Journal of Clinical Pharmacy and Therapeutics最新文献

Remimazolam has shown safety and efficacy in providing sedation during gastroscopy, but research on its specific clinical dosage is limited. This study aimed to determine the 90% effective dose (ED₉₀) of remimazolam when used with a low dose of alfentanil for inducing sedation in adult patients undergoing gastroscopy. Fifty adult participants underwent upper gastrointestinal (GI) endoscopy with anesthesia via intravenous boluses of remimazolam and alfentanil (4 μg/kg). The initial remimazolam dose was 0.2 mg/kg, adjusted using the biased coin up-and-down (BCUD) sequential method. The ED₉₀ of remimazolam, administered with 4 μg/kg alfentanil, was found to be 0.2375 mg/kg (95% CI: 0.1500–0.2725). Hemodynamics remained stable, with no significant adverse events and high satisfaction scores from patients, anesthesiologists, and endoscopists (4.90 ± 0.043, 4.92 ± 0.039, and 4.92 ± 0.039, respectively, on a 5-point scale). The combination of remimazolam and low-dose alfentanil is safe and effective for adult upper GI endoscopy.

Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2200062535

Hypersensitivity reactions (HSRs) can be a significant barrier to a patient’s cancer treatment journey. HSRs caused by immunomodulating agents, specifically lenalidomide (LEN) can be overwhelmingly distressful, paradoxically depriving patients of access to a clinically meaningful drug. Based on our historical clinical experiences, we have learned that the rapid desensitization protocol (RDP), when executed precisely, can enable patients to successfully resume LEN treatment. This served as the impetus for initiating our prospective study. We consecutively enrolled 10 patients diagnosed with plasma cell disease who had experienced a previous HSR specifically with LEN. After fully recovering from their initial reactions, patients underwent a controlled 10–12 steps incremental increase in drug dosage administration, followed by daily resumption of LEN over a 90-day period. All 10 (100%) patients successfully completed the protocol and continued on further LEN treatment cycles, although 1 patient voluntarily chose to withdraw from the study due to recurrent symptoms after receiving 2 doses of LEN. Three (30%) patients remained symptom-free throughout the follow-up period. Six (60%) patients experienced mild and short-lived HSR reactivation; however, all had the ability to take LEN for the majority of the study period. RDP enables patients to continue taking LEN and maintains the health-related quality of life (HR-QoL) by reducing the occurrence of HSR. RDP empowers patients to participate in future clinical trialsinvolving novel treatments that contain LEN as a backbone therapy, opportunities they would have otherwise been ineligible for.

The short hydration method using magnesium and diuretics has been widely adopted to prevent cisplatin-induced nephrotoxicity. Both mannitol and furosemide are commonly used as diuretics in this approach, but there is no clear consensus on the benefits or risks of combining the two. Mannitol is associated with a higher risk of vascular problems, such as extravascular leakage and vasculitis, owing to its high osmolality. In this study, we investigated the risk of vascular problems and cisplatin-induced nephrotoxicity in patients who underwent short hydration with both mannitol and furosemide and in those who underwent short hydration with furosemide alone during the administration of cisplatin. Propensity score matching was performed to control for background characteristics, and logistic regression analysis was conducted to identify risk factors. The use of both mannitol and furosemide was significantly associated with a higher risk of extravasation (odds ratio [OR] = 8.29) and vascular events (OR = 12.58) compared with the use of furosemide alone. In contrast, the degree of renal function decline and incidence of grade ≥ 2 nephrotoxicity did not significantly differ between the groups. These findings suggest that adding mannitol to furosemide does not provide an additional benefit in preventing cisplatin-induced nephrotoxicity but may increase the risk of vascular adverse events. Therefore, as a general rule, furosemide alone is recommended as the diuretic in the short hydration method to prevent cisplatin-induced nephrotoxicity as well as extravascular leakage and vasculitis.

Objective: To explore the impact of two different ART regimens on AIDS patients with lymphoma.

Methods: A retrospective study was carried out involving 60 patients diagnosed with AIDS and lymphoma and treated in our hospital during the period from June 2022 to December 2023. All patients underwent DA-EPOCH chemotherapy. According to the differences in ART treatment regimens, patients receiving the DTG + lamivudine (3TC) regimen will be categorized into the DTG + 3TC group, and patients receiving the TDF + 3TC + efavirenz (EFV) regimen will be classified into the TDF + 3TC + EFV group, with 30 cases in each group. The HIV viral load was compared between the two groups pretreatment and posttreatment (at 12, 24, and 26 weeks). The immunological indices (CD4⁺ and CD8⁺), liver function indices (serum total bilirubin [TBIL], alanine transaminase [ALT], aspartate transaminase [AST], serum albumin [ALB], and prothrombin time [PT]), and blood creatinine (Scr) levels of the two groups were compared before and after treatment (at 36 weeks). The occurrence of adverse reactions was documented.

Results: After 12, 24, and 36 weeks of treatment, the HIV viral load in the DTG + 3TC group was consistently lower than that in the EFV + TDF + 3TC group (p < 0.05). At week 36 posttreatment, compared with the EFV + TDF + 3TC group, the DTG + 3TC group showed higher CD4⁺ counts and lower CD8⁺ counts (p < 0.05). Following treatment at week 36, levels of AST, ALT, TBiL, and PT were elevated in both groups but lower in the DTG + 3TC group (p < 0.05). The levels of ALB in both groups were decreased, but the DTG + 3TC group was significantly higher (p < 0.05). Additionally, at week 36 posttreatment, Scr levels were significantly better in the DTG + 3TC group compared to the EFV + TDF + 3TC group (p < 0.05). The incidence of adverse reactions in the DTG + 3TC group and EFV + TDF + 3TC group differed significantly, with rates of 13.33% and 23.33%, respectively (p > 0.05).

Conclusion: There is no difference in the safety of DTG + 3TC in the treatment of AIDS patients with ARL compared with TDF +3TC + EFV. However, the combination of DTG + 3TC simplified regimen is superior to the three-drug regimen of TDF + 3TC + EFV in reducing viral load and has positive effects on the improvement of liver function and blood creatinine, with no obvious side effects.

Antiangiogenic therapy plays a critical role in cancer treatment. This study analyzed vascular and lymphatic adverse events linked to four FDA-approved agents—aflibercept, bevacizumab, olaratumab, and ramucirumab—using WHO-VigiAccess data. Disproportionality analysis (ROR and PRR) identified drug-specific risks, focusing on hypertension, hemorrhage, thrombosis, and flushing, to inform safer and personalized clinical use.