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Kumar S, Bagepally BS. Cost-effectiveness of tumor necrosis factor-alpha inhibitors: a systematic review and meta-analysis of cost-utility studies. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1027-1040. [PMID: 37604704 DOI: 10.1080/14737167.2023.2249610] [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: 02/13/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To systematically review the cost-utility evidence of TNF-a-i treatment for rheumatoid arthritis (RA) and to estimate the pooled incremental net benefit (INBp). METHODS We selected economic evaluation studies reporting the cost-utility of TNF-a-i compared to other disease-modifying anti-rheumatic drugs (DMARDs) after a systematic search in PubMed, Embase, Scopus, and Tufts Medical Centers' cost-effective analysis registry. The results were reported as pooled INB in purchasing power parity-adjusted US dollars, along with 95% confidence intervals. We used GRADE quality assessment to present summaries of evidence and random-effects meta-analysis to synthesize cost-utility of TNF-a-i. RESULTS We included 86 studies for systematic review, of which 27 for meta-analysis. TNF-a-i is not cost-effective [$ -4,129(-6,789 to -1,469)] compared to other DMARDs but with high heterogeneity. There was no evidence of publication bias (p = 0.447). On separate analysis, TNF-a-i is not cost-effective [$ -4,805(-7,882 to -1,728)] compared to conventional synthetic DMARDs for RA treatment. GRADE assessment indicated very low confidence in pooled cost-utility results and likely presence of risk of bias on the overall ECOBIAS checklist in studies. CONCLUSION Based on the available evidence during the study period, TNF-a-i is not a cost-effective option for treating RA compared to other DMARDs. However, high heterogeneity and low confidence in GRADE quality assessment preclude the results from being generalizable.
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Affiliation(s)
- Sajith Kumar
- Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Bhavani Shankara Bagepally
- Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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Kuwana M, Tamura N, Yasuda S, Fujio K, Shoji A, Yamaguchi H, Iwasaki K, Makishima M, Kawata Y, Yamashita K, Igarashi A. Cost-effectiveness analyses of biologic and targeted synthetic disease-modifying anti-rheumatic diseases in patients with rheumatoid arthritis: Three approaches with a cohort simulation and real-world data. Mod Rheumatol 2023; 33:302-311. [PMID: 35445720 DOI: 10.1093/mr/roac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in rheumatoid arthritis. METHODS We conducted three analyses: a lifetime analysis with a cohort model (Study A) and two short-term analyses (Studies B and C). Study A evaluated the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained from costs of standard treatments. Study B evaluated yearly costs per person achieving American College of Rheumatology (ACR) response (ACR20, ACR50, and ACR70), and Study C evaluated costs per person achieving previously defined claims-based effectiveness (equivalent to 28-joint Disease Activity Score ≤ 3.2). The proportion of ACR responders to the drugs of interest were determined by mixed treatment comparisons. Studies B and C estimated costs using a claims database. RESULTS In Study A, ICERs of all b/tsDMARDs were lower than 5.0 million Japanese yen (JPY) per QALY. In Study B, yearly costs per person with ACR50 response were lower for subcutaneous tocilizumab (TCZ-SC; 1.9 million JPY) and SC abatacept (2.3 million JPY). In Study C, costs per person were lower for TCZ-SC (1.3 million JPY) and intravenous TCZ (1.6 million JPY) and effectiveness rates were higher for intravenous TCZ (45.3%) and infliximab (43.0%). CONCLUSION The b/tsDMARDs with lower prices showed higher cost-effectiveness.
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Affiliation(s)
- Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ayako Shoji
- Medilead Inc., Tokyo Opera City Tower, Shinjuku-ku, Tokyo 163-1424, Japan
| | - Hiroko Yamaguchi
- Medilead Inc., Tokyo Opera City Tower, Shinjuku-ku, Tokyo 163-1424, Japan
| | - Katsuhiko Iwasaki
- Medilead Inc., Tokyo Opera City Tower, Shinjuku-ku, Tokyo 163-1424, Japan
| | | | - Yuichi Kawata
- Chugai Pharmaceutical Co., Ltd., Chuo-ku, Tokyo 103-8324, Japan
| | | | - Ataru Igarashi
- Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University of Medicine, Yokohama 236-0004, Japan
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Kumar SS, Haridoss M, Venkataraman K, Bagepally BS. Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies. Front Pharmacol 2022; 13:1090361. [PMID: 36582538 PMCID: PMC9792993 DOI: 10.3389/fphar.2022.1090361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Janus kinase inhibitors (JAK-i), a class of targeted synthetic disease-modifying antirheumatic drugs (tDMARDs), are suggested as second or third-line therapies in rheumatoid arthritis (RA). Synthesized cost-effective evidence would aid in informed decision-making given the similar clinical effectiveness of JAKi, but incongruent cost-effectiveness reports. Methods: Literature search was conducted in PubMed, Embase, Scopus, and Tufts Medical Centers' cost-effective analysis registry. We pooled the incremental net benefit (INB) with 95% confidence interval (CI) using random-effects model and the heterogeneity was assessed using Cochrane-Q test and I2 statistic. Modified economic evaluation bias checklist was used to assess the quality of selected studies. Publication bias was assessed using a funnel plot and Egger's test. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was performed to assess the certainty of outcomes presented. Results: We included seventeen relevant studies for systematic review, of which fifteen were eligible for meta-analysis. The meta-analysis results showed that JAK-i is cost-effective compared to csDMARDS/bDMARDs with a pooled INB (INBp) of $19,886 (95% CI, 1,635 to 38,137) but with considerable heterogeneity (I2 = 99.14). As a second-line treatment for csDMARD failed RA, JAK-i is cost-effective than csDMARD/bDMARD with a pooled INB of $23,144 (74.1-46,214) and high heterogeneity (I2 = 99.67). But on a separate analysis JAK-i as second-line treatment is not cost-effective than TNF-a-i (INBp = $25,813, -5,714 to 57,340). However, leave-one-out analysis found that omitting a single outlier makes JAK-i cost-effective. Further, JAK-i is not cost-effective as a third-line treatment for csDMARD-TNF-a-I failed RA, compared to csDMARDs/bDMARDs with INBp $26,157 (-7,284 to 59,598). Conclusion: Meta-analysis suggests that JAK-i is cost-effective when used after csDMARD failure but not cost-effective when used after csDMARD-TNF-a-i failure with low certainty of evidence. Clinical Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222541, identifier CRD42021222541.
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Affiliation(s)
- S. Sajith Kumar
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - Madhumitha Haridoss
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
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Bonfiglioli KR, da Mota LMH, de Medeiros Ribeiro AC, Kakehasi AM, Laurindo IMM, Giorgi RDN, Duarte ALBP, Reis APMG, Ubirajara E Silva de Souza MPG, Brenol CV, da Rocha Castelar Pinheiro G, de Albuquerque CP, de Moura Castro CH, Pinto GLB, Verztman JF, Muniz LF, Bertolo MB, da Costa Pinto MR, Louzada Júnior P, Cruz VA, Pereira IA, de Freitas MVC, Cruz BA, Paiva E, Monticielo O, Provenza JR, Xavier RM. Recommendations of the Brazilian Society of Rheumatology for the use of JAK inhibitors in the management of rheumatoid arthritis. Adv Rheumatol 2021; 61:70. [PMID: 34819172 DOI: 10.1186/s42358-021-00228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Disciplina Reumatologia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), Av. Dr. Arnaldo, 455 - 3° andar - Reumatologia, São Paulo, SP, CEP, 01246-903, Brasil.
| | | | - Ana Cristina de Medeiros Ribeiro
- Disciplina Reumatologia do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), Av. Dr. Arnaldo, 455 - 3° andar - Reumatologia, São Paulo, SP, CEP, 01246-903, Brasil
| | - Adriana Maria Kakehasi
- Serviço de Reumatologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Rina Dalva Neubarth Giorgi
- Serviço de Reumatologia, Hospital do Servidor Público Estadual de São Paulo (HSPE-IAMSPE), São Paulo, Brazil
| | | | | | | | - Claiton Viegas Brenol
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, Brazil
| | | | | | | | | | | | | | - Manoel Barros Bertolo
- Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Paulo Louzada Júnior
- Disciplina de Reumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), Ribeirão Preto, Brazil
| | - Vitor Alves Cruz
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil
| | - Ivanio Alves Pereira
- Serviço de Reumatologia do Hospital Universitário, Universidade Federal de Santa Catarina-UFSC, Florianópolis, Brazil
| | | | | | - Eduardo Paiva
- Disciplina de Reumatologia, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Odirlei Monticielo
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, Brazil
| | - José Roberto Provenza
- Disciplina de Reumatologia da Pontificia, Universidade Católica de Campinas, PUC-Campinas, Campinas, Brazil
| | - Ricardo Machado Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, Brazil
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Li S, Li J, Peng L, Li Y, Wan X. Cost-Effectiveness of Baricitinib for Patients with Moderate-to-Severe Rheumatoid Arthritis After Methotrexate Failed in China. Rheumatol Ther 2021; 8:863-876. [PMID: 33893943 PMCID: PMC8217482 DOI: 10.1007/s40744-021-00308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION A phase 3 (RA-BEAM study) clinical trial reported that baricitinib (BCT) + methotrexate (MTX) had clinical improvement compared with adalimumab (ADA) + MTX as a first-line strategy in patients with rheumatoid arthritis (RA) who had inadequate responses to MTX monotherapy. However, from the perspective of the Chinese healthcare system, the cost-effectiveness of introducing BCT into current treatment for patients with RA unresponsive to MTX remains unclear. METHODS A patient-level microsimulation model was used to extrapolate the lifetime incremental cost per quality-adjusted life-year (QALY) and other outcomes. This study compared treatment sequences with or without first-line BCT with current treatment sequences, including adalimumab, etanercept, tocilizumab, and palliative care. Effectiveness and physical function were assessed using the American College of Rheumatology (ACR) 20/50/70 response and Health Assessment Questionnaire (HAQ). The input parameters of the model, comprising patient characteristics (sex and age) and treatment efficacy (ACR responses and HAQ score), were derived from a phase III clinical trial and network meta-analysis. The total cost estimation included direct costs and indirect costs. Probabilistic and univariate sensitivity analyses were performed, as were a series of scenario analyses. RESULTS The lifetime analysis revealed that adding BCT as a first-line treatment resulted in a QALY gain of 2.66 years; this gain would cost an incremental $26,662, leading to an incremental cost-effectiveness ratio of $10,036/QALY per patient compared with the current treatment sequence. Sensitivity and scenario analyses showed the results to be robust. CONCLUSIONS From a Chinese payer perspective, the introduction of BCT into the current treatment sequence is projected to be a cost-effective option as first-, second-, third-, and fourth-line treatment for patients with moderate-to-severe RA.
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Affiliation(s)
- SiNi Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.,The Xiangya Nursing School, Central South University, Changsha, 410013, China
| | - JianHe Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - LiuBao Peng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - YaMin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, 410011, China. .,The Xiangya Nursing School, Central South University, Changsha, 410013, China.
| | - XiaoMin Wan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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Angelini J, Talotta R, Roncato R, Fornasier G, Barbiero G, Dal Cin L, Brancati S, Scaglione F. JAK-Inhibitors for the Treatment of Rheumatoid Arthritis: A Focus on the Present and an Outlook on the Future. Biomolecules 2020; 10:E1002. [PMID: 32635659 PMCID: PMC7408575 DOI: 10.3390/biom10071002] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
Janus kinase inhibitors (JAKi) belong to a new class of oral targeted disease-modifying drugs which have recently revolutionized the therapeutic panorama of rheumatoid arthritis (RA) and other immune-mediated diseases, placing alongside or even replacing conventional and biological drugs. JAKi are characterized by a novel mechanism of action, consisting of the intracellular interruption of the JAK-STAT pathway crucially involved in the immune response. The aim of this narrative review is to globally report the most relevant pharmacological features and clinical outcomes of the developed and incoming JAKi for RA, based on the available preclinical and clinical evidence. A total of 219 papers, including narrative and systematic reviews, randomized controlled trials (RCTs), observational studies, case reports, guidelines, and drug factsheets, were selected. The efficacy and safety profile of both the first generation JAKi (baricitinib and tofacitinib) and the second generation JAKi (upadacitinib, filgotinib, peficitinib, decernotinib and itacitinib) were compared and discussed. Results from RCTs and real-life data are encouraging and outline a rapid onset of the pharmacologic effects, which are maintained during the time. Their efficacy and safety profile are comparable or superior to those of biologic agents and JAKi proved to be efficacious when given as monotherapy. Finally, the manufacturing of JAKi is relatively easier and cheaper than that of biologics, thus increasing the number of compounds being formulated and tested for clinical use.
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Affiliation(s)
- Jacopo Angelini
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20133 Milan, Italy; (J.A.); (G.F.); (G.B.); (L.D.C.); (S.B.)
| | - Rossella Talotta
- Department of Clinical and Experimental Medicine, Rheumatology Unit, AOU “Gaetano Martino”, University of Messina, 98100 Messina, Italy
| | - Rossana Roncato
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pordenone, 33081 Aviano, Italy;
| | - Giulia Fornasier
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20133 Milan, Italy; (J.A.); (G.F.); (G.B.); (L.D.C.); (S.B.)
- Pharmacy Unit, IRCCS-Burlo Garofolo di Trieste, 34137 Trieste, Italy
| | - Giorgia Barbiero
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20133 Milan, Italy; (J.A.); (G.F.); (G.B.); (L.D.C.); (S.B.)
| | - Lisa Dal Cin
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20133 Milan, Italy; (J.A.); (G.F.); (G.B.); (L.D.C.); (S.B.)
| | - Serena Brancati
- Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20133 Milan, Italy; (J.A.); (G.F.); (G.B.); (L.D.C.); (S.B.)
| | - Francesco Scaglione
- Head of Clinical Pharmacology and Toxicology Unit, Grande Ospedale Metropolitano Niguarda, Department of Oncology and Onco-Hematology, Director of Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, 20162 Milan, Italy;
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Ezzeldin E, Iqbal M, Asiri YA, Ali AA, Alam P, El-Nahhas T. A Hydrophilic Interaction Liquid Chromatography-Tandem Mass Spectrometry Quantitative Method for Determination of Baricitinib in Plasma, and Its Application in a Pharmacokinetic Study in Rats. Molecules 2020; 25:E1600. [PMID: 32244454 PMCID: PMC7180984 DOI: 10.3390/molecules25071600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 12/19/2022] Open
Abstract
Baricitinib, is a selective and reversible Janus kinase inhibitor, is commonly used to treat adult patients with moderately to severely active rheumatoid arthritis (RA). A fast, reproducible and sensitive method of liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the quantification of baricitinib in rat plasma has been developed. Irbersartan was used as the internal standard (IS). Baracitinib and IS were extracted from plasma by liquid-liquid extraction using a mixture of n-hexane and dichloromethane (1:1) as extracting agent. Chromatographic separation was performed using Acquity UPLC HILIC BEH 1.7 µm 2.1 × 50 mm column with the mobile phase consisting of 0.1% formic acid in acetonitrile and 20 mM ammonium acetate (pH 3) (97:3). The electrospray ionization in the positive-mode was used for sample ionization in the multiple reaction monitoring mode. Baricitinib and the IS were quantified using precursor-to-production transitions of m/z 372.15 > 251.24 and 429.69 > 207.35 for baricitinib and IS, respectively. The method was validated according to the recent FDA and EMA guidelines for bioanalytical method validation. The lower limit of quantification was 0.2 ng/mL, whereas the intra-day and inter-day accuracies of quality control (QCs) samples were ranged between 85.31% to 89.97% and 87.50% to 88.33%, respectively. Linearity, recovery, precision, and stability parameters were found to be within the acceptable range. The method was applied successfully applied in pilot pharmacokinetic studies.
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Affiliation(s)
- Essam Ezzeldin
- Department of Pharmaceutical Chemistry and Drug Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia or (M.I.)
- National Organization for Drug Control and Research, Cairo 12611, Egypt
| | - Muzaffar Iqbal
- Department of Pharmaceutical Chemistry and Drug Bioavailability Unit, Central Laboratory, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia or (M.I.)
| | - Yousif A. Asiri
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Azza A Ali
- Pharmacology and Toxicology Department, Faculty of Pharmacy (Girls) Al-Azhar University, Cairo 11754, Egypt;
| | - Prawez Alam
- Pharmacognosy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Toqa El-Nahhas
- Pharmacology and Toxicology Department, Faculty of Pharmacy (Girls) Al-Azhar University, Cairo 11754, Egypt;
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