pharmacology

Tramadol is a painkiller prescribed for chronic pain and is considered safer than other opioids. A systematic review with meta-analysis that included 19 clinical trials with more than 6,500 people showed that, although it relieved pain, the effect was small and below what would be considered clinically effective. In addition, the analysis indicated that the drug is likely to increase serious adverse events, particularly cardiac events. Although an increased risk of some types of cancer was also detected, the authors question this effect due to the short follow-up period. ‘Given the limited analgesic benefits and increased risk of harm, the use of tramadol for chronic pain should be reconsidered, with preference given to safer alternatives and additional high-quality trials to clarify its risk-benefit profile,’ the researchers note in the study, published in BMJ Evidence Based Medicine.

An article published in Nature Medicine outlines the new framework for pharmacologically treating obesity and its complications established by the European Association for the Study of Obesity (EASO). The new guidelines establish semaglutide and tirzepatide as first-line treatment for this disease and most associated conditions. The team of authors, with Spanish participation, reviewed the scientific evidence on the effects of drugs on total weight loss and its complications and designed an algorithm to help medical personnel guide treatment, taking into account each patient's medical history and the action profiles of available medications.

At a press conference at the White House on Monday, Donald Trump and health authorities linked the use of paracetamol during pregnancy to cases of autism. They also recommended leucovorin as a treatment for autism. Immediately afterwards, the US Food and Drug Administration (FDA) announced in a press release that it had begun the approval process for calcium leucovorin tablets for patients with cerebral folate deficiency. “People with cerebral folate deficiency have been observed to have developmental delays with autistic characteristics, seizures, and movement and coordination problems,” they said. The update on the use of the drug, discussed by the scientific community, will authorize the treatment of children with autism spectrum disorder.

On Monday, US federal health authorities will advise pregnant women against taking paracetamol in the early stages of pregnancy, unless they have a fever, as reported yesterday by The Washington Post. The announcement will be accompanied by a recommendation for a drug called leucovorin as a treatment for autism, the article adds. Donald Trump said yesterday: ‘Tomorrow we are going to have one of the most important announcements... from a medical standpoint, I think, in the history of our country. I think we have found an answer to autism.’

Most rare diseases are caused by mutations in DNA, but the same gene can mutate in different ways, which complicates treatment. Now, a team from the CRG in Barcelona has shown that an already approved drug is capable of stabilising almost all mutated versions of a human protein—specifically, the vasopressin V2 receptor, which is linked to a rare disease called nephrogenic diabetes insipidus. According to the researchers, who published their findings in Nature Structural & Molecular Biology, the study is the first proof of concept demonstrating that a drug can act as a ‘near-universal’ treatment, which could accelerate the development of therapies.

In mice, administering semaglutide - the molecule marketed under the name Ozempic or Wegovy - does not reduce muscle mass as much as expected, but it does affect muscle function, according to a study published in Cell Metabolism. In some types of muscle, the experiment measured a decrease in force-generating capacity of about 20%, disproportionately greater than the loss of muscle mass.

An oral formulation of risperidone could be administered weekly instead of daily to treat patients with schizophrenia with the same efficacy, according to a phase III clinical trial published in The Lancet Psychiatry. The study included 83 patients in the United States.

Narcolepsy type 1 is a sleep disorder characterised by excessive daytime sleepiness and cataplexy - sudden loss of muscle tone. Existing treatments are based on palliation of symptoms, with moderate success. Now, an international phase 2 clinical trial, involving CEU San Pablo University and other Spanish centres, published in the journal NEJM, shows the results of a new drug targeting the cause of the disorder. Overall, the benefits appear superior and no serious adverse effects were observed. According to the authors, ‘the results are promising’ and represent ‘a very significant impact on the quality of life of these patients’.

An experimental drug called mavoglurant can reduce the consumption of both cocaine and alcohol in people with cocaine use disorder, according to the results of a phase 2 clinical trial with 68 participants. Although trials with more participants are needed, the results suggest that this drug should be studied further. The findings, in which Spanish teams have participated, are published in the journal Science Translational Medicine.

EMA’s human medicines committee has recommended not authorising the marketing of Kisunla (donanemab), a drug intended for the treatment of early-stage Alzheimer's disease. The committee considered that the benefits of this drug were not great enough to outweigh the risk of potentially fatal events. In recent years, several patients have died due to microbleeds in the brain.