacy and versatility, and a unique, multifaceted nature of activity in the treatment of dermatomycoses. [less ▲]

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See detailA review of gliptins in 2011.
SCHEEN, André ULg

in Expert Opinion on Pharmacotherapy (2012), 13(1), 81-99

INTRODUCTION: Dipeptidylpeptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes (T2DM). AREAS COVERED: This paper is an updated review, providing an analysis of both the ... [more ▼]

INTRODUCTION: Dipeptidylpeptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes (T2DM). AREAS COVERED: This paper is an updated review, providing an analysis of both the similarities and the differences between the various compounds known as gliptins, currently used in the clinic (sitagliptin, vildagliptin, saxagliptin, alogliptin and linagliptin). This paper discusses the pharmacokinetic and pharmacodynamic characteristics of gliptins; both the efficacy and safety profiles of gliptins in clinical trials (compared with classical glucose-lowering agents), given as monotherapy or in combination, including in special populations; the positioning of DPP-4 inhibitors in the management of T2DM in recent guidelines; and various unanswered questions and perspectives. EXPERT OPINION: The role of DPP-4 inhibitors in the therapeutic armamentarium of T2DM is evolving, as their potential strengths and weaknesses become better defined. Future critical issues may include the durability of glucose control, resulting from better beta-cell protection, positive effects on cardiovascular outcomes and long-term safety issues. [less ▲]

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See detailMetformin + saxagliptin for type 2 diabetes.
SCHEEN, André ULg

in Expert Opinion on Pharmacotherapy (2012), 13(1), 139-46

INTRODUCTION: Metformin is considered as the first-line drug therapy for the management of type 2 diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors, by promoting insulin secretion and reducing glucagon ... [more ▼]

INTRODUCTION: Metformin is considered as the first-line drug therapy for the management of type 2 diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors, by promoting insulin secretion and reducing glucagon secretion in a glucose-dependent manner, offer new opportunities for oral therapy after failure of metformin. AREAS COVERED: An updated review of the literature demonstrates that saxagliptin, a DPP-4 inhibitor, and metformin may be administered together, separately or in fixed-dose combination (FDC), either as saxagliptin added to metformin or as initial combination in drug-naive patients. Both compounds exert complementary pharmacodynamic actions leading to better improvement in blood glucose control (fasting plasma glucose, postprandial glucose, HbA1c) than either compound separately. Adding saxagliptin to metformin monthotherapy results in a consistent, sustained and safe reduction in HbA1c levels. Tolerance is excellent without hypoglycemia or weight gain. EXPERT OPINION: The combination saxaglitpin plus metformin may be used as first-line or second-line therapy in the management of type 2 diabetes, especially as a valuable alternative to the classical metformin-sulfonylurea combination. [less ▲]

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See detailNew approaches in light/laser therapies and photodynamic treatment of acne.
Pierard-Franchimont, Claudine; PAQUET, Philippe ULg; PIERARD, Gérald ULg

in Expert Opinion on Pharmacotherapy (2011), 12(4), 493-501

Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne ... [more ▼]

Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne, including light/laser treatments and photodynamic therapy. This review summarizes findings about such treatment modalities with particular emphasis on efficacy and safety. A number of laser/light-based modalities have been developed to meet the increasing demand for new acne treatments. The current devices correspond, on the one hand, to light-emitting diode therapy and, on the other hand, to the 532-nm potassium titanyl phosphate laser, the 585- and 595-nm pulsed dye laser, the 1450-nm diode laser, the 1320-nm Nd:YAG laser and intense pulsed light. Photodynamic therapy is also available. It is claimed that light/laser treatments might induce a faster response compared with the 1-3 months needed for response to traditional oral and topical treatments. In conclusion, pulsed dye laser shows efficacy in some patients with mild to moderate acne. The relative effectiveness compared with other treatments is unconfirmed; from the published information, evidence-based efficacy assessment of light/laser therapies in acne remains almost impossible. [less ▲]

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See detailCurrent options for the management of postmenopausal osteoporosis.
LECART, Marie-Paule ULg; Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2011), 12(16), 2533-52

INTRODUCTION: Osteoporosis is a well-recognized disease with severe consequences if left untreated. The prevention of osteoporosis-associated fractures should include fall prevention, calcium ... [more ▼]

INTRODUCTION: Osteoporosis is a well-recognized disease with severe consequences if left untreated. The prevention of osteoporosis-associated fractures should include fall prevention, calcium supplementation and life-style advice, as well as pharmacological therapy using agents with proven antifracture efficacy. AREAS COVERED: This manuscript offers an evidence-based critical assessment of the currently available efficacy data on all new chemical entities that have been granted a marketing authorization for the management of primary osteoporosis in women. EXPERT OPINION: The availability of new therapeutic agents makes clinical decision making in osteoporosis more complex. Therapeutic decisions should be based on a balance between the benefits and risks of treatment, which must be carefully considered in each particular case, both by the physician and the patient. Indeed, no single agent is appropriate for all patients. Therefore, treatment decisions should be made on a tailor-made basis, taking into account all measures of treatment effect and risk, before making informed judgments about the best individual treatment option. [less ▲]

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See detailStrontium ranelate: a look back at its use for osteoporosis
Reginster, Jean-Yves ULg; Neuprez, Audrey ULg

in Expert Opinion on Pharmacotherapy (2010), 11(17), 2915-2927

Importance of the field: Osteoporosis is now considered as a major health problem in all developed and in most developing (non-African) coutries. Areas covered in this review: In the present review, we ... [more ▼]

Importance of the field: Osteoporosis is now considered as a major health problem in all developed and in most developing (non-African) coutries. Areas covered in this review: In the present review, we provide an extensive literature survey (MEDLINE, PubMed, Cochrane Controlled Register), for articles dealing with osteoporosis management and/or strontium ranelate, from 1920 to 2010. What the reader will gain: The objective is to provide an extensive, unbiased assessment of the available data allowing to place strontium ranelate in perspective, with other anti-osteoporosis treatments. Take home message: Owing to a positive benefit/risk ratio, strontium ranelate may now be considered as a first-line treatment in the management of osteoporosis. [less ▲]

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See detailInterest of lasofoxifene in the treatment of osteoporosis. Evaluation of "Lasofoxifene in postmenopausal women with osteoporosis". N Engl J Med 2010;362:686-96.
Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2010), 11(10), 1773-5

Lasofoxifene, a new selective estrogen receptor modulator (SERM), was investigated to assess its efficacy and safety in the management of postmenopausal osteoporosis. A dose of 0.5 mg/day of lasofoxifene ... [more ▼]

Lasofoxifene, a new selective estrogen receptor modulator (SERM), was investigated to assess its efficacy and safety in the management of postmenopausal osteoporosis. A dose of 0.5 mg/day of lasofoxifene, given to postmenopausal women with osteoporosis, induced a reduction in vertebral fracture rates after 3 years and a reduction, after 5 years, of nonvertebral fractures, estrogen receptor-positive and invasive breast cancers, major coronary heart diseases and strokes. However, this dose was associated with significant side effects including venous thromboembolisms, pulmonary embolisms, leg cramps, hot flushes, uterine polyps, endometrial hypertrophy, arthralgia and vaginal candidiasis. Since no effect was evidenced on hip fractures, the risk-benefit ratio of this new medication, compared with previously marketed SERMs is, at best, uncertain. [less ▲]

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See detailEmerging therapies for ionizing radiation-associated skin field carcinogenesis.
Pierard, Gérald ULg; Pierard, Claudine ULg; Paquet, Philippe ULg et al

in Expert Opinion on Pharmacotherapy (2009), 10(5), 813-21

BACKGROUND: Radiodermatitis in its acute and chronic presentations represents a set of specific adverse effects resulting from ionizing radiations. Skin-field cancerization is another condition associated ... [more ▼]

BACKGROUND: Radiodermatitis in its acute and chronic presentations represents a set of specific adverse effects resulting from ionizing radiations. Skin-field cancerization is another condition associated to or independent of clinically recognizable radiodermatitis. This condition leads to the risk of later occurrence of skin malignancies. METHOD: Review of the current and most pertinent peer-reviewed publications with the addition of personal perspectives. RESULT/CONCLUSION: The presence of field cancerization encompasses subclinical changes, precursors of malignant alterations, as well as single or multiple primary neoplasms and local neoplastic recurrences. These tumours commonly require repeated treatments over time and cause significant morbidity. In general, specific tumour-directed treatments using ablative or destructive techniques require regular follow-up and screening for disclosing any further neoplasm. Another strategy corresponding to field-directed treatment targets a larger area of irradiated skin to reduce the risk of developing second neoplasms and local recurrences. Imiquimod is an immune response modifier of the imidazoquinoline class. It is the archetype drug used to control skin-field carcinogenesis. Cryotherapy, topical 5-fluorouracil, diclofenac and conventional photodynamic therapy are supposed to bring effects differing by their indications, healing rates and remission rates. The possibility of inducting a radiation recall dermatitis by some of these therapeutic modalities has not been thoroughly evaluated, and at present cannot be ruled out with confidence. [less ▲]

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See detailFungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women.
Quatresooz, Pascale ULg; Franchimont, Claudine ULg; Szepetiuk, Grégory ULg et al

in Expert Opinion on Pharmacotherapy (2009), 10(14), 2221-9

BACKGROUND: Corneocyte accumulation (hyperkeratosis, xerosis) commonly occurs in the stratum corneum (SC) of the feet of diabetic patients, as well as menopausal women. OBJECTIVE: To compare the effects ... [more ▼]

BACKGROUND: Corneocyte accumulation (hyperkeratosis, xerosis) commonly occurs in the stratum corneum (SC) of the feet of diabetic patients, as well as menopausal women. OBJECTIVE: To compare the effects of a 2.5% chitin-glucan formulation with its placebo, and commercially available glycerol formulations. METHODS: This two-step controlled double-blind, randomized, intra-individual study was performed in 30 type 1 and 2 diabetic menopausal women suffering from xerosis of the feet. The formulations were applied once daily for 3 weeks. Electrometric assessments were performed on three sites of the feet at entry in the study, at weekly intervals during the treatment phase, and in a 2-week follow-up out of treatment. Positive controls consisted in two commercially available formulations enriched in glycerol. RESULTS: Data revealed an unequivocal benefit provided by the 2.5% chitin-glucan formulation compared with placebo. The electrometric values were significantly higher at each evaluation time during both treatment and follow-up phases. The two glycerol-enriched formulations showed slightly different kinetics of SC moisturization. A steep increase was followed by a plateau level and a rapid decline after stopping the treatments. CONCLUSION: The increased moisturization of the SC of the sole probably improves the desquamation process and reduces xerosis of the soles. [less ▲]

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See detailPoor adherence to oral bisphosphonate treatment and its consequences: a review of the evidence.
Rabenda, Véronique ULg; Hiligsmann, Mickaël ULg; Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2009), 10(14), 2303-15

Poor therapeutic adherence is a major issue faced by physicians today. This paper summarizes the adherence rates with oral bisphosphonate (OBP) treatment in clinical practice and their impact on clinical ... [more ▼]

Poor therapeutic adherence is a major issue faced by physicians today. This paper summarizes the adherence rates with oral bisphosphonate (OBP) treatment in clinical practice and their impact on clinical outcomes. Studies systematically demonstrated that overall compliance and persistence with OBPs among osteoporotic women are poor. Although extending dosing intervals improved adherence, the gains are suboptimal. Most importantly, low compliance and persistence rates consistently resulted in increased rates of fractures. The results emphasize the importance of adherence to treatment to achieve optimal antifracture efficacy. There is an urgent need to implement strategies and to encourage physicians to take measures that increase patients' awareness of the need to use osteoporosis medications as directed in order to benefit from them fully. [less ▲]

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See detailNovelties in the multifaceted miconazole effects on skin disorders.
Quatresooz, Pascale ULg; Vroome, Valérie; Borgers, Marcel et al

in Expert Opinion on Pharmacotherapy (2008), 9(11), 1927-34

BACKGROUND: Miconazole nitrate is a time-honored antifungal of the imidazole class. OBJECTIVE: To revisit the various aspects of action of the drug in a dermatologic setting. METHOD: Review of the current ... [more ▼]

BACKGROUND: Miconazole nitrate is a time-honored antifungal of the imidazole class. OBJECTIVE: To revisit the various aspects of action of the drug in a dermatologic setting. METHOD: Review of the current peer-reviewed publications. RESULTS/CONCLUSION: Miconazole essentially inhibits 14alpha-demethylase, an enzyme required for the biosynthesis of ergosterol, which is the main sterol constituent of fungal cell membranes. Hence, toxic methylated sterols accumulate. Synthesis of triglycerides and phospholipids is also affected. In addition, miconazole also exhibits other ancillary mechanisms of action that probably participate in the therapeutic efficacy of the drug. The oxidative and peroxidative enzyme activities are altered leading to an intracellular build up of a toxic concentration of hydrogen peroxide. This may contribute to the deterioration of subcellular organelles and to cell necrosis. Farnesol synthesis is stimulated in Candida spp. leading to the prevention of yeast-to-mycelium formation. Overall, miconazole is fungistatic through its effect on ergosterol biosynthesis, but it may also have a fungicidal effect against a number of fungal species due to its effect on hydrogen peroxide accumulation. In addition, miconazole is active against a series of Gram-positive bacteria and has been shown to help the repair of the skin barrier function and to help mitigate some inflammatory cell reactions (such as in acne). To conclude, miconazole exerts multi-pronged effects both against pathogenic fungi and on skin physiology. [less ▲]

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See detailHighlights from the Seventh European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis
Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2007), 8(11), 1779-1784

The Seventh European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ECCEO), which was held in Porto between March 28 and March 30, 2007, was the largest meeting in Europe in ... [more ▼]

The Seventh European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ECCEO), which was held in Porto between March 28 and March 30, 2007, was the largest meeting in Europe in the field of osteoporosis and osteoarthritis. The meeting was attended by similar to 4000 scientists and health professionals seeking information on the epidemiology, pathogenesis, prevention and treatment of osteoporosis and osteoarthritis. Specifically addressing these topics, > 500 abstracts were submitted. This paper highlights and summarises the important findings of ECCEO 2007. [less ▲]

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See detailDevelopments in the pharmacotherapeutic management of osteoporosis
Close, Pierre; Neuprez, A.; Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2006), 7(12), 1603-1615

During the last two decades, several medications have been granted a marketing authorisation for the management of osteoporosis. Bisphosphonates are the most widely prescribed drugs in this area ... [more ▼]

During the last two decades, several medications have been granted a marketing authorisation for the management of osteoporosis. Bisphosphonates are the most widely prescribed drugs in this area, worldwide. Alendronate and risedronate are given daily or weekly and have demonstrated their ability to reduce fracture rates at the spine and hip. Ibandronate has demonstrated spine antifracture efficacy with intervals between closings greater than weekly. New developments in this class include intravenous administration of ibandronate or zoledronate, once every three months or once yearly. Raloxifene, a selective estrogen-receptor modulator, reduces spine fractures and, in post-hoc analyses, non-spine fractures in high-risk subjects. New selective estrogen-receptor modulators, including lasofoxifene, bazedoxifene and arzoxifene, are expected to demonstrate antifracture efficacy at the hip level, whilst retaining the extra-skeletal benefits (such as in the breast) that are obtained with raloxifene. The peptides from the parathyroid hormone family are potent stimulators of bone formation. Teriparatide (1 - 34 amino acid fragment of the parathyroid hormone) reduces spine and non-spine fractures, an effect that is sustained for up to 30 months after the withdrawal of treatment. The intact hormone (1 -84 amino acids) showed similar results on spine fractures, and more data are requested to evaluate its effect on non-spine or hip fractures. Strontium ranelate is suggested to be the first medication to uncouple bone formation from bone resorption. It has shown antifracture efficacy at all sites in a large number of postmenopausal women. New developments include: denosumab, an antibody against receptor activator of NF-kappa B ligand (RANKL); a cytokine that is responsible for osteoclastogenesis; and inhibitors of cathepsin K, a cysteine protease that is involved in the cleavage of collagen. [less ▲]

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See detailOral ibandronate: a less frequently administered therapeutic option for postmenopausal osteoporosis
Reginster, Jean-Yves ULg

in Expert Opinion on Pharmacotherapy (2005), 6(13), 2301-2313

Osteoporosis is a severe condition, associated with significant disability as a result of fragility fractures and increased mortality. Oral bisphosphonates effectively reduce the risk of osteoporotic ... [more ▼]

Osteoporosis is a severe condition, associated with significant disability as a result of fragility fractures and increased mortality. Oral bisphosphonates effectively reduce the risk of osteoporotic fracture and are generally well tolerated. Unfortunately, patient outcomes are often compromised by suboptimal therapeutic adherence. In other disease areas, reduced dosing frequency has been shown to improve therapeutic adherence. A positive impact for adherence has been observed with a reduction in the bisphosphonate dosing frequency from daily to weekly. However, overall adherence remains suboptimal. lbandronate is a potent nitrogen-containing bisphosphonate specifically designed for less frequent than weekly administration, without compromise for efficacy or tolerability. This article reviews the pharmacology, efficacy and tolerability of oral ibandronate when administered with extended dosing intervals in postmenopausal osteoporosis. [less ▲]

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See detailPharmacotherapy of onychomycosis
Baran, R.; Gupta, A. K.; Pierard, Gérald ULg

in Expert Opinion on Pharmacotherapy (2005), 6(4), 609-624

Fungal infections of the nails are frequent in some segments of the population. Dermatophytes, yeasts and moulds are potential pathogens. A series of antifungal treatments are available to the clinician ... [more ▼]

Fungal infections of the nails are frequent in some segments of the population. Dermatophytes, yeasts and moulds are potential pathogens. A series of antifungal treatments are available to the clinician, differing by both their mechanistic nature and mode of administration. The pharmacodynamic and pharmacokinetic properties of each antifungal agent are distinct. This review focuses on the characteristics of amorolfine, bifonazole, ciclopirox, fluconazole, griseofulvin, itraconazole, ketoconazole, ravuconazole, R126638 and terbinafine. Single drug treatments and combined therapies are presented. None of the current drug regimens have demonstrated reliable efficacy against all cases of onychomycosis. Treatment failures, relapses and reinfections remain stubborn problems in the management of onychomycosis. [less ▲]

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See detailThe use of mycophenolate mofetil in liver transplant recipients
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Expert Opinion on Pharmacotherapy (2003), 4(11), 1949-1957

Mycophenolate mofetil is an important drug in the modern immunosuppressive arsenal. Mycophenolate mofetil is the semisynthetic morpholinoethyl ester of mycophenolate acid. Mycophenolate acid prevents T ... [more ▼]

Mycophenolate mofetil is an important drug in the modern immunosuppressive arsenal. Mycophenolate mofetil is the semisynthetic morpholinoethyl ester of mycophenolate acid. Mycophenolate acid prevents T and B cell proliferation by specifically inhibiting a purine pathway required for lymphocyte division. This paper extensively reviews the experience of mycophenolate mofetil use in liver transplant recipients. In randomised trials, mycophenolate mofetil decreased the rate of acute rejection after liver transplantation, without a significant increase of septic complications. However, so far, there are no data indicating that mycophenolate mofetil increases liver transplant patient or graft survivals. Mycophenolate mofetil is interesting because of its particular side effects profile, which is very different from the other immunosuppressants. The absence of mycophenolate mofetil nephrotoxicity is of specific interest in liver recipients with impairment of renal function. The monitoring of mycophenolate acid area under the concentration time curve might be interesting to limit side effects and provide better clinical efficacy but the exact role of mycophenolate acid monitoring in liver recipients has yet to be further evaluated in large series. [less ▲]

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