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Bernard Bannwarth

Publications and source records attributed to Bernard Bannwarth.

At least 19 recordsLinked to original sources
PubMed2007

Drug-induced musculoskeletal disorders.

Drug-induced musculoskeletal disorders represent a broad clinical spectrum, from asymptomatic biological abnormalities to severe and even life-threatening diseases. Since an increasing number of drugs have been implicated in inducing rheumatic symptoms and/or syndromes, this review is not meant to be exhaustive, bearing in mind that the development of any musculoskeletal disorder should be considered as possibly related to a medication. The purpose of this article is to provide an overview of the more frequent drug-induced musculoskeletal disorders. These include: (i) arthralgias and arthropathies, including chondropathies and inflammatory arthritis; (ii) connective tissue diseases, especially lupus-like syndromes; (iii) periarticular disorders, including tendinopathies, enthesopathies and frozen shoulder; (iii) bone diseases, such as osteoporosis, osteomalacia and osteonecrosis; and (iv) myopathies. Although virtually all drug classes may induce musculoskeletal disorders, a significant part of them are related to corticosteroids, vaccines, antibacterials and lipid-lowering agents. Knowledge of drug-induced musculoskeletal disorders avoids carrying out unnecessary investigations, and allows optimal management of the patients, i.e. early discontinuation of the offending agent, adequate treatment monitoring and/or intervention with appropriate preventive actions.

Adrenal Cortex Hormones↗
PubMed2007

Emergency department visits caused by adverse drug events: results of a French survey.

BACKGROUND: Adverse drug events (ADEs) are a substantial cause of hospital admissions. However, little is known about the incidence, preventability and severity of ADEs resulting in emergency department visits. To address this issue, we conducted a prospective survey in emergency departments of French public hospitals. METHODS: This study was performed over two periods of 1 week each, one in June 1999 and one in December 1999, in emergency departments of five university hospitals and five general hospitals throughout France. All patients aged>or=15 years presenting with medical complaints were included in the study. Trauma patients, those with gynaecological conditions and those with alcohol intoxication or intentional drug poisoning were excluded from the study. Each patient was assessed by two local emergency physicians to determine whether the visit was the result of an ADE. All medical records were subsequently validated by an independent group of medical lecturers in iatrogenic disorders. RESULTS: Out of a total of 1937 patients consulting, 1562 were taking at least one drug during the previous week and were included for analysis; 328 (21%; 95% CI 19, 23) of these patients consulted an emergency physician because of an ADE. Patients with ADEs were older than those without (mean age 63.5 vs 54.8 years; p<0.0001). Furthermore, ADE patients were more likely to have a higher severity presentation than the non-ADE group (p=0.019). The number of drug exposures was significantly higher in patients with an ADE than in those without (mean number of medications 5.17 vs 3.82; p<0.0001). On multivariate analysis, only age and the number of medications taken were significantly associated with adverse events. In total, 410 drugs were incriminated in the occurrence of 328 ADEs. The most frequently incriminated drug classes were: (i) psychotropic agents (n=84; 20.5%); (ii) diuretics (n=48; 11.7%), anticoagulants (n=38; 9.3%) and other cardiovascular drugs (n=63; 15.4%); and (iii) analgesics, including NSAIDs (n=57; 13.9%). Preventability could be assessed in 280 of the 328 cases. In 106 cases (37.9%), the ADE was judged to be preventable. CONCLUSION: ADEs leading to emergency department visits are frequent, and many are preventable, confirming that there is a need to develop prevention strategies.

Adult↗
PubMed2006

Molecular lipophilicity determination of a huperzine series by HPLC: comparison of C18 and IAM stationary phases.

Two hydrophobic parameters (logkw-C18 and logkw-IAM, respectively) of a huperzine A series were extrapolated by high performance liquid chromatography (HPLC) using both C18 and immobilised artificial membrane (IAM) columns. A mathematical correlation between C18 and IAM hydrophobic parameters was completed, suggesting a similar behaviour on both columns. This behaviour was principally led by hydrophobic forces. The theoretical lipophilicity (logP) of each compound was computed using Pallas software and compared to experimental values, showing a similar lipophilic behaviour. Finally, the huperzine logkw-IAM and logkw-C18 values were correlated with the relative bound percentage of huperzine in human serum albumin, confirming that hydrophobic forces are predominant in the huperzine-HSA binding mechanism.

Alkaloids↗
PubMed2006

Acetaminophen or NSAIDs for the treatment of osteoarthritis.

Although non-pharmacological interventions are the cornerstone of osteoarthritis management, analgesics are an important component of treatment during the symptomatic periods of the disease. In this respect, current practice guidelines advocate the use of a simple analgesic, acetaminophen, or a non-steroidal anti-inflammatory drug (NSAID), given either systemically or topically as first-line or second-line drug therapies. The present paper aims first to assess the evidence for the efficacy and safety of these medications. Given the increasing importance of patient involvement in decision-making, the following key practical issue regarding acetaminophen and NSAIDs will then be addressed: 'which drug do patients prefer?' Regarding NSAIDs, a further question concerns the place for non-selective agents and cyclo-oxygenase-2 (COX-2) selective inhibitors (coxibs) in the light of new warnings and contraindications concerning coxibs in patients with increased risk of cardiovascular thrombotic events.

Acetaminophen↗
PubMed2006

Peptic ulcer disease in a patient with ankylosing spondylitis receiving a conventional nonsteroidal anti-inflammatory drug.

BACKGROUND: A 42-year-old man with a 10-year history of HLA-B27-positive ankylosing spondylitis presented with upper abdominal pain and nausea after receiving oral ketoprofen 200 mg/day. His gastrointestinal symptoms did not improve with the addition of ranitidine 150 mg twice daily. He had previously responded well to conventional nonsteroidal anti-inflammatory drugs. INVESTIGATIONS: Physical examination, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, radiography, laboratory tests, upper gastrointestinal endoscopy, histopathologic examination and culture of biopsy specimens. DIAGNOSIS: Helicobacter pylori-positive duodenal ulcer. TREATMENT: For eradication of H. pylori: omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily for 1 week. For ankylosing spondylitis: diclofenac 150 mg/day in combination with omeprazole 20 mg/day for 2 months.

Adult↗
PubMed2005

Guidelines for the use of antidepressants in painful rheumatic conditions.

OBJECTIVES: Antidepressants are widely used to treat painful chronic rheumatic conditions but, contrary to neuropathic conditions, little is known about their true analgesic properties and value in these situations. Our group, which focuses on pain in rheumatology, aimed to develop recommendations for the use of antidepressants in rheumatology, based on evidence-based review of published data and expert opinion. METHOD: We identified relevant drugs and conditions and searched Medline, Embase and Pascal (1966-2003) for relevant publications in a number of European languages. We scored each study for quality, and used an expert consensus approach to formulate recommendations. RESULTS: We identified 77 studies and 12 meta-analyses and literature review on the use of antidepressant to treat painful rheumatological conditions. Forty-nine of these clinical studies were considered valid and were used to develop the recommendations. When evidence was lacking we based recommendations on our clinical experience. CONCLUSIONS: These recommendations for the treatment of painful rheumatological conditions with antidepressants were developed using evidence-based and expert consensus approaches and are the first of their kind in this field. Our review of the literature highlights the need for further, well-designed clinical studies of the use of antidepressants to treat painful rheumatological conditions.

Antidepressive Agents↗
PubMed2005

Clinical pharmacology of lumiracoxib, a second-generation cyclooxygenase 2 selective inhibitor.

Although highly selective cyclooxygenase (COX)-2 inhibitors have been shown to be less toxic to the gastrointestinal tract than conventional non-steroidal anti-inflammatory drugs (NSAIDs), their overall safety profile is questioned. Since different selective COX-2 inhibitors were found to be associated with increased cardiovascular thrombotic events, the thrombotic hazard may be a class effect. Furthermore, warnings have been issued regarding serious skin and hypersensitivity reactions associated with valdecoxib. Lumiracoxib is a novel COX-2 selective inhibitor (coxib) with improved biochemical selectivity over that of currently available coxibs. It is structurally distinct from other drugs in the class and has weakly acidic properties. Clinical studies support a once-daily dosing regimen, despite its relatively short plasma elimination half-life (3 - 6 h). In randomised, controlled clinical trials, lumiracoxib 100 - 200 mg/day has been shown to be superior to placebo in patients with symptomatic osteoarthritis, with clinical efficacy similar to diclofenac 150 mg/day, celecoxib 200 mg/day or rofecoxib 25 mg/day. Furthermore, lumiracoxib 200 - 400 mg/day appeared to be effective in patients with rheumatoid arthritis. In patients with acute pain related to primary dysmenorrhoea, dental or orthopaedic surgery, lumiracoxib 400 mg/day was found to be at least as effective as standard doses of traditional NSAIDs and other coxibs. Endoscopic studies have indicated that lumiracoxib is associated with a rate of gastroduodenal ulcer formation that is significantly lower than with ibuprofen and does not differ from celecoxib. In the Therapeutic Arthritis Research and Gastrointestinal Trial, which enrolled 18,325 patients with osteoarthritis, the cumulative 1-year incidence of ulcer complications (primary end point) was significantly reduced by approximately threefold on lumiracoxib 400 mg/day compared with naproxen 1000 mg/day or ibuprofen 2400 mg/day (0.32 versus 0.91%). Reduction in ulcer complications was more pronounced in the population not taking low-dose aspirin (0.2 versus 0.92%, respectively). Conversely, the gastrointestinal advantage of lumiracoxib was abrogated in patients receiving low-dose aspirin (0.69 versus 0.88%, respectively, p = 0.49). Regarding cardiovascular events contributing to the trialists' composite end point (myocardial infarction, stroke or cardiovascular death), there was no significant difference between lumiracoxib (0.65%) versus combined comparator NSAIDs (0.55%). Similarly, no significant difference was recorded in rates of myocardial infarction (clinical and silent) between the lumiracoxib (0.25%) and the combined NSAID (0.19%) treatment groups. Liver function test abnormalities were more frequent with lumiracoxib (2.57%) than with the comparator NSAIDs (0.63%). Whether or not this would result in an increased risk of clinical hepatitis in the real world setting is unforeseeable.

Animals↗
PubMed2005

Do selective cyclo-oxygenase-2 inhibitors have a future?

The dramatic withdrawal of rofecoxib on 30 September 2004, along with safety concerns about other cyclo-oxygenase (COX)-2 inhibitors (especially valdecoxib), raises important issues for clinicians, pharmaceutical companies and regulatory authorities. Some of these are examined in this article, including: (i) was the cardiotoxicity of rofecoxib evident long before its withdrawal?; (ii) is the thrombotic hazard a class effect that is applicable to all COX-2 inhibitors?; (iii) may conventional NSAIDs also confer a risk of cardiovascular thrombosis?; and (iv) is there any future for selective COX-2 inhibitors?

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

A randomized, double-blind, placebo controlled triphosphate in study of oral adenosine subacute low back pain.

OBJECTIVE: To assess the efficacy and safety of oral adenosine triphosphate (ATP) in subacute low back pain. METHODS: This was a randomized, double-blind, parallel group, placebo controlled clinical trial. The patients were given either ATP 90 mg once daily (n=81) or placebo (n=80) for one month. The patients were assessed 3 times during the study period, at days 0, 7, and 30. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ) at day 30. Secondary measures of efficacy included visual analog scale (VAS) pain, overall assessments of efficacy by both patient and investigator, and number of dextropropoxyphene and acetaminophen combination tablets used as rescue analgesic. RESULTS: Regarding the RDQ, the mean values dropped from 10.3 +/-2.8 at baseline to 7.5 +/-3.8 (day 7) and 5.2 +/-5.2 (day 30) in the ATP group, and from 11.0 +/- 3.5 to 9.1 +/- 4.2 (day 7) and 6.1 +/- 4.3 (day 30) in the placebo group. The difference between the 2 groups was statistically significant at day 7 (p= 0.02) but not at day 30 (p=0.2). In other words, the mean changes from baseline were 2.8 +/- 3.1 and 2.0 +/- 2.6 at day 7 (p=0.06), and 5.1 +/- 3.9 and 5.0 +/- 4.2 at day 30 (p=0.78) in the ATP group and the placebo group, respectively. There were no statistically significant differences in the VAS pain and overall assessments of efficacy between groups at any time point during the study. Conversely, there was a significant difference in the use of the rescue analgesic between groups, in favor of ATP (p=0.04). Oral ATP was well tolerated. CONCLUSION: Oral ATP might have an early acting effect in subacute low back pain.

Adenosine Triphosphate↗
PubMed2004

[Selective COX-2 inhibitors: do they retain any gastroduodenal toxicity].

Endoscopic studies have shown that cyclo-oxygenase-1 sparing non steroidal anti-inflammatory drugs (NSAIDs) of the coxib family did not produce more gastroduodenal ulcers than placebo in patients who were free of ulcer at baseline. However, the clinical relevance of these data is disputable. Only celecoxib and rofecoxib have been subject to large scale gastrointestinal outcome studies. Both have been shown to reduce the risk of symptomatic ulcers and ulcer complications (perforation, gastric outlet obstruction, bleeding) by about 50% compared to classical NSAIDs used at their maximum therapeutic doses. However, coxibs appear to retain some residual risk, especially in patients at high risk of developing serious gastrointestinal adverse events. This is the case in patients requiring low dose aspirin for cardiovascular purposes. Whether coxibs are still less toxic to the gastroduodenal tract that non-selective NSAIDs in these patients is controversial. Although coxibs have a superior upper gastrointestinal tolerability relative to traditional NSAIDs, dyspepsia, abdominal pain and nausea remain the major factor limiting their use.

Clinical Trials as Topic↗
PubMed2004

Is licofelone, a dual inhibitor of cyclo-oxygenase and 5-lipoxygenase, a promising alternative in anti-inflammatory therapy?

As prostaglandins and leukotrienes are critical in inflammation, dual cyclo-oxygenase and 5-lipoxygenase enzymes inhibitors, especially licofelone, are being developed by pharmaceutical companies. Experimental data indicate that licofelone shares the antipyretic, analgesic, anti-inflammatory and anti-platelet activities of conventional nonsteroidal anti-inflammatory drugs (NSAIDs), and exhibits anti-allergic properties. Although licofelone may lead to similar adverse effects on the kidney than available NSAIDs, it appeared to induce less gastrointestinal damaging effects than nonselective NSAIDs in animals. Unfortunately, preliminary clinical studies provided less impressive data with respect to efficacy. Finally, the experimental promise of licofelone as a safe and potent anti-inflammatory and analgesic agent remains to be proved in humans.

Acetates↗
PubMed2004

Diffusion of arylpropionate non-steroidal anti-inflammatory drugs into the cerebrospinal fluid: a quantitative structure-activity relationship approach.

A quantitative structure-activity relationship (QSAR) analysis of a series of arylpropionic acid non-steroidal anti-inflammatory drugs (NSAIDs) has been performed to determine which physicochemical properties of these compounds are involved in their diffusion into the cerebrospinal fluid (CSF). The penetration of eight arylpropionic acid derivatives into CSF was studied in male Wistar rats. After intraperitoneal administration of each compound (5 mg/kg), blood and CSF samples were collected at different times (0.5, 1, 3 and 6 h). The fraction unbound to plasma protein was determined using ultrafiltration. The areas under the curve of the free plasma (AUCF) and CSF (AUCCSF) concentrations were calculated according to the trapezoidal rule. The overall drug transit into CSF was estimated by the ratio RAUC (AUCCSF : AUCF). The lipophilicity was expressed as the chromatographic capacity factor (log kIAM) determined by high-performance liquid chromatography on an immobilized artificial membrane (IAM) column. A significant parabolic relationship was sought between lipophilicity (log kIAM) and the capacity of diffusion across the blood-brain barrier (log RAUC) (r = 0.928; P < 0.01). The arylpropionic acid NSAIDs exhibiting a lipophilicity value between 1.1 and 1.7 entered the CSF easily (RAUC > 1). The molecular weight (MW) was included in this parabolic relationship by means of a multiple regression analysis. This physicochemical parameter improved the correlation (r = 0.976; P < 0.005). Based on our findings, diffusion of arylpropionic acid NSAIDs into CSF appears to depend primarily on their lipophilicity and MW.

Algorithms↗
PubMed2004

Gastrointestinal safety of paracetamol: is there any cause for concern?

Paracetamol is classically considered as a very safe analgesic/antipyretic compound and, more specifically, as being virtually devoid of any gastrointestinal (GI) ulcerogenic potential. Accordingly, it is widely stated that paracetamol is particularly suitable for patients at high risk of developing GI ulcers or bleeds. This view has been challenged by recent epidemiological studies using computerised prescription data, which indicated that paracetamol exhibits dose-dependent GI toxicity. However, the results of these studies are most likely incorrect for reasons of inherent biases and confounding. Furthermore, their findings conflict with those of clinical trials and case-control studies in which information about drug exposure was obtained by direct questioning of both cases and controls. Finally, paracetamol, especially at high doses, may induce upper GI symptoms such as abdominal pain/discomfort, heartburn, nausea or vomiting. Conversely, the risk for ulcers and ulcer complications due to paracetamol is not supported by available data.

Acetaminophen↗
PubMed2003

Potential of immobilized artificial membrane chromatography for lipophilicity determination of arylpropionic acid non-steroidal anti-inflammatory drugs.

Molecular lipophilicity can be expressed by logP or more conveniently by logk, i.e. determined by the traditional shake-flask technique or by liquid chromatography. The logk of 11 arylpropionic non-steroidal anti-inflammatory drugs (NSAIDs) was determined at pH 7.4 of the eluent using two stationary phases i.e. octadecylsilane phase and an immobilized artificial membrane (IAM.PC.MG) packing. The chromatographic retention factors extrapolated to 100% aqueous phase (logk(wODS) and logk(wIAM)) were correlated with n-octanol/water lipophilicity parameters (logP) and with n-octanol/water partition coefficients corrected for ionization at pH 7.4 (logD7.4). In this series of compounds, significant linear correlations (r>0.94) between the chromatographic parameters (logk(wIAM)) and the reference lipophilicity data (logP and logD7.4) were described. Moreover, regression analysis between the lipophilicity parameters and some pharmacokinetic data for the drugs under study were performed. The logk(wIAM) parameter over n-octanol/water partition data seems to provide a good model to obtain lipophilicity parameters of arylpropionic acid NSAIDs for quantitative structure-activity relationships studies.

Algorithms↗