1
|
Abd Talib AKA, Tan SC, Jamal R, Azizan EA, Shaharir SS, Abdul Murad NA. Associated genetic polymorphisms and clinical manifestations in systemic lupus erythematosus in Asian populations - A systematic literature review. Med J Malaysia 2021; 76:541-550. [PMID: 34305116] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a chronic and life-threatening autoimmune disease. Its prevalence and clinical manifestations are known to be particularly severe in the Asian populations. Although genetics is known to play an important role in SLE susceptibility and clinical manifestations, the specific polymorphisms associated with these phenotypes in Asia are unclear. Therefore, we aim to review the association of SLE genetic polymorphisms with lupus manifestations across Asian populations and their role in the pathogenesis of SLE. METHODS A systematic search was conducted on PubMed, EBSCOHost, and Web of Science. We identified 22 casecontrol studies that matched our inclusion and exclusion criteria. Information such as study characteristics, genetic polymorphisms associated with SLE, and organ manifestations was extracted and reported in this review. RESULTS In total, 30 polymorphisms in 16 genes were found to be associated with SLE among Asians. All included polymorphisms also reported associations with various SLE clinical features. The association of rs1234315 in TNFSF4 linking to SLE susceptibility (P=4.17x10-17 OR=1.45 95% CI=1.34-1.59) and musculoskeletal manifestation (P=3.35x10-9, OR=1.37, 95%CI= 1.23-1.51) might be the most potential biomarkers to differentiate SLE between Asian and other populations. In fact, these associated genetic variants were found in loci that were implicated in immune systems, signal transduction, gene expression that play important roles in SLE pathogenesis. DISCUSSIONS AND CONCLUSIONS This review summarized the potential correlation between 30 genetic polymorphisms associated with SLE and its clinical manifestations among Asians. More efforts in dissecting the functional implications and linkage disequilibrium of associated variants may be required to validate these findings.
Collapse
Affiliation(s)
- A K A Abd Talib
- Universiti Kebangsaan Malaysia (UKM), UKM Medical Molecular Biology Institute (UMBI), Cheras, Kuala Lumpur, Malaysia
| | - S C Tan
- Universiti Kebangsaan Malaysia (UKM), UKM Medical Molecular Biology Institute (UMBI), Cheras, Kuala Lumpur, Malaysia
| | - R Jamal
- Universiti Kebangsaan Malaysia (UKM), UKM Medical Molecular Biology Institute (UMBI), Cheras, Kuala Lumpur, Malaysia
| | - E A Azizan
- Universiti Kebangsaan Malaysia (UKM), Department of Medicine, Endocrinology Unit, Cheras, Kuala Lumpur, Malaysia
| | - S S Shaharir
- Universiti Kebangsaan Malaysia (UKM), Department of Internal Medicine, Rheumatology Unit, Cheras, Kuala Lumpur, Malaysia
| | - N A Abdul Murad
- Universiti Kebangsaan Malaysia (UKM), UKM Medical Molecular Biology Institute (UMBI), Cheras, Kuala Lumpur, Malaysia.
| |
Collapse
|
2
|
Pancharatnam D, Yong SM, Tan SC. Osteomyelitis: An Uncommon Complication of BCG Vaccination. Malays Orthop J 2021; 15:144-145. [PMID: 33880166 PMCID: PMC8043633 DOI: 10.5704/moj.2103.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- D Pancharatnam
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - S M Yong
- Department of Orthopaedic Surgery, Tung Shin Hospital, Kuala Lumpur, Malaysia
| | - S C Tan
- Department of Paediatric, Tung Shin Hospital, Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Loong HH, Wong CKH, Leung LKS, Dhankhar P, Insinga RP, Chandwani S, Hsu DC, Lee MYK, Huang M, Pellissier J, Rai A, Achra M, Tan SC. Cost Effectiveness of PD-L1-Based Test-and-Treat Strategy with Pembrolizumab as the First-Line Treatment for Metastatic NSCLC in Hong Kong. Pharmacoecon Open 2020; 4:235-247. [PMID: 31531842 PMCID: PMC7248157 DOI: 10.1007/s41669-019-00178-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Pembrolizumab, a monoclonal antibody against programmed death ligand 1 (PD-L1), is approved by several regulatory agencies for first-line treatment of metastatic non-small-cell lung cancer (NSCLC) with a PD-L1 tumor proportion score (TPS) ≥ 50% and no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase genomic tumor aberrations. This study was conducted from the perspective of the Hospital Authority in Hong Kong and aimed to evaluate the cost effectiveness of a biomarker (PD-L1) test-and-treat strategy (BTS), in which patients with a TPS ≥ 50% received pembrolizumab and other patients received platinum doublet chemotherapy versus all patients receiving platinum doublet chemotherapy. METHODS The model used a partitioned survival approach to estimate the incremental cost-effectiveness ratio (ICER) expressed as the cost per quality-adjusted life-year (QALY) gained. The clinical efficacy, utility and safety data were derived from the KN024 trial. Costs and health outcomes were projected over a 10-year time horizon and discounted at 3% per year. Costs for drug acquisition, PD-L1 testing, drug administration and disease management were used. Sensitivity analyses were conducted to evaluate the robustness of results. RESULTS The BTS approach led to an increase of 0.29 QALYs at an additional cost of Hong Kong dollars (HK$) 249,077 (US$31,933) compared with platinum doublet chemotherapy, resulting in an ICER of HK$865,189 (US$110,922) per QALY gained. This is lower than the World Health Organization cost-effectiveness threshold of three times the 2016 gross domestic product (GDP) per capita for Hong Kong of HK$1017,819 (US$130,490). Probabilistic sensitivity analyses showed a 59.4% chance that the ICER would be below this threshold. CONCLUSION First-line treatment with pembrolizumab in a BTS to identify patients with NSCLC with PD-L1 TPS ≥ 50% can be considered cost effective in Hong Kong compared with platinum doublet chemotherapy based on a three-times GDP per capita threshold. However, local data on clinical efficacy and safety were not available to estimate overall survival (OS) and progression-free survival (PFS) specific to patients with NSCLC in Hong Kong. Further, uncertainty is inherent in the survival projections/extrapolation of PFS and OS beyond the trial period, and future research may help to further inform these parameters.
Collapse
Affiliation(s)
- Herbert H Loong
- Department of Clinical Oncology, State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Linda Kam Suet Leung
- Department of Clinical Oncology, State Key Laboratory in Oncology of South China, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Praveen Dhankhar
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Ralph P Insinga
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA.
| | - Sheenu Chandwani
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - Danny C Hsu
- Merck Sharp & Dohme (Asia) Ltd, Hong Kong, Hong Kong
| | - Mary Y K Lee
- Merck Sharp & Dohme (Asia) Ltd, Hong Kong, Hong Kong
| | - Min Huang
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - James Pellissier
- Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence, North Wales, PA, USA
| | - Akanksha Rai
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Monika Achra
- Complete HEOR Solutions LLC, 1120 Welsh Road, Suite 205, North Wales, PA, 19454, USA
| | - Seng Chuen Tan
- Merck Sharp & Dohme (Asia Pacific), Singapore, Singapore
| |
Collapse
|
4
|
Yong YF, Tan SC, Liew MWO, Yaacob NS. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) method development for screening of potential tamoxifen-drug/herb interaction via in vitro cytochrome P450 inhibition assay. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1148:122148. [PMID: 32416571 DOI: 10.1016/j.jchromb.2020.122148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/19/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
Screening for potential drug-drug interaction (DDI) or herb-drug interaction (HDI) using in vitro cytochrome P450 inhibition (IVCI) assays requires robust analytical methods with high sensitivity and reproducibility. Utilization of liquid chromatography-mass spectrometry (LC-MS) for analyte quantification is often hampered by the presence of non-volatile IVCI sample buffer constituents that often results in ion suppression. In this study, to enable screening of drug interactions involving tamoxifen (TAM) metabolism using IVCI-LC-MS/MS, a liquid-liquid extraction (LLE) method was developed and optimized for sample clean-up. Utilization of chloroform as extraction solvent and adjustment of sample pH to 11 was found to result in satisfactory recovery (>70%) and low ion suppression (<19%). A LC-MS/MS method was subsequently developed and validated for simultaneous quantification of major TAM metabolites, such as N-desmethyltamoxifen (NDT), endoxifen (EDF) and 4-hydroxytamoxifen (HTF) to enable IVCI sample analysis. Satisfactory separation of E-/Z-isomers of endoxifen with peak resolution (Rs) of 1.9 was achieved. Accuracy and precision of the method was verified within the linear range of 0-50 ng/mL for NDT, 0-25 ng/mL for HTF and 0-25 ng/mL for EDF (E/Z isomers). Inhibitory potency (IC50, Ki and mode of inhibition) of known CYP inhibitors and Strobilanthes crispus extract was then evaluated using the validated method. In summary, the results demonstrated applicability of the developed LLE and validated LC-MS/MS method for in vitro screening of DDI and HDI involving TAM metabolism.
Collapse
Affiliation(s)
- Y F Yong
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - S C Tan
- Usains Biomics Laboratory Testing Services Sdn. Bhd., Universiti Sains Malaysia, Minden 11800, Penang, Malaysia
| | - Mervyn W O Liew
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Minden 11800, Penang, Malaysia.
| | - N S Yaacob
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| |
Collapse
|
5
|
Loong HH, Wong CKH, Leung LKS, Tan SC, Jen J, Lee MYK, Aguiar-Ibáñez R, Wang J. Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong. Cost Eff Resour Alloc 2020; 18:2. [PMID: 31969794 PMCID: PMC6964068 DOI: 10.1186/s12962-020-0200-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma. Methods A partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer's perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome. Results In base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904. Conclusions Pembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.
Collapse
Affiliation(s)
- Herbert H Loong
- 1Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.,State Key Laboratory in Translational Research, Hong Kong Cancer Institute, Hong Kong, Hong Kong SAR, China
| | - Carlos K H Wong
- 3Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Linda K S Leung
- 1Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.,State Key Laboratory in Translational Research, Hong Kong Cancer Institute, Hong Kong, Hong Kong SAR, China
| | - S C Tan
- MSD Asia Pacific, Singapore, Singapore
| | | | | | | | | |
Collapse
|
6
|
Qin S, Kruger E, Tan SC, Cheng S, Wang N, Liang J. Cost-effectiveness analysis of FOLFOX4 and sorafenib for the treatment of advanced hepatocellular carcinoma in China. Cost Eff Resour Alloc 2018; 16:29. [PMID: 30087583 PMCID: PMC6076412 DOI: 10.1186/s12962-018-0112-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. In China, sorafenib and oxaliplatin plus infusional-fluorouracil/leucovorin (FOLFOX4) are approved for the systemic treatment of advanced HCC. This study compared the cost-effectiveness of these therapies from a healthcare system perspective and a patient perspectives. Methods A Markov model was constructed using overall and progression-free survival rates and adverse event (AE) rate from two randomized controlled studies of advanced HCC patients from Asia: EACH for FOLFOX4 and ORIENTAL for sorafenib. The patients in the Markov model were followed until death, the length of each Markov cycle was 1 month, and the survival was adjusted for quality-adjusted life years (QALYs). Direct medical costs included costs of therapies, AE treatment, general ward and tests. Costs were derived from published sources, interviews with oncologists and hospital data from China. One-way and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the results. Results From the healthcare system perspective, FOLFOX4 dominated sorafenib with lower therapy costs (FOLFOX4: US$ 6972; sorafenib: US$ 12,289), lower direct medical costs (FOLFOX4: US$ 8428; sorafenib: US$ 12,798), and higher QALYs (FOLFOX4: 0.42; sorafenib: 0.38) per patient. This result was robust according to comprehensive one-way sensitivity analyses. According to the PSA, at the cost-effectiveness threshold for China (3 × GDP, US$ 22,073), FOLFOX4 should be chosen in 63.9% of simulations. From the patient perspective, FOLFOX4 also dominated sorafenib. Conclusions The study results indicate that FOLFOX4 dominates sorafenib because it appears to provide higher effectiveness with significantly lower costs in treating Chinese advanced HCC patients.
Collapse
Affiliation(s)
- Shukui Qin
- Department of Medical Oncology, People's Liberation Army Cancer Center, Eight One Hospital, Nanjing, China
| | - Eliza Kruger
- Economics and Outcomes, Real World Evidence, IMS Health, San Francisco, USA
| | - Seng Chuen Tan
- Economics and Outcomes, Real World Evidence, IMS Health, Singapore, Singapore
| | - Shuqun Cheng
- 4Department of Hepatic Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Nanya Wang
- 5Cancer Center, First Hospital of Jilin University, Jilin, China
| | - Jun Liang
- 6Department of Medical Oncology, Peking University Cancer Hospital, Peking University International Hospital, No. 1 Life Garden Road, Zhongguancun Life Science Park, Changping District, Beijing, 102206 China
| |
Collapse
|
7
|
Younossi ZM, Chan HLY, Dan YY, Lee MH, Lim YS, Kruger E, Tan SC. Impact of ledipasvir/sofosbuvir on the work productivity of genotype 1 chronic hepatitis C patients in Asia. J Viral Hepat 2018; 25:228-235. [PMID: 29053909 DOI: 10.1111/jvh.12808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022]
Abstract
Chronic, untreated hepatitis C virus (HCV) infection is associated with a poor clinical prognosis and a detrimental impact on patients' lives, including on work productivity. To estimate the value of productivity losses due to genotype 1 (GT1) HCV infection in Hong Kong, Singapore, South Korea and Taiwan and to estimate the potential productivity gains associated with treating patients with ledipasvir/sofosbuvir (LDV/SOF) therapy, an economic model was developed with a time horizon of 1 year. Hepatitis C virus patients entered the model at 12 weeks post-treatment, having achieved or not achieved sustained virological response (SVR). Absenteeism and presenteeism rates were taken from a pooled analysis of data from the ION 1-3 studies. These rates were converted into hours of lost productivity, multiplied by the average wage and applied to the total employed, adult GT1 population in each country. Results were compared assuming no treatment, and assuming all patients were treated with LDV/SOF. Total productivity losses due to untreated HCV were: $11.3 million, $17.1 m, $146.0 m and $349.1 m in Hong Kong, Singapore, South Korea and Taiwan. LDV/SOF treatment resulted in economic gains of $4.5 m, $6.8 m, $58.7 m and $138 m, respectively. These gains were due to reduced presenteeism. The results were sensitive to changes in the prevalence of HCV and the average wage. In conclusion, productivity losses due to untreated HCV infection represent a substantial economic burden. By instituting universal HCV treatment with LDV/SOF (or other therapies with high SVR rates), productivity gains can be achieved.
Collapse
Affiliation(s)
- Z M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - H L Y Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Y Y Dan
- University Medicine Cluster, National University Hospital, Singapore City, Singapore
| | - M H Lee
- National Yang-Ming University, Taipei, Taiwan
| | - Y-S Lim
- Department of Gastroenterology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - E Kruger
- IMS Health, Singapore City, Singapore
| | - S C Tan
- IMS Health, Singapore City, Singapore
| |
Collapse
|
8
|
Nagaya D, Zahari Z, Saleem M, Yahaya BH, Tan SC, Yusoff NM. An analysis of genetic association in opioid dependence susceptibility. J Clin Pharm Ther 2017; 43:80-86. [PMID: 28656735 DOI: 10.1111/jcpt.12585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
WHAT IS KNOWN Drug addiction is a novelty-seeking personality trait that is associated with the candidate genes OPRD1 (opioid delta receptors), OPRK1 (opioid kappa receptors) and PDYN (prodynorphin). However, associations between single nucleotide polymorphisms (SNPs) rs1042114 (80G>T) of the OPRD1 gene, rs702764 (843 A>G) of the OPRK1 gene, and rs910080 (3' UTR _743T>C), rs1997794 (5' UTR -381A>G) and rs1022563 (3' UTR) of the PDYN gene and novelty seeking remain controversial as reported results have not been reproducible. OBJECTIVE The goal of this study was to determine the frequencies of SNPs rs1042114, rs702764, rs1997794, rs1022563 and rs910080 in the Malaysian population and to study their association with opioid dependence in Malaysian Malays. METHODS A total of 459 Malay male with opioid dependence and 543 healthy male (controls) subjects were included in this study. SNPs were genotyped using the TaqMan SNP genotyping assay. Statistical analysis was performed using Golden Helix SVS software suite to identify the distribution of allele and genotype frequencies, and SNP-SNP interactions were also analysed in this study. RESULTS AND DISCUSSION SNP rs1042114 in the OPRD1 gene is strongly associated with opiate addiction (P=.0001). In individuals homozygous for this risk allele, the likelihood of opiate addiction is increased by a factor 1.62 (95% confidence interval (CI) 1.412-1.875). Polymorphic alleles at SNP rs702764 of OPRK1 were not associated with opioid dependence. A significant association between opioid dependence and SNP rs910080 of PDYN (P=.0217) was detected, but there was no association for SNPs rs199774 and rs1022563. A significant interaction was also identified between homozygous wild-type genotype TT of rs702764 with the risk genotypes TG/GG of rs1042114 (odds ratio (OR)=2.111 (95% CI 1.227-3.631), P=.0069) and with the risk genotypes GA/AA of rs910080 (OR=1.415 (95% CI 1.04-1.912), P=.0239). WHAT IS NEW AND CONCLUSION The results indicate that SNPs rs1042114 and rs910080 contribute to vulnerability to opioid dependence in the Malaysian Malay population. These results will help us to understand the effect of the SNPs and the SNP-SNP interaction on opioid dependence and may assist in efforts to screen vulnerable individuals and match them with individually tailored prevention and treatment strategies.
Collapse
Affiliation(s)
- D Nagaya
- Cluster for Regenerative Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Minden, Penang, Malaysia.,Penang Medical College, George Town, Penang, Malaysia
| | - Z Zahari
- Department of Pharmacy, Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - M Saleem
- GenomixLab, Advanced Genomics Sdn Bhd, Petaling Jaya, Malaysia
| | - B H Yahaya
- Cluster for Regenerative Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - S C Tan
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - N M Yusoff
- Cluster for Regenerative Medicine, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Minden, Penang, Malaysia
| |
Collapse
|
9
|
Sheng G, Chen S, Dong C, Zhang R, Miao M, Wu D, Tan SC, Liu C, Xiong T. Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis. J Med Econ 2017; 20:371-381. [PMID: 27936995 DOI: 10.1080/13696998.2016.1271336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective. METHODS A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses. RESULTS In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers). CONCLUSIONS The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.
Collapse
Affiliation(s)
- Guangying Sheng
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Suning Chen
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Chaohui Dong
- b Institute for Social Security Research, Ministry of Human Resources and Social Security of P.R.C , Beijing , PR China
| | - Ri Zhang
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Miao Miao
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Depei Wu
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Seng Chuen Tan
- c Health Economics & Outcomes Research, IMS Health Asia Pacific , Singapore
| | - Chao Liu
- d Novartis Oncology (China) , Beijing , PR China
| | - Tengbin Xiong
- e Health Economics & Outcomes Research, IMS Health China , Shanghai , PR China
| |
Collapse
|
10
|
Sheng G, Chen S, Zhang R, Miao M, Wu D, Tan SC, Liu C, Xiong T. The impact of medical insurance coverage and molecular monitoring frequency on outcomes in chronic myeloid leukemia: real-world evidence in China. J Med Econ 2017; 20:382-387. [PMID: 27937141 DOI: 10.1080/13696998.2016.1271337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Imatinib (Glivec) has been covered by critical disease insurance for treatment of chronic myeloid leukemia (CML) in Jiangsu province of China since 2013. Further, free molecular monitoring has been provided to patients at top clinical centers as part of a pilot study that has changed the local treatment pattern and outcomes of patients with CML. This study evaluates the impact of medical insurance coverage and the molecular monitoring frequency on outcomes of patients with CML treated at a central hospital in Jiangsu, China, according to patient-level data. METHODS The study investigated 335 CML patients receiving medical treatment in a central hospital between January 1, 2011 and December 31, 2014. Demographic and clinical characteristics were extracted from the patients' clinical records. Univariate and multivariate analyses using the logistic regression model were performed to identify the differences in outcomes of major molecular response (MMR) or complete cytogenetic response (CCyR) between patients who were insured vs uninsured, or between patients with frequency of PCR monitoring ≤2 times vs ≥3 times per year. RESULTS Both the achievement of MMR (BCR-ABLIS ≤0.1%) (50.4% vs 37.5%) and CCyR (80.7% vs 62.8%) at 12 months have shown significant differences that favored patients with insurance coverage of imatinib, while there was no significant difference in the outcome of BCR-ABLIS ≤1% between insured and non-insured groups (56.0% vs 51.3%) at 6 months. The long-term results at 24 months demonstrated that there was a statistically significant difference in MMR rates between the group with 3 or more PCR monitoring tests per year and the group of patients with 2 or less PCR tests per year (76.9% vs 52.2%). CONCLUSIONS The study findings suggest that CML patients benefit from insurance coverage of imatinib and higher frequency (≥3) of regularly scheduled molecular monitoring PCR in China.
Collapse
Affiliation(s)
- Guangying Sheng
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Suning Chen
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Ri Zhang
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Miao Miao
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Depei Wu
- a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University , Suzhou , PR China
| | - Seng Chuen Tan
- b Health Economics & Outcomes Research, IMS Health Asia Pacific , Singapore
| | - Chao Liu
- c Novartis Oncology (China) , Beijing , PR China
| | - Tengbin Xiong
- d Health Economics & Outcomes Research, IMS Health China , Shanghai , PR China
| |
Collapse
|
11
|
Yang L, Chuen Tan S, Chen C, Wang X, Li X, Yang X. Economic Evaluation of Sevelamer versus Calcium-based Binders in Treating Hyperphosphatemia among Patients with End-stage Renal Disease in China. Clin Ther 2016; 38:2459-2467.e1. [PMID: 27751671 DOI: 10.1016/j.clinthera.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. METHODS A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon. A hazard ratio (0.54; 95% CI, 0.32-0.93) of the overall survival for sevelamer versus CBBs was used to calculate the survival of the sevelamer group. Clinical and cost data were derived from literature and health care system in the local setting. Incremental life year and quality-adjusted life year (QALY) were the primary outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the model assumptions and parameters. The results were reported in 2015 Chinese Renminbi. FINDINGS The incremental cost per life year and per QALY gained of sevelamer versus CBBs was ¥44,475 and ¥57,910, respectively. The incremental cost per QALY gained was below the World Health Organization's recommended cost-effectiveness threshold (¥151,070), which is 3 times the gross domestic product per capita of 2015 in China. The incremental cost-effectiveness ratio was most sensitive to the hazard ratio of overall survival with sevelamer versus CBBs in the 1-way sensitivity analysis. The cost-effectiveness acceptability curve indicated that sevelamer had a 89.6% likelihood of cost-effectiveness at the ¥151,070 threshold. IMPLICATIONS Sevelamer is likely to be a cost-effective option in treating hyperphosphatemia among patients with ESRD compared with CBBs in the local context of China.
Collapse
Affiliation(s)
- Li Yang
- Peking University Health Science Centre, Beijing, China.
| | | | - Can Chen
- IMS Health Asia Pacific, Singapore
| | | | - Xinya Li
- Peking University Health Science Centre, Beijing, China
| | | |
Collapse
|
12
|
Cui M, Tu CC, Chen EZ, Wang XL, Tan SC, Chen C. A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China. Adv Ther 2016; 33:1600-11. [PMID: 27397588 DOI: 10.1007/s12325-016-0375-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. METHODS This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters' uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation. RESULTS The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold. CONCLUSION This analysis suggests that treatment with clopidogrel plus ASA for up to 1 year for patients with NSTEACS is cost effective in the local context of China from a public payers' perspective. FUNDING Sanofi China.
Collapse
|
13
|
Tan SC, Li L, Yu W, Chen C, Shi R. Review of cardiovascular disease prevention and control programs: international experience and challenges in China. ICFJ 2016. [DOI: 10.17987/icfj.v6i0.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
<p style="margin: 0cm 9.35pt 0pt 0cm; text-align: justify; -ms-text-justify: inter-ideograph;"><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;" lang="EN-GB">Major cardiovascular risk factors in China</span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt; mso-fareast-font-family: 宋体; mso-fareast-theme-font: minor-fareast; mso-fareast-language: ZH-CN;" lang="EN-GB">, such as hyperlipidemia, hypertension, dietary factors, exposure to tobacco, diabetes, obesity and physical inactivity, </span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;" lang="EN-GB">have contributed to deteriorating trends in cardiovascular disease (CVD) deaths. In past years, a number of CVD prevention programs have been initiated in European and American countries and successfully brought down CVD related death rate by involving various parties such as physicians, patients, government agencies and payers. However, there is </span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt; mso-fareast-font-family: 宋体; mso-fareast-theme-font: minor-fareast; mso-fareast-language: ZH-CN;" lang="EN-GB">rare</span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;" lang="EN-GB"> published literature that systemically reviewed such experience, which would be highly valuable for China and other countries with high CVD burden. In this article, we review the published literature on CVD prevention and control programs and report on interviews of local and foreign experts to provide recommendations for China-specific CVD prevention </span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt; mso-fareast-font-family: 宋体; mso-fareast-theme-font: minor-fareast; mso-fareast-language: ZH-CN;" lang="EN-GB">and control </span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;" lang="EN-GB">programs. </span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt; mso-fareast-font-family: 宋体; mso-fareast-theme-font: minor-fareast; mso-fareast-language: ZH-CN;" lang="EN-GB">In order to provide practical suggestions, w</span><span style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;" lang="EN-GB">e describe the type of programs as patient, physician, pharmacist, nurse, or payer-focused. Based on this evidence and identified challenges in China, programs focusing on disease management, treatment adherence, physician/health care provider education, financial incentives, and integrated healthcare are recommended for the prevention and control of CVD in China.</span></p>
Collapse
|
14
|
Tan SC, Matzen P, Yeo LN. Budget Impact Analysis Of Biphasic Insulin Aspart In The Treatment Of Type 2 Diabetes Mellitus In Malaysia: A Public Payer Perspective. Value Health 2014; 17:A743. [PMID: 27202679 DOI: 10.1016/j.jval.2014.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - P Matzen
- Novo Nordisk Pharma Malaysia, Kuala Lumpur, Malaysia
| | - L N Yeo
- Novo Nordisk Pharma Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
15
|
Tan SC, Matzen P, Khoo SP. Budget Impact Analysis Of Wider Adoption Of Biphasic Insulin Aspart (Biasp) In The Treatment Of Type 2 Diabetes Mellitus (T2dm): A Perspective Of Patients Treated By Public Providers In Singapore. Value Health 2014; 17:A743. [PMID: 27202681 DOI: 10.1016/j.jval.2014.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - P Matzen
- Novo Nordisk Pharma Malaysia, Kuala Lumpur, Malaysia
| | - S P Khoo
- Novo Nordisk Pharma Singapore, Singapore
| |
Collapse
|
16
|
Tan SC, Low PY, Chia MTXY. Drug Access Through Sharing Public And Individual Responsibilities In The Public Health Care System Of Singapore. Value Health 2014; 17:A790. [PMID: 27202947 DOI: 10.1016/j.jval.2014.08.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
17
|
Huang Y, Gao L, Xie X, Tan SC. Epidemiology of dyslipidemia in Chinese adults: meta-analysis of prevalence, awareness, treatment, and control. Popul Health Metr 2014; 12:28. [PMID: 25371655 PMCID: PMC4219092 DOI: 10.1186/s12963-014-0028-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [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: 03/12/2014] [Accepted: 10/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous epidemiology studies on dyslipidemia have been conducted in China. However, a nationally representative estimate for dyslipidemia prevalence is lacking. The aim of this study is to appraise the nationwide prevalence, awareness, treatment, and control rates of dyslipidemia in adults in China. METHODS We performed a systematic review of the related observational studies published since 2003 by searching English and Chinese literature databases. Meta-analyses were conducted in eligible studies using a random effect model to summarize the dyslipidemia prevalence, awareness, treatment, and control rates. Heterogeneity and publication bias were analyzed. Sensitivity analyses were performed to explain heterogeneity and examine the impact of study quality on the results of meta-analyses. RESULTS Thirty-eight papers were included for meta-analyses, with a total sample size of 387,825. The prevalence, awareness, treatment, and control rates of dyslipidemia were 41.9% (95% CI: 37.7% - 46.2%), 24.4% (95% CI: 14.4% - 38.4%), 8.8% (95% CI: 7.7% - 10.0%), and 4.3% (95% CI: 4.1% - 4.5%), respectively. The prevalence of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, low levels of high-density lipoprotein cholesterol, and high levels of low-density lipoprotein cholesterol were 10.1% (95% CI: 5.8% - 16.9%), 17.7% (95% CI: 14.0% - 22.1%), 5.1% (95% CI: 3.1% - 8.2%), 11.0% (95% CI: 8.0% - 15.0%), and 8.8% (95% CI: 4.1% - 17.8%), respectively. Sensitivity analyses revealed that males had a higher prevalence of dyslipidemia (43.2%) than females (35.6%). Study samples of age 30 and above in the eastern region tended to have higher prevalence of dyslipidemia. The quality of the studies has a slight impact on the pooled estimates. CONCLUSIONS The overall pooled prevalence of dyslipidemia in Chinese adults was estimated to be 41.9%, with males having a higher rate than females.
Collapse
Affiliation(s)
- Yuanxiu Huang
- />School of Public Health, Central South University, Changsha, China
| | - Lin Gao
- />School of Public Health, Central South University, Changsha, China
| | - Xiaoping Xie
- />Outcomes Research, Pfizer Investment Co. Ltd, Beijing, China
| | - Seng Chuen Tan
- />Health Economics & Outcomes Research, IMS Health Asia Pacific, 8 Cross Street, #21-01/02/03 PWC Building, Singapore, 048424 Singapore
| |
Collapse
|
18
|
Khaw KY, Choi SB, Tan SC, Wahab HA, Chan KL, Murugaiyah V. Prenylated xanthones from mangosteen as promising cholinesterase inhibitors and their molecular docking studies. Phytomedicine 2014; 21:1303-1309. [PMID: 25172794 DOI: 10.1016/j.phymed.2014.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 04/30/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
Garcinia mangostana is a well-known tropical plant found mostly in South East Asia. The present study investigated acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities of G. mangostana extract and its chemical constituents using Ellman's colorimetric method. Cholinesterase inhibitory-guided approach led to identification of six bioactive prenylated xanthones showing moderate to potent cholinesterases inhibition with IC50 values of lower than 20.5 μM. The most potent inhibitor of AChE was garcinone C while γ-mangostin was the most potent inhibitor of BChE with IC50 values of 1.24 and 1.78 μM, respectively. Among the xanthones, mangostanol, 3-isomangostin, garcinone C and α-mangostin are AChE selective inhibitors, 8-deoxygartanin is a BChE selective inhibitor while γ-mangostin is a dual inhibitor. Preliminary structure-activity relationship suggests the importance of the C-8 prenyl and C-7 hydroxy groups for good AChE and BChE inhibitory activities. The enzyme kinetic studies indicate that both α-mangostin and garcinone C are mixed-mode inhibitors, while γ-mangostin is a non-competitive inhibitor of AChE. In contrast, both γ-mangostin and garcinone C are uncompetitive inhibitors, while α-mangostin is a mixed-mode inhibitor of BChE. Molecular docking studies revealed that α-mangostin, γ-mangostin and garcinone C interacts differently with the five important regions of AChE and BChE. The nature of protein-ligand interactions is mainly hydrophobic and hydrogen bonding. These bioactive prenylated xanthones are worthy for further investigations.
Collapse
Affiliation(s)
- K Y Khaw
- Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - S B Choi
- Bioprocess Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - S C Tan
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - H A Wahab
- Pharmaceutical Design and Simulation (PhDS) Laboratory, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - K L Chan
- Discipline of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - V Murugaiyah
- Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
| |
Collapse
|
19
|
Wu MS, Tan SC, Xiong T. Indirect comparison of randomised controlled trials: comparative efficacy of dexlansoprazole vs. esomeprazole in the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2013; 38:190-201. [PMID: 23718547 DOI: 10.1111/apt.12349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 04/16/2013] [Accepted: 05/07/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dexlansoprazole is a new proton pump inhibitor (PPI) with a dual delayed-release system. Both dexlansoprazole and esomeprazole are an enantiomer of lansoprazole and omeprazole respectively. However, there is no head-to-head trial data or indirect comparison analyses between dexlansoprazole and esomeprazole. AIM To compare the efficacy of dexlansoprazole with esomeprazole in healing erosive oesophagitis (EO), the maintenance of healed EO and the treatment of non-erosive reflux disease (NERD). METHODS Randomised Controlled Trials (RCTs) comparing dexlansoprazole or esomeprazole with either placebo or another PPI were systematically reviewed. Random-effect meta-analyses and adjusted indirect comparisons were conducted to compare the treatment effect of dexlansoprazole and esomeprazole using a common comparator. The relative risk (RR) and 95% confidence interval (CI) were calculated. RESULTS The indirect comparisons revealed significant differences in symptom control of heartburn in patients with NERD at 4 weeks. Dexlansoprazole 30 mg was more effective than esomeprazole 20 mg or 40 mg (RR: 2.01, 95% CI: 1.15-3.51; RR: 2.17, 95% CI: 1.39-3.38). However, there were no statistically significant differences between the two drugs in EO healing and maintenance of healed EO. Comparison of symptom control in healed EO was not able to be made due to different definitions used in the RCTs. CONCLUSIONS Adjusted indirect comparisons based on currently available RCT data suggested significantly better treatment effect in symptom control of heartburn in patients with NERD for dexlansoprazole against esomeprazole. No statistically significant differences were found in other EO outcomes. However, these study findings need to be interpreted with caution due to small number of studies and other limitations.
Collapse
Affiliation(s)
- M S Wu
- Department of Internal Medicine, Taiwan National University, Taipei, Taiwan
| | | | | |
Collapse
|
20
|
Tan TJ, Tan SC. Concomitant early avascular necrosis of the femoral head and acute bacterial arthritis by enteric Gram-negative bacilli in four oncologic patients. Singapore Med J 2013. [DOI: 10.11622/smedj.2013065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Wong HS, Tan SC, Wang N, Durkan C. Hydrothermally-grown ZnO nanowire tips for scanning tunnelling microscopy. J Nanosci Nanotechnol 2012; 12:2394-2398. [PMID: 22755064 DOI: 10.1166/jnn.2012.5727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The probe tip is pivotal in determining the resolution and nature of features observed in the Scanning Tunnelling Microscope (STM). We have augmented a conventional Pt/Ir metallic tip with a hydrothermally grown ZnO nanowire (NW). Atomic resolution imaging of graphite is attained. Current-voltage (IV) characteristics demonstrate an asymmetry stemming from the unintentional n-type doping of the ZnO NW, whereas the expected Schottky barrier at the ZnO-Pt/Ir interface is shown to have negligible effect. Moreover the photoconductivity of the system is investigated, paving the way towards a photodetector capable of atomic resolution.
Collapse
Affiliation(s)
- H S Wong
- Nanoscience, University of Cambridge, 11 JJ Thomson Avenue, Cambridge CB3 0FF, UK
| | | | | | | |
Collapse
|
22
|
Khoo JN, Tan SC. MR imaging of tophaceous gout revisited. Singapore Med J 2011; 52:840-847. [PMID: 22173256] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gout is the most common form of microcrystalline arthropathy, and does not usually pose a diagnostic challenge when patients have a typical presentation, appropriate biochemical picture and classical radiographic appearance. However, magnetic resonance (MR) imaging is increasingly used as the first-line imaging modality in patients with first presentation of joint pain or mass, and tophaceous gout is frequently a forgotten differential diagnosis. This article serves to review the MR imaging characteristics and appearance of gouty tophi in various joints, their clinical presentations and complications, as well as the common differential diagnoses.
Collapse
Affiliation(s)
- J N Khoo
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608.
| | | |
Collapse
|
23
|
Patel BK, Tan SC, Jackson SHD, Swift CG, Hutt AJ. Enantiomeric disposition of ibuprofen in young and elderly volunteers. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1998.tb02441.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B K Patel
- Department of Pharmacy, King’s College London, Manresa Road, London SW3 6LX
| | - S C Tan
- Department of Pharmacy, King’s College London, Manresa Road, London SW3 6LX
| | - S H D Jackson
- Clinical Age Research Unit, King’s College London, Denmark Hill, London SE5 9RS
| | - C G Swift
- Clinical Age Research Unit, King’s College London, Denmark Hill, London SE5 9RS
| | - A J Hutt
- Department of Pharmacy, King’s College London, Manresa Road, London SW3 6LX
| |
Collapse
|
24
|
Jones J, Takeda A, Tan SC, Cooper K, Loveman E, Clegg A. Gemcitabine for the treatment of metastatic breast cancer. Health Technol Assess 2010; 13 Suppl 2:1-7. [PMID: 19804683 DOI: 10.3310/hta13suppl2/01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper presents a summary of the evidence review group (ERG) report into the evidence for the clinical effectiveness and cost-effectiveness of gemcitabine with paclitaxel for the first-line treatment of metastatic breast cancer (MBC) in patients who have already received chemotherapy treatment with an anthracycline, compared with current standard of care, based upon the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The clinical evidence for gemcitabine as a treatment for MBC comes from the unpublished JHQG trial (some data commercial-in-confidence): overall survival was 3 months longer for the gemcitabine/paclitaxel arm (18.5 months) than for the paclitaxel arm (15.8 months) (p = 0.0489); gemcitabine/paclitaxel also improved tumour response and time to documented progression of disease compared with paclitaxel monotherapy, but haematological serious adverse events were more common. In the absence of any formal methods of indirect comparison there is insufficient robust evidence to compare the relative effectiveness of gemcitabine/paclitaxel with docetaxel monotherapy or docetaxel/capecitabine combination therapy. The manufacturers used a Markov state transition model to estimate the effect of treatment with five different chemotherapy regimes, adopting a 3-year time horizon with docetaxel monotherapy as the comparator. Health state utilities for different stages of disease progression and for patients experiencing treatment-related toxicity are used to derive quality-adjusted life expectancy with each treatment. The base-case cost-effectiveness estimate for gemcitabine/paclitaxel versus docetaxel is 17,168 pounds per quality-adjusted life-year (QALY). When longer survival with docetaxel is assumed in a sensitivity analysis, the incremental cost-effectiveness ratio (ICER) is 30,000 pounds per QALY. Probabilistic sensitivity analysis estimates a 70% probability of gemcitabine/paclitaxel being cost-effective relative to docetaxel at a willingness-to-pay threshold of 35,000 pounds. There is considerable uncertainty over the results because of the lack of formal quality assessment or assessment of the comparability of the 15 trials included in the input data, and the questionable validity of the indirect comparison method adopted. An illustrative analysis using a different method for indirect comparison carried out by the ERG produces an ICER of 45,811 pounds per QALY for gemcitabine/paclitaxel versus docetaxel. The guidance issued by NICE in November 2006 as a result of the STA states that gemcitabine in combination with paclitaxel, within its licensed indication, is recommended as an option for the treatment of MBC only when docetaxel monotherapy or docetaxel plus capecitabine is also considered appropriate.
Collapse
Affiliation(s)
- J Jones
- Southampton Health Technology Assessments Centre, Southampton, UK
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
This paper presents a summary of the evidence review group (ERG) report into the evidence for the clinical effectiveness and cost-effectiveness of gemcitabine with paclitaxel for the first-line treatment of metastatic breast cancer (MBC) in patients who have already received chemotherapy treatment with an anthracycline, compared with current standard of care, based upon the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The clinical evidence for gemcitabine as a treatment for MBC comes from the unpublished JHQG trial (some data commercial-in-confidence): overall survival was 3 months longer for the gemcitabine/paclitaxel arm (18.5 months) than for the paclitaxel arm (15.8 months) (p = 0.0489); gemcitabine/paclitaxel also improved tumour response and time to documented progression of disease compared with paclitaxel monotherapy, but haematological serious adverse events were more common. In the absence of any formal methods of indirect comparison there is insufficient robust evidence to compare the relative effectiveness of gemcitabine/paclitaxel with docetaxel monotherapy or docetaxel/capecitabine combination therapy. The manufacturers used a Markov state transition model to estimate the effect of treatment with five different chemotherapy regimes, adopting a 3-year time horizon with docetaxel monotherapy as the comparator. Health state utilities for different stages of disease progression and for patients experiencing treatment-related toxicity are used to derive quality-adjusted life expectancy with each treatment. The base-case cost-effectiveness estimate for gemcitabine/paclitaxel versus docetaxel is £17,168 per quality-adjusted life-year (QALY). When longer survival with docetaxel is assumed in a sensitivity analysis, the incremental cost-effectiveness ratio (ICER) is £30,000 per QALY. Probabilistic sensitivity analysis estimates a 70% probability of gemcitabine/paclitaxel being cost-effective relative to docetaxel at a willingness-to-pay threshold of £35,000. There is considerable uncertainty over the results because of the lack of formal quality assessment or assessment of the comparability of the 15 trials included in the input data, and the questionable validity of the indirect comparison method adopted. An illustrative analysis using a different method for indirect comparison carried out by the ERG produces an ICER of £45,811 per QALY for gemcitabine/paclitaxel versus docetaxel. The guidance issued by NICE in November 2006 as a result of the STA states that gemcitabine in combination with paclitaxel, within its licensed indication, is recommended as an option for the treatment of MBC only when docetaxel monotherapy or docetaxel plus capecitabine is also considered appropriate.
Collapse
Affiliation(s)
- J Jones
- Southampton Health Technology Assessments Centre, Southampton, UK
| | - A Takeda
- Southampton Health Technology Assessments Centre, Southampton, UK
| | - SC Tan
- Southampton Health Technology Assessments Centre, Southampton, UK
| | - K Cooper
- Southampton Health Technology Assessments Centre, Southampton, UK
| | - E Loveman
- Southampton Health Technology Assessments Centre, Southampton, UK
| | - A Clegg
- Southampton Health Technology Assessments Centre, Southampton, UK
| |
Collapse
|
26
|
Aasim WRW, Gan SH, Tan SC. Development of a simultaneous liquid-liquid extraction and chiral derivatization method for stereospecific GC-MS analysis of amphetamine-type stimulants in human urine using fractional factorial design. Biomed Chromatogr 2008; 22:1035-42. [PMID: 18655218 DOI: 10.1002/bmc.1073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A stereospecific gas chromatography-mass spectrometry analysis method for amphetamine-type stimulants in human urine was recently developed. For maximum efficiency, liquid-liquid extraction and chiral derivatization of the analytes using (R)-(-)-alpha-methoxy-alpha-(trifluoromethyl)phenylacetyl chloride were performed simultaneously. The effects of (1) use of saturated sodium chloride in 2.0 M sodium hydroxide, (2) extraction solvent volume, (3) percentage of triethylamine, (4) derivatization reagent volume, (5) sample mixing time, (6) incubation temperature and (7) incubation time on method sensitivity and variability were assessed using a two-level, eight-run Plackett-Burman design followed by a fold-over design. The use of saturated sodium chloride solution and the derivatization reagent volume were significant factors (ANOVA, p<0.01). The saturated sodium chloride solution decreased sensitivity whereas an increased volume of derivatization reagent increased sensitivity. Calibration curves for all analytes were linear between 5 and 500 microg/L, with correlation coefficients of >0.99. Detection limits were <or=2.3 microg/L and quantitation limits <or=7.7 microg/L. Reproducibility was good, with relative standard deviation values at <20%. Recovery exceeded 100% for most analytes. The experimental design enabled easy and rapid identification of significant factors using a minimal number of samples. This method has good potential for studies requiring rapid and sensitive stereospecific quantification of amphetamine-type stimulants.
Collapse
Affiliation(s)
- W R Wan Aasim
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | | | | |
Collapse
|
27
|
Colquitt JL, Jones J, Tan SC, Takeda A, Clegg AJ, Price A. Ranibizumab and pegaptanib for the treatment of age-related macular degeneration: a systematic review and economic evaluation. Health Technol Assess 2008; 12:iii-iv, ix-201. [PMID: 18462575 DOI: 10.3310/hta12160] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of ranibizumab and pegaptanib for subfoveal choroidal neovascularisation (CNV) associated with wet age-related macular degeneration (AMD). DATA SOURCES Electronic databases were searched from inception to September 2006. Experts in the field were consulted and manufacturers' submissions were examined. REVIEW METHODS The quality of included studies was assessed using standard methods and the clinical effectiveness data were synthesised through a narrative review with full tabulation of results. A model was developed to estimate the cost-effectiveness of ranibizumab and of pegaptanib (separately), compared with current practice or best supportive care, from the perspective of the NHS and Personal Social Services. Two time horizons were adopted for each model. The first adopted time horizons determined by the available trial data. The second analysis extrapolated effects of treatment beyond the clinical trials, adopting a time horizon of 10 years. RESULTS The combined analysis of two randomised controlled trials (RCTs) of pegaptanib [0.3 mg (licensed dose), 1.0 mg and 3.0 mg] versus sham injection in patients with all lesion types was reported by three publications (the VISION study). Three published RCTs of ranibizumab were identified (MARINA, ANCHOR, FOCUS), and an additional unpublished RCT was provided by the manufacturer (PIER). Significantly more patients lost less than 15 letters of visual acuity at 12 months when taking pegaptanib (0.3 mg: 70% of patients; 1.0 mg: 71% of patients; 3.0 mg: 65% of patients) or ranibizumab (0.3 mg: 94.3-94.5%; 0.5 mg: 94.6-96.4%) than sham injection patients (55% versus pegaptanib and 62.2% versus ranibizumab) or, in the case of ranibizumab, photodynamic therapy (PDT) (64.3%). The proportion of patients gaining 15 letters or more (a clinically important outcome having a significant impact on quality of life) was statistically significantly greater in the pegaptanib group for doses of 0.3 and 1.0 mg but not for 3.0 mg, and for all ranibizumab groups compared to the sham injection groups or PDT. This was also statistically significant for patients receiving 0.5 mg ranibizumab plus PDT compared with PDT plus sham injection. Pegaptanib patients lost statistically significantly fewer letters after 12 months of treatment than the sham group [mean letters lost: 7.5 (0.3 mg), 6.5 (1.0 mg) or 10 (3.0 mg) vs 14.5 (sham)]. In the MARINA and ANCHOR trials, ranibizumab patients gained letters of visual acuity at 12 months whereas patients with sham injection or PDT lost about 10 letters (p<0.001) and in the PIER study, ranibizumab patients lost significantly fewer than the sham injection group. Significantly fewer patients receiving pegaptanib or ranibizumab deteriorated to legal blindness compared with the control groups. Adverse events were common for both pegaptanib andranibizumab but most were mild to moderate. Drug costs for 1 year of treatment were estimated as 4626 pounds for pegaptanib and 9134 pounds for ranibizumab. Non-drug costs accounted for an additional 2614 pounds for pegaptanib and 3120 pounds for ranibizumab. Further costs are associated with the management of injection-related adverse events, from 1200 pounds to 2100 pounds. For pegaptanib compared with usual care, the incremental cost-effectiveness ratio (ICER) ranged from 163,603 pounds for the 2-year model to 30,986 pounds for the 10-year model. Similarly, the ICERs for ranibizumab for patients with minimally classic and occult no classic lesions, compared with usual care, ranged from 152,464 pounds for the 2-year model to 25,098 pounds for the 10-year model. CONCLUSIONS Patients with AMD of any lesion type benefit from treatment with pegaptanib or ranibizumab on measures of visual acuity when compared with sham injection and/or PDT. Patients who continued treatment with either drug appeared to maintain benefits after 2 years of follow-up. When comparing pegaptanib and ranibizumab, the evidence was less clear due to the lack of direct comparison through head-to-head trials and the lack of opportunity for indirect statistical comparison due to heterogeneity. The cost-effectiveness analysis showed that the two drugs offered additional benefit over the comparators of usual care and PDT but at increased cost. Future research should encompass trials to compare pegaptanib with ranibizumab and bevacizumab, and to investigate the role of verteporfin PDT in combination with these drugs. Studies are also needed to assess adverse events outside the proposed RCTs, to consider the optimal dosing regimes of these drugs and the benefits of re-treatment after initial treatment, and to review costing in more detail. Health state utilities and their relationship with visual acuity and contrast sensitivity, the relationship between duration of vision loss and the quality of life and functional impact of vision loss, behavioural studies of those genetically at risk are other topics requiring further research.
Collapse
Affiliation(s)
- J L Colquitt
- Southampton Health Technology Assessments Centre, Wessex Institute for Health Research and Development, University of Southampton, UK
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
The genetically polymorphic cytochrome P450 (CYP) 2A6 is the major nicotine-oxidase in humans that may contribute to nicotine dependence and cancer susceptibility. The authors investigated the types and frequencies of CYP2A6 alleles in the three major ethnic groups in Malaysia and CYP2A6*1A, CYP2A6*1B, CYP2A6*1x2, CYP2A6*2, CYP2A6*3, CYP2A6*4, CYP2A6*5, CYP2A6*7, CYP2A6*8 and CYP2A6*10 were determined by allele-specific polymerase chain reaction (PCR) in 270 Malays, 172 Chinese and 174 Indians. Except for CYP2A6*2 and *3 that were not detected in the Malays and Chinese, all the other alleles were detected. Frequencies for the CYP2A6*4 allele were 7, 5 and 2%, respectively, in Malays, Chinese and Indians. A statistically significant high frequency of the duplicated CYP2A6*1x2 allele occurred among Chinese. Among Malays and Chinese, the most common allele was CYP2A6*1B, but it was CYP2A6*1A among Indians. These ethnic difference in frequencies suggested that further studies are required to investigate the implications on diseases such as cancer and smoking behaviour among these major ethnic groups in Malaysia.
Collapse
Affiliation(s)
- M Nurfadhlina
- Pharmacogenetics Research Group, INFORMM, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | | | | | | | | |
Collapse
|
29
|
Du XY, Fu YQ, Tan SC, Luo JK, Flewitt AJ, Maeng S, Kim SH, Choi YJ, Lee DS, Park NM, Park J, Milne WI. ZnO film for application in surface acoustic wave device. ACTA ACUST UNITED AC 2007. [DOI: 10.1088/1742-6596/76/1/012035] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Du X, Fu Y, Tan SC, Luo J, Flewitt A, Maeng S, Kim SH, Choi Y, Lee DS, Park RM, Milne B. ZnO film based surface acoustic wave micro-pump. ACTA ACUST UNITED AC 2007. [DOI: 10.1088/1742-6596/76/1/012047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Takeda AL, Jones J, Loveman E, Tan SC, Clegg AJ. The clinical effectiveness and cost-effectiveness of gemcitabine for metastatic breast cancer: a systematic review and economic evaluation. Health Technol Assess 2007; 11:iii, ix-xi, 1-62. [PMID: 17462169 DOI: 10.3310/hta11190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of gemcitabine, used in combination with paclitaxel, as a second-line treatment for people with metastatic breast cancer who have relapsed following treatment with anthracycline-based chemotherapy. DATA SOURCES Electronic databases were searched from inception to March 2006. Clinical advisers were also consulted. REVIEW METHODS A systematic review of the literature was undertaken to appraise the clinical and cost-effectiveness of gemcitabine. A Markov state transition model was developed for the economic evaluation. RESULTS The systematic review identified only one randomised controlled trials (RCT), and this has not yet been fully published. The methodological quality and quality of reporting of the included trial were assessed to be poor using standard criteria, but this may be due to the lack of information in the limited publications rather than being a fair reflection of the trial's quality. This RCT compared gemcitabine and paclitaxel therapy with paclitaxel monotherapy in 529 patients with metastatic breast cancer who had previously received anthracyclines, but no prior chemotherapy for metastatic breast cancer. Approximately 71% of the gemcitabine/paclitaxel patients survived for 1 year, compared with 61% of the paclitaxel group. The hazard ratio showed a 26% lower chance of survival in the paclitaxel group, and time to progressive disease was also shorter in this group. The overall response rate was higher in the gemcitabine/paclitaxel group than in the paclitaxel group. Adverse events, particularly neutropenia, were more common with gemcitabine/paclitaxel combination therapy than with paclitaxel therapy alone. The economic model was run for a simulation of 1000 patients, assuming that chemotherapy continued until patients' disease progressed. This base-case analysis found an incremental cost-effectiveness ratio (ICER) of 58,876 pounds per quality-adjusted life-year (QALY) gained and 30,117 pounds per life-year gained. The model was re-run with treatment restricted to a maximum of six cycles per patient, reflecting normal practice. This yielded an ICER of 38,699 pounds per QALY gained and 20,021 pounds per life-year gained. CONCLUSIONS The review of clinical effectiveness is based on data from a single RCT that has not yet been fully published. While only tentative conclusions can be drawn from this, the evidence may indicate that treatment with gemcitabine and paclitaxel confers an improved outcome for patients in terms of survival and disease progression, but at the cost of increased toxicity. An economic model developed for this review reflects high costs per QALY for this treatment combination. The base-case analysis shows high ICERs, with costs per QALY gained close to 60,000 pounds. Adopting a more realistic treatment protocol, with chemotherapy limited to a maximum of six cycles, gives a more favourable cost-effectiveness estimate. However, this was still higher than would usually be considered to be a cost-effective treatment from the NHS's perspective. Future research recommendations include an update of this review in 12-18 months' time, by which time the included RCT should be fully published. It would also be useful to compare gemcitabine with currently used treatments for metastatic breast cancer, including capecitabine and vinorelbine.
Collapse
Affiliation(s)
- A L Takeda
- Southampton Health Technology Assessments Centre, University of Southampton, UK
| | | | | | | | | |
Collapse
|
32
|
Abstract
Two new drugs provide startling benefits in the treatment of age-related macular degeneration (AMD). The clinical and cost effectiveness of ranibizumab (Lucentis) was compared to that of bevacizumab (Avastin), which costs up to 100 times less. A cost effectiveness model was developed to assess the cost per quality adjusted life year (QALY) over 10 years. For predominantly classic AMD, the efficacy of bevacizumab relative to ranibizumab would have to be around 40% for the latter to achieve 30 k pounds per QALY, a NICE threshold. Similar but worse results applied to the other main forms of AMD, minimally occult and occult with no classic lesions. The price of ranibizumab would have to be drastically reduced for it to be cost effective. Continued unlicensed use of bevacizumab raises ethical, legal and policy questions. Public pressure may be the most potent weapon in persuading Genentech to license bevacizumab for AMD.
Collapse
Affiliation(s)
- James Raftery
- Wessex Institute for Health R&D, Medical School, University of Southampton, Southampton, UK.
| | | | | | | | | |
Collapse
|
33
|
Coombs CJ, Richardson PW, Johnstone BR, Tan SC. The "U-ligament" for collateral ligament reconstruction in duplicate thumb. ACTA ACUST UNITED AC 2006; 10:237-41. [PMID: 16568520 DOI: 10.1142/s0218810405002978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/13/2004] [Accepted: 12/16/2005] [Indexed: 11/18/2022]
Abstract
Duplicate thumb is a common congenital difference with complex management. Surgical treatment includes reconstruction of the collateral ligaments to optimise future function and cosmesis. We present the use of the "U-ligament" to further refine collateral ligament reconstruction. We have found it to be a simple and reliable technique.
Collapse
Affiliation(s)
- C J Coombs
- Melbourne Paediatric Hand Centre, Department of Plastic and Maxillofacial Surgery Royal Children's Hospital, Melbourne, Australia.
| | | | | | | |
Collapse
|
34
|
Abstract
An investigation was conducted on the usage of a single-step extraction procedure involving the retention of a phenylboronate-salbutamol complex on an end-capped C18 solid-phase sorbent to determine the level of salbutamol in human plasma samples. Propranolol, a beta-blocker, was chosen as the internal standard for this assay. In this solid-phase clean-up method, 50 mM sodium carbonate buffer, pH 9.60, was used for conditioning the column as well as washing the endogenous interference. Under the optimal conditions, the recovery of salbutamol from spiked plasma samples was found to be high and reproducible with mean recoveries (n = 3) of more than 90% after elution by using 50% 1 M trifluoroacetic acid in methanol. This sample clean-up step was effectively analyzed under reversed-phase high-performance liquid chromatography with fluorimetric detection. The method was successfully applied to the routine measurement of salbutamol in human plasma from the bioequivalence study on the different administration route of salbutamol. Quantification of salbutamol was convincingly reported with the correlation of coefficient of 0.9980 for the concentration range from 0 to 1000 ng ml(-1). An adequate precision was achieved with both between- and within-day precisions of less than 10% (n = 6) for 100 and 1000 ng ml(-1) and less than 15% (n = 6) for 10 ng ml(-1).
Collapse
Affiliation(s)
- Y M Koh
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
| | | | | |
Collapse
|
35
|
Tan SC, Patel BK, Jackson SHD, Swift CG, Hutt AJ. Stereoselectivity of ibuprofen metabolism and pharmacokinetics following the administration of the racemate to healthy volunteers. Xenobiotica 2002; 32:683-97. [PMID: 12296989 DOI: 10.1080/00498250210142994] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
1. The stereoselective metabolism and pharmacokinetics of the enantiomers of ibuprofen have been investigated following the oral administration of the racemic drug (400 mg) to 12 healthy volunteers.2. The stereochemical composition of the drug in serum, both total and unbound, and drug and metabolites, both free and conjugated, in urine were determined by a combination of the direct and indirect chromatographic procedures to enantiomeric analysis. 3. The oral clearance of (S)-ibuprofen was significantly greater than that of the R-enantiomer (74.5 +/- 18.1 versus 57.1 +/- 11.7 ml min(-1); p < 0.05) and the clearance of (R)-ibuprofen via inversion was ca two fold that via alternative pathways. 4. Some 74.0 +/- 9.6% of the dose was recovered in urine over 24 h as ibuprofen, 2-hydroxyibuprofen and carboxyibuprofen, both free and conjugated with glucuronic acid. Analysis of the stereochemical composition of the urinary excretion products indicated that 68% of the dose of (R)-ibuprofen had undergone chiral inversion. 5. Metabolism via glucuronidation and both routes of oxidation, showed enantio-selectivity for (S)-ibuprofen, the enantiomeric ratios (S/R) in partial metabolic clearance being 7.1, 4.8 and 3.4 for formation of ibuprofen glucuronide, 2-hydroxyibuprofen and carboxyibuprofen respectively.6. Modest stereoselectivity was observed in the formation of (2'R, 2R)- and (2'S, 2S)-carboxyibuprofen in comparison to the alternative diastereoisomers, the ratios in formation clearance being 1.6 and 1.2 respectively.
Collapse
Affiliation(s)
- S C Tan
- Department of Pharmacy, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NN, UK
| | | | | | | | | |
Collapse
|
36
|
Tan SC, Chai J, Wozniak WT, Takahashi Y. Flexural strength of a glass-infiltrated alumina dental ceramic incorporated with silicon carbide whiskers. INT J PROSTHODONT 2001; 14:350-4. [PMID: 11508091] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
PURPOSE The addition of silicon carbide whiskers has been known to reinforce ceramics. This study compared the flexural strength of a glass-infiltrated alumina dental ceramic with various amounts of silicon carbide whiskers incorporated into the alumina matrix. MATERIALS AND METHODS Three groups with a total of 30 specimens were included: glass-infiltrated alumina dental ceramic with 0, 0.125, and 0.25 wt% silicon carbide whiskers. The flexural strength was measured using a three-point bending test, and the data were analyzed with one-way analysis of variance. Scanning electron microscopy was used to examine the fracture surfaces of all three materials. RESULTS There were no significant differences in the flexural strength among the three groups. Glass-infiltrated alumina dental ceramic failed predominantly by transgranular fracture and to a lesser degree by intergranular fracture. CONCLUSION The addition of silicon carbide whiskers did not change the flexural strength of glass-infiltrated alumina dental ceramic.
Collapse
Affiliation(s)
- S C Tan
- Department of Prosthodontics, College of Dentistry, University of Iowa, Iowa City, Iowa 52242, USA
| | | | | | | |
Collapse
|
37
|
Tan SC, Harwant S, Selvakumar K, Kareem BA. Predictive factors in the evolution of neural deficit in tuberculosis of the spine. Med J Malaysia 2001; 56 Suppl C:46-51. [PMID: 11814249] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This study was conducted to determine the factors involved in predicting the onset of paraplegia in tuberculosis of the spine. A cross-sectional, case control review of 85 cases of spinal tuberculosis was conducted at the National Tuberculosis Centre in Kuala Lumpur. Sixty-nine of these cases were normal neurologically, whilst 16 cases experienced neural deficit. The data was analysed using backward logistic regression and Fishers exact probability test. The factors studied included symptoms and signs of spinal tuberculosis, common investigations for tuberculosis, and physical factors of the disease. Only the erythrocyte sedimentation rate (ESR) showed a significant difference between the neural deficit and neurologically normal groups. This suggests that the ESR may be a factor in predicting evolution of paraplegia in spinal tuberculosis. In addition, it was noted that a low proportion of patients had positive sputum smear results and bacterial culture growth for mycobacterium tuberculosis suggesting these tests are of limited value for tuberculosis of the spine.
Collapse
Affiliation(s)
- S C Tan
- Universiti Putra Malaysia, Jalan Pahang, Kuala Lumpur
| | | | | | | |
Collapse
|
38
|
Abstract
Crustacean shells constitute the traditional and current commercial source of chitin. Conversely, the control of fungal fermentation processes to produce quality chitin makes fungal mycelia an attractive alternative source. Therefore, the exploitation of both of these sources to produce chitin in a concurrent process should be advantageous and is reported here. Three proteolytic Aspergillus niger (strains 0576, 0307 and 0474) were selected from a screening for protease activity from among 34 zygomycete and deuteromycete strains. When fungi and shrimp shell powder were combined in a single reactor, the release of protease by the fungi facilitated the deproteinization of shrimp-shell powder and the release of hydrolyzed proteins. The hydrolyzed proteins in turn were utilized as a nitrogen source for fungal growth, leading to a lowering of the pH of the fermentation medium, thereby further enhancing the demineralization of the shrimp-shell powder. The shrimp-shell powders and fungal mycelia were separated after fermentation and extracted for chitin with 5% LiCl/DMAc solvent. Chitin isolates from the shells were found to have a protein content of less than 5%, while chitin isolates from the three fungal mycelia strains had protein content in the range of 10-15%. The relative molecular weights as estimated by GPC for all chitin samples were in the 10(5) dalton range. All samples displayed characteristic profiles for chitin in their FTIR and solid-state NMR spectra. All chitin samples evaluated with MTT and Neutral Red assays with three commercial cell lines did not display cytotoxic effects.
Collapse
Affiliation(s)
- W L Teng
- Department of Chemistry, Faculty of Science, National University of Singapore, 3 Science Drive, 117543, Singapore, Singapore
| | | | | | | | | |
Collapse
|
39
|
Tay ST, Habsah MY, Tan SC, Rohani MY. Detection of Mycoplasma pneumoniae from cerebrospinal fluid samples of pediatric patients. Southeast Asian J Trop Med Public Health 2000; 31:684-7. [PMID: 11414412] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Central nervous system manifestations are probably the most frequent extrapulmonary complications of infections due to Mycoplasma pneumoniae, occur mostly in children. In this study, we attempted to isolate M. pneumoniae and to detect the organism by polymerase chain reaction (PCR) from cerebrospinal fluid samples (CSF) of pediatric patients. Of the 244 CSF samples, no M. pneumoniae was isolated. Six (2.5%) of the CSF samples were positive by PCR amplification. More effort are necessary to isolate the organism from CSF samples in order to ascertain the role of M. pneumoniae in causing neurological complications.
Collapse
Affiliation(s)
- S T Tay
- Bacteriology Division, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
40
|
Tay ST, Habsah MY, Tan SC, Rohani MY. Isolation and polymerase chain reaction detection of Mycoplasma pneumoniae in Malaysian patients with respiratory tract infections. Southeast Asian J Trop Med Public Health 2000; 31:688-92. [PMID: 11414413] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Isolation and polymerase chain reaction (PCR) were performed for detection of Mycoplasma pneumoniae from respiratory tract specimens obtained from 200 adult and 200 pediatric patients. M. pneumoniae was isolated from bronchoalveolar lavage fluid of 1(0.5%) adult patient and 4(2.0%) tracheal aspirates of pediatric patients. PCR was positive for only one (0.5%) broncoalveolar lavage fluid of an adult patient and fifteen (7.5%) tracheal aspirates of pediatric patients. This study suggested that M. pneumoniae was more frequently detected in pediatric patients and PCR appears to have advantages over isolation, in terms of rapidity and sensitivity.
Collapse
Affiliation(s)
- S T Tay
- Bacteriology Division, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
41
|
Abstract
Salbutamol ¿2-(tert-butylamino)-1-[4-hydroxy-3- (hydroxymethyl)phenyl]ethanol¿, also known as albuterol, is clinically the most widely used beta 2-adrenoceptor agonist in the treatment of bronchial asthma. During this study, we evaluated liquid-liquid extraction (LLE) and solid-phase extraction (SPE) in order to develop a reliable extraction method followed by analysis using liquid chromatography and gas chromatography. An assay is described which involves SPE as the clean-up method followed by gas chromatography-mass spectrometry to determine salbutamol levels in human serum after oral administration. The SPE method requires the use of a hyper-cross-linked styrene-divinylbenzene bonded phase (ENV+) without involving any sample pre-treatment to obtain 60-65% recoveries for salbutamol and terbutaline as the internal standard. Distilled water and 1% trifluoroacetic acid in methanol were found to be the most suitable washing solvent and eluting solvent, respectively. A detection limit of 2 ng mL-1 was achieved by derivatization with N-methyl-N-trimethylsilyltrifluoroacetamide to form trimethylsilyl (TMS)-salbutamol (m/z 369) and TMS-terbutaline (m/z 356). The relationship between the ratio of the peak area of salbutamol to that of the internal standard and concentration was linear for the range tested (2-200 ng mL-1) and the correlation of coefficient was 0.9999 with a y-intercept not significantly different from zero. The inter-day relative standard deviation (RSD) was < 10% for all three concentrations. The intra-day RSD was 14% for 2 ng mL-1. This assay was then successfully applied to human serum samples obtained from clinical trials after oral administration of salbutamol.
Collapse
Affiliation(s)
- M I Saleh
- School of Chemical Sciences, Doping Control Center, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | | | | | | |
Collapse
|
42
|
Tan SC, Baker JA, Stevens N, deBiasi V, Salter C, Chalaux M, Afarinkia K, Hutt AJ. Synthesis, chromatographic resolution and chiroptical properties of carboxyibuprofen stereoisomers: major metabolites of ibuprofen in man. Chirality 2000; 9:75-87. [PMID: 9094205 DOI: 10.1002/(sici)1520-636x(1997)9:1<75::aid-chir14>3.0.co;2-n] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The chromatographic resolution of the four stereoisomers of carboxy-ibuprofen, a major metabolite of ibuprofen in man, was achieved using a Chiralpak AD chiral stationary phase (CSP) (J.T. Baker, Milton, Keynes, UK). The elution order of the stereoisomers was determined to be 2'S,2R;2'R,2R;2'R,2S;2'S,2S by a combination of stereoselective synthesis of diastereoisomeric mixtures and analysis of the two diastereoisomers isolated from human urine following the administration of (S)-ibuprofen. The individual stereoisomers were isolated by semipreparative chiral phase chromatography and characterized by circular dichroism spectroscopy.
Collapse
Affiliation(s)
- S C Tan
- Department of Pharmacy, King's College London, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Tan SC, Patel BK, Jackson SH, Swift CG, Hutt AJ. Ibuprofen stereochemistry: double-the-trouble? Enantiomer 1999; 4:195-203. [PMID: 10550887] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Racemic ibuprofen is an important NSAID used in the treatment of pain and inflammation in a variety of musculoskeletal and rheumatic disorders. The metabolism of ibuprofen, and that of a number of the related 2-arylpropionic acid NSAIDs, involves chiral inversion of the relatively inactive R-enantiomers to their active S-antipodes, together with other potentially stereoselective conjugative and oxidative pathways. Enantiospecific analytical methodology suitable for the determination of both the drug and its metabolites is essential in order to evaluate the significance of stereoselectivity both in terms of drug action and disposition. Recent investigations have also indicated that the R-enantiomers of these agents may not be totally devoid of useful biological activity, that the formation of acyl-coenzyme A derivatives results in interactions with lipid biochemistry, and has provided new insights into the disposition of these drugs in man. Ibuprofen represents a classical example of a drug where stereochemical considerations are essential for an understanding of its biological properties.
Collapse
Affiliation(s)
- S C Tan
- Department of Pharmacy, King's College London, UK
| | | | | | | | | |
Collapse
|
44
|
Yap KL, Lim YH, Tan SC. Rotavirus electropherotypes from the Kuala Lumpur Hospital: a re-examination after an interval of seven years. Malays J Pathol 1998; 20:25-30. [PMID: 10879260] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The objective of this study was to ascertain the extent changes have occurred in the epidemiology of human rotavirus electropherotypes from the same location 7 to 8 years after an earlier study. Genomic RNA profiles of rotaviruses from diarrhoeic children admitted to the Kuala Lumpur Hospital from April to December 1996 were determined by polyacrylamide gel electrophoresis and silver staining. A total of 179 group A rotaviruses were detected from 870 children: 175 with legible staining of all RNA segments were classified into 14 distinct electropherotypes (10 and 4 with long and short migration patterns respectively). In addition, the results revealed: high predominance of long pattern electropherotypes (94% of the total electropherotypes); most long electropherotypes with RNA profiles which all 11 RNAs migrated separately (8 of 10 electropherotypes); all short electropherotypes had segments 2 and 3 that co-migrated; presence of a very numerically dominant electropherotype (75% of all electropherotypes); frequent co-circulation of the dominant electropherotype-present throughout the study period--with other electropherotypes present for limited periods; sequential temporal appearances by similar electropherotypes. These observations were similar to that of an earlier study conducted in 1988/89. Nevertheless, the dominant electropherotype in the present study was different and not among the electropherotypes detected in the earlier study.
Collapse
Affiliation(s)
- K L Yap
- Department of Biomedical Sciences, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia
| | | | | |
Collapse
|
45
|
Kirnpal-Kaur BS, Yap KL, Tan SC. Detection of false positives by incorporation of a confirmatory blocking test into a commercial enzyme-linked immunosorbent assay specific for adenovirus antigen. Malays J Pathol 1997; 19:133-6. [PMID: 10879254] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A blocking test was incorporated into the commercial IDEIA Adenovirus test (DAKO Diagnostics Ltd., Cambridgeshire, UK) to detect false positive results when faecal specimens were tested for adenovirus antigen. Immune rabbit serum raised against pooled adenovirus particles from human faecal specimens, together with the pre-immune serum, was used. Assessment of positive showed that false positives were produced under two different conditions: when results were based on visual determination instead of a cut-off value determined from photometric reading, and when absorbance values were not immediately read at the end of the test. Under the optimum condition for reading and assessment of test results (immediate reading and photometric determination), 11% of 65 adenovirus-positive samples were checked by the blocking ELISA as false positives. The rest of the specimens showed blocking of positive absorbance values by 70 to 98%. ELISA was found to be more sensitive than immune electron microscopy on samples with lower antigen concentration.
Collapse
MESH Headings
- Adenovirus Infections, Human/diagnosis
- Adenovirus Infections, Human/immunology
- Adenovirus Infections, Human/virology
- Adenoviruses, Human/immunology
- Adenoviruses, Human/isolation & purification
- Adenoviruses, Human/ultrastructure
- Animals
- Antibodies, Blocking
- Antigens, Viral/analysis
- Child
- Child, Preschool
- Diarrhea/diagnosis
- Diarrhea/immunology
- Diarrhea/virology
- Enzyme-Linked Immunosorbent Assay/methods
- False Positive Reactions
- Feces/virology
- Humans
- Microscopy, Immunoelectron
- Predictive Value of Tests
- Rabbits
- Rotavirus/immunology
- Rotavirus/isolation & purification
- Rotavirus Infections/diagnosis
- Rotavirus Infections/immunology
- Rotavirus Infections/virology
- Sensitivity and Specificity
Collapse
Affiliation(s)
- B S Kirnpal-Kaur
- Department of Biomedical Sciences, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
46
|
Tan SC, Jackson SH, Swift CG, Hutt AJ. Stereospecific analysis of the major metabolites of ibuprofen in urine by sequential achiral-chiral high-performance liquid chromatography. J Chromatogr B Biomed Sci Appl 1997; 701:53-63. [PMID: 9389338 DOI: 10.1016/s0378-4347(97)00338-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A sequential achiral-chiral HPLC method has been developed for the stereospecific analysis of the two major urinary metabolites of ibuprofen, namely hydroxyibuprofen and carboxyibuprofen. Achiral analysis was carried out using a Partisil column (250x4.6 mm, 5 microm) and a mobile phase of hexane:ethanol (98.2:1.8, v/v) containing trifluoroacetic acid (TFA; 0.05%, v/v) at a flow-rate of 2.0 ml/min. The HPLC eluate containing the two metabolites was separately collected, evaporated under nitrogen and the residue dissolved in the mobile phase used for chiral chromatography. Chiral-phase analysis was carried out using a Chiralpak AD CSP (250x4.6 mm, 10 microm) with a mobile phase of hexane:ethanol (92:8, v/v) containing TFA (0.05%, v/v) at a flow-rate of 1.0 ml/min. In both assays the analytes were quantified by ultraviolet detection at a wavelength of 220 nm. Modification of the mobile-phase composition allowed the resolution of all six analytes in a single chromatographic run but with an increase in run time and consequent band broadening. The analytical method described allows the direct quantitation of the stereoisomers of both metabolites of ibuprofen in urine following the administration of therapeutic doses of the racemic drug to man.
Collapse
Affiliation(s)
- S C Tan
- Department of Pharmacy, King's College London, UK
| | | | | | | |
Collapse
|
47
|
Aislaitner G, Bello A, Tan SC, Hutt AJ, Marriott C, Gorrod JW. Metabolism of (-)-(S)-nicotine in the isolated perfused rabbit lung. Eur J Drug Metab Pharmacokinet 1997; 22:395-402. [PMID: 9512940 DOI: 10.1007/bf03190976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The metabolism of (-)-(S)-nicotine has been investigated following intratracheal administration to the recirculating perfused rabbit lung model. The metabolic products present in the perfusate were identified by co-chromatography (HPLC and GC) with authentic standards and quantified by HPLC. After the 180 min perfusion period, nicotine was found to be metabolically transformed to cotinine (33.7%), 3-hydroxycotinine (10.4%), cotinine-1-N-oxide (3.4%) and nicotine-1'-N-oxide (14.4%). Norcotinine, nornicotine, 3-pyridyl-4-oxo-N-methylbutyramide and an uncharacterised metabolite were also detected in low amounts. Following the perfusion experiment, part of the lung tissue was homogenised in the presence of [14C]-sodium cyanide. Subsequent analysis of the homogenates indicated the formation of 2'-cyanonicotine, 1'-cyanomethylnornicotine and the diastereoisomeric 5'-cyanonicotines.
Collapse
Affiliation(s)
- G Aislaitner
- Chelsea Department of Pharmacy, King's College London, University of London, UK
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
Approximately 1 in 4 therapeutic agents are marked as racemic mixtures, the individual enantiomers of which frequently differ in both their pharmacodynamic and pharmacokinetic profiles. The use of racemates has become the subject of considerable discussion in recent years, and an area of concern for both the pharmaceutical industry and regulatory authorities. The use of single enantiomers has a number of potential clinical advantages, including an improved therapeutic/pharmacological profile, a reduction in complex drug interactions, and simplified pharmacokinetics. In a number of instances stereochemical considerations have contributed to an understanding of the observed pharmacological effects of a drug administered as a racemate. However, relatively little is known of the influence of patient factors (e.g. disease state, age, gender and genetics) on drug enantiomer disposition and action in man. Examples may also be cited where the use of a single enantiomers, nonracemic mixtures and racemates of currently used agents may offer clinical advantages. The issues associated with drug chirality are complex and depend upon the relative merits of the individual agent. In the future it is likely that a number of existing racemates will be re-marketed as single enantiomer products with potentially improved clinical profiles and possible novel therapeutic indications.
Collapse
Affiliation(s)
- A J Hutt
- Department of Pharmacy, King's College London, England
| | | |
Collapse
|
49
|
Keah KC, Jegathesan M, Tan SC, Chan SH, Chee OM, Cheong YM, Suleiman AB. Bacterial contamination of hospital disinfectants. Med J Malaysia 1995; 50:291-7. [PMID: 8668045] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A study to determine contamination of diluted disinfectants at different points in preparation and use in 6 Malaysian hospitals was done using the in-use test. A growth of > or = 250 organisms/ml was taken as an indication of contamination. A total of 342 (7.9%) of the 4316 freshly diluted samples collected from disinfectant bottles in the pharmacy were found to be contaminated. The bacterial isolates obtained were Pseudomonas spp. (42.4%), Moraxella spp. (22.0%), Flavobacterium spp. (11.6%) and Enterobacter spp. (4.2%). Three hundred and sixty seven out of 2278 ward stock were contaminated. The isolates were Pseudomonas spp. (48.6%), Moraxella spp. (17.8%), Acinetobacter spp. (8.9%) and Flavobacterium spp. (7.0%). Of the 9265 disinfectants in-use, 1519 (16.4%) were contaminated. Among the organisms isolated were Pseudomonas spp. (44.3%), Bacillus spp. (13.0%), Enterobacter spp. (9.5%) and Acinetobacter spp. (7.3%). The results indicated a high level of contamination of diluted disinfectants prepared in the pharmacy, stored and used in the wards. This gave a high index of suspicion that recommendations for cleaning of disinfectant containers before refilling, handling of diluted stock solutions and using of disinfectants were not closely adhered to. Standard disinfection procedures outlined in the disinfection and sterilization policy by the Ministry of Health should therefore be followed.
Collapse
Affiliation(s)
- K C Keah
- Pathology Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor
| | | | | | | | | | | | | |
Collapse
|
50
|
Keah KC, Jegathesan M, Tan SC, Chan SH, Chee OM, Cheong YM, Suleiman AB. Disinfection: gaps between recommended and actual practice. Southeast Asian J Trop Med Public Health 1995; 26:795-8. [PMID: 9139397] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Basic practices on disinfection was surveyed in 6 hospitals using an observation and interview checklist. Two surveys were done, one pre-(first survey) and one post-intervention (second survey). The disinfection and sterilization policy of the Ministry of Health was not available in 66 (70.2%) and 12 (13%) of the units in the first and second survey respectively. In the second survey, staff in all the units washed disinfectant containers before refilling compared with 41.5% of the units in the first survey. Dilution of disinfectants not recommended was found to be used in the first survey. Storing cleaned and sterile items in disinfectants, using disinfectant as a substitute for sterilization of autoclavable items and not decontaminating spillages were some of the wrong practices observed. Considerable improvements were made in the second survey. Improper usage of disinfectants was also indicated by failure of the in-use test. Rate of failure of disinfectants in-use decreased from 11.6% in the first survey to 5.0% in the second survey. To ensure proper disinfection practices, a comprehensive training program on disinfection is required for nurses and attendants.
Collapse
Affiliation(s)
- K C Keah
- Pathology Department, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
| | | | | | | | | | | | | |
Collapse
|