Safety and efficacy of anagrelide in Japanese post-marketing surveillance, with subgroup analyses on the effect of previous cytoreductive therapies, age, and starting dose.

BACKGROUND: In Japan, anagrelide has been approved for use in patients with essential thrombocythemia. Here, the safety and efficacy of anagrelide was assessed in clinical practice as post-marketing surveillance. Subgroup analyses were conducted to compare patients (1) with or without a history of cytoreductive therapy (CRT), (2) <60 or ≥60 years of age, and (3) with an anagrelide starting dose of ≤0.5 mg/day or 1.0 mg/day. METHODS: Data were collected for all patients who received anagrelide, with an observation period of 12 months after treatment initiation. RESULTS: Of the 648 patients, 54.3% experienced adverse drug reactions (ADRs). The most commonly reported ADRs were headaches, palpitations, and anemia. No significant difference was observed in overall ADRs across patient subgroups. A significantly higher incidence of headaches was observed in patients < 60 years versus those ≥ 60 years (P < 0.001). The incidence of anemia and serious ADRs were significantly higher in patients ≥ 60 years, and those with a history of CRT (P < 0.05). The discontinuation rate at 6 months was significantly lower in patients started at the lower anagrelide dose (P < 0.05). Platelet counts decreased in all analyzed groups. CONCLUSIONS: This surveillance showed that anagrelide has a tolerable safety and efficacy profile.

Diseases prevalent before major depressive disorder diagnosis: an exploratory nested case-control study using health insurance-based claims data.

OBJECTIVES: Major depressive disorder (MDD) is often comorbid with other chronic and/or serious diseases. However, little is known about the prevalence of various diseases that are present before MDD onset. We examined the prevalence of all pre-existing diseases in the 12 months before an MDD diagnosis. DESIGN: Exploratory nested case-control study. SETTING: Data, including diagnoses based on International Statistical Classification of Diseases and Related Health Problems, 10th revision codes, were from a Japanese health insurance database (JMDC). PARTICIPANTS: Adults newly diagnosed with MDD during 2015, 2016 or 2017 (but not the preceding year) (cases) were matched (exact) 1:10 to controls by age, sex, index date and working status. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the proportion of patients in each group with each pre-existing disease during the 12 months before the index date (ie, before MDD diagnosis in cases). Odds ratios (ORs) for onset of MDD were calculated for each pre-existing disease. A post hoc multivariate analysis examined interactions of metabolic risk factors (diabetes, hypertension, dyslipidaemia), psychiatric disorders (sleep disorders, psychiatric disorders other than depression) and MDD-related symptoms (headache, pain, autonomic nerve imbalance) on MDD diagnosis. RESULTS: There were 13 420 cases and 134 200 controls (mean age 41.9 years; 66.5% male). The prevalence of almost all pre-existing diseases was higher in cases than in controls. The highest ORs (5.8-21.0) were for psychiatric diseases and sleep disorders. Insomnia (21.1% of patients; OR 8.7) and neurosis (9.7%; OR 10.6) were particularly prevalent in the case group. The odds of MDD increased in the presence of metabolic risk factors, psychiatric disorders and/or MDD-related symptoms. CONCLUSIONS: There is a high prevalence of pre-existing diseases in Japanese patients who develop MDD compared with matched controls without MDD. These results suggest that patients with chronic and/or serious diseases should be actively monitored for depression.

Detection and Quantification of 4-Methylimidazole in Cola by Matrix-assisted Laser Desorption Ionization Mass Spectrometry with Fe2O3 Nanoparticles on Zeolite.

Food additives generally used in carbonated drinks, such as 4-methylimidazole (4MI), caffeine (Caf?), citric acid (CA), and aspartame (Apm), were measured by matrix-assisted laser desorption ionization mass spectrometry (MALDI MS) using nanometer-sized particles of iron oxide (Fe2O3 NPs). The quantification of 4MI in Coca Cola (C-cola) was carried out. In order to improve the reproducibility of the peak intensities, Fe2O3 NPs loaded on ZSM5 zeolite were used as the matrix for quantification. By using 2-ethylimidazole (2EI) as the internal standard, the amount of 4MI in C-cola was determined to range from 88 to 65 µg/355 mL. The results agree with the published value (approx. 72 µg/355 mL). It was found that MALDI using Fe2O3 was applicable to the quantification of 4MI in C-cola.

Synthesis of saxitoxin derivatives bearing guanidine and urea groups at C13 and evaluation of their inhibitory activity on voltage-gated sodium channels.

Here, we describe the synthesis of the first C13-N-substituted STX derivatives 4, 5, and 6 bearing a guanidine, a urea group, and an acetamide, respectively, via the fully protected saxitoxinol derivative 8. These compounds are of interest because a previous docking study of saxitoxin (STX) with voltage-gated sodium channels (NaVCh) suggested that the C13 carbamoyl group of STX interacts with residue E403 in the pore region of NaVCh. In a cell-based assay with Neuro-2a cells, the NaVCh-inhibitory activities of 4 and 5 were more than 20- to 50-fold weaker than that of decarbamoyl-STX (3), which is 10-fold less potent than STX. On the other hand, 6 was 1000 times less potent than 3. The electrostatic analysis of C13 in STX and its analogs 4-6 using EON calculations suggested that the NaVCh-inhibitory activity of these derivatives is influenced by both the hydrophilicity and the charge balance of the substituent at C13.

Synthetic approaches to tetracyclic pyrrole imidazole marine alkaloids.

Oroidin derived, pyrrole imidazole marine alkaloids (PIAs) are attractive targets for synthetic organic chemists because of their structural complexity and diversity, as well as their interesting biological activities. A number of efforts have been carried out to develop strategies for the synthesis of these natural products. Members of PIAs (eg., 2-7), which contain tetracyclic ring systems possessing characteristic cyclic guanidine or urea moieties, show significant biological activities including anticancer activity and agonistic activity against the adrenoceptor. In this review, investigations of the total synthesis of the representative tetracyclic PIAs, dibromophakellin (2) and dibromophakellstatin (3), are described.

Synthesis of skeletal analogues of saxitoxin derivatives and evaluation of their inhibitory activity on sodium ion channels Na(V)1.4 and Na(V)1.5.

Skeletal analogues of saxitoxin (STX) that possess a fused-type tricyclic ring system, designated FD-STX, were synthesized as candidate sodium ion channel modulators. Three kinds of FD-STX derivatives 4a-c with different substitution at C13 were synthesized, and their inhibitory activity on sodium ion channels was examined by means of cell-based assay. (-)-FD-STX (4a) and (-)-FD-dcSTX (4b), which showed moderate inhibitory activity, were further evaluated by the use of the patch-clamp method in cells that expressed Na(V)1.4 (a tetrodotoxin-sensitive sodium channel subtype) and Na(V)1.5 (a tetrodotoxin-resistant sodium channel subtype). These compounds showed moderate inhibitory activity towards Na(V)1.4, and weaker inhibitory activity towards Na(V)1.5. Uniquely, however, the inhibition of Na(V)1.5 by (-)-FD-dcSTX (4b) was "irreversible".

Total synthesis of (+)-dibromophakellin and (+)-dibromophakellstatin.

A new method for the preparation of quaternary chiral aminals has been developed that employs an enamide-type Overman rearrangement process. This methodology was applied to enantioselective total syntheses of (+)-dibromophakellin and (+)-dibromophakellstatin.