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Li R, Ranganath B. Preoperative depression is an independent risk factor for short-term morbidities in autologous and implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 95:190-198. [PMID: 38924897 DOI: 10.1016/j.bjps.2024.05.060] [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: 02/26/2024] [Revised: 05/03/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Depression is notably common among patients who have undergone mastectomy. Several post-mastectomy patients opt for elective breast reconstruction. However, evidence on the influence of preoperative depression on breast reconstruction outcomes remains limited. This study aimed to evaluate the effect of preoperative depression on the short-term outcomes of autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) using a comprehensive national registry. METHODS Patients who underwent ABR or IBR were identified from the national inpatient sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between the patients with and without depression, adjusted for demographics, primary payer status, hospital characteristics, and comorbidities. RESULTS Among the 12,984 patients who underwent ABR, 1578 (12 %) had depression whereas 1980 (11 %) out of 17,963 patients who underwent IBR had depression. In ABR and IBR, preoperative depression was associated with higher superficial wound complications (ABR, aOR = 1.386, 95 % CI = 1.035-1.856, p = 0.03; IBR, aOR = 1.281, 95 % CI = 1.001-1.638, p = 0.04), hemorrhage/hematoma (ABR, aOR = 1.164, 95 % CI = 1.010-1.355, p = 0.04; IBR, aOR = 1.614, 95 % CI = 1.279-2.037, p < 0.01), and longer hospital length of stay (p < 0.01). In ABR, patients with depression had higher incidences of infection (aOR = 1.906, 95 % CI = 1.246-2.917, p < 0.01) and sepsis (aOR = 15.609, 95 % CI = 1.411-172.65, p = 0.03). In IBR, patients with depression had higher risks of capsular contracture (aOR = 1.477, 95 % CI = 1.105-1.976, p = 0.01) and seroma (aOR = 1.489, 95 % CI = 1.005-2.208, p = 0.04). CONCLUSION Preoperative depression is independently associated with major morbidities after ABR and IBR. Preoperative screening for depression can be beneficial. Findings from this study can facilitate preoperative risk stratification and post-operative care for patients with depression.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Bharat Ranganath
- Department of Surgery, The George Washington University Hospital, Washington, DC, United States
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Brisnik V, Vukas J, Jung-Sievers C, Lukaschek K, Alexander GC, Thiem U, Thürmann P, Schüle C, Fischer S, Baum E, Drey M, Harder S, Niebling W, Janka U, Krause O, Gensichen J, Dreischulte T. Deprescribing of antidepressants: development of indicators of high-risk and overprescribing using the RAND/UCLA Appropriateness Method. BMC Med 2024; 22:193. [PMID: 38735930 PMCID: PMC11089726 DOI: 10.1186/s12916-024-03397-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/18/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Antidepressants are first-line medications for many psychiatric disorders. However, their widespread long-term use in some indications (e.g., mild depression and insomnia) is concerning. Particularly in older adults with comorbidities and polypharmacy, who are more susceptible to adverse drug reactions, the risks and benefits of treatment should be regularly reviewed. The aim of this consensus process was to identify explicit criteria of potentially inappropriate antidepressant use (indicators) in order to support primary care clinicians in identifying situations, where deprescribing of antidepressants should be considered. METHODS We used the RAND/UCLA Appropriateness Method to identify the indicators of high-risk and overprescribing of antidepressants. We combined a structured literature review with a 3-round expert panel, with results discussed in moderated meetings in between rounds. Each of the 282 candidate indicators was scored on a 9-point Likert scale representing the necessity of a critical review of antidepressant continuation (1-3 = not necessary; 4-6 = uncertain; 7-9 = clearly necessary). Experts rated the indicators for the necessity of review, since decisions to deprescribe require considerations of patient risk/benefit balance and preferences. Indicators with a median necessity rating of ≥ 7 without disagreement after 3 rating rounds were accepted. RESULTS The expert panel comprised 2 general practitioners, 2 clinical pharmacologists, 1 gerontopsychiatrist, 2 psychiatrists, and 3 internists/geriatricians (total N = 10). After 3 assessment rounds, there was consensus for 37 indicators of high-risk and 25 indicators of overprescribing, where critical reviews were felt to be necessary. High-risk prescribing indicators included settings posing risks of drug-drug, drug-disease, and drug-age interactions or the occurrence of adverse drug reactions. Indicators with the highest ratings included those suggesting the possibility of cardiovascular risks (QTc prolongation), delirium, gastrointestinal bleeding, and liver injury in specific patient subgroups with additional risk factors. Overprescribing indicators target patients with long treatment durations for depression, anxiety, and insomnia as well as high doses for pain and insomnia. CONCLUSIONS Explicit indicators of antidepressant high-risk and overprescribing may be used directly by patients and health care providers, and integrated within clinical decision support tools, in order to improve the overall risk/benefit balance of this commonly prescribed class of prescription drugs.
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Affiliation(s)
- Vita Brisnik
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany
| | - Jochen Vukas
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany
| | - Caroline Jung-Sievers
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany
| | - G Caleb Alexander
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ulrich Thiem
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Geriatrics, Albertinen-Haus, Hamburg, Germany
| | - Petra Thürmann
- Chair of Clinical Pharmacology, Faculty of Health, Department of Medicine, University Witten/Herdecke, Witten, Germany
- Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Cornelius Schüle
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Fischer
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Psychiatric Services Lucerne, Lucerne, Switzerland
| | - Erika Baum
- Institute of General Practice and Family Medicine, Philipps University Marburg, Marburg, Germany
| | - Michael Drey
- Department of Medicine IV, Geriatrics, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Harder
- Institute for Clinical Pharmacology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Wilhelm Niebling
- Department of Medicine, Division of General Practice, Medical Center, University of Freiburg, Freiburg, Germany
| | - Ulrike Janka
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Olaf Krause
- Institute of General Practice and Palliative Medicine, Medical School Hannover, Hannover, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
- Graduate Program "POKAL - Predictors and Outcomes in Primary Care Depression Care", (DFG - GrK 2621), Munich, Germany.
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Chen Y, Li J, Liao M, He Y, Dang C, Yu J, Xing S, Zeng J. Efficacy and safety of agomelatine versus SSRIs/SNRIs for post-stroke depression: a systematic review and meta-analysis of randomized controlled trials. Int Clin Psychopharmacol 2024; 39:163-173. [PMID: 37781768 DOI: 10.1097/yic.0000000000000509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Agomelatine is effective in the treatment of depression, but its effect for post-stroke depression (PSD) remains unclear. This study was conducted to compare the efficacy and safety of agomelatine versus SSRIs/SNRIs in treating PSD. We systematically searched Embase, PubMed, Cochrane Library, WanFang Data, China National Knowledge Infrastructure, and Cqvip databases for double-blind randomized controlled studies comparing the efficacy and safety of agomelatine versus SSRIs/SNRIs for PSD until December 2022. The primary efficacy endpoint was the Hamilton Depression Rating Scale (HAMD) score, and the primary safety endpoint was the incidence of overall adverse reactions. Nine studies comprising 857 patients with PSD were included. After 6-12 weeks of treatment, the HAMD score ( P = 0.16) and the overall response rates ( P = 0.20) in the agomelatine group were comparable to that in the SSRIs/SNRIs group. Participants treated with agomelatine achieved higher Barthel Index scores compared with the SSRIs/SNRIs group ( P = 0.02). There was a significantly lower incidence of overall adverse reactions ( P = 0.008) and neurological adverse reactions ( P < 0.0001) in the agomelatine group. The efficacy of agomelatine for treating PSD is probably comparable to that of SSRIs/SNRIs, and it may improve stroke outcomes with better safety.
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Affiliation(s)
- Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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Rehem AR, da Gama Viveiro LR, De Souza Santos EL, do Carmo PHF, da Silva NS, Junqueira JC, Scorzoni L. Antifungal and antibiofilm effect of duloxetine hydrochloride against Cryptococcus neoformans and Cryptococcus gattii. Folia Microbiol (Praha) 2024:10.1007/s12223-024-01164-1. [PMID: 38652436 DOI: 10.1007/s12223-024-01164-1] [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: 10/24/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
Cryptococcosis is an invasive mycosis caused mainly by Cryptococcus gattii and C. neoformans and is treated with amphotericin B (AMB), fluconazole and 5-fluorocytosine. However, antifungal resistance, limited and toxic antifungal arsenal stimulate the search for therapeutic strategies such as drug repurposing. Among the repurposed drugs studied, the selective serotonin reuptake inhibitors (SSRIs) have shown activity against Cryptococcus spp. However, little is known about the antifungal effect of duloxetine hydrochloride (DH), a selective serotonin and norepinephrine reuptake inhibitor (SSNRI), against C. neoformans and C. gattii. In this study, DH inhibited the growth of several C. neoformans and C. gattii strains at concentrations ranging from 15.62 to 62.50 µg/mL. In addition, DH exhibited fungicidal activity ranging from 15.62 to 250 µg/mL. In biofilm, DH treatment reduced Cryptococcus spp. biomass at a level comparable to AMB, with a significant reduction (85%) for C. neoformans biofilms. The metabolic activity of C. neoformans and C. gattii biofilms decreased significantly (99%) after treatment with DH. Scanning electron micrographs confirmed the anti-biofilm activity of DH, as isolated cells could be observed after treatment. In conclusion, DH showed promising antifungal activity against planktonic cells and biofilms of C. neoformans and C. gattii, opening perspectives for further studies with DH in vivo.
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Affiliation(s)
- Amanda Rodrigues Rehem
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Letícia Rampazzo da Gama Viveiro
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Evelyn Luzia De Souza Santos
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Paulo Henrique Fonseca do Carmo
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Newton Soares da Silva
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil
| | - Liliana Scorzoni
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), Av. Engenheiro Francisco José Longo, 777 São José dos Campos, São Paulo 12245-000, Brazil.
- Universidade de Guarulhos (UNG), Programa de Pós-Graduação em Enfermagem, Guarulhos, SP, Brasil.
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Axelsson MAB, Tukukino C, Parodi López N, Wallerstedt SM. Bleeding in patients on concurrent treatment with a selective serotonin reuptake inhibitor (SSRI) and low-dose acetylsalicylic acid (ASA) compared with SSRI or low-dose ASA alone-A systematic review and meta-analysis. Br J Clin Pharmacol 2024; 90:916-932. [PMID: 38351575 DOI: 10.1111/bcp.16000] [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: 09/12/2023] [Revised: 11/12/2023] [Accepted: 12/06/2023] [Indexed: 04/05/2024] Open
Abstract
AIMS The aim of this study was to systematically review whether concurrent treatment with an SSRI and low-dose ASA increases the risk of bleeding compared with treatment with an SSRI alone or ASA alone. METHODS Medline, Embase, the Cochrane Library, PsycINFO and Web of Science (from database inception to January 2023) were searched according to PICO: P = patients on treatment with an SSRI and/or low-dose ASA; I = intervention: SSRI + ASA; C = comparison: ASA or SSRI alone; O = outcomes: bleeding/major bleeding. The included articles were assessed using checklists. Studies without major risk of bias formed the basis for the conclusions. Extracted data were pooled using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE. RESULTS Twenty-four studies met the PICO and were included. One randomized and six nonrandomized studies were assessed not to have major risk of bias. Regarding SSRI + ASA vs. ASA only, the pooled hazard ratio of three nonrandomized studies (n = 38 467) was 1.37 (95% confidence interval: 1.10; 1.70; I2 = 0%), and the pooled odds ratio of two nonrandomized studies (n = 28 296) was 0.95 (0.77; 1.19; I2 = 0%). Regarding SSRI + ASA vs. SSRI only, the randomized controlled trial (n = 1048) reported a hazard ratio of 1.82 (0.66; 5.02), the hazard ratio being 1.60 (1.24; 2.06) for ASA vs. placebo in patients without SSRI treatment; and one nonrandomized controlled study (n = 18 920) reported an incidence rate ratio of 1.03 (0.96; 1.12). CONCLUSIONS The compiled evidence was too uncertain to support an interaction when an SSRI is added to low-dose ASA. Low-dose ASA added to an SSRI may imply an increased risk of bleeding primarily attributable to the initiation of ASA.
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Affiliation(s)
- Magnus A B Axelsson
- Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carina Tukukino
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- HTA-centrum, Sahlgrenska University Hospital, Gothenburg, Sweden
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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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Chaichan W, Ruengorn C, Thavorn K, Hutton B, Szepietowski JC, Bernstein JA, Chuamanochan M, Nochaiwong S. Comparative Safety Profiles of Individual Second-Generation H1-Antihistamines for the Treatment of Chronic Urticaria: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2365-2381. [PMID: 37088368 DOI: 10.1016/j.jaip.2023.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The comparative safety and/or dosing regimens of individual second-generation H1-antihistamines (sgAHs) in patients with chronic urticaria (CU) remain poorly elucidated. OBJECTIVE To compare the safety profiles of individual sgAHs and/or dosing regimens in adolescents or adult patients with CU using a systematic review and network meta-analysis of all available evidence. METHODS With limited English publications, electronic databases and gray literature were searched for randomized clinical trials from inception, with searches last updated on January 20, 2023. Relevant safety outcomes included treatment unacceptability (all-cause discontinuation), tolerability (discontinuation due to any adverse events), adverse events, serious adverse events, central nervous system (CNS) side effects, and anticholinergic side effects. Regarding the network estimates, the probability of being associated with the highest adverse outcome risk was estimated for each treatment comparison. RESULTS Fifty-one randomized clinical trials with 14 individual sgAHs and different dosing regimens, involving 7502 participants, were included. On the basis of the findings from network meta-analyses, variations in sgAH treatment comparisons were observed regarding the unacceptability of treatment, tolerability, adverse events, and CNS side effects. There were no statistically significant differences between the results of sgAH treatment for serious adverse events and those for anticholinergic side effects. On the basis of the ranking of safety profiles, emedastine 4 mg, mizolastine 10 mg, and cetirizine 10 mg were the top 3 ranked treatments with unfavorable safety profiles associated with CNS side effects and any adverse events. CONCLUSIONS These findings suggest evidence of variations in safety profiles among sgAHs for CU treatment, particularly in terms of adverse events and CNS side effects.
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Affiliation(s)
- Wasuchon Chaichan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, ICES uOttawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
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8
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Forgerini M, Schiavo G, Urbano G, de Nadai TR, Zapata-Cachafeiro M, Herdeiro MT, Mastroianni PDC. Use of Antidepressants and the Risk of Upper Gastrointestinal Tract Bleeding: A Case-control Study. Clin Ther 2023; 45:e159-e166. [PMID: 37179194 DOI: 10.1016/j.clinthera.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To investigate the association between the use of antidepressants and the risk of upper gastrointestinal tract bleeding (UGIB). METHODS A Case-control study was conducted in a Brazilian hospital complex. Cases were defined as patients with a diagnosis of UGIB and controls as patients admitted for reasons unrelated to gastrointestinal bleeding, gastric concerns, or complications associated with low-dose aspirin (LDA) or nonsteroidal anti-inflammatory drugs (NSAIDs) use. Sociodemographic and clinical data, comorbidities, drug therapy in use (long-term use and self-medication), and lifestyle habits were recorded through face-to-face interviews. Two groups were defined: use of antidepressants in general and use of antidepressants according to their affinity for serotonin transporters. The presence of synergism between the concomitant use of antidepressants and LDA or NSAIDs on the risk of UGIB was also explored. FINDINGS A total of 906 participants were recruited (200 in the case group and 706 in the control group). The use of antidepressants was not associated with the risk of UGIB (odds ratio [OR] = 1.503; 95% CI, 0.78-2.88) or the use of antidepressants with high affinity for serotonin receptors (OR = 1.983; 95% CI, 0.81-4.85). An increased risk of UGIB was observed in concomitant users of antidepressants and LDA (OR = 5.489; 95% CI, 1.60-18.81) or NSAIDs (OR = 18.286; 95% CI, 3.18-105.29). Despite the lack of significance, the use of antidepressants appears to be a positive modifier of UGIB risk in LDA and NSAID users. IMPLICATIONS These findings indicate an increased risk of UGIB in concomitant users of antidepressants and LDA or NSAIDs, suggesting the need to monitor antidepressant users, especially those most likely to develop UGIB. In addition, further studies with larger sample sizes are needed to confirm these findings.
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Affiliation(s)
- Marcela Forgerini
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Geovana Schiavo
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil
| | - Gustavo Urbano
- Department of Surgery, School of Medicine, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Tales Rubens de Nadai
- Department of Public Health, Bauru School of Dentistry, University of São Paulo (USP), Bauru, Brazil
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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Seifert J, Eckermann G, Heck J, Bleich S, Dabbert D, Grohmann R, Toto S. [Understanding and assessing the antidepressant drug-associated risk of bleeding]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023. [PMID: 37327817 DOI: 10.1055/a-2089-3490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are the most commonly prescribed psychopharmacological drug group. Thus, a precise knowledge of the expected adverse drug reactions is indispensable. The increased risk of bleeding events is well documented, especially in patients treated with SSRIs. However, many other antidepressant drug groups have also been implicated in increasing the risk of bleeding. In the following review, the thrombocytic serotonin system and the respective targets of the different antidepressants are explained. Subsequently, the available literature on bleeding under the respective antidepressant classes or individual substances is presented, using data from meta-analyses whenever possible. In addition to the risk of bleeding in general, individual bleeding entities are also considered, such as gastrointestinal and cerebral hemorrhages. Finally, the effects of other drugs that increase the risk of bleeding (i. e., nonsteroidal anti-inflammatory drugs, platelet aggregation inhibitors and anticoagulants) in combination with antidepressant drugs are discussed. The information presented here is meant to guide practitioner's decision making regarding an appropriate antidepressant pharmacotherapy based on the patient's individual risk constellation.
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Affiliation(s)
- Johanna Seifert
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gabriel Eckermann
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie, Arbeitsgruppe Polypharmazie, München, Germany
| | - Johannes Heck
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Stefan Bleich
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Dominik Dabbert
- Klinik für Forensische Psychiatrie und Psychotherapie, Klinikum Bremen-Ost gGmbH, Bremen, Germany
| | - Renate Grohmann
- Psychiatrie und Psychotherapie, Klinik und Poliklinik der Ludwig-Maximilians-Universität München, München, Germany
| | - Sermin Toto
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
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10
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Varesi A, Campagnoli LIM, Chirumbolo S, Candiano B, Carrara A, Ricevuti G, Esposito C, Pascale A. The Brain-Gut-Microbiota Interplay in Depression: a key to design innovative therapeutic approaches. Pharmacol Res 2023; 192:106799. [PMID: 37211239 DOI: 10.1016/j.phrs.2023.106799] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
Depression is the most prevalent mental disorder in the world associated with huge socio-economic consequences. While depressive-related symptoms are well known, the molecular mechanisms underlying disease pathophysiology and progression remain largely unknown. The gut microbiota (GM) is emerging as a key regulator of the central nervous system homeostasis by exerting fundamental immune and metabolic functions. In turn, the brain influences the intestinal microbial composition through neuroendocrine signals, within the so-called gut microbiota-brain axis. The balance of this bidirectional crosstalk is important to ensure neurogenesis, preserve the integrity of the blood-brain barrier and avoid neuroinflammation. Conversely, dysbiosis and gut permeability negatively affect brain development, behavior, and cognition. Furthermore, although not fully defined yet, changes in the GM composition in depressed patients are reported to influence the pharmacokinetics of common antidepressants by affecting their absorption, metabolism, and activity. Similarly, neuropsychiatric drugs may shape in turn the GM with an impact on the efficacy and toxicity of the pharmacological intervention itself. Consequently, strategies aimed at re-establishing the correct homeostatic gut balance (i.e., prebiotics, probiotics, fecal microbiota transplantation, and dietary interventions) represent an innovative approach to improve the pharmacotherapy of depression. Among these, probiotics and the Mediterranean diet, alone or in combination with the standard of care, hold promise for clinical application. Therefore, the disclosure of the intricate network between GM and depression will give precious insights for innovative diagnostic and therapeutic approaches towards depression, with profound implications for drug development and clinical practice.
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Affiliation(s)
- Angelica Varesi
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy.
| | | | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37121 Verona, Italy
| | - Beatrice Candiano
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Adelaide Carrara
- Child Neurology and Psychiatric Unit, IRCCS Mondino, Pavia, Italy
| | | | - Ciro Esposito
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy; Nephrology and dialysis unit, ICS S. Maugeri SPA SB Hospital, Pavia, Italy; High School in Geriatrics, University of Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy.
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11
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McFarland D, Merchant D, Khandai A, Mojtahedzadeh M, Ghosn O, Hirst J, Amonoo H, Chopra D, Niazi S, Brandstetter J, Gleason A, Key G, di Ciccone BL. Selective Serotonin Reuptake Inhibitor (SSRI) Bleeding Risk: Considerations for the Consult-Liaison Psychiatrist. Curr Psychiatry Rep 2023; 25:113-124. [PMID: 36708455 DOI: 10.1007/s11920-023-01411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW To present a clinically oriented review of selective serotonin reuptake inhibitor (SSRI)-related bleeding issues commonly addressed by consult-liaison psychiatrists. RECENT FINDINGS Concomitant medical, surgical, or hospital-based conditions exacerbate the risk of SSRI-related bleeding even though a review of the literature suggests it is only marginally elevated. Psychiatrists and other clinicians need to consider these conditions along with antidepressant benefits when answering the question: to start, hold, continue, or change the antidepressant? Where an evidence base is limited, mechanistic understanding may help consult-liaison psychiatrists navigate this terrain and collaborate with other medical specialties on responsible antidepressant management. Most often, the risk is cumulative; data are not directly applicable to complex clinical situations. This review incorporates a hematologic perspective and approach to bleeding risk assessment along with extant data on SSRI-induced bleeding risk ad specific medical conditions.
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Affiliation(s)
- Daniel McFarland
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA. .,Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
| | - Dale Merchant
- Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia.,Department of Consultation-Liaison Psychiatry, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Abhisek Khandai
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mona Mojtahedzadeh
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA.,Simms-Mann Center for Integrative Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Omar Ghosn
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jeremy Hirst
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Hermioni Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology, Dana-Farber Cancer Center, Boston, MA, USA
| | - Depti Chopra
- Department of Psychiatry, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Shehzad Niazi
- Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
| | - Jennifer Brandstetter
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andrew Gleason
- Department of Consultation-Liaison Psychiatry, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Garrett Key
- Department of Psychiatry, Ascension Seton Medical Center, Austin, TX, USA
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12
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Očovská Z, Maříková M, Vlček J. Potentially clinically significant drug-drug interactions in older patients admitted to the hospital: A cross-sectional study. Front Pharmacol 2023; 14:1088900. [PMID: 36817138 PMCID: PMC9932507 DOI: 10.3389/fphar.2023.1088900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Background: An international consensus list of potentially clinically significant drug-drug interactions (DDIs) in older people has been recently validated. Our objective was to describe the prevalence and characteristics of drug combinations potentially causing clinically significant DDIs identified in the medication history of older patients admitted to the hospital and the prevalence and characteristics of manifest DDIs-DDIs involved in adverse drug events present at hospital admission, DDIs that contributed to ADE-related hospital admissions, and DDIs involved in drug-related laboratory deviations. Methods: The data were obtained from our previous study that examined the drug-relatedness of hospital admissions to University Hospital Hradec Králové via the department of emergency medicine in the Czech Republic. Patients ≥ 65 years old were included. Drug combinations potentially causing clinically significant DDIs were identified using the international consensus list of potentially clinically significant DDIs in older people. Results: Of the 812 older patients admitted to the hospital, 46% were exposed to drug combinations potentially causing clinically significant DDIs. A combination of medications that affect potassium concentrations accounted for 47% of all drug combinations potentially causing clinically significant DDIs. In 27 cases, potentially clinically significant DDIs were associated with drug-related hospital admissions. In 4 cases, potentially clinically significant DDIs were associated with ADEs that were present at admissions. In 4 cases, the potentially clinically significant DDIs were associated with laboratory deviations. Manifest DDIs that contributed to drug-related hospital admissions most frequently involved antithrombotic agents and central nervous system depressants. Conclusion: The results confirm the findings from the European OPERAM trial, which found that drug combinations potentially causing clinically significant DDIs are very common in older patients. Manifest DDIs were present in 4.3% of older patients admitted to the hospital. In 3.3%, manifest DDIs contributed to drug-related hospital admissions. The difference in the rates of potential and manifest DDIs suggests that if a computerized decision support system is used for alerting potentially clinically significant DDIs in older patients, it needs to be contextualized (e.g., take concomitant medications, doses of medications, laboratory values, and patients' comorbidities into account).
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Affiliation(s)
- Zuzana Očovská
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Martina Maříková
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiří Vlček
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital Hradec Králové, Hradec Králové, Czech Republic,*Correspondence: Jiří Vlček,
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13
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Use of tramadol and the risk of bleeding complications in patients on oral anticoagulants: a systematic review and meta-analysis. Eur J Clin Pharmacol 2022; 78:1889-1898. [PMID: 36323905 DOI: 10.1007/s00228-022-03411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to determine whether tramadol intake increases the risk of bleeding in patients receiving oral anticoagulants. METHODS This systematic review was registered on PROSPERO, CRD42022327230. We searched PubMed and Embase up to 14 April 2022, and references and citations of included studies were screened. Comparative and non-comparative studies exploring bleeding complications among adult patients on oral anticoagulants and tramadol were included. Risk of bias was assessed using an adaptation of the Drug Interaction Probability Scale for case reports and case series and the Newcastle-Ottawa Scale for comparative studies. A meta-analysis was performed for the risk of serious bleeding (leading to hospitalisation or death) associated with tramadol in patients on vitamin K antagonists. RESULTS A total of 17 studies were included: 1 case series, 12 case reports, 2 case-control studies and 2 cohort studies. Most of the studies described tramadol-vitamin K antagonists' concomitant use; one case-control study also assessed dabigatran and rivaroxaban; one case report involved dabigatran. Among case reports/series, a total of 33 patients had a bleeding complication while using tramadol and an oral anticoagulant. The 4 comparative studies reported an increased bleeding risk during tramadol and vitamin K antagonist intake which was statistically significant in one study; the pooled risk ratio of serious bleeding was 2.68 [95% CI: 1.45 to 4.96; p < 0.001]. CONCLUSION This systematic review confirms an association between tramadol use and risk of bleeding in patients on vitamin K antagonists. Evidence is too limited to assess whether this risk extends to patients on direct oral anticoagulants, and further studies are needed.
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14
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Risk of Bleeding Among Individuals on Direct-Acting Oral Anticoagulants: An Academic Medical Center Cohort Study. J Cardiovasc Pharmacol 2022; 80:813-819. [PMID: 36084025 DOI: 10.1097/fjc.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/20/2022] [Indexed: 12/13/2022]
Abstract
ABSTRACT Previous research has identified risk factors that may affect the risk of bleeding when individuals are exposed to oral anticoagulants. It is unclear if the risk continues to exist with the direct oral anticoagulants (DOACs). The purpose of this study was to assess the risk of bleeding in patients on DOACs (apixaban, rivaroxaban, dabigatran, edoxaban, and betrixaban) based on known risk factors including demographics, medical conditions, and concomitant medications. This study was a retrospective analysis using electronic health record data from the University of Utah Hospital (Division of Cardiovascular Medicine) of individuals receiving a DOAC from 2015 to 2020. The primary outcome of interest was bleeding events [gastrointestinal (GI) bleeding, other anatomical site bleeding (excluding GI), and any bleeding] recorded in the electronic health record that codes using International Classification of Diseases 9th and 10th codes. Known risk factors were used to predict bleeding using multivariate logistic regression. A total of 5492 patients received a DOAC during the study period. Less than half the study population were female (2287, 41.6%). During the follow-up, there were 988 patients (18.0%) experiencing a bleeding event. Of them, 351 patients (35.5%) had a GI bleeding event. Significant risk factors of GI bleeding included clopidogrel [odds ratio (OR) 1.71; 95% confidence interval (95% CI), 1.16-2.52] and previous GI bleeding episodes (OR 7.73; 95% CI, 5.36-11.16). Exposure to corticosteroids (OR 1.50; 95% CI, 1.20-1.87) and previous GI bleeding (OR 1.61; 95% CI, 1.10-2.35) were associated with an increase in bleeding at other anatomical sites (not GI included).
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15
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Pineda E, Singh J, Pineda MV, Umanzor JG, Baires F, Benitez LG, Burgos C, Sekhon AK, Crisp N, Lewis AS, Radwanski J, Bermudez M, Barjun KS, Diaz O, Palou E, Escalante RE, Hernandez CI, Stevens ML, Eberhard D, Sierra M, Alvarado T, Videa O, Sierra-Hoffman M, Valerio-Pascua F. Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study. Front Pharmacol 2022; 13:1054644. [PMID: 36532727 PMCID: PMC9748291 DOI: 10.3389/fphar.2022.1054644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 09/06/2023] Open
Abstract
Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic. Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007-0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (-10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26-0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14-0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09-0.58). Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.
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Affiliation(s)
- Estela Pineda
- Department of Internal Medicine Hospital CEMESA, San Pedro Sula, Honduras
| | - Jarmanjeet Singh
- Department of Cardiovascular Medicine, University of California, Riverside, Riverside, CA, United States
| | - Miguel Vargas Pineda
- Department of Internal Medicine Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Jose Garay Umanzor
- Department of Obstetrics and Gynecology Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Fernando Baires
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luis G. Benitez
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Cesar Burgos
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Nicole Crisp
- Wound Care Department El Campo Memorial Hospital, El Campo, TX, United States
| | - Anita S. Lewis
- Pharmacy Department El Campo Memorial Hospital, El Campo, TX, United States
| | - Jana Radwanski
- Pharmacy Department Citizens Hospital, Victoria, TX, United States
| | - Marco Bermudez
- Department of Medicine SBH Health System, Bronx, NY, United States
| | - Karen Sanchez Barjun
- Department of Internal Medicine Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Oscar Diaz
- Department of Critical Care Hospital Regional del Norte Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Elsa Palou
- Internal Medicine Department, Facultad de Ciencas Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Rossany E. Escalante
- Department of Medicine, Facultad de Ciencas Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Mark L. Stevens
- Research Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
| | - Deke Eberhard
- Research Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
| | - Manuel Sierra
- Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras
| | - Tito Alvarado
- Infectiology Department, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Omar Videa
- Clínica de Atención Medica Integral CAMI, Tegucigalpa, Honduras
| | - Miguel Sierra-Hoffman
- Research and Infectious Disease Department, Texas A&M College of Medicine, Detar Family Medicine Residency Program, Victoria, TX, United States
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16
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Ngamvichchukorn T, Ruengorn C, Noppakun K, Thavorn K, Hutton B, Sood MM, Knoll GA, Nochaiwong S. Association Between Pretransplant Dialysis Modality and Kidney Transplant Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2237580. [PMID: 36264575 PMCID: PMC9585427 DOI: 10.1001/jamanetworkopen.2022.37580] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE The benefits and disadvantages of different pretransplant dialysis modalities and their posttransplant outcomes remain unclear in contemporary kidney transplant care. OBJECTIVE To summarize the available evidence of the association of different pretransplant dialysis modalities, including hemodialysis and peritoneal dialysis (PD), with posttransplant outcomes. DATA SOURCES MEDLINE, Embase, PubMed, Cochrane Library, Scopus, CINAHL, and gray literature were searched from inception to March 18, 2022 (updated to April 1, 2022), for relevant studies and with no language restrictions. STUDY SELECTION Randomized clinical trials and nonrandomized observational (case-control and cohort) studies that investigated the association between pretransplant dialysis modality and posttransplant outcomes regardless of age or donor sources (living or deceased) were abstracted independently by 2 reviewers. DATA EXTRACTION AND SYNTHESIS Following Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines, 2 reviewers independently extracted relevant information using a standardized approach. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratio (HR) or odds ratio and 95% CI. MAIN OUTCOMES AND MEASURES Primary outcomes included all-cause mortality, overall graft failure, death-censored graft failure, and delayed graft function. Secondary outcomes included acute rejection, graft vessel thrombosis, oliguria, de novo heart failure, and new-onset diabetes after transplant. RESULTS The study analyzed 26 nonrandomized studies (1 case-control and 25 cohort), including 269 715 patients (mean recipient age range, 14.5-67.0 years; reported proportions of female individuals, 29.4%-66.9%) whose outcomes associated with pretransplant hemodialysis vs pretransplant PD were compared. No significant difference, with very low certainty of evidence, was observed between pretransplant PD and all-cause mortality (13 studies; n = 221 815; HR, 0.92 [95% CI, 0.84-1.01]; P = .08) as well as death-censored graft failure (5 studies; n = 96 439; HR, 0.98 [95% CI, 0.85-1.14]; P = .81). However, pretransplant PD was associated with a lower risk for overall graft failure (10 studies; n = 209 287; HR, 0.96 [95% CI, 0.92-0.99]; P = .02; very low certainty of evidence) and delayed graft function (6 studies; n = 47 118; odds ratio, 0.73 [95% CI, 0.70-0.76]; P < .001; low certainty of evidence). Secondary outcomes were inconclusive due to few studies with available data. CONCLUSIONS AND RELEVANCE Results of the study suggest that pretransplant PD is a preferred dialysis modality option during the transition to kidney transplant. Future studies are warranted to address shared decision-making between health care professionals, patients, and caregivers as well as patient preferences.
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Affiliation(s)
- Tanun Ngamvichchukorn
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Kajohnsak Noppakun
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A. Knoll
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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17
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Belialov F. Drug classification for patients with comorbidities. J Pharm Policy Pract 2022; 15:56. [PMID: 36138411 PMCID: PMC9494913 DOI: 10.1186/s40545-022-00453-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Farid Belialov
- Department of Gerontology, Geriatrics, and Clinical Pharmacology, Russian Medical Academy of Continuous Professional Education, Yubileiny 100/4, Irkutsk, 664079, Russia.
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18
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Teppo K, Jaakkola J, Biancari F, Halminen O, Linna M, Putaala J, Mustonen P, Kinnunen J, Jolkkonen S, Niemi M, Hartikainen J, Airaksinen KEJ, Lehto M. Mental health conditions and bleeding events in patients with incident atrial fibrillation: A Finnish nationwide cohort study. Gen Hosp Psychiatry 2022; 78:117-122. [PMID: 36057233 DOI: 10.1016/j.genhosppsych.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We assessed the hypothesis that mental health conditions (MHCs) are associated with higher risk of bleeding in patients with atrial fibrillation (AF). METHODS The registry-based FinACAF study covers all patients with AF diagnosed during 2007-2018 in Finland. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and any MHC. The outcomes were first-ever gastrointestinal, intracranial, and any bleeding event. RESULTS We identified 205,019 patients (50.9% female; mean age 72.3 [standard deviation 13.4] years) with incident AF without prior bleeding, and the prevalence of any MHC was 6.1%. Any MHC, depression, and anxiety disorder were associated with the risk of any bleeding (adjusted hazard ratios (HRs) 1.19 [1.12-1.27], 1.21 [1.13-1.30], and 1.21 [1.08-1.35], respectively). Additionally, any MHC and depression were associated with the risk of gastrointestinal and intracranial bleeding and anxiety disorder with gastrointestinal bleeding. Bipolar disorder and schizophrenia were not associated with risk of bleeding. Use of oral anticoagulants was associated with the risk of any bleeding (adjusted HR 1.24 [95% CI 1.21-1.28)]), and this association was similar in patients with and without MHCs. Serotonin reuptake inhibitors were not associated with bleeding risk. CONCLUSIONS MHCs are associated with a higher risk of bleeding in patients with AF.
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Affiliation(s)
| | - Jussi Jaakkola
- University of Turku, Turku, Finland; Heart Unit, Satakunta Central Hospital, Pori, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Miika Linna
- Aalto University, Espoo, Finland; University of Eastern Finland, Kuopio, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Janne Kinnunen
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
| | - Juha Hartikainen
- University of Eastern Finland, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - K E Juhani Airaksinen
- University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland
| | - Mika Lehto
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Faculty of Medicine, Helsinki, Finland; Lohja Hospital, Department of Internal Medicine, Lohja, Finland
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19
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Hecker M, Frahm N, Bachmann P, Debus JL, Haker MC, Mashhadiakbar P, Langhorst SE, Baldt J, Streckenbach B, Heidler F, Zettl UK. Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases. Front Pharmacol 2022; 13:946351. [PMID: 36034780 PMCID: PMC9416235 DOI: 10.3389/fphar.2022.946351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with multiple sclerosis (MS) often undergo complex treatment regimens, resulting in an increased risk of polypharmacy and potential drug-drug interactions (pDDIs). Drug interaction databases are useful for identifying pDDIs to support safer medication use. Objective: To compare three different screening tools regarding the detection and classification of pDDIs in a cohort of MS patients. Furthermore, we aimed at ascertaining sociodemographic and clinical factors that are associated with the occurrence of severe pDDIs. Methods: The databases Stockley's, Drugs.com and MediQ were used to identify pDDIs by screening the medication schedules of 627 patients. We determined the overlap of the identified pDDIs and the level of agreement in pDDI severity ratings between the three databases. Logistic regression analyses were conducted to determine patient risk factors of having a severe pDDI. Results: The most different pDDIs were identified using MediQ (n = 1,161), followed by Drugs.com (n = 923) and Stockley's (n = 706). The proportion of pDDIs classified as severe was much higher for Stockley's (37.4%) than for Drugs.com (14.4%) and MediQ (0.9%). Overall, 1,684 different pDDIs were identified by at least one database, of which 318 pDDIs (18.9%) were detected with all three databases. Only 55 pDDIs (3.3%) have been reported with the same severity level across all databases. A total of 336 pDDIs were classified as severe (271 pDDIs by one database, 59 by two databases and 6 by three databases). Stockley's and Drugs.com revealed 47 and 23 severe pDDIs, respectively, that were not included in the other databases. At least one severe pDDI was found for 35.2% of the patients. The most common severe pDDI was the combination of acetylsalicylic acid with enoxaparin, and citalopram was the drug most frequently involved in different severe pDDIs. The strongest predictors of having a severe pDDI were a greater number of drugs taken, an older age, living alone, a higher number of comorbidities and a lower educational level. Conclusions: The information on pDDIs are heterogeneous between the databases examined. More than one resource should be used in clinical practice to evaluate pDDIs. Regular medication reviews and exchange of information between treating physicians can help avoid severe pDDIs.
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Affiliation(s)
- Michael Hecker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Niklas Frahm
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Paula Bachmann
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Jane Louisa Debus
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Marie-Celine Haker
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Pegah Mashhadiakbar
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Silvan Elias Langhorst
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Julia Baldt
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.,Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Barbara Streckenbach
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.,Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | | | - Uwe Klaus Zettl
- Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany
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20
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Zhu H, Liu H, Zhu JH, Wang SY, Zhou SS, Kong M, Mao Q, Long F, Fang ZJ, Li SL. Reply to "Comment on 'Efficacy of ginseng and its ingredients as adjuvants to chemotherapy in non-small cell lung cancer'" by H. W. Lee, L. Ang and M. S. Lee, Food Funct., 2022, 13, DOI: 10.1039/d1fo01914g. Food Funct 2022; 13:8332-8333. [PMID: 35834291 DOI: 10.1039/d2fo00744d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- He Zhu
- Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China. .,Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Hui Liu
- Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
| | - Jin-Hao Zhu
- Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
| | - Si-Yu Wang
- Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
| | - Shan-Shan Zhou
- Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Ming Kong
- Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Qian Mao
- Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Fang Long
- Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Zhi-Jun Fang
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
| | - Song-Lin Li
- Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China. .,Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
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21
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Pivato CA, Chandiramani R, Petrovic M, Nicolas J, Spirito A, Cao D, Mehran R. Depression and ischemic heart disease. Int J Cardiol 2022; 364:9-15. [PMID: 35643217 DOI: 10.1016/j.ijcard.2022.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022]
Abstract
Depression is common in patients with ischemic heart disease, and depressed patients are more likely to develop atherosclerosis and experience major cardiac events compared with the general population. The underlying pathophysiological mechanisms of these two diseases are highly interwoven and include an increased release of stress hormones, dysregulation of the autonomic nervous system, alterations of pathways related to primary and secondary hemostasis, endothelial dysfunction, and higher level of residual inflammation. Furthermore, depression negatively impacts compliance with medication regimens. As such, early recognition and treatment of depression provide the opportunity to improve outcomes of patients with ischemic heart disease. In the present review, we provide a summary of the evidence on the epidemiology, pathophysiology and management of depression in patients with ischemic heart disease.
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Affiliation(s)
- Carlo A Pivato
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rishi Chandiramani
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, USA
| | - Marija Petrovic
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Johny Nicolas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
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22
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Nochaiwong S, Chuamanochan M, Ruengorn C, Noppakun K, Awiphan R, Phosuya C, Tovanabutra N, Chiewchanvit S, Sood MM, Hutton B, Thavorn K, Knoll GA. Use of Thiazide Diuretics and Risk of All Types of Skin Cancers: An Updated Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14102566. [PMID: 35626169 PMCID: PMC9140049 DOI: 10.3390/cancers14102566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The use of thiazide diuretics is associated with skin cancer risk; however, whether this applies to all skin cancer types is unclear. Methods: In this meta-analysis, we searched multiple electronic databases and gray literature up to 10 April 2022, with no language restrictions, to identify relevant randomized controlled trials (RCTs) and non-randomized studies (cohort, case-control) that investigated the association between thiazide diuretics and skin cancer. The primary outcomes of interest were malignant melanoma and non-melanoma skin cancer (basal cell carcinoma [BCC], squamous cell carcinoma [SCC]). Secondary outcomes included other skin cancers (lip cancer, Merkel cell carcinoma, malignant adnexal skin tumors, oral cavity cancer, and precursors of skin cancer). We used a random-effects meta-analysis to estimate pooled adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Thirty non-randomized studies (17 case-control, 13 cohort, no RCTs) were included. Thiazide diuretic users had a higher risk of malignant melanoma (17 studies; n = 10,129,196; pooled adjusted OR, 1.10; 95% CI, 1.04−1.15; p < 0.001; strength of evidence, very low; very small harmful effect), BCC (14 studies; n = 19,780,476; pooled adjusted OR, 1.05; 95% CI, 1.02−1.09; p = 0.003; strength of evidence, very low; very small harmful effect), and SCC (16 studies; n = 16,387,862; pooled adjusted OR, 1.35; 95% CI, 1.22−1.48; p < 0.001; strength of evidence, very low; very small harmful effect) than non-users. Thiazide diuretic use was also associated with a higher risk of lip cancer (5 studies; n = 161,491; pooled adjusted OR, 1.92; 95% CI, 1.52−2.42; p < 0.001; strength of evidence, very low; small harmful effect), whereas other secondary outcomes were inconclusive. Conclusions: Thiazide diuretics are associated with the risk of all skin cancer types, including malignant melanoma; thus, they should be used with caution in clinical practice.
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Affiliation(s)
- Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (C.R.); (R.A.); (C.P.)
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
- Correspondence: (S.N.); (M.C.); Tel.: +66-53-944-342 (S.N.); +66-53-946-234 (M.C.)
| | - Mati Chuamanochan
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
- Department of Internal Medicine, Division of Dermatology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Correspondence: (S.N.); (M.C.); Tel.: +66-53-944-342 (S.N.); +66-53-946-234 (M.C.)
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (C.R.); (R.A.); (C.P.)
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
| | - Kajohnsak Noppakun
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ratanaporn Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (C.R.); (R.A.); (C.P.)
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
| | - Chabaphai Phosuya
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (C.R.); (R.A.); (C.P.)
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
| | - Napatra Tovanabutra
- Department of Internal Medicine, Division of Dermatology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Siri Chiewchanvit
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
- Department of Internal Medicine, Division of Dermatology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Manish M. Sood
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (M.M.S.); (G.A.K.)
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
- ICES uOttawa, Ottawa, ON K1Y 4E9, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai 50200, Thailand; (K.N.); (S.C.); (K.T.)
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
- ICES uOttawa, Ottawa, ON K1Y 4E9, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Greg A. Knoll
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (M.M.S.); (G.A.K.)
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
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