1
|
Holt A, Strange JE, Rasmussen PV, Blanche P, Nouhravesh N, Jensen MH, Schjerning AM, Schou M, Torp-Pedersen C, Gislason GH, Hansen ML, McGettigan P, Lamberts M. Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran. Am J Med 2022; 135:595-602.e5. [PMID: 34861201 DOI: 10.1016/j.amjmed.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bleeding safety in relation to use of systemic fluconazole and topical azoles among patients with atrial fibrillation treated with apixaban, rivaroxaban, or dabigatran is insufficiently explored, despite clinical relevance and several reports suggesting associations. METHODS Using nationwide Danish registers, we identified patients with atrial fibrillation initiated on apixaban, rivaroxaban, or dabigatran from 2012-2018. We investigated associations between bleeding incidents and systemic fluconazole or topical azole treatment using a case-crossover design with 30-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI). RESULTS We included 32,340 (36%), 32,409 (36%), and 24,940 (28%) patients initiated on apixaban, rivaroxaban, and dabigatran, respectively. Patients on apixaban were older (median age: 77 years; interquartile range [IQR] 70-84) compared with rivaroxaban users (median age: 75 years; IQR 68-82) and patients on dabigatran (median age: 73 years; IQR 66-80). Apixaban users had a significantly increased risk of bleeding following exposure to systemic fluconazole: odds ratio (OR) 3.5; 95% confidence interval (CI), 1.4-10.6. No increased risk was found among rivaroxaban and dabigatran users: ORs of 0.9 (95% CI, 0.2-3.0) and 1.7 (95% CI, 0.5-5.6), respectively. As to bleeding risk pertaining to topical azole exposure among apixaban, rivaroxaban, and dabigatran users, no association was found, with corresponding ORs of 0.8 (95% CI, 0.5-1.3); 1.3 (95% CI, 0.9-2.1); and 1.2 (95% CI 0.8-1.8), respectively. CONCLUSION In patients with atrial fibrillation on either apixaban, rivaroxaban, or dabigatran, an association between an elevated bleeding risk and use of systemic fluconazole was found among patients on apixaban. We found no increased risk of bleeding following co-exposure to topical azoles.
Collapse
Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark.
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Paul Blanche
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark; Section of Biostatistics, University of Copenhagen, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Mads Hashiba Jensen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Departments of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
2
|
Hamim H, Sangeda RZ, Bundala M, Mkumbwa S, Bitegeko A, Sillo HB, Fimbo AM, Chambuso M, Mbugi EV. Utilization Trends of Antiviral and Antifungal Agents for Human Systemic Use in Tanzania From 2010 to 2017 Using the World Health Organization Collaborating Centre for Drug Statistics Methodology. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.723991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.
Collapse
|
3
|
Becker P, Lecerf P, Claereboudt J, Devleesschauwer B, Packeu A, Hendrickx M. Superficial mycoses in Belgium: Burden, costs and antifungal drugs consumption. Mycoses 2020; 63:500-508. [PMID: 32048335 DOI: 10.1111/myc.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/20/2020] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Monitoring of superficial mycoses requires more attention due to their important incidence, health costs and antifungal drugs consumption. OBJECTIVES The objectives were to estimate the burden of superficial mycoses in Belgium and to assess trends in associated antifungal consumption. METHODS The burden of dermatophytoses (including onychomycosis), as well as skin and genital candidiasis, was estimated using disability-adjusted life years (DALY). Moreover, trends in systemic and topical antifungal consumption in ambulatory care were examined for the period 2010-2017, together with their associated costs. RESULTS Due to their high incidence and long treatment duration, dermatophytoses represented the bulk of the burden, accounting for 92.2% of the total DALYs of superficial mycoses. Terbinafine was the most prescribed antifungal in terms of doses (35.4% of the total doses) while fluconazole was the most delivered drug in terms of packages (29.1% of the total packages). More than 70% of the prescriptions were made by general practitioners while consumption varied according to age and gender of the patients. A global 12% decrease in antifungal prescriptions was observed between 2011 and 2017. However, this reduction would result mainly from packaging changes and increased self-medication. A significant decrease in itraconazole treatments was notably compensated by an increased prescription of fluconazole packages. CONCLUSION This study emphasises that dermatological presentations of superficial mycoses are the most important in terms of both burden and antifungal consumption in Belgium. Further reduction in antifungals use can be achieved by applying the adequate treatment after identification of the causative agent.
Collapse
Affiliation(s)
- Pierre Becker
- Department of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Pauline Lecerf
- Dermatology Department, University Hospitals Brugmann & Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Claereboudt
- Gynaecology and Obstetrics Department, Sainte-Anne Saint-Remi Clinic, CHIREC, Université Libre de Bruxelles, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Ann Packeu
- Department of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Marijke Hendrickx
- Department of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| |
Collapse
|
4
|
Goemaere B, Lagrou K, Spriet I, Hendrickx M, Vandael E, Becker P, Catry B. Systemic antifungal drug use in Belgium—One of the biggest antifungal consumers in Europe. Mycoses 2019; 62:542-550. [DOI: 10.1111/myc.12912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/28/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Berdieke Goemaere
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Clinical Department of Laboratory Medicine National Reference Centre for Mycosis University Hospitals Leuven Leuven Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences KU Leuven Leuven Belgium
- Pharmacy Department University Hospitals Leuven Leuven Belgium
| | - Marijke Hendrickx
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Eline Vandael
- Healthcare‐Associated Infections and Antimicrobial Resistance Sciensano Brussels Belgium
| | - Pierre Becker
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Boudewijn Catry
- Healthcare‐Associated Infections and Antimicrobial Resistance Sciensano Brussels Belgium
- Faculty of Medicine Université Libre de Bruxelles (ULB) Brussels Belgium
| |
Collapse
|
5
|
Fontana RJ, Cirulli ET, Gu J, Kleiner D, Ostrov D, Phillips E, Schutte R, Barnhart H, Chalasani N, Watkins PB, Hoofnagle JH. The role of HLA-A*33:01 in patients with cholestatic hepatitis attributed to terbinafine. J Hepatol 2018; 69:1317-1325. [PMID: 30138689 PMCID: PMC6472700 DOI: 10.1016/j.jhep.2018.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Terbinafine is an antifungal agent that has been associated with rare instances of hepatotoxicity. In this study we aimed to describe the presenting features and outcomes of patients with terbinafine hepatotoxicity and to investigate the role of human leukocyte antigen (HLA)-A*33:01. METHODS Consecutive high causality cases of terbinafine hepatotoxicity enrolled into the Drug Induced Liver Injury Network were reviewed. DNA samples underwent high-resolution confirmatory HLA sequencing using the Ilumina MiSeq platform. RESULTS All 15 patients with terbinafine hepatotoxicity were more than 40 years old (median = 57 years), 53% were female and the median latency to onset was 38 days (range 24 to 114 days). At the onset of drug-induced liver injury, 80% were jaundiced, median serum alanine aminotransferase was 448 U/L and alkaline phosphatase was 333 U/L. One individual required liver transplantation for acute liver failure during follow-up, and 7 of the 13 (54%) remaining individuals had ongoing liver injury at 6 months, with 4 demonstrating persistently abnormal liver biochemistries at month 24. High-resolution HLA genotyping confirmed that 10 of the 11 (91%) European ancestry participants were carriers of the HLA-A*33:01, B*14:02, C*08:02 haplotype, which has a carrier frequency of 1.6% in European Ancestry population controls. One African American patient was also an HLA-A*33:01 carrier while 2 East Asian patients were carriers of a similar HLA type: A*33:03. Molecular docking studies indicated that terbinafine may interact with HLA-A*33:01 and A*33:03. CONCLUSIONS Patients with terbinafine hepatotoxicity most commonly present with a mixed or cholestatic liver injury profile and frequently have residual evidence of chronic cholestatic injury. A strong genetic association of HLA-A*33:01 with terbinafine drug-induced liver injury was confirmed amongst Caucasians. LAY SUMMARY A locus in the human leukocyte antigen gene (HLA-A*33:01, B*14:02, C*08:02) was significantly overrepresented in Caucasian and African American patients with liver injury attributed to the antifungal medication, terbinafine. These data along with the molecular docking studies demonstrate that this genetic polymorphism is a plausible risk factor for developing terbinafine hepatotoxicity and could be used in the future to help doctors make a diagnosis more rapidly and confidently.
Collapse
Affiliation(s)
| | | | | | | | - David Ostrov
- University of Florida College of Medicine, Gainesville, FL
| | | | - Ryan Schutte
- University of Florida College of Medicine, Gainesville, FL
| | | | | | | | - Jay H. Hoofnagle
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| |
Collapse
|
6
|
An overview about the medical use of antifungals in Portugal in the last years. J Public Health Policy 2016; 37:200-15. [PMID: 26865319 DOI: 10.1057/jphp.2016.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite the introduction of new antifungal agents, the frequency of invasive and mucocutaneous fungal infections as well as resistance to antifungal drugs continues to increase. Over 300 million persons are infected annually with fungi. Resistance to antimicrobials is one of today's major health threats. Can the possible causes of fungal antimicrobial resistance be understood and prevented to minimize risks to public health. We provide an overview of antifungal drug use in European countries, particularly Portugal. We reviewed prescriptions for and over-the-counter sales (OTC) of azoles in Portuguese pharmacies and in alternative shops. We conclude that in Portugal, azole antifungal sales, as well as medical prescribed azoles are very high. The Portuguese population consumes more antifungal drugs per capita than others in Europe.
Collapse
|
7
|
Adriaenssens N, Uka V, Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, Korinteli I, Kambaralieva B, Cizmovic L, Carp A, Radonjic V, Maqsudova N, Alkan A, Coenen S, Pedersen HB, Sautenkova N, Goossens H. Systemic antimycotic and antifungal use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. J Antimicrob Chemother 2015; 70:2173-5. [PMID: 25802285 DOI: 10.1093/jac/dkv064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Valdet Uka
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ganna Bolokhovets
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise of the Ministry of Health, Yerevan, Armenia
| | - Vafa Abilova
- Ministry of Health of Azerbaijan Republic, Analytical Expertise Centre for Medicines, Baku, Azerbaijan
| | - Galina Pyshnik
- Department on Organization of Medicines Provision, Ministry of Health, Minsk, Republic of Belarus
| | - Tijana Spasojevic
- Agency for Medicines and Medical Devices of Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
| | | | | | - Lidija Cizmovic
- Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro
| | - Angela Carp
- Agency of Medicines, Chisinau, Republic of Moldova
| | - Vesela Radonjic
- Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
| | | | - Ali Alkan
- Ministry of Health of Turkey, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium Centre for General Practice, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Hanne Bak Pedersen
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Nina Sautenkova
- Health Technologies and Pharmaceuticals, Division of Health Systems and Public Health, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | |
Collapse
|
8
|
Tyczkowska-Sieron E, Gaszynski W, Tyczkowski J, Glowacka A. Analysis of the relationship between fluconazole consumption and non–C. albicans Candida infections. Med Mycol 2014; 52:758-65. [DOI: 10.1093/mmy/myu053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Raschi E, Poluzzi E, Koci A, Caraceni P, Ponti FD. Assessing liver injury associated with antimycotics: Concise literature review and clues from data mining of the FAERS database. World J Hepatol 2014; 6:601-612. [PMID: 25232453 PMCID: PMC4163743 DOI: 10.4254/wjh.v6.i8.601] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/26/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To inform clinicians on the level of hepatotoxic risk among antimycotics in the post-marketing setting, following the marketing suspension of oral ketoconazole for drug-induced liver injury (DILI).
METHODS: The publicly available international FAERS database (2004-2011) was used to extract DILI cases (including acute liver failure events), where antimycotics with systemic use or potential systemic absorption were reported as suspect or interacting agents. The reporting pattern was analyzed by calculating the reporting odds ratio and corresponding 95%CI, a measure of disproportionality, with time-trend analysis where appropriate.
RESULTS: From 1687284 reports submitted over the 8-year period, 68115 regarded liver injury. Of these, 2.9% are related to antimycotics (1964 cases, of which 112 of acute liver failure). Eleven systemic antimycotics (including ketoconazole and the newer triazole derivatives voriconazole and posaconazole) and terbinafine (used systemically to treat onychomicosis) generated a significant disproportionality, indicating a post-marketing signal of risk.
CONCLUSION: Virtually all antimycotics with systemic action or absorption are commonly reported in clinically significant cases of DILI. Clinicians must be aware of this aspect and monitor patients in case switch is considered, especially in critical poly-treated patients under chronic treatment.
Collapse
|
10
|
Raschi E, Poluzzi E, Koci A, Caraceni P, Ponti FD. Assessing liver injury associated with antimycotics: Concise literature review and clues from data mining of the FAERS database. World J Hepatol 2014. [PMID: 25232453 DOI: 10.4254/wjh.v6.i8.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To inform clinicians on the level of hepatotoxic risk among antimycotics in the post-marketing setting, following the marketing suspension of oral ketoconazole for drug-induced liver injury (DILI). METHODS The publicly available international FAERS database (2004-2011) was used to extract DILI cases (including acute liver failure events), where antimycotics with systemic use or potential systemic absorption were reported as suspect or interacting agents. The reporting pattern was analyzed by calculating the reporting odds ratio and corresponding 95%CI, a measure of disproportionality, with time-trend analysis where appropriate. RESULTS From 1687284 reports submitted over the 8-year period, 68115 regarded liver injury. Of these, 2.9% are related to antimycotics (1964 cases, of which 112 of acute liver failure). Eleven systemic antimycotics (including ketoconazole and the newer triazole derivatives voriconazole and posaconazole) and terbinafine (used systemically to treat onychomicosis) generated a significant disproportionality, indicating a post-marketing signal of risk. CONCLUSION Virtually all antimycotics with systemic action or absorption are commonly reported in clinically significant cases of DILI. Clinicians must be aware of this aspect and monitor patients in case switch is considered, especially in critical poly-treated patients under chronic treatment.
Collapse
Affiliation(s)
- Emanuel Raschi
- Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy
| | - Elisabetta Poluzzi
- Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy
| | - Ariola Koci
- Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy
| | - Paolo Caraceni
- Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy
| | - Fabrizio De Ponti
- Emanuel Raschi, Elisabetta Poluzzi, Ariola Koci, Paolo Caraceni, Fabrizio De Ponti, Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, I-40126 Bologna BO, Italy
| |
Collapse
|