Safety and effectiveness of a biosimilar biphasic insulin in the management of diabetes mellitus during routine clinical practice in Asian patients.

INTRODUCTION: Biosimilar insulins have the potential to increase access to treatment among patients with diabetes mellitus (DM), reduce treatment costs, and expand market competition. There are no published studies evaluating the performance of biosimilar insulins in routine clinical practice in Asia. This study assessed the safety and effectiveness of biphasic isophane insulin injection in Malaysian DM patients. MATERIALS AND METHODS: In this open label, single-arm, observational, post marketing study, patients received biphasic isophane insulin injection as per the Prescribing Information; and were assessed for safety (adverse events including hypoglycaemia), effectiveness (glycosylated haemoglobin [HbA1c]; fasting blood sugar, [FBS]; and patient's condition by patient and physician) over a period of 24 weeks. RESULTS: Adult male and female diabetes patients (N=119; type 2 DM, n=117) with a mean (SD) diabetes duration of 13 years were included. No new safety signals have been identified. Significant reduction in HbA1c was observed at weeks 12 and 24 (mean [SD] - baseline: 9.6% [1.9]; Week 12: 9.0% [1.7] and at Week 24: 9.1% [1.7]; p < 0.001). There were 10 serious and 9 non-serious adverse events reported in the study. Expected mild events included hypoglycaemia and injection site pruritus. However, the majority of the adverse events were non-study drug related events. No deaths were reported during the study. DISCUSSION: Biphasic isophane insulin injection was well tolerated with no new safety concerns. It was found effective in post- marketing studies conducted in routine clinical settings when administered in DM patients in this study.

Development of safer molecules through chirality.

Many of the drugs currently used in medical practice are mixtures of enantiomers (racemates). Many a times, the two enantiomers differ in their pharmacokinetic and pharmacodynamic properties. Replacing existing racemates with single isomers has resulted in improved safety and/or efficacy profile of various racemates. In this review, pharmacokinetic and pharmacodynamic implications of chirality are discussed in brief, followed by an overview of some important chiral switches that have yielded safer alternatives. These include levosalbutamol, S-ketamine, levobupivacaine, S-zopiclone, levocetirizine, S-amlodipine, S-atenolol, S-metoprolol, S-omeprazole, S-pantoprazole and R-ondansetron. Few potential chiral switches under evaluation and some chiral switches that have not been successful are also discussed.

Screening the partial coding region of metallothionein isoform-2 gene in Zebu cattle.

Metallothionein (MT) is important because it binds tightly to heavy metals to decrease their toxicity. DNA was isolated from 30 toxic metal exposed and 30 toxic metal unexposed Zebu cows. The amplified metallothionein isoform-2 (MT-2) PCR product (489 bp) was further used for PCR-RFLP and DNA sequencing. MT-2 TaqI PCR-RFLP revealed homozygous genotype (AA) except for the E23 animal (AB). The genotype frequency of AA and AB (E23) genotypes in the exposed groups was 0.967 and 0.033 respectively. DNA sequencing was carried out for the toxic metal exposed sample (E23) and the control group sample (C13). Blast comparisons of the sequences were then aligned against a nucleotide database which revealed 150 nucleotide substitutions consisting of 70 transitions and around 80 transversions. DNA sequencing followed by PCR-RFLP for MT-2 revealed a higher number of nucleotide substitutions (150) for the AB genotype of E23 as compared to the AA genotype (38) of E21. The proportions of transversion mutations in the AB genotype were higher as compared to the MT-2 AA genotype. DNA sequencing was carried out based on random sampling for E21 and C13. Alignment analysis of the E21 and C13 sample revealed 38 nucleotide substitutions consisting of equal numbers of transition and transversion. BLAST analysis of the identified partial sequence revealed 89% identity with Bos taurus, 85% identity with sheep, 98% identity with buffalos and 100% identity with goat MT-2 sequences. Overall findings of the present study revealed DNA sequence variation in the coding region of the MT-2 gene of Zebu cattle which can be utilised to characterize and explore markers for heavy metal homeostasis in Zebu cattle.

Study of anti-fertility effect of lemon seeds (Citrus limonum) in female albino mice.

Among the citrus species, Citrus-limonum is native of North West region of India. The petroleum ether, alcoholic and aqueous extracts of Citrus-limonum (lemon) seeds were investigated for anti-fertility effect in female albino mice. The extracts were administered orally for 7 days after insemination (i.e. post-ovulatory test). The control group received 4% gum acacia. The animals were examined for implantation sites on 10th day of pregnancy and the number of pups delivered at term for each group was recorded. The alcoholic extract showed significant anti-fertility effect as compared to petroleum ether and aqueous extracts. The alcoholic extract was subjected for fractionation and the fractions were again tested for their anti-fertility effect. The fraction of ethyl-acetate (12-25 fractions) showed most encouraging anti-fertility activity. In second part of the study, the alcoholic extract and its ethyl-acetate fraction (12-25 fractions) were subjected to evaluation of their mechanism of action and it was found that their principal mode of action is as an anti-zygotic agent. Withdrawal of the test drug, resulted in complete restoration of fertility. Thus the ethyl-acetate fraction (12-25 fractions) of alcoholic extract of lemon seeds exerted reversible anti-fertility effect in female mice by virtue of its anti-zygotic action.