PurposeTo examine the efficacy and safety of duloxetine in Japanese patients with knee pain due to osteoarthritis.Patients and methodsPatients were randomized to receive duloxetine 60 mg/day or placebo for 14 weeks in a double-blind manner (ClinicalTrials.gov Identifier: NCT02248480). The primary efficacy endpoint was mean change in Brief Pain Inventory pain severity (BPI-Severity) average pain. Secondary endpoints included improvement in other BPI-Severity scales, Patient Global Impression of Improvement, Clinical Global Impressions of Severity, health-related quality of life (HRQoL) scales, range of motion of the knee joint, safety and tolerability, and structural changes on X-ray images.ResultsOf the 354 randomized patients, 161 in the duloxetine group and 162 in the placebo group completed the study. BPI-Severity average pain improved significantly with duloxetine vs. placebo (−2.57 vs. −1.80; adjusted mean difference: −0.77; 95% CI: −1.11 to −0.43; P<0.0001). Secondary efficacy endpoints and most HRQoL scales showed greater improvements in the duloxetine group than the placebo group. Adverse events observed in ≥5% of patients that were more frequent in the duloxetine than placebo group were somnolence, constipation, dry mouth, nausea, malaise, and decreased appetite. There were no marked changes in range of motion of the knee joint (efficacy), X-ray images, or Kellgren–Lawrence grade (safety) in either group.ConclusionDuloxetine reduced pain and improved function in patients with knee osteoarthritis, without causing X-ray abnormalities or altered knee joint mobility. Reduced pain was associated with improved HRQoL. Adverse events were consistent with duloxetine’s known safety profile.
The ring-opening multibranching polymerizations of 1,6-anhydro-β-d-glucopyranose (1) and 1,6-anhydro-β-d-galactopyranose (2) have been studied in order to synthesize hyperbranched polysaccharides. The solution polymerization in propylene carbonate and the bulk polymerization of 1 and 2 using a thermally induced cationic initiator proceeded through a ring-opening reaction and a proton transfer reaction to afford highly water-soluble polysaccharides, i.e., poly-1 and poly-2, respectively. For the polymers from 1 and 2 with the same polymerization conditions, the M w,SLS and yield of poly-1 were higher than those of poly-2. Here, poly-1 and poly-2 were characterized as hyperbranched polysaccharides consisting of α- and β-linked d-hexopyranosyl and d-hexofuranosyl repeating units, hyperbranched d-glucan and d-galactan, respectively. In addition, poly-1 and poly-2 had ca. 30−40 mol % nonreducing d-hexopyranosyl and d-hexofuranosyl terminal units, and the degree of branching was ca. 0.38 for poly-1 and 0.44−0.60 for poly-2. The respective viscosities of poly-1 and poly-2 in aqueous NaNO3(0.2 mol·L-1) solution were very low with the intrinsic viscosity values of 0.023−0.042 dL·g-1. The steady shear flow of poly-1 in aqueous solution exhibited a Newtonian behavior with steady shear viscosities independent of the shear rate, even at high concentrations. The results indicated that the characteristics of the viscosities were attributed to the spherical structure of the hyperbranched polysaccharide in aqueous solution.
A novel biodegradable unimolecular reversed micelle consisting of a poly(L‐lactide) (PLA) shell and a hyperbranched D‐mannan (HBM) core, that is, a chestnut‐shaped polymer (PLA–HBM), was synthesized by the polymerization of L‐lactide on HBM with 4‐(dimethylamino)pyridine (DMAP) as the catalyst. The obtained polymers were soluble in dimethyl sulfoxide, tetrahydrofuran, and chloroform but insoluble in H2O. The molecular weights of the PLA chain on PLA–HBM tended to increase with increasing polymerization time. The number of PLA chains on PLA–HBM could be controlled by the ratio of DMAP to the sugar unit in HBM. The obtained copolymer, PLA–HBM, acted as a unimolecular reversed micelle with an encapsulation ability toward the hydrophilic molecule. In addition, the entrapped hydrophilic molecules were slowly released from the core of PLA–HBM, and the release rate was accelerated by the breaking of the PLA chains of the shell when proteinase K as a hydrolase of PLA was used. © 2005 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 44: 406–413, 2006
The thermally induced cationic polymerization of 1,6-anhydro-β-d-mannopyranose (1) as a latent cyclic AB4-type monomer was carried out using 2-butenyltetramethylenesulfonium hexafluoroantimonate (2) as the initiator. The solution polymerization in propylene carbonate proceeded without gelation to produce the water-soluble hyperbranched polysaccharides (3) with controlled molecular weights and narrow polydispersities. The weight-average molecular weight (M w,SLS) values of 3 measured by static laser light scattering (SLS) varied in the range 6.5 × 103 to 6.4 × 105, which were significantly higher than the weight-average molecular weight (M w,SEC) values by size exclusion chromatography (SEC). The viscosity of the solution of 3 was very low, and the intrinsic viscosities were from 0.032 to 0.047 dL·g-1. Polymer 3 was composed of α- and β-linked hyperbranched polysaccharides consisting of 19 kinds of d-mannopyranosyl and d-mannofuranosyl repeating units, which had numerous nonreducing d-mannopyranosyl terminal units. The degree of branching (DB), estimated by the methylation analysis of 3, was in the range of 0.38−0.44. The thermally induced cationic polymerization of 1 using 2 is a facile method leading to the hyperbranched polysaccharide with a high DB value.
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