2015, volume 31, issue 1

Review article

Multiple sclerosis – new treatment options and hope for the future

Agnieszka Morel, Elżbieta Miller, Joanna Saluk
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 9–28

Multiple sclerosis (MS) is a chronic disease of the central nervous system, which a million people are currently suffering from. It is a heterogeneous autoimmune disease with variable clinical courses, a diverse pathophysiological picture which can lead to disturbances in the neurotransmission processes. MS has been known for over a hundred years, and yet the direct cause of the development of the disease is still unknown. Current therapies slow down the progression of MS; however, no effective causal treatment has been developed so far. Do recently new treatment methods constitute hope for the future and will they provide a more effective therapy? Finally, will they increase chances of complete recovery? The purpose of this paper is to present innovative therapies of MS, with special emphasis on injection therapy (interferon β, glatiramer acetate, natalizumab) to reduce inflammatory foci via modulation of the immune system as well as reduction in the frequency of relapses of the disease, limiting the occurrence of severe relapses, delaying disease progress (interferon β, natalizumab), slowing down MS progress by inducing specific suppressor T-cells and inhibiting specific effector T-cells (glatiramer acetate). The necessity of frequent injections is quite uncomfortable for patients with MS; therefore, oral therapy plays an important role as it is best tolerated by patients and it guarantees better therapeutic compliance. The most important first-line oral treatment in MS and include: teriflunomide, dimethyl fumarate, and the second-line treatment – fingolimod. The therapy with the stem cell bandages is recognized as a promising therapeutic method for the patients with secondary progressive form of multiple sclerosis. Pharmacogenetic profiling increases efficacy, reduces toxicity of the drugs and is responsible for the selection of the drugs that are individually customized to a given patient. Cryotherapy, in turn, supports physical therapy and improves the patient's overall functioning.

Review article

Adverse effects of glucocorticosteroids due to management of relapses of multiple sclerosis

Łukasz Smoliński, Dagmara Mirowska-Guzel, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 29–44

In the vast majority of cases, multiple sclerosis commences with its relapsing – remitting form and therefore the management of relapses continues to be an important aspect of the clinical care despite the emergence of efficacious disease modifying drugs. Current evidence indicates, that glucocorticoid therapy for multiple sclerosis relapses improves functional status within several weeks from administration with no effect on the long-term prognosis. The safety profile of glucocorticosteroids used for the management of multiple sclerosis relapses is considered favourable. The most common adverse effects of glucocorticosteroids are benign and include mainly gastrointestinal symptoms, mood disturbances and insomnia. The remaining adverse effects such as hyperglycaemia, infections, hypertension, oedema, arrhythmias, venous thrombosis occur rarely. While using glucocorticoid therapy, adequate care should be given to patients with co-morbidities, which can increase the risk of adverse effects. These are patients using non-steroidal anti-inflammatory drugs, warfarin, anti-epileptic drugs, other medications metabolized by the cytochrome P450, patients diagnosed with diabetes, hypertension, glaucoma, and pregnant women. It was noted that the occurrence of adverse reactions depends on glucocorticosteroid formulation.

Review article

Prospects of statins as therapeutic agents in neurodegenerative disorders

Maria Rutkowska, Wojciech Słupski
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 45–56

This review paper discusses the relationship between cholesterol metabolism and the incidence of neurodegenerative disorders. It also describes the mechanisms of central action of statins. Based on the current literature review, it presents data regarding potential use of statins in Alzheimer's disease, Parkinson's disease and in multiple sclerosis. Most of the studies conducted to date indicate that statins may reduce the risk of Alzheimer's disease. In the case of Parkinson's disease, primary results were not conclusive. The usefulness of statins in the treatment of multiple sclerosis must be confirmed in further clinical trials.

Review article

Second-generation long-acting antipsychotics: when to use and how

Marek Jarema, Adam Wichniak, Dominika Dudek, Jerzy Samochowiec, Janusz Rybakowski, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 57–66

Long-acting antipsychotics constitute a valuable therapeutic option for people suffering from schizophrenia and other psychotic disorders. They are designated for the treatment of psychotic states, mainly in patients with schizophrenia, who require long-term antipsychotic treatment. The most important advantage of long-acting antipsychotics is the fact that they ensure a stable level of antipsychotic medication. Besides, the use of long-acting antipsychotics improves patient's compliance with treatment. Unsatisfactory treatment compliance increases the risk of worsening/relapse and it also increases the risk of patient's re-hospitalization. The improvement of treatment compliance also results in the reduction in family burden caused by the disease. Thus, the second-generation long-acting antipsychotics are of great help in the therapy of people with schizophrenia. The use of a second-generation long-acting antipsychotic agent combines the advantages of the treatment with a long-acting antipsychotic resulting from a more stable drug level with the advantages of the use of an atypical antipsychotic drug: better efficacy against negative and affective symptoms, and better influence on patient's cognitive functioning, but also with the decreased risk of bothersome side-effects, mainly extrapyramidal symptoms. The indications and contra-indications for the use of the second-generation long-acting antipsychotics are presented. The guidelines for the beginning of treatment as well as treatment continuation are also presented. The dosage and the potential drug-drug interactions are discussed with regard to four second-generation long-acting antipsychotics: aripiprazole, olanzapine, paliperidone, and risperidone. The availability of these drugs in Poland is also discussed.

Review article

Can patients with bipolar disorder safely drive a motor vehicle? Overview of research, classification of drugs and legislation

Piotr Joachimiak, Jan Jaracz
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 67–86

Bipolar disorder is a chronic condition that requires a long-term treatment with mood stabilising drugs. Pharmacological therapy is always fraught with the risk of side effects of drugs, and the occurrence of side effects translates into worse functioning of the patient, regardless of the existing conditions resulting from the disease. Among the possible side effects caused by medication, specifically of note is the cognitive impairment affecting driving skills, ability to operate machinery or work at heights. Practising psychiatrists often face doubts on the first problem, i.e. driving vehicles by patients on prescription drugs treatment. Many such patients have a driver's license and, regardless of pharmacotherapy, they want to drive a car for a variety of reasons. This situation forces the psychiatrist to consider their driving safety in the light of potential side effects of the prescribed drugs. This problem emerges regularly and despite several conducted studies, it has not been fully resolved. In most of the characteristics of medical products, there are no clear guidelines for drivers in the pharmacotherapy. Usually, this decision is left to the doctor, who unfortunately does not have conclusive evidence to make an informed decision. Guidelines developed by international organisations (ICADTS, DRUID) may be of some help, yet they are not based on a sufficiently scientific basis. This report presents results of studies, current medical recommendations and law regulations related to safety while driving under the use of mood stabilisers.

Review article

The effect of lithium on hematopoietic system

Ewa Ferensztajn-Rochowiak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii 2015, 31 (1), 87–98

The effect of lithium on hematopoietic system makes an interesting, albeit somewhat forgotten topic of research, which started in the 60's and has continued into the 70's and the 80's of the 20th century. The most important actions of lithium concern the increase in the granulocyte count and modulation of their function, the increase in the platelet count, also in patients after chemotherapy and radiotherapy, the decrease in T-lymphocytes, in NK cells activity and in the production of immunoglobulins. The data of lithium effect on erythropoiesis are equivocal. The effect of lithium on blood cells enables its application in the treatment of hematological disorders, particularly congenital and iatrogenic neutropenia. In a murine model of AIDS (MAIDS), lithium improves hematopoiesis and reduces splenomegaly, lymphadenopathy as well as hypergammaglobulinemia. Also, increased tolerance of zidovudine and amelioration of myelosuppression and thrombocytopenia have been noted. Lithium is effective in treating neutropenia induced by clozapine, carbamazepine, cyclophosphamide, vinblastine and radiotherapy. Lithium has a positive effect on the number of leukocytes in patients with lymphosarcoma, prostate cancer, Hodgkin and non-Hodgkin lymphoma and in multiple myeloma. A shorter duration of neutropenia, less severe febrile neutropenia episodes, fewer days of hospitalization with fever and neutropenia, fewer infection-related deaths and improved quality of life were observed in patients with various types of cancers receiving additional lithium therapy. Lack of effect of lithium was observed in neutropenia associated with glycogenosis, during chemotherapy of acute myeloid leukaemia and in leukaemia of T-cell large granular lymphocytes.