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Cattaneo D, Caloni B, Caronni S, Calvagna N, Bonini I, Giacomelli A, Gervasoni C. Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference-A Case Study. Ther Drug Monit 2024; 46:277-280. [PMID: 38723113 DOI: 10.1097/ftd.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/23/2023] [Indexed: 05/14/2024]
Abstract
BACKGROUND Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations. METHODS A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia. RESULTS A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses. CONCLUSIONS The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug-drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.
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Affiliation(s)
- Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) Outpatient clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
| | - Beatrice Caloni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
| | - Stefania Caronni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
| | - Nunziata Calvagna
- Department of Laboratory Medicine, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Igor Bonini
- Department of Laboratory Medicine, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
| | - Cristina Gervasoni
- Gestione Ambulatoriale Politerapie (GAP) Outpatient clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy; and
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Giacomelli A, Ridolfo AL, Pezzati L, Oreni L, Carrozzo G, Beltrami M, Poloni A, Caloni B, Lazzarin S, Colombo M, Pozza G, Pagano S, Caronni S, Fusetti C, Gerbi M, Petri F, Borgonovo F, D’Aloia F, Negri C, Rizzardini G, Antinori S. Mortality rates among COVID-19 patients hospitalised during the first three waves of the epidemic in Milan, Italy: A prospective observational study. PLoS One 2022; 17:e0263548. [PMID: 35404963 PMCID: PMC9000097 DOI: 10.1371/journal.pone.0263548] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction This paper describes how mortality among hospitalised COVID-19 patients changed during the first three waves of the epidemic in Italy. Methods This prospective cohort study used the Kaplan-Meier method to analyse the time-dependent probability of death of all of the patients admitted to a COVID-19 referral centre in Milan, Italy, during the three consecutive periods of: 21 February-31 July 2020 (first wave, W1), 1 August 2020–31 January 2021 (second wave, W2), and 1 February-30 April 2021 (third wave, W3). Cox models were used to examine the association between death and the period of admission after adjusting for age, biological sex, the time from symptom onset to admission, disease severity upon admission, obesity, and the comorbidity burden. Results Of the 2,023 COVID-19 patients admitted to our hospital during the study period, 553 (27.3%) were admitted during W1, 838 (41.5%) during W2, and 632 (31.2%) during W3. The crude mortality rate during W1, W2 and W3 was respectively 21.3%, 23.7% and 15.8%. After adjusting for potential confounders, hospitalisation during W2 or W3 was independently associated with a significantly lower risk of death than hospitalisation during W1 (adjusted hazard ratios [AHRs]: 0.75, 95% confidence interval [CI] 0.59–0.95, and 0.58, 95% CI 0.44–0.77). Among the patients aged >75 years, there was no significant difference in the probability of death during the three waves (AHRs during W2 and W3 vs W1: 0.93, 95% CI 0.65–1.33, and 0.88, 95% CI 0.59–1.32), whereas those presenting with critical disease during W2 and W3 were at significantly lower risk of dying than those admitted during W1 (AHRs 0.61, 95% CI 0.43–0.88, and 0.44, 95% CI 0.28–0.70). Conclusions Hospitalisation during W2 and W3 was associated with a reduced risk of COVID-19 death in comparison with W1, but there was no difference in survival probability in patients aged >75 years.
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Affiliation(s)
- Andrea Giacomelli
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- * E-mail: ,
| | - Anna Lisa Ridolfo
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Laura Pezzati
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Letizia Oreni
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Giorgia Carrozzo
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martina Beltrami
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Poloni
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Beatrice Caloni
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Samuel Lazzarin
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martina Colombo
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giacomo Pozza
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Simone Pagano
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Stefania Caronni
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Chiara Fusetti
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Martina Gerbi
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Francesco Petri
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Fabio Borgonovo
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Fabiana D’Aloia
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Cristina Negri
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Giuliano Rizzardini
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Spinello Antinori
- Infectious Diseases Department, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Virgilio E, Vecchio D, Crespi I, Barbero P, Caloni B, Naldi P, Cantello R, Dianzani U, Comi C. Serum Vitamin D as a Marker of Impaired Information Processing Speed and Early Disability in Multiple Sclerosis Patients. Brain Sci 2021; 11:brainsci11111521. [PMID: 34827520 PMCID: PMC8615879 DOI: 10.3390/brainsci11111521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 01/18/2023] Open
Abstract
Slowed information processing speed (IPS) is the hallmark and first cognitive domain to be altered in multiple sclerosis (MS) patients. Insufficient serum vitamin D was previously associated with disease development, relapses, and progression, but little is reported on cognition. However, vitamin D and cognitive impairment (CI) in other neurodegenerative diseases have already been linked. We explored the possible correlation between vitamin D and IPS at diagnosis and early disability at last follow-up in 81 MS patients. At diagnosis, we collected vitamin D levels and performed a Symbol Digit Modalities Test (SDMT). Raw scores were adjusted for age, gender, and educational level. Early disability was evaluated with MS severity score (MSSS) and age-related MSSS (ARMSS). A total of 71 patients (86.58%) showed hypovitaminosis D (19.71 ± 8.76 ng/mL) and 18 patients (21.95%) had CI. Patients with CI showed severe hypovitaminosis D (p = 0.004). No patients with sufficient vitamin D levels had CI. We found a positive correlation between vitamin D levels at diagnosis and (1) SDMT raw and z-score that persisted after correction for sunlight exposure and MRI baseline characteristics, and (2) EDSS, MSSS, and ARMSS after a mean 2 year follow-up. Low vitamin D levels may affect both cognition and early disability in newly diagnosed MS patients.
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Affiliation(s)
- Eleonora Virgilio
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
- Ph.D. Program in Medical Sciences and Biotechnologies, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy;
- Correspondence: ; Tel.: +39-0321-3733964
| | - Domizia Vecchio
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Ilaria Crespi
- Clinical Biochemistry, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Paolo Barbero
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
| | - Beatrice Caloni
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
| | - Paola Naldi
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
| | - Roberto Cantello
- Neurology Unit, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy; (D.V.); (P.B.); (B.C.); (P.N.); (R.C.)
| | - Umberto Dianzani
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
- Clinical Biochemistry, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100 Vercelli, Italy;
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
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