Current Pharmaceutical Design - Online First

Iron-based phosphate binders are a new therapy for Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD). Currently, the commonly used iron-based phosphate binders in clinical practice are of two types: sucroferric oxyhydroxide (SFOH) and ferric citrate (FC). This study aimed to examine randomized controlled clinical trials of SFOH and FC for the treatment of CKD patients, as part of a systematic review and meta-analysis.

The databases of Medline (PubMed), Web of Science, Embase, and the Cochrane Library were searched for relevant literature published from the inception of the databases to February 25^th, 2025. The effectiveness and safety of iron-based phosphate binders and non-calcium phosphate binders were analyzed and compared.

The phosphate reduction effect of iron-based phosphate binders in CKD patients demonstrated no significant difference from that of non-calcium phosphate binders. Iron-based phosphate binders can achieve the same phosphate-reducing effect at lower doses and increase serum ferritin and hemoglobin levels. However, iron-based phosphate binders increase the incidence of gastrointestinal adverse events, mainly diarrhea and changes in stool color.

This study demonstrated the absolute advantage of iron-based phosphorus binders in terms of medication load. Additionally, they were also found to improve anemia. This study did not analyze the effects of different drug dose subgroups on calcium and phosphorus metabolism, so it was impossible to determine whether iron-based phosphorus binders achieved greater reductions in phosphorus at the same dose.

Compared with non-calcium-based phosphate binders, iron-based phosphate binders have a lower medication burden and can improve anemia, but increase the incidence of overall gastrointestinal adverse events.

Diabetic kidney disease (DKD) is a major global health concern, and finerenone is a potentially effective drug for its treatment. This meta-analysis was conducted to assess the clinical efficacy and safety of finerenone in patients with DKD.

The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to October 8, 2024, for randomized controlled trials (RCTs) evaluating finerenone in patients with DKD. Data were extracted and analyzed. Risk of bias was assessed using the Cochrane Collaboration’s risk-of-bias tool in Review Manager 5.3. Publication bias was examined using Begg’s test, Egger’s test, and funnel plots in Stata version 14.0.

Seven RCTs involving 15,527 patients (n = 8,536 in the finerenone group; n = 6,991 in the control group) met the inclusion criteria. Regarding efficacy, the finerenone group showed a significantly greater reduction in urinary albumin-to-creatinine ratio from baseline (p < 0.00001) but experienced a greater decline in estimated glomerular filtration rate (eGFR) (p < 0.00001). However, finerenone significantly reduced the risk of a ≥40% decline in eGFR (p < 0.0001), a ≥57% decline in eGFR (p < 0.0001), progression to end-stage kidney disease (p = 0.04), composite cardiac outcomes (p = 0.001), and hospitalization for heart failure (p = 0.004) compared with control. No significant differences were observed in cardiovascular mortality, myocardial infarction, or all-cause hospitalization (p > 0.05). Safety analysis revealed comparable rates of total adverse events between groups (p > 0.05). However, finerenone was associated with higher incidences of study-drug-related adverse events and hyperkalemia, but a lower risk of total serious adverse events.

Finerenone significantly reduces renal and cardiovascular risks in DKD patients, including kidney disease progression and heart failure hospitalization, despite a higher incidence of hyperkalemia. These findings support its role as a promising therapy, especially for patients intolerant to steroidal agents, and highlight the importance of potassium monitoring in clinical practice.

This meta-analysis suggests that finerenone provides significant renal and cardiovascular benefits in patients with DKD without causing intolerable adverse effects, supporting its potential as a novel therapeutic option. These findings warrant further confirmation through rigorously designed, large-scale RCTs.

Oral fast melt films (OFMF) present a convenient and user-friendly delivery system that supports oral health maintenance, improves patient compliance, and promotes accessible preventive care. Bacillus coagulans, a probiotic known for its dental health benefits, holds promise in addressing the global burden of oral diseases. This study aims to develop and characterise OFMF incorporating Bacillus coagulans for daily oral health support.

Nineteen OFMF formulations were prepared using varying ratios of carboxymethyl cellulose (CMC), hydroxypropyl methylcellulose (HPMC), and polyvinyl alcohol (PVA), along with PEG 400 and glycerine, via solvent casting followed by freeze-drying. The optimised PVA-based film was enriched with Bacillus coagulans, sucrose, citric acid, and mint water. Films were characterised using SEM, DSC, and PXRD, and evaluated for physicochemical, mechanical, disintegration, and probiotic viability.

The final OFMF formulation exhibited smooth morphology, average weight of 0.139 ± 0.00076 g, thickness of 0.4 ± 0.011 mm, tensile strength of 0.016 ± 0.00064 MPa, extension strain of 69.6 ± 16.84%, Young’s modulus of 0.024 ± 0.0060 MPa, folding endurance >100 folds, pH of 6, and rapid disintegration time of 3 ± 0.52 seconds.

The formulation demonstrated excellent mechanical integrity, rapid disintegration, and sustained probiotic viability. These findings support its potential for daily oral health maintenance, though further in vivo validation is warranted.

The developed OFMFs provide a stable, effective, and user-friendly platform for delivering Bacillus coagulans, with strong potential for routine oral health supplementation.

The global rise in antibiotic resistance poses a serious threat to public health by undermining the effectiveness of standard antimicrobial therapies. The rapid rise of multidrug-resistant (MDR) bacterial strains has created an urgent demand for the identification of novel drug targets and the development of innovative therapeutic approaches.

The methodology for this review was based on an extensive literature search using databases such as PubMed, Google Scholar, Scopus, and Web of Science, covering studies from 1998 to 2025. Articles focusing on novel drug targets, antimicrobial resistance mechanisms, and next-generation therapeutic strategies were screened and selected based on their scientific quality and contribution to the field. Data from clinical trial registries and reputable websites were also incorporated to provide comprehensive insights into emerging approaches against multidrug-resistant bacteria.

The review identifies several promising approaches for combating MDR pathogens. These include targeting bacterial virulence factors, cell wall synthesis enzymes (Mur ligases, Lipid II, and C55-PP), and proteins that mediate resistance. Additionally, advanced drug delivery systems, such as liposomes, solid lipid nanoparticles, exosomes, and biomimetic carriers, enhance antibiotic bioavailability and site-specific action. Pharmacogenomic approaches further personalize treatment regimens, potentially improving outcomes and reducing the emergence of resistance.

The review highlights that multidrug-resistant bacteria continue to pose a significant threat, necessitating the development of innovative therapeutic approaches. Although novel molecular targets and nanocarrier-based delivery systems offer substantial promise, their clinical translation is limited by challenges such as off-target effects, biological barriers to delivery, and regulatory hurdles. Overcoming these obstacles will require the integration of advanced technologies with pharmacogenomics and host-targeted therapeutic strategies.

Combating antibiotic resistance requires an integrated approach combining novel drug targets, advanced delivery systems, and tailored therapeutic approaches. Innovations in nanotechnology, immunotherapy, and pharmacogenomics offer viable solutions to this escalating crisis. Strategic interdisciplinary collaboration is critical for developing sustainable antimicrobial treatments and preserving the efficacy of existing antibiotics.

Self-medication is widely discussed regarding over-the-counter pharmaceutical drugs, as well as some prescription drugs, especially antibiotics. There are virtually no studies on self-medication with cardiovascular drugs.

To assess the prevalence of self-medication and adherence to prescribed treatment in patients with Cardiovascular Diseases (CVD) seeking advice at a cardiology dispensary.

Our cross-sectional study included all patients aged 50 years or older (n=300) who repeatedly visited an outpatient clinic for CVD from December 14, 2023, to August 07, 2024. The information on previously prescribed and actually taken medicinal drugs by the patient was recorded during the visit. Patient-reported adherence was evaluated using a specific scale.

Self-medication was detected in 120 patients (40%) who either replaced or added drugs to the therapy prescribed by their attending physician. The most common recorded practice was self-prescription of medicinal drugs (106 cases, 88.3%), especially prescription drugs (72 of 106 patients, 67.9%). In 17 patients, self-medication led to inappropriate administration of the drug. In 7 patients (41.2%), self-medication resulted in potentially dangerous combinations of drugs. In 4 patients (23.5%), self-medication resulted in inadequate replacement of the drug, and in 6 patients (35.3%), duplication of drugs was noted. The majority of patients (76.3%) exhibited various violations of compliance with medical recommendations. Among patients practicing self-medication, there were more partially nonadherent patients, and in the subgroup without self-medication, there were more completely nonadherent patients (p=0.008).

Self-medication is potentially associated with several risks, including delayed professional consultation, incorrect self-diagnosis, severe adverse reactions, dangerous drug-drug interactions, masking of severe conditions, and the risk of drug abuse. Existing literature predominantly focuses on self-medication with over-the-counter drugs. This study demonstrates that in the Russian Federation, self-medication (including the use of cardiovascular drugs) is remarkably prevalent. More than a third of the surveyed patients independently added new medications to their physician’s regimen or substituted prescribed ones. Moreover, more than half of the self-medications were for prescription drugs.

Self-medication, as one of the options for nonadherence, was employed by 40% of CVD patients. In some cases, this has led to the emergence of potentially dangerous drug combinations.