National drug utilization trend of analgesics in China: an analysis of procurement data at 793 public hospitals from 2013 to 2018

Sufentanil combined with parecoxib sodium inhibits proliferation and metastasis of HER2-positive breast cancer cells and regulates epithelial-mesenchymal transition

BACKGROUND

Sufentanil combined with parecoxib sodium is a commonly used postoperative medication for cancer patients. However, the effects of this combination therapy on human epidermal growth factor receptor-2 (HER2)-positive breast cancer cells have still remained elusive. This study aimed to investigate the effects and potential mechanisms of sufentanil combined with parecoxib sodium on HER2-positive breast cancer cells.

METHODS

The cell counting kit-8 (CCK-8), colony formation, flow cytometry, scratch, transwell invasion, and angiogenesis assays were used to assess the proliferation, cell cycling, migration, invasion, and angiogenesis of HER2-positive breast cancer BT474 cells. Western blot assay was employed for detecting the expression levels of proteins involved in the cell cycle, migration, invasion, angiogenesis, and epithelial-mesenchymal transition (EMT). The in vivo effects of tumor growth and metastasis were examined by establishing an orthotopic transplantation mouse model of HER2-positive breast cancer (MMTV-PyMT).

RESULTS

Functional assays indicated that sufentanil combined with parecoxib sodium induced blockade of HER2-positive breast cancer BT474 cells in the G1 phase of the cell cycle and inhibited cell proliferation, migration, angiogenesis, and invasion in vitro. Western blot assay revealed that sufentanil combined with parecoxib sodium downregulated the expression levels of cyclin D1, matrix metalloproteinase-9 (MMP-9), cyclooxygenase-2 (COX-2), vascular endothelial growth factor A (VEGFA), and EMT-related proteins (N-cadherin, Vimentin, and Snail), while up-regulated the expression level of E-cadherin in BT474 cells. In addition, it was found that sufentanil combined with parecoxib sodium inhibited tumor growth and metastasis in the orthotopic transplantation mouse model of HER2-positive breast cancer.

CONCLUSION

Sufentanil combined with parecoxib sodium inhibited HER2-positive breast cancer progression, including cell proliferation, cell cycle, migration, invasion, and angiogenesis, and regulated EMT.

A Brief Overview of the Neuropharmacology of Opioid Addiction

The world is in the midst of an opioid crisis. Nearly 92,000 persons in the U.S. alone died from illicit drugs and prescription opioids in 2020 [1]. This number does not include the countless other individuals who die as a result of the violent crime that accompanies the illicit drug trade. To address this crisis, we need to appreciate aspects of drug addiction. The goal of this brief review is to highlight some major facets of addiction neurobiology, focused on opioids, to provide a basic understanding of the research and terminology encountered in more detailed in-depth articles and discussions on addiction.

New insight into the analgesic recipe: A cohort study based on smart patient-controlled analgesia pumps records

Purpose: Intravenous patient-controlled analgesia (IV-PCA) has been widely used; however, regimen criteria have not yet been established. In China, the most often used opioid is sufentanil, for which repeated doses are a concern, and empirical flurbiprofen axetil (FBP) as an adjuvant. We hypothesized that hydromorphone would be a better choice and also evaluated the effectiveness of FBP as an adjuvant.

Methods: This historical cohort study was conducted in two tertiary hospitals in China and included 12,674 patients using hydromorphone or sufentanil for IV-PCA between April 1, 2017, and January 30, 2021. The primary outcome was analgesic insufficiency at static (AIS). The secondary outcomes included analgesic insufficiency with movement (AIM) and common opioid-related adverse effects such as postoperative nausea and vomiting (PONV) and dizziness.

Results: Sufentanil, but not the sufentanil-FBP combination, was associated with higher risks of AIS and AIM compared to those for hydromorphone (OR 1.64 [1.23, 2.19], p < 0.001 and OR 1.42 [1.16, 1.73], p < 0.001). Hydromorphone combined with FBP also decreased the risk of both AIS and AIM compared to those for pure hydromorphone (OR 0.74 [0.61, 0.90], p = 0.003 and OR 0.80 [0.71, 0.91], p < 0.001). However, the risk of PONV was higher in patients aged ≤35 years using FBP (hydromorphone-FBP vs. hydromorphone and sufentanil-FBP vs. hydromorphone, OR 1.69 [1.22, 2.33], p = 0.001 and 1.79 [1.12, 2.86], p = 0.015).

Conclusion: Hydromorphone was superior to sufentanil for IV-PCA in postoperative analgesia. Adding FBP may improve the analgesic effects of both hydromorphone and sufentanil but was associated with an increased risk of PONV in patients <35 years of age.

Free Radical Scavenging and Analgesic Activities of 70% Ethanol Extract of Luvunga sarmentosa (BI.) Kurz from Central Kalimantan

Luvunga sarmentosa, commonly known as saluang belum, is widely used in Kalimantan to relieve pains, rheumatism, boost the immune system, and fever. The research on the free radical scavenging and analgesic effect of the L. sarmentosa stem extract has not been reported. This study aimed to evaluate the free radical scavenging and analgesic activity of the ethanol extract of L. sarmentosa. The L. sarmentosa stem was extracted using 70% ethanol and tested for free radical scavenging using the 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) and analgesic activity, acetic acid-induced writhing test, and hot plate test in an animal model. The results showed that the 70% ethanol extract of the L. sarmentosa had an anti-free radical scavenging and analgesic activity. The extract has weak free radical scavenging with an IC50 value of 293.45 µg/mL. Analgesic activity using the writhing test indicated that the extract significantly reduced the writhes count after oral administration in a dose-dependent manner compared to the negative control. Extract at a dose of 550 mg/kg BW can reduce the writhing test by 67.60% compared to others. In contrast, the diclofenac sodium reduced the number of writhes by 74.74%. While in a hot plate, the extract at a dose of 550 mg/kg BW produced a maximum possible analgesia (MPA) of 17.64%, lower than the MPA of diclofenac sodium (51.01%). Analgesic activity of the extract has higher inhibition on the writhing test than on the hot plate. The extract could be responsible for the peripheral mechanism by inhibiting the prostaglandin biosynthesis.

Prospective Prescription Review System Promotes Safe Use of Analgesics, Improves Clinical Outcomes, and Saves Medical Costs in Surgical Patients: Insights from Nanjing Drum Tower Hospital

Introduction

The rate of awareness of prospective prescription review for inpatient prescriptions remains low, and no study has evaluated prospective prescription review systems among hospitalized patients. In this study we evaluate the effect of a prospective prescription review system on the use of analgesics, clinical outcomes, and medical costs in hospitalized patients who underwent surgery.

Methods

A single-center, real-world study was conducted retrospectively at Drum Tower Hospital, Nanjing, China. Patient data were extracted from the medical records, before (June 2016–May 2017) and after (June 2018–May 2019) prescription review system implementation. The primary outcome was proportion of prescriptions of analgesics with potential risks. The secondary outcomes included prescription of opioids or non-opioids, usage of medications to manage analgesics-related adverse events, clinical outcomes, and medical costs. Propensity score matching was used to balance the cohort of patients before and after implementation of the prescription review system.

Results

A total of 28,150 inpatients were included for study analysis. After implementation of the prescription review system, the proportion of prescriptions of analgesics with potential risk was significantly reduced (6.3% vs 26.1%, P < 0.05). A significant decrease was observed in the proportion of patients prescribed opioids (24.3% vs 27.5%, P < 0.001) and tramadol (4.7% vs 12.1%, P < 0.001). There was a significant decrease in prescription of antiemetics (21.8% vs 34.1%, P < 0.001) and cathartics (38.4% vs 50.6%, P < 0.001) which were used in the management of opioid-related adverse events. There was a decreased length of stay in hospital [median (Q1, Q3) 10 (6, 17) vs 11 (7, 18), P < 0.01)] with similar readmission rates within 30 days post discharge (1.0% vs 0.8%, P = 0.099).

Conclusions

The introduction of the prescription review system was associated with safer prescribing, including a reduction in prescriptions of analgesics with potential risk and necessity of medication to manage analgesics-related adverse events, which resulted in better clinical outcomes and cost saving.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01935-z.