Evidence-Based Pharmacotherapies for Alcohol Use Disorder

Fairbanks, Jeremiah; Umbreit, Audrey; Kolla, Bhanu Prakash; Karpyak, Victor M.; Schneekloth, Terry D.; Loukianova, Larissa L.; Sinha, Shirshendu

doi:10.1016/j.mayocp.2020.01.030

Cited by 47 publications

(39 citation statements)

References 84 publications

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“…Indeed, the role of genetic variants in drug-metabolizing genes (pharmacogenetics) is well established and is highly relevant for variable responses and even toxic outcomes in the treatment of pain and depression. [86][87][88][89][90][91] Genetic variant evaluation is a powerful tool since it can direct the analyst to specific mechanisms in the body that are likely to be dysfunctional under injury or stress, and other systems that are likely to be normal. 92 These tools are therefore most useful early in the course of disease before the damage of poorly managed pathogenic pathways becomes irreversible.…”

Section: Cp As a Complex Gene-environment-metabolic Diseasementioning

confidence: 99%

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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Pain is the most distressing and disruptive feature of recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) resulting in low quality of life (QOL) and disabilities. There is no single, characteristic pain pattern in patients with RAP and CP. Abdominal imaging features of CP accurately reflect morphologic features but they do not correlate with pain. Pain is the major driver of poor quality of life (QOL) and it is the constant pain, rather than intermittent pain that drives poor QOL. Furthermore, the most severe constant pain experience in CP is also a complex condition. The ability to target the etiopathogenesis of severe pain requires new methods to detect the exact pain mechanisms in an individual at cellular, tissue, system and psychiatric levels. In patients with complex and severe disease, it is likely that multiple overlapping mechanisms are simultaneously driving pain, anxiety and depression. Quantitative sensory testing (QST) shows promise in detecting alterations in central processing of pain signals and to classify patients for mechanistic and therapeutic studies. New genetic research suggests that genetic loci for severe pain in CP overlap with genetic loci for depression and other psychiatric disorders, providing additional insights and therapeutic targets for individual patients with severe CP pain. Well-designed clinical trials that integrate clinical features, QST, genetics and psychological assessments with targeted treatment and assessment of responses are required for a quantum leap forward. A better understanding of the context and mechanisms contributing to severe pain experiences in individual patients is predicted to lead to better therapies and quality of life.

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Section: Cp As a Complex Gene-environment-metabolic Diseasementioning

confidence: 99%

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Dunbar¹,

Saloman²,

Phillips³

et al. 2021

JPR

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“…Hier liegen nur relativ wenig Befunde vor [86,87]. Die Bedeutung der "personalisierten Medizin" in diesem Indikationsbereich wird als gering angesehen [88]. Am ehesten von Relevanz sind funktionelle Polymorphismen im mu-Opioidrezeptorgen OPRM1.…”

Section: Pharmakogenetikunclassified

“…Am ehesten von Relevanz sind funktionelle Polymorphismen im mu-Opioidrezeptorgen OPRM1. Hier wurde die Bedeutung eines spezifischen Polymorphismus A118G (rs1799971) für die Naltrexonwirkung (response) untersucht [88]. Letztlich ist die Datenbasis nicht überzeugend.…”

Section: Pharmakogenetikunclassified

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Pharmakologische Rückfallprophylaxe der Alkoholabhängigkeit

Soyka¹

2021

Nervenheilkunde

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ZUSAMMENFASSUNGNur wenige Substanzen sind als sogenannte Anti-Craving-Me-dikamente zur pharmakogestützten Rückfallprophylaxe der Alkoholabhängigkeit zugelassen. Dazu gehören das in Deutschland nicht mehr vertriebene Disulfiram, die Opioidantagonisten Naltrexon und Nalmefen sowie Acamprosat. Gerade für Acamprosat und Naltrexon ist die Evidenzbasierung recht gut, bei mäßiger, aber klinisch signifikanter Effizienz. Sie werden trotzdem selten eingesetzt. Interessante Substanzen mit klinischer Perspektive sind am ehesten Baclofen, Vareniclin und Gabapentin. Die klinischen Befunde und Perspektiven der Pharmakotherapie bei Alkoholabhängigkeit werden dargestellt.

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“…FDA-approved medications comprise disulfiram, naltrexone, and acamprosate. Alcoholism, as other substance use disorders, is widely undertreated with less than 10% of individuals with AUD receiving treatment [73]. Some years ago, the possibility of using red blood cells for alcohol detoxification was first introduced by our group [2].…”

Section: Alcohol Detoxificationmentioning

confidence: 99%

Preclinical developments of enzyme-loaded red blood cells

Rossi

Pierigé

Bregalda

et al. 2020

Expert Opinion on Drug Delivery

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Introduction: Therapeutic enzymes are currently used in the treatment of several diseases. In most cases, the benefits are limited due to poor in vivo stability, immunogenicity, and drug-induced inactivating antibodies. A partial solution to the problem is obtained by masking the therapeutic protein by chemical modifications. Unfortunately, this is not a satisfactory solution because frequent adverse events, including anaphylaxis, can arise. Area covered: Among the delivery systems, we focused on red blood cells for the delivery of therapeutic enzymes. Erythrocytes possess a long circulation time, a reduced immunogenicity, there is no need of chemical modifications and the encapsulated enzyme remains active because it is protected by the cell membrane. Here we discuss some representative applications of the preclinical developments of the field. Some of these are currently in clinic, others are approaching the clinic and others are illustrative of the development process. The selected examples are not always the most recent, but they are the most useful for a comparative approach. Expert opinion: The results discussed confirm the central role that red blood cells can play in the treatment of several conditions and suggest the benefit in using a natural cellular carrier in terms of pharmacokinetic, biodistribution, safety, and efficacy.

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Evidence-Based Pharmacotherapies for Alcohol Use Disorder

Cited by 47 publications

References 84 publications

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Severe Pain in Chronic Pancreatitis Patients: Considering Mental Health and Associated Genetic Factors

Pharmakologische Rückfallprophylaxe der Alkoholabhängigkeit

Preclinical developments of enzyme-loaded red blood cells

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