Risk factors associated with the severity of adverse drug reactions by Xiyanping injection: A propensity score-matched analysis

Safety analysis of antineoplastic drugs for lung cancer: a retrospective analysis based on Shaanxi Province in Western China

BACKGROUND

China has the highest proportion of lung cancer-related deaths. Drug therapy is the main tool of comprehensive anticancer treatment. However, most studies to date have focused on certain types of targets or immunotherapeutic modalities for drug safety; few studies have addressed the factors that influence ADRs for each type of drug in patients with lung cancer, and even fewer studies have explored the risk factors for certain types of ADRs. Based on it, we comprehensively evaluate the drug safety of patients and provide a clinical reference with a focus on lung cancer.

RESEARCH DESIGN AND METHODS

We examined 767 reports of adverse drug reactions (ADRs) in patients with lung cancer and conducted a logistic regression analysis on the risk factors that may cause different types of organ system damage and serious ADRs.

RESULTS

The logistic regression identified various independent risk factors for system organ damage, and ADRs involving erythrocyte abnormalities (P < 0.001), respiratory system damage (P < 0.001), and leukocyte and reticuloendothelial system abnormalities (P < 0.001) were more likely to be severe.

CONCLUSIONS

Rare adverse reactions and different Clinical medication guidelines for molecular-targeted drugs were identified. These findings had certain practical significance in clinical safe drug use.

Magnetic Ti3C2 MXene Nanosheets Prepared for Enrichment of Phosphopeptides

MXenes have received lots of attention since discovered and have been applied in various fields. In this work, Ti₃C₂-Fe₃O₄ composites with exposed non-modified Ti₃C₂ MXene nanosheets were designed and prepared by an in situ growth strategy and then applied in the enrichment of phosphopeptides. The two-dimensional composites could interact with the phosphopeptides through a metal oxide affinity chromatography mechanism provided by Ti-O and Fe-O bonds and a hydrophilic interaction chromatography mechanism by surface hydroxyl groups. This magnetic nanomaterial with a specific surface area of 66.1 m²·g^-1 had high sensitivity to phosphopeptides (0.5 nmol·L^-1) and high selectivity (1:1000 of the molar ratio of β-casein to bovine serum albumin). Non-fat milk was adopted as a real sample to preliminarily examine the applicability of the Ti₃C₂-Fe₃O₄-based protocol. Subsequently, Qingkailing injection, a kind of traditional Chinese medicine injection, was introduced to further explore the suitability of the nanocomposites for phosphopeptide enrichment from more complex matrices and satisfactory results were obtained.

Variable importance for projection (VIP) scores for analyzing the contribution of risk factors in severe adverse events to Xiyanping injection

BACKGROUND

Age and herb-drug combination are risk factors for the severity of Xiyanping injection (XYP) associated adverse events (AEs).

OBJECTIVE

To analyze risk factors contributing to the severity of XYP's AEs using a variable importance for projection (VIP) method.

METHODS

AEs related to the use of XYP were extracted from the China National Adverse Drug Reaction Monitoring Information System (2004-2017) and classified as general or severe. Data were analyzed with respect to age and 12 herb-drug combinations, including ribavirin (RB), ceftriaxone, penicillin sodium, ambroxol hydrochloride (AH), clindamycin, cefoxitin sodium, azithromycin (AZM), ceftazidime, amoxicillin sodium/potassium clavulanate, levofloxacin hydrochloride, sodium cefazolin pentahydrate, and acyclovir according to VIP scores and correlation coefficient (Coeff).

RESULTS

A total of 21,714 AEs (general 20,660; severe 1054) related to XYP combinations were included. Using XYP alone tended to produce general AEs (All VIP = 3.124; 1.329; 1.857; 2.169; 2.400, Coeff < 0). For all set, 0-6 years old patients tend to have general AEs (VIP = 2.425, Coeff < 0), while those > 41 years old patients tend to have severe AEs (VIP = 1.180; 2.323, Coeff > 0). For 0-40 years old patients, XYP-RB combination had a greater impact on the severity of AEs (VIP = 1.158; 1.360; 1.147, Coeff > 0). For 7-17 years old patients, XYP-AZM combination tended to produce general AEs (VIP = 1.502, Coeff < 0). In individuals > 65 years old, XYP-AH combination tended to result in severe AEs (VIP = 1.232, Coeff > 0).

CONCLUSIONS

VIP method was expected to effectively analyze risk factors in affecting the severity of AEs and control AEs more effectively. Age is the key factor contributing to the severity of AEs, and there are different influence directions. It is recommended that clinicians pay closer attention to the metabolic characteristics of different age groups. It is safe to use XYP alone and strictly implementing standardized operations such as medication interval and flushing will avoid undesired AEs.

Clinical features of adverse events associated with Xiyanping-Ribavirin combination: A systematic review

ETHNOPHARMACOLOGICAL RELEVANCE

In China, Xiyanping (XYP) has been widely used in combination with Ribavirin (RB) for the treatment of infectious diseases. It has been found that this combination may change the severity of XYP-associated adverse events (AEs).

AIM

To provide a comprehensive review about the clinal features of AEs of XYP-RB combination from randomized controlled trials, cohort studies, case-control studies, case reports, case series, and data from the National Adverse Drug Reaction Monitoring Information System (NADRMIS).

MATERIALS AND METHODS

Seven electronic databases were searched in March 2021. Articles on AEs associated with XYP published from January 2004 to December 2020 in the NADRMIS were included. Data on the incidence of AEs, distribution of AEs, occurrence time of AEs, type and possible signal of AEs, primary diseases, allergic history, family history of allergies, dosage, and combination interval were extracted.

RESULTS

We included 228 cases of AEs with XYP-RB combination (63 cases from randomized controlled trials, 1 from a cohort study, and 164 from the NADRMIS). The most common primary disease was hand-foot-and-mouth disease. The main age distribution was 0-6 years (118 cases, 72%) and 8 cases (6.8%) experienced serious AEs. The combination group showed a significant reduction than the RB group in the incidence of AEs in those with hand-foot-and-mouth disease (risk ratio = 0.54, 95% confidence interval = 0.38-0.78, P = 0.0008) and children with viral pneumonia (risk ratio = 0.36, 95% confidence interval = 0.14-0.95, P = 0.04). Allergic history and infusion interval were not described in the randomized controlled trials. AEs were reported in 57.9% of cases in the first combination (XYP-RB were combined for the first time) (NADRMIS), 56.4% of which were skin and appendage reactions, and the risk signal of skin and appendage reactions was a maximum (Information Component = 6.21).

CONCLUSION

The major AE associated with XYP-RB combination was skin and appendage reactions. Most of the combination AEs were pseudo-allergic reactions. These findings suggest that we should increase awareness about the safety of XYP-RB combination treatment and standardize medication protocol, especially for children. Unless absolutely necessary, children should avoid combination therapy. More rigorous high-quality studies are needed to obtain more evidence.

Concomitant Medication Use With Xiyanping Injection and the Risk of Suspected Allergic Reactions: A Nested Case–Control Study Based on China’s National Medical Insurance Database

Introduction: Xiyanping injection (XYP), a type of Traditional Chinese Medicine, is widely used and often applied in combination with other medications in treating bronchitis, tonsillitis, and bacillary dysentery in China. In recent years, an elevated risk of allergic reactions has been observed following XYP, but whether concomitant medication use contributes to this risk is still unknown.

Objective: This study aims to investigate the association between the concomitant use of XYP and the 25 most frequently co-applied medications with suspected allergic reactions for China’s patients receiving XYP.

Methods: A nested case–control study was conducted using the sampling data from 2015 China’s Urban Employees Basic Medical Insurance and Urban Residents Basic Medical Insurance database. Four anti-allergic marker drugs were used to evaluate suspected allergic reactions. Univariate analyses and multivariable conditional logistic regression were conducted, and results were reported as odds ratios (ORs) with a 95% confidence interval (CI). Sensitivity analyses were performed on the expanded sample by including those prescribed with anti-allergic marker drugs on the same day as XYP and then stopped XYP on the next day.

Results: Out of 57,612 participants with XYP prescription, we obtained 949 matched case–control pairs. Multivariable conditional logistic regression revealed that seven concomitant medications including gentamicin [OR = 4.29; 95% CI (2.52, 7.30)], cefoperazone-sulbactam [OR = 4.26; 95% CI (1.40, 13.01)], lidocaine [OR = 2.76; 95% CI (1.79, 4.25)], aminophylline [OR = 1.73; 95% CI (1.05, 2.85)], ribavirin [OR = 1.54; 95% CI (1.13, 2.10)], potassium chloride [OR = 1.45; 95% CI (1.10, 1.91)], and vitamin C [OR = 1.32; 95% CI (1.03, 1.70)] were associated with increased risk, while cefathiamidine [OR = 0.29; 95% CI (0.16, 0.51)] was associated with reduced risk. Sensitivity analysis on 2,438 matched pairs revealed similar findings.

Conclusion: Increased risks for suspected allergic reactions were found for the concomitant use of XYP with seven medications. Our data suggest that gentamicin, cefoperazone-sulbactam, lidocaine, and ribavirin should be applied with precautions for patients receiving XYP, and further studies on drug interactions and allergy mechanisms are warranted.

Correlation analysis of physicochemical properties with anti-inflammatory activity of Andrographis paniculata (Burm.f.) Nees based on HPLC-DAD, colorimeter and multivariate statistics: A comprehensive quality evaluation strategy

Andrographis paniculata (Burm.f.) Nees is an essential traditional herbal medicine with various bioactivities in Asian countries. The quality of herbal medicines directly affects its clinical efficacy, so a comprehensive strategy, including color assay, chemical profiles, quantitative analysis, and anti-inflammatory activity assay, is constructed to evaluate the quality of A. paniculata in this paper. Here, 16 batches of commercial A. paniculata were collected, and there were noticeable differences in appearance, chemical compounds, and bioactivity among batches. Principal component analysis (PCA) indicated the color and diterpenoid lactones could be used to classify A. paniculat. And then, correlation analysis found the batches with greener color have higher contents of diterpenoid lactones and more efficient anti-inflammatory activity. Based on the results above, the partial least squares (PLS) regression models were finally established to predict the contents of diterpenoid lactones using the color assay data. All diterpenoid lactones models showed good performance, especially neoandrographolide. Notably, PLS regression models were first used for the nondestructive quantitative analysis of A. paniculata. This comprehensive quality evaluation strategy can theoretically elucidate the relationship between good appearance, high contents of diterpenoid lactones, and superior bioactivity of A. paniculata, which is meaningful for its quality control and evaluation. It also laid a theoretical basis for appearance and bioactivity evaluations of high-quality traditional herbal medicine.

Chinese herbal injections for coronavirus disease 2019 (COVID-19): A narrative review

Background

The outbreak of Coronavirus disease 2019 (COVID-19) has caused more than 180 million infections and 3.9 million deaths. To date, emerging clinical evidence has shown the synergetic benefits of Chinese herbal injections in treating this contagious respiratory disease. This review aims to summarize and analyze the efficacy and safety of Chinese herbal injections in the therapy of COVID-19.

Methods

The literature from 3 electronic databases, PubMed, CNKI, and Web of Science, were searched using the search terms “COVID-19”, “SARS-CoV-2”, “traditional Chinese medicine”, “herb”, “herbal”, and “injection”. Then the identified articles were comprehensively evaluated.

Results

Limited data demonstrated that Chinese herbal injections could significantly improve the clinical outcomes of COVID-19 patients, especially in combination with conventional treatment strategies. The benefits of which were mainly associated with the relief of symptoms, prevention of secondary infection, regulation of inflammation and immune function. There was also evidence showing the inhibitory effects on SARS-CoV-2 replication in vitro. Nevertheless, available real-world data suggested the increased risk of adverse event. Furthermore, the defects of existing researches and the insights for discovering novel antiviral drugs were prospectively discussed.

Conclusion

Evidence-based advances revealed that Chinese herbal injections such as XueBiJing injection and ShenMai injection, exerted potent effects against COVID-19. Further laboratory researches and clinical evaluation are needed to gather scientific evidence on the efficacy and safety.

Analysis of Traditional Chinese Medicine Diagnosis and Treatment Strategies for COVID-19 Based on "The Diagnosis and Treatment Program for Coronavirus Disease-2019" from Chinese Authority

In December 2019, coronavirus disease-2019 (COVID-19) broke out in Wuhan and other places. Seven versions of the Diagnosis and Treatment Program for Coronavirus Disease-2019 successively issued by the Chinese government have designated traditional Chinese medicine (TCM) as a necessary medical strategy. Based on the changes in TCM diagnosis and treatment strategies in these seven versions of Diagnosis and Treatment Program for Coronavirus Disease-2019, this paper collected data reported by the Chinese government media; analyzed the understanding of the etiology, pathogenesis, syndrome differentiation, treatment methods, and prescriptions of COVID-19 by TCM and evaluated the clinical efficacy of TCM strategies. COVID-19 is associated with TCM disease of pestilence, and its pathogenesis can be summarized as an "epidemic pathogen invading the body, followed by entering the internal organs and transforming into heat, resulting in pathogen trapping in the interior and healthy qi collapsing, and deficiency of qi and yin". Pathological processes should be emphasized in syndrome differentiation. The manifestations of qi deficiency and yin deficiency are exhibited during the recovery period. TCM strategies represented by Qing Fei Pai Du Tang have shown apparent advantages in improving symptoms, promoting virus clearance, and shortening hospitalization, as well as surprising efficacy of zero patient progressing from mild to severe cases in a TCM cabin hospital. Clinical data illustrate the effectiveness of TCM strategies proposed by the Chinese government. This major epidemic may bring new opportunities for TCM development.