International Journal of Clinical Pharmacy最新文献

Introduction: Collaborative pharmacist prescribing models involve pharmacists working with doctors and patients to develop medication plans and prescribe medications. Limited evidence exists on the impact of these models on medication discrepancies in hospitals using electronic prescribing systems (EPS).

Aim: This study aimed to evaluate the impact of collaborative pharmacist prescribing on medication discrepancies and potential patient harm within a statewide healthcare system using EPS.

Method: A multi-site matched cohort study involving 240 patients was conducted. EPS data for 120 patients aged ≥ 18 years who received collaborative pharmacist prescribing was matched 1:1 with 120 patients who received usual care of independent medical prescribing. Matching variables were hospital, clinical unit, sex, age, admission date, triage category and pre-admission medication count. The electronic medical record was reviewed to identify undocumented medication discrepancies, which were defined as any unexplained difference between the pharmacist-led medication history and medications prescribed on admission. The frequency of undocumented discrepancies was calculated. An independent multi-disciplinary clinician panel determined potential harm, using the Harm Associated with Medication Error Classification (HAMEC) tool.

Results: There were fewer undocumented discrepancies per medication prescribed in the collaborative pharmacist prescribing group compared to usual care (RR 0.04, 95% CI 0.03-0.06) and the relative risk of undocumented discrepancies per patient was lower (RR 0.23, 95% CI 0.13-0.39). The expert clinician panel found that undocumented discrepancies rarely posed serious or severe harm in either group (0 undocumented discrepancies with potential to cause serious or severe harm in the collaborative pharmacist prescribing group compared to 8 in the usual care group).

Conclusion: The implementation of collaborative pharmacist prescribing within a statewide EPS significantly reduced undocumented discrepancies and lowered the potential for patient harm. As healthcare systems globally shift towards electronic prescribing, this study provides timely and actionable evidence to inform policy and support the adoption of collaborative prescribing models in hospitals using EPS. Such models offer a practical strategy to improve medication safety, reduce patient harm and strengthen interprofessional collaboration at the point of prescribing.

Introduction: Cisplatin is a cornerstone chemotherapeutic agent frequently associated with dose-limiting ototoxicity. Increasing evidence suggests that immune-mediated mechanisms may influence interindividual susceptibility to this adverse effect; however, the role of inherited immune traits remains poorly understood.

Aim: This study aimed to evaluate the causal relationship between 33 inherited immune traits and cisplatin-induced ototoxicity using Mendelian randomization (MR), and to identify age-stratified susceptibility markers in pediatric and adult cancer survivors.

Method: MR was used to assess the causal effects of genetically predicted immune traits on cisplatin-induced ototoxicity. Single-nucleotide polymorphisms associated with immune traits were selected from large-scale genome-wide association study datasets. The primary analysis used the inverse variance weighted method with MR-Egger, weighted median, weighted mode, and MR-PRESSO as the sensitivity approaches. Bidirectional MR and sensitivity analyses were conducted to assess robustness and rule out reverse causation. Bonferroni correction was employed to minimize potential false-positive findings (P < 0.05/165 ≈ 0.0003).

Results: Transforming Growth Factor-beta principal component analysis (TGF-β PCA) showed an age-stratified effect: it was associated with increased risk of hearing loss in pediatric patients (OR (95% CI): 1.0 × 10¹ (1.6 × 10⁰-6.6 × 10¹), P = 0.014) but conferred strong protection against Speech Recognition Threshold (SRT) impairment (OR (95% CI): 2.8 × 10⁻¹ (1.4 × 10⁻¹-5.3 × 10⁻¹), P = 0.00012) and hearing loss (OR (95% CI): 4.7 × 10⁻¹ (2.7 × 10⁻¹-8.1 × 10⁻¹), P = 0.006) in adults. Additional protective associations have been identified for T Central Memory (TCM) cells and Programmed Cell Death Protein-1 (PD-1) in adults. Reverse MR analysis excluded significant reverse causation. Following Bonferroni correction, the association between TGF-β PCA and SRT remained statistically significant (P < 0.0003) in the adult cohort. However, all other associations in adults and the entire pediatric cohort demonstrated only nominal significance (0.0003 ≤ P < 0.05).

Conclusion: Inherited immune traits, particularly TGF-β PCA, PD-1, and TCM cells, exhibit age-stratified causal effects on cisplatin-induced ototoxicity. These findings suggest the use of immunogenetic profiling for risk prediction and personalized strategies in oncology pharmacy practice.

Introduction: Drug-eluting stents are the cornerstone of treatment in patients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI). However, long-term comparative data on rapamycin-eluting and everolimus-eluting stents remain limited.

Aim: This study aimed to evaluate the long-term (5-7 years) safety, effectiveness, and cost profiles of rapamycin-eluting stents versus everolimus-eluting stents in patients with ACS following PCI.

Method: This was a prospective, single-center cohort study. Consecutive patients with ACS who underwent PCI with either rapamycin-eluting stents or everolimus-eluting stents between October 2018 and October 2019 were enrolled and followed-up from November 2024 to February 2025 via clinic visits or telephone interviews. The primary outcome was the incidence of overall adverse events (AEs). The secondary outcomes included all-cause mortality, readmission rate, EuroQol Visual Analog Scale (EQ-VAS) scores, treatment costs, out-of-pocket expenses, new-onset hypertension, diabetes, and hyperlipidemia. Potential predictors of AEs were first identified by univariate logistic regression (P < 0.1). Confounders, determined using Directed Acyclic Graphs (DAGs), were then adjusted for in a multivariable logistic regression model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: In total, 120 patients (60 per group) were included. No significant association was found between stent type and overall AEs [27/60 (45.00%) vs. 25/60 (41.67%); adjusted odds ratio (OR) = 1.08, 95% CI 0.45-2.58; P = 0.87]. Although all-cause mortality [8/60 (13.33%) vs. 4/60 (6.67%); relative risk (RR) = 2.00, 95% CI 0.64-6.29; P = 0.24] and readmission rates [4/60 (6.67%) vs. 1/60 (1.67%); RR = 4.00, 95% CI: 0.45-35.27; P = 0.36] were higher in the rapamycin-eluting stent group, the differences were not statistically significant. EQ-VAS scores did not differ significantly between the groups (70.28 vs. 72.30; mean difference =  - 2.02, 95% CI - 6.70 to 2.66; P = 0.42). However, the everolimus-eluting stent group had significantly higher treatment costs (¥58,853.38 RMB vs. ¥48,609.22 RMB; P = 0.00).

Conclusion: Rapamycin-eluting stents demonstrated long-term safety and effectiveness comparable to everolimus-eluting stents in ACS patients post-PCI while offering a significant cost advantage. These findings suggest that rapamycin-eluting stents are potentially more cost-effective. For healthcare systems seeking to enhance value-based procurement, these results justify the preferential selection and wider adoption of rapamycin-eluting stents in clinical practice. However, confirmation through large-scale, multicenter, prospective studies is warranted.

Introduction: Atherosclerosis is the pathological foundation of most cardiovascular diseases and remains the leading cause of mortality worldwide. Increasing evidence shows that pyroptosis, a pro-inflammatory form of programmed cell death mediated by inflammasome activation and gasdermin D (GSDMD)-mediated pore formation, plays a key role in vascular endothelial dysfunction, immune cell activation, and plaque destabilization. Understanding how pharmacological agents modulate pyroptotic signaling is crucial for identifying new therapeutic strategies for atherosclerosis prevention and treatment.

Aim: This narrative review aims to summarize the current evidence on the mechanisms by which pyroptosis contributes to the initiation and progression of atherosclerosis and to explore pharmacological strategies, including natural and synthetic compounds that target pyroptotic pathways to exert anti-atherosclerotic effects.

Method: A narrative literature review was conducted using PubMed, Web of Science, and Scopus, from database inception to September 2025. The search combined terms related to "pyroptosis," "atherosclerosis," "inflammasome," "gasdermin," "drug," and "natural compound." Studies reporting the mechanisms or pharmacologic modulation of pyroptosis in endothelial cells, macrophages, or vascular smooth muscle cells were included, and data were synthesized according to cell type and mechanism of drug action.

Results: Pyroptosis contributes to all the stages of atherosclerosis by promoting vascular inflammation, lipid accumulation, and plaque rupture. The NLRP3 inflammasome, caspase-1, and GSDMD are major pharmacological targets. Small-molecule inhibitors, such as MCC950 and VX-765, suppress inflammasome activation and cytokine release, thereby reducing plaque burden. Multiple natural compounds, including salidroside, salvianolic acids, puerarin, oxymatrine, and quercetin, exert protective effects through antioxidative and anti-inflammatory mechanisms that inhibit inflammasome activation and restore endothelial integrity. These findings suggest the feasibility of combining pyroptosis-targeting compounds with established antiatherosclerotic therapies.

Conclusion: Targeting pyroptosis offers a promising pharmacological approach for mitigating vascular inflammation and stabilizing atherosclerotic plaques. Natural compounds with inflammasome-modulating activities serve as valuable chemical scaffolds for the development of novel therapeutics. Further pharmacokinetic, toxicological, and clinical studies are needed to translate these mechanistic insights into effective treatment strategies for patients with atherosclerotic cardiovascular disease.

Background: The potentially inappropriate medications (PIM)-China criteria, published in 2017, require updates to reflect new therapeutic evidence and address limitations such as outdated medications and condition-specific considerations.

Aim: This study aimed to develop an updated version of the PIM-China criteria through a modified Delphi consensus methodology, ensuring evidence-based and clinically relevant recommendations for older adults in China.

Method: A literature review of six PIM criteria (Beers, STOPP, FORTA, EU(7)-PIM, Japan and Korea criteria) and relevant literature (2018-2023) informed a preliminary list of PIMs. A multidisciplinary panel of 33 experts, comprising 12 physicians and 21 pharmacists, evaluated 210 candidate criteria over three Delphi rounds. Statistical measures were used to validate consensus, including Kendall's W, coefficient of variation (CV), and expert authority coefficient (Cr). Cr values ≥ 0.80 indicated high reliability, while Kendall's W > 0.20 signified moderate to strong agreement.

Results: The updated criteria consist of 154 items, a 57% increase from 2017, including 100 individual medications or drug classes and 54 condition-specific PIMs. Notable additions include recommendations addressing drug-drug interactions, renal function adjustments, and alternative treatments. Consensus improved significantly across rounds, with Kendall's W increasing from 0.145 to 0.271 for individual PIMs and 0.118 to 0.360 for condition-specific PIMs (P < 0.05). Cr reached 0.85, reflecting the panel's high authority.

Conclusion: The updated 2024 PIM-China criteria enhance prescribing safety and clinical relevance by incorporating new evidence and expert consensus. These criteria are vital for reducing adverse drug events, optimizing prescribing practices, and improving healthcare for older adults in China.

Introduction: Excessive polypharmacy, which is defined as the use of ten medications or more, poses considerable challenges regarding patient health and healthcare resources. Individuals who exhibit excessive polypharmacy are predisposed to adverse drug effects, drug interactions, and non-adherence, which can result in increased hospitalization, emergency room visits, and mortality. Given their expertise in medication management, pharmacists are uniquely positioned to address the risks associated with excessive medication use. Therefore, exploring their role in this phenomenon across their various fields of practice is essential.

Aim: The aim of this review was to summarize the existing literature on the role of pharmacists in addressing excessive polypharmacy in different care settings and to highlight areas where more research is needed.

Method: A scoping review was conducted by adopting Arksey and O'Malley's methodological framework, along with subsequent enhancements implemented by Levac et al. It was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search was conducted across five databases: MEDLINE, EMBASE, PubMed, CINAHL and Cochrane CENTRAL from their inception until June 2024. Covidence was used for data selection and extraction. The results were analyzed using narrative synthesis.

Results: We identified 5236 articles, of which 19 were included. All studies were available in English and were conducted in high-income countries with the majority (84%) being published after 2019. The interventions were carried out in primary care clinics, hospitals, home care, and long-term care facilities, but none of the studies were conducted in community pharmacies. The analysis identified four predominant roles: performing medication reconciliation during care transitions, assessing medication appropriateness, raising awareness among prescribing healthcare professionals, and ensuring patient follow-up and monitoring. These roles emphasized collaboration between patients and interprofessional teams and were supported by various polypharmacy management tools.

Conclusion: This review's results highlight pharmacists' various roles in managing excessive polypharmacy across care settings. The scope of practice, physical proximity to other health professionals, expertise, higher qualifications and/or additional training all influenced these roles.

Introduction: Clinical studies have shown that omadacycline is non-inferior to moxifloxacin, a widely used respiratory fluoroquinolone, in terms of efficacy. However, the higher acquisition cost of omadacycline raises questions regarding its economic value, particularly in resource-limited healthcare systems such as China.

Aim: This study evaluated the cost-effectiveness of omadacycline versus moxifloxacin as initial treatment for CABP in China.

Method: A decision-tree model was constructed using TreeAge Pro 2020 to assess sequential intravenous (IV)-to-oral omadacycline versus moxifloxacin in adult patients with non-severe CABP. Parameter values were obtained from published literature, public databases, and medical service pricing datas. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed to assess model robustness. A regimen was considered cost-effective if the ICER fell below the willingness-to-pay (WTP) threshold of $19,012 per quality-adjusted life year (QALY).

Results: In the base-case analysis, omadacycline provided an additional 0.004 QALY at an incremental cost of $597.8, resulting in an ICER of $148,700/QALY-substantially exceeding the $19,012 threshold. The cost of oral and IV omadacycline were the most influential parameters. Omadacycline was optimal in 7.6% of 10,000 Monte Carlo simulations at the $19,012/QALY threshold. Province-specific WTP thresholds showed cost-effectiveness probabilities ranging from 1.1% (Gansu) to 16.2% (Beijing).

Conclusion: Omadacycline is not cost-effective compared to moxifloxacin as the initial treatment for CABP in China, unless significant price reductions are achieved.

Introduction: Inhaled therapies are essential for managing asthma and chronic obstructive pulmonary disease (COPD), but device choice carries environmental consequences. Inhaler devices influence climate impact; propellant-based metered-dose inhalers (MDIs) have substantially higher carbon footprints than non-propellant inhalers (NPIs). Ireland has committed to net-zero greenhouse gas emissions by 2050, making prescribing practices a relevant focus for mitigation.

Aim: To describe national dispensing patterns of inhaled respiratory medicines and estimate associated CO₂-equivalent (CO₂e) emissions in Irish primary care, 2020-2022.

Method: We analysed Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) dispensing data for inhaled respiratory medicines (ATC R03) products. Items were classified as MDIs or NPIs. Trends of inhalers use were expressed as year-on-year inhalers dispensed. We conducted scenario analysis in which 10%, 25%, and 50% of 2022 MDIs use were replaced with NPIs to calculate the reduction in carbon emissions. Notably, PCRS schemes cover ~ 43% of the Irish population (predominantly older adults and a lower income group).

Results: Between 2020 and 2022, a total of 9.94 million inhalers were dispensed under HSE-PCRS schemes, with annual volumes rising from 3.04 million (2020) to 3.60 million (2022). MDIs increased from 1.50 million (2020) to 1.79 million (2021) and 1.95 million (2022), while NPIs declined - 15.7% in 2021 and then rebounded + 26.8% in 2022. The MDIs share of all inhalers changed from 49.2% (2020) to 57.9% (2021) to 54.2% (2022) for which estimated MDIs carbon emissions were 28.6, 34.6, and 37.6 kt CO₂e, respectively. This emission was accounted for 95-96% of inhaler-related emissions annually. In scenario analyses, replacing 10%, 25%, and 50% of 2022 MDIs use with NPIs resulted in estimated emission reduction of ~ 3.6, 8.9, and 17.9 kt CO₂e, respectively.

Conclusion: The results show how MDIs influence the carbon footprint of the health sector and they encourage healthcare providers to support sustainable alternatives. When clinically appropriate, choosing sustainable devices provides significant, short-term CO2 savings without sacrificing treatment.

Introduction: Severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening. Children and adolescents are especially vulnerable due to developmental pharmacology, immature immune systems, and limited premarketing safety data. However, large-scale evidence of drug-specific SCAR patterns in pediatric populations remains limited.

Aim: To investigate the epidemiology, clinical features, drug associations, and safety signals of SCARs in children and adolescents using the FDA Adverse Event Reporting System (FAERS).

Method: Reports of SCARs in patients aged ≤ 18 years were retrieved from FAERS from Q1 2004 to Q2 2024 and identified using narrow-scope Standardised MedDRA Queries (SMQs). Data cleaning followed the FDA-recommended procedures. Disproportionality analysis was performed using four methods: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN; yielding Information Component, IC), Multi-item Gamma Poisson Shrinker (MGPS), and empirical Bayes geometric mean (EBGM). Drug-label reviews were used to compare the signal detection results with existing safety warnings.

Results: A total of 7183 pediatric SCAR reports were included. The number of reports has increased over time, with adolescents (13-17 years) and school-aged children (7-12 years) accounting for 68% of cases. The most frequently reported Preferred Terms were drug reaction with eosinophilia and systemic symptoms (DRESS; 32.5%), Stevens-Johnson syndrome (SJS; 27.9%), and toxic epidermal necrolysis (TEN; 19.0%). Hospitalization occurred in 64.5% of cases, and 6.3% were fatal. Among the 2005 cases with available onset time, 82.7% developed within 30 days of drug exposure. Thirty-eight drugs showed positive signals, including lamotrigine, phenytoin, sulfamethoxazole, and phenobarbital. Four drugs, ranitidine, anakinra, clonazepam, and rifampin, showed signals without corresponding warnings in the FDA pediatric labeling.

Conclusion: SCARs in children and adolescents show distinct patterns, high hospitalization and mortality, and strong links with antiepileptics and anti-infectives. Strengthening pediatric pharmacovigilance, implementing risk-alert systems, and promoting genotype-guided prescribing may help prevent these severe reactions.

Introduction: Pneumonia is a leading cause of morbidity and mortality worldwide, with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) representing the two most common subtypes. Antimicrobials are central to treatment; however, systematic reviews (SRs) evaluating their use have reported highly variable outcomes, limiting evidence synthesis and comparability. The development of a core outcome set (COS) may address this gap.

Aim: To summarize the primary outcomes reported in SRs of antimicrobials for adult pneumonia and to construct an preliminary list of candidate outcomes to inform COS development.

Method: A systematic search was performed in PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, and China Science and Technology Journal Database from inception to December 2024. Eligible studies included SRs or meta-analyses that evaluated antimicrobial therapy in adults (≥ 18 years) with CAP or HAP. Two reviewers independently screened the studies, extracted data on the study characteristics, pneumonia type, severity assessment tools, and outcomes. The Corrected Covered Area (CCA) was calculated to quantify the overlap in primary outcome reporting. Outcomes were grouped by pneumonia type and severity and categorized into five domains following the COMET taxonomy.

Results: A total of 97 SRs were included. Twenty-one distinct primary outcomes were identified, with limited overlap. Mortality and clinical success were the most frequently reported outcomes, though inconsistently defined across studies. Significant variability was noted in the definitions and time points of outcomes, as well as in severity assessment tools. Registered SRs reported fewer outcomes than non-registered ones.

Conclusion: There is considerable variation in primary outcome reporting in antimicrobial SRs for adult pneumonia. Mortality and clinical success are the most commonly reported outcomes, but their definitions lack consistency. Developing subtype- and severity-specific COS is crucial for standardizing outcome reporting and improving evidence synthesis.