Current Drug Research Reviews - Online First

Hepatocellular carcinoma (HCC), commonly referred to as primary liver cancer, is a malignant neoplasm that originates within the liver. Conventional treatment modalities frequently result in less than satisfactory outcomes, primarily attributed to the intricate physiological and pathological contexts. Compound Kushen Injection (CKI), formulated from the botanicals Sophora flavescens and Atractylodes macrocephala, is employed as a supplementary therapy in the treatment of advanced-stage malignant tumors, including HCC.

Our study combined network pharmacology, bioinformatics, GeneMANIA-based functional association (GMFA), and experimental validation to elucidate CKI's therapeutic targets and mechanisms.

STRING was used to build a protein-protein interaction network, and GO and KEGG analyses were performed with DAVID and ShinyGO on the overlapping targets of CKI and HCC. Hub targets were identified using CytoHubba and their clinical relevance was confirmed with GEPIA2. GMFA and TIMER assessed the functions of key hub genes. The findings were further verified through significant KEGG analysis, molecular docking, and experimental validation.

10 hub targets were identified for CKI against HCC and analyzed for their impact on HCC patient survival and gene expression. GMFA confirmed four key hub genes, and TIMER assessed the correlation between SRC expression and immune infiltration. Significant KEGG analysis highlighted SRC's role in cell proliferation and migration through the MMP/EGFR-PI3K/AKT pathway. Molecular docking showed interactions between SRC and desmethylanhydroicaritin or resokaempferol. Experiments in HepG2 cells confirmed CKI's inhibitory effect on tumor cells.

CKI’s anti-HCC effects may be exerted by regulating SRC via active compounds desmethylanhydroicaritin and resokaempferol.

Menopause is a natural physiological transition marked by hormonal changes that can lead to a range of physical, emotional, and psychological symptoms, often impacting a woman's quality of life. This review aims to evaluate the effectiveness of herbal remedies as alternative or complementary options to conventional treatments, particularly hormone replacement therapy (HRT), in managing menopausal symptoms.

An extensive literature review was conducted, focusing on commonly used herbs such as black cohosh, red clover, Dong Quai, and chaste tree berry. The review assessed the phytoestrogenic and adaptogenic properties of these herbs, exploring their mechanisms of action, clinical efficacy, safety profiles, and potential interactions. Comparisons were made with HRT and other conventional therapies. Non-hormonal pharmacological options and lifestyle interventions, including yoga and dietary changes, were also examined.

Herbal remedies, particularly black cohosh and red clover, demonstrated moderate effectiveness in alleviating menopausal symptoms, attributed to their phytoestrogenic and adaptogenic actions. Clinical evidence supports their safety, though individual responses and drug interactions vary. Additionally, non-hormonal treatments and lifestyle modifications, such as yoga and dietary adjustments, contribute to symptom relief.

The findings underscore the potential of herbal remedies as viable alternatives or adjuncts to HRT. While generally safe and moderately effective, the variability in individual response and the need for awareness of possible interactions are important considerations. Integrating herbal approaches with evidence-based medical practices may offer more personalized and holistic menopause care.

Herbal therapies present a promising, well-tolerated option for managing menopausal symptoms. When combined with conventional or lifestyle-based interventions, they broaden the spectrum of therapeutic choices available to women, enabling individualized, integrative care during menopause.

The primary objective of this systematic review was to evaluate the therapeutic efficacy and safety profile of intralesional Ionic Contra-Viral Therapy (ICVT)-a combination of digoxin and furosemide-in the treatment of multiple cutaneous warts.

This meta-analysis was conducted in accordance with PRISMA guidelines and was prospectively registered in PROSPERO (CRD42024544551). A comprehensive literature search was performed up to April 2024 across PubMed, MEDLINE, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar. Eligible studies included randomized controlled trials involving adults with ≥2 cutaneous warts treated with intralesional digoxin and furosemide, assessing outcomes, such as complete and partial clearance, wart size reduction, and adverse events. Exclusion criteria included case reports, reviews, and preclinical studies. Data extraction was performed independently by two reviewers, with discrepancies resolved through consensus. The Cochrane RoB 2 tool was used for risk of bias assessment. Meta-analyses were conducted using a random-effects model, and heterogeneity was evaluated using the I² statistic. The quality of evidence was graded using the GRADE framework.

Seven randomized trials, including a total of 391 patients, were analyzed. The ICVT group demonstrated significantly higher complete wart clearance compared to placebo (56.8% vs. 2.8%; RR = 13.27, 95% CI = 2.93-60.17; p = 0.0018). Partial response was lower in the ICVT group (5.08% vs. 10%; RR = 0.66, 95% CI = 0.09-5.09; p = 0.69). Adverse events occurred more frequently in the ICVT group (85% vs. 58.8%; RR = 1.33, 95% CI = 0.47-3.79; p = 0.59; I² = 97%). Pain during injection was also more commonly reported in the ICVT group (96.6% vs. 63.3%; RR = 1.45, 95% CI = 0.29-7.22; p = 0.65; I² = 99%). The certainty of evidence was rated as very low for complete clearance, moderate for partial response, and low for adverse events and injection pain. Trial Sequential Analysis (TSA) indicated that the required information size was not met for any of the outcomes.

While the results suggest that ICVT may be effective in achieving complete clearance of multiple cutaneous warts, the current evidence is limited by small sample sizes, methodological heterogeneity, and potential biases. The higher incidence of adverse events and injection-related pain raises safety concerns. The low to very low certainty of evidence, coupled with the TSA findings, underscores the need for more rigorous investigation. Variability in trial design, dosing protocols, and outcome reporting further limits the applicability of current findings.

Intralesional ICVT shows promise as a therapeutic option for multiple cutaneous warts, particularly in achieving complete clearance. However, due to the limited certainty of available evidence and inconsistent safety data, further large-scale, high-quality randomized controlled trials are necessary to validate these findings and establish standardized treatment protocols.

Escalating healthcare costs and increasing demands on healthcare systems have increased the need for efficient resource allocation. Pharmacoeconomics is a vital field that quantifies and compares the value of therapeutic drugs or treatments. It provides a systematic framework for decision-makers in the pharmaceutical industry, government, and private sectors to optimize healthcare delivery and spending. This review aimed to explore the role of pharmacoeconomic models in assessing the economic and clinical value of therapies. It emphasizes the importance of cost-effectiveness, cost-utility, cost-benefit, and cost-minimization analyses in balancing costs with outcomes and guiding healthcare resource allocation.

Pharmacoeconomic methodologies focus on assessing the costs, processes, and outcomes associated with therapeutic interventions. Key methods include cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses. These approaches are critical in regulatory compliance, reimbursement decisions, cost assessments, and sustaining pharmaceutical models.

This review reveals that pharmacoeconomic approaches such as Cost-Effectiveness Analysis (CEA), Cost-Utility Analysis (CUA), and Cost-Benefit Analysis (CBA) are widely used to guide healthcare policy decisions, particularly in resource-constrained settings. CEA is the most commonly applied method due to its simplicity, while CUA is gaining traction in advanced policy frameworks like Health Technology Assessment (HTA). In India, pharmacoeconomic research is emerging but faces barriers such as limited access to real-world data, the absence of national reimbursement systems, and high out-of-pocket costs. Innovative methods like machine learning and pharmacogenomics are being explored to improve the relevance and precision of these evaluations.

While pharmacoeconomic models offer valuable insights for healthcare decision-making, their real-world impact is limited by inconsistencies in data quality and variations in implementation standards. In India, fragmented governance, low public health spending, and a lack of coordination among stakeholders further hinder effective application. Addressing systemic challenges-such as establishing interoperable data systems, standard treatment guidelines, and equitable healthcare access-is crucial. Tailored approaches, including localized utility values and digital health initiatives, are essential to make pharmacoeconomics a practical and influential tool in policy formulation and resource allocation in India and similar settings.

Pharmacoeconomic studies evaluate clinical efficacy, adverse effects, and production costs while incorporating perspectives from patients, providers, payers, and communities. For India, unique challenges such as limited rural healthcare access, infrastructure disparities, and high out-of-pocket expenses necessitate tailored adaptations. Strategies such as integrating accessibility metrics, localized data, equity considerations, preventive care, tiered pricing, and public-private partnerships can enhance healthcare delivery. Pharmacoeconomic models are essential for improving health outcomes, ensuring equitable resource allocation, and addressing the diverse needs of India.