Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review
AbstractPsychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assess...
Source: CNS Drugs - April 20, 2021 Category: Neurology Source Type: research

Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies
AbstractAs many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug –drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug–drug interactio...
Source: CNS Drugs - April 18, 2021 Category: Neurology Source Type: research

Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report
ConclusionThe final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms.Clinical Trials RegistryClinicalTrials.gov identifier: NCT016557. (Source: CNS Drugs)
Source: CNS Drugs - April 16, 2021 Category: Neurology Source Type: research

Disruption of Pharmacotherapy During the Transition from Adolescence to Early Adulthood in Patients with Attention-Deficit/Hyperactivity Disorder: A Claims Database Analysis Across the USA
AbstractBackground and ObjectiveAttention-deficit/hyperactivity disorder (ADHD) treatment rates in adults are low, possibly owing to discontinuation of pediatric care due to various circumstances (including inadequate health insurance coverage, poor disease insight, and patient/family resistance, as well as those who manage their ADHD independent of pharmacologic intervention) during the transition from adolescence to adulthood. To improve the understanding of treatment patterns during this transition, this study characterized pharmacotherapy use in patients with ADHD aged 16 –21 years.MethodsA retrospective claims a...
Source: CNS Drugs - April 15, 2021 Category: Neurology Source Type: research

Predicting Infection Risk in Multiple Sclerosis Patients Treated with Ocrelizumab: A Retrospective Cohort Study
ConclusionsHigher serum IgA and IgG and older age were associated with reduced odds of infection. Our findings highlight that infection risk is not uniform in patients with MS receiving ocrelizumab and substantiate the need to monitor immunoglobulin levels pre-treatment and whilst on therapy. (Source: CNS Drugs)
Source: CNS Drugs - April 13, 2021 Category: Neurology Source Type: research

Comparative Efficacy and Safety of Ozanimod and Dimethyl Fumarate for Relapsing-Remitting Multiple Sclerosis Using Matching-Adjusted Indirect Comparison
ConclusionsAfter adjustment of baseline patient characteristics, the MAIC demonstrated that the efficacy and safety of ozanimod 1.0 mg OD was superior to that of DMF 240 mg BID. Although a MAIC is less likely to produce biased estimates than a na ïve or a standard indirect treatment comparison via a common comparator, limitations include potential confounding due to unobserved and thus unaccounted for baseline differences. (Source: CNS Drugs)
Source: CNS Drugs - April 13, 2021 Category: Neurology Source Type: research

Pharmacotherapy for Frontotemporal Dementia
AbstractFrontotemporal dementia is a heterogeneous spectrum of neurodegenerative disorders. The neuropathological inclusions are tau proteins, TAR DNA binding protein 43 kDa-TDP-43, or fused in sarcoma-ubiquitinated inclusions. Genetically, several autosomal mutations account for the heritability of the disorder. Phenotypically, frontotemporal dementia can present with a behavioral variant or a language variant called primary progressive aphasia. To date, there are no approved symptomatic or disease-modifying treatments for frontotemporal dementia. Currently used therapies are supported by low-level of evidence (mostly unc...
Source: CNS Drugs - April 11, 2021 Category: Neurology Source Type: research

The Impact of Antipsychotic Formulations on Time to Medication Discontinuation in Patients with Schizophrenia: A Dutch Registry-Based Retrospective Cohort Study
ConclusionsTime to discontinuation differed considerably between formulations. The duration of recent antipsychotic use was a strong predictor of time to discontinuation. While oral-daily formulations had the longest time to discontinuation in the long-term recent antipsychotic use group, discontinuation trends were similar for oral-weekly and depot formulations. An oral-weekly formulation, whose administration route is noninvasive, might therefore be considered an alternative to depot formulations. (Source: CNS Drugs)
Source: CNS Drugs - April 10, 2021 Category: Neurology Source Type: research

Sphingosine 1-Phosphate Receptor Modulators for Multiple Sclerosis
AbstractFingolimod (Gilenya) received regulatory approval from the US FDA in 2010 as the first-in-class sphingosine 1-phosphate (S1P) receptor (S1PR) modulator and was the first oral disease-modifying therapy (DMT) used for the treatment of the relapsing forms of multiple sclerosis (MS). Development of this new class of therapeutic compounds has continued to be a pharmacological goal of high interest in clinical trials for treatment of various autoimmune disorders, including MS. S1P is a physiologic signaling molecule that acts as a ligand for a group of cell surface receptors. S1PRs are expressed on various body tissues a...
Source: CNS Drugs - April 2, 2021 Category: Neurology Source Type: research

Pharmacokinetics and Bioavailability of Monomethyl Fumarate Following a Single Oral Dose of Bafiertam ™ (Monomethyl Fumarate) or Tecfidera ® (Dimethyl Fumarate)
ConclusionsBased on the statistical analysis results of the pharmacokinetic parameters of MMF, a single oral dose of two Bafiertam ™ DR 95 mg capsules is bioequivalent to a single oral dose of one Tecfidera® DR 240  mg capsule.Clinical Trial RegistrationThis study was retrospectively registered with ClinicalTrials.gov (NCT04570670) on 30 September, 2020. (Source: CNS Drugs)
Source: CNS Drugs - March 30, 2021 Category: Neurology Source Type: research

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study
ConclusionsClinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation. (Source: CNS Drugs)
Source: CNS Drugs - March 29, 2021 Category: Neurology Source Type: research

Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions
AbstractIn this review, we consider issues relating to the pharmacological treatment of young children with attention deficit hyperactivity disorder (ADHD). ADHD in preschool-age children has a profound impact on psychosocial function and developmental trajectory. Clinical studies on pharmacotherapies for ADHD in young children have expanded rapidly in the past 2 decades, providing some evidence of efficacy for both psychostimulant and non-psychostimulant medications. However, preschool children may be more susceptible to adverse effects of medications, including growth reduction and cardiovascular side effects. Many quest...
Source: CNS Drugs - March 26, 2021 Category: Neurology Source Type: research

First-in-Human Randomized Trial to Assess Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of the KDM1A Inhibitor Vafidemstat
ConclusionsVafidemstat displayed good safety and tolerability. This phase I trial confirmed KDM1A TE and CNS penetration and permitted characterization of platelet dynamics and selection of phase IIa doses.Trial registrationEUDRACT No. 2015-003721-33, filed 30 October 2015. (Source: CNS Drugs)
Source: CNS Drugs - March 23, 2021 Category: Neurology Source Type: research

Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox –Gastaut Syndrome
ConclusionsThe currently available data suggest that response to treatment with a highly purified, plant-derived CBD oil-based solution can be seen in patients across a broad range of epilepsy disorders and etiologies. The existing evidence can provide preliminary support for additional research. (Source: CNS Drugs)
Source: CNS Drugs - March 22, 2021 Category: Neurology Source Type: research

COVID-19 in Patients with Multiple Sclerosis: Associations with Disease-Modifying Therapies
The objective of this study was to describe the overall risk of coronavirus disease 2019 (COVID-19) infection, severe disease course, and potential population-level predictors of COVID-19 infection in PwMS, and to provide a context using a cohort of patients with systemic lupus erythematosus (SLE). In addition, the association of different MS DMTs with the incidence and clinical course of COVID-19 was evaluated. Safety data from the Biogen Global Safety Database are also presented on reported cases of COVID-19 in patients treated with Biogen MS therapies.MethodsThe IBM® Explorys electronic health record database of>...
Source: CNS Drugs - March 20, 2021 Category: Neurology Source Type: research

Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program
ConclusionsFindings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study. (Source: CNS Drugs)
Source: CNS Drugs - March 13, 2021 Category: Neurology Source Type: research

Cognitive Outcomes with Sequential Escitalopram Monotherapy and Adjunctive Aripiprazole Treatment in Major Depressive Disorder: A Canadian Biomarker Integration Network in Depression (CAN-BIND-1) Report
ConclusionsEscitalopram monotherapy in acute MDD did not result in significant cognitive improvements. We provide novel evidence that escitalopram continuation in responders does not adversely affect cognition, but adjunctive aripiprazole in escitalopram non-responders worsens reaction time. Treatments targeting cognitive dysfunction are needed in MDD.ClinicalTrials.gov identifierNCT01655706; 2 August, 2012. (Source: CNS Drugs)
Source: CNS Drugs - March 8, 2021 Category: Neurology Source Type: research

Targeting β-Arrestins in the Treatment of Psychiatric and Neurological Disorders
AbstractTherapies for psychiatric and neurological disorders have been in the development and refinement process for the past 5 decades. Yet, most of these therapies lack optimal therapeutic efficacy and have multiple debilitating side effects. Recent advances in understanding the pathophysiological processes of psychiatric and neurological disorders have revealed an important role for β-arrestins, which are important regulators of G-protein-coupled receptor (GPCR) function, including desensitization and intracellular signaling. These findings have pushed β-arrestins to the forefront as potential therapeutic targ...
Source: CNS Drugs - March 2, 2021 Category: Neurology Source Type: research

Psychotropic Drug-Induced Glaucoma: A Practical Guide to Diagnosis and Management
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals wit...
Source: CNS Drugs - February 19, 2021 Category: Neurology Source Type: research

Effect of Enzyme-Inducing Antiseizure Medications on the Risk of Sub-Therapeutic Concentrations of Direct Oral Anticoagulants: A Retrospective Cohort Study
ConclusionsConcurrent EI-ASM and DOAC use presents a possible risk for DOAC concentrations below the expected range. The clinical significance of the interaction is currently unclear. (Source: CNS Drugs)
Source: CNS Drugs - February 17, 2021 Category: Neurology Source Type: research

Use of Topiramate in the Spectrum of Addictive and Eating Disorders: A Systematic Review Comparing Treatment Schemes, Efficacy, and Safety Features
DiscussionThough off-label, addiction specialists should consider topiramate as a second-line option for drinking reduction in alcohol use disorder, as well as for binge eating disorder or cocaine use disorder. (Source: CNS Drugs)
Source: CNS Drugs - February 16, 2021 Category: Neurology Source Type: research

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations
AbstractInfusion of levodopa-carbidopa intestinal gel (LCIG; also designated carbidopa-levodopa enteral suspension) for 16 hours is a standard treatment for patients with advanced Parkinson ’s disease, and clinical observations suggest that 24-hour LCIG infusion may further reduce symptoms. This review provides practical advice on the management of patients transitioning to 24-hour LCIG infusion. We review available clinical data for 24-hour infusion and discuss adjustments to dosing , recommendations for monitoring, and management of patient concerns, based on our clinical experience. Data from multiple studies sugg...
Source: CNS Drugs - February 13, 2021 Category: Neurology Source Type: research

Sex Differences in the Risk of Cutaneous Adverse Drug Reactions Induced by Antiseizure Medications: A Systematic Review and Meta-analysis
This study sought to perform a systematic review, meta-analysis, and meta-regression to compare the ASM cADR risks between females and males.MethodsWe searched the literature using three databases (EMBASE, PubMed, and Web of Science) between October 1998 and November 2018, later updated to October 2019. Studies were included in the meta-analysis if they met the following criteria: (1) observational studies that estimated the incidence of cADRs related to ASMs; (2) provided the risk or odds ratio (OR) for cADRs among female and male patients exposed to ASMs; and (3) provided information on patients ’ characteristics. ...
Source: CNS Drugs - February 12, 2021 Category: Neurology Source Type: research

Rotigotine Transdermal Patch for Motor and Non-motor Parkinson ’s Disease: A Review of 12 Years’ Clinical Experience
AbstractMotor and non-motor symptoms (NMS) have a substantial effect on the health-related quality of life (QoL) of patients with Parkinson's disease (PD). Transdermal therapy has emerged as a time-tested practical treatment option, and the rotigotine patch has been used worldwide as an alternative to conventional oral treatment for PD. The efficacy of rotigotine on motor aspects of PD, as well as its safety and tolerability profile, are well-established, whereas its effects  on a wide range of NMS have been described and studied but are not widely appreciated. In this review, we present our overall experience wi...
Source: CNS Drugs - February 9, 2021 Category: Neurology Source Type: research

Pharmacotherapy to Manage Central Post-Stroke Pain
AbstractCentral post-stroke pain is a chronic neuropathic pain syndrome following a cerebrovascular accident. The development of central post-stroke pain is estimated to occur in 8 to 55% of stroke patients and is described as constant or intermittent neuropathic pain accompanied by dysesthesia of temperature and/or pressure sensations. These pain and sensory deficits are within the area of the body corresponding to the stroke lesion. The onset of pain is usually gradual, though it can develop either immediately after stroke or years after. Given the diversity in its clinical presentation, central post-stroke pain is a cha...
Source: CNS Drugs - February 7, 2021 Category: Neurology Source Type: research

Idarucizumab Reversal of Dabigatran in Patients with Acute Ischemic Stroke and Intracranial Hemorrhage: Comparison with Non-idarucizumab-Treated Patients
AbstractBackgroundIdarucizumab reverses the anticoagulant dabigatran; it is recommended during intravenous thrombolysis treatment of dabigatran-treated patients with acute ischemic stroke (AIS) and in dabigatran-treated patients with intracranial hemorrhage (ICH).MethodsOutcomes of consecutive idarucizumab/dabigatran-treated patients with intravenous thrombolysis-treated AIS (n = 22) were compared with consecutive similar intravenous thrombolysis-treated patients with AIS who were not anticoagulated (n = 182) [primary aim]; idarucizumab/dabigatran-treated patients with ICH (n = 13) were compared with patients with ICH who ...
Source: CNS Drugs - February 6, 2021 Category: Neurology Source Type: research

Application of Real-World Data and the REWARD Framework to Detect Unknown Benefits of Memantine and Identify Potential Disease Targets for New NMDA Receptor Antagonists
ConclusionThe present results confirm that NMDA receptor antagonism may have broader therapeutic utility than previously recognized. Further observational and clinical research may be warranted to explore the therapeutic benefit of NMDA antagonists for the outcomes found in this study. (Source: CNS Drugs)
Source: CNS Drugs - February 4, 2021 Category: Neurology Source Type: research

Inhibitors of Src Family Kinases, Inducible Nitric Oxide Synthase, and NADPH Oxidase as Potential CNS Drug Targets for Neurological Diseases
AbstractNeurological diseases share common neuroinflammatory and oxidative stress pathways. Both phenotypic and molecular changes in microglia, astrocytes, and neurons contribute to the progression of disease and present potential targets for disease modification. Src family kinases (SFKs) are present in both neurons and glial cells and are upregulated following neurological insults in both human and animal models. In neurons, SFKs interact with post-synaptic protein domains to mediate hyperexcitability and neurotoxicity. SFKs are upstream of signaling cascades that lead to the modulation of neurotransmitter receptors and ...
Source: CNS Drugs - January 30, 2021 Category: Neurology Source Type: research

Intranasal Insulin for Alzheimer ’s Disease
AbstractBrain insulin signaling contributes to memory function and might be a viable target in the prevention and treatment of memory impairments including Alzheimer ’s disease. This short narrative review explores the potential of central nervous system (CNS) insulin administration via the intranasal pathway to improve memory performance in health and disease, with a focus on the most recent results. Proof-of-concept studies and (pilot) clinical trials in ind ividuals with mild cognitive impairment or Alzheimer’s disease indicate that acute and prolonged intranasal insulin administration enhances memory perfor...
Source: CNS Drugs - January 30, 2021 Category: Neurology Source Type: research

Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview
AbstractThe availability of long-acting injectable (LAI) antipsychotics for the treatment of schizophrenia provides clinicians with options that deliver continuous drug exposure and may improve adherence compared with daily oral antipsychotics. However, all LAI antipsychotics have unique formulations and pharmacokinetic characteristics that have implications for medication selection, administration interval, and injection site. This review outlines key differences in drug formulations and pharmacokinetics among LAI antipsychotics. A systematic search of the PubMed database was conducted to identify physical and formulation...
Source: CNS Drugs - January 28, 2021 Category: Neurology Source Type: research

Expanding the Treatment Landscape for Lennox-Gastaut Syndrome: Current and Future Strategies
AbstractLennox-Gastaut syndrome (LGS), a childhood-onset severe developmental and epileptic encephalopathy (DEE), is an entity that encompasses a heterogenous group of aetiologies, with no single genetic cause. It is characterised by multiple seizure types, an abnormal EEG with generalised slow spike and wave discharges and cognitive impairment, associated with high morbidity and profound effects on the quality of life of patients and their families. Drug-refractory seizures are a hallmark and treatment is further complicated by its multiple morbidities, which evolve over the patient ’s lifetime. This review provides...
Source: CNS Drugs - January 21, 2021 Category: Neurology Source Type: research

Correction to: Siponimod: A Review in Secondary Progressive Multiple Sclerosis
The article Siponimod: A Review in Secondary Progressive Multiple Sclerosis (Source: CNS Drugs)
Source: CNS Drugs - January 18, 2021 Category: Neurology Source Type: research

Correction to: OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use
The article OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use, written by James E. Frampton, was originally published electronically on SpringerLink on 11 December 2020 without open access. After publication in volume 34, issue 12, page 1287 –1298, AbbVie requested that the article be Open Choice to make the article an open access publication. Post-publication open access was funded by AbbVie. Therefore, the copyright of the article has been changed to © Springer Nature Switzerland AG 2020 and the article is forthwith distributed und er the terms of the Creative Commons Attribution NonCommercial 4.0 I...
Source: CNS Drugs - January 16, 2021 Category: Neurology Source Type: research

Efficacy and Safety of Ibuprofen Plus Paracetamol in a Fixed-Dose Combination for Acute Postoperative Pain in Adults: Meta-Analysis and a Trial Sequential Analysis
AbstractBackgroundIbuprofen and paracetamol (acetaminophen) are very commonly used for analgesia and pain. In 2020, the US FDA gave its first approval of a fixed-dose combination (FDC) of the two drugs in the same tablet for postoperative pain. There has been no quantitative, summative analysis of the FDC effect size measures against postoperative pain in adults. Similar analyses exist, but only in pediatric patients.ObjectiveThis was the first meta-analysis to compare the efficacy and safety outcomes of the ibuprofen/paracetamol FDC against placebo, administered postoperatively, for moderate to severe pain relief in adult...
Source: CNS Drugs - January 11, 2021 Category: Neurology Source Type: research

Safety and Efficacy of Sovateltide (IRL-1620) in a Multicenter Randomized Controlled Clinical Trial in Patients with Acute Cerebral Ischemic Stroke
AbstractBackgroundSovateltide (IRL-1620, PMZ-1620), an endothelin-B receptor agonist, has been previously shown to increase cerebral blood flow, have anti-apoptotic activity and produce neurovascular remodeling when administered intravenously following acute cerebral ischemic stroke in rats. Its safety and tolerability were confirmed in healthy human volunteers (CTRI/2016/11/007509).ObjectiveOur objective was to determine the safety, tolerability and efficacy of sovateltide as an addition to standard of care (SOC) in patients with acute cerebral ischemic stroke.MethodsA prospective, multicentric, randomized, double-blind, ...
Source: CNS Drugs - January 11, 2021 Category: Neurology Source Type: research

Opicapone: A Review in Parkinson ’s Disease
AbstractOral opicapone (Ongentys®), a potent third-generation, peripheral catechol-O-methyltransferase (COMT) inhibitor, is approved as adjunctive therapy to preparations of levodopa/dopa-decarboxylase inhibitor (L-dopa/DDCI) in adults with Parkinson ’s disease (PD) and end-of dose (EoD) motor fluctuations. In pivotal global trials (BIPARK 1 and BIPARK 2; 14–15 weeks’ duration), open-label extensions (OLEs) of BIPARK, and in the real-world setting (OPTIPARK; 3–6 months), opicapone 50 mg once daily was an effective and generally well tole rated adjunctive therapy to L-dopa/DDCI plus other PD ther...
Source: CNS Drugs - January 11, 2021 Category: Neurology Source Type: research

OnabotulinumtoxinA in Chronic Migraine: A Profile of Its Use
AbstractOnabotulinumtoxinA (Botox®; a formulation of botulinum toxin type A (BoNT/A)] is indicated for the prevention of headaches in adults with chronic migraine (CM) in numerous countries, including those of Europe. In clinical trials, intramuscular administration of BoNT/A (155 –195 units at 12-week intervals) to patients with CM was generally well tolerated and associated with sustained and clinically meaningful improvements in multiple assessments of headache symptoms, headache-related impact and/or disability and migraine-specific health-related quality of life over a period of 1 year (in the pivotal PREEMP...
Source: CNS Drugs - December 11, 2020 Category: Neurology Source Type: research

Evaluation of Prescription Practices of Domperidone in Parkinson ’s Disease: A Cross Sectional Study Among French Neurologists
ConclusionsThese findings show most French neurologists who responded to our questionnaire do not fully follow the restrictions on domperidone use, particularly in terms of treatment duration, and in patients receiving continuous apomorphine treatment. This may reflect the unmet need to prevent nausea in patients with Parkinson ’s disease treated with dopaminergic drugs, particularly continuous apomorphine therapy. (Source: CNS Drugs)
Source: CNS Drugs - December 5, 2020 Category: Neurology Source Type: research

Cannabinoids in the Treatment of Insomnia Disorder: A Systematic Review and Meta-Analysis
ConclusionsFew studies have examined the efficacy of cannabinoids in the treatment of insomnia disorder. Despite some possible signals for efficacy, the heterogeneity of participants, interventions, efficacy outcomes and results, and the high risk of bias across included trials, do not reliably inform evidence-based practice. This review highlights shortcomings in the existing literature, including lack of diagnostic clarity, poorly defined participant groups, non-standardised interventions and studies of inappropriate design, duration and power to detect clinically meaningful outcomes. Further research in the form of high...
Source: CNS Drugs - November 26, 2020 Category: Neurology Source Type: research

Three-Year Effectiveness of Dimethyl Fumarate in Multiple Sclerosis: A Prospective Multicenter Real-World Study
The objective of this study was to describe the profile of patients who receive DMF and to assess the effectiveness of DMF regarding relapses, disability progression, magnetic resonance imaging activity, and NEDA (No Evidence Disease Activity)-3 status in a Spanish population in a real-world setting.MethodsWe conducted a multicenter prospective study of patients who started DMF between 2014 and 2019 in Spain. Three subgroups were considered: na ïve, switch to DMF because of inefficacy, and switch to DMF because of adverse effects. The effects of DMF on clinical and radiological measures were evaluated.ResultsAmong 886...
Source: CNS Drugs - November 23, 2020 Category: Neurology Source Type: research

Pharmacological Interactions between the Dual Orexin Receptor Antagonist Daridorexant and Ethanol in a Double-Blind, Randomized, Placebo-Controlled, Double-Dummy, Four-Way Crossover Phase I Study in Healthy Subjects
ConclusionsApart from a shift intmax, no relevant changes in PK parameters were observed following coadministration of daridorexant and ethanol. The coadministration led to reinforced drug actions that were, at most, indicative of infra-additive effects on certain PD markers. Patients will be advised not to consume ethanol with daridorexant.Clinical Trials Registration number:NCT03609775 (ClinicalTrials.gov Identifier) (Source: CNS Drugs)
Source: CNS Drugs - November 18, 2020 Category: Neurology Source Type: research

Acknowledgement to Referees
(Source: CNS Drugs)
Source: CNS Drugs - November 13, 2020 Category: Neurology Source Type: research

Improving the Delivery of Levodopa in Parkinson ’s Disease: A Review of Approved and Emerging Therapies
AbstractLevodopa is the most effective drug for the treatment of Parkinson ’s disease, but its use as an oral medication is complicated by its erratic absorption, extensive metabolism and short plasma half-life. On long-term use and with disease progression, there is a high incidence of motor and non-motor complications, which remain a major clinical and research challen ge. It is widely accepted that levodopa needs to be administered using formulations that result in good and consistent bioavailability and the physiologically relevant and continuous formation of dopamine in the brain to maximise its efficacy while a...
Source: CNS Drugs - November 4, 2020 Category: Neurology Source Type: research

Levetiracetam versus Phenytoin for the Pharmacotherapy of Benzodiazepine-Refractory Status Epilepticus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
ConclusionPharmacotherapy for BZD-refractory SE by LEV is superior to PHT in efficacy and safety outcomes. (Source: CNS Drugs)
Source: CNS Drugs - October 27, 2020 Category: Neurology Source Type: research

Siponimod: A Review in Secondary Progressive Multiple Sclerosis
AbstractOral siponimod (Mayzent®), a next-generation, selective sphingosine 1-phosphate receptor (S1PR) 1 and 5 modulator, is approved in several countries for the treatment of secondary progressive multiple sclerosis (SPMS), with specific indications varying between individual countries. In the pivotal EXPAND trial (median duration double-blind treatment 18 months) in a broad spectrum of patients with SPMS, once-daily oral siponimod 2  mg (initial dose titration over 6 days) was significantly more effective than placebo in reducing clinical and MRI-defined outcomes of disease activity and disability progression, ...
Source: CNS Drugs - October 27, 2020 Category: Neurology Source Type: research

The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases
AbstractDepression is common in older adults and those with cardiovascular disease. Although selective serotonin reuptake inhibitors generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when selective serotonin reuptake inhibitors are not effective. This qualitative narrative review summarizes what is known about the cardiovascular side effects of some of the newer antidepressants. Twelve novel non-selective serotonin reuptake inhibitor antidepressants were identified from the literature: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levo...
Source: CNS Drugs - October 16, 2020 Category: Neurology Source Type: research

Antipsychotics and Risk of Neuroleptic Malignant Syndrome: A Population-Based Cohort and Case-Crossover Study
ConclusionsOur results suggest that recent use of antipsychotics is associated with NMS. Although a case-only design inherently controls for confounding by time-invariant factors, residual confounding by acute medical conditions with similar presentations to NMS cannot be fully excluded. (Source: CNS Drugs)
Source: CNS Drugs - October 2, 2020 Category: Neurology Source Type: research

Effects of Antipsychotic Drugs: Cross Talk Between the Nervous and Innate Immune System
AbstractConverging lines of evidence suggest that activation of microglia (innate immune cells in the central nervous system [CNS]) is present in a subset of patients with schizophrenia. The extent to which antipsychotic drug treatment contributes to or combats this effect remains unclear. To address this question, we reviewed the literature for evidence that antipsychotic exposure influences brain microglia as indexed by in vivo neuroimaging and post-mortem studies in patients with schizophrenia and experimental animal models. We found no clear evidence from clinical studies for an effect of antipsychotics on either trans...
Source: CNS Drugs - September 24, 2020 Category: Neurology Source Type: research

Overview of Current Drug Delivery Methods Across the Blood –Brain Barrier for the Treatment of Primary Brain Tumors
AbstractExisting drug delivery methods have not led to a significant increase in survival for patients with malignant primary brain tumors. While the combination of conventional therapies consisting of surgery, radiotherapy, and chemotherapy has improved survival for some types of brain tumors (e.g., WNT medulloblastoma), other types of brain tumors (e.g., glioblastoma and diffuse midline glioma) still have a poor prognosis. The reason for the differences in response can be largely attributed to the blood –brain barrier (BBB), a specialized structure at the microvasculature level that regulates the transport of molec...
Source: CNS Drugs - September 22, 2020 Category: Neurology Source Type: research

Rapidity of CNS Effect on Photoparoxysmal Response for Brivaracetam vs. Levetiracetam: A Randomized, Double-blind, Crossover Trial in Photosensitive Epilepsy Patients
ConclusionOutcome studies directly comparing LEV and BRV are needed to define the clinical utility of the response with BRV, which was several minutes faster than that with LEV.Clinical trialsClinTrials.gov Identifier  = NCT03580707; registered 07-09-18 (Source: CNS Drugs)
Source: CNS Drugs - September 18, 2020 Category: Neurology Source Type: research