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Niedrig DF, Pyra M, Lussmann R, Serra A, Russmann S. Rosuvastatin-induced rhabdomyolysis: case report and call for proactive multifactorial risk assessment and preventive management of statin therapy in high-risk patients. Eur J Hosp Pharm 2024; 31:281-284. [PMID: 37451842 DOI: 10.1136/ejhpharm-2023-003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Cholesterol-lowering statins are frequently prescribed for primary and secondary prevention of ischaemic vascular events. Whereas most patients tolerate statins without problems, statin-associated myopathy is well documented, as are several risk factors. We present a case report of an 80-90-year-old man with coronary artery disease who rapidly developed severe rhabdomyolysis during treatment with rosuvastatin while in intensive care. He had several concomitant risk factors for statin-induced myopathy including high dosage, old age, renal and hepatic impairment, and a pharmacogenetic SLCO1B1*1 a/*5 variant. Single known risk factors have a low predictive value for statin-induced myopathy and may therefore be underestimated in clinical practice. However, adverse drug reactions frequently involve the joint action of a multitude of environmental and genetic component causes, and statin-induced myopathy should be regarded as a multicausal event. We therefore advocate a proactive multifactorial risk assessment to guide and individualise statin therapy in high-risk patients.
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Affiliation(s)
- David Franklin Niedrig
- Clinical Servcies, Hirslanden AG, Glattpark, Switzerland
- drugsafety.ch, Kusnacht, Switzerland
| | - Martin Pyra
- 24h Accident & Emergency Unit Zurich, Hirslanden Hospital Hirslanden, Zürich, Switzerland
| | - Roger Lussmann
- Institute of Physicians for Anaesthesia and Intensive Care, Hirslanden Klinik Hirslanden, Zürich, Switzerland
| | - Andreas Serra
- Centre for Nephrology and Dialysis, Hirslanden Hospital Hirslanden, Zürich, Switzerland
- University of Zurich Institute of Epidemiology Biostatistics and Prevention, Zürich, Switzerland
| | - Stefan Russmann
- drugsafety.ch, Kusnacht, Switzerland
- Hirslanden Hospital Hirslanden, Zürich, Switzerland
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Nisar F, Ali A, Shahid H, Iqbal MM, Khan H, Khan Q, Iqbal A, Samreen S, Syed W, Al-Rawi MBA. Questionnaire-Based Study of 392 Women in Abbottabad, Pakistan, to Evaluate the Types of Cosmetic Products Purchased Between December 2018 and March 2019 and Their Associated Adverse Events. Med Sci Monit Basic Res 2024; 30:e943048. [PMID: 38549239 PMCID: PMC10986314 DOI: 10.12659/msmbr.943048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Cosmetics are applied topically to enhance appearance and are commonly used by women of all ages. Cosmetics contain many chemical agents, but the incidence of adverse reactions is low, possibly due to underreporting. This questionnaire-based study included 392 women to evaluate information on the types of cosmetics purchased between December 2018 and March 2019, their use by the women surveyed, and their associated adverse events. MATERIAL AND METHODS A cross-sectional study was conducted among 392 women in Abbottabad, Pakistan, using a pre-structured and validated questionnaire to evaluate information on the types of cosmetics, their use, and their associated adverse events. Part 1 of the study collected information about demographics. Part 2 contained a total of 11 items, and collected the frequency of use of cosmetic on skin and hair care products. Part 3 consisted of 4 items and collected information about problems encountered due to the use of cosmetics. RESULTS In the winter season, 47.7% (n=187) of women preferred chemical-based cosmetic products, while 30.9% (n=121) preferred Ayurvedic products. Among commonly used cosmetic products, 26.9% (n=106) of women used foundations. The most frequently used skin care product was face wash 39.5% (n=155). The most prevalent adverse events related to cosmetics were pimples (19.9%, n=78), redness (17.6%, n=69), and eye discomfort (15.8%, n=62). Furthermore, 51.3% (n=201) strongly agreed that cosmetics aid in getting a whiter complexion. CONCLUSIONS The survey concluded that most women preferred cosmetics with a chemical base, which are associated with rashes, redness, and acne. It is important to encourage cosmetovigilance and awareness campaigns among cosmetic product sellers and users.
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Affiliation(s)
- Fatima Nisar
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | - Atif Ali
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | - Hira Shahid
- School of Psychology, South China Normal University, Guangzhou, Guangdong, PR China
| | - Muhammad Mamoon Iqbal
- Internal Medicine Trainee, University Hospitals of Leicester, Leicester, United Kingdom
| | - Hira Khan
- Department of Pharmacy, Abbottabad University of Science and Technology, Havelian, Pakistan
| | - Qasim Khan
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | - Ayesha Iqbal
- Department of Pharmacy Practice and Policy, University Park Campus, University of Nottingham, Nottingham, United Kingdom
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sana Samreen
- Aurobindo College of Pharmacy, Warangal, Telangana, India
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyad, Saudi Arabia
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Jiang Y, Hwang M, Cho Y, Friese CR, Hawley ST, Manojlovich M, Krauss JC, Gong Y. The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study. J Med Internet Res 2024; 26:e47685. [PMID: 38457204 PMCID: PMC10960221 DOI: 10.2196/47685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. OBJECTIVE We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. METHODS A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. RESULTS Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5%) and easy to use (157/204, 77%), had a positive attitude toward use (162/204, 79.4%), and were willing to use such a system (129/204, 63.2%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95% CI 1.37-7.78). CONCLUSIONS In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care.
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Affiliation(s)
- Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Misun Hwang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Christopher R Friese
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sarah T Hawley
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, United States
| | | | - John C Krauss
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Celestino IC, Antunes DE, Santos DF, Gimenes VL, de Souza FM, Goulart IMB. Adverse reactions induced by MDT/WHO (Rifampicin+Clofazimine+Dapsone) and ROM (Rifampicin+Ofloxacin+Minocycline) regimens used in the treatment of leprosy: a cohort study in a National Reference Center in Brazil. Front Pharmacol 2024; 15:1346169. [PMID: 38515839 PMCID: PMC10955366 DOI: 10.3389/fphar.2024.1346169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Background: Recommended standard treatment for leprosy is multidrugtherapy (MDT/WHO), consisting Rifampicin+Dapsone+Clofazimine. Other medications are recommended in cases of resistance, adverse reactions and intolerances, including ROM regimen, Rifampicin+Ofloxacin+Minocycline. Therefore, pharmacovigilance is an important tool in understanding these adverse drug reactions (ADRs), supporting pharmacotherapy management and medication safety. This study seeks to evaluate ADRs comparing two therapeutic regimens, MDT and ROM, used in treatment of patients with leprosy, analyzing prognostic factors regarding risk and safety. Methods:A retrospective cohort study was performed by assessing medical records of 433 patients diagnosed with leprosy from 2010 to 2021 at a National Reference Center in Brazil. They were subject to 24 months or more of treatment with MDT or ROM regimens. ADR assessments were analyzed by two experienced researchers, who included clinical and laboratory variables, correlating them with temporality, severity and the causality criteria of Naranjo and WHO. Results: The findings observed an average of 1.3 reactions/patient. Out of individuals experiencing reactions, 67.0% (69/103) were utilizing MDT/MB, while 33.0% (34/103) were using ROM. The median time for ADR of 79 days for MDT and 179 days for ROM. In first reaction, Dapsone was the most frequently involved medication; the most affected system was hematopoietic. As compared to Clofazimine, results indicated that use of Dapsone was associated with 7% increased risk of ADR occurrence (HR: 1.07; p = 0.866). Additionally, Rifampicin was linked to 31% increased risk of ADRs (HR: 1.31; p = 0.602); and Ofloxacin showed 35% elevated risk (HR: 1.35; p = 0.653). Conversely, results for Minocycline indicated 44% reduction in the risk of ADRs (HR: 0.56; p = 0.527), although statistical significance was not reached. The use of MDT conferred 2.51 times higher risk of developing ADRs in comparison to ROM. Conclusion: The comparison between MDT and ROM revealed that MDT caused more ADRs, and these reactions were more severe, indicating less safety for patients. Dapsone was the most common medication causing ADRs, followed by Rifampicin. The combination with Clofazimine was associated with an additional risk of ADRs, warranting further studies to confirm this hypothesis. Given the high magnitude of ADRs, healthcare teams need to monitor patients undergoing leprosy treatment with focus on pharmacovigilance.
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Affiliation(s)
- Isadora Costa Celestino
- Post-Graduation Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Douglas Eulalio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Diogo Fernandes Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Victor Lemos Gimenes
- Faculty of Medicine, Higher School of Health Sciences, Federal District Health Department, Brasília, Brazil
| | | | - Isabela Maria Bernardes Goulart
- Post-Graduation Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
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Aftab OM, Davis M, Obeidallah A, Rogers A, Hou L, Abdollah F, Ahmed M, Billah MS. Short-Term Reported Urologic Adverse Events Following COVID-19 Immunization: A Vaccine Adverse Event Reporting System Analysis. Urol Pract 2024; 11:312-323. [PMID: 38377155 DOI: 10.1097/upj.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Medical misinformation regarding COVID-19 immunization remains rampant and a public concern, and as such, there is a need for national studies evaluating the immunization's safety profile. We sought to quantify and analyze urologic adverse events and symptoms after COVID-19 immunization, compare these events reported between COVID-19 vaccine types, and compare these events reported following COVID-19 immunization relative to those reported following other immunizations. METHODS We conducted a retrospective case-control disproportionality analysis by querying the Food and Drug Administration Vaccine Adverse Event Reporting System for all reported symptoms following COVID-19 immunization through December 23, 2022, as well as for all non-COVID immunizations. RESULTS Using a total of 704,231 event reports containing 2,982,187 symptoms related to COVID vaccination and a total of 770,975 event reports containing 2,198,993 symptoms related to all vaccinations other than COVID-19 for disproportionality analysis, no urologic symptom produced a positive signal when grouping all vaccinations. When stratifying by manufacturer, some symptoms related to Janssen vaccination were positive, but this may be in part due to overreporting secondary to media attention rather than a strong association between Janssen vaccination and urologic adverse events. CONCLUSIONS Although there have been anecdotal reports of adverse events associated with the COVID-19 vaccine, our review of the Vaccine Adverse Event Reporting System database did not produce positive signals across all 4 measures for any potential adverse event. Our findings do not suggest increased scrutiny is required regarding these adverse events potentially related to the COVID-19 immunization. Further evaluation and analysis of the COVID-19 immunization is ongoing.
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Affiliation(s)
- Owais M Aftab
- Division of Urology, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Matthew Davis
- Vattikuti Urology Institute-Center for Outcomes Research, Analysis, and Evaluation, Detroit, Michigan
| | - Aisha Obeidallah
- Division of Urology, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Alexandra Rogers
- Vattikuti Urology Institute-Center for Outcomes Research, Analysis, and Evaluation, Detroit, Michigan
| | - Laurence Hou
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey
| | - Firas Abdollah
- Vattikuti Urology Institute-Center for Outcomes Research, Analysis, and Evaluation, Detroit, Michigan
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey
| | - Mubashir Shabil Billah
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey
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Sahib Din J, Navarro Garcia E, Al-Rubaye H, Julian C. Knee Buckling as an Atypical Adverse Effect of Clozapine: A Case Report. Cureus 2024; 16:e55865. [PMID: 38595866 PMCID: PMC11002468 DOI: 10.7759/cureus.55865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
Clozapine has become a widely popular and effective medication in the treatment of refractory schizophrenia and refractory bipolar disorder. Although the use of clozapine proves to be an effective resort, it has to be closely monitored due to its narrow therapeutic range and multiple dangerous adverse effects. In rare cases, clozapine has been known to cause an antagonistic myoclonic jerk that leads to knee buckling. Here, we present the case of a 29-year-old female who is being treated for schizoaffective disorder, bipolar, manic type, who reported two instances of knee buckling associated with falls while taking clozapine.
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Affiliation(s)
| | - Ernesto Navarro Garcia
- Nanotechnology, University of Central Florida, Orlando, USA
- Physiology and Neuroscience, St George's University, St. George's, GRD
| | - Hiba Al-Rubaye
- Physiology and Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | - Carlos Julian
- Physiology and Neuroscience, St. George's University School of Medicine, St. George's, GRD
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Sekar VD, Joshi K, Bhide S, Rao S, Phirke C, Patil S, Kothari R, Patel M, Shankar A. Adverse Drug Reactions and Prescription Patterns of Antiretroviral Drugs: A Longitudinal Observational Study From a Tertiary Care Hospital in Western India. Cureus 2024; 16:e56424. [PMID: 38638708 PMCID: PMC11024481 DOI: 10.7759/cureus.56424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background In 2018, the World Health Organisation (WHO) released interim guidelines, advising a change of regimens to dolutegravir-based first- and second-line antiretroviral therapy (ART), based on which, in 2021, the National Aids Control Organisation (NACO) updated its guidelines to include the tenofovir + lamivudine + dolutegravir (TLD) regimen as a first line of therapy for all people living with HIV (PLHIV) and second- and third-line regimens to dolutegravir-based regimens. Considering this change of regimen, the adverse drug reaction (ADR) profiling and longitudinal prescription pattern of antiretroviral and concomitant medications in adult patients at the ART centre of a tertiary care hospital were assessed in this study. Methods Ninety-seven PLHIV out of all the patients who attended the ART centre from September 2021 to July 2022 were enrolled and followed up for six months. The ADRs that occurred during this period were collected along with details of prescription patterns and analyzed by descriptive statistics. Causality assessment for ADR was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Results Seventy-eight percent (n=76 out of 97) of patients experienced at least one ADR, and 128 ADRs were seen in 97 patients. The most common ADRs were increased alkaline phosphatase (39.0%, n=128), dyslipidaemia (12.5%, n=128), and nephrotoxicity (10.1%, n=128). The drug most suspected of causing ADRs was dolutegravir (27.5%, n=342). The most common therapeutic regimen was TLD (71.2%, n=97). The most prescribed drug was lamivudine (30.6%, n=1183). The most prescribed concomitant medication was cotrimoxazole (15%, n=312). Conclusions Dolutegravir-based regimens have been implemented for PLHIV in a phased-out manner from previous non-dolutegravir-based ART regimens, which is in line with the recent NACO guidelines. However, it has also led to an increase in dolutegravir-associated ADRs like increased alkaline phosphatase, dyslipidaemia, and nephrotoxicity. Continuous monitoring of prescriptions and ADRs can add to our knowledge regarding their use and ADRs.
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Affiliation(s)
- Vijaya Dhaarani Sekar
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Kavita Joshi
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Shruti Bhide
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Shirish Rao
- Department of Research, Association for Socially Applicable Research, Pune, IND
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Chetan Phirke
- Department of Pharmacology, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, IND
| | - Saurabh Patil
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Rahul Kothari
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Mudra Patel
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Arun Shankar
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
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Hembrom SB, Ahmed G, Karim HMR, Singh V, Rai P, Meshram SV. Steroid Premedication Might Protect From Postoperative Erythema Nodosum Leprosum in Leprosy: A Case Report. Cureus 2024; 16:e55986. [PMID: 38606250 PMCID: PMC11007188 DOI: 10.7759/cureus.55986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Leprosy is known for its diverse pathophysiologic involvement and resulting multisystemic manifestation and morbidities. Despite global efforts to eliminate this public health illness, it is still prevalent in some Asian and European countries. Perioperative management of a leprosy patient is challenging owing to the indirect and direct involvement of the airway, respiratory, and cardiac systems; treatment-related side-effects involving the hepato-renal systems affecting the anesthesia techniques and drugs pharmacokinetic and pharmacodynamics. While anaesthesiologists are aware of such happenings and often tailor the anesthesia management for the concerning issues, immunological aspects of the disease and drug-related adverse events are less enquired about, such as type-2 lepra reaction, i.e., erythema nodosum leprosum (ENL), etc. Further, data on perioperative ENL management and prevention are still being determined. We report one case of a 52-year-old female who underwent gynecology surgery and developed ENL on the third postoperative day, which was managed using Steroids. Unfortunately, the patient had a surgical site infection, which required another surgery within the month, while the patient was still under the steroid successfully without any adverse events. Although a single case cannot provide causation or association, the case is presented to highlight the probable preventive action of steroids on the occurrence of postoperative ENL, where surgical stress is considered a risk factor.
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Affiliation(s)
- Shweta B Hembrom
- Anesthesiology, Critical Care, and Pain Medicine, All Indian Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Ghazal Ahmed
- Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Vineeta Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Priyanka Rai
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Suchita V Meshram
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
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Marghalani S, Alghamdi Y, Albrakati BA, Huwait HF, Mohanna AT. Pityriasis Rosea Eruption Following the Administration of Oxford-AstraZeneca Vaccine. Cureus 2024; 16:e56310. [PMID: 38628985 PMCID: PMC11019476 DOI: 10.7759/cureus.56310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) infection has led to accelerated development and utilization of vaccines to prevent its implications on health. One of these vaccines is a vector-based, Oxford-AstraZeneca Vaccine (AZD1222). Frequently reported side effects are related to host-immune response. While dermatologic manifestation is peculiar in nature and denotes a serious eruption that might defer future vaccination. Herein, we present a case of a medically free 37-year-old female who developed clinical and histological evidence of pityriasis rosea (PR) after administration of a second-dose vaccination of AZD1222. The first dose of vaccination was administered as Pfizer BioNTech COVID-19 mRNA (BNT162b2) vaccine. This case is unique in nature as this patient developed AZD1222-induced PR, while some reports in the literature have linked PR to the BNT162b2 vaccine. This patient continued to receive a booster vaccination with BNT162b2 with no reportable side effects.
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Affiliation(s)
| | - Yara Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- King Abdullah International Medical Research Center, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | | | | | - Abdulrahman T Mohanna
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Choi CS, Kin K, Cao K, Hutcheon E, Lee M, Chan STF, Arafat Y, Baird PN, Yeung JMC. The association of body composition on chemotherapy toxicities in non-metastatic colorectal cancer patients: a systematic review. ANZ J Surg 2024; 94:327-334. [PMID: 38059530 DOI: 10.1111/ans.18812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND In recent years, certain body composition measures, assessed by computed tomography (CT), have been found to be associated with chemotherapy toxicities. This review aims to explore available data on the relationship between skeletal muscle and adiposity, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular and intermuscular adipose tissue and their association with chemotherapy toxicity in non-metastatic colorectal cancer (CRC) patients. METHODS A systematic literature search following PRISMA guidelines was conducted in Medline, Embase, Cochrane and Web of Science, for papers published between 2011 and 2023. The search strategy combined keywords and MESH terms relevant to 'body composition', 'chemotherapy toxicities', and 'non-metastatic colorectal cancer'. RESULTS Out of 3868 studies identified, six retrospective studies fulfilled the inclusion criteria with 1024 eligible patients. Low skeletal muscle mass was strongly associated with increased incidence of both chemotherapy toxicities and dose-limiting toxicity (DLT). The association of VAT, intramuscular and intermuscular adiposity was heterogeneous and inconclusive. There was no association between SAT and chemotherapy intolerance. No universal definitions or cut-offs for sarcopenia and obesity were noted. All studies utilized 2-dimensional (2D) CT slices for CT body composition assessment with varied selection on the vertebral landmark and inconsistent reporting of tissue-defining Hounsfield unit (HU) measurements. CONCLUSION Low skeletal muscle is associated with chemotherapy toxicities in non-metastatic CRC. However, quality evidence on the role of adiposity is limited and heterogeneous. More studies are needed to confirm these associations with an emphasis on a more coherent body composition definition and an approach to its assessment, especially regarding sarcopenia.
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Affiliation(s)
- Cheuk Shan Choi
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Kamol Kin
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Ke Cao
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Evelyn Hutcheon
- Western Health Library Service, Western Health, Melbourne, Victoria, Australia
| | - Margaret Lee
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
| | - Steven T F Chan
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasser Arafat
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Paul N Baird
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Justin M C Yeung
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
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Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Arienti C, Negrini S. Therapeutic exercises for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2024; 2:CD007837. [PMID: 38415871 PMCID: PMC10900302 DOI: 10.1002/14651858.cd007837.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/29/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a pathology that changes the three-dimensional shape of the spine and trunk. While AIS can progress during growth and cause cosmetic issues, it is usually asymptomatic. However, a final spinal curvature above the critical threshold of 30° increases the risk of health problems and curve progression in adulthood. The use of therapeutic exercises (TEs) to reduce the progression of AIS and delay or avoid other, more invasive treatments is still controversial. OBJECTIVES To evaluate the effectiveness of TE, including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two clinical trials registers to 17 November 2022. We also screened reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing TE with no treatment, other non-surgical treatments (braces, electrical stimulation, manual therapy), and different types of exercises. In the previous version of the review, we also included observational studies. We did not include observational studies in this update since we found sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Our major outcomes were progression of scoliosis (measured by Cobb angle, trunk rotation, progression, bracing, surgery), cosmetic issues (measured by surface measurements and perception), and quality of life (QoL). Our minor outcomes were back pain, mental health, and adverse effects. MAIN RESULTS We included 13 RCTs (583 participants). The percentage of females ranged from 50% to 100%; mean age ranged from 12 to 15 years. Studies included participants with Cobb angles from low to severe. We judged 61% of the studies at low risk for random sequence generation and 46% at low risk for allocation concealment. None of the studies could blind participants and personnel. We judged the subjective outcomes at high risk of performance and detection bias, and the objective outcomes at high risk of detection bias in six studies and at low risk of bias in the other six studies. One study did not assess any objective outcomes. Comparing TE versus no treatment, we are very uncertain whether TE reduces the Cobb angle (mean difference (MD) -3.6°, 95% confidence interval (CI) -5.6 to -1.7; 2 studies, 52 participants). Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR) (MD -0.8°, 95% CI -3.8 to 2.1; 1 study, 45 participants), may reduce the waist asymmetry slightly (MD -0.5 cm, 95% CI -0.8 to -0.3; 1 study, 45 participants), and may result in little to no difference in the score of cosmetic issues measured by the Spinal Appearance Questionnaire (SAQ) General (MD 0.7 points, 95% CI -0.1 to 1.4; 1 study, 16 participants). PSSE may result in little to no difference in self-image measured by the Scoliosis Research Society - 22 Patient Questionnaire (SRS-22) (MD 0.3 points, 95% CI -0.3 to 0.9; 1 study, 16 participants) and improve QoL slightly measured by SRS-22 Total score (MD 0.3 points, 95% CI 0.1 to 0.4; 2 studies, 61 participants). Only Cobb angle results were clinically meaningful. Comparing PSSE plus bracing versus bracing, low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle (-2.2°, 95% CI -3.8 to -0.7; 2 studies, 84 participants). Comparing GTE plus other non-surgical interventions versus other non-surgical interventions, low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle (MD -8.0°, 95% CI -11.5 to -4.5; 1 study, 80 participants). We are uncertain whether PSSE plus other non-surgical interventions versus other non-surgical interventions reduces Cobb angle (MD -7.8°, 95% CI -12.5 to -3.1; 1 study, 18 participants) and ATR (MD -8.0°, 95% CI -12.7 to -3.3; 1 study, 18 participants). PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues as measured by SAQ General (-0.2 points, 95% CI -0.9 to 0.5; 1 study, 34 participants), self-image score as measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -0.3 to 0.5; 1 study, 34 participants), and QoL measured by SRS-22 Total score (MD 0.2 points, 95% CI -0.1 to 0.5; 1 study, 34 participants). None of these results were clinically meaningful. Comparing TE versus bracing, we are very uncertain whether PSSE allows progression of Cobb angle (MD 2.7°, 95% CI 0.3 to 5.0; 1 study, 60 participants), changes self-image measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -1.0 to 1.1; 1 study, 60 participants), and QoL measured by SRS-22 Total score (MD 3.2 points, 95% CI 2.1 to 4.2; 1 study, 60 participants). None of these results were clinically meaningful. Comparing PSSE with GTE, we are uncertain whether PSSE makes little or no difference in Cobb angle (MD -3.0°, 95% CI -8.2 to 2.1; 4 studies, 192 participants; very low-certainty evidence). PSSE probably reduces ATR (clinically meaningful) (-MD 3.0°, 95% CI -3.4 to -2.5; 2 studies, 138 participants). We are uncertain about the effect of PSSE on QoL measured by SRS-22 Total score (MD 0.26 points, 95% CI 0.11 to 0.62; 3 studies, 168 participants) and on self-image measured by SRS-22 Self-Image and Walter Reed Visual Assessment Scale (standardised mean difference (SMD) 0.77, 95% CI -0.61 to 2.14; 3 studies, 168 participants). Further, low-certainty evidence indicates that 38/100 people receiving GTE may progress more than 5° Cobb versus 7/100 receiving PSSE (risk ratio (RR) 0.19, 95% CI 0.67 to 0.52; 1 study, 110 participants). None of the included studies assessed adverse effects. AUTHORS' CONCLUSIONS The evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and many different comparisons. We found only one study following participants to the end of growth showing the efficacy of PSSE over TE. This result was weakened by adding studies with short-term results and unclear preparation of treating physiotherapists. More RCTs are needed to strengthen the current evidence and study other highly clinically relevant outcomes such as QoL, psychological and cosmetic issues, and back pain.
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Affiliation(s)
- Michele Romano
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Jones A, Veale B, Li T, Aggarwal VR, Twigg J. Interventions for managing oral submucous fibrosis. Cochrane Database Syst Rev 2024; 2:CD007156. [PMID: 38415846 PMCID: PMC10900301 DOI: 10.1002/14651858.cd007156.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/29/2024]
Abstract
BACKGROUND Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced mouth opening. OSF has a significant impact on eating and swallowing, affecting quality of life. There is an increased risk of oral malignancy in people with OSF. The main risk factor for OSF is areca nut chewing, and the mainstay of treatment has been behavioural interventions to support habit cessation. This review is an update of a version last published in 2008. OBJECTIVES To evaluate the benefits and harms of interventions for the management of oral submucous fibrosis. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 5 September 2022. SELECTION CRITERIA We considered randomised controlled trials (RCTs) of adults with a biopsy-confirmed diagnosis of OSF treated with systemic, locally delivered or topical drugs at any dosage, duration or delivery method compared against placebo or each other. We considered surgical procedures compared against other treatments or no active intervention. We also considered other interventions such as physiotherapy, ultrasound or alternative therapies. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. participant-reported resumption of normal eating, chewing and speech; 2. change or improvement in maximal mouth opening (interincisal distance); 3. improvement in range of jaw movement; 4. change in severity of oral/mucosal burning pain/sensation; 5. ADVERSE EFFECTS Our secondary outcomes were 6. quality of life; 7. postoperative discomfort or pain as a result of the intervention; 8. participant satisfaction; 9. hospital admission; 10. direct costs of medication, hospital bed days and any associated inpatient costs for the surgical interventions. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 30 RCTs (2176 participants) in this updated review. We assessed one study at low risk of bias, five studies at unclear risk of bias and 24 studies at high risk of bias. We found diverse interventions, which we categorised according to putative mechanism of action. We present below our main findings for the comparison 'any intervention compared with placebo or no active treatment' (though most trials included habit cessation for all participants). Results for head-to-head comparisons of active interventions are presented in full in the main review. Any intervention versus placebo or no active treatment Participant-reported resumption of normal eating, chewing and speech No studies reported this outcome. Interincisal distance Antioxidants may increase mouth opening (indicated by interincisal distance (mm)) when measured at less than three months (mean difference (MD) 3.11 mm, 95% confidence interval (CI) 0.46 to 5.77; 2 studies, 520 participants; low-certainty evidence), and probably increase mouth opening slightly at three to six months (MD 8.83 mm, 95% CI 8.22 to 9.45; 3 studies, 620 participants; moderate-certainty evidence). Antioxidants may make no difference to interincisal distance at six-month follow-up or greater (MD -1.41 mm, 95% CI -5.74 to 2.92; 1 study, 90 participants; low-certainty evidence). Pentoxifylline may increase mouth opening slightly (MD 1.80 mm, 95% CI 1.02 to 2.58; 1 study, 106 participants; low-certainty evidence). However, it should be noted that these results are all less than 10 mm, which could be considered the minimal change that is meaningful to someone with oral submucous fibrosis. The evidence was very uncertain for all other interventions compared to placebo or no active treatment (intralesional dexamethasone injections, pentoxifylline, hydrocortisone plus hyaluronidase, physiotherapy). Burning sensation Antioxidants probably reduce burning sensation visual analogue scale (VAS) scores at less than three months (MD -30.92 mm, 95% CI -31.57 to -30.27; 1 study, 400 participants; moderate-certainty evidence), at three to six months (MD -70.82 mm, 95% CI -94.39 to -47.25; 2 studies, 500 participants; moderate-certainty evidence) and at more than six months (MD -27.60 mm, 95% CI -36.21 to -18.99; 1 study, 90 participants; moderate-certainty evidence). The evidence was very uncertain for the other interventions that were compared to placebo and measured burning sensation (intralesional dexamethasone, vasodilators). Adverse effects Fifteen studies reported adverse effects as an outcome. Six of these studies found no adverse effects. One study evaluating abdominal dermal fat graft reported serious adverse effects resulting in prolonged hospital stay for 3/30 participants. There were mild and transient general adverse effects to systemic drugs, such as dyspepsia, abdominal pain and bloating, gastritis and nausea, in studies evaluating vasodilators and antioxidants in particular. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that antioxidants administered systemically probably improve mouth opening slightly at three to six months and improve burning sensation VAS scores up to and beyond six months. We found only low/very low-certainty evidence for all other comparisons and outcomes. There was insufficient evidence to make an informed judgement about potential adverse effects associated with any of these treatments. There was insufficient evidence to support or refute the effectiveness of the other interventions tested. High-quality, adequately powered intervention trials with a low risk of bias that compare biologically plausible treatments for OSF are needed. It is important that relevant participant-reported outcomes are evaluated.
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Affiliation(s)
- Adam Jones
- Oral Surgery, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Benjamin Veale
- Oral and Maxillofacial Surgery, Airedale General Hospital, Keighley, UK
| | - Tiffany Li
- Oral and Maxillofacial Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Joshua Twigg
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Department of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
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Qin Y, Chen Z, Gao S, Shen Y, Ye Y. Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients. Eur J Hosp Pharm 2024; 31:94-100. [PMID: 35477677 PMCID: PMC10895188 DOI: 10.1136/ejhpharm-2022-003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Linezolid is the first oxazolidinone antimicrobial agent developed for treating multi-drug-resistant gram-positive bacterial infections. The study aimed to investigate the risk factors of linezolid (LI)-induced thrombocytopenia (LI-TP) and to develop and validate a risk prediction model to identify elderly patients at high risk of developing LI-TP during linezolid therapy. METHODS A retrospective cohort study was performed at Zhongshan Hospital, FuDan University, China. The study involved elderly Chinese patients aged ≥65 years administered with linezolid (600 mg) twice a day between January 2015 and April 2021. We collected the patients' clinical characteristics and demographic data from electronic medical records, and compared the differences between LI-TP patients and those who had not developed thrombocytopenia (NO-TP) after linezolid treatment. The risk prediction model was developed based on the regression coefficient generated from logistic regression model. RESULTS A total of 343 inpatients were enrolled from January 2015 to August 2020 and were used as the training set. Among them, 67 (19.5%) developed LI-TP. Multivariate logistic regression analysis revealed that baseline platelet counts <150×109·L-1 (odds ratio (OR)=3.576; p<0.001), age ≥75 years (OR=2.258; p=0.009), estimated glomerular filtration rate (eGFR <60 mL·(min·1.73 m2)-1 (OR=2.553; p=0.002), duration of linezolid therapy ≥10 d (OR=3.218; p<0.001), intensive care unit (ICU) admittance (OR=2.682; p=0.004), concomitant piperacillin-tazobactam (OR=3.863; p=0.006) were independent risk factors for LI-TP in elderly patients. The LI-TP risk prediction model was established using a scoring method based on the regression coefficient and exhibited a good discriminative power, with an area under the curve (AUC) of 0.795 (95% confidence interval (CI) 0.740 to 0.851) and 0.849 (95% CI 0.760 to 0.939) in the training set (n=343) and validation set (n=90) respectively. CONCLUSIONS These findings indicate that duration of linezolid therapy, age, eGFR, ICU admittance, baseline platelet counts, concomitant piperacillin-tazobactam were significantly associated with LI-TP in elderly patients. A risk prediction model based on these risk factors showed a good discriminative performance and may be useful for clinicians to identify patients at high risk of developing LI-TP.
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Affiliation(s)
- Yan Qin
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Zhe Chen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Shuai Gao
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yun Shen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Yanrong Ye
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
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Ranković A, Milentijevic I, Jankovic S. Factors associated with potential drug-drug interactions in psychiatric inpatients. Eur J Hosp Pharm 2024; 31:127-134. [PMID: 35728951 PMCID: PMC10895174 DOI: 10.1136/ejhpharm-2022-003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and severity of potential drug-drug interactions (pDDIs) in hospitalised patients with major psychiatric disorders and to identify factors associated with their occurrence. METHODS The research was designed as an observational, cross-sectional study conducted at the Clinic for Mental Disorders (CMD) 'Dr. Laza Lazarevic', Belgrade, Serbia. Medscape, Epocrates and Lexicomp bases were used to detect potential drug interactions among inpatients. Multivariate regression analysis was used to reveal risk and protective factors associated with the number of pDDIs. RESULTS The study included 511 patients, average age 44.63±11.81 years. The average number of pDDIs per patient ranged from 5.9±4.7 (Medscape) to 8.2±5.4 (Epocrates) and 8.5±5.1 (Lexicomp). The following risk factors were identified by all three interaction checkers used: C-reactive protein, number of pharmacological subgroups, number of prescribed drugs, antibiotics, antacids, vitamins, number of associated comorbidities, route, form and dose of the drug. CONCLUSIONS When making clinical decisions to reduce drug problems, including DDIs, one should consult several interaction databases, which should be reviewed by a multidisciplinary team consisting of an experienced clinical pharmacist, physician, nurse, and so on.
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Affiliation(s)
- Anica Ranković
- Pharmacology and Toxicology Department, University of Kragujevac Faculty of Medicine, Kragujevac, Serbia
| | - Iva Milentijevic
- Department of Psychiatry, University of Kragujevac Faculty of Medicine, Kragujevac, Serbia
| | - Slobodan Jankovic
- Pharmacology and Toxicology Department, University of Kragujevac Faculty of Medicine, Kragujevac, Serbia
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Emma C, Vesela P, Kay P, Huseyin H, Alison H, Mara S, Floriana DA, Sara C. Psoriasiform dermatitis following ocrelizumab in relapsing-remitting multiple sclerosis: Case report and literature review. Mult Scler 2024:13524585241232277. [PMID: 38385208 DOI: 10.1177/13524585241232277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
We present a case of a 30-year-old man with relapsing-remitting multiple sclerosis who developed psoriasiform dermatitis following his second course of ocrelizumab. This resolved with topical therapies and discontinuation of treatment. Cases of psoriasiform rashes have been increasingly reported in the use of ocrelizumab and are possibly due to B-cell (CD20) depletion and T-cell overregulation. Nevertheless, skin-related adverse reactions are not yet considered in the risk management plans of anti-CD20 treatments in multiple sclerosis.
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Affiliation(s)
- Callanan Emma
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Petkova Vesela
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Polly Kay
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Huseyin Huseyin
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Hassett Alison
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Sittampalam Mara
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - De Angelis Floriana
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Collorone Sara
- Department of Neurology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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Bonnet B, Tournier L, Deschamps F, Yevich S, Marabelle A, Robert C, Albiges L, Besse B, Bonnet V, De Baère T, Tselikas L. Thermal Ablation Combined with Immune Checkpoint Blockers: A 10-Year Monocentric Experience. Cancers (Basel) 2024; 16:855. [PMID: 38473217 DOI: 10.3390/cancers16050855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/03/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE We report a 10-year experience in cancer therapy with concomitant treatment of percutaneous thermal ablation (PTA) and immune checkpoint blockers (ICBs). MATERIAL AND METHODS This retrospective cohort study included all patients at a single tertiary cancer center who had received ICBs at most 90 days before, or 30 days after, PTA. Feasibility and safety were assessed as the primary outcomes. The procedure-related complications and immune-related adverse events (irAEs) were categorized according to the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Efficacy was evaluated based on overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) according to the indication, ablation modality, neoplasm histology, and ICB type. RESULTS Between 2010 and 2021, 78 patients (57% male; median age: 61 years) were included. The PTA modality was predominantly cryoablation (CA) (61%), followed by radiofrequency ablation (RFA) (31%). PTA indications were the treatment of oligo-persistence (29%), oligo-progression (14%), and palliation of symptomatic lesions or prevention of skeletal-related events (SREs) (56%). Most patients received anti-PD1 ICB monotherapy with pembrolizumab (n = 35) or nivolumab (n = 24). The feasibility was excellent, with all combined treatment performed and completed as planned. Ten patients (13%) experienced procedure-related complications (90% grade 1-2), and 34 patients (44%) experienced an irAE (86% grade 1-2). The only factor statistically associated with better OS and PFS was the ablation indication, favoring oligo-persistence (p = 0.02). Tumor response was suggestive of an abscopal effect in four patients (5%). CONCLUSIONS The concomitant treatment of PTA and ICBs within 2-4 weeks is feasible and safe for both palliative and local control indications. Overall, PTA outcomes were found to be similar to standards for patients not on ICB therapy. While a consistently reproducible abscopal effect remains elusive, the safety profile of concomitant therapy provides the framework for continued assessment as ICB therapies evolve.
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Affiliation(s)
- Baptiste Bonnet
- Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France
| | - Louis Tournier
- Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France
- Department of Radiology, Saint-Louis Hospital, Université de Paris, F-75010 Paris, France
| | - Frédéric Deschamps
- Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France
| | - Steven Yevich
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aurélien Marabelle
- Drug Development Department (DITEP), F-94805 Villejuif, France
- Laboratoire de Recherche Translationnelle en Immunothérapies (LRTI), Inserm U1015, F-94805 Villejuif, France
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
| | - Caroline Robert
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
- Gustave Roussy, Département de Médecine Oncologique, F-94805 Villejuif, France
| | - Laurence Albiges
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
- Gustave Roussy, Département de Médecine Oncologique, F-94805 Villejuif, France
| | - Benjamin Besse
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
- Gustave Roussy, Département de Médecine Oncologique, F-94805 Villejuif, France
| | - Victoire Bonnet
- Medicine Department, Campus Pierre et Marie Curie, Sorbonne University, 4 Place Jussieu, F-75005 Paris, France
| | - Thierry De Baère
- Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
| | - Lambros Tselikas
- Gustave Roussy, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France
- Laboratoire de Recherche Translationnelle en Immunothérapies (LRTI), Inserm U1015, F-94805 Villejuif, France
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
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Oliveira SH, Silva BS, Carvalho LMR, Gontijo TL, Pinto IC, Guimarães EADA, de Oliveira VC. Prevalence and underreporting of immunization errors in childhood vaccination: results of a household survey. Rev Esc Enferm USP 2024; 57:e20230253. [PMID: 38373188 PMCID: PMC10878123 DOI: 10.1590/1980-220x-reeusp-2023-0253en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/22/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To investigate underreporting of immunization errors based on vaccination records from children under five years of age. METHOD An epidemiological, cross-sectional analytical study, carried out through a household survey with 453 children aged 6 months to 4 years in three municipalities in Minas Gerais in 2021. A descriptive analysis was carried out, and the prevalence of the error was calculated per 100 thousand doses applied between 2016 and 2021. The magnitude was estimated of the association between variables by prevalence and 95% Confidence Intervals (95%CI). To analyze underreporting, State reporting records were used. RESULTS A prevalence of immunization errors was found to be 41.9/100,000 doses applied (95%CI:32.2 - 51.6). The highest prevalence occurred between 2020 (50.0/100,000 doses applied) and 2021 (78.6/100,000 doses applied). The most frequent error was an inadequate interval between vaccines (47.2%) associated with adsorbed diphtheria, tetanus and pertussis (DTP) vaccine (13.7/100,000) administration. Vaccination delay was related to immunization errors (7.55 95% CI:2.30 - 24.80), and the errors found were underreported. CONCLUSION The high prevalence of underreported errors points to a worrying scenario, highlighting the importance of preventive measures.
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Affiliation(s)
- Stênio Henrique Oliveira
- Universidade Federal de São João del-Rei, Programa de Pós-Graduação
em Enfermagem, Divinópolis, MG, Brazil
| | - Brener Santos Silva
- Universidade do Estado de Minas Gerais, Departamento de Ciências da
Reabilitação e Saúde, Divinópolis, MG, Brazil
| | | | - Tarcísio Laerte Gontijo
- Universidade Federal de São João del-Rei, Programa de Pós-Graduação
em Enfermagem, Divinópolis, MG, Brazil
| | - Ione Carvalho Pinto
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Programa de Pós-Graduação Enfermagem em Saúde Pública, Ribeirão Preto, SP,
Brazil
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Henshaw DS, Schwenk ES, Gupta RK. Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: an infographic. Reg Anesth Pain Med 2024; 49:102-103. [PMID: 37591616 DOI: 10.1136/rapm-2023-104873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Daryl S Henshaw
- Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rajnish K Gupta
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Solanki PK, Yellapragada S, Lynch B, Eibel M, Viscusi ER, Emerick T. Emergence of xylazine as a public health threat: what does the anesthesiologist need to know for perioperative care? Reg Anesth Pain Med 2024:rapm-2023-105190. [PMID: 38242642 DOI: 10.1136/rapm-2023-105190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/24/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
This paper explores the rapid emergence of xylazine exposure in the USA and its implications for anesthesiologists. Xylazine, a non-opioid sedative and analgesic often used in veterinary medicine, has increasingly been found as an adulterant in the illicit substance supply, leading to serious health implications. The pharmacological properties of xylazine, its clinical effects, and the challenges it poses for clinicans will be discussed. Perioperative strategies for anesthesiologists to manage these potential cases are provided. Furthermore, this paper necessitates an epidemiological understanding for detection and multidisciplinary collaboration in addressing this emerging public health threat. The manuscript concludes by emphasizing the role anesthesiologists will have to play in managing the clinical implications of xylazine and contributing to public health strategies aimed at curbing its misuse.
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Affiliation(s)
- Pawan K Solanki
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
| | - Samir Yellapragada
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
| | - Brendan Lynch
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
| | - Maria Eibel
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
| | - Eugene R Viscusi
- Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, Chronic Pain Division, UPMC, Pittsburgh, Pennsylvania, USA
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Wiuff AC, Rohde C, Jensen BD, Nierenberg AA, Østergaard SD, Köhler-Forsberg O. Association between lithium treatment and renal, thyroid and parathyroid function: A cohort study of 6659 patients with bipolar disorder. Bipolar Disord 2024; 26:71-83. [PMID: 37300391 DOI: 10.1111/bdi.13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/12/2023]
Abstract
OBJECTIVES Although potential adverse effects of lithium treatment on renal and endocrine systems have been extensively investigated, most prior studies are limited by selected populations and short follow-up. METHODS Within the Psychiatric Services of the Central Denmark Region, we identified all patients with bipolar disorder and ≥1 serum-lithium (se-Li) measurements between January 1, 2013, and July 20, 2022, and reference patients with bipolar disorder matched on age, sex, and baseline creatinine. Outcomes were diagnoses of renal, thyroid and parathyroid disease, and blood tests measuring creatinine, estimated glomerular filtration rate (eGFR), thyroid-stimulating hormone (TSH), parathyroid hormone (PTH) and calcium. Analyses included unadjusted multilevel regression to describe changes in biochemical markers, and adjusted Cox regression to compare rates of disease/biochemical outcomes between lithium users and reference patients. RESULTS Among 1646 lithium users (median age 36 years, 63% women) and 5013 reference patients, lithium users had decreasing TSH and eGFR, stable PTH, and increasing calcium levels over time. Lithium use was associated with increased rates of renal, thyroid and parathyroid disease, and levels of biochemical markers outside normal ranges (hazard rate ratios: 1.07-11.22), but the absolute number of severe outcomes was low (e.g., chronic kidney disease: N = 10, 0.6%). Notably, the rate of blood testing was substantially higher among lithium users than among reference patients (e.g., mean number of creatinine tests during the second year of follow-up: lithium users = 2.5, reference patients = 1.4). CONCLUSIONS Severely adverse renal and endocrine outcomes are rare during lithium treatment. Observational studies of long-term lithium treatment are prone to detection bias.
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Affiliation(s)
- Anne Christine Wiuff
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Botilla Dalsgaard Jensen
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrew A Nierenberg
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
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Hall S, Chew CY, Kovitwanichkanont T, Ip KHK, Cahill J, Gin A, McLean CA, Gin D. Subcorneal pustular dermatosis induced by dupilumab: A novel case. Australas J Dermatol 2024; 65:74-76. [PMID: 38009895 DOI: 10.1111/ajd.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/23/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Sasha Hall
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher Y Chew
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
| | | | - Ken Hiu-Kan Ip
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
| | - Jennifer Cahill
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
| | - Alexander Gin
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Douglas Gin
- Department of Dermatology, Alfred Health, Melbourne, Victoria, Australia
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Ayala Torres JD, Noreña B, Suarez Poveda AT. Eosinophilic Pneumonia Induced by Daptomycin. Cureus 2024; 16:e55095. [PMID: 38558746 PMCID: PMC10978459 DOI: 10.7759/cureus.55095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Daptomycin-induced eosinophilic pneumonia (DIEP) is a rare but serious complication associated with the use of this broad-spectrum antibiotic. We present the case of a teenager with a history of nasopharyngeal cancer who developed DIEP while receiving daptomycin to treat an infection associated with an implanted chamber catheter. Symptoms included recurrent dyspnea and peripheral eosinophilia, with radiological findings consistent with DIEP. The pathophysiology involves an immune response triggered by daptomycin, resulting in eosinophilic pulmonary inflammation. Diagnosis requires a thorough evaluation of medical history, clinical laboratory tests, and radiological findings. The main treatment involves discontinuation of daptomycin and, in severe cases, the use of steroids. It is essential to consider DIEP in patients with respiratory failure and bilateral pulmonary opacities who have used daptomycin and to suspect it in those with blood eosinophilia or in bronchoalveolar lavage.
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Affiliation(s)
| | - Brian Noreña
- Radiology, Universidad de Antioquia, Medellín, COL
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Price L, Garrity L, Stiehl S. Evaluation of the safety and tolerability of intravenous undiluted levetiracetam at a pediatric institution. Pharmacotherapy 2024; 44:141-148. [PMID: 38050327 DOI: 10.1002/phar.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 12/06/2023]
Abstract
STUDY OBJECTIVE Recent studies suggest rapid administration of high-dose, undiluted levetiracetam is safe in adults; however, no information exists in pediatric patients. The purpose of this study was to evaluate the safety and tolerability of undiluted levetiracetam at a pediatric institution. DESIGN Retrospective, single-center, cohort study. SETTING Pediatric Academic Medical Center. PATIENTS All patients who received high-dose >60 mg/kg (-10%) up to 4500 mg undiluted or diluted intravenous levetiracetam were included. INTERVENTION Rapid intravenous administration of undiluted versus diluted levetiracetam. MEASUREMENTS AND MAIN RESULTS A total of 776 levetiracetam doses were included, 358 doses administered and 418 doses wasted. The doses administered (61 undiluted and 297 diluted) accounted for a total of 252 patients (39 received undiluted, and 213 received diluted levetiracetam) (median [minimum-maximum range] age, 2 years [1 day to 32.7 years]; mean (standard deviation [SD]) weight, 20.1 kg [22.1 kg]). The incidence of hemodynamic disturbances and infusion-related reactions was not statistically significant between undiluted (24.6%) and diluted (26.3%) groups (p = 0.87). The median (interquartile range [IQR]) time difference between first-line antiseizure medication and levetiracetam administration in patients with status epilepticus was 18 min (10.5-30.5) in the undiluted group versus 36.5 min (21.8-67.3) in the diluted group (p < 0.01). Additionally, there was a significant amount of drug waste from dispensed but not administered doses of the diluted bag compared to undiluted vials (57.6% diluted vs. 18.7% undiluted, p < 0.001). CONCLUSION Undiluted levetiracetam was not associated with an increased incidence of adverse effects compared to diluted levetiracetam in high-doses, up to 4500 mg given over 5 min in pediatric patients.
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Affiliation(s)
- Lily Price
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa Garrity
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sarah Stiehl
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Ferraris A, Szmulewicz AG, Burry L, Phipps A, Wunsch H, Scales DC, Angriman F. New antipsychotic prescription and recurrent infections among adult sepsis survivors: A population-based cohort study. Pharmacoepidemiol Drug Saf 2024; 33:e5747. [PMID: 38126218 DOI: 10.1002/pds.5747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Antipsychotic agents, which may increase the risk of infection through dopaminergic dysregulation, are prescribed to a fraction of patients following critical illness. We compared the rate of recurrent sepsis among patients who filled a prescription for antipsychotics with high- or low-D2 affinity. METHODS Population-based cohort with active comparator design. We included sepsis survivors older than 65 years with intensive care unit admission and new prescription of antipsychotics in Ontario 2008-2019. The primary outcome were recurrent sepsis episodes within 1 year of follow-up. Patients who filled a prescription within 30 days of hospital discharge for high-D2 affinity antipsychotics (e.g., haloperidol) were compared with patients who filled a prescription within 30 days of hospital discharge for low-D2 affinity antipsychotics (e.g., quetiapine). Multivariable zero-inflated Poisson regression models with robust standard errors adjusting for confounding at baseline were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS Overall, 1879 patients filled a prescription for a high-D2, and 1446 patients filled a prescription for a low-D2 affinity antipsychotic. Patients who filled a prescription for a high-D2 affinity antipsychotic did not present a higher rate of recurrent sepsis during 1 year of follow-up, compared with patients who filled a prescription for a low-D2 affinity antipsychotic (IRR: 1.12; 95% CI: 0.94, 1.35). CONCLUSIONS We did not find conclusive evidence of a higher rate of recurrent sepsis associated with the prescription of high-D2 affinity antipsychotics (compared with low-D2 affinity antipsychotics) by 1 year of follow-up in adult sepsis survivors with intensive care unit admission.
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Affiliation(s)
- Augusto Ferraris
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Laboratory of Applied Statistics in Health Sciences, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro G Szmulewicz
- Epidemiology Department, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Amanda Phipps
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Federico Angriman
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Fernández Martínez V, García-Avello Fernández-Cueto A, Valencia Soto CM, Barbadillo Villanueva S, Ochagavía Sufrategui M, Rioja Carrera M, Alonso Buznego LA, Valero Domínguez M. Pembrolizumab-induced agranulocytosis. J Oncol Pharm Pract 2024:10781552241228774. [PMID: 38291678 DOI: 10.1177/10781552241228774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION With the widespread use of anti-programmed death-1 monoclonal antibodies, such as pembrolizumab, rare side effects appear in clinical practice. CASE REPORT We report the case of a man diagnosed with non-keratinizing squamous lung carcinoma stage IVB with programmed death-ligand 1 70% who developed agranulocytosis 10 days after a single dose of pembrolizumab as monotherapy. MANAGEMENT AND OUTCOME Pembrolizumab was discontinued immediately. Grade 4 neutrophil decrease is mentioned in the product information sheet as a rare side effect. The patient was admitted in poor physical condition with grade 4 neutropenic fever, mucositis and anemia. Agranulocytosis did not improve despite treatment with granulocyte colony-stimulating factor, intravenous corticosteroids and intravenous immunoglobulins. He experienced a rapid worsening and died 3 weeks after admission. The causal relationship between pembrolizumab and the appearance of agranulocytosis was determined as possible according to Naranjo's modified Karch and Lasagna's imputability algorithm. DISCUSSION Hematologic immune-related adverse events are uncommon but important side effects among patients treated with immune checkpoint inhibitors. Agranulocytosis and neutropenia are infrequently reported but can be life-threatening. The main approach for agranulocytosis consists of intravenous corticosteroids, granulocyte colony-stimulating factors and blood products. Depending on bone marrow characteristics, treatments for refractory patients include intravenous immunoglobulins or cyclosporine. After an immune-related adverse event, benefits and risks must be considered before continuation with an immune checkpoint inhibitor. Detection and communication of adverse drug reactions to the Pharmacovigilance Systems have special relevance for rare side effects.
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Affiliation(s)
| | | | | | | | | | - María Rioja Carrera
- Pharmacy Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Moreno G, Ramirez C, Corbalán J, Peñaloza B, Morel Marambio M, Pantoja T. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev 2024; 1:CD008973. [PMID: 38269441 PMCID: PMC10809033 DOI: 10.1002/14651858.cd008973.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/26/2024]
Abstract
BACKGROUND This is an updated version of a Cochrane Review first published in 2014. Phimosis is a condition in which the prepuce (foreskin) cannot be fully retracted past the head of the penis (glans). Phimosis is often treated surgically by circumcision or prepuce plasty; however, reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have suggested favorable outcomes. OBJECTIVES To assess the effects of topical corticosteroids applied to the stenotic portion of the prepuce for the treatment of phimosis in boys compared with placebo or no treatment. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, and ClinicalTrial.gov. We checked reference lists of included studies and relevant reviews for additional studies. There were no restrictions on the language of publication. The date of the last search was 4 October 2023. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that compared the use of any topical corticosteroid with placebo or no treatment for boys with any type or degree of phimosis. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data related to the review's primary and secondary outcomes, and assessed the studies' risk of bias. We used the random-effects model for statistical analyses and expressed dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We contacted the authors of the primary articles to request details of the study design and specific outcome data. We used GRADE to assess the certainty of evidence on a per-outcome basis. MAIN RESULTS In this update, we identified two new studies with 111 participants, bringing the total number of included studies to 14 (1459 randomized participants). We found that types of corticosteroids investigated, participant age, degree of phimosis, type of phimosis, and treatment duration varied considerably among studies. Compared with placebo or no treatment, topical corticosteroids may increase the complete resolution of phimosis after four to eight weeks of treatment (RR 2.73, 95% CI 1.79 to 4.16; I² = 72%; 10 trials, 834 participants; low-certainty evidence). Based on 252 complete resolutions per 1000 boys in the control group, this corresponds to 436 more complete resolutions per 1000 boys (95% CI 199 more to 796 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious inconsistency. Topical corticosteroids may also increase the partial resolution of phimosis at four to eight weeks of treatment compared with placebo or no treatment (RR 1.68, 95% CI 1.17 to 2.40; I² = 44%; 7 trials, 745 participants; low-certainty evidence). Based on 297 partial resolutions per 1000 boys in the control group, this corresponds to 202 more partial resolutions per 1000 boys (95% CI 50 more to 416 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious inconsistency. We are uncertain of the effect of topical corticosteroids compared to placebo on change in retractability score (standardized mean difference [SMD] -1.48, 95% CI -2.93 to -0.03; I²91%; 2 trials, 177 participants; very low-certainty evidence). We downgraded the certainty of the evidence by one level for serious study limitations, one level for serious heterogeneity, and one level for serious imprecision. Compared with placebo, topical corticosteroids may increase the long-term complete resolution of phimosis six or more months after treatment (RR 4.09, 95% CI 2.80 to 5.97; I² = 0%; 2 trials, 280 participants; low-certainty evidence). Based on 171 long-term complete resolutions per 1000 boys in the control group, this corresponds to 528 more complete resolutions per 1000 boys (95% CI 308 more to 850 more). We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious imprecision. There may be little or no difference in the risk of adverse effects between topical corticosteroids and placebo or no treatment (RR 0.28, 95% CI 0.03 to 2.62; I² = 22%; 11 trials, 1091 participants; low-certainty evidence). Only two of 11 studies that recorded adverse effects reported any adverse effects; one event occurred in the corticosteroid group and six in the control group. We downgraded the certainty of the evidence by one level for serious study limitations and by one level for serious imprecision. AUTHORS' CONCLUSIONS Topical corticosteroids, compared to placebo or no treatment, may increase complete and partial resolution of phimosis when assessed after four to eight weeks of treatment, and may increase long-term complete resolution of phimosis assessed six or more months after treatment. Topical corticosteroids may have few or no adverse effects, and we are uncertain about their effect on retractability scores. The body of evidence is limited by poor reporting of methods in the studies, important clinical heterogeneity, and serious imprecision in the results. Future, higher-quality trials with long-term follow-up would likely improve our understanding of the effects of topical corticoids on phimosis in boys.
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Affiliation(s)
- Gladys Moreno
- Department of Family Medicine, Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Ramirez
- Cochrane Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Corbalán
- Health Policy and Systems Research Unit, Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Blanca Peñaloza
- Department of Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Tomas Pantoja
- Department of Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abdul Kareem S, Joseph SG, Wilson A, Kareem SA, Kunjumon Vilapurathu J. Incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine-containing chemotherapy regimens. J Oncol Pharm Pract 2024:10781552241228175. [PMID: 38263642 DOI: 10.1177/10781552241228175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hand-foot syndrome is a common adverse effect of 5-fluorouracil infusion or oral capecitabine. Several types of research have shown that clinical presentations of hand-foot syndrome vary by ethnicity, so we tried to look at the incidence and severity of hand-foot syndrome in individuals receiving infusional 5-fluorouracil or oral capecitabine at a tertiary care hospital in central Kerala, India. AIM To determine the incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine chemotherapy regimen. METHODOLOGY A prospective cohort study was conducted at the oncology department of a tertiary care hospital in Kerala, India. Our study subjects were those who underwent chemotherapy with infusional 5-fluorouracil or oral capecitabine and later developed hand-foot syndrome. The patients who developed hand-foot syndrome after chemotherapy were assessed to determine the incidence of hand-foot syndrome. Also, the severity of hand-foot syndrome among cancer patients was estimated using CTCAE version 5.0. RESULTS Out of 104 study participants, 76.90% (N = 80) of the patients had hand-foot syndrome, whereas 23.07% (N = 24) did not. The onset of hand-foot syndrome symptoms varied depending on the patient. Most patients (60%) displayed grade-one symptoms in their third cycle. The remaining patients showed grade-one symptoms in cycle one (3.75%), cycle two (17.5%), and cycle four (18.75%). The study also showed t no association between the incidence of hand-foot syndrome and the type of regimen. CONCLUSION The majority of the patients suffered from hand-foot syndrome. As well, most of the patients were afflicted by grade one hand-foot syndrome.
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Affiliation(s)
- Sulaikha Abdul Kareem
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Simi Grace Joseph
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Aneena Wilson
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
| | - Shahnaz Abdul Kareem
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, KL, India
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Aoul AT, Al-Nasseri A, Hall C, He C, Abernathy J. Stevens-Johnson Syndrome in a Patient on Concomitant Treatment with Levetiracetam and Trimethoprim/Sulfamethoxazole. Am J Case Rep 2024; 25:e942982. [PMID: 38247161 PMCID: PMC10812293 DOI: 10.12659/ajcr.942982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/19/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Trimethoprim/sulfamethoxazole and levetiracetam are commonly prescribed medications in the treatment of infections and seizures, respectively. Despite their known efficacy, each has a reputation for triggering severe and sometimes life-threatening cutaneous adverse drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Although the mechanism of such cutaneous adverse drug reactions cannot be fully explained, it is thought to be a type IV T cell and NK cells-mediated hypersensitivity reaction that leads to keratinocyte apoptosis and epidermal necrosis. It is also thought that cutaneous adverse drug reactions are also linked to a patient's genetic predispositions, especially the human leukocyte antigens profiles and the N-acetyl transferase 2 phenotypic variation. CASE REPORT We describe a case of Stevens-Johnson syndrome in a severely ill 51-year-old man who was treated in an outside health care facility simultaneously with Trimethoprim/sulfamethoxazole and levetiracetam. The patient presented to our Emergency Department with Stevens-Johnson syndrome believed to possibly be related to the combination of these 2 agents. CONCLUSIONS The concomitant use of Trimethoprim/sulfamethoxazole and levetiracetam might have been responsible for heightening the potential of these 2 medications to trigger an unfortunate adverse drug reaction, but no formal culprit was able to be identified and no in vivo study was performed, due to ethical considerations. Thus, through this case report we strive to increase awareness of the potential risk of simultaneously prescribing these 2 medications.
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Affiliation(s)
- Amel Tabet Aoul
- Department of Internal Medicine, HCA Healthcare Florida Citrus Hospital Florida, Inverness, FL, USA
| | - Abraheim Al-Nasseri
- Department of Internal Medicine, HCA Healthcare Florida Citrus Hospital Florida, Inverness, FL, USA
| | - Chase Hall
- Department of Internal Medicine, HCA Healthcare Florida Citrus Hospital Florida, Inverness, FL, USA
| | - Chun He
- Department of Pathology, HCA Healthcare Florida Citrus Hospital Florida, Inverness, FL, USA
| | - John Abernathy
- Department of Internal Medicine, HCA Healthcare Florida Citrus Hospital Florida, Inverness, FL, USA
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Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Concepción-Urteaga LA, Pecho-Silva S, Rodríguez-Hidalgo LA, Concepción-Zavaleta MJ. Drug-induced hypothyroidism in tuberculosis. Expert Rev Endocrinol Metab 2024:1-8. [PMID: 38258451 DOI: 10.1080/17446651.2024.2307525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse reactions to tuberculosis treatment can impact patient adherence and prognosis. Hypothyroidism is a frequent adverse reaction caused using ethionamide, prothionamide, and para-aminosalicylic acid and is often underdiagnosed. AREAS COVERED We searched Scielo, Scopus, and EMBASE databases, including 67 articles. Antitubercular drug-induced hypothyroidism has a prevalence of 17%. It occurs after 2 to 3 months of treatment and resolves within 4 to 6 weeks after discontinuation. It is postulated to result from the inhibition of thyroperoxidase function, blocking thyroid hormone synthesis. Symptoms are nonspecific, necessitating individualized thyroid-stimulating hormone measurement for detection. Specific guidelines for management are lacking, but initiation of treatment with levothyroxine, as is customary for primary hypothyroidism, is recommended. Discontinuation of antitubercular drugs is discouraged, as it may lead to unfavorable consequences. EXPERT OPINION Antitubercular drug-induced hypothyroidism is more common than previously thought, affecting one in six MDR-TB patients. Despite diagnostic and treatment recommendations, implementation is hindered in low-income countries due to the lack of certified laboratories. New drugs for tuberculosis treatment may affect thyroid function, requiring vigilant monitoring for complications, including hypothyroidism.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | - Samuel Pecho-Silva
- Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Perú
- Division of Pneumology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Shin J, Shim SR, Lee J, Ryu HS, Kim JY. Otorhinolaryngologic complications after COVID-19 vaccination, vaccine adverse event reporting system (VAERS). Front Public Health 2024; 11:1338862. [PMID: 38269374 PMCID: PMC10807421 DOI: 10.3389/fpubh.2023.1338862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Background There have been reports of otolaryngological adverse event following immunization (AEFI) such as instances of olfactory and gustatory dysfunction following COVID-19 vaccination. This study aimed to analyze otolaryngological AEFIs following COVID-19 vaccination. Methods This study was conducted with a secondary data analysis that the Vaccine Adverse Events Reporting System (VAERS) and the COVID-19 Data Tracker, which are both administered by the Centers for Disease Control and Prevention in the US. Using Medical Dictionary for Regulatory Activities (MedDRA) concepts, AEFIs included: Considering the overall frequency and similarity of symptoms in the first 153 PTs, they were grouped into major 19 AEFIs groups. The incidence rates (IRs) of AEFIs per 100,000 were calculated on individual and cumulative AEFIs levels, involving people who received complete primary series and an updated bivalent booster dose with one of the available COVID-19 vaccines in the US. The proportions of AEFIs by age, sex, and vaccine manufacturer were reported. We also calculated the proportional reporting ratio (PRR) of AEFIs. Results We identified 106,653 otorhinolaryngologic AEFIs from the VAERS database, and a total of 226,593,618 people who received complete primary series in the US. Overall, the IR of total Otorhinolaryngologic AEFIs was 47.068 of CPS (completed primary series) and 7.237 UBB (updated bivalent booster) per 100,000. For most symptoms, being female was associated with statistically significant higher AEFIs. Upon examining the impact of different vaccine manufacturers, the researchers found that Janssen's vaccine exhibited higher IRs for hearing loss (5.871), tinnitus (19.182), ear infection (0.709), dizziness (121.202), sinusitis (2.088), epistaxis (4.251), anosmia (5.264), snoring (0.734), allergies (5.555), and pharyngitis (5.428). The highest PRRs were for Anosmia (3.617), Laryngopharyngeal Reflux - Acid Reflux (2.632), and Tinnitus -Ringing in the ears (2.343), in that order, with these three significantly incidence than other background noises. Conclusion This study, utilizing an extensive sample sizes, represents a significant step toward comprehensively characterizing the otolaryngological AEFIs associated with COVID-19 vaccinations. This large-scale analysis aims to move beyond isolated case reports and anecdotal evidence, providing a robust and detailed portrait of the otolaryngological AEFIs landscape in response to COVID-19 vaccinations.
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Affiliation(s)
- Jieun Shin
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jaekwang Lee
- Department of Emergency Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hyon Shik Ryu
- Department of Emergency Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
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Lusa V, Karjalainen TV, Pääkkönen M, Rajamäki TJ, Jaatinen K. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2024; 1:CD001552. [PMID: 38189479 PMCID: PMC10772978 DOI: 10.1002/14651858.cd001552.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/09/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Surgery is considered when symptoms persist despite the use of non-surgical treatments. It is unclear whether surgery produces a better outcome than non-surgical therapy. This is an update of a Cochrane review published in 2008. OBJECTIVES To assess the evidence regarding the benefits and harms of carpal tunnel release compared with non-surgical treatment in the short (< 3 months) and long (> 3 months) term. SEARCH METHODS In this update, we included studies from the previous version of this review and searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov and WHO ICTRP until 18 November 2022. We also checked the reference lists of included studies and relevant systematic reviews for studies. SELECTION CRITERIA We included randomised controlled trials comparing any surgical technique with any non-surgical therapies for CTS. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS The 14 included studies randomised 1231 participants (1293 wrists). Eighty-four per cent of participants were women. The mean age ranged from 32 to 53 years, and the mean duration of symptoms from 31 weeks to 3.5 years. Trial sizes varied from 22 to 176 participants. The studies compared surgery with: splinting, corticosteroid injection, splinting and corticosteroid injection, platelet-rich plasma injection, manual therapy, multimodal non-operative treatment, unspecified medical treatment and hand support, and surgery and corticosteroid injection with corticosteroid injection alone. Since surgery is generally used for its long-term effects, this abstract presents only long-term results for surgery versus splinting and surgery versus corticosteroid injection. 1) Surgery compared to splinting in the long term (> 3 months) Surgery probably results in a higher rate of clinical improvement (risk ratio (RR) 2.10, 95% confidence interval (CI) 1.04 to 4.24; 3 studies, 210 participants; moderate-certainty evidence). Surgery probably does not provide clinically important benefit in symptoms or hand function compared with splinting (moderate-certainty evidence). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (scale 1 to 5; higher is worse; minimal clinically important difference (MCID) = 1) was 1.54 with splint and 0.26 points better with surgery (95% CI 0.52 better to 0.01 worse; 2 studies, 195 participants). The mean BCTQ Functional Status Scale (scale 1 to 5; higher is worse; MCID 0.7) was 1.75 with splint and 0.36 points better with surgery (95% CI 0.62 better to 0.09 better; 2 studies, 195 participants). None of the studies reported pain. Surgery may not provide better health-related quality of life compared with splinting (low-certainty evidence). The mean EQ-5D index (scale 0 to 1; higher is better; MCID 0.074) was 0.81 with splinting and 0.04 points better with surgery (95% CI 0.0 to 0.08 better; 1 study, 167 participants). We are uncertain about the risk of adverse effects (very low-certainty evidence). Adverse effects were reported amongst 60 of 98 participants (61%) in the surgery group and 46 of 112 participants (41%) in the splinting group (RR 2.11, 95% CI 0.37 to 12.12; 2 studies, 210 participants). Surgery probably reduces the risk of further surgery; 41 of 93 participants (44%) were referred to surgery in the splinting group and 0 of 83 participants (0%) repeated surgery in the surgery group (RR 0.03, 95% CI 0.00 to 0.21; 2 studies, 176 participants). This corresponds to a number needed to treat for an additional beneficial outcome (NNTB) of 2 (95% CI 1 to 9). 2) Surgery compared to corticosteroid injection in the long term (> 3 months) We are uncertain if clinical improvement or symptom relief differs between surgery and corticosteroid injection (very low-certainty evidence). The RR for clinical improvement was 1.23 (95% CI 0.73 to 2.06; 3 studies, 187 participants). For symptoms, the standardised mean difference (SMD) was -0.60 (95% CI -1.88 to 0.69; 2 studies, 118 participants). This translates to 0.4 points better (95% CI from 1.3 better to 0.5 worse) on the BCTQ Symptom Severity Scale. Hand function or pain probably do not differ between surgery and corticosteroid injection (moderate-certainty evidence). For function, the SMD was -0.12 (95% CI -0.80 to 0.56; 2 studies, 191 participants) translating to 0.10 points better (95% CI 0.66 better to 0.46 worse) on the BCTQ Functional Status Scale with surgery. Pain (0 to 100 scale) was 8 points with corticosteroid injection and 6 points better (95% CI 10.45 better to 1.55 better; 1 study, 123 participants) with surgery. We found no data to estimate the difference in health-related quality of life (very low-certainty evidence). We are uncertain about the risk of adverse effects and further surgery (very low-certainty evidence). Adverse effects were reported amongst 3 of 45 participants (7%) in the surgery group and 2 of 45 participants (4%) in the corticosteroid injection group (RR 1.49, 95% CI 0.25 to 8.70; 2 studies, 90 participants). In one study, 12 of 83 participants (15%) needed surgery in the corticosteroid group, and 7 of 80 participants (9%) needed repeated surgery in the surgery group (RR 0.61, 95% CI 0.25 to 1.46; 1 study, 163 participants). AUTHORS' CONCLUSIONS Currently, the efficacy of surgery in people with CTS is unclear. It is also unclear if the results can be applied to people who are not satisfied after trying various non-surgical options. Future studies should preferably blind participants from treatment allocation and randomise people who are dissatisfied after being treated non-surgically. The decision for a patient to opt for surgery should balance the small benefits and potential risks of surgery. Patients with severe symptoms, a high preference for clinical improvement and reluctance to adhere to non-surgical options, and who do not consider potential surgical risks and morbidity a burden, may choose surgery. On the other hand, those who have tolerable symptoms, who have not tried non-surgical options and who want to avoid surgery-related morbidity can start with non-surgical options and have surgery only if necessary. We are uncertain if the risk of adverse effects differs between surgery and non-surgical treatments. The severity of adverse effects may also be different.
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Affiliation(s)
- Vieda Lusa
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Teemu V Karjalainen
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Markus Pääkkönen
- Turku University Hospital, Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Tuomas Jaakko Rajamäki
- Department of Hand Surgery, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Kati Jaatinen
- Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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Quiroz-Aldave JE, Durand-Vásquez MDC, Chávez-Vásquez FS, Rodríguez-Angulo AN, Gonzáles-Saldaña SE, Alcalde-Loyola CC, Coronado-Arroyo JC, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA, Haro-Varas JC, Concepción-Zavaleta MJ. Ifosfamide-induced nephrotoxicity in oncological patients. Expert Rev Anticancer Ther 2024; 24:5-14. [PMID: 38031874 DOI: 10.1080/14737140.2023.2290196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Ifosfamide is an alkylating chemotherapeutic agent used in the treatment of various neoplasms. Its main adverse effects include renal damage. AREAS COVERED A comprehensive review was conducted, including 100 articles from the Scielo, Scopus, and EMBASE databases. Ifosfamide-induced nephrotoxicity is attributed to its toxic metabolites, such as acrolein and chloroacetaldehyde, which cause mitochondrial damage and oxidative stress in renal tubular cells. Literature review found a 29-year average age with no gender predominance and a mortality of 13%. Currently, no fully effective strategy exists for preventing ifosfamide-induced nephrotoxicity; however, hydration, forced diuresis, and other interventions are employed to limit renal damage. Long-term renal function monitoring is essential for patients treated with ifosfamide. EXPERT OPINION Ifosfamide remains essential in neoplasm treatment, but nephrotoxicity, often compounded by coadministered drugs, poses diagnostic challenges. Preventive strategies are lacking, necessitating further research. Identifying timely risk factors can mitigate renal damage, and a multidisciplinary approach manages established nephrotoxicity. Emerging therapies may reduce ifosfamide induced nephrotoxicity.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | | | | | | | | | | | - Juan Carlos Haro-Varas
- Division of Medical Oncology, Division of Medical Oncology. Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
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Dixon EG, Rasool S, Otaalo B, Motee A, Dear JW, Sloan D, Stagg HR. No action is without its side effects: Adverse drug reactions and missed doses of antituberculosis therapy, a scoping review. Br J Clin Pharmacol 2024; 90:313-320. [PMID: 37712491 PMCID: PMC10952801 DOI: 10.1111/bcp.15908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS A key reason for the failure of antituberculosis (anti-TB) treatment is missed doses (instances where medication is not taken). Adverse drug reactions (ADRs) are 1 cause of missed doses, but the global evidence, their relative contribution to missed doses vs. other causes, the patterns of missed doses due to ADRs and the specific ADRs associated with missed doses have not been appraised. We sought to address these questions through a scoping review. METHODS MEDLINE, Embase and Web of Science were searched on 3 November 2021 using terms around active TB, missed doses and treatment challenges. Studies reporting both ADR and missed dose data were examined (PROSPERO: CRD42022295209). RESULTS Searches identified 108 eligible studies: 88/108 (81%) studies associated ADRs with an increase in missed doses; 33/61 (54%) studies documenting the reasons for missed doses gave ADRs as a primary reason. No studies examined patterns of missed doses due to ADRs; 41/108 (38%) studies examined associations between 68 types of ADR (across 15 organ systems) and missed doses. Nuance around ADR-missed doses relations regarding drug susceptibility testing profile and whether the missed doses originated from the patient, healthcare professionals, or both were found. CONCLUSION There is extensive evidence that ADRs are a key driver for missed doses of anti-TB treatment. Some papers examined specific ADRs and none evaluated the patterns of missed doses due to ADRs, demonstrating a knowledge deficit. Knowing why doses both are and are not missed is essential in providing targeted interventions to improve treatment outcomes.
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Affiliation(s)
- Eleanor G. Dixon
- Usher InstituteUniversity of EdinburghEdinburghUK
- NIHR RIGHT4 Centre for Poisoning, Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | | | - Brian Otaalo
- Infectious Disease Institute, Makerere UniversityCollege of Health SciencesKampalaUganda
| | | | - James W. Dear
- NIHR RIGHT4 Centre for Poisoning, Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Derek Sloan
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - Helen R. Stagg
- Usher InstituteUniversity of EdinburghEdinburghUK
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
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Hsi RS, Crivelli JJ, Yan PL, Shahinian V, Hollingsworth JM. Comparison of Class-Specific Side Effects Across Preventative Pharmacologic Therapies for Kidney Stone Disease. Urol Pract 2024; 11:172-178. [PMID: 38117963 PMCID: PMC10751065 DOI: 10.1097/upj.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Clinical guidelines recommend monitoring for metabolic derangements while on preventive pharmacologic therapy for kidney stone disease. The study objective was to compare the frequency of side effects among patients receiving alkali citrate, thiazides, and allopurinol. METHODS Using claims data from working-age adults with kidney stone disease (2008-2019), we identified those with a new prescription for alkali citrate, thiazide, or allopurinol within 12 months after their index stone-related diagnosis or procedure. We fit multivariable logistic regression models, adjusting for cohort characteristics like comorbid illness and medication adherence, to estimate 2-year measured frequencies of claims-based outcomes of acute kidney injury, falls/hip fracture, gastritis, abnormal liver function tests/hepatitis, hypercalcemia, hyperglycemia/diabetes, hyperkalemia, hypokalemia, hyponatremia, and hypotension. RESULTS Our cohort consisted of 1776 (34%), 2767 (53%), and 677 (13%) patients prescribed alkali citrate, thiazides, or allopurinol, respectively. Comparing unadjusted rates of incident diagnoses, thiazides compared to alkali citrate and allopurinol were associated with the highest rates of hypercalcemia (2.3% vs 1.5% and 1.0%, respectively, P = .04), hypokalemia (6% vs 3% and 2%, respectively, P < .01), and hyperglycemia/diabetes (17% vs 11% and 16%, respectively, P < .01). No other differences with the other outcomes were significant. In adjusted analyses, compared to alkali citrate, thiazides were associated with a higher odds of hypokalemia (OR=2.01, 95% CI 1.44-2.81) and hyperglycemia/diabetes (OR=1.52, 95% CI 1.26-1.83), while allopurinol was associated with a higher odds of hyperglycemia/diabetes (OR=1.34, 95% CI 1.02-1.75). CONCLUSIONS These data provide evidence to support clinical guidelines that recommend periodic serum testing to assess for adverse effects from preventive pharmacologic therapy.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Phyllis L Yan
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Vahakn Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Domingues ÍP, Costa MRD. [Update of triggers for detection of adverse drug events in hematologic patients]. CAD SAUDE PUBLICA 2023; 39:e00077923. [PMID: 38126560 PMCID: PMC10740396 DOI: 10.1590/0102-311xpt077923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
The use of triggers for the active search and detection of adverse drug events (ADEs) has been gaining ground within pharmacovigilance services. Thus, the main objective of the study was to propose a new list of triggers to be used in a center specialized in hematology in Rio de Janeiro, Brazil. The update of the list of triggers consisted of revising the current list, with the exclusion and inclusion of new triggers. To verify the performance of the new list of triggers, a cross-sectional study was conducted in which the new triggers were used to investigate the occurrence of ADEs in patients attended in the emergency unit or hospitalized from January to March 2022. For each suspected ADEs, the patient's profile and adverse drug reactions (ADRs) were characterized regarding causality and severity. The performance of the triggers and their ability to capture ADEs were estimated using the following indicators: frequency of the trigger per 100 medical records, frequency of ADEs per 100 records, and positive predictive value (PPV). To evaluate the overall performance of the proposed new list, the PPV was estimated. A total of 374 prescriptions for triggers were identified in 186 medical records. The most efficient in the detection of possible ADEs were: lidocaine, loperamide, bisacodyl, filgrastim and glycerin clyster. The overall PPV of the new suggested list was 48% versus 10% of the previous list. This study demonstrated the importance of an updated list of triggers for the monitoring of ADEs and improvement of the care provided.
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Affiliation(s)
- Íris Pilegi Domingues
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti, Rio de Janeiro, Brasil
| | - Milene Rangel da Costa
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
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Shen S, Chen Y, Carpio A, Chang C, Iyengar NM. Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. Cancer 2023; 129:3854-3861. [PMID: 37743730 PMCID: PMC10863751 DOI: 10.1002/cncr.34928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The combination of fulvestrant with alpelisib, a PI3K inhibitor, improves progression-free survival in metastatic hormone receptor-positive, PIK3CA-mutant breast cancer. This study describes the incidence, risk factors, and treatment of alpelisib-associated hyperglycemia. METHODS Patients with metastatic breast cancer who received alpelisib from 2013 to 2021 at Memorial Sloan Kettering Cancer Center were included in this retrospective study. Alpelisib prescription dates and patient/tumor characteristics were abstracted from medical records. Risk factors associated with hyperglycemia and alpelisib dose reduction/discontinuation were evaluated using Pearson's χ2 tests. RESULTS Among 247 patients, baseline median body mass index was 25.4 kg/m2 and median hemoglobin A1c (HbA1c) was 5.5%. A total of 152 patients (61.5%) developed any-grade hyperglycemia and 72 patients (29.2%) developed grade 3-4 hyperglycemia; median time to onset was 16 days. A total of 100 patients (40.5%) received alpelisib on a clinical trial; rates of hyperglycemia were significantly higher in patients treated as standard care versus on a clinical trial (any-grade hyperglycemia 80.3% vs. 34.0%, grade 3-4 hyperglycemia 40.2% vs. 13.0%, p < .001). Baseline HbA1c was significantly associated with development of hyperglycemia (p < .001) and alpelisib dose reduction/discontinuation (p = .015). Among those who developed hyperglycemia, 101 (40.9%) received treatment, most commonly with metformin. A total of 49 patients (19.8%) were referred to an endocrinologist, which was associated with SGLT2 inhibitor prescription (p = .007). CONCLUSIONS Rates of hyperglycemia among patients treated with alpelisib as standard care were significantly higher than patients treated on clinical trials. Elevated baseline HbA1c is associated with alpelisib-induced hyperglycemia and requiring dose modification. Optimization of glycemic status before alpelisib initiation should become routine practice.
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Affiliation(s)
- Sherry Shen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuan Chen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Carpio
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Neil M. Iyengar
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical Center, New York, NY
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Panebianco M, Bresnahan R, Marson AG. Lamotrigine add-on therapy for drug-resistant focal epilepsy. Cochrane Database Syst Rev 2023; 12:CD001909. [PMID: 38078494 PMCID: PMC10712213 DOI: 10.1002/14651858.cd001909.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/18/2023]
Abstract
BACKGROUND This is an updated version of a Cochrane Review last updated in 2020. Epilepsy is a common neurological disorder, affecting 0.5% to 1% of the population. In nearly 30% of cases, epilepsy is resistant to currently available drugs. Pharmacological treatment remains the first choice to control epilepsy. Lamotrigine is a second-generation antiseizure medication. When used as an add-on (in combination with other antiseizure medications), lamotrigine can reduce seizures, but with some adverse effects. OBJECTIVES To evaluate the benefits and harms of add-on lamotrigine, compared with add-on placebo or no add-on treatment in people with drug-resistant focal epilepsy. SEARCH METHODS For this update, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE (Ovid) on 3 October 2022 with no language restrictions. CRS Web includes randomised and quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups, including Epilepsy. SELECTION CRITERIA We included randomised controlled trials (RCTs) that investigated add-on lamotrigine versus add-on placebo or no add-on treatment in people of any age with drug-resistant focal epilepsy. We used data from the first period of eligible cross-over trials. DATA COLLECTION AND ANALYSIS For this update, two review authors independently selected trials and extracted data. Our primary outcome was 50% or greater reduction in seizure frequency. Our secondary outcomes were treatment withdrawal, adverse effects, cognitive effects, and quality of life. Primary analyses were by intention-to-treat. We performed sensitivity best- and worse-case analyses to account for missing outcome data. We calculated pooled risk ratios (RRs) with 95% confidence intervals (95% Cls) for dichotomous outcomes. MAIN RESULTS We identified no new studies for this update, so the results and conclusions of the review are unchanged. We included five parallel-group studies in adults or children, eight cross-over studies in adults or children, and one parallel study with a responder-enriched design in infants. In total, these 14 studies enroled 1806 eligible participants (38 infants, 199 children, 1569 adults). Baseline phases ranged from four to 12 weeks and treatment phases ranged from eight to 36 weeks. We rated 11 studies (1243 participants) at low overall risk of bias and three (697 participants) at unclear overall risk of bias due to lack of information on study design. Four studies (563 participants) reported effective blinding. Lamotrigine compared with placebo probably increases the likelihood of achieving 50% or greater reduction in seizure frequency (RR 1.80, 95% CI 1.45 to 2.23; 12 trials, 1322 participants (adults and children); moderate-certainty evidence). There is probably little or no difference in risk of treatment withdrawal for any reason among people treated with lamotrigine versus people treated with placebo (RR 1.11, 95% CI 0.91 to 1.37; 14 trials; 1806 participants; moderate-certainty evidence). Lamotrigine compared with placebo is probably associated with a greater risk of ataxia (RR 3.34, 99% Cl 2.01 to 5.55; 12 trials; 1525 participants; moderate-certainty evidence), dizziness (RR 1.76, 99% Cl 1.28 to 2.43; 13 trials; 1768 participants; moderate-certainty evidence), nausea (RR 1.81, 99% CI 1.22 to 2.68; 12 studies, 1486 participants; moderate-certainty evidence), and diplopia (RR 3.79, 99% Cl 2.15 to 6.68; 3 trials, 944 participants; moderate-certainty evidence). There is probably little or no difference in the risk of fatigue between lamotrigine and placebo (RR 0.82, 99% CI 0.55 to 1.22; 12 studies, 1552 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Lamotrigine as an add-on treatment for drug-resistant focal seizures is probably effective for reducing seizure frequency. Certain adverse effects (ataxia, dizziness, diplopia, and nausea) are probably more likely to occur with lamotrigine compared with placebo. There is probably little or no difference in the number of people who withdraw from treatment with lamotrigine versus placebo. The trials were of relatively short duration and provided no long-term evidence. In addition, some trials had few participants. Further trials are needed to assess the long-term effects of lamotrigine and to compare lamotrigine with other add-on drugs.
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Affiliation(s)
- Mariangela Panebianco
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rebecca Bresnahan
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Health Partners, Liverpool, UK
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Pereira M, Castro CTD, Magno L, Oliveira TDA, Gomes FS, Neves FMF, Nascimento PRDSD, Dourado I. Adverse effects of daily oral pre-exposure prophylaxis in men who have sex with men and transgender women: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00089522. [PMID: 38088646 PMCID: PMC10712916 DOI: 10.1590/0102-311xen089522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 12/18/2023] Open
Abstract
The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran's Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control.
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Affiliation(s)
- Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | | | | | | | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Guedes L, Vieira M, Gama H, Magano D, Fernandes M, Calero P, Di Foggia V. Thirteen years of experience with eslicarbazepine acetate in the United Kingdom and Republic of Ireland: A safety perspective. Epileptic Disord 2023; 25:803-814. [PMID: 37584596 DOI: 10.1002/epd2.20146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Eslicarbazepine acetate (ESL) is a once-daily oral antiseizure medication. Its safety and tolerability from clinical trials have been mostly confirmed by real-world data. The main purpose of this report is to provide an overview of the safety profile of ESL in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS Safety data were obtained from the UK and ROI post-marketing sources (October 2009-April 2022) by the marketing authorization holder. All individual reports were included in the Argus Safety™ database. All adverse events (AEs) were coded using MedDRA® version 24.1. Only valid cases (meeting the minimum pharmacovigilance reporting requirements) were included. RESULTS During 13 years of ESL marketing, with cumulative estimated exposure of 2 210 395 patients-years, 183 reports were received. A total of 402 AEs were reported for the 155 valid reports. The most common reported AEs (≥6% of total reported), per system organ class (SOC), were: nervous system disorders (23.4%), injury, poisoning, and procedural complications (18.9%), general disorders and administration site conditions (12.9%), psychiatric disorders (12.7%) and gastrointestinal disorders (6.7%). The most frequently reported (≥2% of total reported) AEs were: seizure (4.5%), hyponatremia (4.2%), dizziness (2.7%), rash, fatigue (2.5% each), and somnolence (2.0%). Twenty-six percent of events were classified as serious (including six fatal cases). SIGNIFICANCE The current analysis supports the known safety profile of ESL, as generally well-tolerated with most AEs being non-serious. The most common AEs were considered either expected according to the disease itself or to the reference safety information. ESL continues to be a relevant medication in the treatment of partial (focal-onset) epilepsy, as also confirmed by the 2022 NICE guidelines.
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Affiliation(s)
- Luís Guedes
- BIAL-Portela & Cª., S.A., São Mamede do Coronado, Portugal
| | - Mariana Vieira
- BIAL-Portela & Cª., S.A., São Mamede do Coronado, Portugal
| | - Helena Gama
- BIAL-Portela & Cª., S.A., São Mamede do Coronado, Portugal
| | - Daniel Magano
- BIAL-Portela & Cª., S.A., São Mamede do Coronado, Portugal
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Caré W, Pinel S, Dufayet L, Langrand J, Micallef J, Vodovar D. Trends in adverse drug reactions related to oral weak opioid analgesics in therapeutic use in adults: A 10-year French vigilances retrospective study. Fundam Clin Pharmacol 2023; 37:1205-1217. [PMID: 37400273 DOI: 10.1111/fcp.12929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
AIM To describe the symptoms, patient demographics, and trends over time of adverse drug reactions (ADRs) related to weak opioid analgesics reported to the French vigilance networks. METHODS Retrospective study of data from French Poison Control Centers and Pharmacovigilance Centers databases of weak opioid analgesics-related ADRs cases, with high causality score, in adults, in therapeutic analgesic use, without co-exposure, between 2011 and 2020. RESULTS The number of cases was 388 in the Poisonings database and 155 in the Pharmacovigilance database; ratio of the number of these cases to all reported cases during the study period was 0.02% and 0.03%, respectively. Tramadol was most often involved (74% and 56.1%, respectively), followed by codeine (26% and 38.7%, respectively). There was no significant variation in the number of cases reported. Cases most often involved young adults (median age: 40 years) and mostly women (76%). Gastrointestinal symptoms were mostly reported (80% and 65%, respectively) as described in the Summary of Products Characteristics. Patterns of ADRs were comparable in both databases, except for codeine-associated acute pancreatitis and anaphylaxis that were reported in the Pharmacovigilance database. No fatality was observed. Severity was more often observed in the Pharmacovigilance database (30%) than in the Poisonings database (moderate toxicity: 7%). CONCLUSION ADRs mostly occurred among young women using tramadol, without significant variation in the number of reported cases over time. Serious ADRs were more frequently reported to the Pharmacovigilance database, particularly for codeine. Women seemed to be at greater risk of ADRs.
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Affiliation(s)
- Weniko Caré
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
- Internal Medicine Department, Bégin Military Teaching Hospital, Saint-Mandé, France
- Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, Inserm, Paris, France
| | - Sylvine Pinel
- Regional Pharmacovigilance Center, Hôpital Fernand Widal, AP-HP, Paris, France
| | - Laurène Dufayet
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, Inserm, Paris, France
- Forensic Department, Hôpital Hôtel Dieu, AP-HP, Paris, France
- UFR de médecine, Université de Paris, Paris, France
| | - Jérôme Langrand
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, Inserm, Paris, France
| | - Joëlle Micallef
- Clinical Pharmacology Department, Regional Pharmacovigilance Center, Assistance publique-Hôpitaux de Marseille, Marseille, France
- INSERM, UMR 1106, Marseille, France
- Université d'Aix-Marseille, Marseille, France
| | - Dominique Vodovar
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, Inserm, Paris, France
- UFR de médecine, Université de Paris, Paris, France
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Beaton AC, Solanki D, Salazar H, Folkerth S, Singla N, Minkowitz HS, Leiman D, Vaughn B, Skuban N, Niebler G. A randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a bupivacaine hydrochloride implant in patients undergoing abdominoplasty. Reg Anesth Pain Med 2023; 48:601-607. [PMID: 37076252 PMCID: PMC10646917 DOI: 10.1136/rapm-2022-104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Surgical site infiltration with bupivacaine hydrochloride (HCl) is a standard element of postoperative analgesia for soft tissue surgeries, but results in short-lived analgesia. A novel bupivacaine implant, XARACOLL (bupivacaine HCl), is Food and Drug Administration approved for treatment of acute postsurgical pain following adult inguinal herniorrhaphy. This study examined the efficacy and safety of the bupivacaine implant (300 mg) compared with placebo for postsurgical pain after abdominoplasty. METHODS In this double-blind, placebo-controlled study, patients undergoing abdominoplasty were randomized to three 100 mg bupivacaine implants or three placebo collagen implants, in a 1:1 ratio, implanted intraoperatively. No other analgesics were administered into the surgical site. Patients were allowed opioids and acetaminophen for postoperative pain. Patients were followed for up to 30 days after treatment. PRIMARY OUTCOME the analgesic effect of the bupivacaine implants through 24 hours postsurgery, measured by the sum of time-weighted pain intensity (SPI24). Prespecified key secondary outcomes included SPI48 and SPI72, percentage of opioid-free patients through 24, 48, and 72 hours, and adverse events, which were tested sequentially to control for multiplicity (ie, if the first variable failed to reach significance, no subsequent variables were declared statistically significant). RESULTS The bupivacaine implant patients (n=181) reported statistically significant lower SPI24 (mean (SD) SPI24=102 (43), 95% CI 95 to 109) compared with placebo patients (n=184; SPI24=117 (45), 95% CI 111 to 123, p=0.002). SPI48 was 190 (88, 95% CI 177 to 204) for INL-001 and 206 (96, 95% CI 192 to 219) for placebo, and not significantly different between groups. The subsequent secondary variables were therefore declared not statistically significant. SPI72 was 265 (131, 95% CI 244 to 285) for INL-001 and 281 (146, 95% CI 261 to 301) for placebo. The opioid-free percentage of patients at 24, 48, and 72 hours was 19%, 17%, and 17% for INL-001 and 6.5% for placebo patients (at all timepoints). The only adverse event occurring in ≥5% of patients and for which proportion INL-001 >placebo was back pain (7.7% vs 7.6%). CONCLUSION The study design was limited by not containing an active comparator. Compared with placebo, INL-001 provides postoperative analgesia that is temporally aligned with the period of maximal postsurgical pain in abdominoplasty and offers a favorable safety profile. TRIAL REGISTRATION NUMBER NCT04785625.
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Affiliation(s)
| | | | | | | | - Neil Singla
- Lotus Clinical Research, LLC, Pasadena, California, USA
| | | | - David Leiman
- HD Research/First Surgical Hospital, Bellaire, Texas, USA
| | | | - Nina Skuban
- Innocoll Pharmaceuticals Limited, Innocoll Biotherapeutics, Princeton, New Jersey, USA
| | - Gwendolyn Niebler
- Innocoll Pharmaceuticals Limited, Innocoll Biotherapeutics, Princeton, New Jersey, USA
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Wang GHM, Morris E, Vouri SM, Keshwani S, Schmidt S, Pepine CJ, Smith SM. Modifiable statin characteristics associated with potential statin-related prescribing cascades. Pharmacotherapy 2023; 43:1307-1316. [PMID: 37771303 DOI: 10.1002/phar.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/11/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
STUDY OBJECTIVE Clinicians may prescribe new medications (marker drug) to treat statin-related (index drug) adverse events, constituting a prescribing cascade. We aimed to identify modifiable statin characteristics (intensity and individual statin agents) associated with lower risk of prescribing cascades to inform clinical decisions in the presence of statin-related adverse events. DESIGN A secondary analysis based on our previous work, a high-throughput sequence symmetry analysis screening for potential statin-related prescribing cascades. DATA SOURCE MarketScan Commercial and Medicare Supplemental Insurance claims databases between 2005 and 2019. PATIENTS Adults who initiated a statin between 2007 and 2018, and who were continuously enrolled in the same healthcare plan for at least 720 days before and 360 days after statin initiation. INTERVENTION Among the previously identified 57 potential prescribing cascades, 42 statin-marker class dyad with a sample size of ≥ 500 were assessed in this study. MEASUREMENTS We measured patients' baseline characteristics within -360 days of statin initiation and reported by modifiable statin characteristics. We also performed logistic regression and reported the adjusted odds ratios (aOR) with 95% confidence intervals (CI) of modifiable statin characteristics after adjusting for baseline characteristics. MAIN RESULTS We identified 1,307,867 statin initiators who met the study criteria (21% elderly, 52% female). Compared with patients initiating low-intensity statins, those initiating moderate- or high-intensity statins had significantly greater odds to develop 29 (69%) prescribing cascades, including antidiabetic drugs such as dipeptidyl peptidase 4 (DPP-4) inhibitors (aOR 1.22; 95% CI, 1.11-1.35) and glucagon-like peptide-1 (GLP-1) analogs (aOR 1.31; 95% CI, 1.16-1.47), and opioids (aOR 1.18; 95% CI, 1.13-1.23). Individual statin agent selection also had a differential effect on 34 (81%) of the prescribing cascades. For example, compared with simvastatin initiators, the probability of initiating osmotically acting laxatives was significantly higher for lovastatin initiators (aOR 1.09; 95% CI, 1.03-1.15) and significantly lower in atorvastatin initiators (aOR 0.92; 95% CI, 0.89-0.94). CONCLUSION Compared with low-intensity statins, high-intensity statins are associated with increased risk in many potential prescribing cascades, while the choice of individual statin agents affects the risk of prescribing cascades bidirectionally.
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Affiliation(s)
- Grace Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
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Gomez-Lumbreras A, Mercadal Vilchez S, Villa-Zapata L, Malone DC, Couriel DR. Chimeric antigen receptor T-cell immunotherapies adverse events reported to FAERS database: focus on cytopenias. Leuk Lymphoma 2023; 64:2071-2080. [PMID: 37708442 DOI: 10.1080/10428194.2023.2254430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy presents a promising treatment for hematologic malignancies, displaying high efficacy but not being exempt from toxicity. In this observational study, we assessed adverse events (AEs) reported to the Food and Drug Adverse Event Reporting System (FAERS) including any of the six approved CAR T-cell therapies. A total of 5249 reports mentioning a CAR T-cell as a suspect product were retrieved from the FAERS database, containing a total of 24333 AEs, of which 3236 (13.3%) were cytopenias. The highest number of AEs mentioned by the report was observed for tisagenlecleucel (mean = 6.7), with the lowest for ciltacabtagene (mean = 1.3). Among all reports, hematopoietic leukopenia was the most frequently reported AEs (n = 1386, 5.7%), with hematopoietic erytropenia the least reported (n = 291, 1.2%). Tisagenlecleucel showed a high reporting odds ratio for hematopoietic erythropenia (27.28, 95%CI 14.04-53.00), leukopenia (4.04, 95%CI 3.52-4.64), and thrombocytopenia (4.01, 95%CI 3.19-5.03). Cytopenias represent one of the most frequently reported AEs in FAERS, a CAR T-cell therapy is indicated, with haematopoetic leukopenia being the most common. When comparing different CAR-T cell therapies, the cytopenias' reporting odds ratio was particularly high for tisagenlecleucel, especially in relation to hematopoietic erythropenia.
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Affiliation(s)
- Ainhoa Gomez-Lumbreras
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Santiago Mercadal Vilchez
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, UT, USA
- Cellular Therapy and Regenerative Medicine, University of Utah, UT, USA
| | - Lorenzo Villa-Zapata
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Daniel R Couriel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, UT, USA
- Cellular Therapy and Regenerative Medicine, University of Utah, UT, USA
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Park CS, Nadeem A. Advanced Heart Block and Asystole After Regadenoson Infusion: When Cautionary Tales Become Reality. Cureus 2023; 15:e50787. [PMID: 38239541 PMCID: PMC10795854 DOI: 10.7759/cureus.50787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Regadenoson (brand name Lexiscan) is a specific adenosine receptor agonist commonly used in pharmacologic stress testing due to its coronary vasodilatory effects. Despite it being generally well-tolerated, the American Society of Nuclear Cardiology established absolute and relative contraindications to the use of regadenoson in patients with certain co-morbidities such as uncontrolled hyper/hypotension, sinus node disease, and second-degree heart blocks. While cases of advanced heart block after the administration of regadenoson have been reported, they remain incidental. We report the case of an 84-year-old male sustaining second-degree type II heart block, followed by pulseless electrical activity and asystole after the administration of regadenoson.
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Affiliation(s)
- Christopher S Park
- Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Amin Nadeem
- Section of Critical Care, Captain James Lovell FHCC (Federal Health Care Center) and Rosalind University of Medicine and Science, North Chicago, USA
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Billings SA, Felix HM, Prier CC, Hedges MS. Rhabdomyolysis Associated With Semaglutide Therapy: A Case Report. Cureus 2023; 15:e50227. [PMID: 38192938 PMCID: PMC10773591 DOI: 10.7759/cureus.50227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
This report describes the case of a 47-year-old woman with myalgias, weakness, and elevated creatine kinase associated with semaglutide therapy prescribed for weight loss. Her symptoms and laboratory markers were consistent with rhabdomyolysis and resolved after discontinuation of semaglutide. Upon rechallenge at a lower dose, symptoms recurred, and urinalysis was consistent with myoglobinuria. Symptoms again rapidly resolved upon discontinuation of the medication. It is imperative for physicians to recognize semaglutide as a possible cause of myalgias and rhabdomyolysis in clinically suspected patients. To the best of our knowledge, this is the first reported case in the literature and may be specific to semaglutide rather than a class effect of glucagon-like peptide 1 (GLP-1) agonists.
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Affiliation(s)
| | - Heidi M Felix
- Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Cara C Prier
- Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mary S Hedges
- Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Thomas K, Schonmann Y. Musculoskeletal corticosteroid injection and risk of acute coronary syndrome: a case control study. Fam Pract 2023; 40:552-559. [PMID: 37535976 DOI: 10.1093/fampra/cmad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/05/2023] Open
Abstract
BACKGROUND Musculoskeletal corticosteroid injection (CSI) is a frequently used treatment, considered safe with a low incidence of minor side effects. OBJECTIVE To investigate whether the incidence of acute coronary syndrome (ACS) is increased following corticosteroid injection for musculoskeletal conditions. METHODS Data were reviewed from 41,276 patients aged over 40 years and hospitalised with ACS between January 2015 and December 2019. Each ACS case was allocated up to 10 control patients from their primary care clinic, matched for age and sex. The cases and controls were reviewed for orthopaedic or rheumatological consultation including a CSI procedure and occurring prior to the hospital admission date. The incidence of CSI was compared between the case and control groups. RESULTS Data from a total of 413,063 patients were reviewed, 41,276 ACS cases and 371,787 controls. The mean age was 68.1, standard deviation (SD) = 13.1, 69.4% male. In the week prior to their hospital admission, 118 ACS patients were treated with CSI compared with 495 patients in the control group; odds ratio (OR) = 1.95 (1.56-2.43). In total, 98% of CSI procedures were carried out by orthopaedic specialists. An association between ACS and prior CSI was strongest in the days immediately prior to hospitalisation: OR = 3.11 (2.10-4.61) for patients who were injected 1 day before ACS. The association between ACS and CSI declined with increasing time between injection and hospital admission: at 90 days OR = 1.08 (0.98-1.18). The association remained robust when cardiovascular risk factors, history of rheumatological disease, and other co-morbidity were taken into consideration. CONCLUSIONS Musculoskeletal corticosteroid injection appears to substantially increase the risk of acute coronary syndrome.
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Affiliation(s)
- Katharine Thomas
- Clalit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yochai Schonmann
- Clalit Health Services, Tel Aviv, Israel
- Sial Research Center, Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Miles N, Masters A, Desta Z, Goldman JL, Suppes SL, Tillman EM. Multidisciplinary Approach to Deciphering Etoposide Infusion Reactions and Potential Role of Polyethersulfone Filter Membranes. J Pediatr Pharmacol Ther 2023; 28:643-648. [PMID: 38025152 PMCID: PMC10681083 DOI: 10.5863/1551-6776-28.7.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Etoposide, a topoisomerase II inhibitor used clinically to treat cancer, has been associated with severe anaphylactic infusion related adverse drug reactions (ADRs). In a previous study we identified a hydrophilic polyethersulfone filter as a possible cause of increased rates of pediatric etoposide infusion reactions. In this multidisciplinary follow-up analytical study, we aimed to assess the chemical structure of etoposide after passing through the same hydrophilic polyethersulfone filter. METHODS An etoposide 0.4 mg/mL infusion was prepared under aseptic conditions and then passed through a standard IV infusion set with an in-line filter in place. Samples were taken in triplicate using a needle-less access system to include sampling sites directly from the IV bag port and from the IV tubing both before and after the in-line filter. Samples were diluted into mobile phase, then an aliquot was injected into a high-performance liquid chromatography mass spectrometry HPLC-MS (Thermo TSQ Quantum Ultra) system coupled to a Diode Array Detector (DAD) (Thermo Dionex Ultimate 3000). Etoposide was monitored using a selected reaction monitoring scan (SRM) of 606.2/228.8 and wavelengths of 210, 220, 254, and 280 nm for 30 minutes. RESULTS No detectable differences were observed upon comparing the three samples. Based on these results, a chemical change in etoposide resulting from an in-line filter is unlikely to be the primary cause of increased rates of infusion reactions. CONCLUSION Pharmacists working in healthcare systems, observe many ADRs, but rarely have the resources necessary to investigate the potential etiology or causality. This report highlights importance of multi-disciplinary collaboration to investigate serious ADRs.
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Affiliation(s)
- Nicholas Miles
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
| | - Andi Masters
- Indiana University Comprehensive Cancer Center (AM), Indiana University School of Medicine, Indianapolis, IN
| | - Zeruesenay Desta
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer L. Goldman
- Department of Pediatrics (JLG), Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, MO
| | - Sarah L. Suppes
- Division of Clinical Pharmacology (SLS), Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, MO
| | - Emma M. Tillman
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
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Aldeghaither S, Deschênes PJF, Samoukovic G. Anticholinergic Toxidrome as a Possible Explanation for Methylene Blue Toxicity. Am J Case Rep 2023; 24:e941453. [PMID: 37967040 PMCID: PMC10660293 DOI: 10.12659/ajcr.941453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/11/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Methylene blue has multiple uses in medicine. It is generally used to treat refractory vasoplegia and methemoglobin toxicity, and can be used as a dye to localize the parathyroid glands intra-operatively. In refractory vasoplegia, methylene blue inhibits endothelial nitric oxide and guanylate cyclase, causing vasoconstriction and potentially stabilizing blood pressure. Multiple complications have been associated with the use of methylene blue. These are related to either the sole effect of methylene blue or the combined effect of methylene blue and certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). To the best of our knowledge, in the setting of post-cardiac surgery vasoplegia, there have been no reports of the neurological toxicity of methylene blue in the absence of SSRI use. In this case report, we describe the anticholinergic manifestations associated with the use of methylene blue in post-cardiac surgery vasoplegia. CASE REPORT A male patient in his mid-sixties with severe mitral regurgitation underwent elective mitral valve replacement. Postoperatively, he was hypotensive and required a high dose of vasopressors. Methylene blue was administered to treat refractory vasoplegia. The patient became anuric and febrile, with bilateral mydriasis. Internal cooling and continuous renal replacement therapy were initiated, and symptoms rapidly resolved. The patient was discharged after prolonged hospitalization with a permanent catheter for hemodialysis. CONCLUSIONS Anticholinergic toxidrome may explain the neurological adverse effects associated with high doses of methylene blue. Physicians should be cautious when using methylene blue in combination with other anticholinergic drugs and in conditions of renal failure. The development of methylene blue toxicity warrants the urgent discontinuation of the agent and early drug elimination.
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Affiliation(s)
- Saud Aldeghaither
- Department of Critical Care Medicine, McGill University, Montreal, QC, Canada
- Department of Critical Care Medicine, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | | | - Gordan Samoukovic
- Department of Critical Care Medicine, McGill University, Montreal, QC, Canada
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Hallo-Carrasco A, Eldrige J, Provenzano DA, Gonzalez-Estrada A, Abdel-Latif T, Klasova J, Furtado-Pessoa-de-Mendonca L, Yan D, Hunt C. Hidden risk of gadolinium-based contrast agents during interventional pain medicine procedures: a retrospective chart review. Reg Anesth Pain Med 2023:rapm-2023-104952. [PMID: 37951601 DOI: 10.1136/rapm-2023-104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/18/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Epidural steroid injections and epidural blood patches commonly involve the injection of a small amount of radiocontrast media under fluoroscopy to properly identify the target tissue or anatomic space and prevent off-target or intravascular delivery of therapeutic or diagnostic drugs. Iodinated low osmolar non-ionic contrast media is the standard preparation used as it is considered safe and cost-effective, but gadolinium-based preparations have been used as an alternative for patients with an 'iodine'-related or radiocontrast media allergy label to prevent hypersensitivity reactions. The risk of neurotoxic events when gadolinium is inadvertently injected into the intrathecal space has been reported in recent years, raising concerns when gadolinium-based contrast media is used in lieu of iodinated low osmolar non-ionic contrast media. METHODS A retrospective review was conducted of patients who received gadolinium-based contrast media for procedures with risk of inadvertent intrathecal access from January 1, 2019 to May 1, 2022. Information on patient demographics, allergy label information, and procedure description was documented for all patients who received gadolinium-based contrast media for axial spine procedures (including epidural steroid injections, epidural blood patch procedures, and selective nerve root blocks), and all side effects reported within 1 month of the procedure were recorded. Saved fluoroscopy images of all procedures for which there was concern for possible gadolinium-based contrast media-related side effect were reviewed for evidence of inadvertent intrathecal gadolinium-based contrast media administration. Descriptive statistical analysis was performed using REDCap and IBM SPSS Statistics V.28. RESULTS We identified 508 patients who received gadolinium-based contrast media during a fluoroscopically guided axial spine procedure. These patients underwent 697 epidural procedures and 23 patients were identified as experiencing an adverse event that could be consistent with possible, probable, or clear signs of exposure to intrathecal gadolinium. Our calculated adverse event rate was 3.3%. Ten patients required additional medical evaluation or treatment. DISCUSSION Almost all patients in our cohort had an allergy label on their chart that guided the provider to switch to gadolinium-based contrast media, but most were incomplete, ill-defined, or related to allergy to iodine but not iodinated contrast media. Such practice is not recommended based on current guidelines. The current study raises concern regarding the use of gadolinium-based contrast media in axial spine procedures, with the risk of potential severe adverse events, without evidence-based need for avoiding iodinated contrast media.
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Affiliation(s)
| | - Jason Eldrige
- Pain Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | | | - Alexei Gonzalez-Estrada
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Johana Klasova
- Pain Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | | | - Dan Yan
- Pain Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Christine Hunt
- Pain Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
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50
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Pilla SJ, Jalalzai R, Tang O, Schoenborn NL, Boyd CM, Bancks MP, Mathioudakis NN, Maruthur NM. A National Survey of Physicians' Views on the Importance and Implementation of Deintensifying Diabetes Medications. J Gen Intern Med 2023:10.1007/s11606-023-08506-8. [PMID: 37940754 DOI: 10.1007/s11606-023-08506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Guidelines recommend deintensifying hypoglycemia-causing medications for older adults with diabetes whose hemoglobin A1c is below their individualized target, but this rarely occurs in practice. OBJECTIVE To understand physicians' decision-making around deintensifying diabetes treatment. DESIGN National physician survey. PARTICIPANTS US physicians in general medicine, geriatrics, or endocrinology providing outpatient diabetes care. MAIN MEASURES Physicians rated the importance of deintensifying diabetes medications for older adults with type 2 diabetes, and of switching medication classes, on 5-point Likert scales. They reported the frequency of these actions for their patients, and listed important barriers and facilitators. We evaluated the independent association between physicians' professional and practice characteristics and the importance of deintensifying and switching diabetes medications using multivariable ordered logistic regression models. KEY RESULTS There were 445 eligible respondents (response rate 37.5%). The majority of physicians viewed deintensifying (80%) and switching (92%) diabetes medications as important or very important to the care of older adults. Despite this, one-third of physicians reported deintensifying diabetes medications rarely or never. While most physicians recognized multiple reasons to deintensify, two-thirds of physicians reported barriers of short-term hyperglycemia and patient reluctance to change medications or allow higher glucose levels. In multivariable models, geriatricians rated deintensification as more important compared to other specialties (p=0.027), and endocrinologists rated switching as more important compared to other specialties (p<0.006). Physicians with fewer years in practice rated higher importance of deintensification (p<0.001) and switching (p=0.003). CONCLUSIONS While most US physicians viewed deintensifying and switching diabetes medications as important for the care of older adults, they deintensified infrequently. Physicians had ambivalence about the relative benefits and harms of deintensification and viewed it as a potential source of conflict with their patients. These factors likely contribute to clinical inertia, and studies focused on improving shared decision-making around deintensifying diabetes medications are needed.
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Affiliation(s)
- Scott J Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rabia Jalalzai
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olive Tang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy L Schoenborn
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cynthia M Boyd
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael P Bancks
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nestoras N Mathioudakis
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisa M Maruthur
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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