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Zhang X, Mu H, Zhong Y, Wang R, Li W. Effect of High Altitude Environment on Pharmacokinetic and Pharmacodynamic of Warfarin in Rats. Curr Drug Metab 2024; 25:54-62. [PMID: 38409697 DOI: 10.2174/0113892002277930240201101256] [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: 10/27/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND High altitude environment affects the pharmacokinetic (PK) parameters of drugs and the PK parameters are an important theoretical basis for guiding the rational clinical use of drugs. Warfarin is an oral anticoagulant of the coumarin class commonly used in clinical practice, but it has a narrow therapeutic window and wide individual variation. However, the effect of high altitude environment on PK and pharmacodynamic (PD) of warfarin is unclear. OBJECTIVE The objective of this study is to investigate the effect of a high altitude environment on PK and PD of warfarin in rats. METHOD Rats were randomly divided into plain group and high altitude group and blood samples were collected through the orbital venous plexus after administration of 2 mg/kg warfarin. Warfarin concentrations in plasma samples were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and PK parameters were calculated by the non-compartment model using WinNonlin 8.1 software. Meanwhile, the expression of PXR, P-gp and CYP2C9 in liver tissues was also determined by western blotting. The effect of high altitude environment on PD of warfarin was explored by measuring activated partial thromboplastin time (APTT) and prothrombin time (PT) values and then calculated international normalized ratio (INR) values based on PT. RESULTS Significant changes in PK behaviors and PD of warfarin in high altitude-rats were observed. Compared with the plain-rats, the peak concentration (Cmax) and the area under the plasma concentration-time curve (AUC) increased significantly by 50.9% and 107.46%, respectively. At the same time, high altitude environment significantly inhibited the expression of PXR, P-gp and CYP2C9 in liver tissues. The results of the PD study showed that high altitude environments significantly prolonged PT, APTT and INR values. CONCLUSION High altitude environment inhibited the metabolism and increased the absorption of warfarin in rats and increased the effect of anticoagulant effect, suggesting that the optimal dose of warfarin for patients at high altitude should be reassessed.
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Affiliation(s)
- Xiaojing Zhang
- Department of Pharmacy, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Hongfang Mu
- Department of Pharmacy, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Yan Zhong
- Department of Pharmacy, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Rong Wang
- Department of Pharmacy, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Wenbin Li
- Department of Pharmacy, 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, China
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Chen LJ, Zhou YJ, Wen ZH, Tian F, Li JY. Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis : A systematic review and meta-analysis of randomized controlled trials. Z Rheumatol 2021; 80:432-446. [PMID: 33346891 PMCID: PMC8189982 DOI: 10.1007/s00393-020-00944-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 01/21/2023]
Abstract
The current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13-1.74), 2.09 (95% CI, 1.67-2.61), and 2.24 (95% CI, 1.53-3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92-1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.
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Affiliation(s)
- L-J Chen
- Department of Rheumatology and Immunology, The Affiliated ZhuZhou Hospital of XiangYa Medical College, Central South University, 116 South Changjiang Road, 412007, ZhuZhou, Hunan Province, China
| | - Y-J Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Z-H Wen
- Department of Rheumatology and Immunology, The Affiliated ZhuZhou Hospital of XiangYa Medical College, Central South University, 116 South Changjiang Road, 412007, ZhuZhou, Hunan Province, China
| | - F Tian
- Department of Rheumatology and Immunology, The Affiliated ZhuZhou Hospital of XiangYa Medical College, Central South University, 116 South Changjiang Road, 412007, ZhuZhou, Hunan Province, China
| | - J-Y Li
- Department of Rheumatology and Immunology, The Affiliated ZhuZhou Hospital of XiangYa Medical College, Central South University, 116 South Changjiang Road, 412007, ZhuZhou, Hunan Province, China.
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Han Q, Zheng Z, Liang Q, Fu X, Yang F, Xie R, Ding J, Zhang K, Zhu P. Iguratimod reduces B-cell secretion of immunoglobulin to play a protective role in interstitial lung disease. Int Immunopharmacol 2021; 97:107596. [PMID: 33892300 DOI: 10.1016/j.intimp.2021.107596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our study aimed to investigate the effect of Iguratimod (IGU) on bleomycin (BLM)-induced interstitial lung disease (ILD). METHODS The pulmonary fibrosis model group mice were developed by intratracheal injection of BLM. Mice were divided into two groups at random: (1) Control group (BLM group) - endotracheal BLM (BLM, 3.5 mg/kg, Kayaku, Japan) plus an intraperitoneal injection of normal saline, and (2) BLM + IGU group - intratracheal BLM (same as the control group) + IGU intraperitoneal injection (50 mg/kg/d). The alveolar lavage fluid, histopathology/immunohistochemistry, imaging, and other tests were performed on days 7, 14, 21, and 28 after injection. RESULTS Lung function, including Compliance (Crs),Tissue damping (G), Static compliance (Cst), Inspiratory capacity (IC), Elastance (Ers), Tissue elastance (H) and Respiratory system resistance (Rrs) in mice, was improved by IGU. IGU reduced BLM-induced changes in pulmonary fibrosis and pulmonary inflammation, as shown in histological examination.Collagen production and inflammatory damage in the lungs caused by BLM were also reduced by IGU. IGU reduced the expression of immunoglobulin IgG and type I collagen in BLM-induced pulmonary fibrosis mice by inhibiting the production of B cells and immunoglobulin, and also delayed the deterioration of imaging changes. CONCLUSION IGU inhibits immunoglobulin secretion by B cells to relieve pulmonary inflammation and fibrosis. IGU also plays a protective role in the lung in ILD.
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Affiliation(s)
- Qing Han
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Qiang Liang
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Xianghui Fu
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Fengfan Yang
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ronghua Xie
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Jin Ding
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Kui Zhang
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Ping Zhu
- Department of Clinical Immunology, PLA Specialized Research Institute of Rheumatology & Immunology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, Shaanxi Province, China; National Translational Science Center for Molecular Medicine, Xi'an, China.
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Iguratimod: a valuable remedy from the Asia Pacific region for ameliorating autoimmune diseases and protecting bone physiology. Bone Res 2019; 7:27. [PMID: 31646017 PMCID: PMC6804744 DOI: 10.1038/s41413-019-0067-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
Autoimmune diseases are affected by complex pathophysiology involving several cell types, cytokines, antibodies, and mimicking factors. Different drugs are used to ameliorate these autoimmune reactions, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antiantibodies, and small molecular drugs (DMARDs), and they are clinically in vogue for diseases such as rheumatoid arthritis (RA). Nevertheless, low cost-effectiveness, reduced efficacy, adverse effects, and patient nonresponse are unappealing factors driving the development of new drugs such as iguratimod. Iguratimod is primarily used to ameliorate RA in Japanese and Chinese clinics. However, its efficacy against other autoimmune ailments is also under intense investigation, and the number of investigations is becoming increasingly larger with each passing day. The articular structure comprises synovium, ligaments, and bone. The latter is more complex than the others since it regulates blood cells and autoimmunity in addition to providing skeletal support to the body. Therefore, its protection is also of prime importance in RA and other autoimmune diseases. Herein, we have highlighted the role of iguratimod in autoimmune diseases and bone protection. We suggest that iguratimod’s unique mode of action compared with that of other DMARDs and its good patient response makes it a suitable antirheumatic and bone-protecting drug.
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Ishikawa K, Ishikawa J. Iguratimod, a synthetic disease modifying anti-rheumatic drug inhibiting the activation of NF-κB and production of RANKL: Its efficacy, radiographic changes, safety and predictors over two years’ treatment for Japanese rheumatoid arthritis patients. Mod Rheumatol 2018; 29:418-429. [DOI: 10.1080/14397595.2018.1481565] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Xia Y, Zhao S, Gong M, Ding L. A rapid and sensitive LC-MS/MS method for analysis of iguratimod in human plasma: Application to a pharmacokinetic study in Chinese healthy volunteers. Biomed Chromatogr 2018; 32:e4277. [PMID: 29729125 DOI: 10.1002/bmc.4277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/09/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022]
Abstract
A rapid, sensitive and reproducible LC-MS/MS method was developed and validated to determine iguratimod in human plasma. Sample preparation was achieved by protein precipitation with acetonitrile. Chromatographic separation was operated on an Ultimate® XB-C18 column (2.1 × 50 mm, 3.5 μm, Welch) with a flow rate of 0.400 mL/min, using a gradient elution with acetonitrile and water which contained 2 mm ammonium acetate and 0.1% formic acid as the mobile phase. The detection was performed on a Triple Quad™ 5500 mass spectrometer coupled with an electrospray ionization interface under positive-ion multiple reaction monitoring mode with the transition ion pairs of m/z 375.2 → 347.1 for iguratimod and m/z 244.3 → 185.0 for agomelatine (the internal standard), respectively. The method was linear over the range of 5.00-1500 ng/mL with correlation coefficients ≥0.9978. The accuracy and precision of intra- and inter-day, dilution accuracy, recovery and stability of the method were all within the acceptable limits and no matrix effect or carryover was observed. As a result, the main pharmacokinetic parameters of iguratimod were as follows: Cmax , 1074 ± 373 ng/mL; AUC0-72 , 13591 ± 4557 ng h/mL; AUC0-∞ , 13,712 ± 4613 ng h/mL; Tmax , 3.29 ± 1.23 h; and t1/2 , 8.89 ± 1.23 h.
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Affiliation(s)
- Ying Xia
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Shunbo Zhao
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Meng Gong
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
| | - Li Ding
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
- Nanjing Clinical Tech. Laboratories Inc., Nanjing, China
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Nakano T, Nakamura T, Nakamura Y, Irie K, Sato K, Matsuo K, Imakyure O, Ogata K, Mishima K, Kamimura H. Effects of Teicoplanin on the PT-INR Controlled by Warfarin in Infection Patients. YAKUGAKU ZASSHI 2017; 137:909-916. [PMID: 28674307 DOI: 10.1248/yakushi.17-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Warfarin (WF) shows a number of interactions with other drugs, which alter its anticoagulant effects. The albumin binding interaction is one such pharmacokinetic mechanism of drug interaction with WF, which induces a rise in the free WF concentration and thus increases the risk of WF toxicity. Teicoplanin (TEIC) is an anti-methicillin-resistant Staphylococcus aureus drug, which also binds strongly to albumin in the plasma. Therefore, co-administration of TEIC may displace WF from the albumin binding site, and possibly result in a toxicity. The present study was performed to investigate the drug-drug interaction between WF and TEIC in comparison with controls treated with vancomycin (VCM), which has the same spectrum of activity as TEIC but a lower albumin binding ratio.The records of 49 patients treated with WF and TEIC or VCM at Fukuoka University Hospital between 2010 and 2015 were retrospectively reviewed. These 49 patients consisted of 18 treated with TEIC in combination with WF, while 31 received VCM in combination with WF. Prothrombin time-international normalized ratio (PT-INR) showed a significant increase of 80.9 (52.0-155.3) % after co-administration of TEIC with WF. In contrast, the rate of PT-INR elevation associated with VCM plus WF was 30.6 (4.5-44.1) %. These observations suggested that TEIC can cause a rise in free WF concentration by albumin binding interaction. Therefore, careful monitoring of PT-INR elevation is necessary in patients receiving WF plus TEIC.
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Affiliation(s)
- Takafumi Nakano
- Department of Pharmacy, Fukuoka University Hospital.,Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University
| | | | - Yoshihio Nakamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital
| | - Keiichi Irie
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Keisuke Sato
- Department of Pharmacy, Fukuoka University Hospital
| | - Kohichi Matsuo
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Osamu Imakyure
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Kentaro Ogata
- Department of Pharmacy, Fukuoka University Hospital.,Department of Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Kenichi Mishima
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Hidetoshi Kamimura
- Department of Pharmacy, Fukuoka University Hospital.,Department of Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University
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Mimori T, Harigai M, Atsumi T, Fujii T, Kuwana M, Matsuno H, Momohara S, Takei S, Tamura N, Takasaki Y, Ikeuchi S, Kushimoto S, Koike T. Safety and effectiveness of 24-week treatment with iguratimod, a new oral disease-modifying antirheumatic drug, for patients with rheumatoid arthritis: interim analysis of a post-marketing surveillance study of 2679 patients in Japan. Mod Rheumatol 2016; 27:755-765. [PMID: 27919207 DOI: 10.1080/14397595.2016.1265695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the real-world safety and effectiveness of iguratimod (IGU) for rheumatoid arthritis (RA), a 52-week, Japanese, post-marketing surveillance study was conducted. An interim analysis at week 24 was performed. METHODS This study included all RA patients who received IGU following its introduction to the market. All adverse events (AEs) and adverse drug reactions (ADRs) were collected. Effectiveness was evaluated by the change in Disease Activity Score 28-C-reactive protein (DAS28-CRP) from baseline to week 24. RESULTS Safety was analyzed in 2679 patients. The overall incidences of AEs, ADRs, and serious ADRs were 38.41, 31.65, and 3.21%, respectively; the most commonly reported serious ADRs were pneumonia/bacterial pneumonia, interstitial lung disease, and Pneumocystis jiroveci pneumonia. Concomitant glucocorticoid use and comorbid conditions associated with respiratory disease were identified as risk factors for serious infections. Pulmonary alveolar hemorrhage and increased international normalized ratio of prothrombin time were observed with concomitant use of IGU and warfarin. The DAS28-CRP decreased from baseline to week 24. CONCLUSION Although a safety concern was identified with concomitant use of IGU and warfarin, this real-world study showed no other new safety concerns and similar effectiveness to clinical trials. IGU is a new therapeutic option for RA patients.
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Affiliation(s)
- Tsuneyo Mimori
- a Department of Rheumatology and Clinical Immunology , Graduate School of Medicine, Kyoto University , Kyoto , Japan
| | - Masayoshi Harigai
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Tatsuya Atsumi
- c Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Hokkaido , Japan
| | - Takao Fujii
- d Department of Rheumatology and Clinical Immunology , Wakayama Medical University , Wakayama , Japan
| | - Masataka Kuwana
- e Department of Allergy and Rheumatology , Nippon Medical School Graduate School of Medicine , Tokyo , Japan
| | | | - Shigeki Momohara
- g Hakkeikai Incorporated Medical Institution , Shizuoka , Japan.,h Department of Orthopaedic Surgery , Keio University , Tokyo , Japan
| | - Syuji Takei
- i Department of Pediatric Rheumatology, Faculty of Medicine , School of Health Sciences, Medical Center for Children, Kagoshima University , Kagoshima , Japan
| | - Naoto Tamura
- j Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Yoshinari Takasaki
- k Faculty of Medicine , Juntendo University Koshigaya Hospital, Juntendo University , Saitama , Japan
| | - Satoshi Ikeuchi
- l Frontier PMS Section, Neurology Medical Department , Medical Division, Eisai Co, Ltd , Tokyo , Japan
| | - Satoru Kushimoto
- m Post-Marketing Surveillance Group, Data Science and Administration Department , Toyama Chemical Co, Ltd , Tokyo , Japan , and
| | - Takao Koike
- n Sapporo Medical Center NTT EC , Hokkaido , Japan
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