Factors affecting the development of adverse drug reactions to β-blockers in hospitalized cardiac patient population

Adverse drug reactions of Rituximab in patients suffering from autoimmune neurological diseases

BACKGROUND

Rituximab, a chimeric human/mouse monoclonal antibody targeting CD-20 antigens, has been used recently for various rheumatological and autoimmune diseases, including autoimmune neurological disorders.

OBJECTIVES

We aimed to study the frequency, seriousness, causality, and preventability of adverse drug reactions (ADRs) of rituximab in Iranian patients with autoimmune neurological diseases.

METHODS

In this cross-sectional observational study, patients with autoimmune neurological diseases who had an indication for rituximab treatment were enrolled. Naranjo adverse drug reaction probability scale was used to assess the causality of ADRs, and the preventability of the ADRs was determined by P-Method. The seriousness of ADRs was also determined.

RESULTS

A total of 264 ADRs were recorded from 97 patients. The Median (min-max) number of ADRs experienced by patients was 3 (1-7) events. 11.3% of patients experienced serious ADRs. 18.2% and 26.9% of ADRs were Definite and Probable, respectively. Only 5% of the ADRs were ''preventable". The most frequent ADRs were rituximab infusion-related reactions.

CONCLUSION

Rituximab had an acceptable safety profile in our study patients. However, there must be certain cautions regarding the use of the medication for the elderly or patients with a compromised immune system. Timely detection and management of ADRs would also be crucial to prevent severe and permanent damages. Moreover, considering that rituximab is used as an off-label treatment for autoimmune neurological diseases, a risk-benefit assessment would be necessary before deciding on the treatment choice.

The impact of pharmacogenetic testing in patients exposed to polypharmacy: a scoping review

Polypharmacy poses a significant risk for adverse reactions. While there are clinical decision support tools to assist clinicians in medication management, pharmacogenetic testing to identify potential drug-gene or drug-drug-gene interactions is not widely implemented in the clinical setting. A PRISMA-compliant scoping review was performed to determine if pharmacogenetic testing for absorption, distribution, metabolism, and excretion (ADME)-related genetic variants is associated with improved clinical outcomes in patients with polypharmacy. Six studies were reviewed. Five reported improved clinical outcomes, reduced side effects, reduction in the number of drugs used, or reduced healthcare utilization. The reviewed studies varied in methodological quality, risk of bias, and outcome measures. Age, diet, disease state, and treatment adherence also influence drug response, and may confound the relationship between genetic polymorphisms and treatment outcomes. Further studies using a randomized control design are needed. We conclude that pharmacogenetic testing represents an opportunity to improve health outcomes in patients exposed to polypharmacy, particularly in patients with psychiatric disorders and the elderly.

LncRNA-LET relieves hypoxia-induced injury in H9c2 cells through regulation of miR-138

Ischemic heart disease (IHD) is a common cardiovascular disease, occurs when coronary artery blood circularity cannot match with the heart's need. The present work attempted to study the effects of long noncoding RNA (lncRNA) low expression in tumor (LET) on the progression of IHD. H9c2 cells were injured by hypoxia to mimic a cell model of IHD. The effects of lncRNA-LET on hypoxia-injured H9c2 cells were tested by using cell counting kit-8 assay, flow cytometry, and Western blot analysis. MicroRNA-138 (miR-138) expression was tested by a quantitative real-time polymerase chain reaction, and the expression of c-Jun N-terminal kinase (JNK) and p38MAPK (p38-mitogen-activated protein kinase) proteins was measured by Western blot analysis. We found that hypoxia exposure significantly repressed the viability of H9c2 cells, and induced apoptosis. Meanwhile, phosphorylation of JNK and p38MAPK was enhanced by hypoxia. The expression of lncRNA-LET was repressed by hypoxia. Overexpression of lncRNA-LET attenuated hypoxia-induced injury in H9c2 cells. Moreover, miR-138 was a downstream effector of lncRNA-LET, that miR-138 was highly expressed in lncRNA-LET-overexpressed cell. The cardioprotective effects of lncRNA-LET were abolished when miR-138 was silenced. In conclusion, this study revealed the cardioprotective function of lncRNA-LET. lncRNA-LET conferred its cardioprotective effects possibly via upregulation of miR-138 and thus repressing the JNK and p38MAPK pathways.

‘You feel like you haven’t got any control’: A qualitative study of side effects from medicines

Objectives

An aging UK population and multi-morbidity means patients are receiving an increasing number of medicines. This can lead to greater risk of unintended side effects. The aim of this study was to increase understanding of how people identify and manage side effects from their medicines.

Design

A qualitative interview study with patients who had experienced side effects, recruited from community pharmacies.

Methods

This study examined patients’ experiences of side effects and the impact of these effects on their daily life. Fifteen participants were interviewed – 10 females and 5 males, with ages that ranged between 25 and 80 years, using different types and numbers of medicines.

Results

Thematic analysis revealed six themes: side effect experience, identification, adherence, information use, coping and body awareness. Participants described a wide range of physical and psychological symptoms which had both explicit and implicit impact on their lives. A system of identification based on constructed cognitive processes was common across participants. A variety of strategies were used by participants to cope with their side effects which included information seeking, social support seeking and non-adherent behaviours.

Conclusions

Psychological factors, such as medication beliefs, symptom interpretation and body awareness, contribute to cognitive and behavioural processes used to identify and manage side effects. These processes can have significant impacts on an individual’s decisions about adherence.

YiQiFuMai injection for chronic heart failure: Protocol for a systematic review and meta-analysis

BACKGROUND

Chronic heart AQ4 failure (CHF) is the final stage of various heart diseases. YiQiFuMai injection (YQFMI) has been widely applied in the treatment of CHF. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails (RCTs) regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the efficacy and safety of YQFMI for CHF.

METHODS

To evaluate the clinical efficacy of YQFMI in treating CHF, 2 researcher members will independently search the RCTs in the following 8 Chinese and English databases, in which the data collection will be from the time when the respective databases were established to January 2018. The databases will include MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, VIP Information and Wanfang Data. The therapeutic effects according to the mortality and the New York Heart Association (NYHA) function classification will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.

RESULTS

This study will provide a high-quality synthesis of current evidence of YQFMI for CHF from several aspects including mortality, NYHA function classification.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether YQFMI is an effective intervention for CHF.PROSPERO registration number: PROSPERO CRD42017079696.