The cardiovascular safety of antiobesity drugs-analysis of signals in the FDA Adverse Event Report System Database.

AIMS: Over the past several decades, many antiobesity drugs have been withdrawn from the market due to unanticipated adverse events, often involving cardiotoxicity. This study aimed to evaluate the presence of cardiovascular safety signals with currently marketed antiobesity drugs. METHODS: We used the US Food and Drug Administration Adverse Event Reporting System (FAERS) database and retrieved data from January 2013 through December 2018. We performed disproportionality analyses to detect cardiovascular safety signals with three antiobesity drugs recently approved for marketing: lorcaserin, naltrexone-bupropion, phentermine, and phentermine-topiramate. Three main cardiovascular outcomes were evaluated: valvular disorders, and pulmonary hypertension (PH) and other cardiovascular events (myocardial infarction, stroke, cardiovascular death, cardiac failure, and arrhythmia). RESULTS: During the evaluated period, a total of 6,787,840 adverse event reports were submitted to FAERS. Of these, 2687 involved lorcaserin, 3960 involved phentermine/phentermine-topiramate, and 2873 involved naltrexone-bupropion. Lorcaserin was associated with a significantly greater proportion of reports of valvular disorders (ROR = 4.39; 95% CI 2.72-5.07). None of the antiobesity drugs were associated with a safety signal for valvulopathy, PH, or other cardiovascular events. CONCLUSIONS: Our analyses revealed a signal for valvular disorders with lorcaserin and did not detect a safety signal for other cardiovascular events with recently approved antiobesity drugs. Further research is needed to explore and validate this signal.

Efficacy of weekly docetaxel and bevacizumab in mesenchymal chondrosarcoma: a new theranostic method combining xenografted biopsies with a mathematical model.

The paucity of clinical treatment data on rare tumors, such as mesenchymal chondrosarcoma (MCS), emphasizes the need in theranostic tools for these diseases. We put forward and validated a new theranostic method, combining tumor xenografts and mathematical models, and used it to suggest an improved treatment schedule for a particular MCS patient. Growth curves and gene expression analysis of xenografts, derived from a patient's lung metastasis, served for creating a mathematical model of MCS progression and adapting it to the xenograft setting. The pharmacokinetics and pharmacodynamics of six drugs were modeled, with model variables being adjusted by patient-specific chemosensitivity tests. The xenografted animals were treated by various monotherapy and combination schedules, and the MCS xenograft model was computer simulated under the same treatment scenario. The mathematical model for xenograft growth was then up-scaled to retrieve the MCS patient's tumor progression under different treatment schedules. An average accuracy of 87.1% was obtained when comparing model predictions with the observed tumor growth inhibition in the xenografted animals. Simulation results suggested that a regimen containing bevacizumab applied i.v. in combination with once-weekly docetaxel would be more efficacious in the MCS patient than all other simulated schedules. Weekly docetaxel in the patient resulted in stable metastatic disease and relief of pancytopenia due to tumor infiltration. We suggest that the advantage of weekly docetaxel on the triweekly regimen is directly related to the angiogenesis rate of the tumor. Further validation of this conclusion, and the theranostic method we provide, may facilitate personalization of solid cancer pharmacotherapy.

High quality binding modes in docking ligands to proteins.

Multiple near-optimal conformations of protein-ligand complexes provide a better chance for accurate representation of biomolecular interactions, compared with a single structure. We present ISE-dock--a docking program which is based on the iterative stochastic elimination (ISE) algorithm. ISE eliminates values that consistently lead to the worst results, thus optimizing the search for docking poses. It constructs large sets of such poses with no additional computational cost compared with single poses. ISE-dock is validated using 81 protein-ligand complexes from the PDB and its performance was compared with those of Glide, GOLD, and AutoDock. ISE-dock has a better chance than the other three to find more than 60% top single poses under RMSD = 2.0 A and more than 80% under RMSD = 3.0 A from experimental. ISE alone produced at least one 3.0 A or better solutions among the top 20 poses in the entire test set. In 98% of the examined molecules, ISE produced solutions that are closer than 2.0 A from experimental. Paired t-tests (PTT) were used throughout to assess the significance of comparisons between the performances of the different programs. ISE-dock provides more than 100-fold docking solutions in a similar time frame as LGA in AutoDock. We demonstrate the usefulness of the large near optimal populations of ligand poses by showing a correlation between the docking results and experiments that support multiple binding modes in p38 MAP kinase (Pargellis et al., Nat Struct Biol 2002;9:268-272] and in Human Transthyretin (Hamilton, Benson, Cell Mol Life Sci 2001;58:1491-1521).