Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis

Long Buu Huynh, Mercer University College of Pharmacy

Osteoporosis, or “porous bone”, is a bone disease characterized by a loss of bone mass and change in bone structure. There are no symptoms since osteoporosis is a silent condition. Risk factors that can cause osteoporosis are lifestyle choices, certain diseases, medications, and age. [1] Romosozumab is a medication used to help increase bone formation and decrease bone resorption. Alendronate is classified as an antiresorptive agent and used as first-line therapy for osteoporosis. The aim of this study is to investigate the effectiveness of romosozumab followed by alendronate compared with alendronate alone in postmenopausal women with osteoporosis and a previous fracture. [2]

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Where are We with the New Zika Vaccine?

Tanya Huang, Mercer University College of Pharmacy

The Zika virus (ZIKV) was first discovered in 1947 in Uganda, and infection cases were observed sporadically in Africa and Southeast Asia. The virus is primarily transmitted to humans through Aedes mosquitoes, which are also present in the United States (Aedes albopictus). Transmission through mosquito bites are implicated for pathogenic outbreaks. Other modes of transmission include sexual transmission and transfusion-related transmission. Although the virus is detectable in breast milk, transmission via breastfeeding has not yet been reported.    Zika virus infection are often asymptomatic (~80%) or exhibit mild symptoms that resolve in a few days. Common symptoms of the infection are fever, itchy maculopapular rash, nonpurulent conjunctivitis, arthralgia of small joints of the hands and feet, myalgia, and headache involving retro-orbital pain. Serious complications such as death, hemorrhagic complications, and/or hospitalizations due to infection are rare compared to other types of infections (e.g. yellow fever and dengue infections). [1]

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Pantoprazole or Placebo for Stress Ulcer Prophylaxis?

Kishan Patel, Mercer University College of Pharmacy

Stress ulcer prophylaxis is recommended for adult ICU patients with coagulopathy or patients that require mechanical ventilation for more than 48 hours according to guidelines by the American Society of Health System Pharmacists (ASHP) and the Society for Critical Care Medicine. [1,2] However, there have only been two studies that compare the use of proton pump inhibitors (PPIs) with placebo for the prevention of gastrointestinal (GI) bleeding in adult patients in the ICU. Furthermore, neither study results provide robust evidence that supports the use of PPI in for stress ulcer prophylaxis. [3] Moreover, several other observational studies have seen a strong association between stress ulcer prophylaxis treatment and Clostridium difficile infections and ventilator-associated pneumonia. Therefore, some suggest that the use of PPIs for prophylaxis in critically ill patients may be causing more harm than benefit. [4,5]

Despite the limited evidence and potential harm, use of PPI for stress ulcer prophylaxis is a common practice. Therefore, the Pantoprazole or Placebo for Stress Ulcer Prophylaxis (POP-UP) trial was designed as an exploratory study to evaluate whether the benefits of stress ulcer prophylaxis outweigh its potential harm. [3]

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Tezepelumab in Adults with Uncontrolled Asthma

Christopher Ling, Mercer University College of Pharmacy

Asthma is a prevalent disorder that affects approximately 300 million people worldwide and is projected to increase to 400 million by 2025. [1] While most patients can be managed on current recommended therapies (e.g. long-acting and short-acting beta agonists [LABAs/ SABAs], inhaled glucocorticoids, long-acting and short-acting muscarinic antagonists), some patients remain uncontrolled. [2] Thymic stromal lymphopoietin (TSLP) is a cytokine produced in response to environmental and proinflammatory stimuli with the ability to promote B cell and dendritic cell activation. [3]  Its expression is increased in patients with severe asthma and is suggested to be correlated with Th2 cytokine and chemokine expression. [4]

Tezepelumab is a human IgG2 monoclonal antibody that inhibits TSLP interactions with TSLP receptor complexes. One study showed that in mild, atopic asthmatic patients, tezepelumab inhibited both early and late asthmatic response and suppressed biomarkers of type 2 inflammation after inhaled allergen challenge. [5] To further explore the effectiveness of tezepelumab, the following study evaluated the effects of tezepelumab in patients with moderate-to-severe asthma who were uncontrolled with LABAs combined with medium-to-high doses of inhaled glucocorticoids. [6]

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Early Exposure of Peanuts to Reduce Risk of Peanut Allergy

Christopher Ling, Mercer University College of Pharmacy

Peanut allergy is one of the most common food allergies, and is represented as nearly a quarter of all allergies in children. It is suggested the allergy is least likely to be outgrown, and is associated with more severe reactions in children. [1] Due to the prevalence and severity of reaction, some recommend introducing peanut-containing products as early as four months old in those at risk of developing a peanut allergy. Moreover, if the infant has severe eczema, egg allergy, or both, specific immunoglobulin E (sIgE) measurements, skin prick test (SPT), and/or oral food challenge (OFC) are recommended before the exposure. [2] This recommendation is based on the Learning Early About Peanut Allergy (LEAP) trial results that show higher risk of peanut allergy in infants with severe eczema and/or egg allergy. [3]

In a study analyzing the data from the LEAP trial, children that consumed peanut products early had less prevalence of a peanut allergy than those that avoided peanut products in both SPT negative (1.9% vs. 13.7%; p< 0.001)  and SPT positive (10.6% vs. 35.3%; p= 0.004) groups. [4] The same authors then did a follow up study (LEAP-ON) consisting of all the eligible patients from the LEAP trial. A summary of the study is provided below. [5]

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Bivalirudin vs. Heparin for Improving Clinical Outcomes in PCI patients

Akpan Anani, Mercer College of Pharmacy

For patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS), anticoagulant therapy is necessitated by risk of thrombotic events. [1] Angiomax® (bivalirudin) is a direct thrombin inhibitor indicated for patients undergoing PCI and concurrently using a glycoprotein IIb/IIIa inhibitor (GPI). [2] Bivalirudin has been shown in some studies to cause less major bleeding than Hep-Lock® (heparin) in myocardial infarction (MI) patients needing anticoagulation [1,3]; however, limited research exists comparing bivalirudin to heparin for assessment of repeat MI or all-cause mortality risk.

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Long-Term Effects of Repeated Injections of Local Anesthetic with or Without Corticosteroid for Lumbar Spinal Stenosis

Eku Oben, Mercer University College of Pharmacy

Lumbar spinal stenosis is the narrowing of the space around the spinal cord, most commonly caused by arthritis. [1] Guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, corticosteroid injections, anesthetic injections, physical therapy, or a lumbar brace for treatment of lumbar spinal stenosis. [2] Comparing lumbar spinal stenosis patient pain scores shows no difference between groups that received steroid injections after anesthesia and placebo groups at the first month (p= 0.793). [3]

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