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      A Randomized Double‐Blind Controlled Trial of Intravenous Meloxicam in the Treatment of Pain Following Dental Impaction Surgery

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          Abstract

          This randomized, controlled phase 2 study was conducted to evaluate the analgesic efficacy, safety, and tolerability of single intravenous (IV) doses of 15 mg, 30 mg, and 60 mg meloxicam compared with oral ibuprofen 400 mg and placebo after dental impaction surgery. The primary efficacy end point was the sum of time‐weighted pain intensity differences for 0‐24 hours postdose. Among 230 evaluable subjects, meloxicam IV 60 mg produced the greatest reduction in pain, followed by the 30‐mg and 15‐mg doses. Statistically significant differences in summed pain intensity differences over 24 hours were demonstrated for each active‐treatment group vs placebo (favoring active treatment) and for meloxicam IV 30 mg and 60 mg vs ibuprofen 400 mg (favoring meloxicam IV). Moreover, there was a statistically significant dose response for meloxicam IV 15 mg to 60 mg. The onset of action for meloxicam IV was rapid and sustained; significant differences in pain intensity differences were detected as early as 10 minutes postdose and lasted through the 24‐hour postdose period. Subjects in the meloxicam IV groups were more likely than placebo recipients to achieve perceptible and meaningful pain relief and were less likely to use rescue medication. Patient‐reported global evaluation showed that meloxicam IV 60 mg had the highest rating. There were no deaths, serious adverse events, or discontinuations due to adverse events. The incidence of subjects with ≥1 treatment‐emergent adverse event was greatest in the placebo group, followed by the groups that received ibuprofen, meloxicam IV 15 mg, 30 mg, and 60 mg. Nausea was the most commonly reported treatment‐emergent adverse event. Clinical trial registration number: NCT00945763.

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          Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update

          Abstract Hepatic injury and subsequent hepatic failure due to both intentional and non-intentional overdose of acetaminophen (APAP) has affected patients for decades, and involves the cornerstone metabolic pathways which take place in the microsomes within hepatocytes. APAP hepatotoxicity remains a global issue; in the United States, in particular, it accounts for more than 50% of overdose-related acute liver failure and approximately 20% of the liver transplant cases. The pathophysiology, disease course and management of acute liver failure secondary to APAP toxicity remain to be precisely elucidated, and adverse patient outcomes with increased morbidity and mortality continue to occur. Although APAP hepatotoxicity follows a predictable timeline of hepatic failure, its clinical presentation might vary. N-acetylcysteine (NAC) therapy is considered as the mainstay therapy, but liver transplantation might represent a life-saving procedure for selected patients. Future research focus in this field may benefit from shifting towards obtaining antidotal knowledge at the molecular level, with focus on the underlying molecular signaling pathways.
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            Nanonization strategies for poorly water-soluble drugs.

            Poor water solubility for many drugs and drug candidates remains a major obstacle to their development and clinical application. Conventional formulations to improve solubility suffer from low bioavailability and poor pharmacokinetics, with some carriers rendering systemic toxicities (e.g. Cremophor(®) EL). In this review, several major nanonization techniques that seek to overcome these limitations for drug solubilization are presented. Strategies including drug nanocrystals, nanoemulsions and polymeric micelles are reviewed. Finally, perspectives on existing challenges and future opportunities are highlighted. Published by Elsevier Ltd.
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              Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations.

              This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable to many other acute pain studies conducted in different settings.
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                Author and article information

                Contributors
                rmack@recropharma.com
                Journal
                J Clin Pharmacol
                J Clin Pharmacol
                10.1002/(ISSN)1552-4604
                JCPH
                Journal of Clinical Pharmacology
                John Wiley and Sons Inc. (Hoboken )
                0091-2700
                1552-4604
                12 January 2018
                May 2018
                : 58
                : 5 ( doiID: 10.1002/jcph.v58.5 )
                : 593-605
                Affiliations
                [ 1 ] Jean Brown Research Salt Lake City UT USA
                [ 2 ] Stephen A. Cooper, LLC Palm Beach Gardens FL USA
                [ 3 ] Recro Pharma, Inc. Malvern PA USA
                [ 4 ] Clinical Statistics Consulting Blue Bell PA USA
                Author notes
                [*] [* ] Corresponding Author:

                Randall J. Mack, BS, Recro Pharma, Inc., 490 Lapp Road, Malvern, PA 19355

                Email: rmack@ 123456recropharma.com

                Article
                JCPH1058
                10.1002/jcph.1058
                5947566
                29329493
                166668c7-48c7-4cae-9b4c-f717632316cc
                © 2018, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 05 October 2017
                : 08 November 2017
                : 09 November 2017
                Page count
                Figures: 7, Tables: 2, Pages: 13, Words: 7533
                Funding
                Funded by: Recro Pharma, Inc.
                Categories
                Therapeutics
                Therapeutics
                Custom metadata
                2.0
                jcph1058
                May 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.8.2 mode:remove_FC converted:11.05.2018

                acute postoperative pain,cyclooxygenase‐2 inhibitor,dental impaction surgery,intravenous,meloxicam,nonsteroidal anti‐inflammatory drugs,sum of pain intensity differences

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