Journal of Clinical Pharmacy and Therapeutics最新文献

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.

Background: Occupational health programs play a critical role in maintaining employee well-being, particularly for healthcare workers exposed to unique risks. Clinical pharmacists are well-positioned to address drug-related problems (DRPs) in these settings, yet their role in occupational health remains underexplored. This study assesses the frequency and resolution of DRPs following clinical pharmacist interventions among pharmacy staff in an occupational health setting.

Methods: This experimental study was conducted at the 13-Aban Pharmacotherapy Clinic of Tehran University of Medical Sciences, Tehran, Iran. Pharmacy staff with chronic diseases or abnormal test results was identified based on medical records. A single clinical pharmacist reviewed DRPs using the DOCUMENT classification system, provided interventions, and followed up. Recommendations were made directly to participants, and adherence to these recommendations was assessed. Data were analyzed using descriptive statistics and correlation tests.

Results: Among 601 medical records reviewed, 239 participants met inclusion criteria, and 139 attended pharmacotherapy visits. A total of 277 DRPs were identified, averaging 1.99 DRPs per participant. The most common DRPs were the need for preventative therapy (37.2%), untreated conditions (15.9%), and laboratory monitoring (14.8%). A total of 443 recommendations were provided to participants, with an adherence rate of 76.4%. Among those who fully adhered to the recommendations, 97.2% of DRPs were resolved. While adherence was initially higher among female participants, overall compliance rates did not significantly differ by gender.

Conclusion: Clinical pharmacist interventions effectively identified and resolved DRPs among pharmacy staff, improving medication management. These findings highlight the value of integrating clinical pharmacists into occupational health programs to enhance medication safety and adherence.

Objective: Drug repurposing is a promising alternative for the development of new treatment options. During the COVID-19 pandemic, multiple repurposed drugs were tested and some became pillars of treatment and the standard of care. However, whether the benefits of drug repurposing over de novo drug development actually materialize remains an open question, especially since former analyses have been complicated by challenges to attract enough funding for late-stage clinical trials.

Methods: We conducted a systematic analysis of repurposing efforts against COVID-19 focusing on the 100 most frequently prescribed drugs in the United States including both preclinical and clinical work.

Results: In total, we identify (pre)clinical research for 42 drugs and evidence of anti-COVID-19 effects for 33 drugs. The rate of studies with positive results decreased from in vitro to animal studies to randomized clinical trials. While we find positive RCTs for 12 drugs, these trials had mostly low participant numbers and several reported endpoints of minor clinical relevance. Assessment of the methodological quality assessment indicates that preregistration, blinding, and power calculations are currently still an exception in preclinical studies. In the end, none of these drugs were recommended by treatment guidelines.

Conclusions: Our analysis underlines the large efforts undertaken to repurpose commonly prescribed drugs against COVID-19, which eventually proved futile. This finding may serve as a cautionary example for drug repurposing also for other fields of biomedicine. However, it should be noted that a limitation of this study is its focus on only the 100 most prescribed drugs in the United States, as we chose to analyze widely available and generally affordable medications.