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Werz O, Stettler H, Theurer C, Seibel J. The 125th Anniversary of Aspirin-The Story Continues. Pharmaceuticals (Basel) 2024; 17:437. [PMID: 38675399 PMCID: PMC11054228 DOI: 10.3390/ph17040437] [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: 02/27/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The year 2024 marks the 125th anniversary of aspirin, still one of the most frequently used drugs worldwide. Despite its veritable age, it is still relevant in pharmacotherapy and its use has spread to new areas over time. Due to aspirin's multiple pharmacological actions unified in one single molecule (i.e., analgesic, antipyretic, anti-inflammatory, antithrombotic, and antiviral effects), it continues to attract considerable attention in the scientific community and is subject to intense basic and clinical research. In fact, recent results confirmed aspirin's potential role as an antiviral drug and as an agent that can block harmful platelet functions in inflammatory/immunological processes. These features may open up new horizons for this ancient drug. The future of aspirin looks, therefore, bright and promising. Aspirin is not yet ready for retirement; on the contrary, its success story continues. This 125th anniversary paper will concisely review the various therapeutic uses of aspirin with a particular emphasis on the latest research results and their implications (e.g., use as an antiviral agent). In addition, the reader is provided with future perspectives for this remarkable drug.
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Affiliation(s)
- Oliver Werz
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich Schiller University Jena, 07743 Jena, Germany;
| | - Hans Stettler
- Bayer Consumer Care AG, Peter Merian-Strasse 84, 4002 Basel, Switzerland;
| | - Christoph Theurer
- Bayer Vital GmbH, Kaiser-Wilhelm-Allee 70, 51373 Leverkusen, Germany;
| | - Jens Seibel
- Bayer Vital GmbH, Kaiser-Wilhelm-Allee 70, 51373 Leverkusen, Germany;
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Hayward CJ, Batty JA, Westhead DR, Johnson O, Gale CP, Wu J, Hall M. Disease trajectories following myocardial infarction: insights from process mining of 145 million hospitalisation episodes. EBioMedicine 2023; 96:104792. [PMID: 37741008 PMCID: PMC10520333 DOI: 10.1016/j.ebiom.2023.104792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Knowledge of post-myocardial infarction (MI) disease risk to date is limited-yet the number of survivors of MI has increased dramatically in recent decades. We investigated temporally ordered sequences of all conditions following MI in nationwide electronic health record data through the application of process mining. METHODS We conducted a national retrospective cohort study of all hospitalisations (145,670,448 episodes; 34,083,204 individuals) admitted to NHS hospitals in England (1st January 2008-31st January 2017, final follow-up 27th March 2017). Through process mining, we identified trajectories of all major disease diagnoses following MI and compared their relative risk (RR) and all-cause mortality hazard ratios (HR) to a risk-set matched non-MI control cohort using Cox proportional hazards and flexible parametric survival models. FINDINGS Among a total of 375,669 MI patients (130,758 females; 34.8%) and 1,878,345 matched non-MI patients (653,790 females; 34.8%), we identified 28,799 unique disease trajectories. The accrual of multiple circulatory diagnoses was more common amongst MI patients (RR 4.32, 95% CI 3.96-4.72) and conferred an increased risk of death (HR 1.32, 1.13-1.53) compared with matched controls. Trajectories featuring neuro-psychiatric diagnoses (including anxiety and depression) following circulatory disorders were markedly more common and had increased mortality post MI (HR ranging from 1.11 to 1.73) compared with non-MI individuals. INTERPRETATION These results provide an opportunity for early intervention targets for survivors of MI-such as increased focus on the psychological and behavioural pathways-to mitigate ongoing adverse disease trajectories, multimorbidity, and premature mortality. FUNDING British Heart Foundation; Alan Turing Institute.
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Affiliation(s)
- Christopher J Hayward
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - Jonathan A Batty
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK
| | - David R Westhead
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; School of Molecular and Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Owen Johnson
- School of Computing, Faculty of Engineering and Physical Sciences, University of Leeds, LS2 9JT, UK
| | - Chris P Gale
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, E1 4NS, UK
| | - Marlous Hall
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9JT, UK.
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Rojas-Aguilar FA, Briones-Aranda A, Jaramillo-Morales OA, Romero-Nava R, Esquinca-Avilés HA, Espinosa-Juárez JV. The Additive Antinociceptive Effect of Resveratrol and Ketorolac in the Formalin Test in Mice. Pharmaceuticals (Basel) 2023; 16:1078. [PMID: 37630993 PMCID: PMC10460057 DOI: 10.3390/ph16081078] [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: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Pain represents one of the leading causes of suffering and disability worldwide. Currently available drugs cannot treat all types of pain and may have adverse effects. Hence, the use of pharmacological combinations is an alternative treatment strategy. Therefore, this study aimed to evaluate the combination of resveratrol and ketorolac through isobolographic analysis. CD1 mice were used to study the antinociceptive effect of this combination using the formalin test and the study was divided into two phases. In the first phase, four individual doses of each drug were evaluated, totaling eight testing groups. From these data, the median effective doses (ED50) of each drug were calculated. In the second phase, four testing groups were used to evaluate the combination of sub-doses of both drugs and obtain the experimental ED50. To evaluate gastric damage, five groups were employed, including indomethacin, vehicle, resveratrol, ketorolac, and combined resveratrol and ketorolac groups. Stomach samples from the mice were taken after 5 h of treatment, and the area of the ulcers was determined. Resveratrol plus ketorolac elicited a reduction in nociceptive behavior during both phases of the formalin test, and isobologram analysis revealed that the theoretical and experimental ED50 values of resveratrol and ketorolac did not differ significantly, implying an additive interaction between the drugs. Additionally, the drug combination did not generate gastric ulcers, thus enhancing the desired effects without increasing the adverse effects. Consequently, these findings substantiate the efficacy of the resveratrol and ketorolac combination in the formalin test, thereby highlighting its potential as a viable alternative for alleviating pain.
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Affiliation(s)
- Fidencio Abner Rojas-Aguilar
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de Mexico 11340, Mexico; (F.A.R.-A.); (R.R.-N.)
| | - Alfredo Briones-Aranda
- Laboratorio de Farmacología, Facultad de Medicina Humana, Universidad Autónoma de Chiapas, Tuxtla Gutiérrez 29050, Chiapas, Mexico;
| | - Osmar Antonio Jaramillo-Morales
- División de Ciencias de la Vida, Departamento de Enfermería y Obstetricia, Campus Irapuato-Salamanca, Universidad de Guanajuato, Irapuato 36500, Guanajuato, Mexico;
| | - Rodrigo Romero-Nava
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de Mexico 11340, Mexico; (F.A.R.-A.); (R.R.-N.)
| | | | - Josué Vidal Espinosa-Juárez
- Escuela de Ciencias Químicas, Universidad Autónoma de Chiapas, Ocozocoautla de Espinosa 29140, Chiapas, Mexico;
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Leporini C, De Sarro C, Palleria C, Caccavo I, Piro B, Citraro R, De Sarro G. Pediatric Drug Safety Surveillance: A 10-Year Analysis of Adverse Drug Reaction Reporting Data in Calabria, Southern Italy. Drug Saf 2022; 45:1381-1402. [PMID: 36112324 PMCID: PMC9483327 DOI: 10.1007/s40264-022-01232-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 01/09/2023]
Abstract
Introduction The paucity of pediatric clinical trials has led to many medicines frequently prescribed to children without a license for use in pediatrics, resulting in an increased risk of adverse drug reactions. Pharmacovigilance databases remain, among others, a valuable tool for evaluating pediatric drug safety in the real-life setting. Objective We aimed to characterize pediatric adverse drug reactions reported in the Italian Pharmacovigilance database coming from the Calabria region (Southern Italy) over 10 years. Methods All Individual Case Safety Reports (ICSRs) concerning individuals aged under 18 years were extracted from 2010 to 2019. Duplicate and vaccine ICSRs were excluded. The remaining ICSRs were analyzed with respect to patients’ demographic data, suspected drugs, and category of adverse drug reactions across different age groups. Results Among 6529 selected ICSRs, 395 pediatric ICSRs corresponding to 556 adverse drug reactions were analyzed. From 2010 to 2015, an increasing number of ICSRs were observed, but the reporting rate decreased after 2015. The highest proportion of ICSRs concerned children and adolescents. Around 52% of ICSRs involved boys: a trend observed in all age groups excluding newborns. Sixty ICSRs were serious and among them, 75% required hospitalization mainly in children and adolescents. Most of the ICSRs were issued by physicians (64.1%), followed by other healthcare professionals (22.5%) and pharmacists (9.9%). Anti-infective agents for systemic use and skin disorders were, respectively, the most frequently reported drug group and adverse drug reaction category. Conclusions This study provides an overview of adverse drug reactions reported in the pediatric population of the Calabria region and emphasizes the need for strengthening the surveillance in specific age subgroups and on given drugs in relation to their pattern of use. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01232-w.
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Rossi C, Ruggiero R, Sportiello L, Pentella C, Gaio M, Pinto A, Rafaniello C. Did the COVID-19 Pandemic Affect Contrast Media-Induced Adverse Drug Reaction’s Reporting? A Pharmacovigilance Study in Southern Italy. J Clin Med 2022; 11:jcm11175104. [PMID: 36079034 PMCID: PMC9457281 DOI: 10.3390/jcm11175104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Medical imaging is required for a complete clinical evaluation to identify lung involvement or pulmonary embolism during SARS-CoV-2 infection or pulmonary and cardiovascular sequelae. Contrast media (CM) have undoubtedly been useful in clinical practice due to their ability to improve medical imaging in COVID-19 patients. Considering their important use, especially in hospitalized COVID-19 patients, and that increased use of a medical tool could also be associated with its deeper knowledge, we chose to explore if new information emerged regarding CM safety profiles. We analyzed all Individual Case Safety Reports (ICSRs) validated by Campania Pharmacovigilance Regional Centre from 1 January 2018 to 31 December 2021 and reported a CM (ATC code V08) as a suspected drug. We compared CM-related reporting between 2 years before (period 1) and 2 years during (period 2) the COVID-19 pandemic. From our analysis, it emerged that, during the COVID-19 pandemic, CM-related ADR reporting decreased, but a significant increase in reporting of serious cases emerged. Serious ADRs were mainly related to iodinated CM (V08A ATC) compared to magnetic resonance imaging CM (V08C ATC). Cutaneous and respiratory disorders were the most frequently reported in both periods. No new or unknown ADRs were reported in the overall study period.
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Affiliation(s)
- Claudia Rossi
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Rosanna Ruggiero
- Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
- Correspondence:
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
| | - Ciro Pentella
- Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
| | - Mario Gaio
- Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
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Kuczyńska J, Nieradko-Iwanicka B. The effect of ketoprofen lysine salt on mucosa of rat stomach after ethyl alcohol intoxication. Biomed Pharmacother 2021; 141:111938. [PMID: 34328086 DOI: 10.1016/j.biopha.2021.111938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Ketoprofen is a commonly used nonsteroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. Side effects of ketoprofen occur mainly from the gastrointestinal tract due to the inhibition of cyclooxygenaze-1. Binge drinking at least once a week is reported by 80 million Europeans. On the day after many of them use NSAIDs. This increases the risk for damage of gastric mucosa. AIM The aim of the study was to check if use of ketoprofen lysine salt (KLS) has any gastroprotective effect on mucosa of rat stomach after ethyl alcohol intoxication. MATERIALS AND METHODS There were 6 groups of 6 male rats which received: RESULTS: In groups 1, 2 and 3 the histopathologic examination of the stomachs revealed normal picture, without signs of inflammation. In the group 4, 5 and 6 within the mucosa and submucosa there were visible numerous infiltrates of inflammatory cells, consisting mainly of lymphocytes, plasmocytes and eosinophilia. Total leukocyte count was elevated in group 3, 4, 6. There was a significant decrease of blood urea concentration in group 6 vs 2 and significant decrease of serum albumin in group 6 vs 1 and 2, and total protein vs group 1. CONCLUSION Side effects of ketoprofen occur mainly from the gastrointestinal tract. KLS has no gastroprotective effect after ethanol-gastric injury and does not protect gastric mucosa from damage produced by binge drinking. Therefore it should not be used after drinking distilled spirits.
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Affiliation(s)
- Joanna Kuczyńska
- Chair and Department of Hygiene, Medical University of Lublin, Radziwillowska 11 Street, 20-080 Lublin, Poland; Doctoral School, Medical University of Lublin, Poland.
| | - Barbara Nieradko-Iwanicka
- Chair and Department of Hygiene, Medical University of Lublin, Radziwillowska 11 Street, 20-080 Lublin, Poland.
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Zhao C, Wang J, Xiao Q. Efficacy of Teprenone for Prevention of NSAID-Induced Gastrointestinal Injury: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:647494. [PMID: 33898483 PMCID: PMC8058206 DOI: 10.3389/fmed.2021.647494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The study aimed to conduct a systematic review and meta-analysis comparing the efficacy of teprenone with control or other drugs for reducing the incidence of gastrointestinal (GI) adverse events in patients receiving long-term non-steroidal anti-inflammatory drugs (NSAIDs). Methods: Databases of PubMed, Embase, BioMed Central, CENTRAL, and Google Scholar were searched up to November 10th, 2020 for randomized controlled trials (RCTs) comparing teprenone with control or other drugs. A random-effects model was used for the meta-analysis. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used for assessing the certainty of evidence. Results: Seven RCTs were included. Six compared teprenone with control and one with famotidine. Meta-analysis indicated a statistically significant reduced risk of GI ulcers in patients receiving teprenone as compared to control after 12 weeks/3months (RR 0.37 95% CI 0.17, 0.18 I 2 = 0% p = 0.01). Pooled data of three open-label studies indicated statistically significant reduction of GI symptoms in patients on teprenone as compared to control at 6 months and 12 months, but not at 3 months. Comparing teprenone with control, our analysis indicated non-significant but a tendency of better reduction in Modified Lanza Score (MLS) with teprenone. The RCT comparing teprenone to famotidine demonstrated better reduction of MLS with famotidine. The certainty of evidence-based on GRADE was deemed to be low. Conclusion: Low-quality evidence indicates a beneficial role of teprenone in preventing GI injuries in patients receiving long-term NSAIDs. Further high-quality RCTs comparing teprenone with placebo as well as other gastroprotective drugs are needed to strengthen current evidence.
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Affiliation(s)
- Chongxiang Zhao
- Department of Gastroenterology, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
| | - Jingwu Wang
- Department of Gastroenterology, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
| | - Qiang Xiao
- Department of Gastroenterology, Zaozhuang Hospital of Traditional Chinese Medicine, Zaozhuang, China
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Ghasemkhani N, Tabrizi AS, Namazi F, Nazifi S. Treatment effects of Shilajit on aspirin-induced gastric lesions in rats. Physiol Rep 2021; 9:e14822. [PMID: 33818003 PMCID: PMC8020045 DOI: 10.14814/phy2.14822] [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] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
The present study investigated the effects of Shilajit extract on aspirin-induced gastric lesions in rats. We evaluated macroscopic and histopathological lesions in the stomach, measured the activity of oxidative stress enzymes in gastric tissue homogenates, and assessed serum electrolytes and parameters of kidney and liver function. Forty-five male rats were allocated to five groups: Normal control, positive control, omeprazole treatment, Shilajit treatment, and Shilajit control. The treatment period lasted for four consecutive days. The size and number of gastric lesions were significantly reduced in the Shilajit and omeprazole groups compared to the positive control group, indicating a reduction in mucosal damage and the severity of edema and leukocyte infiltration in tissue sections. A significant increase was observed in the levels of all oxidative stress parameters, except malondialdehyde, in rats treated with Shilajit and omeprazole compared to those in the positive control group. The effect of the aqueous extract of Shilajit was comparable to that of omeprazole. These results indicated the protective effects of Shilajit against aspirin-induced gastric lesions.
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Affiliation(s)
- Naghmeh Ghasemkhani
- Department of Clinical Studies, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Aidin Shojaee Tabrizi
- Department of Clinical Studies, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Fatemeh Namazi
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Saeed Nazifi
- Department of Clinical Studies, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review. Pharmaceuticals (Basel) 2021; 14:ph14030219. [PMID: 33807930 PMCID: PMC7998670 DOI: 10.3390/ph14030219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative joint disease. The aim of this review was to present the general characteristics of orally administered nonsteroidal anti-inflammatory drugs (NSAIDs) and to present the efficacy of NSAIDs in the treatment of TMJ OA. Methods: PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((disorders) OR (osteoarthritis) AND (treatment)) AND (nonsteroidal anti-inflammatory drug)". After screening of 180 results, 6 studies have been included in this narrative review. Results and Conclusions: Nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs for alleviation of pain localized in the orofacial area. The majority of articles predominantly examined and described diclofenac sodium in the treatment of pain in the course of TMJ OA. Because of the limited number of randomized studies evaluating the efficacy of NSAIDs in the treatment of TMJ OA, as well as high heterogeneity of published researches, it seems impossible to draw up unequivocal recommendations for the usage of NSAIDs in the treatment of TMJ OA. However, it is highly recommended to use the lowest effective dose of NSAIDs for the shortest possible time. Moreover, in patients with increased risk of gastrointestinal complications, supplementary gastroprotective agents should be prescribed.
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Abstract
Severe Acute Respiratory Syndrome-Coronavirus-2 is responsible for the current pandemic that has led to more than 10 million confirmed cases of Coronavirus Disease-19 (COVID-19) and over 500,000 deaths worldwide (4 July 2020). Virus-mediated injury to multiple organs, mainly the respiratory tract, activation of immune response with the release of pro-inflammatory cytokines, and overactivation of the coagulation cascade and platelet aggregation leading to micro- and macrovascular thrombosis are the main pathological features of COVID-19. Empirical multidrug therapeutic approaches to treat COVID-19 are currently used with extremely uncertain outcomes, and many others are being tested in clinical trials. Acetylsalicylic acid (ASA) has both anti-inflammatory and antithrombotic effects. In addition, a significant ASA-mediated antiviral activity against DNA and RNA viruses, including different human coronaviruses, has been documented. The use of ASA in patients with different types of infections has been associated with reduced thrombo-inflammation and lower rates of clinical complications and in-hospital mortality. However, safety issues related both to the risk of bleeding and to that of developing rare but serious liver and brain damage mostly among children (i.e., Reye's syndrome) should be considered. Hence, whether ASA might be a safe and reasonable therapeutic candidate to be tested in clinical trials involving adults with COVID-19 deserves further attention. In this review we provide a critical appraisal of current evidence on the anti-inflammatory, antithrombotic, and antiviral effects of ASA, from both a pre-clinical and a clinical perspective. In addition, the potential benefits and risks of use of ASA have been put in the context of the adult-restricted COVID-19 population.
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Bentley-Hewitt KL, Perrott M, Butts CA, Hedderley DI, Stoklosinski HM, Parkar SG. Influence of kiwifruit on gastric and duodenal inflammation-related gene expression in aspirin-induced gastric mucosal damage in rats. Sci Rep 2020; 10:13055. [PMID: 32747727 PMCID: PMC7400567 DOI: 10.1038/s41598-020-70006-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
Kiwifruit (KF) contains bioactive compounds with potential anti-inflammatory properties. In this study, we investigated the protective effects of KF on gastric and duodenal damage induced by soluble aspirin in healthy rats. Sixty-four male Sprague Dawley rats were allocated to eight experimental treatments (n = 8) and the experimental diets were fed for 14 days ad libitum. The experimental diets were 20% fresh pureed KF (green-fleshed and gold-fleshed) or 10% glucose solution (control diet). A positive anti-inflammatory control treatment (ranitidine) was included. At the end of the 14-day feeding period, the rats were fasted overnight, and the following morning soluble aspirin (400 mg/kg aspirin) or water (control) was administered by oral gavage. Four hours after aspirin administration, the rats were euthanized and samples taken for analysis. We observed no significant ulcer formation or increase in infiltration of the gastric mucosal inflammatory cells in the rats with the aspirin treatment. Despite this, there were significant changes in gene expression, such as in the duodenum of aspirin-treated rats fed green KF where there was increased expression of inflammation-related genes NOS2 and TNF-alpha. We also observed that gold and green KF diets had a number of contrasting effects on genes related to inflammation and gastro-protective effects.
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Affiliation(s)
- Kerry L Bentley-Hewitt
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand.
| | - Matthew Perrott
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Christine A Butts
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
| | - Duncan I Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
| | - Halina M Stoklosinski
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
| | - Shanthi G Parkar
- The New Zealand Institute for Plant and Food Research Limited, Private Bag 11600, Palmerston North, 4442, New Zealand
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Capuano A, Scavone C, Racagni G, Scaglione F. NSAIDs in patients with viral infections, including Covid-19: Victims or perpetrators? Pharmacol Res 2020; 157:104849. [PMID: 32360482 PMCID: PMC7189871 DOI: 10.1016/j.phrs.2020.104849] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022]
Abstract
Taking anti-inflammatory drugs, including non-steroidal (NSAIDs), during Covid-19 infection, how much is risky? The French Minister of Health, who has raised an alarm on a possible risk deriving from the use of ibuprofen for the control of fever and other symptoms during the disease, opened the debate a few days ago. In this paper we examine available evidence from preclinical and clinical studies that had analysed the role of COX in the inflammatory process and the effects of NSAIDs in patients with infections. Most of the published studies that suggested not protective effects of NSAIDs were mainly performed in vitro or on animals. Therefore, their meaning in humans is to be considered with great caution. Based also on data suggesting protective effects of NSAIDs, we concluded that currently there is no evidence suggesting a correlation between NSAIDs and a worsening of infections. Further studies will be certainly needed to better define the role of NSAIDs and particularly COX2 inhibitors in patients with infections. In the meantime, we must wait for results of the revision started by the PRAC on May 2019 on the association ibuprofen/ketoprofen and worsening of infections. Since nowadays no scientific evidence establishes a correlation between NSAIDS and worsening of COVID-19, patients should be advice against any NSAIDs self-medication when COVID-19 like symptoms are present.
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Affiliation(s)
- Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy.
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Clinical Pharmacology Unit, ASST-GOM Niguarda Hospital, Milan, Italy
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13
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Sales TA, Marcussi S, Ramalho TC. Current Anti-Inflammatory Therapies and the Potential of Secretory Phospholipase A2 Inhibitors in the Design of New Anti-Inflammatory Drugs: A Review of 2012 - 2018. Curr Med Chem 2020; 27:477-497. [PMID: 30706775 DOI: 10.2174/0929867326666190201120646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 11/12/2018] [Accepted: 12/11/2018] [Indexed: 01/30/2023]
Abstract
The inflammatory process is a natural self-defense response of the organism to damage agents and its action mechanism involves a series of complex reactions. However, in some cases, this process can become chronic, causing much harm to the body. Therefore, over the years, many anti-inflammatory drugs have been developed aiming to decrease the concentrations of inflammatory mediators in the organism, which is a way of controlling these abnormal chain reactions. The main target of conventional anti-inflammatory drugs is the cyclooxygenase (COX) enzyme, but its use implies several side effects. Thus, based on these limitations, many studies have been performed, aiming to create new drugs, with new action mechanisms. In this sense, the phospholipase A2 (PLA2) enzymes stand out. Among all the existing isoforms, secretory PLA2 is the major target for inhibitor development, since many studies have proven that this enzyme participates in various inflammatory conditions, such as cancer, Alzheimer and arthritis. Finally, for the purpose of developing anti-inflammatory drugs that are sPLA2 inhibitors, many molecules have been designed. Accordingly, this work presents an overview of inflammatory processes and mediators, the current available anti-inflammatory drugs, and it briefly covers the PLA2 enzymes, as well as the diverse structural array of the newest sPLA2 inhibitors as a possible target for the production of new anti-inflammatory drugs.
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Affiliation(s)
- Thais A Sales
- Molecular Modeling Laboratory, Chemistry Department, Federal University of Lavras, 37200-000 Lavras, Brazil
| | - Silvana Marcussi
- Biochemistry Laboratory, Chemistry Department, Federal University of Lavras, 37200-000 Lavras, Brazil
| | - Teodorico C Ramalho
- Molecular Modeling Laboratory, Chemistry Department, Federal University of Lavras, 37200-000 Lavras, Brazil.,Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, 62, 50003 Rokitanskeho, Czech Republic
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14
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Eslamian L, Torshabi M, Motamedian SR, Hemmati YB, Mortazavi SA. The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study. Dental Press J Orthod 2020; 24:27e1-27e7. [PMID: 31994643 PMCID: PMC6986181 DOI: 10.1590/2177-6709.24.6.27.e1-7.onl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/07/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF). Methods: In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied. Results: A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours. Conclusion: In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.
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Affiliation(s)
- Ladan Eslamian
- Shahid Beheshti University of Medical Sciences, Dentofacial Deformities Research Center, Department of Orthodontics, School of Dentistry (Tehran, Iran)
| | - Maryam Torshabi
- Shahid Beheshti University of Medical Sciences, Dental Biomaterials Department, School of Dentistry (Tehran, Iran)
| | - Saeed Reza Motamedian
- Shahid Beheshti University of Medical Sciences, Dentofacial Deformities Research Center, Department of Orthodontics, School of Dentistry (Tehran, Iran)
| | - Yasamin Babaee Hemmati
- Guilan University of Medical Sciences, Dental Sciences Research Center, Department of Orthodontics, School of Dentistry (Rasht, Iran)
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15
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Varrassi G, Pergolizzi JV, Dowling P, Paladini A. Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review. Adv Ther 2020; 37:61-82. [PMID: 31705437 DOI: 10.1007/s12325-019-01144-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 02/06/2023]
Abstract
Ibuprofen first came to market about 50 years ago and rapidly moved to over-the-counter (OTC) sales. In April 2019, the National Agency for the Safety of Medicines and Health Products (ANSM) of France issued a warning for NSAID uses by patients with infectious diseases based on an analysis of 20 years of real-world safety data on ibuprofen and ketoprofen. Nevertheless, ibuprofen remains a mainstay in the analgesic armamentarium and with numerous randomized clinical trials, head-to-head studies, and decades of clinical experience. The authors offer a review of the safety of ibuprofen and how it may differ from other NSAIDs. Ibuprofen is associated with certain well-known gastrointestinal adverse effects that are related to dose and patient population. Among nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen has a comparatively low risk of cardiovascular adverse effects. It has been associated with renal and hepatic adverse effects, which appear to depend on dose, concomitant medications, and patient population. The association of ibuprofen with infections is more complex in that it confers risk in some situations but benefits in others, the latter in cystic fibrosis. Emerging interest in the literature is providing evidence of the role of ibuprofen as a possible endocrine disrupter as well as its potential antiproliferative effects for cancer cells. Taken altogether, ibuprofen has a favorable safety profile and is an effective analgesic for many acute and chronic pain conditions, although it-like other NSAIDs-is not without risk. After 50 years, evidence is still emerging about ibuprofen and its unique safety profile among NSAIDs. FUNDING: The Rapid Service Fee was funded by Abbott Established Pharmaceuticals Division (EPD).
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Affiliation(s)
- Giustino Varrassi
- Paolo Procacci Foundation, Via Tacito 7, 00193, Rome, Italy.
- World Institute of Pain, Winston-Salem, USA.
| | | | - Pascal Dowling
- Abbott Product Operations AG, Allschwil, EPD Headquarters, Hegenheimermattweg 127, 4123, Allschwil, Switzerland
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16
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Affiliation(s)
- Emma Sverdén
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden
| | - Lars Agréus
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- The University of Newcastle, Australia
| | - Jason M Dunn
- School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK
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17
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Mascolo A, Ruggiero R, Sessa M, Scavone C, Sportiello L, Rafaniello C, Rossi F, Capuano A. Preventable Cases of Oral Anticoagulant-Induced Bleeding: Data From the Spontaneous Reporting System. Front Pharmacol 2019; 10:425. [PMID: 31114497 PMCID: PMC6503045 DOI: 10.3389/fphar.2019.00425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022] Open
Abstract
Background Despite the risk of bleeding is a well-known adverse effect of oral anticoagulants, there is scarce evidence on the preventability of oral anticoagulant-induced bleedings. Therefore, we investigated the potential risk factors related to preventable cases of oral anticoagulant-induced bleedings. Methods We performed a study using Individual Case Safety Reports (ICSRs) with an oral anticoagulant as suspected drug among those reported through the spontaneous reporting system of Campania Region from 1 July 2012 to 31 December 2017. The P-method was used for the preventability assessment of all cases of bleeding. Results In total, 58 cases out of 253 (22.9%) were preventable, and the most reported suspected drug was an indirect oral anticoagulant (warfarin). Sixty-eight critical criteria for preventability were identified, all related to healthcare professionals' practices. The most detected risk factor related to healthcare professionals' practices was the labeled drug-drug interaction for both direct and indirect oral anticoagulants. Conclusion Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription.
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Affiliation(s)
- Annamaria Mascolo
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosanna Ruggiero
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Sessa
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Concetta Rafaniello
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Rossi
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
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18
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Hunt R, B Lazebnik L, C Marakhouski Y, Manuc M, Gn R, S Aye K, S Bordin D, V Bakulina N, S Iskakov B, A Khamraev A, M Stepanov Y, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol 2019; 8:148-160. [PMID: 30828557 PMCID: PMC6395481 DOI: 10.5005/jp-journals-10018-1281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations. Methods A modified ‘Delphi’ process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists. Results The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events. Conclusion/clinical significance These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients. How to cite this article: Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160.
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Affiliation(s)
- Richard Hunt
- Department of Medicine, McMaster University Health Science Centre, Hamilton, Ontario, Canada
| | - Leonid B Lazebnik
- Hospital Therapy, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Yury C Marakhouski
- Department of Gastroenterology and Nutrition, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Mircea Manuc
- Clinic of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ramesh Gn
- Centre of Excellence in Gastroenterology and Integrated Liver Care Aster Medi City, Cochin, Kerala, India
| | - Khin S Aye
- Department of Gastroenterology, University of Medicine, Yangon, Yangon Region, Myanmar
| | - Dmitry S Bordin
- Department of Pancreatic, Biliary tract and Upper GI disease, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - Natalia V Bakulina
- Department of Therapy and Clinical Pharmacology, North-Western State Medical University, Sankt-Peterburg, Russian Federation
| | - Baurzhan S Iskakov
- Department of Healthcare, Almaty Health Authority, Almaty, Almaty Province, Kazakhstan
| | - Abror A Khamraev
- Department of Gatroenterology, Tashkent Medical Academy, Tashkent, Tashkent Province, Uzbekistan
| | - Yurii M Stepanov
- Institute of Gastroenterology of National Academy of Medical Sciences of Ukraine, Dnipropetrovsk Dnipropetrovsk Oblast, Ukraine
| | - Reidwaan Ally
- Department of Gastroenterolgy, Wits University, Johannesburg, Gauteng, South Africa
| | - Amit Garg
- Department of Emerging Markets, Dr Reddy's Laboratories Ltd, Hyderabad, Andhra Pradesh, India
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Ibuprofen, a Potential Cause of Acute Hemorrhagic Gastritis in Children - A Case Report. ACTA ACUST UNITED AC 2018; 4:143-146. [PMID: 30574567 PMCID: PMC6296277 DOI: 10.2478/jccm-2018-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
Abstract
Introduction Upper gastrointestinal bleeding is an uncommon but possible life-threatening entity in children, frequently caused by erosive gastritis. Non-steroidal anti-inflammatory drugs are one of the most common class of drugs which can cause gastrointestinal complications, including hemorrhagic gastritis. Case report The case of a 6-year-old male, admitted for hematemesis, abdominal pain and loss of appetite. It was ascertained at the time of admission, that ibuprofen had been prescribed as the patient had a fever. This was inappropriately administered as the mother did not respect the intervals between the doses. Initial laboratory tests revealed neutrophilia, leukopenia, high levels of lactate dehydrogenase and urea. An upper digestive endoscopy revealed an increased friability of the mucosa, digested blood in the gastric corpus and fornix. No active bleeding site was detected. The histopathological examination described a reactive modification of the corporeal gastric mucosa. Intravenous treatment with proton pump inhibitors and fluid replacement were initiated, with favorable results. Conclusion Ibuprofen can lead to upper digestive hemorrhage independently of the administered dose. Parents should avoid administering Ibuprofen for fever suppression without consulting their pediatrician.
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20
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Lee CH. Epithelial-mesenchymal transition: Initiation by cues from chronic inflammatory tumor microenvironment and termination by anti-inflammatory compounds and specialized pro-resolving lipids. Biochem Pharmacol 2018; 158:261-273. [DOI: 10.1016/j.bcp.2018.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023]
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21
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Sessa M, Mascolo A, Scavone C, Perone I, Di Giorgio A, Tari M, Fucile A, De Angelis A, Rasmussen DB, Jensen MT, Kragholm K, Rossi F, Capuano A, Sportiello L. Comparison of Long-Term Clinical Implications of Beta-Blockade in Patients With Obstructive Airway Diseases Exposed to Beta-Blockers With Different β1-Adrenoreceptor Selectivity: An Italian Population-Based Cohort Study. Front Pharmacol 2018; 9:1212. [PMID: 30459608 PMCID: PMC6232895 DOI: 10.3389/fphar.2018.01212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/05/2018] [Indexed: 12/28/2022] Open
Abstract
Rationale: Long-term clinical implications of beta-blockade in obstructive airway diseases remains controversial. We investigated if within the first 5 years of treatment patients with heart failure and obstructive airway diseases using non β1-adrenoreceptor selective beta-blockers have an increased risk of being hospitalized for all-causes, heart failure, and chronic obstructive pulmonary disease (COPD) when compared to patient using selective beta-blockers. Methods: Carvedilol users were propensity matched 1:1 for co-treatments, age, gender, and year of inclusion in the cohort with metoprolol/bisoprolol/nebivolol users. Cox proportional hazard regression model was used to compare all causes, COPD, and heart failure hospitalization or the beta-blocker discontinuation between cohorts. For statistically significant associations, we computed the rate difference and the attributable risk. Results: Overall, 11,844 patients out of the 51,214 (23.1%) were exposed to carvedilol and 39,370 (76.9%) to metoprolol/bisoprolol/nebivolol. Carvedilol users had a higher hazard for heart failure hospitalization (HR 1.29; 95% Confidence Interval [CI] 1.18–1.40) with 106 (95%CI 76–134; p-value < 0.001) additional cases of heart failure hospitalization per 10000 person-years if compared to metoprolol/bisoprolol/nebivolol users. In all, 26.8% (95%CI 22.5–30.9%; p-value < 0.001) of heart failure hospitalizations in the study population could be attributed to being exposed to carvedilol. Carvedilol users had a higher hazard (HR 1.06; 95%CI 1.02–1.10) of discontinuing the pharmacological treatment with 131 (95%CI 62–201; p-value < 0.001) additional cases of beta-blocker discontinuation per 10000 person-years metoprolol/bisoprolol/nebivolol users. In all, 6.5% (95%CI 3.9–9.0%; p-value < 0.001) of beta-blocker discontinuation could be attributed to being exposed to carvedilol. Conclusion: On long-term follow-up period, carvedilol was associated with a higher risk of heart failure hospitalization and discontinuation if compared to metoprolol/bisoprolol/nebivolol users among patients with heart failure and obstructive airway diseases.
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Affiliation(s)
- Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ilaria Perone
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | | | - Antonella De Angelis
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Daniel Bech Rasmussen
- Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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22
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Scavone C, Sessa M, Clementi E, Corrao G, Leone R, Mugelli A, Rossi F, Spina E, Capuano A. Real World Data on the Utilization Pattern and Safety Profile of Infliximab Originator Versus Biosimilars in Italy: A Multiregional Study. BioDrugs 2018; 32:607-617. [PMID: 30341487 PMCID: PMC6290713 DOI: 10.1007/s40259-018-0313-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In recent years, several biosimilar drugs, including those of infliximab, have obtained marketing authorization from the European Medicines Agency (EMA). Given the peculiarity of the safety profile of biological medical products (originator and biosimilars), the evaluation of their tolerability represents an important component of pre-marketing and post-marketing clinical development. For example, infliximab products may cause adverse drug reactions (ADRs) including acute infusion reactions, delayed hypersensitivity reactions, and loss of efficacy, as a direct consequence of immunogenicity. Therefore, specific contraindications, special warnings and precautions have been introduced in the infliximab Summary of Product Characteristics (SPC). OBJECTIVE The aim was to assess the magnitude of preventable ADRs in individual case safety reports (ICSRs) having infliximab as a suspected drug across Italy (using the spontaneous reporting systems), and the probability of reporting infections, infusion reactions, lack of efficacy, and hypersensitivity for originator and biosimilars of infliximab. METHODS We analyzed ADRs reported across the 2015-2017 period in the databases of five Italian regions: Campania, Lombardy, Sicily, Tuscany, and Veneto. Preventability of ADRs was assessed using the P-method. To compare the probability of reporting infections, infusion reactions, lack of efficacy, and hypersensitivity as ADRs as opposed to other types of ADRs between originator and biosimilars of infliximab, we used the reporting odds ratio (ROR). For descriptive purposes, the number of ICSRs involving infliximab, the number of infliximab vials distributed in the aforementioned Italian regions and the relative reporting rate stratified by semester were reported. RESULTS From October 2015 to October 2017, 459 ICSRs reported infliximab as a suspected drug (222 ICSRs related to infliximab originator and 237 to infliximab biosimilars). In the same period, 81,906 vials of infliximab were distributed, resulting in a reporting rate of six ICSRs/1000 vials. Overall, 34 cases (7.41%) were categorized as preventable. The most frequently detected critical criteria were "documented hypersensitivity to administered drug or drug class," "inappropriate prescription for patient's underlying medical condition" and "incorrect dose." Biosimilars had, in adjusted analyses, an increased probability of being reported as suspected in ICSRs reporting infusion reactions (ROR 4.09; 95% confidence interval [CI] 1.26-13.32) when compared to Remicade®. On the contrary, they had a decreased probability of being reported as suspected in ICSRs reporting infections or lack of efficacy (ROR 0.33; 95% CI 0.12-0.89; ROR 0.35; 95% CI 0.20-0.61). CONCLUSION Our study demonstrates that, along with a rapid increase in the utilization of infliximab biosimilars across Italy, there was also an increase in reporting ADRs induced by infliximab biosimilars. Of the reported ADRs, 7.4% were considered preventable. In adjusted analyses, infliximab biosimilars were shown to have an increased probability of being reported as suspected drugs in infusion reactions and a decreased probability of being reported as suspected drugs in cases of lack of efficacy or infection. Considering the potential advantages offered by the utilization of biosimilars in clinical practice, we believe that the use of biosimilars, including those of infliximab, should be supported. In order to achieve this aim, increased knowledge on safety and efficacy of biosimilar drugs should be obtained from real world clinical practice.
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Affiliation(s)
- Cristina Scavone
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Maurizio Sessa
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Clementi
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy.,Unit of Clinical Pharmacology, Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Roberto Leone
- Pharmacology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Drug Research and Child's Health, University of Florence, Florence, Italy
| | - Francesco Rossi
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Edoardo Spina
- Unit of Clinical Pharmacology, AOU Policlinico "G. Martino", Messina, Sicily, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicily, Italy
| | - Annalisa Capuano
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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23
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Guerriero F, Orlando V, Monetti VM, Colaccio FM, Sessa M, Scavone C, Capuano A, Menditto E. Predictors of new oral anticoagulant drug initiation as opposed to warfarin in elderly adults: a retrospective observational study in Southern Italy. Ther Clin Risk Manag 2018; 14:1907-1914. [PMID: 30349269 PMCID: PMC6183659 DOI: 10.2147/tcrm.s171346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM The aim of this study was to assess the predictive role of age, gender, and number and type of co-treatments for new oral anticoagulant (NOAC) vs warfarin prescription in elderly patients naïve for the aforementioned drugs. MATERIALS AND METHODS Data collected in the period from January 1, 2014, to December 31, 2014, in Caserta Local Health Unit administrative databases (Campania Region, Italy) were screened to identify new users of oral anticoagulants (OACs) who were 75 years or older and whose OAC prescriptions amounted to >90 days of treatment. Age, gender, and number and type of concomitant medications at the time of first OAC dispensation were retrieved. Multivariable logistic regression analysis was used to assess the role of the aforementioned predictors for NOAC initiation as opposed to warfarin. RESULTS Overall, 2,132 incident users of OAC were identified, of whom 967 met all inclusion criteria. In all, 490 subjects (50.7%) received an NOAC and 477 (49.3%) received warfarin. Age >75 years was positively associated with lower odds of NOAC initiation (OR: 0.969, 95% CI: 0.941-0.998, P=0.038). Similarly, multiple concomitant medication was negatively associated with NOAC initiation compared to warfarin (OR [five to nine drugs] group: 0.607, 95% CI: 0.432-0.852, P=0.004; OR [ten+ drugs] group: 0.372, 95% CI: 0.244-0.567, P<0.001). Prior exposure to platelet aggregation inhibitor drugs was associated with the initiation of NOACs (OR: 3.474, 95% CI: 2.610-4.625). CONCLUSION Age and multiple co-medication were negatively associated with NOAC initiation.
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Affiliation(s)
- Francesca Guerriero
- Center of Pharmacoeconomics (CIRFF), University of Naples Federico II, Naples, Italy,
| | - Valentina Orlando
- Center of Pharmacoeconomics (CIRFF), University of Naples Federico II, Naples, Italy,
| | | | | | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology, Regional Center of Pharmacovigilance, University of Campania "L. Vanvitelli", Naples, Italy
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, DK, Denmark
| | - Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology, Regional Center of Pharmacovigilance, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology, Regional Center of Pharmacovigilance, University of Campania "L. Vanvitelli", Naples, Italy
| | - Enrica Menditto
- Center of Pharmacoeconomics (CIRFF), University of Naples Federico II, Naples, Italy,
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Chi TY, Liu Y, Zhu HM, Zhang M. Thromboelastography-derived parameters for the prediction of acute thromboembolism following non-steroidal anti-inflammatory drug-induced gastrointestinal bleeding: A retrospective study. Exp Ther Med 2018; 16:2257-2266. [PMID: 30186466 PMCID: PMC6122363 DOI: 10.3892/etm.2018.6468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/25/2018] [Indexed: 12/28/2022] Open
Abstract
Efficacy of thromboelastography (TEG)-derived parameters for the prediction of acute thromboembolism (AT) in patients with non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB) remains to be determined. A retrospective propensity score matching (PSM) study was performed to evaluate this efficacy. Patients with NSAID-induced GIB (98 with AT; 830 without AT) were matched for age, sex and history of cardiovascular and cerebrovascular diseases using PSM. Multivariate logistic regression was used to determine the efficacy of TEG-derived predictors of AT. Mean Decrease Gini (MDG) coefficients were used to rank the importance of the variables from random forest algorithm results. Univariate analysis indicated that the following indexes were significantly different between the two groups: Reaction time (R value), coagulation forming time, solidification angle, maximum amplitude (MA), coagulation index (CI), hemoglobin levels, D-dimer levels, platelet aggregation test (pAgt) results, fibrinogen levels and Acute Physiology and Chronic Health Evaluation II score (all P<0.001). Multifactor logistic regression analysis indicated that the R value (P=0.010), solidification angle (P=0.004), MA (P=0.038), D-dimer levels (P=0.012) and pAgt results (P=0.015) were independent predictors of AT in patients with NSAID-induced GIB, achieving an area under the curve of 0.999 in receiver operating characteristic curve analyses. The five most important parameters according to the MDG scores (MDGS) were: Solidification angle (MDGS=58.14), R value (MDGS=20.42), pAgt results (MDGS=15.61), D-dimer levels (MDGS=12.78) and CI (MDGS=12.61). The results of the present study indicated that TEG-derived parameters including the R value, solidification angle, MA and CI, as well as D-dimer levels and pAgt score were significant predictors of AT in patients with NSAID-induced GIB.
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Affiliation(s)
- Tian-Yu Chi
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Ying Liu
- Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Hong-Ming Zhu
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Mei Zhang
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
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Sessa M, Bernardi FF, Vitale A, Schiavone B, Gritti G, Mascolo A, Bertini M, Scavone C, Sportiello L, Rossi F, Capuano A. Adverse drug reactions during hepatitis C treatment with direct-acting antivirals: The role of medication errors, their impact on treatment discontinuation and their preventability. New insights from the Campania Region (Italy) spontaneous reporting system. J Clin Pharm Ther 2018; 43:867-876. [PMID: 30014479 DOI: 10.1111/jcpt.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Medication errors, such as unnecessary treatment discontinuation during treatment with direct-acting antivirals (DAAs), can lead to imbalances in the benefit-to-risk ratio. This risk is especially high when the medication error leads to adverse drug reactions (ADRs). However, to date, evidence on the frequency of this phenomenon is scarce. This study aims to provide better insight into ADRs possibly due to medication errors leading to DAA discontinuation and their preventability. METHODS The Italian Pharmacovigilance Network database was used to extract individual case safety reports (ICSRs) generated from July 2012 to March 2017 via the Campania Region (Italy) spontaneous reporting system. ICSRs that included ledipasvir/sofosbuvir, ombitasvir/paritaprevir/ritonavir, dasabuvir, daclatasvir, sofosbuvir, simeprevir or elbasvir/grazoprevir as suspected drugs were included in this study. A preventability assessment was then performed utilizing the "P-Method," an algorithm that evaluates known risk factors due to medication errors that can be detected in ICSRs. RESULTS AND DISCUSSION Of the 355 cases included in this study, 6 (1.69%) were classified as preventable and 52 (14.6%) were classified as potentially preventable. The most frequently identified critical criteria (risk factor) for preventable or potentially preventable cases were drug-drug interactions and incorrect drug dosing as part of the antiviral treatment scheme. In total, 89 of the 355 cases (25.1%) discontinued use of the DAAs due to ADRs, of which 20 of the 89 cases (22.5%) were due to an unimportant medical event as classified by the European Medicine Agency important medical event list. WHAT IS NEW AND CONCLUSION This study found a proportion of preventable/potentially preventable ADRs involving DAA, which could be improved in the Campania Region (Italy). Additionally, the study identified a high proportion of seemingly unnecessary DAA discontinuations among patients who experienced ADRs.
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Affiliation(s)
- Maurizio Sessa
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Andrea Vitale
- Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Giulia Gritti
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Michele Bertini
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
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Sessa M, di Mauro G, Mascolo A, Rafaniello C, Sportiello L, Scavone C, Capuano A. Pillars and Pitfalls of the New Pharmacovigilance Legislation: Consequences for the Identification of Adverse Drug Reactions Deriving From Abuse, Misuse, Overdose, Occupational Exposure, and Medication Errors. Front Pharmacol 2018; 9:611. [PMID: 29946258 PMCID: PMC6006791 DOI: 10.3389/fphar.2018.00611] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/21/2018] [Indexed: 12/16/2022] Open
Abstract
Rationale: The aim of this study is to investigate if following the implementation of the Regulation EU/1235/2010 and the Directive 2010/84/EU there was an increase of individual case safety reports (ICSRs) deriving from a medication error, abuse, misuse, overdose, or occupational exposure. Other objectives are the identification of drugs mostly involved in such cases, to establish if the codification of aforementioned conditions is performed correctly and, whenever codification errors exist, to identify predictors of codification errors. Finally, we estimated the magnitude of these errors on signal detection activities. Methods: ICSRs sent through Campania Region (Italy) spontaneous reporting system from July 2nd 2012 to December 31th 2017 were used as data source. A multivariable logistic regression model was used to identify predictors of codification errors. Four measures of disproportionality were used to investigate the magnitude of codification errors on a known safety signal or rather the association between benzodiazepines derivatives and abuse. Results: In all, 358 (1.4%) out of 25610 ICSRs reported "non-normal use" of drugs, mainly as cases of abuse. Drugs mostly involved in abuse were "Benzodiazepines derivatives" (171/358; 47.8%). For medication errors instead, "Other antiseptics and disinfectants" (9/358; 2.5%). At the first quality control, 125 (34.9%) out of 358 ICSRs did not have a codification of "non-normal use" or codifications were performed wrongly. Codification errors included misclassification of abuse as overdose (10/125; 8.0%) and misclassification of medication error as overdose (7/125; 5.6%) or abuse (7/125; 5.6%). Compared to pharmaceutical companies, patients/citizens (as reporters) had a 24.88 higher odd (Reporting Odds Ratio 24.88, 95%CI 1.82-449.95; p-value: 0.02) of performing un-classification or misclassification of aforementioned codifications. Codification errors were associated with the underestimation of measure of disproportionality' estimates in the identification of the safety signal "Benzodiazepine derivatives /abuse". Conclusion: In conclusion, this study found that in Campania Region (southern Italy) there was an exponential increase of ICSR reporting "non-normal use," mainly as cases of abuse, with an improvable proportion of cases misclassified/unclassified. Moreover, this study found that ICSRs sent by patients/citizens were associated with an increased odd of un-classification or misclassification that had a relevant impact on signal detection activities.
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Affiliation(s)
- Maurizio Sessa
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Gabriella di Mauro
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Concetta Rafaniello
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Cristina Scavone
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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Al Khaja KAJ, Veeramuthu S, Isa HA, Sequeira RP. Prescription audit of NSAIDs and gastroprotective strategy in elderly in primary care. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2018; 29:57-68. [PMID: 28885223 DOI: 10.3233/jrs-170742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of non-steroidal anti-inflammatory drug (NSAIDs) is deemed a major risk factor for peptic ulcer disease in elderly population that requires concomitant therapy with gastroprotective agents (GPAs). OBJECTIVE This study evaluated the rational prescribing of NSAIDs and GPAs, and extent of adherence to the guideline recommendations in primary care. METHODS Nationwide audit of prescriptions issued to elderly patients (≥65 years) with hypertension or diabetic hypertension in primary care. RESULTS Among 2090 elderly, 45.9% were on low-dose aspirin, and 13.5% on other NSAIDs. Diclofenac-XR was the most frequently prescribed NSAIDs to three-quarter patients whereas naproxen, the safest NSAID for patients with high cardiovascular (CV) risk, was rarely prescribed. Among those on NSAID, 82.9% were on a scheduled dosing regimen; of these 78.8% received long-term NSAID therapy (3.9±0.9 months). The prescription rate of GPAs was low: 29.2% for aspirin and 33.3% for other NSAIDs. A quarter of the patients on histamine type-2 receptor antagonists received ranitidine at subtherapeutic single-dose for gastroprotection. Approximately half of the patients on proton pump inhibitors (PPIs) were prescribed supra-therapeutic double-dose regimen: omeprazole and esomeprazole accounted for 63.2% of overall prescribed PPIs. CONCLUSIONS The rational choice of NSAIDs and physicians' adherence to gastroprotective measures was suboptimal in primary care. The choice of NSAIDs and gastroprotective strategy in elderly be guided by the CV and gastrointestinal adverse events likelihood due to the NSAIDs and risk profile of patients for such adverse events.
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Affiliation(s)
- Khalid Ahmed Jassim Al Khaja
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Sindhan Veeramuthu
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | | | - Reginald Paul Sequeira
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Chi TY, Zhu HM, Zhang M. Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing. Medicine (Baltimore) 2018; 97:e0665. [PMID: 29718891 PMCID: PMC6392961 DOI: 10.1097/md.0000000000010665] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal (GI) bleeding is an unwanted side effect common to all chemical types of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in elderly people. However, the risk factors of GI bleeding associated with NSAIDs for elderly people remain unknown. This study aims to evaluate the risks of GI bleeding associated with NSAIDs in 4728 elderly people over 60 years old based on database from a hospital in Beijing.This retrospective hospital-based study included 4728 patients over 60 years old prescribed with NSAIDs, of which 928 patients had GI bleeding and 3800 did not have. Odds ratios (OR) for the risk of GI bleeding associated with NSAIDs were determined by logistic regression analysis. Mean Decrease Gini (MDG) involved in random forest algorithm was used to rank the associated factors with GI bleeding.In multivariate analysis, family history of GI bleeding (OR, 3.348; P = .000), history of peptic ulcers (OR, 4.068; P = .000), history of cardiovascular and cerebrovascular disease (OR, 1.476; P = .001), diabetes mellitus (OR, 1.408; P = .000), antiplatelet drugs (OR, 3.106; P = .000), Helicobacter pylori infection (OR, 1.312; P = .001), cholesterol level (OR, 0.516; P = .000), upper abdominal discomfort (OR, 3.467; P = .000), anorexia (OR, 2.038; P = .000), and NSAIDs used for 0.5 to 3 months (OR, 0.780; P = .000) were associated with GI bleeding. After ranked the MDG of each factor, the top 5 ranked factors associated with GI bleeding were melena, hematemesis, antiplatelet drugs, cholesterol level, and upper abdominal discomfort.We found that family history of GI bleeding, history of peptic ulcers, history of cardiovascular and cerebrovascular disease, diabetes mellitus, antiplatelet drugs, Helicobacter pylori infection, hypocholesterolemia, and NSAIDs used for 0.5 to 3 months were independent risk factors for GI bleeding on people over 60 years old. Meanwhile, upper abdominal discomfort might be the predictor of GI bleeding associated with NSAIDs elderly users.
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Affiliation(s)
- Tian-Yu Chi
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sessa M, Rafaniello C, Scavone C, Mascolo A, di Mauro G, Fucile A, Rossi F, Sportiello L, Capuano A. Preventable statin adverse reactions and therapy discontinuation. What can we learn from the spontaneous reporting system? Expert Opin Drug Saf 2018; 17:457-465. [PMID: 29619841 DOI: 10.1080/14740338.2018.1458837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Statin treatment is often associated with poor adherence, which may be due to the onset of adverse drug reactions (ADRs). We investigated on potential risk factors related to preventable cases of statin-induced ADRs and to the discontinuation of statin therapy. METHODS We performed a study using the database of Italian spontaneous reporting. The target population for the preventability assessment was all patients with suspected statin-induced ADRs deriving from Campania Region (a territory of Southern Italy) between 2012 and 2017. Additionally, a local sentinel surveillance site involving General Practitioners was selected to countercheck in routine clinical practice the role of ADRs for statin discontinuation. RESULTS In total, 34 of 655 (5.19%) regional cases were preventable and among detected risk factors 90.0% was related to healthcare professionals' practices and 10.0% to patient behaviour. In 81.4% (533/655) of cases, statin therapy was discontinued due to ADRs, mainly classified as not serious and associated with a positive prognosis. These results were also confirmed in the active sentinel site. CONCLUSIONS Our findings suggest an inappropriate use of statins among the identified preventable cases and a potential inappropriate statin discontinuation due to ADRs. These factors may be useful for targeting interventions to improve statin adherence.
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Affiliation(s)
- Maurizio Sessa
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Concetta Rafaniello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Cristina Scavone
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annamaria Mascolo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Gabriella di Mauro
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annamaria Fucile
- b Pharmaceutical department , Local Health Unit of Caserta , Caserta , Italy
| | - Francesco Rossi
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Liberata Sportiello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annalisa Capuano
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
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Evaluation of community pharmacists' roles in screening and communication of risks about non-steroidal anti-inflammatory drugs in Thailand. Prim Health Care Res Dev 2018; 19:598-604. [PMID: 29551098 DOI: 10.1017/s1463423618000142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AimThis study aimed to explore community pharmacists' roles on screening for risk factors, providing safety information-related non-steroidal anti-inflammatory drugs (NSAIDs) to patients. BACKGROUND: NSAIDs are widely dispensed without a prescription from pharmacies in Thailand, while they are frequently reported as causing adverse events. METHODS: Self-administered questionnaires were distributed to all accredited pharmacies in Thailand, inviting the main pharmacist in each pharmacy to participate in this study.FindingsOut of 406 questionnaires distributed, 159 were returned (39.2%). Almost all pharmacists claimed to engage in NSAID dispensing practice, but not all of them provided relevant good practice, such as, screening for risk factors (56.3-95.5%), communication on adverse drug reactions (ADRs) (36.9-63.2%) and ADR management (58.9-79.7%), history of gastrointestinal (GI) problems was frequently mentioned for screening, but many pharmacists did not screen for history of NSAID use (24.7-35.5%), older age (45.2-48.9%), concomitant drug (63.7%), and problems of cardiovascular (24.1%), renal (34.9-43.3%), and liver systems (60.3-61.0%). Male pharmacists were significantly less likely to inform users of non-selective NSAIDs about ADRs [odds ratio (OR) 0.44], while provision of information about selective NSAID ADRs was higher among pharmacy owners (OR 2.28), pharmacies with more pharmacists (OR 3.18), and lower in pharmacies with assistants (OR 0.41). Screening for risk factors, and risk communication about NSAIDs were not generally conducted in Thai accredited community pharmacists, nor were NSAID complications fully communicated. Promoting of community pharmacists' roles in NSAID dispensing should give priority to improving, especially in high-risk patients for taking NSAIDs.
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Sessa M, Rossi C, Mascolo A, Scavone C, di Mauro G, Grassi R, Sportiello L, Cappabianca S, Rafaniello C. Contrast media-induced nephropathy: how has Italy contributed in the past 30 years? A systematic review. Ther Clin Risk Manag 2017; 13:1463-1478. [PMID: 29123405 PMCID: PMC5661489 DOI: 10.2147/tcrm.s144418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objective The use of contrast media in Italy has exponentially increased in the past 3 decades. However, it is unknown whether there has been an increase in clinical research evaluating the risks associated with contrast media usage, especially regarding contrast-induced nephropathy. To fill this gap in knowledge, we performed a systematic review. Study eligibility criteria Meta-analyses, observational studies, and clinical trials assessing contrast media-induced nephropathy as the safety outcome, in which at least one author was affiliated with an Italian university/health care structure, were eligble. Data sources Ovid MEDLINE, Ovid Embase, Cochrane Methodology Register, and Web of Science were screened. Participants Men and women exposed to contrast media. Results In total, 60 original articles were retrieved with an incremental trend between 1990 and 2017. Cohort studies were the most common study design represented. In total, 45 of 60 (75.0%) studies were monocenter studies and 41 of 60 (68.3%) received no funding. In all, 91.7% of studies disclosed no conflicts of interest and 81.7% had no external collaboration. Most of the studies provided a level of evidence of III-2 (32/60; 53.3%) and II (23/60; 38.3%). In total, 50 of 60 studies (83.3%) were published in a scientific journal ranked in the first quartile of their subject area. Conclusion There was an increased number of studies evaluating contrast-induced nephropathy in Italy during the last three decades. These studies covered procedures to prevent contrast-induced nephropathy or aimed to identify risk factors, biomarkers, and scores, and their related prognosis.
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Affiliation(s)
- Maurizio Sessa
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Claudia Rossi
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Gabriella di Mauro
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Liberata Sportiello
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Section of Radiology and Radiotherapy, Department of Clinical and Experimental Medicine "Magrassi-Lanzara", University of Campania "L Vanvitelli", Naples, Italy
| | - Concetta Rafaniello
- Section of Pharmacology "L Donatelli", Department of Experimental Medicine, University of Campania "L Vanvitelli", Naples, Italy
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Sales TA, Marcussi S, da Cunha EFF, Kuca K, Ramalho TC. Can Inhibitors of Snake Venom Phospholipases A₂ Lead to New Insights into Anti-Inflammatory Therapy in Humans? A Theoretical Study. Toxins (Basel) 2017; 9:E341. [PMID: 29068410 PMCID: PMC5705956 DOI: 10.3390/toxins9110341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 11/16/2022] Open
Abstract
Human phospholipase A₂ (hPLA₂) of the IIA group (HGIIA) catalyzes the hydrolysis of membrane phospholipids, producing arachidonic acid and originating potent inflammatory mediators. Therefore, molecules that can inhibit this enzyme are a source of potential anti-inflammatory drugs, with different action mechanisms of known anti-inflammatory agents. For the study and development of new anti-inflammatory drugs with this action mechanism, snake venom PLA₂ (svPLA₂) can be employed, since the svPLA₂ has high similarity with the human PLA₂ HGIIA. Despite the high similarity between these secretory PLA₂s, it is still not clear if these toxins can really be employed as an experimental model to predict the interactions that occur with the human PLA₂ HGIIA and its inhibitors. Thus, the present study aims to compare and evaluate, by means of theoretical calculations, docking and molecular dynamics simulations, as well as experimental studies, the interactions of human PLA₂ HGIIA and two svPLA₂s,Bothrops toxin II and Crotoxin B (BthTX-II and CB, respectively). Our theoretical findings corroborate experimental data and point out that the human PLA₂ HGIIA and svPLA₂ BthTX-II lead to similar interactions with the studied compounds. From our results, the svPLA₂ BthTX-II can be used as an experimental model for the development of anti-inflammatory drugs for therapy in humans.
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Affiliation(s)
- Thaís A Sales
- Department of Chemistry, Federal University of Lavras, P.O. Box 3037, 37200-000 Lavras, MG, Brazil.
| | - Silvana Marcussi
- Department of Chemistry, Federal University of Lavras, P.O. Box 3037, 37200-000 Lavras, MG, Brazil.
| | - Elaine F F da Cunha
- Department of Chemistry, Federal University of Lavras, P.O. Box 3037, 37200-000 Lavras, MG, Brazil.
| | - Kamil Kuca
- Biomedical Research Center, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic.
- Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 500 03 Hradec Kralove, Czech Republic.
| | - Teodorico C Ramalho
- Department of Chemistry, Federal University of Lavras, P.O. Box 3037, 37200-000 Lavras, MG, Brazil.
- Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 500 03 Hradec Kralove, Czech Republic.
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Scavone C, Sportiello L, Sullo MG, Ferrajolo C, Ruggiero R, Sessa M, Berrino PM, di Mauro G, Berrino L, Rossi F, Rafaniello C, Capuano A. Safety Profile of Anticancer and Immune-Modulating Biotech Drugs Used in a Real World Setting in Campania Region (Italy): BIO-Cam Observational Study. Front Pharmacol 2017; 8:607. [PMID: 28932193 PMCID: PMC5592230 DOI: 10.3389/fphar.2017.00607] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives: To investigate the occurrence of adverse events (AEs) in naïve patients receiving biotech drugs. Design: A prospective observational study. Setting: Onco-hematology, Hepato-gastroenterology, Rheumatology, Dermatology, and Neurology Units in Campania Region (Italy). Participants: 775 patients (53.81% female) with mean age 56.0 (SD 15.2). The mean follow-up/patient was 3.48 (95% confidence interval 3.13–3.84). Main outcome measures: We collected all AEs associated to biotech drugs, including serious infections and malignancies. Serious AEs were defined according to the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use, clinical safety data management: definitions and standards for expedited reporting E2A guideline. Results: The majority of the study population was enrolled in Onco-hematology and Rheumatology Units and the most common diagnosis were hematological malignancies, followed by rheumatoid arthritis, colorectal cancer, breast cancer, and psoriatic arthritis. The most commonly prescribed biotech drugs were rituximab, bevacizumab, infliximab, trastuzumab, adalimumab, and cetuximab. Out of 775 patients, 320 experienced at least one AE. Most of patients experienced AEs to cetuximab therapy, rituximab and trastuzumab. Comparing female and male population, our findings highlighted a statistically significant difference in terms of AEs for adalimumab (35.90% vs. 7.41%, p < 0.001) and etanercept (27.59% vs. 10.00%, p = 0.023). Considering all biotech drugs, we observed a peak for all AEs occurrence at follow-up 91–180 days category. Bevacizumab, brentuximab, rituximab, trastuzumab and cetuximab were more commonly associated to serious adverse events; most of these were possibly related to biotech drugs, according to causality assessment. Three cases of serious infections occurred. Conclusions: The results of our study demonstrated that the majority of AEs were not serious and expected. Few cases of serious infections occurred, while no case of malignancy did. Overall, the safety profile of biotech drugs used in our population was similar to those observed in pivotal trials. Notwithstanding the positive results of our study, some safety concerns still remain unresolved. In order to collect more effectiveness and safety data on biotech drugs, the collection and analysis of real world data should be endorsed as well as the management of post-authorization studies.
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Affiliation(s)
- Cristina Scavone
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Liberata Sportiello
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Maria G Sullo
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Carmen Ferrajolo
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Rosanna Ruggiero
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Maurizio Sessa
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Pasquale M Berrino
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Gabriella di Mauro
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Liberato Berrino
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Francesco Rossi
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Concetta Rafaniello
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
| | - Annalisa Capuano
- The authors would like to thank all the members of the BIO-Cam group who provided patient data for this study: University Hospital of Università degli Studi della Campania "Luigi Vanvitelli" Naples; Hospital SG Moscati-Avellino; Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale" Naples; Hospital AORN Cardarelli Naples; Hospital G Rummo Benevento; Hospital Sant'Anna e San Sebastiano Caserta; University Hospital Università degli Studi di Napoli Federico II Naples; Fondazione Maugeri Benevento; University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno; Hospital Ospedale dei Colli Naples
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Mascolo A, Scavone C, Sessa M, di Mauro G, Cimmaruta D, Orlando V, Rossi F, Sportiello L, Capuano A. Can causality assessment fulfill the new European definition of adverse drug reaction? A review of methods used in spontaneous reporting. Pharmacol Res 2017; 123:122-129. [PMID: 28694146 DOI: 10.1016/j.phrs.2017.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/07/2017] [Accepted: 07/05/2017] [Indexed: 12/29/2022]
Abstract
Causality assessment is a fundamental biomedical technique for the signal detection performed by Pharmacovigilance centers in a Spontaneous reporting system. Moreover, it is a crucial and important practice for detecting preventable adverse drug reactions. Among different methods for causality assessment, algorithms (such as the Naranjo, or Begaud Methods) seem for their operational procedure and easier applicability one of the most commonly used methods. With the upcoming of the new European Pharmacovigilance legislation including in the definition of the adverse event also effects resulting from abuse, misuse and medication error, all well-known preventable causes of ADRs, there was an emerging need to evaluate whether algorithms could fulfill this new definition. In this review, twenty-two algorithmic methods were identified and none of them seemed to fulfill perfectly the new criteria of adverse event although some of them come close. In fact, several issues were arisen in applying causality assessment algorithms to these new definitions as for example the impossibility to answer the rechallenge question in case of medication error or AEFI (Adverse Event Following Immunization). Moreover, the exact conditions at which events occurred, as for example dosage or mode of administration should be considered to better assess causality in conditions of abuse/overdose, or misuse as well as in conditions of lack of expected efficacy reports for biotechnological drugs and adverse event occurring after mixing of vaccines. Therefore, this review highlights the need of updating algorithmic methods to allow a perfect applicability in all possible clinical scenarios accordingly or not with the terms of marketing authorization.
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Affiliation(s)
- Annamaria Mascolo
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy.
| | - Cristina Scavone
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Maurizio Sessa
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Gabriella di Mauro
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Daniela Cimmaruta
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Valentina Orlando
- Center of Pharmacoeconomics (CIRFF), Department of Pharmacy University of Naples, 'Federico II', Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology L. Donatelli, University of Campania 'L. Vanvitelli', Naples, Italy; Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania 'L. Vanvitelli', Naples, Italy
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Deidda A, Pisanu C, Micheletto L, Bocchetta A, Del Zompo M, Stochino ME. Interstitial lung disease induced by fluoxetine: Systematic review of literature and analysis of Vigiaccess, Eudravigilance and a national pharmacovigilance database. Pharmacol Res 2017; 120:294-301. [DOI: 10.1016/j.phrs.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 01/24/2023]
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Sessa M, Sportiello L, Mascolo A, Scavone C, Gallipoli S, di Mauro G, Cimmaruta D, Rafaniello C, Capuano A. Campania Preventability Assessment Committee (Italy): A Focus on the Preventability of Non-steroidal Anti-inflammatory Drugs' Adverse Drug Reactions. Front Pharmacol 2017; 8:305. [PMID: 28603499 PMCID: PMC5445158 DOI: 10.3389/fphar.2017.00305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/10/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aims to investigate preventability criteria of adverse drug reactions (ADRs) involving non-steroidal anti-inflammatory drugs (NSAIDs) by analyzing individual case safety reports (ICSRs) sent through Campania region (Italy) spontaneous reporting system from July 2012 to October 2016. Methods: For all the ICSRs that reported NSAIDs as suspected drug, a trained multidisciplinary team of Campania Pharmacovigilance Regional Centre composed of clinical pharmacologists and pharmacists with pluriannual experience in Pharmacovigilance assessed preventability by using the P-method. Results: In all 19,039 ICSRs were sent to Campania Pharmacovigilance Regional Centre, of which 550 reported NSAIDs as suspected drug. In total, 94 cases (17.1%) out of 550 ICSRs were preventable. In the 94 preventable cases, 201 critical criteria were detected of which 182/201 (90.5%) related to healthcare professionals' practices, 0/201 (0.0%) to drug quality, and 19/201 (9.5%) to patient behavior. The most detected critical criteria were the necessary medication not given (52/182; 28.6%), labeled drug-drug interaction (36/182; 19.7%), incorrect drug administration duration (31/182; 16.9%), wrong indication (26/182; 14.2%), therapeutic duplication (18/182; 10.0%), and documented hypersensitivity to administered drug or drug class (10/182; 5.6%). In seventeen (18.1%) preventable cases, there were 19 critical criteria involving non-compliance (15/19 critical criteria; 78.9%) and self-medication with the non-over-the-counter drugs (4/19 critical criteria; 21.1%). In all, 17 out 94 (18.1%) preventable cases involved over-the-counter drugs. Conclusion: A call for action for Campania Pharmacovigilance Regional Centre is necessary in order to promote initiatives to increase the awareness of healthcare professionals and citizens on the risk associated with inappropriate use of NSAIDs.
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Affiliation(s)
- Maurizio Sessa
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Liberata Sportiello
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Annamaria Mascolo
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Silvia Gallipoli
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Gabriella di Mauro
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Daniela Cimmaruta
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Concetta Rafaniello
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University of Campania "Luigi Vanvitelli"Naples, Italy
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Zhang Q, Zhu B, Li Y. Resolution of Cancer-Promoting Inflammation: A New Approach for Anticancer Therapy. Front Immunol 2017; 8:71. [PMID: 28210259 PMCID: PMC5288347 DOI: 10.3389/fimmu.2017.00071] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/17/2017] [Indexed: 12/31/2022] Open
Abstract
Inflammation is a protective response that eliminates harmful stimuli and restores tissue homeostasis, whereas the failure to resolve inflammation leads to the development of malignancies. Immune cells in the tumor inflammatory microenvironment endow cancer cells with their specific hallmarks, including mutations, metabolic reprograming, angiogenesis, invasion, and metastasis. Targeting the inflammatory microenvironment with anti-inflammatory drugs (e.g., aspirin) or by enhancing antitumor immunity (e.g., chimeric antigen receptor T cell therapy) has been extensively investigated and has achieved promising results in many cancers. Recently, a novel approach promoting antitumor immunity via a dual anti-inflammatory and pro-resolving strategy was proposed based on the discovery of potent, endogenous, specialized pro-resolving mediators, including lipoxins, resolvins, protectins, and maresins. In this review, we describe the updated principal cellular and molecular mechanisms of inflammation resolution and cancer immunity and discuss the pro-resolution strategy in cancer treatment and prevention.
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Affiliation(s)
- Qi Zhang
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University , Chongqing , China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University , Chongqing , China
| | - Yongsheng Li
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University , Chongqing , China
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Gaydukova IZ, Bichurina DM, Popova YR, Rebrov AP. Antiinflammatory treatment in patients with chronic back pain. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:46-51. [DOI: 10.17116/jnevro201711712146-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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