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A scoping review of the clinical utility of adverse drug reaction causality analysis tools for use in the hospital setting. 药物不良反应因果关系分析工具在医院环境中的临床应用范围综述。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-13 DOI: 10.1080/17512433.2024.2429677
Benjamin Deutscher, Nazanin Falconer, Keshia De Guzman, Adam La Caze

Introduction: Identification and monitoring of adverse drug reactions (ADRs) and interventions to reduce ADRs, is essential for patient safety in hospitals. Causality analysis (CA) is an approach that helps to determine a causal link between a medication and patient harm (i.e. an ADR). Whilst numerous CA tools exist, there is no gold standard.

Areas covered: Five online databases were searched to identify studies that evaluated the potential clinical utility of CA tools for ADRs. CA tools were mapped against the Bradford Hill (BH) criteria and included if they adhered to the first seven criteria proposed by BH. Upon the database search, 550 studies were identified, with 41 studies being selected that looked at tools mapped to BH. Thirty-four different CA tools were identified in the included studies.

Expert opinion: Naranjo and WHO-UMC were the most reported CA tools for studies examining inter-rater and intra-rater reliability. Naranjo commonly received a 'fair' agreement level while WHO-UMC received a 'substantial' agreement level between raters. Along with kappa statistics, time using the CA tool was also analyzed; with WHO-UMC being the most time-efficient. There does not appear to be one CA tool that can be applied universally to pharmacovigilance efforts in hospital in-patient settings.

导言:药物不良反应(ADRs)的识别和监测以及减少 ADRs 的干预措施对医院的患者安全至关重要。因果关系分析(CA)是一种有助于确定药物与患者伤害(即 ADR)之间因果关系的方法。虽然有许多 CA 工具,但并没有黄金标准:对五个在线数据库进行了检索,以确定对 ADR 的 CA 工具的潜在临床效用进行评估的研究。根据布拉德福德-希尔(Bradford Hill,BH)标准对CA工具进行比对,如果符合BH提出的前七条标准,则纳入CA工具。通过数据库搜索,共发现了 550 项研究,其中 41 项研究选择了与 BH 标准相对应的工具。在纳入的研究中发现了 34 种不同的 CA 工具:纳兰霍(Naranjo)和世卫组织医学中心(WHO-UMC)是对评分者之间和评分者内部可靠性研究报告最多的CA工具。Naranjo通常获得 "尚可 "的一致性水平,而WHO-UMC则获得评分者之间 "基本 "的一致性水平。除了卡帕统计,还分析了使用 CA 工具所需的时间;WHO-UMC 最省时。似乎没有一种 CA 工具可以普遍应用于医院住院环境中的药物警戒工作。
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引用次数: 0
The use of oral GnRH antagonist to inhibit the LH surge in women undergoing ovarian stimulation for in vitro fertilization. 使用口服 GnRH 拮抗剂抑制体外受精卵巢刺激妇女的 LH 激增。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-08 DOI: 10.1080/17512433.2024.2428342
Valentina Grisendi, Giovanni Grandi, Martina Capuzzo, Antonio La Marca
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引用次数: 0
Understanding the efficacy and tolerability of migraine treatment: a deep dive into CGRP antagonists. 了解偏头痛治疗的疗效和耐受性:深入研究 CGRP 拮抗剂。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-10-18 DOI: 10.1080/17512433.2024.2417655
Marta Waliszewska-Prosół, Bianca Raffaelli, Marcin Straburzyński, Paolo Martelletti

Introduction: The discovery of the role of the calcitonin gene-related peptide (CGPR) in migraine pathogenesis ushered in a new era in headache medicine. This evidence led to the development of small-molecule CGRP receptor antagonists and monoclonal antibodies targeting either CGRP or its receptor.

Areas covered: We will present selected aspects of the role of CGRP in the pathogenesis of migraine, the efficacy of CGRP-targeted treatment, and the still-open questions regarding the practical application of CGRP antagonists in headache medicine.

Expert opinion: CGRP-targeting drugs represent a transformative approach to migraine treatment, offering superior efficacy and tolerability compared to traditional therapies, they are a helpful addition to the treatment arsenal but also have their flaws and require further observation. Their availability provides new hope for migraine patients, particularly those who have not responded adequately to conventional treatments. Future directions for migraine care planning, especially for chronic migraine and medication-overuse headache, should include universal access to these specific and effective forms of therapy to prevent complications from the disease and its negative effects in many aspects of a patient's life.

导言:降钙素基因相关肽(CGPR)在偏头痛发病机制中的作用的发现,开创了头痛医学的新纪元。这一证据推动了小分子 CGRP 受体拮抗剂和针对 CGRP 或其受体的单克隆抗体的开发:我们将从 CGRP 在偏头痛发病机制中的作用、CGRP 靶向治疗的疗效以及 CGRP 拮抗剂在头痛医学中的实际应用等方面进行介绍:CGRP靶向药物代表了偏头痛治疗的一种变革性方法,与传统疗法相比,其疗效和耐受性更胜一筹,是治疗手段的有益补充,但也存在缺陷,需要进一步观察。它们的出现为偏头痛患者,尤其是对传统疗法反应不佳的患者带来了新的希望。偏头痛治疗规划的未来方向,尤其是针对慢性偏头痛和药物滥用性头痛的治疗规划,应包括普及这些特殊而有效的治疗方法,以预防疾病的并发症及其对患者生活诸多方面的负面影响。
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引用次数: 0
Semaglutide and smoking cessation in individuals with type 2 diabetes mellitus: there is no smoke without fire! 塞马鲁肽与 2 型糖尿病患者的戒烟:无烟不成火!
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-10-21 DOI: 10.1080/17512433.2024.2418398
Djordje S Popovic, Dimitrios Patoulias, Theocharis Koufakis, Paschalis Karakasis, Ieva Ruža, Nikolaos Papanas

Tobacco use represents the leading preventable risk factor for premature deaths worldwide. A meta-analysis of 74 epidemiological studies, including 3.2 million individuals with type 2 diabetes mellitus (T2DM) from 33 countries, reported a pooled prevalence of smoking of 20.8% among individuals with T2DM. Cigarette smoking further aggravates existing deleterious vascular effects of T2DM. Namely, chronic hyperglycemia and exposure to cigarette smoke cause additive injurious effect on the endothelium, leading to an acceleration of vascular complications seen in persons with T2DM and tobacco use disorders (TUD). In a recent study, Wang and colleagues found that semaglutide use was associated with a significantly lower risk for medical encounters for TUD, when compared to other antidiabetic drug classes; indeed, this effect was strongest compared with insulins and weakest compared with other glucagon-like peptide-1 receptor agonists. Semaglutide was associated with reduced smoking cessation medication prescriptions and counseling. Similar findings were observed irrespective of the presence of obesity. Therefore, semaglutide use might be useful in terms of smoking cessation among individuals with T2DM, thus offering an additional benefit for this constantly growing population. However, those interesting findings should be confirmed through dedicated, large-scale randomized controlled trials.

吸烟是导致全球过早死亡的主要可预防风险因素。一项对 74 项流行病学研究(包括来自 33 个国家的 320 万 2 型糖尿病(T2DM)患者)的荟萃分析报告显示,T2DM 患者的吸烟率为 20.8%。吸烟进一步加剧了 T2DM 对血管的有害影响。也就是说,慢性高血糖和暴露于香烟烟雾会对血管内皮产生叠加伤害效应,从而加速 T2DM 和烟草使用障碍(TUD)患者的血管并发症。在最近的一项研究中,Wang 及其同事发现,与其他抗糖尿病药物相比,使用塞马鲁肽可显著降低因 TUD 而就医的风险;事实上,与胰岛素相比,这种效应最强,而与其他胰高血糖素样肽-1 受体激动剂相比,这种效应最弱。塞马鲁肽与戒烟药物处方和咨询的减少有关。无论是否存在肥胖,都观察到了类似的结果。因此,使用塞马鲁肽可能有助于T2DM患者戒烟,从而为这一不断增长的人群带来额外的益处。不过,这些有趣的发现还需要通过专门的大规模随机对照试验来证实。
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引用次数: 0
Messenger interference RNA therapies targeting apolipoprotein C-III and angiopoietin-like protein 3 for mixed hyperlipidemia: the future of plozasiran and zodasiran. 针对脂蛋白 C-III 和血管生成素样蛋白 3 的信使干扰 RNA疗法治疗混合型高脂血症:plozasiran 和 zodasiran 的未来。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-11-03 DOI: 10.1080/17512433.2024.2423724
Zonghao Pan, Muhammad Adnan Zaman, Sidra Kalsoom, Yani Zhang

Introduction: Mixed hyperlipidemia represents a substantial public health issue and a considerable burden on healthcare systems. Although the introduction of statins and LDL-cholesterol lowering agents have significantly reduced the incidence of atherosclerotic cardiovascular diseases (ASCVD), a significant portion of the population continues to exhibit ASCVD progression due to elevated triglyceride-rich lipoprotein (TRL) levels. This persistent risk has catalyzed the development of novel pharmacological interventions targeting these lipoproteins.

Areas covered: Our special report commenced with a targeted PubMed search using keywords such as 'plozasiran,' 'zodasiran,' and terms related to APOC3 and ANGPTL3. As the review progressed, emergent research questions guided further searches, allowing for the inclusion of additional relevant articles to comprehensively illustrate the linkage between TRLs and cardiovascular disease, discuss the roles of APOC3, ANGPTL3, and the pharmaceutical agents that target these proteins, and provide a comparison on the ARCHES-2 and MUIR trials.

Expert opinion: The ARCHES-2 and MUIR trials demonstrated effective triglyceride reduction by these therapies, yet it is uncertain if this correlates with significant clinical benefits. Advances in antisense oligonucleotide technology, especially the GalNAc delivery platform, show promise for personalized lipid management, though challenges such as cost and safety concerns remain.

导言:混合型高脂血症是一个重大的公共卫生问题,也是医疗系统的沉重负担。尽管他汀类药物和降低低密度脂蛋白胆固醇药物的引入大大降低了动脉粥样硬化性心血管疾病(ASCVD)的发病率,但由于富含甘油三酯的脂蛋白(TRLs)水平升高,仍有相当一部分人群的 ASCVD 病情持续恶化。这种持续存在的风险促进了针对这些脂蛋白的新型药物干预措施的开发:我们的特别报告首先使用 "plozasiran"、"zodasiran "等关键词以及与 APOC3 和 ANGPTL3 相关的术语在 PubMed 上进行了有针对性的搜索。随着综述的深入,新出现的研究问题引导了进一步的搜索,从而纳入了更多的相关文章,以全面说明TRL与心血管疾病之间的联系,讨论APOC3、ANGPTL3和针对这些蛋白的药物的作用,并对ARCHES-2和MUIR试验进行比较:ARCHES-2和MUIR试验表明,这些疗法能有效降低甘油三酯,但还不能确定这是否与显著的临床疗效相关。反义寡核苷酸技术的进步,尤其是 GalNAc 递送平台,为个性化血脂管理带来了希望,但成本和安全性等挑战依然存在。
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引用次数: 0
Population pharmacokinetics of nirmatrelvir/ritonavir in critically ill Chinese COVID-19 patients and recommendations for medication use: a two-center retrospective study. 中国 COVID-19 重症患者中尼马瑞韦/利托那韦的群体药代动力学及用药建议:一项双中心回顾性研究。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1080/17512433.2024.2410385
Junjun Xu, Jinmeng Li, Meng Chen, Huifang Jiang, Xudong Fan, Yangmin Hu, Haili Shan, Mingdong Yang, Yichao Xu, Yuying Lang, Haibin Dai, Xinjun Cai

Background: This study aimed to establish population pharmacokinetics (PPK) models of nirmatrelvir/ritonavir in critically ill Chinese patients with the coronavirus disease 2019 (COVID-19) infection, explore factors affecting the pharmacokinetics (PK) of nirmatrelvir/ritonavir.

Methods: A total of 285 serum samples and clinical data were collected from 152 patients. The PPK models of nirmatrelvir/ritonavir were analyzed using nonlinear mixed-effect modeling (NONMEM) approach. The optimal dosing regimen for patients with different renal function was determined using Monte Carlo simulations.

Results: The population typical values of apparent clearance (CL/F) and apparent volume of distribution (V/F) of nirmatrelvir were 2.26 L/h and 15.3 L, respectively. Notably, creatinine clearance (CrCL) significantly influenced the PK variation of nirmatrelvir. Monte Carlo simulations suggested that patients with mild-to-moderate renal impairment experienced a 22.0-59.9% increase in the area under the curve (AUC) when they were administered a standard dose of nirmatrelvir compared to those with normal renal function. The AUC in patients with severe renal impairment after administration of 150 mg q12h nirmatrelvir was similar to that in patients with normal renal function after administration of 300 mg q12h nirmatrelvir.

Conclusions: PPK modeling and simulation provided a reference for the rational clinical application of nirmatrelvir/ritonavir in critically ill Chinese patients.

研究背景本研究旨在建立中国2019年冠状病毒病(COVID-19)感染重症患者中尼马瑞韦/利托那韦的群体药代动力学(PPK)模型,探讨影响尼马瑞韦/利托那韦药代动力学(PK)的因素:方法:共收集了152名患者的285份血清样本和临床数据。采用非线性混合效应模型(NONMEM)方法分析了那瑞瑞韦/利托那韦的药代动力学(PK)模型。通过蒙特卡洛模拟确定了不同肾功能患者的最佳给药方案:结果:nirmatrelvir 的表观清除率(CL/F)和表观分布容积(V/F)的人群典型值分别为 2.26 L/h 和 15.3 L。值得注意的是,肌酐清除率(CrCL)对尼尔马特韦的 PK 变化有显著影响。蒙特卡洛模拟显示,与肾功能正常的患者相比,轻度至中度肾功能受损的患者在服用标准剂量的尼尔马特韦时,其曲线下面积(AUC)会增加 22.0-59.9%。严重肾功能损害患者服用150毫克 q12小时的尼尔马特雷韦后,其AUC与肾功能正常患者服用300毫克 q12小时的尼尔马特雷韦后的AUC相似:PPK建模和模拟为尼马瑞韦/利托那韦在中国重症患者中的临床合理应用提供了参考。
{"title":"Population pharmacokinetics of nirmatrelvir/ritonavir in critically ill Chinese COVID-19 patients and recommendations for medication use: a two-center retrospective study.","authors":"Junjun Xu, Jinmeng Li, Meng Chen, Huifang Jiang, Xudong Fan, Yangmin Hu, Haili Shan, Mingdong Yang, Yichao Xu, Yuying Lang, Haibin Dai, Xinjun Cai","doi":"10.1080/17512433.2024.2410385","DOIUrl":"10.1080/17512433.2024.2410385","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to establish population pharmacokinetics (PPK) models of nirmatrelvir/ritonavir in critically ill Chinese patients with the coronavirus disease 2019 (COVID-19) infection, explore factors affecting the pharmacokinetics (PK) of nirmatrelvir/ritonavir.</p><p><strong>Methods: </strong>A total of 285 serum samples and clinical data were collected from 152 patients. The PPK models of nirmatrelvir/ritonavir were analyzed using nonlinear mixed-effect modeling (NONMEM) approach. The optimal dosing regimen for patients with different renal function was determined using Monte Carlo simulations.</p><p><strong>Results: </strong>The population typical values of apparent clearance (CL/F) and apparent volume of distribution (V/F) of nirmatrelvir were 2.26 L/h and 15.3 L, respectively. Notably, creatinine clearance (CrCL) significantly influenced the PK variation of nirmatrelvir. Monte Carlo simulations suggested that patients with mild-to-moderate renal impairment experienced a 22.0-59.9% increase in the area under the curve (AUC) when they were administered a standard dose of nirmatrelvir compared to those with normal renal function. The AUC in patients with severe renal impairment after administration of 150 mg q12h nirmatrelvir was similar to that in patients with normal renal function after administration of 300 mg q12h nirmatrelvir.</p><p><strong>Conclusions: </strong>PPK modeling and simulation provided a reference for the rational clinical application of nirmatrelvir/ritonavir in critically ill Chinese patients.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1071-1079"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Renin-angiotensin system inhibition and mortality in patients undergoing dialysis with coronary artery disease: insights from a multi-center observational study. 肾素-血管紧张素系统抑制与冠心病透析患者的死亡率:一项多中心观察研究的启示。
IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-10-23 DOI: 10.1080/17512433.2024.2419915
Enmin Xie, Shuoyan An, Yaxin Wu, Zixiang Ye, Xuecheng Zhao, Yike Li, Nan Shen, Yanxiang Gao, Jingang Zheng

Background: While the survival benefits of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are firmly established in the general population, their efficacy within patient undergoing dialysis with coronary artery disease (CAD) remains controversial.

Methods: Between January 2015 and June 2021, 1168 patients undergoing dialysis with CAD were assessed from 30 tertiary medical centers. The primary outcome was all-cause death, and the secondary outcome was cardiovascular death. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for between-group differences.

Results: Overall, ACEI or ARB were prescribed to 518 patients (44.3%) upon discharge. After a median follow-up of 22.2 months, 361 (30.9%) patients died, including 243 cardiovascular deaths. The use of ACEI or ARB was associated with a significantly lower risk of all-cause (25.3% vs 35.4%, hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82, p < 0.001) and cardiovascular death (17.0% vs 23.8%; HR 0.64, 95% CI 0.48-0.83, p = 0.001). These findings remained consistent across IPTW and PSM analyses. Sensitivity analyses for ACEI and ARB use separately yielded similar results.

Conclusions: Our findings suggested that among patients undergoing dialysis with CAD, ACEI or ARB use was associated with a lower risk of all-cause and cardiovascular death.

背景:虽然血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)对普通人群的生存益处已得到证实,但它们对接受透析的冠状动脉疾病(CAD)患者的疗效仍存在争议:2015年1月至2021年6月期间,30家三级医疗中心对1168名接受透析治疗的冠心病患者进行了评估。主要结果为全因死亡,次要结果为心血管死亡。为考虑组间差异,进行了逆概率治疗加权(IPTW)和倾向评分匹配(PSM):共有 518 名患者(44.3%)在出院时接受了 ACEI 或 ARB 治疗。中位随访 22.2 个月后,361 名患者(30.9%)死亡,其中 243 人死于心血管疾病。使用 ACEI 或 ARB 可显著降低全因风险(25.3% vs 35.4%,危险比 [HR] 0.65,95% 置信区间 [CI] 0.52-0.82,P = 0.001)。这些结果在IPTW和PSM分析中保持一致。对分别使用 ACEI 和 ARB 的敏感性分析也得出了相似的结果:我们的研究结果表明,在患有 CAD 的透析患者中,使用 ACEI 或 ARB 与较低的全因死亡和心血管死亡风险相关。
{"title":"Renin-angiotensin system inhibition and mortality in patients undergoing dialysis with coronary artery disease: insights from a multi-center observational study.","authors":"Enmin Xie, Shuoyan An, Yaxin Wu, Zixiang Ye, Xuecheng Zhao, Yike Li, Nan Shen, Yanxiang Gao, Jingang Zheng","doi":"10.1080/17512433.2024.2419915","DOIUrl":"10.1080/17512433.2024.2419915","url":null,"abstract":"<p><strong>Background: </strong>While the survival benefits of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are firmly established in the general population, their efficacy within patient undergoing dialysis with coronary artery disease (CAD) remains controversial.</p><p><strong>Methods: </strong>Between January 2015 and June 2021, 1168 patients undergoing dialysis with CAD were assessed from 30 tertiary medical centers. The primary outcome was all-cause death, and the secondary outcome was cardiovascular death. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for between-group differences.</p><p><strong>Results: </strong>Overall, ACEI or ARB were prescribed to 518 patients (44.3%) upon discharge. After a median follow-up of 22.2 months, 361 (30.9%) patients died, including 243 cardiovascular deaths. The use of ACEI or ARB was associated with a significantly lower risk of all-cause (25.3% vs 35.4%, hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82, <i>p</i> < 0.001) and cardiovascular death (17.0% vs 23.8%; HR 0.64, 95% CI 0.48-0.83, <i>p</i> = 0.001). These findings remained consistent across IPTW and PSM analyses. Sensitivity analyses for ACEI and ARB use separately yielded similar results.</p><p><strong>Conclusions: </strong>Our findings suggested that among patients undergoing dialysis with CAD, ACEI or ARB use was associated with a lower risk of all-cause and cardiovascular death.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1053-1062"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of tenecteplase in ischemic stroke after 4.5 hours: an evaluation of the TRACE-III trial. 替奈替普酶在 4.5 小时后缺血性中风中的作用:TRACE-III 试验评估。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-11-11 DOI: 10.1080/17512433.2024.2427078
Muhammad Imtiaz, Muhammad Adnan Zaman, Abeel Naseer, Sidra Kalsoom

Tenecteplase (TNK), as a thrombolytic treatment for acute ischemic stroke (AIS), has been found to be effective when used within 4.5 hours of symptom onset. However, the efficacy of TNK after 4.5 hours is not well established, especially in patients with large vessel occlusion and with no access to thrombectomy. In this article, we will discuss the results of the recently published TRACE-III trial. The study involved 516 patients with large vessel occlusion, either proximal middle cerebral artery or internal carotid artery, with salvageable brain tissue and no endovascular thrombectomy access. Key safety outcomes included symptomatic intracranial hemorrhage and death. TNK treatment resulted in a higher percentage of patients with a modified Rankin scale score of 0 or 1 at 90 days than standard medical treatment. Mortality at 90 days was 13.3% with TNK and 13.1% with standard medical treatment. The trial found that TNK treatment for Chinese patients with ischemic stroke resulted in less disability and similar survival compared to standard medical treatment. However, there was a higher incidence of symptomatic intracranial hemorrhage within 36 hours.

特奈替普酶(TNK)作为急性缺血性卒中(AIS)的溶栓疗法,在症状出现后 4.5 小时内使用效果显著。然而,TNK 在 4.5 小时后的疗效尚未完全确定,尤其是在大血管闭塞且无法进行血栓切除术的患者中。本文将讨论最近发表的 TRACE-III 试验结果。这项研究涉及 516 名大血管闭塞患者,他们要么是大脑中动脉近端闭塞,要么是颈内动脉闭塞,脑组织可挽救,但没有血管内血栓切除术通路。主要的安全性结果包括症状性颅内出血和死亡。与标准药物治疗相比,TNK治疗90天后改良Rankin量表评分为0或1分的患者比例更高。TNK治疗90天后的死亡率为13.3%,标准药物治疗的死亡率为13.1%。试验发现,与标准药物治疗相比,TNK治疗中国缺血性脑卒中患者的致残率较低,存活率相似。然而,36小时内无症状颅内出血的发生率较高。
{"title":"Role of tenecteplase in ischemic stroke after 4.5 hours: an evaluation of the TRACE-III trial.","authors":"Muhammad Imtiaz, Muhammad Adnan Zaman, Abeel Naseer, Sidra Kalsoom","doi":"10.1080/17512433.2024.2427078","DOIUrl":"10.1080/17512433.2024.2427078","url":null,"abstract":"<p><p>Tenecteplase (TNK), as a thrombolytic treatment for acute ischemic stroke (AIS), has been found to be effective when used within 4.5 hours of symptom onset. However, the efficacy of TNK after 4.5 hours is not well established, especially in patients with large vessel occlusion and with no access to thrombectomy. In this article, we will discuss the results of the recently published TRACE-III trial. The study involved 516 patients with large vessel occlusion, either proximal middle cerebral artery or internal carotid artery, with salvageable brain tissue and no endovascular thrombectomy access. Key safety outcomes included symptomatic intracranial hemorrhage and death. TNK treatment resulted in a higher percentage of patients with a modified Rankin scale score of 0 or 1 at 90 days than standard medical treatment. Mortality at 90 days was 13.3% with TNK and 13.1% with standard medical treatment. The trial found that TNK treatment for Chinese patients with ischemic stroke resulted in less disability and similar survival compared to standard medical treatment. However, there was a higher incidence of symptomatic intracranial hemorrhage within 36 hours.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1013-1016"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Methotrexate polyglutamates. 甲氨蝶呤多聚谷氨酸盐。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI: 10.1080/17512433.2024.2416674
Zhilin Yang, Jiayi Mo, Wenshu Li, Zhigang Zhao, Shenghui Mei

Introduction: Methotrexate polyglutamates (MTXPGs) are intracellular metabolites of methotrexate (MTX) that play a critical role in the drug's activity, influencing both its efficacy and toxicity. As the exact implications of MTXPGs in these processes remain a subject of debate, a comprehensive review of MTXPGs could provide valuable insights for clinicians and pharmacists, potentially minimizing adverse reactions and enhancing therapeutic outcomes.

Areas covered: A comprehensive search of relevant literature was conducted in PubMed and Web of Science databases, including studies from their inception to April 2024. Eligible studies included reviews, clinical trials, and real-world analyses. Additional manual searches and citation reviews were also performed. This review aims to explore MTXPGs with a primary focus on their pharmacokinetics, analytical methods, determinants of drug exposure, and their correlation with MTX efficacy and toxicity.

Expert opinion: MTXPGs have not yet garnered significant attention in clinical practice. However, multiple studies have demonstrated a relationship between MTXPGs and the efficacy and toxicity of MTX, suggesting a potential avenue for personalized treatment strategies. Future research should aim to further validate and refine this correlation. Additionally, attention should also be directed toward other metabolites of MTX, which may hold clinical significance.

简介:甲氨蝶呤多聚谷氨酸盐(MTXPGs)是甲氨蝶呤(MTX)的细胞内代谢产物,在药物活性中起着至关重要的作用,影响着药物的疗效和毒性。由于 MTXPGs 在这些过程中的确切影响仍存在争议,因此对 MTXPGs 进行全面审查可为临床医生和药剂师提供有价值的见解,从而有可能最大限度地减少不良反应并提高治疗效果:在 PubMed 和 Web of Science 数据库中对相关文献进行了全面检索,包括从开始到 2024 年 4 月的研究。符合条件的研究包括综述、临床试验和真实世界分析。此外,还进行了其他人工检索和引文综述。本综述旨在探讨 MTXPGs,主要关注其药代动力学、分析方法、药物暴露的决定因素以及与 MTX 疗效和毒性的相关性:MTXPG尚未在临床实践中引起广泛关注。然而,多项研究表明,MTXPGs 与 MTX 的疗效和毒性之间存在关系,这为个性化治疗策略提供了潜在的途径。未来的研究应旨在进一步验证和完善这种相关性。此外,还应关注 MTX 的其他代谢物,它们可能具有临床意义。
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引用次数: 0
Plasma protein binding of arsenic species in acute promyelocytic leukemia patients and their relationships with hepatic and renal function. 急性早幼粒细胞白血病患者血浆蛋白中砷的结合力及其与肝肾功能的关系。
IF 4.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY Pub Date : 2024-11-01 Epub Date: 2024-10-18 DOI: 10.1080/17512433.2024.2417666
Chunlu Gao, Rui Duan, Shuo Tian, Chunrong Pang, Hong Zhang, Haixia Yang, Xin Hai

Objectives: Percentage protein binding (%PB) of arsenic species in acute promyelocytic leukemia (APL) patients treated with arsenic trioxide remains unclear. It can be different depending on the status of hepatic or renal function.

Methods: This study obtained steady-state blood samples from normal APL patients and those with hepatic or renal impairment. %PB of inorganic arsenic (iAs), monomethylarsonic acid (MMAV), and dimethylarsinic acid (DMAV) was determined by analyzing free and total plasma concentrations using ultrafiltration method by HPLC-HG-AFS.

Results: There is a linear relationship between free and total plasma concentrations for iAs (r2 = 0.952), MMAV (r2 = 0.603), and DMAV (r2 = 0.945). For patients with normal hepatic and renal function, mean %PB was as follows: iAs at 26.7 ± 14.3%, MMAV at 53.3 ± 11.9%, and DMAV at 24.7 ± 7.8%. %PB decreased in patients with renal impairment, with MMAV and DMAV showing statistically significant differences (p < 0.05 for MMAV, p < 0.01 for DMAV). No significant differences in %PB between normal and hepatic impairment group were observed.

Conclusion: Free arsenic species fraction can be estimated by total concentration. DMAV and iAs present low %PB, while MMAV exhibits a relatively high %PB in plasma. Level of %PB is more likely to be affected by renal function and age.

目的:接受三氧化二砷治疗的急性早幼粒细胞白血病(APL)患者体内砷的蛋白结合率(%PB)仍不清楚。方法:本研究采集了正常 APL 患者的稳态血液样本:本研究采集了正常 APL 患者和肝肾功能受损患者的稳态血样。方法:本研究采集了正常 APL 患者和肝肾功能受损患者的稳态血样,采用 HPLC-HG-AFS 超滤法分析游离和总血浆浓度,测定无机砷(iAs)、一甲基砷酸(MMAV)和二甲基砷酸(DMAV)的 PB%:结果:iAs(r2 = 0.952)、MMAV(r2 = 0.603)和 DMAV(r2 = 0.945)的游离浓度和血浆总浓度之间呈线性关系。肝肾功能正常患者的平均 PB 百分比如下:iAs 为 26.7 ± 14.3%,MMAV 为 53.3 ± 11.9%,DMAV 为 24.7 ± 7.8%。肾功能受损患者的血压百分比下降,MMAV 和 DMAV 显示出显著的统计学差异(p V,p V)。正常组和肝功能受损组的 PB 百分比无明显差异:结论:游离砷物种部分可通过总浓度估算。DMAV 和 iAs 的 PB 百分比较低,而 MMAV 在血浆中的 PB 百分比相对较高。PB%的水平更有可能受到肾功能和年龄的影响。
{"title":"Plasma protein binding of arsenic species in acute promyelocytic leukemia patients and their relationships with hepatic and renal function.","authors":"Chunlu Gao, Rui Duan, Shuo Tian, Chunrong Pang, Hong Zhang, Haixia Yang, Xin Hai","doi":"10.1080/17512433.2024.2417666","DOIUrl":"10.1080/17512433.2024.2417666","url":null,"abstract":"<p><strong>Objectives: </strong>Percentage protein binding (%PB) of arsenic species in acute promyelocytic leukemia (APL) patients treated with arsenic trioxide remains unclear. It can be different depending on the status of hepatic or renal function.</p><p><strong>Methods: </strong>This study obtained steady-state blood samples from normal APL patients and those with hepatic or renal impairment. %PB of inorganic arsenic (iAs), monomethylarsonic acid (MMA<sup>V</sup>), and dimethylarsinic acid (DMA<sup>V</sup>) was determined by analyzing free and total plasma concentrations using ultrafiltration method by HPLC-HG-AFS.</p><p><strong>Results: </strong>There is a linear relationship between free and total plasma concentrations for iAs (r<sup>2</sup> = 0.952), MMA<sup>V</sup> (r<sup>2</sup> = 0.603), and DMA<sup>V</sup> (r<sup>2</sup> = 0.945). For patients with normal hepatic and renal function, mean %PB was as follows: iAs at 26.7 ± 14.3%, MMA<sup>V</sup> at 53.3 ± 11.9%, and DMA<sup>V</sup> at 24.7 ± 7.8%. %PB decreased in patients with renal impairment, with MMA<sup>V</sup> and DMA<sup>V</sup> showing statistically significant differences (<i>p</i> < 0.05 for MMA<sup>V</sup>, <i>p</i> < 0.01 for DMA<sup>V</sup>). No significant differences in %PB between normal and hepatic impairment group were observed.</p><p><strong>Conclusion: </strong>Free arsenic species fraction can be estimated by total concentration. DMA<sup>V</sup> and iAs present low %PB, while MMA<sup>V</sup> exhibits a relatively high %PB in plasma. Level of %PB is more likely to be affected by renal function and age.</p>","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"1063-1069"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Expert Review of Clinical Pharmacology
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