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Lv YJ, Xu GX, Lan JR. Impact of frailty on postoperative outcomes after hepatectomy: A systematic review and meta-analysis. World J Gastrointest Surg 2024; 16:2319-2328. [DOI: 10.4240/wjgs.v16.i7.2319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/28/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The impact of frailty on postoperative outcomes in patients undergoing hepatectomy is still unclear.
AIM To study the influence of frailty on postoperative outcomes, such as mortality, rate of complications, and length of hospitalization, following hepatectomy.
METHODS PubMed, EMBASE, and Scopus databases were searched for observational studies with adult (≥ 18 years) patients after planned/elective hepatectomy. A random-effects model was used for all analyses, and the results are expressed as weighted mean difference (WMD), relative risk (RR), or hazards ratio (HR) with 95% confidence interval (CI).
RESULTS Analysis of the 13 included studies showed a significant association of frailty with elevated risk of in-hospital mortality (RR = 2.76, 95%CI: 2.10-3.64), mortality at 30 d (RR = 4.60, 95%CI: 1.85-11.40), and mortality at 90 d (RR = 2.52, 95%CI: 1.70-3.75) in the postoperative period. Frail patients had a poorer long-term survival (HR = 2.89, 95%CI: 1.84-4.53) and higher incidence of “any” complications (RR = 1.69, 95%CI: 1.40-2.03) and major (grade III or higher on the Clavien-Dindo scale) complications (RR = 2.69, 95%CI: 1.85-3.92). Frailty was correlated with markedly lengthier hospital stay (WMD = 3.65, 95%CI: 1.45-5.85).
CONCLUSION Frailty correlates with elevated risks of mortality, complications, and prolonged hospitalization, which need to be considered in surgical management. Further research is essential to formulate strategies for improved outcomes in this vulnerable cohort.
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Affiliation(s)
- Yao-Jia Lv
- Day Surgery Ward, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Guang-Xing Xu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jia-Rong Lan
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou 313000, Zhejiang Province, China
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2
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Moras E, Zaid S, Gandhi K, Barman N, Birnbaum Y, Virani SS, Tamis-Holland J, Jneid H, Krittanawong C. Pharmacotherapy for Coronary Artery Disease and Acute Coronary Syndrome in the Aging Population. Curr Atheroscler Rep 2024; 26:231-248. [PMID: 38722473 DOI: 10.1007/s11883-024-01203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW To provide a comprehensive summary of relevant studies and evidence concerning the utilization of different pharmacotherapeutic and revascularization strategies in managing coronary artery disease and acute coronary syndrome specifically in the older adult population. RECENT FINDINGS Approximately 30% to 40% of hospitalized patients with acute coronary syndrome are older adults, among whom the majority of cardiovascular-related deaths occur. When compared to younger patients, these individuals generally experience inferior clinical outcomes. Most clinical trials assessing the efficacy and safety of various therapeutics have primarily enrolled patients under the age of 75, in addition to excluding those with geriatric complexities. In this review, we emphasize the need for a personalized and comprehensive approach to pharmacotherapy for coronary heart disease and acute coronary syndrome in older adults, considering concomitant geriatric syndromes and age-related factors to optimize treatment outcomes while minimizing potential risks and complications. In the realm of clinical practice, cardiovascular and geriatric risks are closely intertwined, with both being significant factors in determining treatments aimed at reducing negative outcomes and attaining health conditions most valued by older adults.
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Affiliation(s)
- Errol Moras
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syed Zaid
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Kruti Gandhi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nitin Barman
- Cardiac Catheterization Laboratory, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Yochai Birnbaum
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Houston, TX, USA
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Marchesi N, Fahmideh F, Pascale A, Allegri M, Govoni S. Neuropathic Pain in Aged People: An Unresolved Issue Open to Novel Drug Approaches, Focusing on Painful Diabetic Neuropathy. Curr Neuropharmacol 2024; 22:53-64. [PMID: 37550909 DOI: 10.2174/1570159x21666230807103642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 03/15/2023] [Indexed: 08/09/2023] Open
Abstract
A majority of older patients suffer from neuropathic pain (NP) that significantly alters their daily activities and imposes a significant burden on health care. Multiple comorbidities and the risk of polypharmacy in the elderly make it challenging to determine the appropriate drug, dosage, and maintenance of therapy. Age-dependent processes play a contributing role in neuropathy given that diabetic neuropathy (DN) is the most common form of neuropathy. This narrative review is mainly focused on the drug treatment approach for neuropathy-associated pain in aged people including both drugs and dietary supplements, considering the latter as add-on mechanism-based treatments to increase the effectiveness of usual treatments by implementing their activity or activating other analgesic pathways. On one hand, the limited clinical studies assessing the effectiveness and the adverse effects of existing pain management options in this age segment of the population (> 65), on the other hand, the expanding global demographics of the elderly contribute to building up an unresolved pain management problem that needs the attention of healthcare providers, researchers, and health authorities as well as the expansion of the current therapeutic options.
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Affiliation(s)
- Nicoletta Marchesi
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Foroogh Fahmideh
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Massimo Allegri
- Ensemble Hospitalier de la Cote - Centre Lemanique d'antalgie et Neuromodulation, Morges, Switzerland
| | - Stefano Govoni
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
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4
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Galvin A, Amadéo B, Frasca M, Soubeyran P, Rondeau V, Delva F, Pérès K, Coureau G, Helmer C, Mathoulin-Pélissier S. Association between pre-diagnosis geriatric syndromes and overall survival in older adults with cancer (the INCAPAC study). J Geriatr Oncol 2023; 14:101539. [PMID: 37320933 DOI: 10.1016/j.jgo.2023.101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Several population-based studies have reported disparities in overall survival (OS) among older patients with cancer. However, geriatric syndromes, known to be associated with OS in the geriatric population, were rarely studied. Thus, our aim was to identify the determinants of OS among French older adults with cancer, including geriatric syndromes before cancer diagnosis. MATERIALS AND METHODS Using cancer registries, we identified older subjects (≥65 years) with cancer in three French prospective cohort studies on aging from the Gironde department. Survival time was calculated from the date of diagnosis to the date of all-cause death or to the date of last follow-up, whichever came first. Demographic and socioeconomic characteristics, smoking status, self-rated health, cancer-related factors (stage at diagnosis, treatment), as well as geriatric syndromes (polypharmacy, activity limitation, depressive symptomatology, and cognitive impairment or dementia) were studied. Analyses were performed using Cox proportional hazard models for the whole population, then by age group (65-84 and 85+). RESULTS Among the 607 subjects included in the study, the median age at cancer diagnosis was 84 years. Smoking habits, activity limitations, cognitive impairment or dementia, advanced cancer stage and absence of treatment were significantly associated with lower OS in the analysis including the whole population. Women presented higher OS. Factors associated with OS differed by age group. Polypharmacy was inversely associated with OS in older adults aged 65-84 and 85 + . DISCUSSION Our findings support that geriatric assessment is needed to identify patients at higher risk of death and that an evaluation of activity limitation in older adults is essential. Improving early detection could enable interventions to address factors (activity limitations, cognitive impairment) associated with OS, potentially reducing disparities and lead to earlier palliative care.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France.
| | - Brice Amadéo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Matthieu Frasca
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Vinco team, UMR 1218, Bordeaux F-33000, France
| | - Virginie Rondeau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Biostatistics team, UMR 1219, Bordeaux F-33000, France
| | - Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Sepia team, UMR 1219, Bordeaux F-33000, France
| | - Gaëlle Coureau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Department of Public Health, Bordeaux University Hospital, Bordeaux F-3300, France
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, Bordeaux F-33000, France
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux F-33000, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, Bordeaux F-33000, France
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Konstandi M, Johnson EO. Age-related modifications in CYP-dependent drug metabolism: role of stress. Front Endocrinol (Lausanne) 2023; 14:1143835. [PMID: 37293497 PMCID: PMC10244505 DOI: 10.3389/fendo.2023.1143835] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 06/10/2023] Open
Abstract
Accumulating clinical evidence indicates extensive inter-individual variations in the effectiveness and adverse effects of standard treatment protocols, which are largely attributed to the multifactorial regulation of the hepatic CYP-dependent drug metabolism that is connected with either transcriptional or post-translational modifications. Age and stress belong to the most important factors in CYP gene regulation. Alterations in neuroendocrine responses to stress, which are associated with modified hypothalamo-pituitary-adrenal axis function, usually accompany ageing. In this light, ageing followed by a decline of the functional integrity of organs, including liver, a failure in preserving homeostasis under stress, increased morbidity and susceptibility to stress, among others, holds a determinant role in the CYP-catalyzed drug metabolism and thus, in the outcome and toxicity of pharmacotherapy. Modifications in the drug metabolizing capacity of the liver with age have been reported and in particular, a decline in the activity of the main CYP isoforms in male senescent rats, indicating decreased metabolism and higher levels of the drug-substrates in their blood. These factors along with the restricted experience in the use of the most medicines in childhood and elderly, could explain at an extent the inter-individual variability in drug efficacy and toxicity outcomes, and underscore the necessity of designing the treatment protocols, accordingly.
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Affiliation(s)
- Maria Konstandi
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elizabeth O Johnson
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus
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Kanji S, Williamson D, Hartwick M. Potential pharmacological confounders in the setting of death determined by neurologic criteria: a narrative review. Can J Anaesth 2023; 70:713-723. [PMID: 37131030 PMCID: PMC10202973 DOI: 10.1007/s12630-023-02415-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 05/04/2023] Open
Abstract
Guidelines for the determination of death by neurologic criteria (DNC) require an absence of confounding factors if clinical examination alone is to be used. Drugs that depress the central nervous system suppress neurologic responses and spontaneous breathing and must be excluded or reversed prior to proceeding. If these confounding factors cannot be eliminated, ancillary testing is required. These drugs may be present after being administered as part of the treatment of critically ill patients. While measurement of serum drug concentrations can help guide the timing of assessments for DNC, they are not always available or feasible. In this article, we review sedative and opioid drugs that may confound DNC, along with pharmacokinetic factors that govern the duration of drug action. Pharmacokinetic parameters including a context-sensitive half-life of sedatives and opioids are highly variable in critically ill patients because of the multitude of clinical variables and conditions that can affect drug distribution and clearance. Patient-, disease-, and treatment-related factors that influence the distribution and clearance of these drugs are discussed including end organ function, age, obesity, hyperdynamic states, augmented renal clearance, fluid balance, hypothermia, and the role of prolonged drug infusions in critically ill patients. In these contexts, it is often difficult to predict how long after drug discontinuation the confounding effects will take to dissipate. We propose a conservative framework for evaluating when or if DNC can be determined by clinical criteria alone. When pharmacologic confounders cannot be reversed, or doing so is not feasible, ancillary testing to confirm the absence of brain blood flow should be obtained.
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Affiliation(s)
- Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - David Williamson
- Faculté de pharmacie, Université de Montréal, Montreal, QC, Canada
- Pharmacy Department, Hôpital du Sacré-Cœur de Montréal and CIUSSS-Nord-de-l'ile-de-Montreal Research Center, Montreal, QC, Canada
| | - Michael Hartwick
- Department of Pharmacy, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Critical Care, The Ottawa Hospital, Ottawa, Canada
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Rahkonen A, Taipale H, Koponen M, Hartikainen S, Tolppanen AM, Tanskanen A, Tiihonen M. The Cumulative Use of Muscle Relaxants and the Risk of Alzheimer's Disease: A Nationwide Case-Control Study. J Alzheimers Dis 2023; 91:1283-1290. [PMID: 36641664 DOI: 10.3233/jad-220409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders. OBJECTIVE To investigate if the use of muscle relaxants is associated with the risk of Alzheimer's disease (AD). METHODS The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who received AD diagnosis in 2005-2011 were included as cases (the MEDALZ study). Each case was matched with four controls without AD by age, sex, and region of residence (N = 282,858). Data was extracted from Prescription register (1995-2012), Special Reimbursement register (1972-2012), and Hospital Discharge register (1972-2012). Drug use periods were modeled with PRE2DUP-method. Defined daily dose (DDD) was used to quantify the use. Analyses were conducted for any muscle relaxant use, and drug specific analyses were done for orphenadrine and tizanidine. A five-year lag window prior to the diagnosis was used, and results analyzed with conditional logistic regression. RESULTS The use of any muscle relaxant was associated with the risk of AD, aOR (95% CI) 1.04 (1.02-1.07). Stronger associations were observed with longer use (>366 days, aOR 1.12 (1.03-1.21)) than shorter use (1-365 days aOR, 1.04 (1.02-1.06)) compared to non-users. Dose-response was not observed. Tizanidine was not associated with AD, whereas cumulative exposure of orphenadrine (≥101 DDDs) was associated with the risk of AD, aOR 1.19 (1.07-1.32). CONCLUSION Muscle relaxant use was associated with the risk of AD and higher exposure to orphenadrine showed increased risk. Further studies on higher doses and longer durations of use are warranted.
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Affiliation(s)
- Atte Rahkonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | | | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
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Hemmersbach-Miller M, Balevic SJ, Winokur PL, Landersdorfer CB, Gu K, Chan AW, Cohen-Wolkowiez M, Conrad T, An G, Kirkpatrick CMJ, Swamy GK, Walter EB, Schmader KE. Population Pharmacokinetics of Piperacillin/Tazobactam Across the Adult Lifespan. Clin Pharmacokinet 2023; 62:127-139. [PMID: 36633812 PMCID: PMC9969806 DOI: 10.1007/s40262-022-01198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. Using an opportunistic study design, we evaluated the pharmacokinetics of piperacillin/tazobactam as a probe drug to evaluate changes in antibacterial drug exposure and dosing requirements, including in older adults. METHODS A total of 121 adult patients were included. The population pharmacokinetic models that best characterized the observed plasma concentrations of piperacillin and tazobactam were one-compartment structural models with zero-order input and linear elimination. RESULTS Among all potential covariates, estimated creatinine clearance had the most substantial impact on the elimination clearance for both piperacillin and tazobactam. After accounting for renal function and body size, there was no remaining impact of frailty on the pharmacokinetics of piperacillin and tazobactam. Monte Carlo simulations indicated that renal function had a greater impact on the therapeutic target attainment than age, although these covariates were highly correlated. Frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale, was assessed in 60 patients who were ≥ 65 years of age. CONCLUSIONS The simulations suggested that adults ≤ 50 years of age infected with organisms with higher minimum inhibitory concentrations may benefit from continuous piperacillin/tazobactam infusions (12 g/day of piperacillin component) or extended infusions of 4 g every 8 hours. However, for a target of 50% fT + minimum inhibitory concentration, dosing based on renal function is generally preferable to dosing by age, and simulations suggested that patients with creatinine clearance ≥ 120 mL/min may benefit from infusions of 4 g every 8 hours for organisms with higher minimum inhibitory concentrations.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- ICON Plc, North Wales, PA, USA
| | - Stephen J Balevic
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Patricia L Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Kenan Gu
- Division of Microbiology and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Austin W Chan
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Guohua An
- College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Carl M J Kirkpatrick
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Obstetrics Clinical Research, Duke University Medical System, Durham, NC, USA
| | - Emmanuel B Walter
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Duke Box 3469, Durham, NC, 27710, USA.
- Geriatric Research Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA.
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Future liver remnant volume is associated with postoperative fentanyl consumption following open donor hepatectomy: a retrospective multivariate analysis. J Anesth 2022; 36:731-739. [PMID: 36190573 DOI: 10.1007/s00540-022-03110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Liver resection has a risk of postoperative hepatic dysfunction, including drug metabolism. Since fentanyl is primarily metabolized in the liver, liver resection requires exercising caution against fentanyl overdose in postoperative analgesia. The rationale for dose adjustment of fentanyl in the preoperative prescription for patients undergoing liver resection remains unclear. We examined whether postoperative fentanyl consumption is associated with the future liver remnant after liver resection and investigated factors influencing fentanyl consumption. METHODS In this retrospective study, 89 living liver donors undergoing open liver resection received intravenous patient-controlled analgesia with fentanyl 2 mg with thoracic epidural analgesia. The primary outcome was postoperative hourly consumption of intravenous patient-controlled analgesia with fentanyl. Future liver remnant volume (ml) and the ratio of future liver remnant volume to whole liver volume (%) were estimated by computed tomography volumetry and compared to determine which correlated more strongly with fentanyl hourly consumption. Multivariable analysis identified independent factors affecting fentanyl consumption, with adjustments for patient characteristics and intravenous patient-controlled analgesia setting. RESULTS Future liver remnant volume (ml) was significantly correlated more strongly than the ratio of future liver remnant (%) with postoperative fentanyl consumption (r = 0.53 vs. 0.36, p < 0.001). Larger future liver remnant volume (β = 0.25, p = 0.006) and age < 45 years (β = 0.24, p = 0.009) were independently associated with higher fentanyl consumption, while sex and weight were not. CONCLUSIONS Future liver remnant volume was significantly associated with postoperative fentanyl consumption. Smaller remnant liver volume and older age (≥ 45 years) were independent factors reducing postoperative fentanyl consumption in patients undergoing open donor hepatectomy.
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da Silva Lima D, da Silva Gomes L, de Sousa Figueredo E, E Silva YIF, Silva EM, de Souza Bovi T, Taboga SR, Marques MR, Biancardi MF, Dos Santos FCA. Subacute exposure to aluminum chloride causes prolonged morphological insults in the ventral male prostate and in the female prostate of adult gerbils. ENVIRONMENTAL TOXICOLOGY 2022; 37:299-309. [PMID: 34726835 DOI: 10.1002/tox.23398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
Aluminum (Al) is a widespread metal in the environment, and is found in fresh or processed foods, household utensils, packaging, and medicines. In addition to its high toxicity, Al can also have estrogenic agonistic effects on target organs. Considering that the Al effects on the prostate are little known, the aim of this study was to evaluate the impact of aluminum chloride (AlCl3 ) subacute exposure on the morphophysiology of the male ventral prostate and the female prostate of adult gerbils. Furthermore, the glandular restoration capacity in face of the Al insults was evaluated in gerbils that were submitted to 30 days of recovery. Male and female gerbils were orally exposed to AlCl3 (10 mg/kg) for 30 consecutive days. The animals were euthanized 1 day (Al1D) or 30 days (Al30D) after the end of treatment. Prostates were dissected out and processed for structural, ultrastructural and immunohistochemical analyses. Male ventral prostates and female prostates of the Al1D group showed increased cell proliferation, glandular hyperplasia, increased secretory activity and greater androgen receptor immunoreactivity. In males, Al withdrawal (Al30D) allowed a partial recovery of the prostate, as the glandular secretory activity, and frequency of androgen receptor positive cells were similar to the control group. In females, the recuperation interval (Al30D) was not enough to restore the prostatic morphology, since the gland remained hyperplastic, proliferative, and with greater androgen and estrogen receptor immunoreactivity. These data alert to the importance of avoiding Al exposure, since this metal can have a harmful and prolonged action on the prostate.
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Affiliation(s)
- Danilo da Silva Lima
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Liana da Silva Gomes
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Esther de Sousa Figueredo
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Yasmin Inocêncio Fernandes E Silva
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Edvaldo Mendes Silva
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Thais de Souza Bovi
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Sebastião Roberto Taboga
- Department of Biology, Laboratory of Microscopy and Microanalysis, State University of São Paulo - UNESP, São Paulo, Brazil
| | - Mara Rúbia Marques
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Manoel Francisco Biancardi
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Fernanda Cristina Alcantara Dos Santos
- Department of Histology, Embryology and Cell Biology, Laboratory of Microscopy Applied to Reproduction, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
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Inventor BR, Paun O. Pharmacogenomics in Older Adults: An Integrative Review. Res Gerontol Nurs 2021; 14:211-220. [PMID: 34288783 DOI: 10.3928/19404921-20210428-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Through pharmacogenomics testing, identifying genetic variants that influence how individuals respond to medications could potentially decrease the "trial and error" approach to prescribing medications, maximize beneficial effects, and reduce risks of adverse drug events. Yet, pharmacogenomics testing is still subject to an ongoing debate over its clinical validity and utility. The purpose of the current integrative review was to examine and synthesize evidence on the clinical application of pharmacogenomics in medication management among older adults. Gaps were found, such as lack of studies investigating the prospective use of pharmacogenomics testing to improve clinical outcomes and lack of strong evidence on the clinical validity and utility of pharmacogenomics testing in the medication management of older adults. However, the review identified evidence for the potential benefits of pharmacogenomics testing to improve older adults' clinical outcomes that warrant further investigation. [Research in Gerontological Nursing, 14(4), 211-220.].
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Wang K, Yao X, Zhang M, Liu D, Gao Y, Sahasranaman S, Ou YC. Comprehensive PBPK model to predict drug interaction potential of Zanubrutinib as a victim or perpetrator. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:441-454. [PMID: 33687157 PMCID: PMC8129716 DOI: 10.1002/psp4.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/18/2022]
Abstract
A physiologically based pharmacokinetic (PBPK) model was developed to evaluate and predict (1) the effect of concomitant cytochrome P450 3A (CYP3A) inhibitors or inducers on the exposures of zanubrutinib, (2) the effect of zanubrutinib on the exposures of CYP3A4, CYP2C8, and CYP2B6 substrates, and (3) the impact of gastric pH changes on the pharmacokinetics of zanubrutinib. The model was developed based on physicochemical and in vitro parameters, as well as clinical data, including pharmacokinetic data in patients with B-cell malignancies and in healthy volunteers from two clinical drug-drug interaction (DDI) studies of zanubrutinib as a victim of CYP modulators (itraconazole, rifampicin) or a perpetrator (midazolam). This PBPK model was successfully validated to describe the observed plasma concentrations and clinical DDIs of zanubrutinib. Model predictions were generally within 1.5-fold of the observed clinical data. The PBPK model was used to predict untested clinical scenarios; these simulations indicated that strong, moderate, and mild CYP3A inhibitors may increase zanubrutinib exposures by approximately four-fold, two- to three-fold, and <1.5-fold, respectively. Strong and moderate CYP3A inducers may decrease zanubrutinib exposures by two- to three-fold or greater. The PBPK simulations showed that clinically relevant concentrations of zanubrutinib, as a DDI perpetrator, would have no or limited impact on the enzyme activity of CYP2B6 and CYP2C8. Simulations indicated that zanubrutinib exposures are not impacted by acid-reducing agents. Development of a PBPK model for zanubrutinib as a DDI victim and perpetrator in parallel can increase confidence in PBPK models supporting zanubrutinib label dose recommendations.
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Affiliation(s)
- Kun Wang
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Miao Zhang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Yuying Gao
- Shanghai Qiangshi Information Technology Co., Ltd, Shanghai, China
| | | | - Ying C Ou
- BeiGene USA, Inc, San Mateo, CA, USA
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Ou YC, Liu L, Tariq B, Wang K, Jindal A, Tang Z, Gao Y, Sahasranaman S. Population Pharmacokinetic Analysis of the BTK Inhibitor Zanubrutinib in Healthy Volunteers and Patients With B-Cell Malignancies. Clin Transl Sci 2021; 14:764-772. [PMID: 33306268 PMCID: PMC7993273 DOI: 10.1111/cts.12948] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022] Open
Abstract
Zanubrutinib is a potent, second-generation Bruton's tyrosine kinase inhibitor that is currently being investigated in patients with B-cell malignancies and recently received accelerated approval in the United States for treatment of relapsed/refractory mantle cell lymphoma. The objective of this analysis was to develop a population pharmacokinetic (PK) model to characterize the PKs of zanubrutinib and identify the potential impact of intrinsic and extrinsic covariates on zanubrutinib PK. Data across nine clinical studies of patients with B-cell malignancies and data of healthy volunteers (HVs) were included in this analysis, at total daily doses ranging from 20 to 320 mg. In total, 4,925 zanubrutinib plasma samples from 632 subjects were analyzed using nonlinear mixed-effects modeling. Zanubrutinib PKs were adequately described by a two-compartment model with sequential zero-order then first-order absorption, and first-order elimination. A time-dependent residual error model was implemented in order to better capture the observed maximum concentration variability in subjects. Baseline alanine aminotransferase and health status (HVs or patients with B-cell malignancies) were identified as statistically significant covariates on the PKs of zanubrutinib. These factors are unlikely to be clinically meaningful based on a sensitivity analysis. No statistically significant differences in the PKs of zanubrutinib were observed based on age, sex, race (Asian, white, and other), body weight, mild or moderate renal impairment (creatinine clearance ≥ 30 mL/minute as estimated by Cockcroft-Gault), baseline aspartate aminotransferase, bilirubin, tumor type, or use of acid-reducing agents (including proton pump inhibitors). These results support that no dose adjustment is considered necessary based on the aforementioned factors.
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Affiliation(s)
| | - Lucy Liu
- Shanghai Qiangshi Information Technology Co., LtdShanghaiChina
| | | | - Kun Wang
- Shanghai Qiangshi Information Technology Co., LtdShanghaiChina
| | | | | | - Yuying Gao
- Shanghai Qiangshi Information Technology Co., LtdShanghaiChina
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Hermansen CK, Donskov F. Outcomes based on age in patients with metastatic renal cell carcinoma treated with first line targeted therapy or checkpoint immunotherapy: Older patients more prone to toxicity. J Geriatr Oncol 2020; 12:827-833. [PMID: 33388280 DOI: 10.1016/j.jgo.2020.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Older patients with metastatic renal cell carcinoma (mRCC) were underrepresented in pivotal trials. MATERIALS AND METHODS Consecutive patients with mRCC treated at Aarhus University Hospital with first line tyrosine kinase inhibitors (TKI), mTOR inhibitors, or checkpoint immunotherapy (CPI) were retrospectively analyzed in age-subgroups; ≥ 75, 65-74, and < 65 years, with overall survival (OS), time-to-treatment discontinuation (TTD), and progression-free survival (PFS) as endpoints. Hazards ratios were adjusted (aHR) for International Metastatic RCC Database Consortium (IMDC) risk factors, histology, and age. RESULTS Of 838 patients, 159 (19%) were ≥ 75 years, 324 (39%) 65-74 years, and 355 (42%) < 65 years. Treatments were TKI in 729 (87%) patients, mTOR in 43 (5%) and CPI in 67 (8%). Older patients ≥ 75 years compared with 65-74 years and < 65 years had lower toxicity-adjusted median doses of pazopanib, 300 mg vs. 400 mg vs. 600 mg, respectively, (p < 0.001), and sunitinib, 25 mg vs. 37.5 mg vs. 50 mg, respectively (p < 0.001); numerically fewer doses of CPI, median 2 vs. 5 vs. 5, respectively, (p = 0.2); a higher proportion had dose reduction/interruption, 76% vs. 55% vs. 41%, respectively, (p < 0.001); and shorter mean time to dose reduction/interruption, 0.5 months vs. 1.9 months vs. 3.4 months, respectively, (p < 0.001). After adjusting IMDC prognostic factors and histology in multivariate analyses, age did not impact OS (aHR 1.0; 95% CI 0.99-1.02, p = 0.2), TTD (aHR 1.0; 95% CI 0.99-1.01, p = 0.4) or PFS (aHR 1.0, 95% CI 0.99-1.01; p = 0.9). CONCLUSION Older patients with mRCC were more prone to toxicity; but age did not impact outcomes. Proactive dose modification/interruption and awareness may help to reduce toxicity while maintaining efficacy.
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Affiliation(s)
- Carina K Hermansen
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Frede Donskov
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Bienert A, Sobczyński P, Młodawska K, Hartmann-Sobczyńska R, Grześkowiak E, Wiczling P. The influence of cardiac output on propofol and fentanyl pharmacokinetics and pharmacodynamics in patients undergoing abdominal aortic surgery. J Pharmacokinet Pharmacodyn 2020; 47:583-596. [PMID: 32840723 PMCID: PMC7652808 DOI: 10.1007/s10928-020-09712-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/13/2020] [Indexed: 12/27/2022]
Abstract
Cardiac output (CO) is expected to affect elimination and distribution of highly extracted and perfusion rate-limited drugs. This work was undertaken to quantify the effect of CO measured by the pulse pressure method on pharmacokinetics and pharmacodynamics of propofol and fentanyl administrated during total intravenous anesthesia (TIVA). The data were obtained from 22 ASA III patients undergoing abdominal aortic surgery. Propofol was administered via target-controlled infusion system (Diprifusor) and fentanyl was administered at a dose of 2-3 µg/kg each time analgesia appeared to be inadequate. Hemodynamic measurements as well as bispectral index were monitored and recorded throughout the surgery. Data analysis was performed by using a non-linear mixed-effect population modeling (NONMEM 7.4 software). Three compartment models that incorporated blood flows as parameters were used to describe propofol and fentanyl pharmacokinetics. The delay of the anesthetic effect, with respect to plasma concentrations, was described using a biophase (effect) compartment. The bispectral index was linked to the propofol and fentanyl effect site concentrations through a synergistic Emax model. An empirical linear model was used to describe CO changes observed during the surgery. Cardiac output was identified as an important predictor of propofol and fentanyl pharmacokinetics. Consequently, it affected the depth of anesthesia and the recovery time after propofol-fentanyl TIVA infusion cessation. The model predicted (not observed) CO values correlated best with measured responses. Patients' age was identified as a covariate affecting the rate of CO changes during the anesthesia leading to age-related difference in individual patient's responses to both drugs.
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Affiliation(s)
- Agnieszka Bienert
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Sw. Marii Magdaleny 14 Street, 61-861, Poznan, Poland.
| | - Paweł Sobczyński
- Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 1/2 Długa Str., 61-848, Poznań, Poland
| | - Katarzyna Młodawska
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Sw. Marii Magdaleny 14 Street, 61-861, Poznan, Poland
| | - Roma Hartmann-Sobczyńska
- Department of Experimental Anaesthesiology, Poznan University of Medical Sciences, Sw. Marii Magdaleny 14 Street, 61-861, Poznan, Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Sw. Marii Magdaleny 14 Street, 61-861, Poznan, Poland
| | - Paweł Wiczling
- Department of Biopharmacy and Pharmacodynamics, Medical University of Gdansk, Hallera 107 Street, 80-416, Gdansk, Poland
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Alshehri S, Alshibani M, Magboul G, Albandar A, Nasser R, Yaqoub RM, Alzuhayri J, Aljabri A. Adherence to Beers Criteria in Geriatrics: A Retrospective Study in a Saudi Teaching Hospital. Geriatrics (Basel) 2020; 5:geriatrics5040097. [PMID: 33233330 PMCID: PMC7709682 DOI: 10.3390/geriatrics5040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The aging process makes geriatric populations more prone to various chronic diseases. Such diseases require older patients to be on more medications than any other age group and make them more susceptible to adverse drug events related to potentially inappropriate medications (PIMs). Aim: To identify the prevalence of potentially inappropriate medications among older people and explore the most commonly prescribed PIMs in hospitalized patients. Design and Setting: A retrospective study conducted in a large tertiary hospital among patients hospitalized in a 4 year period from January 2015 to December 2018. Methods: The 2019 Beers Criteria were used to assess PIMs in all inpatient prescribed medications focusing on the first class (i.e., drug/drug class to be avoided in older adults). Results: The mean age was 75.17 ± 7.66 years. A total of 684 (80.6%) patients were prescribed at least one medication listed in the first-class category of the 2019 Beers Criteria. Top five drugs were proton pump inhibitors (40.3%), nonsteroidal anti-inflammatory drugs (10.2%), metoclopramide (9.3%), benzodiazepines (8.4%), and insulin (5.4%). Conclusions: The prevalence of PIMs is high among older patients admitted to the hospital. More efforts are needed to investigate the potential reasons and develop action plans to improve concordance to Beers Criteria among healthcare providers.
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Affiliation(s)
- Samah Alshehri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (M.A.); (A.A.)
- Faculty of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Correspondence: ; Tel.: +96-65-6436-2332
| | - Mohannad Alshibani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (M.A.); (A.A.)
- Faculty of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Ghaydaa Magboul
- Faculty of Medicine, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (G.M.); (A.A.); (R.N.); (R.M.Y.)
| | - Albandari Albandar
- Faculty of Medicine, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (G.M.); (A.A.); (R.N.); (R.M.Y.)
| | - Roaa Nasser
- Faculty of Medicine, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (G.M.); (A.A.); (R.N.); (R.M.Y.)
| | - Roaya M. Yaqoub
- Faculty of Medicine, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (G.M.); (A.A.); (R.N.); (R.M.Y.)
| | - Jumana Alzuhayri
- Faculty of Science, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia;
| | - Ahmed Aljabri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz Univeristy, Jeddah 21589, Saudi Arabia; (M.A.); (A.A.)
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
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Di Martino E, Provenzani A, Polidori P. Evidence-based application of explicit criteria to assess the appropriateness of geriatric prescriptions at admission and hospital stay. PLoS One 2020; 15:e0238064. [PMID: 32841285 PMCID: PMC7446960 DOI: 10.1371/journal.pone.0238064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Background Inappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs). Objective The aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing. Methods A retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index. Results The Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled β2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index. Conclusion The prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.
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Affiliation(s)
- Enrica Di Martino
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
- * E-mail: ,
| | - Alessio Provenzani
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Piera Polidori
- Clinical Pharmacy Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study. PLoS One 2020; 15:e0234386. [PMID: 32525902 PMCID: PMC7289385 DOI: 10.1371/journal.pone.0234386] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Polypharmacy has become a global public health concern particularly in the elderly population. The elderly population is the most susceptible to the negative effects of polypharmacy due to their altered pharmacokinetics and decreased drug clearance. Therefore, polypharmacy can lead to poor health status and higher rates of morbidity and mortality. OBJECTIVE The objective of this study was to determine the prevalence of polypharmacy (≥ 5 drugs) and its association with non-communicable diseases (NCDs) in elderly (≥65 years) Qatari patients attending Primary Healthcare (PHC) centers in Qatar. METHODS A retrospective cross-sectional analysis was conducted using the Electronic Medical Record (EMR) database of all PHC centers in Qatar for six months (April-September 2017). RESULTS Out of 5639 patients screened, 75.5% (95% CI: 74.3-76.6) were exposed to polypharmacy. Females were 1.18 times more likely to have polypharmacy compared to males (95% CI: 1.03-1.34). The multivariate analysis identified having hypertension (AOR 1.71; 95% CI: 1.38-2.13), diabetes (AOR 2.38; 95% CI: 1.97-2.87), dyslipidemia (AOR 1.29; 95% CI: 1.06-1.56), cardiovascular disease (AOR 1.56; 95% CI: 1.25-1.95) and asthma (AOR 1.39; 95% CI: 1.13-1.72) to be independent parameters associated with polypharmacy. Also, the Body Mass Index (BMI) and number of NCDs were found to be significant independent parameters associated with polypharmacy. CONCLUSIONS The prevalence of polypharmacy among Qatari elderly attending PHC Centers is very high. Our findings confirm the strong relationship between polypharmacy and BMI, and certain NCDs. Healthcare professionals should be educated about the magnitude of polypharmacy, its negative effects, and its associated factors. Best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.
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Jeong C, Ha J. The Effect of Denosumab on Bone Mass in Super Elderly Patients. J Bone Metab 2020; 27:119-124. [PMID: 32572372 PMCID: PMC7297623 DOI: 10.11005/jbm.2020.27.2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Denosumab is a potent antiresorptive drug leading to significant reduction in the risk of vertebral and non-vertebral fractures in postmenopausal osteoporosis. The effect of denosumab in super-elderly patients lacks data to date and few literature has proven the efficacy to this specific group. The purpose of this study was to determine the effectiveness and safety of denosumab in the super-elderly. METHODS We retrospectively evaluated 60 patients older than 80 with osteoporosis treated with denosumab. Patients were treated with denosumab every 6 months for 12 months 2017 to 2020. The primary endpoint was defined by the changes in bone mineral density (BMD) of 3 measurement sites: the lumbar spine, femoral neck, and total hip. Changes in bone turnover markers, serum calcium, serum phosphate, and 25-hydroxy-vitamin D were also observed. RESULTS All 60 patients were female, and the mean age was 83.9±3.1, from age 80 to 94. After 12 months of denosumab treatment, significant increases in BMD were observed; 3.02±2.74% for the lumbar spine (P=0.000), 3.10±6.90% for the femoral neck (P=0.005), and 2.89±5.80% for the total hip (P=0.002) The bone turnover marker C-terminal telopeptide of type I collagen and osteocalcin significantly declined after 12 months of treatment (-34.8±45.9%; P=0.002 and -35.5±38.9%; P=0.004 respectively). Symptomatic hypocalcemia and serious adverse drug reactions that required drug discontinuation were not observed during treatment. CONCLUSIONS Denosumab is thought to be an anti-osteoporotic medication that is sufficiently effective and safe even for the super-elderly.
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Affiliation(s)
- Chaiho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: a systematic review. BMC Public Health 2019; 19:1488. [PMID: 31703654 PMCID: PMC6842175 DOI: 10.1186/s12889-019-7831-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults. Methods Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles. Results Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from − 3.13 to − 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain. Conclusions Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, BN1 9PH, UK
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Abstract
Introduction: With the majority of elderly persons consuming multiple drugs, inappropriate drug use is a major issue in geriatric medicine. Areas covered: We reviewed PubMed, Embase, and Cochrane from inception to 1 May 2019 for potentially inappropriate use of medications, polypharmacy, and age-dependent changes in pharmacokinetics and pharmacodynamics. We selected to highlight new aspects that have emerged in recent years: appropriate monitoring of drug adherence and the introduction of Big Data analysis in advancing geriatric pharmacology. Expert opinion: There are major gaps in the pharmacological treatment of the elderly. Most drugs were designed and tested in adults, with no pharmacokinetic and pharmacodynamic data on changes in old age. This void must be corrected through systematic and well-designed research programs. Potentially inappropriate use of medications (PIM) in the elderly is a serious issue in advanced age. Analysis of PIM shows relatively low predictive value in real life medicine. Most physicians continue to prescribe to the elderly medicines which should not be given at all, or not combined. Polypharmacy is a complex issue in old age, and in many cases treating physicians are not conducting critical assessment of the need for numerous medications.
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Affiliation(s)
- Gideon Koren
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,b Ariel University , Ariel , Israel.,c Technion Institute of Technology , Haifa , Israel
| | - Galia Nordon
- c Technion Institute of Technology , Haifa , Israel
| | | | - Varda Shalev
- a Maccabi-Kahn Institute of Research and Innovation , Tel Aviv , Israel.,d Tel Aviv University , Tel Aviv , Israel
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Age-Associated Hematological Toxicity in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Docetaxel in Clinical Practice. Drugs Aging 2019; 36:379-385. [PMID: 30734241 DOI: 10.1007/s40266-019-00643-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older patients with metastatic castration-resistant prostate cancer (mCRPC) may be more prone to chemotherapy-induced hematological toxicity, but tailored docetaxel dosing guidelines in older patients are lacking because of conflicting data. OBJECTIVE This study aims to evaluate the impact of older age on the incidence of hematological toxicity in patients with mCRPC treated with docetaxel in daily clinical practice. METHODS This study included patients with mCRPC treated with docetaxel between January 2006 and January 2016 at the Netherlands Cancer Institute and Medical Center Slotervaart for whom dosing and hematological toxicity data were available from electronic patient records. We evaluated the impact of age on the incidence of grade 3 and 4 hematological toxicity. RESULTS In total, 175 patients treated with docetaxel were included in the analysis, with a median age of 67 years (range 47-86). Baseline hematological laboratory values were not age related. After the first treatment cycle, hematological toxicity occurred significantly more frequently in the oldest age quartile (25%, p = 0.02) than in the younger age quartiles (9%, 11%, and 7%, respectively, for age quartiles 1, 2, and 3). CONCLUSION The risk of hematological toxicity was significantly higher in the oldest age quartile than in younger patients with mCRPC treated with docetaxel in daily clinical practice.
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Seeman MV, Becker RE, Greig NH. Geriatric pharmacotherapy: Appraising new drugs for neurologic disorders in older patients. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:3-18. [PMID: 31753138 DOI: 10.1016/b978-0-12-804766-8.00001-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
New drug development for neurologic disorders has one of the highest attrition rates of all clinical drug developments. This is problematic when, with innovative technology available in so many aspects of life, modern societies expect to have effective treatments for neurodegenerative disorders and mental health conditions that provide something beyond simple symptomatic relief-the expectation is treatment that impacts and mitigates fundamental mechanisms that drive these disorders. The disease burden of neurologic disorders remains extremely high, whereas the proportion of patients receiving effective therapy is relatively low, demonstrating a sizeable unmet medical need. Whether for novel breakthrough therapies or for drugs considered successful, deciding on the basis of clinical trial data whether a particular treatment will be effective for a specific patient is always a leap of faith. However, expertise at reading trial results combined with knowledge of the patient and of his or her disease, together with an understanding of the effect of age on drug pharmacokinetics and pharmacodynamics, the effect of age on the patient's condition, and the effect of age on the patient's life and outlook will ensure the landing is safe. The focus of this article is to provide such knowledge and thereby optimize this expertise.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert E Becker
- Aristea Translational Medicine, Park City, UT, United States; Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Nigel H Greig
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.
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Abstract
The overall physiologic changes associated with aging lead to changes in both pharmacokinetic and pharmacodynamic actions of many medications. This, in turn, leads to changes in the impact that a wide variety of medications have on older adults when compared to younger, healthy individuals. These pharmacokinetic and pharmacodynamic variations can cause either lesser or greater than expected responses to medication. Knowledge of the physiologic changes that are expected to occur in the elderly can help to identify medications that may require dose adjustments or that should be avoided, due to increased risk in this population. As a general principle, medications should be started at lower doses in the elderly with slow titration schedules to reduce the risk of adverse effects.
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Affiliation(s)
- Jacob Tillmann
- Pharmacy Service, Department of Veterans Affairs Medical Center, Gainesville, FL, United States.
| | - Ashley Reich
- Pharmacy Service, Department of Veterans Affairs Medical Center, Lake City, FL, United States
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Guaraldi G, Pintassilgo I, Milic J, Mussini C. Managing antiretroviral therapy in the elderly HIV patient. Expert Rev Clin Pharmacol 2018; 11:1171-1181. [PMID: 30444968 DOI: 10.1080/17512433.2018.1549484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Owing to more effective and less toxic antiretroviral therapy (ART), people living with HIV (PLWH) live longer, a phenomenon expected to grow in the next decades. With advancing age, effectively treated PLWH experience not only a heightened risk for non-infective comorbidities and multimorbidity, but also for geriatric syndromes and frailty. In addition, older adults living with HIV (OALWH) have a higher prevalence of so-called iatrogenic triad described as polypharmacy (PP), potentially inappropriate medication use, and drug-drug interactions. Areas covered: This review will focus the management of ART in OALWH. We will discuss iatrogenic triad and best way to address PP. Special focus will be given to pharmacokinetic and pharmacodynamic aspects of ART in the elderly, evaluation of ART toxicities, and specific ART strategies commonly used in this population. Expert commentary: Research should be focused on recruiting more OALWH, frail individuals in particular, into the clinical trials and specific geriatric outcome need to be considered together with traditional viroimmunological outcomes.
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Affiliation(s)
- Giovanni Guaraldi
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Ines Pintassilgo
- c Internal Medicine Department , Hospital Garcia de Orta , Almada , Portugal
| | - Jovana Milic
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy.,d Clinical and Experimental Medicine PhD Program , University of Modena and Reggio Emilia , Modena , Italy
| | - Cristina Mussini
- a Modena HIV Metabolic Clinic , Azienda Policlinico-Universitaria di Modena , Modena , Italy.,b Department of Medical and Surgical Sciences for Children & Adults , University of Modena and Reggio Emilia , Modena , Italy
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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Pruskowski J, Wright R, Bhatnagar M. Pain Management Considerations in Older Adults #356. J Palliat Med 2018; 21:1185-1186. [DOI: 10.1089/jpm.2018.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Functional versus chronological age: geriatric assessments to guide decision making in older patients with cancer. Lancet Oncol 2018; 19:e305-e316. [DOI: 10.1016/s1470-2045(18)30348-6] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/28/2016] [Accepted: 12/22/2016] [Indexed: 01/14/2023]
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Stegemann S. Patient centric drug product design in modern drug delivery as an opportunity to increase safety and effectiveness. Expert Opin Drug Deliv 2018; 15:619-627. [DOI: 10.1080/17425247.2018.1472571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sven Stegemann
- Institute of Process and Particle Engineering, Graz University of Technology, Graz, Austria
- Capsugel a Lonza Company, Lonza, Bornem, Belgium
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30
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Currie GM. Pharmacology, Part 2: Introduction to Pharmacokinetics. J Nucl Med Technol 2018; 46:221-230. [DOI: 10.2967/jnmt.117.199638] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022] Open
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Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2018; 71:2015-2040. [DOI: 10.1016/j.jacc.2017.12.068] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
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Bukvić Mokos Z, Jović A, Čeović R, Kostović K, Mokos I, Marinović B. Therapeutic challenges in the mature patient. Clin Dermatol 2018; 36:128-139. [PMID: 29566917 DOI: 10.1016/j.clindermatol.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the tremendous increase in the proportion of seniors in the global population, geriatric health care has become of greater interest and concern. Increased emphasis on geriatric medicine, along with the growth in the development of age-related skin disorders, has led to particular attention for geriatric, dermatology and dermatopharmacology. An aging population has brought many therapeutic challenges that we need to recognize and overcome by applying geropharmacologic principles. The purpose of this paper is to inform dermatologists of the age-related changes in the pharmacokinetics of common dermatologic drugs, their various interactions potentially occurring in the elderly, and the principles and evidence-based strategies for detection, management, and prevention to improve medication adherence. By implementing these principles and strategies, we can ensure the best and the safest treatment to promote the desired therapeutic outcome and improved quality of life for this fragile subpopulation.
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Affiliation(s)
- Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
| | - Anamaria Jović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Romana Čeović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Krešimir Kostović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Ivica Mokos
- Department of Urology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
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Lund JL, Sanoff HK, Peacock Hinton S, Muss HB, Pate V, Stürmer T. Potential Medication-Related Problems in Older Breast, Colon, and Lung Cancer Patients in the United States. Cancer Epidemiol Biomarkers Prev 2018; 27:41-49. [PMID: 28978563 PMCID: PMC5760326 DOI: 10.1158/1055-9965.epi-17-0523] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/31/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Older adults are often exposed to multiple medications, some of which could be inappropriate or have the potential to interact with each other. Older cancer patients may be at increased risk for medication-related problems due to exposure to cancer-directed treatment.Methods: We described patterns of potentially inappropriate medication (PIM) use and potential drug-chemotherapy interactions among adults age 66+ years diagnosed with stage I-III breast, stage II-III colon, and stage I to II lung cancer. Within the Surveillance, Epidemiology, and End Results-Medicare database, patients had to have Medicare Part D coverage with 1+ prescription in the diagnosis month and Medicare Parts A/B coverage in the prior 12 months. We estimated monthly prevalence of any and cancer-related PIM from 6 months pre- to 23 months postcancer diagnosis and 12-month period prevalence of potential drug-chemotherapy interactions.Results: Overall, 19,318 breast, 7,283 colon, and 7,237 lung cancer patients were evaluated. Monthly PIM prevalence was stable prediagnosis (37%-40%), but increased in the year following a colon or lung cancer diagnosis, and decreased following a breast cancer diagnosis. Changes in PIM prevalence were driven primarily by cancer-related PIM in patients on chemotherapy. Potential drug-chemotherapy interactions were observed in all cohorts, with prevalent interactions involving hydrochlorothiazide, warfarin, and proton-pump inhibitors.Conclusions: There was a high burden of potential medication-related problems among older cancer patients; future research to evaluate outcomes of these exposures is warranted.Impact: Older adults diagnosed with cancer have unique medication management needs. Thus, pharmacy specialists should be integrated into multidisciplinary teams caring for these patients. Cancer Epidemiol Biomarkers Prev; 27(1); 41-49. ©2017 AACR.
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Affiliation(s)
- Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Hanna K Sanoff
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sharon Peacock Hinton
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, North Carolina
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Virginia Pate
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Díaz J, Gándara J, Sénior JM. Características clínicas, angiográficas y desenlaces clínicos en adultos mayores de 65 años con síndrome coronario agudo sin elevación del segmento ST. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Schlender JF, Meyer M, Thelen K, Krauss M, Willmann S, Eissing T, Jaehde U. Development of a Whole-Body Physiologically Based Pharmacokinetic Approach to Assess the Pharmacokinetics of Drugs in Elderly Individuals. Clin Pharmacokinet 2017; 55:1573-1589. [PMID: 27351180 PMCID: PMC5107207 DOI: 10.1007/s40262-016-0422-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Because of the vulnerability and frailty of elderly adults, clinical drug development has traditionally been biased towards young and middle-aged adults. Recent efforts have begun to incorporate data from paediatric investigations. Nevertheless, the elderly often remain underrepresented in clinical trials, even though persons aged 65 years and older receive the majority of drug prescriptions. Consequently, a knowledge gap exists with regard to pharmacokinetic (PK) and pharmacodynamic (PD) responses in elderly subjects, leaving the safety and efficacy of medicines for this population unclear. Objectives The goal of this study was to extend a physiologically based pharmacokinetic (PBPK) model for adults to encompass the full course of healthy aging through to the age of 100 years, to support dose selection and improve pharmacotherapy for the elderly age group. Methods For parameterization of the PBPK model for healthy aging individuals, the literature was scanned for anthropometric and physiological data, which were consolidated and incorporated into the PBPK software PK-Sim®. Age-related changes that occur from 65 to 100 years of age were the main focus of this work. For a sound and continuous description of an aging human, data on anatomical and physiological changes ranging from early adulthood to old age were included. The capability of the PBPK approach to predict distribution and elimination of drugs was verified using the test compounds morphine and furosemide, administered intravenously. Both are cleared by a single elimination pathway. PK parameters for the two compounds in younger adults and elderly individuals were obtained from the literature. Matching virtual populations—with regard to age, sex, anthropometric measures and dosage—were generated. Profiles of plasma drug concentrations over time, volume of distribution at steady state (Vss) values and elimination half-life (t½) values from the literature were compared with those predicted by PBPK simulations for both younger adults and the elderly. Results For most organs, the age-dependent information gathered in the extensive literature analysis was dense. In contrast, with respect to blood flow, the literature study produced only sparse data for several tissues, and in these cases, linear regression was required to capture the entire elderly age range. On the basis of age-informed physiology, the predicted PK profiles described age-associated trends well. The root mean squared prediction error for the prediction of plasma concentrations of furosemide and morphine in the elderly were improved by 32 and 49 %, respectively, by use of age-informed physiology. The majority of the individual Vss and t½ values for the two model compounds, furosemide and morphine, were well predicted in the elderly population, except for long furosemide half-lifes. Conclusion The results of this study support the feasibility of using a knowledge-driven PBPK aging model that includes the elderly to predict PK alterations throughout the entire course of aging, and thus to optimize drug therapy in elderly individuals. These results indicate that pharmacotherapy and safety-related control of geriatric drug therapy regimens may be greatly facilitated by the information gained from PBPK predictions. Electronic supplementary material The online version of this article (doi:10.1007/s40262-016-0422-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan-Frederik Schlender
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, 53121, Bonn, Germany. .,Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany.
| | - Michaela Meyer
- Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany
| | - Kirstin Thelen
- Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany
| | - Markus Krauss
- Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany
| | - Stefan Willmann
- Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany
| | - Thomas Eissing
- Bayer Technology Services GmbH, Computational Systems Biology, 51368, Leverkusen, Germany
| | - Ulrich Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, 53121, Bonn, Germany
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Streeter AJ, Faria EC. Analysis of the variability of the pharmacokinetics of multiple drugs in young adult and elderly subjects and its implications for acceptable daily exposures and cleaning validation limits. Int J Hyg Environ Health 2017; 220:659-672. [PMID: 28396010 DOI: 10.1016/j.ijheh.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
The elderly constitute a significant, potentially sensitive, subpopulation within the general population, which must be taken into account when performing risk assessments including determining an acceptable daily exposure (ADE) for the purpose of a cleaning validation. Known differences in the pharmacokinetics of drugs between young adults (who are typically the subjects recruited into clinical trials) and the elderly are potential contributors affecting the interindividual uncertainty factor (UFH) component of the ADE calculation. The UFH values were calculated for 206 drugs for young adult and elderly groups separately and combined (with the elderly assumed to be a sensitive subpopulation) from published studies where the pharmacokinetics of the young adult and elderly groups were directly compared. Based on the analysis presented here, it is recommended to use a default UFH value of 10 for worker populations (which are assumed to be approximately equivalent to the young adult groups) where no supporting pharmacokinetic data exist, while it is recommended to use a default UFH value of 15 for the general population, to take the elderly into consideration when calculating ADE values. The underlying reasons for the large differences between the exposures in the young adult and elderly subjects for the 10 compounds which show the greatest separation are different in almost every case, involving the OCT2 transporter, glucuronidation, hydrolysis, CYP1A2, CYP2A6, CYP2C19, CYP2D6, CYP3A4 or CYP3A5. Therefore, there is no consistent underlying mechanism which appears responsible for the largest differences in pharmacokinetic parameters between young adult and elderly subjects.
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Affiliation(s)
- Anthony J Streeter
- Janssen Research & Development LLC, Spring House, PA and Raritan, NJ, USA.
| | - Ellen C Faria
- Janssen Research & Development LLC, Spring House, PA and Raritan, NJ, USA.
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Prevalence of drug interactions in elderly patients with multimorbidity in primary care. Int J Clin Pharm 2017; 39:343-353. [DOI: 10.1007/s11096-017-0439-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/10/2017] [Indexed: 01/29/2023]
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Bykov K, Schneeweiss S, Donneyong MM, Dong YH, Choudhry NK, Gagne JJ. Impact of an Interaction Between Clopidogrel and Selective Serotonin Reuptake Inhibitors. Am J Cardiol 2017; 119:651-657. [PMID: 27939386 DOI: 10.1016/j.amjcard.2016.10.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 01/22/2023]
Abstract
Clopidogrel is a pro-drug that requires activation by the cytochrome P450 (CYP) enzyme system. Patients receiving clopidogrel are often treated with selective serotonin reuptake inhibitors (SSRIs) for co-existing depression. SSRIs that inhibit the CYP2C19 enzyme have the potential to reduce the effectiveness of clopidogrel. Using 5 US databases (1998 to 2013), we conducted a cohort study of adults who initiated clopidogrel while being treated with either an SSRI that inhibits CYP2C19 (fluoxetine and fluvoxamine) or a noninhibiting SSRI. Patients were matched by propensity score and followed for as long as they were exposed to both clopidogrel and the index SSRI group (primary analysis) or for 180 days after clopidogrel initiation (sensitivity analysis). Outcomes included a composite ischemic event (myocardial infarction, ischemic stroke, or a revascularization procedure) and a composite major bleeding event (gastrointestinal bleed or hemorrhagic stroke). The final propensity score-matched cohort comprised 9,281 clopidogrel initiators on CYP2C19-inhibiting SSRIs and 44,278 clopidogrel initiators on a noninhibiting SSRIs. Compared with those treated with a noninhibiting SSRI, patients on a CYP2C19-inhibiting SSRI had an increased risk of ischemic events (hazard ratio [HR] 1.12; 95% confidence interval [CI] 1.01 to 1.24), which was more pronounced in patients ≥65 years (HR 1.22; 95% CI 1.00 to 1.48). The HR for major bleeding was 0.76 (95% CI 0.50 to 1.17). In conclusion, the findings from this large, population-based study suggest that being treated with a CYP2C19-inhibiting SSRI when initiating clopidogrel may be associated with slight decrease in effectiveness of clopidogrel.
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Affiliation(s)
- Katsiaryna Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Macarius M Donneyong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yaa-Hui Dong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Kashyap M, D'Cruz S, Sachdev A, Tiwari P. Evidence-based information leads to reduction in inappropriate drug prescribing: Results from Indian older inpatients. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2016; 27:209-17. [PMID: 26756894 DOI: 10.3233/jrs-150665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although several guidelines for appropriate prescribing are available, inappropriate drug prescription remains noteworthy problem among older adults. Indian older patients are also not spare from this issue and existing literature indicates a fair level of inappropriate drug use (IDU). OBJECTIVES Identified potentially IDU and documented their reduction based on provided evidence-based information and also identified possible predictors of IDU in older inpatients. SETTING Three years prospective study included 1510 inpatients aged 60 years or over, of both sexes. IDU identified using the Modified Updated AGS Beers Criteria 2012. RESULTS The patients had an average age of 67.10 ± 0.23 years and on an average were prescribed 9.29 ± 0.11 medications. Using AGS Beers Criteria 2012, total IDU was found to be 21% (n = 325). Of total 287 patients received only one inappropriate drug whereas 38 patients received two or more inappropriate drug(s). According to first list of criteria long acting benzodiazepines, anticholinergics, nitrofurantoin and digoxin were most common IDU. Prescription of theophylline in insomnia followed by aspirin in gastric ulcer and calcium channel blocker in constipation were listed from second list of criteria. 31% reductions in IDU were observed based on evidence-based information regarding each identified inappropriate drugs. CONCLUSIONS The findings of this study provide evidence that provision of unbiased evidenced based information is the best possible means for improvement of pharmacotherapy in older patients.
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Affiliation(s)
| | - Sanjay D'Cruz
- Department of General Medicine, GovernmentMedical College & Hospital, Chandigarh, India
| | - Atul Sachdev
- Department of General Medicine, GovernmentMedical College & Hospital, Chandigarh, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Instituteof Pharmaceutical Education and Research, S.A.S. Nagar, Punjab, India
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Sera L, Uritsky T. Pharmacokinetic and pharmacodynamic changes in older adults and implications for palliative care. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1192319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pharmacokinetics of Vancomycin in Elderly Patients Aged over 80 Years. Antimicrob Agents Chemother 2016; 60:4563-7. [PMID: 27185796 DOI: 10.1128/aac.00303-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/07/2016] [Indexed: 11/20/2022] Open
Abstract
Since the 1950s, vancomycin has remained a reference treatment for severe infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus Vancomycin is a nephrotoxic and ototoxic drug mainly eliminated through the kidneys. It has a large interindividual pharmacokinetic variability, which justifies monitoring its plasma concentrations in patients. This is especially important in patients aged over 80 years, who frequently have renal impairment. However, the pharmacokinetics of vancomycin in this population is very poorly described in the literature. The objective of this work was to propose a model able to predict the pharmacokinetics of vancomycin in very elderly people. First, a population pharmacokinetic model was carried out using the algorithm NPAG (nonparametric adaptive grid) on a database of 70 hospitalized patients aged over 80 years and treated with vancomycin. An external validation then was performed on 41 patients, and the predictive capabilities of the model were assessed. The model had two compartments and six parameters. Body weight and creatinine clearance significantly influenced vancomycin volume of distribution and body clearance, respectively. The means (± standard deviations) of vancomycin volume of distribution and clearance were 36.3 ± 15.2 liter and 2.0 ± 0.9 liter/h, respectively. In the validation group, the bias and precision were -0.75 mg/liter and 8.76 mg/liter for population predictions and -0.39 mg/liter and 2.68 mg/liter for individual predictions. In conclusion, a pharmacokinetic model of vancomycin in a very elderly population has been created and validated for predicting plasma concentrations of vancomycin.
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Tolppanen AM, Taipale H, Koponen M, Lavikainen P, Tanskanen A, Tiihonen J, Hartikainen S. Cohort profile: the Finnish Medication and Alzheimer's disease (MEDALZ) study. BMJ Open 2016; 6:e012100. [PMID: 27412109 PMCID: PMC4947779 DOI: 10.1136/bmjopen-2016-012100] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of the Medicine use and Alzheimer's disease (MEDALZ) study is to investigate the changes in medication and healthcare service use among persons with Alzheimer's disease (AD) and to evaluate the safety and effectiveness of medications in this group. This is important, because the number of persons with AD is rapidly growing and even though they are a particularly vulnerable patient group, the number of representative, large-scale studies with adequate follow-up time is limited. PARTICIPANTS MEDALZ contains all residents of Finland who received a clinically verified diagnosis of AD between 2005 and 2011 and were community-dwelling at the time of diagnosis (N=70 719). The diagnosis is based on the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA) and Diagnostic and Statistical Manual Fourth Edition (DSM-IV) criteria for Alzheimer's disease. The cohort contains socioeconomic data (education, occupational status and taxable income, 1972-2012) and causes of death (2005-2012), data from the prescription register (1995-2012), the special reimbursement register (1972-2012) and the hospital discharge register (1972-2012). Future updates are planned.The average age was 80.1 years (range 34.5-104.6 years). The majority of cohort (65.2%) was women. Currently, the average length of follow-up after AD diagnosis is 3.1 years and altogether 26 045 (36.8%) persons have died during the follow-up. FINDINGS Altogether 53% of the cohort had used psychotropic drugs within 1 year after AD diagnoses. The initiation rate of for example, benzodiazepines and related drugs and antidepressants began to increase already before AD diagnosis. FUTURE PLANS We are currently assessing if these, and other commonly used medications are related to adverse events such as death, hip fractures, head injuries and pneumonia.
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Affiliation(s)
- Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Research Center for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Mori K, Blackshear PE, Lobenhofer EK, Parker JS, Orzech DP, Roycroft JH, Walker KL, Johnson KA, Marsh TA, Irwin RD, Boorman GA. Hepatic Transcript Levels for Genes Coding for Enzymes Associated with Xenobiotic Metabolism are Altered with Age. Toxicol Pathol 2016; 35:242-51. [PMID: 17366318 DOI: 10.1080/01926230601156286] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Metabolism studies are crucial for data interpretation from rodent toxicity and carcinogenicity studies. Metabolism studies are usually conducted in 6 to 8 week old rodents. Long-term studies often continue beyond 100 weeks of age. The potential for age-related changes in transcript levels of genes encoding for enzymes associated with metabolism was evaluated in the liver of male F344/N rats at 32, 58, and 84 weeks of age. Differential expression was found between the young and old rats for genes whose products are involved in both phase I and phase II metabolic pathways. Thirteen cytochrome P450 genes from CYP families 1–3 showed alterations in expression in the older rats. A marked age-related decrease in expression was found for 4 members of the Cyp3a family that are critical for drug metabolism in the rat. Immunohistochemical results confirmed a significant decrease in Cyp3a2 and Cyp2c11 protein levels with age. This indicates that the metabolic capacity of male rats changes throughout a long-term study. Conducting multiple hepatic microarray analyses during the conduct of a long-term study can provide a global view of potential metabolic changes that might occur. Alterations that are considered crucial to the interpretation of long-term study results could then be confirmed by subsequent metabolic studies.
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Affiliation(s)
- Kazuhiko Mori
- National Institute of Environmental Health Sciences, Research Triangle Park, NC 27701, USA
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Bujalska-Zadrożny M, Kogut E, de Cordé A, Dawidowski M, Kleczkowska P. Antinociceptive activity of intraperitoneally administered novel and potent anticonvulsive compound, CY-PROLL-SS, in animal neuropathic pain models. Pharmacol Rep 2016; 68:601-7. [DOI: 10.1016/j.pharep.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 12/27/2022]
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Akhtar S, Liu J, Heng J, Dai F, Schonberger RB, Burg MM. Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations: a study of contemporary practice. J Clin Anesth 2016; 33:208-15. [PMID: 27555166 DOI: 10.1016/j.jclinane.2016.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVE It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged >65. DESIGN Retrospective chart review. SETTING Academic medical center. PATIENTS A total of 1869 adult patients receiving general anesthesia for GI surgical procedures from February 2013 to January 2014. MEASUREMENTS Patients were divided into 3 age groups (age <65, 65-79, ≥80 years) and then further stratified into ASA-PS class (I/II vs III/IV). Multiple pairwise comparisons were conducted using Welch t tests for continuous variables to determine whether dosing was different for the older groups vs the younger group; separate analyses were performed within and across ASA-PS class. This approach was also used to determine differences in mean arterial pressure change in the older groups vs the younger group, whereas the rates of hypotension among different age groups were compared by Cochran-Armitage trend test. MAIN RESULTS No significant decrease in dosing between age groups was observed for fentanyl and midazolam. For propofol, there was a significantly lower dosing for older patients: 17% for patients aged 65-79 and 29% for those aged >80, which was still in less than the recommendations. An inverse relationship was observed between propofol dosing and ASA-PS class, but no consistent relationship was noted for fentanyl and midazolam. There were a significantly larger drop in mean arterial pressure and a greater likelihood of hypotension following induction in patients aged 65-79 years and >80 years as compared with those aged <65 years. CONCLUSIONS This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes.
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Affiliation(s)
- Shamsuddin Akhtar
- Department of Anesthesiology and Pharmacology, Yale School of Medicine, New Haven, CT.
| | - Jia Liu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Joseph Heng
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Feng Dai
- Yale Center for Analytical Sciences, New Haven, CT
| | | | - Matthew M Burg
- Departments of Anesthesiology and Internal Medicine, Yale School of Medicine, New Haven, CT
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Affiliation(s)
- Elizabeth Anderson
- Department of Medical and Social Care Education; University of Leicester; UK
| | - Neena Lakhani
- Leicester School of Pharmacy; De Montfort University; Leicester UK
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Pharmacokinetics of Selected Anticancer Drugs in Elderly Cancer Patients: Focus on Breast Cancer. Cancers (Basel) 2016; 8:cancers8010006. [PMID: 26729170 PMCID: PMC4728453 DOI: 10.3390/cancers8010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/30/2015] [Accepted: 12/29/2015] [Indexed: 01/07/2023] Open
Abstract
Background: Elderly patients receiving anticancer drugs may have an increased risk to develop treatment-related toxicities compared to their younger peers. However, a potential pharmacokinetic (PK) basis for this increased risk has not consistently been established yet. Therefore, the objective of this study was to systematically review the influence of age on the PK of anticancer agents frequently administered to elderly breast cancer patients. Methods: A literature search was performed using the PubMed electronic database, Summary of Product Characteristics (SmPC) and available drug approval reviews, as published by EMA and FDA. Publications that describe age-related PK profiles of selected anticancer drugs against breast cancer, excluding endocrine compounds, were selected and included. Results: This review presents an overview of the available data that describe the influence of increasing age on the PK of selected anticancer drugs used for the treatment of breast cancer. Conclusions: Selected published data revealed differences in the effect and magnitude of increasing age on the PK of several anticancer drugs. There may be clinically-relevant, age-related PK differences for anthracyclines and platina agents. In the majority of cases, age is not a good surrogate marker for anticancer drug PK, and the physiological state of the individual patient may better be approached by looking at organ function, Charlson Comorbidity Score or geriatric functional assessment.
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Sanglier T, Saragoussi D, Milea D, Tournier M. Depressed older adults may be less cared for than depressed younger ones. Psychiatry Res 2015; 229:905-12. [PMID: 26233825 DOI: 10.1016/j.psychres.2015.07.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/16/2015] [Accepted: 07/12/2015] [Indexed: 12/31/2022]
Abstract
The aim of the study was to investigate depression treatment use, either psychotherapy (PT) or antidepressant drugs (ADT) in the older and younger depressed population. Cohorts of 6316 elderly (≥65 year-old) and 25,264 matched non-elderly (25-64 year-old) depressed patients were created from a large national claims database of managed care plans from 2003 to 2006. Factors associated with ADT or PT were assessed using multivariate logistic models. During the 120 days following the depression diagnosis, the elderly persons were less often treated than the younger adults either by ADT (25.6% vs. 33.8%) or by PT (13.0% vs. 34.4%). ADT dispensing occurred later in the elderly group (51 vs. 14 days). ADT was associated with comorbid chronic conditions or polypharmacy in the elderly and younger adults. The selection of treatment (ADT or PT) was associated with the history of treated depression using the same type of treatment, in both groups. Thus, depression goes commonly untreated. Comorbidity was associated with higher ADT dispensing rates. However, although depressed elderly commonly presented with comorbidity, this age group was at higher risk of untreated illness or later treatment.
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Affiliation(s)
- Thibaut Sanglier
- Université Claude Bernard Lyon I, Villeurbanne, France; Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Delphine Saragoussi
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Dominique Milea
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Marie Tournier
- Université de Bordeaux, U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
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Riches Z, Abanda N, Collier AC. BCRP protein levels do not differ regionally in adult human livers, but decline in the elderly. Chem Biol Interact 2015; 242:203-10. [PMID: 26462791 DOI: 10.1016/j.cbi.2015.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study was to characterize the ontogeny and variability of the BCRP (ABCG2) transporter in healthy human liver. Levels of BCRP mRNA and protein were determined with q-RT-PCR and western blot in a cohort of 87 human livers aged from 7 days to 87 years. A study of the regional expression of BCRP within adult livers was also performed in a nested cohort of 14 individuals with multiple samples per person collected from pre-selected sites. Levels of BCRP mRNA were not significantly different at any age, but protein levels for BCRP were lower in the elderly compared with adults (p < 0.001) and children (p < 0.05). The intra-liver levels of BCRP protein ranged approximately 6.5-fold and inter-liver BCRP protein varied 8.5-fold in the cohort. No differences in BCRP mRNA or protein were observed with sex or ethnicity, although higher levels of BCRP mRNA were observed in livers from overweight individuals (Body Mass Index ≥ 25-29.9) as compared to underweight or ideal weight individuals. There were no differences in the levels of BCRP mRNA or protein in different regions of the large lobe (n = 3 regions), small lobe (n = 3 regions), directly adjacent to the portal vein or directly adjacent to the common bile duct. This indicates that BCRP researchers can source tissue from all parts of the adult liver without artificial bias in their results. Lower BCRP protein expression in the elderly may be associated with compromised xeno- and endobiotic transport.
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Affiliation(s)
- Zoe Riches
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T1Z3, Canada
| | - Ngu Abanda
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, HI 96813, USA; Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T1Z3, Canada.
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