Association Between Antipsychotics and Osteoporosis Based on Real-World Data

Background:

Osteoporosis, which is a major public health concern, has been known to reduce health-related quality of life. Some studies have suggested that antipsychotics could perhaps cause osteoporosis by increasing serum prolactin levels. However, the association between antipsychotics and the risk for developing osteoporosis has been controversial.

Objective:

The present study aimed to assess the association between antipsychotic use and onset of osteoporosis in real-world settings.

Methods:

A multimethod data-mining approach using different algorithms and databases was used. First, disproportionality analysis was conducted using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (2004-2017) with reporting odds ratio (ROR) and information component (IC) being used to indicate a signal. Furthermore, a sequence symmetry analysis using data from a large Japanese administrative claims database (2005-2017; JMDC Inc, Japan) was conducted. Short-term intervals (ie, 12, 24, and 36 months) were set to investigate the association between antipsychotic use and onset of osteoporosis using the adjusted sequence ratio (SR) to indicate a signal.

Results:

No potential association between osteoporosis and all antipsychotics was observed in the FAERS database, except for perphenazine, which exhibited significant signals using both ROR and IC. Moreover, no potential association between osteoporosis and antipsychotics was observed in the JMDC claims database, except for sulpiride and aripiprazole. None of the antipsychotics indicated significant signals using all analyzed items (ROR, IC, and adjusted SR).

Conclusion and Relevance:

Real-world data show no association between antipsychotic use and the onset of osteoporosis. Further pharmacoepidemiological studies are needed for causality assessment.

Polypharmacy in elderly patients in Japan: Analysis of Japanese real-world databases

WHAT IS KNOWN AND OBJECTIVE

Polypharmacy is associated with an increased risk of adverse drug reactions (ADRs) and drug interactions, decreased adherence to medication and increased medical cost. Recently, polypharmacy has become a major problem in medical care in Japan as a result of the increase in the ageing population. The purpose of this study was to investigate the current situation of polypharmacy and the association between polypharmacy and adverse events.

METHODS

A retrospective data analysis was performed using two different real-world data from 2007 to 2015 in Japan. The Japanese Adverse Drug Event Report (JADER), a public spontaneous adverse drug reaction database constructed by the Pharmaceuticals and Medical Devices Agency (PMDA), and a large prescription database constructed by a database vendor (Japan Medical Information Research Institute, Inc Japan [JMIRI]) were analysed. Trends of polypharmacy during the study period were investigated.

RESULTS AND DISCUSSION

The mean number of drugs per report in the JADER database and per prescription in the JMIRI databases during the study period ranged from 4.8 to 5.6 and 3.5 to 3.7, respectively. The mean number of drugs increased with age in both the JADER and JMIRI databases, and the peak of the mean number of drugs was at 80-89 years (5.74 drugs) in the JADER database and at 90-99 years (4.97 drugs) in the JMIRI database.

WHAT IS NEW AND CONCLUSIONS

The number of drugs increased until age 90 years or more, even though adverse events are more likely to occur after the age of 80 in Japan. Therefore, polypharmacy in the elderly should be focused on the patients aged ≥80 years rather than patients aged ≥65 years from the viewpoint of the prevention of adverse events.

Inverse Association between Metformin and Amiodarone-Associated Extracardiac Adverse Events

Background: The association between metformin and amiodarone-induced adverse events was examined using spontaneous adverse event database. Additionally, the association between other antidiabetic drugs and amiodarone-induced adverse events were also examined. Methods: A total of 6,153,696 reports from the first quarter of 2004 through the fourth quarter of 2015 were downloaded from the US Food and Drug Administration adverse event reporting system. Reporting odds ratio (ROR) and information component (IC) were used to detect associations between antidiabetic drugs and amiodarone-associated adverse events. Additionally, subset data analysis was performed to investigate whether the use of antidiabetic drugs further increased or decreased the risk of adverse events in patients receiving amiodarone therapy. Next, the RORs were adjusted for coadministered antidiabetic drugs using logistic regression analysis. Results: By whole dataset analysis, significant inverse associations were found between metformin and interstitial lung disease (ROR 0.84, 95% confidence interval [CI] 0.79-0.90; IC -0.24, 95% CI -0.33 to -0.15). In the subset data analysis, metformin (ROR 0.62, 95%CI 0.43-0.89; IC -0.63, 95%CI -1.14 to -0.11), sulfonylureas (ROR 0.53, 95%CI 0.32-0.85; IC -0.85, 95%CI -1.53 to -0.17), and dipeptidyl peptidase-4 (DPP-4) inhibitors (ROR 0.25, 95%CI 0.08-0.78; IC -1.66, 95%CI -3.08 to -0.23) were inversely associated with hyperthyroidism. Additionally, metformin (ROR 0.43, 95%CI 0.33-0.57; IC -1.09, 95%CI -1.49 to -0.69), sulfonylureas (ROR 0.64, 95%CI 0.48-0.86; IC -0.59, 95%CI -1.00 to -0.17), and DPP-4 inhibitors (ROR 0.47, 95%CI 0.27-0.81; IC -0.99, 95%CI -1.76 to -0.22) were inversely associated with interstitial lung disease. In the logistic regression analyses, DPP-4 inhibitors (adjusted ROR 0.32, 95% CI 0.10-1.00) and metformin (adjusted ROR 0.46, 95% CI 0.34-0.62) were inversely associated with amiodarone-associated hyperthyroidism and interstitial lung disease, respectively. Conclusion: Metformin is a candidate drug to reduce the risk of amiodarone-induced hyperthyroidism and interstitial lung disease.

Association between oral anticoagulants and osteoporosis: Real-world data mining using a multi-methodological approach

Introduction: Warfarin and direct oral anticoagulants (DOACs) have been widely used in antithrombotic therapy. Although warfarin use has been suspected to be associated with osteoporosis risk, several studies have shown otherwise. Conversely, a few reports have found an association between DOACs and osteoporosis. This study therefore clarifies the association between oral anticoagulants and osteoporosis by analyzing real-world data using different methodologies, algorithms, and databases. Methods: Real-world data from the US Food and Drug Administration Adverse Event Reporting System (FAERS; 2004-2016) and Japanese administrative claims database (2005-2017; JMDC Inc., Tokyo) were used. Reporting odds ratio (ROR) and information component (IC) were calculated through disproportionality analysis (DPA) using reports recorded in the FAERS. Sequence symmetry analysis (SSA) was employed to calculate the adjusted sequence ratio (SR) using the JMDC Claims Database. For the adjusted SR and ROR, a significant signal was detected when the lower limit of the two-sided 95% confidence interval (CI) was more than 1. For the IC, a significant signal was detected when the lower limit of the 95% CI was more than 0. Results: DPA for warfarin found significant signals for osteoporosis in ROR (1.43, 95% CI: 1.32-1.54) and IC (0.50, 95% CI: 0.39-0.61). SSA showed a significant association between warfarin use and osteoporosis or bisphosphonate use. Moreover, a significant association was observed in males and females, albeit only for warfarin. Conclusion: Multi-methodological data mining revealed that warfarin use, not DOACs, is significantly associated with osteoporosis regardless of sex difference.

Interaction Effects of Behavioral Inhibition System/Behavioral Activation System and Cost/Probability Biases on Social Anxiety

Introduction

Social anxiety disorder (SAD) symptoms are maintained by cognitive biases, which are overestimations of the severity and likelihood of negative social events (cost/probability biases), and by sensitivity to rewards and punishments that are determined according to behavioral inhibition/behavioral activation systems (BIS/BAS). Cost/probability biases might activate the behavioral immune system and exacerbate the avoidance of social events. Earlier studies have proposed that low BIS or high BAS decrease SAD symptoms; BIS/BAS may even change the effects of cognitive biases on SAD symptoms. Hence, the current study investigates the interaction effects of BIS/BAS and cost/probability biases on SAD symptoms.

Method

Seventy-six Japanese undergraduate students completed the Japanese version of the Liebowitz Social Anxiety Scale (LSAS), which comprises Fear and Avoidance subscales, the BIS/BAS Scale, and the Social Cost Probability Scale.

Results

A multiple regression analysis was performed to examine whether cost/probability biases, BIS/BAS, and their interactions affected SAD symptoms; following this, the main effects of cost bias and BIS were determined for LSAS-Fear (β = 0.64, p < 0.001; β = 0.33, p < 0.01) and LSAS-Avoidance (β = 0.49, p < 0.001; β = 0.35, p < 0.01). The interaction effect between cost bias and BAS was significant for LSAS-Avoidance (β = -0.32, p < 0.05). Simple slope analysis showed that the slope of cost bias was significant for low-BAS individuals (β = 0.77, p < 0.001) but not for high-BAS individuals (β = -0.21, n.s.). The interaction effect between probability bias and BAS was significant for LSAS-Avoidance (β = 0.40, p < 0.01) as well. Further, simple slope analysis revealed that the slope of probability bias was significant for low-BAS individuals (β = -0.53, p < 0.05) but not for high-BAS individuals (β = 0.17, n.s.).

Discussion

The study found interesting results with respect to the avoidance of social events. Low-BAS individuals with high cost or low probability biases regarding social events may have a tendency to avoid social events. In contrast, if high-BAS individuals overestimate the cost of social events or underestimate the probability of social events, their anticipation of rewards might prevent them from avoiding social events.

Integrative analysis of clinical and bioinformatics databases to identify anticancer properties of digoxin

Cardiac glycosides, such as digoxin, inhibit Na⁺/K⁺-ATPases and cause secondary activation of Na⁺/Ca²⁺ exchangers. Preclinical investigations have suggested that digoxin may have anticancer properties. In order to clarify the functional mechanisms of digoxin in cancer, we performed an integrative analysis of clinical and bioinformatics databases. The US Food and Drug Administration Adverse Event Reporting System and the Japan Medical Data Center claims database were used as clinical databases to evaluate reporting odds ratios and adjusted sequence ratios, respectively. The BaseSpace Correlation Engine and Connectivity Map bioinformatics databases were used to investigate molecular pathways related to digoxin anticancer mechanisms. Clinical database analyses suggested an inverse association between digoxin and four cancers: gastric, colon, prostate and haematological malignancy. The bioinformatics database analysis suggested digoxin may exert an anticancer effect via peroxisome proliferator-activated receptor α and apoptotic caspase cascade pathways. Our integrative analysis revealed the possibility of digoxin as a drug repositioning candidate for cancers.

Drug interactions between tacrolimus and clotrimazole troche: a data mining approach followed by a pharmacokinetic study

PURPOSE

This study investigated the effects of clotrimazole troche on the risk of transplant rejection and the pharmacokinetics of tacrolimus.

METHODS

The data mining approach was used to investigate whether the use of clotrimazole increased the risk of transplant rejection in patients receiving tacrolimus therapy. Patient data were acquired from the US Food and Drug Administration's Adverse Event Reporting System (FAERS) from the first quarter of 2004 to the end of 2017. Next, we retrospectively investigated the effect of clotrimazole troche on tacrolimus pharmacokinetics in seven patients who underwent heart transplantation between March and December 2017.

RESULTS

The FAERS subset data indicated a significant association between transplant rejection and tacrolimus with clotrimazole [reporting odds ratio 1.92, 95% two-sided confidence interval (95% CI) 1.43-2.58, information component 0.81, 95% CI 0.40-1.23]. The pharmacokinetic study demonstrated a significant correlation between trough concentration (C₀) and area under the concentration-time curve of tacrolimus after discontinuation of clotrimazole (R² = 0.60, P < 0.05) but not before its discontinuation. Furthermore, the median clearance/bioavailability of tacrolimus after discontinuation of clotrimazole was 2.2-fold greater than that before its discontinuation (0.27 vs. 0.59 L/h/kg, P < 0.05). The median C₀ decreased from 10.7 ng/mL on the day after discontinuation of clotrimazole to 6.5 ng/mL at 1 day and 5.3 ng/mL at 2 days after its discontinuation.

CONCLUSION

Immediate dose adjustments of tacrolimus may be beneficial to avoid transplant rejection when clotrimazole troche is added or discontinued.

Predicting Ventral Striatal Activation During Reward Anticipation From Functional Connectivity at Rest

Reward anticipation is essential for directing behavior toward positively valenced stimuli, creating motivational salience. Task-related activation of the ventral striatum (VS) has long been used as a target for understanding reward function. However, some subjects may not be able to perform the respective tasks because of their complexity or subjects' physical or mental disabilities. Moreover, task implementations may differ, which results in limited comparability. Hence, developing a task-free method for evaluating neural gain circuits is essential. Research has shown that fluctuations in neuronal activity at rest denoted individual differences in the brain functional networks. Here, we proposed novel models to predict the activation of the VS during gain anticipation, using the functional magnetic resonance imaging data of 45 healthy subjects acquired during a monetary incentive delay task and under rest. In-sample validation and held-out data were used to estimate the generalizability of the models. It was possible to predict three measures of reward activation (sensitivity, average, maximum) from resting-state functional connectivity (Pearson's r = 0.38-0.54 in validation data). Especially high contributions to the models were observed from the default mode network. These findings highlight the potential of using functional connectivity at rest as a task-free alternative for predicting activation in the VS, offering a possibility to estimate reward response in the broader sampling of subject populations.

Impaired skin barrier function caused by reactive oxygen species in mice with colonic tumours

Purpose: We have previously reported that skin barrier function is disrupted in mice with colonic tumours induced by azoxymethane (AOM) and dextran sodium sulphate (DSS). We postulated that the impaired skin barrier function was associated with reactive oxygen species derived from gp91phox. In this study, we investigated the mechanisms underlying the impaired skin barrier function using gp91phox-/- mice. Materials and methods: We induced colonic tumorigenesis in C57BL/6j mice by AOM + DSS administration and evaluated the influence of reactive oxygen species on skin barrier function by using the hydroxyl radical scavenger N-acetyl-l-cysteine (NAC) or gp91phox-/- mice. Damage to the colon and skin following treatment with AOM + DSS was monitored using protein analysis methods and by detection of inflammatory mediators in the plasma. Results: NAC could not prevent the increase in transepidermal water loss (TEWL) and decrease in skin hydration level caused by AOM + DSS in gp91phox+/+ mice. However, gp91phox-/- mice showed no change in TEWL and skin hydration level. The dermal expression levels of nucleotide-binding domain, leucine-rich containing family, pyrin-domain containing 3 (NLRP3), and caspase-1 were reduced in gp91phox-/- mice. Moreover, the plasma concentrations of interleukin-18 and thymic stromal lymphopoietin (TSLP) were lower in gp91phox-/- mice than those in gp91phox+/+ mice. Inhibition of hydrogen peroxide production from superoxide anions in the gp91phox-/- status prevented the increased TEWL and decreased skin hydration level noted with degradation of NLRP3 and caspase-1. Conclusions: Superoxide anions may play an important role in the onset of the impaired skin barrier function in mice with colonic tumours.

Color change in Perlodel® tablets induced by LED lighting - photolysis of bromocriptine mesylate

Various types of fluorescent lights are found in the dispensing rooms of medical facilities, such as hospitals and pharmacies, in Japan. However, to reduce electric power consumption, it was necessary to evaluate the substitution of fluorescent lighting with light emitting diode (LED) lighting, which has become widespread in recent years. We subjectively evaluated several types of medicines stored under various light sources and found that different color changes were induced in tablets. In this study, we focused on Perlodel ® tablets, containing 2.5 mg bromocriptine mesylate, as an example for the objective evaluation of the differences in the color change of tablets when stored under LED lighting and fluorescent lighting. High-performance liquid chromatography (HPLC) analysis of part of the tablet surface area revealed a change from white to light brown or dark brown after 28 days of irradiation, with a residual concentration of bromocriptine mesylate of 85.5 % under fluorescent lighting, 85.6 % under daylight-color LED lighting, 90.3 % under bulb-color LED lighting, and 99.2 % in the dark. In addition, the ultraviolet (UV)-visible spectral study of the absorbance of a photo-product at 400-550 nm indicated that the color change of the Perlodel^® 2.5 mg tablet was caused by photochemical degradation of bromocriptine mesylate. Thus, this analysis of the photochemical changes in drugs stored under different light sources demonstrated the potency of LED lights. Through the objective evaluation of the color change, the cause of the color change was determined; this will allow us to develop a strategy that minimizes possible disadvantages to patients, such as a decrease in treatment efficacy owing to decomposition of the main component or adverse caused by decomposed matter.

An open-type microdevice to improve the quality of fluorescence labeling for axonal transport analysis in neurons

Abnormal axonal transport of vesicles as well as organelles in a particular set of neurons is implicated in the pathogenesis of many neurodegenerative diseases such as amyotrophic lateral sclerosis, Alzheimer's disease, and Parkinson's disease. Although various types of microfluidic multicompartmental devices with closed microchannels have been recently developed and widely used for axonal transport analysis, most of the existing devices are troublesome and time-consuming to handle, such as culture maintenances, sample collections, and immunocytochemistry. In this study, we overcome such inherent shortcomings by developing a novel open-type device that enables easy cell maintenance and sample collections. In our device, microgrooves instead of microchannels were directly fabricated on a glass substrate, thereby making possible a high-resolution optical observation. Compared with the conventional closed-type devices, our newly designed device allowed us to efficiently and precisely label the axonal acidic vesicles by fluorescent dyes, facilitating a high-throughput analysis of axonal vesicular transport. The present novel device, as a user-friendly and powerful tool, can be implemented in molecular and cellular pathogenesis studies on neurological diseases.

Risk factors increasing blood pressure in Japanese colorectal cancer patients treated with bevacizumab

Bevacizumab has been reported to increase blood pressure. However, the factors, including patient characteristics and laboratory data contributing to this side effect remain unclear. Therefore, we investigated the relationships between increased blood pressure and bevacizumab administration, patient characteristics, and laboratory data. Between April 2007 and January 2018, factor analysis was retrospectively conducted by monitoring increases in blood pressure, the status of bevacizumab administration, patient characteristics, and laboratory data before the first administration in Japanese patients with colorectal cancer who satisfied the criteria for this study. Sixty-seven patients were included, 34 of whom (50.7%) had an increase in blood pressure after bevacizumab administration. On univariate analysis, liver metastasis, antihypertensive drug use, systolic blood pressure at rest before the first bevacizumab administration, body mass index, creatinine, and blood platelet count were significantly different between the two groups. Multivariate analysis was conducted using increased blood pressure as an objective variable and the factors extracted by the univariate analysis as explanatory variables. The results suggested that liver metastasis, antihypertensive drugs, systolic blood pressure at rest before the first bevacizumab administration, and creatinine were associated with the increase in blood pressure. Furthermore, a log-rank test performed based on Kaplan-Meier curves demonstrated that liver metastasis in patients not taking antihypertensive drugs and antihypertensive drug use in patients without liver metastasis were significantly associated with increased blood pressure. Additionally, liver metastasis in patients with antihypertensive drug use was significantly associated with increased blood pressure. Our findings suggest that liver metastasis and antihypertensive drug use, which was previously reported, are risk factors for increased blood pressure.

MENS-associated increase of muscular protein content via modulation of caveolin-3 and TRIM72

Microcurrent electrical neuromuscular stimulation (MENS) is known as an extracellular stimulus for the regeneration of injured skeletal muscle in sports medicine. However, the effects of MENS-associated increase in muscle protein content are not fully clarified. The purpose of this study was to investigate the effects of MENS on the muscular protein content, intracellular signals, and the expression level of caveolin-3 (Cav-3), tripartite motif-containing 72 (TRIM72) and MM isoenzyme of creatine kinase (CK-MM) in skeletal muscle using cell culture system. C2C12 myotubes on the 7th day of differentiation phase were treated with MENS (intensity: 10-20 microA, frequency: 0.3 Hz, pulse width: 250 ms, stimulation time: 15-120 min). MENS-associated increase in the protein content of myotubes was observed, compared to the untreated control level. MENS upregulated the expression of Cav-3, TRIM72, and CK-MM in myotubes. A transient increase in phosphorylation level of Akt was also observed. However, MENS had no effect on the phosphorylation level of p42/44 extracellular signal-regulated kinase-1/2 and 5'AMP-activated protein kinase. MENS may increase muscle protein content accompanied with a transient activation of Akt and the upregulation of Cav-3 and TRIM72.

Impact of forage introduction on cattle grazing practices and crop–livestock systems: a case study in an upland village in northern Laos

Lao smallholders are experiencing livestock grazing land constraints due to resettlement, increasing cattle numbers and commercial cash crop plantations. In this paper we describe changes in cattle grazing systems in an upland village in northern Laos, including the role of forage crops and their effects on cattle productivity. We interviewed 92 Hmong and Khmu households about their migration history, cattle grazing practices, cattle productivity and other livelihood activities. In addition, we measured the heart girths of 231 cattle. We found that the traditional free-range cattle grazing has diverged into three distinct systems incorporating fields fenced to different degrees. Although none of the three systems increased cattle body size, the forage pasture and swidden-farming system successfully increased the grazing capacity compared with other systems. Thus, this method appeared to be the most suitable for Hmong smallholders to manage crop and cattle production in the context of land constraints. Efforts should be made to examine how the newly implemented systems could attenuate villager livelihood and pre-emptively address the problems associated with degrading fallow land.

Effects of behavioural activation on the neural circuit related to intrinsic motivation

BACKGROUND

Behavioural activation is an efficient treatment for depression and can improve intrinsic motivation. Previous studies have revealed that the frontostriatal circuit is involved in intrinsic motivation; however, there are no data on how behavioural activation affects the frontostriatal circuit.AimsWe aimed to investigate behavioural activation-related changes in the frontostriatal circuit.

METHOD

Fifty-nine individuals with subthreshold depression were randomly assigned to either the intervention or non-intervention group. The intervention group received five weekly behavioural activation sessions. The participants underwent functional magnetic resonance imaging scanning on two separate occasions while performing a stopwatch task based on intrinsic motivation. We investigated changes in neural activity and functional connectivity after behavioural activation.

RESULTS

After behavioural activation, the intervention group had increased activation and connectivity in the frontostriatal region compared with the non-intervention group. The increased activation in the right middle frontal gyrus was correlated with an improvement of subjective sensitivity to environmental rewards.

CONCLUSIONS

Behavioural activation-related changes to the frontostriatal circuit advance our understanding of psychotherapy-induced improvements in the neural basis of intrinsic motivation.Declaration of interestNone.