Continued on page 2

Y.S.P.Vol. 781st July 2019

1

xxxxx Printing code xxxxx

Reg No: PP11312 / 03 / 2013 (032051) Publisher: Y.S.P. Industries (M) Sdn. Bhd. (192593 U)Company Address: Level 22, Menara LGB, No. 1 Jalan Wan Kadir, Taman Tun Dr. Ismail, 60000 Kuala Lumpur.Tel: +603 - 7727 6390 (14 lines) Fax: +603 - 7727 6701 Ordering line: 1 800 88 3027 Product Info Line: 1 800 88 3679 Website:http://www.yspsah.comMCI (P) 145 / 02 / 2014 (Singapore Publication Permit)PERCETAKAN ZANDERS SDN. BHD.: No. 16, Jalan BK 1/11, Bandar Kinrara, 47180, Puchong, Selangor Darul Ehsan, Malaysia.

A Subsidiary of

Irstran®

Film Coated Tablet Irbesartan mg150 300

Irbesartan is an angiotensin II type I receptor blocker (ARB) that is effective in controlling blood pressure and improving cardiovascular outcomes.

Once Daily Dosing Consistent Blood Pressure Control Over 24 Hours Effective in Preventing Progression of Diabetic Nephropathy Treatment of Choice in Hypertensive Patients with Type II Diabetes and Microalbuminuria

The Control You Can TrustA Renoprotective Blood Pressure Lowering Agent

Drugs belonging to the ‘-sartan’s family have made global headlines lately due to the recall and safety alerts issued by U.S. Food & Drug Administration (FDA). Some of the valsartan, losartan and irbesartan-containing brands were found containing unacceptable amounts of carcinogenic nitrosamine impurities including N-Nitrosodimethylamine (NDMA), N-Nitrosodiethyamine (NDEA) and N-Nitroso-N-methyl-4-aminobutyric acid (NMBA).1 Recently, the National Pharmaceutical Regulatory Agency (NPRA) in Malaysia has issued a recall for products containing unacceptable amounts of those carcinogenic nitrosamine impurities. YSP’s Irstran® Film Coated Tablet is not implicated on this matter and is safe to be prescribed.

DID YOU KNOW?

How It Works

with ARB

When angiotensin II (AII) is bound to the receptor, blood vessels contract.

ARBs block AII by preventing AII from binding to AII receptors on the muscles surrounding blood vessels. As a result, blood vessels dilate and blood pressure is reduced.

Contracted

Smoothmusclecells

AII

receptor

Dilatedartery =lowerblood

pressure Openscoronaryarteries

ARBSblockAII

receptor

ARB

AIIAII

Strictly for Healthcare Professionals

Continued from page 1

2

References:1. Food and Drug Administration [Internet] FDA Updates and Press Announcements on Angiotensin II Receptor Blocker (ARB) Recalls (Valsartan, Losartan, and Irbesartan) Available from: https://www.fda.gov/Drugs/DrugSafety/ucm613916.htm 2. Messerli F.H, Bandalore S, Bavishi C, Rimoldi S.F, Angiotensin-Converting Enzyme Inhibitors in Hypertension- To Use or Not to Use? j.jacc.2018.01.058

ABBREVIATED PRODUCT INFORMATIONProducts: Irstran® 150mg Film Coated Tablet, Irstran® 300mg Film Coated Tablet Active Ingredient: Irbesartan Indication(s): 1. For the treatment of essential hypertension. 2. For the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (>300mg/ day) in patients with type II diabetes and hypertension. Dosage and Administration(s): Initial and maintenance dose: 150mg once daily, with or without food. In patient with insufficient controlled: Dose of Irstran® can be increased to 300mg, or other antihypertensive agents can be added. In hypertensive type II diabetic patients: Therapy should be initiated at 150mg Irstran® once daily and titrated up to 300mg once daily. Contraindications: 1. Hypersensitivity to the active substance or to any of the excipients. 2. Second and third trimesters of pregnancy. 3. The concomitant use of this product with aliskiren-containing products is contraindicated in patients with diabetes mellitus or renal impairment.

Angiotensin-converting enzyme inhibitors (ACEIs) and ARBs are both classes of drugs that work on the

and compared with placebo trials.2 It is in fact concluded that ARBs are favoured over ACEIs.

d end-stage

of withdrawal.

aggregate indicates that at present there is little, if any, clinical reason to use ACE inhibitors for the treatment of hypertension and so-called compelling indications.

Conclusion

Efficacy

Safety

Cardiovascular mortality 5 1.00 (0.89-1.12)

End-stage renal disease 2 0.88 (0.63-1.22)

Myocardial infarction 5 1.07 (0.94-1.22)

Drug withdrawal 8 0.72 (0.65-0.81)

ACEIs withdrawal 55

Active Treatment Against Placebo

Favors ARBs

Favors Active Treatment

0.5 1.51

Favors Placebo

Favors ACEIs

0.85 (0.67-1.07)

ARBs withdrawal 26 0.68 (0.54-0.87)

Stroke 4 0.92 (0.80-1.06)

Head-to-Head Studies

Outcomes Trials RR*(95% CI*)

CENTRAL ILLUSTRATION: Efficacy and Safety of ACE Inhibitors and ARBs From Head-to-Head Studies and Compared With Placebo Trials

Strictly for Healthcare Professionals

Chemotherapy Induced Nausea and Vomiting (CINV)With the correct use of antiemetics, CINV can be prevented in almost 70% up to 80% of patients undergoing chemotherapy.Multinational Association of Supportive Care in Cancer (MASCC) guidelines, American Society of Clinical Oncology (ASCO) guidelines and the American National Comprehensive Cancer Network (NCCN) guidelines have all recommended the usage of granisetron for CINV. All three guidelines recommend granisetron at a dose of 1mg or 0.01mg/kg IV and 2mg orally (MASCC and ASCO) or 1–2mg orally (NCCN).

Radiotherapy Induced Nausea and Vomiting (RINV)For patients receiving chemoradiation schedules, antiemetic is given according to the emetogenic risk based on the chemotherapy regimen or the radiotherapy treatment field. Granisetron is generally used for moderate to severe emetogenic risk.

Post-operative Nausea and VomitingThe efficacy of granisetron hydrochloride injection for prevention of post-operative nausea and vomiting was evaluated among 868 patients in two randomized, double-blind, placebo-controlled studies in patients who underwent elective gynaecological surgery or cholecystectomy and received general anaesthesia. Patients received a single intravenous dose of granisetron hydrochloride injection (0.1mg, 1mg or 3mg) or placebo either 5 minutes before induction of anesthesia or immediately before reversal of anaesthesia. In both studies, granisetron hydrochloride injection (1mg) was more effective than placebo in preventing post-operative nausea and vomiting.Granil (Granisetron Hydrochloride) Injection is an anti-nausea and antiemetic agent, serving as a selective antagonist 5-HT3 receptor.

References:1. Jordan K, Sippel C, Schmoll HJ. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. Oncologist 2007 Sep;12(9):1143-1150.2. Genentech USA Inc. Drugs@FDA: FDA Approved Drug Products 2011. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=020239 (accessed May 7, 2019).

Granil Solution for Injection A Stronger Stomach for Cancer Patients:Eliminating Nausea and Vomiting

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Chemotherapy Induced Nausea and Vomiting (CINV)

Radiotherapy Induced Nausea and Vomiting (RINV)

Post-operative Nausea and Vomiting

Granisetron is indicated for the prevention and control of

• Quick onset of action• Highly tolerable with no adverse effects

Strictly for Healthcare Professionals

Continued on page 5

LIVING WITH PAIN-FREE JOINTSLIVING WITH PAIN-FREE JOINTS

SINGLE SHOT INTRA-ARTICULAR VISCOSUPPLEMENTATIONTHE SOLUTION FOR OSTEOARTHRITIS (OA)

A sterile, clear, viscoelastic preparation containing cross-linked water insoluble sodium hyaluronate and water soluble sodium hyaluronate polymers that supplements the fluid in the knee to help lubricate and cushion the joint.

HA is a linear long sugar chain consisting units of N-acetyl-glucosamine and D-glucuronic acid. It is found in vitreous humor of the eye, amniotic fluid and extracellular matrix of most tissues including skin. It is also present in high amounts in cartilage and synovial fluid. It forms a complex with lubricin to form a network that creates a boundary lubricant that decreases friction force and reduces wear damage on shearing surfaces in an OA joint.1

What is Hyaluronic acid (HA)? Why is it important in OA?

4

What is injection?

I am a patient who has been suffering from knee OA for ten years. When should I consider injection?

As a healthcare professional,why should I select for my patients? What is so special about the HA in injection?

Patients with stage II knee OA or whom have not received sufficient pain relief from lifestyle modification and painkillers are suitable to receive injection treatment.

HA used in is derived from Streptococcus zooepidemicus using a substrate free of animal origin. It is known as non-animal stabilized hyaluronic acid (NASHA). It involves a two-step process of bacterial synthesis of HA followed by controlled cross-linking.

• 6-month of pain relief of knee OA

• High molecular weight HA with good lubricating and cushioning effect

• Comparable to natural synovial fluid

• Cross-linked HA

• NASHA derived from bacterial fermentation

• Quality assured (CE & MDA certified)

• Low endotoxin level

Strictly for Healthcare Professionals

Continued from page 4

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References:1. Nicholls M, Fierlinger A, Niazi F, Bhandari M. The Disease-Modifying Effects of Hyaluronan in the Osteoarthritic Disease State. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2017;10:117954411772361.2. H.Fam,M.Kontopoulou,J.T Bryant. Effect of concentration and molecular weight on the rheology of hyaluronic acid/bovine calf serum solutions. 2009:10.3233?BIR-2009-05213. Heilmann HH, Lindenhayn K, Walther HU. Synovial volume of healthy and arthritic human knee joints. Z Orthop Ihre Grenzgeb 1996 Mar-Apr; 134(2):144-8

ulticentre study in India, clinical trial report, 2012

Is 6ml injection too much for a patient’s knee?

Cushioning effect

Lubricating effect

More LiquidLower MW Ability to coat and partition Fast biodegradation

Ability to maintain space and pressure Too solid to provide joint lubrication

More SolidHigher MW

The volume of synovial fluid in healthy human knee joints is 6.7± 2.3ml.3 It is always recommended to aspirate the knee joint before injecting to prevent swelling and inflammation.

An open-label, multicentre study was conducted to evaluate the efficacy and safety of single intra-articular injection of in patients with OA, and followed-up for a further period of 26 weeks.1

How effective is injection?

Significant reduction in mean pain score from baseline (12.2±1.7) to week 26 (6.6±1.3) and percentage of reduction was 45.9%.69% patients responded to treatment with regard to WOMAC pain scores at week 8.4

*P<0.001

04

Weeks

Baseline 8 12 18 26

2

4

6

8

10

12

14 12.2

6.3 6.1 5.9 6.4 6.6

Mea

n P

ain

Sco

re

Figure 2: Changes in WOMAC pain scores

Significant reduction in pain in terms of visual analogue scale (72.2±10.4 to 31.5±5.8) from baseline to week 26 and percentage of reduction was 56.4%.4

04

*P<0.001Weeks

72.2

Mea

n V

isua

l Ana

logu

e S

core

(mm

) 32.2 29.7 29.2 30.4 31.5

Baseline 8 12 18 26

1020

3040

50

60

70

80

Figure 3: Changes in current pain scores on Visual Analogue Scale

Do dosage and molecular weight (MW) of HA matter?High dosage and MW of HA stimulates more endogenous HA synthesis which particularly helps in pain relief and cushioning effects within the joint. However, too high a MW of HA may allow greater number of entanglements, leading to high viscosity that is less favorable on lubrication of the joint.2 With 6 million Daltons, meets both needs by lubricating and cushioning the joints as shown in Figure 1.

Figure 1: Spectrum of rheological properties of HA viscosupplements

Strictly for Healthcare Professionals

Ultraviolet (UV) radiation is part of the electromagnetic (light) spectrum that reaches the earth from the sun.1 UV radiation breaks down into different wavelengths, making it invisible to the naked eye. There are three types of wavelengths: UVA, UVB and UVC. But, only UVA and UVB reach the earth’s surface and can penetrate our skin.

UVA and UVB from the sun induce harmful responses to the skin surface and have a key role in developing skin cancer.

Topical sunscreen is commonly known as first line of prevention against harmful UV rays. However, daily topical application of sunscreen possesses inevitable drawbacks such as inconvenience, low compliance and requires reapplication throughout the day.

NUViT SunbloX, a delicious orange and lemon powder drink containing highly anti-oxidative ingredients such as NutroxSun™ and Polypodium Leucotomas extract that protect the skin from within through oral consumption.

NutroxSun™ : The Photo-protective Patented IngredientNutroxSun™ is an exclusive plant-based ingredient comprising of two highly anti-oxidative and anti-inflammatory ingredients, citrus extract and rosemary extract.

NutroxSun™ can prevent photo-aging by inhibiting the formation of reactive oxygen species (ROS) from UV radiation in the skin. This process also prevents cell apoptosis that leads to DNA damage and skin tumours. Study also shown that NutroxSun™ boosted the cell survival exposed to UV radiation and significantly reduced UVB-induced DNA damage in human cells.2

NUViT SunbloX: Protect Your Skin with NutroxSun™

Strictly for Healthcare Professionals

References:1. The Skin Cancer Foundation. UVA & UVB [Internet]. The Skin Cancer Foundation; 2017 [updated 2017 September 20; cited 2019 May 3]. Available from: https://www.skincancer.org/prevention/uva-and-uvb2. Pérez-Sánchez A, Barrajón-Catalán E, Caturla N, Castillo J, Benavente-García O, Alcaraz M, Micol V. Protective effects of citrus and rosemary extracts on UV-induced damage in skin cell model and human volunteers. Journal of Photochemistry and Photobiology B: Biology; 136 (2014) 12–18.

e Journal of Clinical and Aesthetic Dermatology 2015 Feb;8(2):19-23. Feb;15(2):224-228.

7

Fortified with Polypodium Leucotomos ExtractPolypodium Leucotomos extract is a tropical fern from Central America and commonly used as a medicine for skin. It is used to prevent skin problems such as sunburn, eczema, psoriasis, vitiligo and skin cancer. Studies proved that Polypodium Leucotomos extract shown to be photoprotective against UV-induced cell damage, reducing oxidative stress and DNA damage.3,4

Why choose NUViT SunbloX?• A nutritious and tasty beverage to ensure daily compliance and convenience• Provides protection on every part of the skin• 100% natural patented ingredient with NutroxSun™ from Spain• Fortified with Polypodium Leucotomos extract• Enriched with Vitamin C and Collagen Tripeptide• No added sugar• No added preservatives• No artificial colouring• Fat-free

Directions of Use Mix 1 sachet with 180mL room temperature water. Stir well and drink once daily.

Continued from page 6Strictly for Healthcare Professionals

Figure 1: Survival of human keratinocytes after UVB

irradiation at 800 J/m2 in the presence of NutroxSun™

Figure 2: NutroxSun™ decreases UVB-induced DNA

damage in human keratinocytes as per comet score

*Comet score: Measuring DNA integrity; higher score represents more DNA

damage and vice versa.

0

25

50

75

100

125

12.50 10087.57562.55037.525

Cel

l via

billt

y(%

of c

ontr

ol)

NutroxSun™ (µg/ml)

**

*** ******

*** *** ***

Non-irradiated

UVB (800 J/m2)

UVB (1200 J/m2)

Com

et s

core

*(a.

u.)

Combined extract (µg/ml)

-

-

+

-

-

100

+

100

0

100

200

300

400

500