Bioequivalence of Fixed Dose Combination of Atorvastatin 10 mg and Aspirin 150 mg Capsules: A Randomized, Open-Label, Single-Dose, Two-way Crossover Study in Healthy Human Subjects

Active deprescribing program in chronic kidney disease patients undergoing haemodialysis

BACKGROUND

Deprescribing is gaining attention of medical community to address polypharmacy. Existing deprescribing tools were not validated in haemodialysis population. We designed this study to assess the pill burden of patients undergoing haemodialysis and to measure the outcome after implementation of an active deprescribing program.

METHODS

An evidence based deprescription tool was formulated. All patients who were on dialysis for 3 months or more were eligible to participate. Medication reconciliation followed by medication list evaluation for appropriateness was done for all patients. All inappropriate medications were discontinued followed by monitoring for 6 months for complications. Primary outcome was the average number of medications and pills per patient before and 12 weeks after implementation of deprescribing program.

RESULTS

We enrolled 150 patients to the active deprescribing program. Mean age was 60.4 ± 10.9 years. After deprescription, there were significant reduction in the number of medications from 11 (Interquartile range 8-13.25) to 8 (IQR 6-9) (p < .001) and reduction in the number of pills from 16 (IQR 12.75-21.25) to 11 (IQR 8-14.25) (p < .001). Pill burden accessed using Living with Medication Questionnaire-Visual Analogue Scale score also had a significant reduction from 7 (IQR 5-8) to 4 (IQR 3-5) (p < .001).

CONCLUSION

Polypharmacy is a significant problem in haemodialysis patients, which can lead to poor quality of life and health hazards due to side effects of medications. Implementation of a proactive deprescribing program can cut down polypharmacy to a significant extent.

Statins for the prevention of proliferative vitreoretinopathy: cellular responses in cultured cells and clinical statin concentrations in the vitreous

Proliferative vitreoretinopathy (PVR) with rhegmatogenous retinal detachment (RRD) is a complex inflammatory ocular disease. Statins are widely used cholesterol-lowering drugs with putative anti-inflammatory properties. In this study, we have explored their efficacy in controlling post-surgical PVR formation. Simvastatin (SIM), atorvastatin (ATV), or rosuvastatin (RSV) were added to cultures of human retinal pigment epithelial cells (ARPE-19) prior to exposure with the bacterial lipopolysaccharide (LPS), and the production of pro-inflammatory cytokines (IL-6, IL-8, MCP-1) was examined using an enzyme-linked immunosorbent assay. In addition, the concentrations of simvastatin, atorvastatin, rosuvastatin, and their metabolites were measured from the vitreal samples of 20 patients undergoing vitrectomy (16 of them receiving oral statin therapy) using an ultra-performance liquid chromatography-tandem mass spectrometer technique. All statins alleviated LPS-induced inflammation at 5 µM concentration in the ARPE-19 cell cultures. Statin levels in the vitreous samples ranged from 6 to 316 pg/mL (ca. 0.1-7 M^-10). Vitreal statin concentrations were similar to the typical steady-state unbound statin concentrations in plasma, indicating that only the unbound drug distributes from the blood circulation into the vitreous. Pharmacokinetic simulations of the intravitreal delivery of statins indicate that the measured clinical statin concentrations could be maintained with existing drug delivery technologies for months. Our results suggest that intravitreal statin therapy may have the potential in alleviating the risk of post-surgical PVR.