RESUMEN
BACKGROUND: As patents for multiple sclerosis (MS) therapies expire, follow-on disease-modifying treatments (FO-DMTs) become available at reduced cost. Concerns exist that cheaper FO-DMTs are used simply to reduce healthcare costs. However, the well-being of people with MS should take priority. OBJECTIVES: To identify best practices for FO-DMT development and use by agreeing on principles and consensus statements through appraisal of published evidence. METHODS: Following a systematic review, we formulated five overarching principles and 13 consensus statements. Principles and statements were voted on by a multidisciplinary panel from 17 European countries, Argentina, Canada and the United States. RESULTS: All principles and statements were endorsed by >80% of panellists. In brief, FO-DMTs approved within highly regulated areas can be considered effective and safe as their reference products; FO-DMTs can be evaluated case by case and do not always require Phase III trials; long-term pharmacovigilance and transparency are needed; there is lack of evidence for multiple- and cross-switching among FO-DMTs; and education is needed to address remaining concerns. CONCLUSION: Published data support the use of FO-DMTs in MS. The consensus may aid shared decision-making. While our consensus focused on Europe, the results may contribute to enhanced quality standards for FO-DMTs use elsewhere.
Asunto(s)
Esclerosis Múltiple , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Consenso , Costos de la Atención en Salud , Argentina , CanadáRESUMEN
Microbial biotransformations constitute an important alternative as models for drug metabolism study in mammalians and have been used for the industrial synthesis of chemicals with pharmaceutical purposes. Several microorganisms with unique biotransformation ability have been found by intensive screening and put in commercial applications. Ten isolates of Beauveria sp genus filamentous fungi, isolated from soil in the central Brazil, and Beauveria bassiana ATCC 7159 were evaluated for their capability of quercetin biotransformation. Biotransformation processes were carried out for 24 up to 96 hours and monitored by mass spectrometry analyses of the culture broth. All strains were able to metabolize quercetin, forming mammalian metabolites. The results were different from those presented by other microorganisms previously utilized, attrackting attention because of the great diversity of reactions. Methylated, sulphated, monoglucuronidated, and glucuronidated conjugated metabolites were simultaneously detected.
Biotransformações microbianas constituem uma alternativa importante como modelo para o estudo do metabolismo de medicamentos em mamíferos e são empregadas em processos sintéticos industriais com propósitos farmacêuticos. Diversos microrganismos com potencial para biotransformação têm sido encontrados através de screening intensivo e aplicados comercialmente. Dez cepas de fungos filamentosos do gênero Beauveria, isolados na região central do Brasil, e a cepa Beauveria bassiana ATCC 7159 foram avaliadas quanto à capacidade de biotransformação da quercetina. As reações de biotransformações foram realizadas por um período de 24 a 96 horas, e monitoradas através de espectrometria de massas do meio reacional. Todas as cepas foram capazes de metabolizar a quercetina, formando metabólitos encontrados nos mamíferos. Os resultados foram diferentes dos resultados apresentados por outros microrganismos utilizados anteriormente e chamam a atenção devido à diversidade das reações evidenciadas. Diferentes metabólitos conjugados foram detectados simultaneamente: metilados, sulfatados, monoglicuronados, e glicuronados.
Asunto(s)
Bovinos , Beauveria/aislamiento & purificación , Resistencia a Medicamentos , Hongos/aislamiento & purificación , Hongos/metabolismo , Técnicas In Vitro , Quercetina/aislamiento & purificación , Biotransformación , Medios de Cultivo , Métodos , MicrobiologíaRESUMEN
Microbial biotransformations constitute an important alternative as models for drug metabolism study in mammalians and have been used for the industrial synthesis of chemicals with pharmaceutical purposes. Several microorganisms with unique biotransformation ability have been found by intensive screening and put in commercial applications. Ten isolates of Beauveria sp genus filamentous fungi, isolated from soil in the central Brazil, and Beauveria bassiana ATCC 7159 were evaluated for their capability of quercetin biotransformation. Biotransformation processes were carried out for 24 up to 96 hours and monitored by mass spectrometry analyses of the culture broth. All strains were able to metabolize quercetin, forming mammalian metabolites. The results were different from those presented by other microorganisms previously utilized, attrackting attention because of the great diversity of reactions. Methylated, sulphated, monoglucuronidated, and glucuronidated conjugated metabolites were simultaneously detected.