Although renal toxicity was not observed in the clinical studies with golodirsen, potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides. Renal function should be monitored in those taking golodirsen. Pharmacology
Pharmacokinetics
Following single or multiple intravenous infusions, the majority of drug elimination occurs within 24 hours of intravenous administration. The elimination half-life of golodirsen, in parity with eteplirsen was 3 to 6 hours. Clinical benefits
As a first-generation drug, golodirsen is far away from being curative; clinical trial outcomes have demonstrated the drug to have a marginal effect on ameliorating DMD pathology. As of December 2019, golodirsen is approved for therapeutic use in the United States, as well as in the countries that automatically recognize the decisions of the US Food and Drug Administration, under the condition that its benefit will be demonstrated in a confirmatory clinical trial. Society and culture
Golodirsen is one of the very few FDA-approved exon-skipping therapy for Duchenne muscular dystrophy (DMD), although the clinical benefits of the drug are yet to established. While the development of golodirsen needed huge financing, it is only applicable to a small subset of DMD patients. Sarepta Therapeutics has announced that golodirsen will cost in parity with eteplirsen, another drug of a similar kind, which may be as high as US$300,000 a year. Whether the patients should spend so much on a drug with questioned efficacy raises concerns.
Other musculoskeletal conditions that may cause chest pain similar to costochondritis includes but are not limited to, painful xiphoid syndrome, muscle strain, myofascial pain syndrome, thoracic disk herniation, and rib fracture. Other
Rheumatologic conditions such as fibromyalgia, SAPHO syndrome, ankylosing spondylitis, rheumatoid arthritis, and psoriatic arthritis can cause symptoms similar to costochondritis. Oncology-related conditions, namely neoplasms and myelomatous pleural effusion have been associated with chest pain. Chest pain is occasionally experienced with respiratory-related conditions such as pleuritis, precordial catch syndrome, and pneumonia. Psychogenic conditions such as anxiety disorders, panic disorders, and hyperventilation syndrome may cause chest pain. Some gastroenterology conditions may be associated with costochondritis-like chest pain such as gastroesophageal reflux disease, and esophagitis. Viral infections such as herpes zoster and Bornholm disease are seen as differential diagnoses for costochondritis due to chest pain being a reported symptom. Vitamin D deficiency can be a differential diagnosis for costochondritis as it may cause chest pain. Chest pain has also been reported following the use of cocaine, which can increase the risk of various cardiovascular conditions. Treatment
Costochondritis is referred to as being self-limited, which is a condition in which will typically resolve on its own without treatment. Conservative methods are often the first method to treat the condition. If the condition is a result of trauma or over-use of the upper extremity, individuals will be told to rest and avoid activities. Pain relief medications (analgesics) such as acetaminophen, or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or meloxicam may be suggested to relieve discomfort.