Erenumab for the Treatment of Episodic Migraine

Achal Patel, Mercer University College of Pharmacy

It is reported that migraines are the third most prevalent illness in the world, prominently affecting women. [1] Symptoms include visual disturbances, extreme sensitivity to sound, light, touch, and smell, and tingling or numbness in the extremities and face. [1] Migraines can be classified as either episodic (< 15 headache days/month) or chronic (≤ 15 headache days/month). [2]

Erenumab is a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide (CGRP) receptor that is involved in migraine pathophysiology through nociceptive mechanisms in the trigeminovascular system. [3] In a prior phase two trial, erenumab has shown a reduction in the number of episodic migraines at monthly doses of 70 mg and 140 mg. [3]

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Searching for a New Indication

Tibin K. Titus, Mercer University College of Pharmacy

Hypertension is a worldwide problem with its prevalence increasing in the aging population. Complications of hypertension include stroke and cardiovascular diseases. [1] Angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), diuretics, and calcium channel blockers are recommended as first line therapy. [2]

Sacubitril/valsartan (Entresto®) is a combination product consisting of an angiotensin receptor neprilysin inhibitor, sacubitril, and an ARB, valsartan. [3] Previous studies with sacubitril/valsartan have demonstrated significant reductions in office and ambulatory BP compared with valsartan or placebo. [4]

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Reaching a New APEX; Betrixaban vs. Enoxaparin for Thromboprophylaxis

Achal Patel, Mercer University College of Pharmacy

Venous thromboembolism (VTE) is the third leading cause of vascular diagnosis following heart attack and stroke. [1] It is categorized into two types: deep vein thrombosis (DVT) and pulmonary embolism (PE). Venous thromboembolism affects men and women of all ages, and patients that are immobilized are at a higher risk. [1]

The Chest Guidelines recommend anticoagulants for up to two weeks after hospital discharge. [2] However, the risk of a VTE remains increased for at least a month. Therefore, Bevyxxa® (betrixaban), which is a direct and selective factor Xa inhibitor, was tested for extended-duration therapy for thromboprophylaxis in acutely ill medical patients. [3]

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A Possible New Drug for Postmenopausal Osteoporosis

Tibin K. Titus, Mercer University College of Pharmacy

Postmenopausal osteoporosis occurs due to estrogen deficiency resulting in an increase of mature osteoclasts, which will increase bone resorption into the blood. [1] Simultaneously, there is a decrease in calcium absorption and increase in calcium excretion through the gut. [1] Romosozumab is a new monoclonal antibody that is in development for treatment of osteoporosis in postmenopausal women at increased risk of fractures. [2] In a previous trial, romosozumab reduced the risk of fracture compared to placebo; however, it has not been compared with an active comparator. [2] This study was conducted with an active comparator, alendronate, to compare the two drugs for fracture prevention in postmenopausal women with osteoporosis. [3]

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Canagliflozin vs Placebo in Type 2 Diabetes for CV and Renal Events

Achal Patel, Mercer University College of Pharmacy

Type 2 diabetes (T2D) is the more common form of diabetes mellitus compared to type 1 diabetes (T1D) and accounts for ~90% of all diabetes patients. [1] Complications of diabetes include cardiovascular, macrovascular, microvascular, peripheral nerve, and renal diseases. Evidence shows that use of SGLT2 inhibitors may help in reducing the risk of cardiovascular complications, albuminuria, and renal diseases. [2]

Canagliflozin (Invokana®), is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that lowers the renal threshold for glucose and increases urinary glucose excretion by interfering with the reabsorption of renally-filtered glucose across the tubular lumen of the proximal renal tubules. [3] Sodium-glucose cotransporter 2 inhibitors are the most recent type of diabetic agents approved for T2D management in the U.S. Previously, the Food and Drug Administration published a guidance for industry that new diabetic agents should be assessed for their cardiovascular safety. [2] The article below summarizes two canagliflozin trials that assessed its effect on CV risks (CANVAS) and albuminuria (CANVAS-R).

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Efficacy, Acceptability, and Safety of Atypical Antipsychotics in First Episode Schizophrenia

Achaia Taltoan, Mercer University College of Pharmacy

The American Psychiatric Association (APA) schizophrenia guidelines recommend all second-generation (“atypical”) antipsychotics as first-line treatment for first episode schizophrenia. [1] Unlike the APA guidelines, the 2009 schizophrenia PORT statements recommend risperidone, quetiapine, aripiprazole, and ziprasidone as first line therapy but not olanzapine due to the associated metabolic side effects. [2]

While trials such as the EUFEST and the CATIE trial have compared second-generation antipsychotics to first-generation antipsychotics, there is a lack of guidance whether one second-generation antipsychotic is better than the other in certain situations for the treatment of first episode schizophrenia. [3] This trial attempts to provide data to enhance the understanding of the efficacy, discontinuation rate, and adverse events of the second-generation antipsychotics in comparison with one another.

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