• Title/Summary/Keyword: Drug combination

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Drug Resistance and in Vitro Susceptibility of Plasmodium falciparum in Thailand during 1988-2003

  • Suwandittakul, Nantana;Chaijaroenkul, Wanna;Harnyuttanakorn, Pongchai;Mungthin, Mathirut;Bangchang, Kesara Na
    • Parasites, Hosts and Diseases
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    • v.47 no.2
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    • pp.139-144
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    • 2009
  • The aim of the present study was to investigate antimalarial drug pressure resulting from the clinical use of different antimalarials in Thailand. The phenotypic diversity of the susceptibility profiles of antimalarials, i.e., chloroquine (CQ), quinine (QN), mefloquine (MQ), and artesunate (ARS) in Plasmodium falciparum isolates collected during the period from 1988 to 2003 were studied. P. falciparum isolates from infected patients were collected from the Thai-Cambodian border area at different time periods (1988-1989, 1991-1992, and 2003), during which 3 different patterns of drug use had been implemented: MQ+sulphadoxine (S)+pyrimethamine (P), MQ alone and MQ+ARS, respectively. The in vitro drug susceptibilities were investigated using a method based on the incorporation of $[^3H]$ hypoxanthine. A total of 50 isolates were tested for susceptibilities to CQ, QN, MQ, and ARS. Of these isolates, 19, 16, and 15 were adapted during the periods 1988-1989, 1991-1993, and 2003, respectively. P. falciparum isolates collected during the 3 periods were resistant to CQ. Sensitivities to MQ declined from 1988 to 2003. In contrast, the parasite was sensitive to QN, and similar sensitivity profile patterns were observed during the 3 time periods. There was a significantly positive but weak correlation between the $IC_{50}$ values of CQ and QN, as well as between the $IC_{50}$, values of QN and MQ. Drug pressure has impact on sensitivity of P. falciparum to MQ. A combination therapy of MQ and ARS is being applied to reduce the parasite resistance, and also increasing the efficacy of the drug.

Association of Arrhythmia in the Elderly Patients on Combination Therapy of CYP3A4 Substrates and Inhibitors with the Korean Claims Data (CYP3A4 기질과 억제제 약물의 병용 고령환자에서 부정맥 부작용 연관성)

  • Tae Woo Kim;Junhyuk Chang;Eunjung Choo;Rae Woong Park;Sukhyang Lee
    • Korean Journal of Clinical Pharmacy
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    • v.33 no.4
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    • pp.242-253
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    • 2023
  • Background: Arrhythmia due to QT prolongation is one of the most serious adverse events with drug interactions in the elderly. This study aimed to examine the incidence of arrhythmia in Korean elderly patients who administered both cytochrome P450 3A4 (CYP3A4) substrates and inhibitors. Methods: Patients using CYP3A4 substrate and inhibitor were selected from the 2017 elderly patient dataset (the Korean Health Insurance Review and Assessment Service - Aged Population Sample). Selection criteria were patients with a medication possession ratio over 80%, medication duration of at least 7 days, and a follow-up period of 3 months or more. The patient's basic information is age, gender, health insurance type, and comorbidities. The top 50 drug pairs and comorbidity with high-incidence arrhythmia were presented. Results: In patients with drug combinations for over 7 days, there were 981 incidences of arrhythmia, and 351 incidences in those with combinations for over 30 days. The comorbidities of congestive heart failure and myocardial infarction had a significant association with incidence of arrhythmia. Among patients with 7 days or longer, the drug pairs [substrates-inhibitors] with significant adjusted odds ratio (aOR) were [propranolol-cimetidine] (aOR, 2.25; 95% confidence interval [CI], 1.66-3.04). Among patients with 30 days or longer, the drug pairs with significant aOR were [tramadol-amiodarone] (aOR, 2.87; 95% CI, 1.97-4.19). Conclusions: In elderly patients, the incidence of arrhythmia was high with drug interactions of CYP3A4 substrates and inhibitors. The comorbidity of congestive heart failure was the risk factor.

Anticancer Efficacies of Doxorubicin, Verapamil and Quercetin on FM3A Cells under Hyperthermic Temperature

  • Lee, Jeong-Beom;Bae, Jun-Sang;Park, Jeong-Hwan;Ham, Joo-Hyen;Min, Young-Ki;Yang, Hun-Mo;Timothy Othman;Kazuhiro Shimizu
    • Biotechnology and Bioprocess Engineering:BBE
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    • v.9 no.4
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    • pp.261-266
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    • 2004
  • Hyperthermia (HT) in combination with anticancer drugs (ACDs) had proven to more efficacious in various cancers, although efficacies vary according to chemotherapeutic compounds and cancer types. Presently there are few data that compares anticancer efficacies among ACDs under hyperthermic conditions. Therefore, we selected three commonly used ACDs (quercetin, verapamil and doxorubicin) and compared their antitumor effects when each was treated with 43$^{\circ}C$ HT exposure. Firstly, FM3A, a murine breast cancer cell line, was treated with each ACD for 1 h followed by 43$^{\circ}C$ exposure for additional 1 h, and examined the effects of: 1) each drug, 2) 43$^{\circ}C$ HT exposure, and 3) the combination of each drug and 43$^{\circ}C$ HT exposure for 1, 6 and 24 h. The determined overall effects on FM3A cells were arrested cell proliferation, clonogenic efficiency and apoptosis. Pre-treatment of FM3A cells to each ACD followed by 43$^{\circ}C$ HT exposure produced greater antitumor effects including suppressed cell proliferation, reduced clonogenic efficiency and increased apoptotic cell death, compared to ACD treatment or HT exposure alone. Apoptotic cell death occurred in a time-dependent manner. Among the ACDs, antitumor efficacies varied in the order of doxorubicin > verapamil > quercetin. It was concluded that heat exposure during ACD treatment of caner cells may be an important factor to get a better antitumor benefit, even though this benefit may differ from one drug to another.

Combined Treatment with Stattic and Docetaxel Alters the Bax/Bcl-2 Gene Expression Ratio in Human Prostate Cancer Cells

  • Mohammadian, Jamal;Sabzichi, Mehdi;Molavi, Ommoleila;Shanehbandi, Dariush;Samadi, Nasser
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.11
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    • pp.5031-5035
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    • 2016
  • Docetaxel, recognized as a stabilizing microtubule agent, is frequently administrated as a first line treatment for prostate cancers. Due to high side effects of monotherapy, however, combinations with novel adjuvants have emerged as an alternative strategy in cancer therapy protocols. Here, we investigated the combined effects of stattic and docetaxel on the DU145 prostate cancer cell line. Cytotoxicity was evaluated by MTT assay. To understand molecular mechanisms of stattic action, apoptotic related genes including Bcl-2, Mcl-1, Survivin and Bax were evaluated by real-time RT-PCR. Alteration in the expression of pro-apoptotic Bax and anti-apoptotic Bcl-2 genes and Bax/Bcl-2 ratio were investigated via the $2^{{\Delta}{\Delta}CT}$ method. The $IC_{50}$ values for docetaxel and stattic were $3.7{\pm}0.9nM$ and $4.6{\pm}0.8{\mu}M$, respectively. Evaluation of key gene expression levels revealed a noticeable decrease in antiapoptotic Bcl-2 and Mcl-1 along with an increase in pro-apoptotic Bax mRNA levels (p<0.05). Our results suggest that combination of a STAT3 inhibitor with doctaxel can be considered as a potent strategy for induction of apoptosis via increasing Bax mRNA expression.

Combination between Taxol-Encapsulated Liposomes and Eruca sativa Seed Extract Suppresses Mammary Tumors in Female Rats Induced by 7,12 Dimethylbenz(α)anthracene

  • Shaban, Nadia;Abdel-Rahman, Salah;Haggag, Amany;Awad, Doaa;Bassiouny, Ahmad;Talaat, Iman
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.1
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    • pp.117-123
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    • 2016
  • Taxol (paclitaxel) is a powerful anti-cancer drug widely used against several types of malignant tumors. Because Taxol may exert several side effects, a variety of formulations have been developed. One of these features liposomes, regarded as one of the most promising drug carriers, biocompatible and best able to reduce drug toxicity without changing efficacy against tumor cells. Eruca sativa seed extract (SE) is considered a promising natural product from cruciferous vegetables against breast cancer, increasing chemotherapeutic and eliminating harmful side effects. The effects of Taxol-encapsulated liposomes (T) alone and in combination between Eruca sativa seed extract on nuclear factor kappa B (NF-${\kappa}B$), cyclooxygenase-2 (COX-2) and B-cell lymphoma-2 (Bcl-2) gene expression levels were investigated in rat mammary gland carcinogenesis induced by 7,12 dimethylbenz(${\alpha}$) anthracene (DMBA) using qRT-PCR. The results showed that DMBA increased NF-${\kappa}B$, COX-2 and Bcl-2 gene expression levels and lipid peroxidation (LP), while decreasing glutathione-S-transferase (GST) and superoxide dismutase (SOD) activities and total antioxidant concentration (TAC) compared to the control group. T and T-SE treatment reduced NF-${\kappa}B$, COX-2 and Bcl-2 gene expression levels and LP. Hence, T and T-SE treatment appeared to reduce inflammation and cell proliferation, while increasing apoptosis, GST and SOD activities and TAC.

Analysis of Contaminated Heparins by the Combination of Glycosaminoglycan Degrading Enzymes and Nuclear Magnetic Resonance Spectroscopy (글리코사미노글칸 분해 효소와 핵자기공명을 이용한 오염된 헤파린 시료의 분석)

  • Im, A-Rang;Park, You-Mie;Hong, Chong-Hui;Lee, Su-Jung;Lee, Sun-Hee;Kim, Yeong-Shik
    • Korean Journal of Pharmacognosy
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    • v.40 no.2
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    • pp.109-117
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    • 2009
  • We examined the purity of six heparin samples by using heparinase, chondroitinase, $^{1}H-NMR$, and polyacrylamide gel electrophoresis. To obtain high molecular weight contaminants from heparin samples, heparinase I - digested samples were subjected to the exhaustive microcon filtration. The filtration process removed heparin-derived di- and oligosaccharides effectively. By combining chondroitinase ABC treatment and strong anion exchange - high performance liquid chromatography, the result showed all six samples contained chondroitin sulfate as a contaminant ranging from 1.3 to 14.9%. Among them, sample S3 showed the highest content of 14.9%, which was further analyzed by chondroitinase AC treatment to confirm chondroitin sulfate B (dermatan sulfate). $^{1}H-NMR$ chemical shifts of N-acetyl groups clearly suggested the existence of chondroitin sulfate B (sample S3) and oversulfated chondroitin sulfate (samples S2 and S4) as contaminants. In addition, polyacrylamide gel electrophoresis was useful for qualitative detection on the sample's purity. These results suggest that the tools of heparinase I and chondroitinase ABC in combination with NMR spectroscopy would give very useful information for investigation of heparin contaminants such as oversulfated chondroitin sulfate and dermatan sulfate in heparin samples.

Comparisons of Adherence, Efficacy and Price between Sitagliptin/Metformin Fixed-dose Combination Tablets and Concomitant Administration of Sitagliptin and Metformin in Type 2 Diabetes Mellitus Patients (제2형 당뇨병 환자에서 시타글립틴과 메트포민 고정 복합제 투여와 단일제 병용간의 복약 순응도, 효과 및 약가에 대한 비교 연구)

  • Park, Ji Hye;Lee, Byung Koo;Kim, Jae Youn;Gwak, Hye Sun
    • Korean Journal of Clinical Pharmacy
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    • v.24 no.3
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    • pp.193-198
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    • 2014
  • Objective: This study was conducted to compare the adherence, clinical and economical utility of fixed-dose combination tablets of sitagliptin/metformin with concomitant administration of sitagliptin and metformin in patients with type 2 diabetes mellitus. Methods: Adherence was measured as the medication possession ratio (MPR) of ${\geq}80%$, and MPR was calculated as the number of total prescription days divided by the total treatment period. Hemoglobin $A_{1C}$ ($HbA_{1c}$) differences between baseline and predetermined periods were analyzed. Proportions of patients who achieved $HbA_{1c}$ less than 6.5% for three or more consecutive times were compared. To evaluate cost-effectiveness, prices of sitagliptin, metformin and sitagliptin/metformin tablets were investigated. Results: More than 90% of patients showed adherence in both groups (92.0% in fixed-dose combination group vs 95.9% in concomitant administration group), and there was no statistically significant difference (P = 0.113). Proportion of patients with HbA1c less than 6.5% for three or more consecutive times tended to be somewhat higher in fixed dose combination group than in concomitant administration group without a statistically significant difference (32.6% vs. 28.0%, P = 0.344). Total price of metformin and sitagliptin was cheaper up to 222 KRW in the case of fixed-dose combination tablets compared to the case of concomitant administration. Conclusion: The sitagliptin/metformin fixed-dose combination tablet had a similar patient adherence and was not significantly different in efficacy to the concomitant administration of each component. In terms of drug prices, fixed-dose combination tablets were cheaper than concomitant administration of each tablet.

ABT-737 ameliorates docetaxel resistance in triple negative breast cancer cell line

  • Hwang, Eunjoo;Hwang, Seong-Hye;Kim, Jongjin;Park, Jin Hyun;Oh, Sohee;Kim, Young A;Hwang, Ki-Tae
    • Annals of Surgical Treatment and Research
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    • v.95 no.5
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    • pp.240-248
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    • 2018
  • Purpose: This study aimed to validate the synergistic effect of ABT-737 on docetaxel using MDA-MB-231, a triple negative breast cancer (TNBC) cell line overexpressing B-cell lymphoma-2 (Bcl-2). Methods: Western blot analysis was performed to assess expression levels of Bcl-2 family proteins and caspase-related molecules. Cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell cycle distribution was determined by flow cytometry analysis. Benzyloxycarbonyl-Val-Ala-Asp(OMe)-fluoromethylketone (z-VAD-fmk) was used for pretreatment to assess the role of caspases. Results: Cell viability of MDA-MB-231 after combination treatment with ABT-737 and docetaxel was significantly lower than that after docetaxel or ABT-737 monotherapy based on MTT assay (both P < 0.001), with a combination index of 0.41. The proportion of sub-G1 population after combination treatment was significantly higher than that after docetaxel or ABT-737 monotherapy (P = 0.001, P = 0.003, respectively). Pretreatment with z-VAD-fmk completely restored cell viability of MDA-MB-231 from apoptotic cell death induced by combination therapy (P = 0.001). Although pro-caspase-8 or Bid did not show significant change in expression level, pro-casepase-9 showed significantly decreased expression after combination treatment. Cleaved caspase-3 showed increased expression while poly (ADP-ribose) polymerase cleavage was induced after combination treatment. However, hypoxia-inducible factor 1-alpha and aldehyde dehydrogenase 1 totally lost their expression after combination treatment. Conclusion: Combination of ABT-737 with docetaxel elicits synergistic therapeutic effect on MDA-MB-231, a TNBC cell line overexpressing Bcl-2, mainly by activating the intrinsic pathway of apoptosis. Therefore, adjunct of ABT-737 to docetaxel might be a new therapeutic option to overcome docetaxel resistance of TNBCs overexpressing Bcl-2.

Experimental Studies of The Effects of Kyungok-go against Mycobacteria tuberculosis (경옥고(瓊玉膏)가 결핵균(結核菌)에 미치는 영향(影響)에 관(關)한 실험적(實驗的) 연구(硏究))

  • Jung, Hee-Jae;Jung, Seung-Ki;Rhee, Hyung-Koo;Jeon, Sang-Bok
    • The Journal of Internal Korean Medicine
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    • v.21 no.4
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    • pp.555-563
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    • 2000
  • Objective : In order to know the antibacterial effects of Kyungok-go against Mycobacteria tuberculosis, Methods : In this study, I inverstigated these effects in terms of combination of other antibiotics with and without Kyungok-go on several different media conditions. Results: On Ogawa medium, Kyungok-go of the $10{\mu}/ml$ concentration showed the anti-Mycobacteria tuberculosis activity against antibiotic drug-sensitive strain. On Middle-blue medium, Kyungok-go of the $10{\mu}/ml$ concentration showed the anti-Mycobacteria tuberculosis activity against antibiotic drug-sensitive strain. Kyungok-go showed the anti mycobacteria tuberculosis activity with the meaningful result above a certain concentration. The resistance against M, tuberculosis as the concentration of Kyungok-go was decreased significantlly on the high concentration($500{\mu}/ml$) When rifampicin and Kyungok-go were used together, the resistance was decreased with the statistical significance as to the persistant antibacterial effect against M. tuberculosis, When ciprofloxacin and Kyungok-go were used together, the resistance was decreased with the statistical significance as to the persistant antibacterial effect against M. tuberculosis, The combination of treatment, Kyungok-go with both rifampicin and ciprofloxacin, showed much better antibacterial effect against M, tuberculosis than antibiotics alone. Conclusions : This study shows that Kyungok-go has antibacterial effect against M. tuberculosis and in the combination of treatment, Kyungok-go with antibiotics, showed much better antibacterial effect against M. tuberculosis than antibiotics alone,.

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Clinical Outcomes of Antiplatelets Combined with Statins in Patients with Ischemic Heart Disease (허혈성 심장질환 환자에서 스타틴과 병용하는 항혈소판제 종류에 따른 임상결과)

  • Kim, Chungsoo;Lee, Jimin;Park, Rae Woong;Lee, Sukhyang
    • Korean Journal of Clinical Pharmacy
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    • v.29 no.4
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    • pp.254-266
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    • 2019
  • Background: Patients with cardiovascular risks are recommended to use statins and antiplatelet agents to prevent major cerebro-cardiovascular events (MACCE). Antiplatelet agents also possess anti-inflammatory and antioxidant effects, in addition to their inhibitory activity on platelets. The differences in clinical outcomes in ischemic heart disease (IHD) based on the type of antiplatelet therapy combined with statin treatment were investigated in this study. Methods: We conducted a retrospective cohort study using electronic medical records of IHD patients from January 2010 to December 2014 at Ajou University Hospital. Patients on combination therapy of antiplatelet drugs and statins were grouped based on antiplatelet drug types: clopidogrel, cilostazol, or sarpogrelate. Propensity score matching was applied to balance the baseline of the groups of clopidogrel vs. cilostazol and the groups of clopidogrel vs. sarpogrelate. The incidence and risk of MACCE as primary outcomes were assessed between the groups of antiplatelet drugs. Results: Among the approximately 128,500 patients with IHD, 1,049 patients had taken a combination therapy of statin and antiplatelet agents. The cohorts of patients administered clopidogrel, cilostazol, or sarpogrelate were 906, 79, and 64, respectively. The incidence of MACCE was not significantly different among the cohorts (p=0.58), and there were no differences between clopidogrel vs. cilostazol (p=0.72) or clopidogrel vs. sarpogrelate (p=1.00) after propensity score matching. Conclusion: There was no difference in the incidence of MACCE based on the type of antiplatelet drug (clopidogrel, cilostazol, or sarpogrelate) in combination with a statin in patients with IHD.