Efficacy and safety of metformin versus empagliflozin on chronic kidney disease progression (MET-EMPA-CKD): a randomized controlled trial Bassant M. Mahboub, Ayman F. Refaie, Sahar M. El-Haggar, Yasser M. Hafez, Tarek M. Mostafa Diabetology and Metabolic Syndrome, 2026 Background Chronic kidney disease (CKD) is a devastating progressive condition accompanied with high morbidity and mortality rates. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have recently proven their renoprotective effects, whereas evidence for metformin remains limited but suggestive of potential benefit. This study aimed at comparing the efficacy and safety of metformin versus empagliflozin, a SGLT2 inhibitor, on retarding CKD progression with exploring supposed mechanistic pathways in clinical settings. Methods In this 12-month randomized controlled trial, 120 moderate CKD patients were randomized into three groups: metformin 1000 mg/day ( n = 40) or empagliflozin 10 mg/day ( n = 40), both added orally to standard treatment, or control who continued standard of care ( n = 40). The primary outcome was changes in estimated glomerular filtration rate (eGFR). Secondary analyses assessed percent changes of urinary albumin-to-creatinine ratio (uACR), transforming growth factor-β1 (TGF-β1), kidney injury molecule (KIM)-1, and beclin-1 (an autophagy biomarker). Other metabolic and safety issues were also assessed. Results 118 patients completed the study with comparable baseline data. Metformin and empagliflozin halted the decline in eGFR at study end with adjusted mean difference ± SE: 8.91 ± 1.92 ( p ˂0.001) and 5.1 ± 1.89 ( p = 0.03), respectively, compared to control group. Metformin preserved its effect in diabetics and non-diabetics, with superiority than empagliflozin in non-diabetics. uACR was lowered by metformin and empagliflozin than control. Both of them tended to halt the deterioration of intermediates with %relative change of -28.8% (95% CI, -44.4 to -9, p = 0.003) and 179.3% (95% CI, 32.2 to 490, p = 0.003), for metformin versus control in TGF-β1 and beclin-1 levels, respectively. Empagliflozin reduced KIM-1 compared to control [-29% (95% CI, -49.3 to -0.5, p = 0.045)]. Study treatments showed benefits on lipid profile without changing urate levels significantly compared to the control arm. No significant changes were found between metformin and empagliflozin. Adverse effects were comparable across groups with tolerable increased urination frequency by empagliflozin. Conclusion 12-month metformin therapy demonstrated renoprotective effects comparable to empagliflozin, with a greater effect observed among non-diabetics as an exploratory insight. Metformin’s renal actions were linked to antifibrotic and favorable autophagy effects while, empagliflozin preserved mainly tubular injury. Safety issues were generally comparable. Clinicaltrials.Gov identifier NCT05373680, registered on 13/5/2022 “retrospectively”. Graphical abstract
Probiotic Supplementation as an Adjuvant Therapy in Pediatric Drug-Resistant Epilepsy: A Double-Blind Placebo-Controlled Trial Amira R. Rashdan, Sahar M. El‐Haggar, Ahmed Mustafa Kishk, Tarek M. Mostafa Pharmacotherapy, 2026 Background Drug‐resistant epilepsy (DRE) is increasingly linked to neuroinflammatory mechanisms driven by gut dysbiosis. These mechanisms compromise blood–brain barrier integrity, enhance seizure susceptibility, and modulate immune pathways. These insights underscore the therapeutic potential of microbiota‐targeted interventions in epilepsy. Aim The study aimed at assessing the effectiveness of probiotics as an adjunctive therapy to enhance drug sensitivity and clinical outcomes in children with DRE. Methods This randomized, double‐blind, placebo‐controlled trial enrolled 60 pediatric patients with DRE who were assigned to either the control group ( n = 30), which received a standard antiepileptic regimen (valproic acid, oxcarbazepine, and levetiracetam at the maximum tolerated doses) plus a daily placebo capsule, or the probiotic group ( n = 30), which received the same antiepileptic regimen plus a daily probiotic ( Lactobacillus acidophilus ) supplement. The study duration was 6 months. Assessments of clinical and biochemical outcomes were conducted at baseline and 6 months after intervention. Primary end points included seizure frequency and change in quality of life as measured by the quality of life in childhood epilepsy (QOLCE‐55) questionnaire. Secondary end points included the change in the serum levels of high‐mobility group box 1 protein (HMGB1), interleukin‐1β (IL‐1β), homocysteine (Hcy), and NLR family pyrin domain‐containing 3 (NLRP3). Results After 6 months and relative to the control group, the probiotic ( Lactobacillus acidophilus ) group experienced a significant decline in seizure frequency ( p = 0.04) and a significant improvement in the QOLCE‐55 total score ( p < 0.0001). Additionally, the probiotic group exhibited significant decreases in the serum levels of HMGB1 ( p = 0.0005), NLRP3 ( p = 0.002), Hcy ( p = 0.001), and IL‐1β ( p = 0.05) compared with the control group. Conclusion Lactobacillus acidophilus supplementation appears to enhance the effectiveness of conventional antiepileptic drugs, reduce systemic inflammation, improve quality of life, and reduce seizure frequency in children with DRE. However, further validation is necessary. Clinicaltrials.gov Registration Number NCT05539287.
A Novel Approach to Reducing Chemoresistance in Advanced Ovarian Cancer: The Effect of Itraconazole—A Single-Institution Randomized Placebo-Controlled Trial Ahmed E. S. Besheir, Sahar M. El-Hagar, Hesham A. Tawfik, Tarek M. Mostafa Current Oncology, 2026 Background: The five-year survival rate of patients with ovarian cancer remains less than 50%, secondary to chemotherapy resistance. Purpose: This study aims to evaluate the effects of itraconazole as a supplementary treatment with paclitaxel and carboplatin on malignancy response and in preventing the initial development of chemoresistance in chemotherapy-naïve patients with advanced ovarian epithelial cancer. Method: This randomized placebo-controlled double-blind study involved 60 chemotherapy-naïve patients with advanced epithelial ovarian malignancy who were randomized into two arms; the placebo and itraconazole groups. The placebo group received six chemotherapy cycles and four inactive capsules, while the itraconazole group received six chemotherapy cycles and 400 mg oral itraconazole for five days per cycle. Results: Following completion of six chemotherapy cycles and when contrasted with the control arm, the itraconazole arm demonstrated statistically significant improvements in tumor response. The objective response rate was 80% in the itraconazole group compared with 47% in the placebo group (p = 0.015), while the disease control rate was 100% versus 80%, respectively (p = 0.023). The median progression-free survival (PFS), defined as the time point at which 50% of patients experienced disease progression or death, was 13.5 months for the overall study population. PFS was evaluated as a fixed-time endpoint at 18 months following completion of chemotherapy for the overall study population. Progression-free survival was significantly improved in the itraconazole group, with 70% of patients remaining progression-free compared with 26.7% in the placebo group (p = 0.001). Also, the itraconazole group produced significant declines in the serum levels of CA-125 (p = 0.005) and p-glycoprotein (p = 0.042) with significant elevation in VEGFR-2 (p = 0.006) as compared to the control group. Itraconazole was safe and its use was associated with a significant improvement in the quality of life (QOL). Conclusions: Itraconazole could represent a promising add-on therapy to enhance tumor response to chemotherapy in patients with ovarian cancer.
Fenofibrate attenuates doxorubicin-induced cardiotoxicity in patients with breast cancer: a randomized controlled trial Hagar K. Dewidar, Amr A. Ghannam, Tarek M. Mostafa Naunyn Schmiedeberg S Archives of Pharmacology, 2025 Doxorubicin-induced cardiotoxicity (DIC) is a serious condition that limits its use. Thus, this study aimed at evaluating the efficacy and safety of fenofibrate in attenuating DIC in patients with breast cancer. In this randomized controlled parallel study, 44 patients with stage II and/or stage III breast cancer were randomly allocated into two groups: group 1 (control group; n = 22) which received doxorubicin/cyclophosphamide (AC regimen) for four cycles (cycle is every 3 weeks) and group 2 (fenofibrate group; n = 22) which received AC regimen for four cycles (cycle is every 3 weeks) plus 160 mg of oral fenofibrate 24 h prior to the first cycle of chemotherapy and then once daily until the end of the four chemotherapy cycles. At baseline and after the fourth chemotherapy cycle, all participants were submitted to echocardiography (echo) to evaluate left ventricular ejection fraction (LVEF) and blood sample collection to assess the serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Data was analyzed using paired and unpaired t-tests, chi-square test, and Fisher exact test. Compared to baseline, the control group (AC) produced a significant increase in the serum levels of both NT-proBNP (P = 0.004) and MPO (P < 0.001). At the end of the study and as compared to the control group, the fenofibrate group showed significantly higher LVEF (P = 0.048) and a lower incidence of cardiotoxicity (P = 0.036). Additionally, the fenofibrate group showed a significant decline in the serum levels of NT-proBNP (P < 0.001) and MPO (P < 0.001). Moreover, fenofibrate was safe and well-tolerated and did not provoke a significant elevation in liver enzymes (P > 0.05). Fenofibrate could represent a promising prophylactic therapy against doxorubicin-induced cardiotoxicity. Trial registration: ClinicalTrials.gov ID: NCT06155331. Trial registration date 1-12-2023.
Efficacy and safety of nitazoxanide and escitalopram as adjuvant therapies in patients with rheumatoid arthritis: a randomized controlled study Tarek M. Mostafa, Abeer A. El-Sayed, Abdel Moaty A. Afifi, Dalia R. El-Afify European Journal of Clinical Pharmacology, 2025 Objective This research aimed at evaluating the effectiveness and safety of nitazoxanide and escitalopram as adjuvant therapies in patients with rheumatoid arthritis (RA). Methods In this randomized controlled parallel study, 90 patients with active RA were randomized into three groups; group 1 (control group; n = 30) which received traditional therapy, group 2 (Nitazoxanide group; n = 30) which received traditional therapy plus 1 gm/day oral nitazoxanide, and group 3 (Escitalopram group; n = 30) which received traditional therapy plus 10 mg/day oral escitalopram for three months. At baseline and 3 months after treatment, clinical and functional assessments were done through the 28-joint count disease activity score using C-reactive protein (DAS28-CRP), the health assessment questionnaire-disability index (HAQ-DI), and the patient’s global assessment (PGA). Also, serum levels of high-sensitivity C-reactive protein (hs-CRP), signal transducer and activator of transcription-3 (STAT-3), Janus kinase-2 (JAK-2), toll-like receptors 4 (TLR-4), interleukin-1 beta (IL-1β), and malondialdehyde (MDA) were assessed. Data were analyzed using paired t-test and one-way analysis of variance, followed by Tukey’s HDS test. Results Three months after treatment and as compared to the control group, the nitazoxanide group showed a significant decline in PGA (P = 0.042), and serum levels of STAT-3 (P < 0.001), JAK-2 (P < 0.001), TLR-4 (P < 0.001), and IL-1β (P < 0.001). On the other hand, the escitalopram group produced a significant decrease in DAS28-CRP score (P = 0.029), HAQ-DI score (P = 0.001), and serum levels of JAK-2 (P = 0.001), TLR-4 (P < 0.001), IL-1β (P < 0.001), and MDA (P < 0.001). As compared to nitazoxanide group, the escitalopram group produced a significant decline in fatigue score (P < 0.001) and serum levels of both IL-1β (P = 0.023) and MDA (P < 0.001). Both medications were safe; however, chromaturia was the only significant nitazoxanide-related adverse effect. Conclusion Nitazoxanide and escitalopram could serve as potential adjuvant therapies for patients with RA based on their effectiveness and safety data.
Efficacy and safety of metformin versus empagliflozin on chronic kidney disease progression (MET-EMPA-CKD): a randomized controlled trial BM Mahboub, AF Refaie, SM El-Haggar, YM Hafez, TM Mostafa Diabetology & Metabolic Syndrome 18 (1), 17 , 2026 2026
Ketotifen for Preventing Oxaliplatin-Induced Neuropathy in Stage III Colorectal Cancer: a Randomized Controlled Trial SS Wahby, TM Mostafa, MAA El-Din, EI Elberri Journal of Gastrointestinal Cancer 57 (1), 106 , 2026 2026
Efficacy and safety of baclofen in the prophylaxis of postoperative nausea and vomiting after laparoscopic sleeve gastrectomy: a randomized controlled trial AG Moussa, SM El-Haggar, TM El-Mahdy, TM Mostafa BMC Surgery , 2026 2026
L-Carnitine and Biotin as Adjunctive Therapies in Children with Moderate Persistent Asthma: A Randomized Placebo controlled Study MO Khedr, SM El-Haggar, AM Abd El-Razik, TM Mostafa 2026
Atorvastatin reduces recurrent decompensation events in advanced cirrhosis in a randomized placebo-controlled trial KAM Glal, SM El-Haggar, SM Abdel-Salam, TM Mostafa Scientific Reports , 2026 2026
Probiotic Supplementation as an Adjuvant Therapy in Pediatric Drug‐Resistant Epilepsy: A Double‐Blind Placebo‐Controlled Trial AR Rashdan, SM El‐Haggar, AM Kishk, TM Mostafa Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 46 (3 … , 2026 2026 Citations: 2
Efficacy and Safety of Roflumilast in Patients with Non-Alcoholic Steatohepatitis: A Randomized Controlled Study TM Mostafa, MS Mohamed, SM Abdel-Salam, DR El-Afify International Journal of Pharmaceutical Sciences and Research 38 (1), 33-46 , 2026 2026
A Novel Approach to Reducing Chemoresistance in Advanced Ovarian Cancer: The Effect of Itraconazole—A Single-Institution Randomized Placebo-Controlled Trial AES Besheir, SM El-Hagar, HA Tawfik, TM Mostafa Current Oncology 33 (1), 21 , 2025 2025 Citations: 1
Efficacy and Safety of Roflumilast versus Alpha-Lipoic Acid in Type 2 Diabetes with Neuropathy: A Comparative Clinical Study A Elsharab, MZ Nooh, RS Matard, TM Mostafa, DR El-Afify Diabetes, Metabolic Syndrome and Obesity, 4193-4210 , 2025 2025 Citations: 1
Comparative clinical study to evaluate the efficacy and safety of roflumilast versus alpha-lipoic acid in type 2 diabetic patients with diabetic neuropathy AEA Elsharab, TM Mostafa, MZ Nooh, DR El-Afify Journal of the Neurological Sciences 480 , 2025 2025
Protective effect of celecoxib against capecitabine induced hand and foot syndrome in patients with colorectal cancer AM Kettana, TM Mostafa, AA Ghannam, DR El-Afify Cancer Chemotherapy and Pharmacology 95 (1), 72 , 2025 2025 Citations: 1
Pentoxifylline as Adjuvant Therapy in Patients with Generalized Epilepsy Treated with Phenytoin: A Randomized Controlled Study MA Younis, SM El-Haggar, W Mustafa, TM Mostafa Molecular Neurobiology 62 (12), 15978-15987 , 2025 2025
Efficacy and safety of nitazoxanide and escitalopram as adjuvant therapies in patients with rheumatoid arthritis: a randomized controlled study TM Mostafa, AA El-Sayed, AMA Afifi, DR El-Afify European Journal of Clinical Pharmacology 81 (12), 1819-1832 , 2025 2025
Fenofibrate attenuates doxorubicin-induced cardiotoxicity in patients with breast cancer: a randomized controlled trial HK Dewidar, AA Ghannam, TM Mostafa Naunyn-Schmiedeberg's Archives of Pharmacology 398 (12), 17109-17119 , 2025 2025 Citations: 1
Clinical study evaluating the gastroprotective effect of carvedilol in patients with ischemic heart disease on aspirin therapy SM Elkablawy, AE Shaban, TM Mostafa Inflammopharmacology 33 (11), 6831-6838 , 2025 2025 Citations: 1
Role of dexmedetomidine in brain injury: a systematic review R Zekry, RH Werida, ES Hegazy, TM Mostafa Inflammopharmacology 33 (10), 5745-5756 , 2025 2025 Citations: 1
Randomized controlled trial evaluating synbiotic supplementation as an adjuvant therapy in the treatment of Parkinson’s disease ME Ramadan, TM Mostafa, AA Ghali, DR El-Afify Inflammopharmacology 33 (7), 3897-3908 , 2025 2025 Citations: 13
Clinical study evaluating the efficacy and safety of Cilostazol as an adjuvant therapy to methotrexate on patients with rheumatoid arthritis SM Eldadamony, SM El-Haggar, AMA Ali, TM Mostafa Inflammopharmacology 33 (6), 3499-3508 , 2025 2025 Citations: 1
Allopurinol prevents cirrhosis-related complications: a quadruple blind placebo-controlled trial KAM Glal, SM El-Haggar, SM Abdel-Salam, TM Mostafa The American journal of medicine 137 (1), 55-64 , 2024 2024 Citations: 5
Anti-inflammatory therapy in hepatic encephalopathy: A systematic review and meta-analysis K Glal, T Mostafa Journal of Advanced Research 54, S4-S5 , 2023 2023
MOST CITED SCHOLAR PUBLICATIONS
The Phosphodiesterase Inhibitor Pentoxifylline as a Novel Adjunct to Antidepressants in Major Depressive Disorder Patients: A Proof-of-Concept, Randomized, Double-Blind … SM El-Haggar, MAR Eissa, TM Mostafa, KS El-Attar, MS Abdallah Psychotherapy and Psychosomatics , 2018 2018 Citations: 67
Comparative clinical study between the effect of fenofibrate alone and its combination with pentoxifylline on biochemical parameters and liver stiffness in patients with non … SM El-Haggar, TM Mostafa Hepatology international 9 (3), 471-479 , 2015 2015 Citations: 67
Role of metformin in oxaliplatin-induced peripheral neuropathy in patients with stage III colorectal cancer: randomized, controlled study BM El-Fatatry, OM Ibrahim, FZ Hussien, TM Mostafa International journal of colorectal disease 33 (12), 1675-1683 , 2018 2018 Citations: 61
Alpha-lipoic acid improves subclinical left ventricular dysfunction in asymptomatic patients with type 1 diabetes SK Hegazy, OA Tolba, TM Mostafa, MA Eid, DR El-Afify The review of diabetic studies: RDS 10 (1), 58 , 2013 2013 Citations: 60
Role of alpha-lipoic acid in counteracting paclitaxel-and doxorubicin-induced toxicities: a randomized controlled trial in breast cancer patients RH Werida, RA Elshafiey, A Ghoneim, S Elzawawy, TM Mostafa Supportive Care in Cancer 30 (9), 7281-7292 , 2022 2022 Citations: 48
Study on the therapeutic benefit on lactoferrin in patients with colorectal cancer receiving chemotherapy TM Moastafa, AEDE El-Sissy, GK El-Saeed, MSED Koura International Scholarly Research Notices 2014 (1), 184278 , 2014 2014 Citations: 48
The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients T Mostafa, G Badra, M Abdallah Turkish Journal of Gastroenterology 26 (2), 163-169 , 2015 2015 Citations: 47
Nigella sativa as a promising intervention for metabolic and inflammatory disorders in obese prediabetic subjects: A comparative study of Nigella sativa versus both lifestyle … TM Mostafa, SK Hegazy, SS Elnaidany, WA Shehabeldin, ES Sawan Journal of Diabetes and its Complications 35 (7), 107947 , 2021 2021 Citations: 40
Circulating IRAPe, irisin, and IL-34 in relation to insulin resistance in patients with type 2 diabetes TM Mostafa, NM El-Gharbawy, RH Werida Clinical therapeutics 43 (7), e230-e240 , 2021 2021 Citations: 38
The plausible mechanisms of tramadol for treatment of COVID-19 NE El-Ashmawy, AHA Lashin, KM Okasha, AMA Kamer, TM Mostafa, ... Medical Hypotheses 146, 110468 , 2021 2021 Citations: 36
Levetiracetam and lamotrigine effects as mono-and polytherapy on bone mineral density in epileptic patients SM El-Haggar, TM Mostafa, HMS Allah, GH Akef Arquivos de Neuro-Psiquiatria 76 (07), 452-458 , 2018 2018 Citations: 33
Alpha-lipoic acid improved anemia, erythropoietin resistance, maintained glycemic control, and reduced cardiovascular risk in diabetic patients on hemodialysis: a multi-center … DZA Hamid, YA Nienaa, TM Mostafa European Review for Medical & Pharmacological Sciences 26 (7) , 2022 2022 Citations: 30
Role of alpha-lipoic acid in the management of anemia in patients with chronic renal failure undergoing hemodialysis GA El-Nakib, TM Mostafa, TM Abbas, MM El-Shishtawy, MM Mabrouk, ... International journal of nephrology and renovascular disease, 161-168 , 2013 2013 Citations: 30
Nitazoxanide versus rifaximin in preventing the recurrence of hepatic encephalopathy: A randomized double‐blind controlled trial KAM Glal, SM Abd‐Elsalam, TM Mostafa Journal of Hepato‐Biliary‐Pancreatic Sciences 28 (10), 812-824 , 2021 2021 Citations: 27
Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism RH Werida, NM El-Gharbawy, TM Mostafa Archives of Endocrinology and Metabolism 65, 126-136 , 2021 2021 Citations: 27
Viability and functionality of bovine chromaffin cells encapsulated into alginate-PLL microcapsules with a liquefied inner core T Moustafa, S Girod, F Tortosa, R Li, JC Sol, F Rodriguez, R Bastide, ... Cell Transplantation 15 (2), 121-133 , 2006 2006 Citations: 26
The impact of fish oil and wheat germ oil combination on mineral-bone and inflammatory markers in maintenance hemodialysis patients: a randomized, double-blind, placebo … H Zakaria, TM Mostafa, GA El-Azab, AM Abd El Wahab, H Elshahawy, ... International Urology and Nephrology 49 (10), 1851-1858 , 2017 2017 Citations: 23
Celecoxib as an adjuvant to chemotherapy for patients with metastatic colorectal cancer: A randomized controlled clinical study TM Mostafa, MAA El-Din, AR Rashdan Saudi Medical Journal 43 (1), 37 , 2022 2022 Citations: 22
Effect of metformin as an adjuvant therapy to letrozole on estradiol and other biomarkers involved in the pathogenesis of breast cancer in overweight and obese postmenopausal … AA El-Attar, OM Ibrahim, SA Alhassanin, ES Essa, TM Mostafa European Journal of Clinical Pharmacology 79 (2), 299-309 , 2023 2023 Citations: 21
Adipokines and biochemical changes in Egyptian obese subjects: possible variation with sex and degree of obesity SM El-Haggar, TM Mostafa Endocrine 48 (3), 878-885 , 2015 2015 Citations: 19