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Safety of Lipid-Lowering Therapy with Statins according to a Regional Pharmacovigilance Centre 根据区域药物警戒中心,他汀类药物降脂治疗的安全性
Pub Date : 2023-09-26 DOI: 10.30895/2312-7821-2023-11-3-271-278
E. O. Kochkina, N. V. Verlan
Scientific relevance. Since statins are widely used to prevent cardiovascular diseases, the control of statin-related complications is essential from both medical and social perspectives.Aim. The study aimed to analyse unsolicited reports on adverse drug reactions (ADRs) to control the safety of statin therapy.Materials and methods. The study analysed information on ADRs observed during statin treatment from the reporting forms submitted by medical organisations in Irkutsk to the database of the Regional Centre for Drug Safety Monitoring of the Irkutsk Region in 2011–2022. The causal relationship between ADRs and statin therapy was assessed using the Naranjo scale.Results. The database contained 1068 ADR reporting forms; 12 (1.1%) were spontaneous reports of statin-related complications, including 4 cases (33.4%) of myalgia, 7 cases (58.3%) of myalgia with moderately elevated transaminase levels (3–5 times the upper limit of normal), and 1 case of rhabdomyolysis that required statin discontinuation. In all cases, a reduction in the statin dose resulted in a regression in the clinical symptoms of ADRs. Most ADRs were observed in women with comorbidities (diabetes mellitus, obesity, and hypothyroidism), but the small sample size prevented the authors from testing the identified differences for statistical significance.Conclusions. According to the study results, statins have a reliable safety profile. Adequate and patient-specific selection of statin doses and ADR prevention are important responsibilities of clinical practitioners.
科学的相关性。由于他汀类药物被广泛用于预防心血管疾病,从医学和社会的角度来看,控制他汀类药物相关并发症是至关重要的。的目标。该研究旨在分析有关药物不良反应(adr)的主动报告,以控制他汀类药物治疗的安全性。材料和方法。该研究分析了2011-2022年伊尔库茨克医疗机构向伊尔库茨克地区药物安全监测中心数据库提交的报告表中关于他汀类药物治疗期间观察到的不良反应的信息。使用Naranjo量表评估不良反应与他汀类药物治疗之间的因果关系。结果。该数据库包含1068份ADR报告表格;12例(1.1%)自发性报告他汀类药物相关并发症,包括4例(33.4%)肌痛,7例(58.3%)肌痛伴有中度转氨酶水平升高(正常上限的3-5倍),1例横纹肌溶解需要停药。在所有病例中,他汀类药物剂量的减少导致不良反应临床症状的消退。大多数不良反应发生在有合并症(糖尿病、肥胖和甲状腺功能减退)的女性中,但样本量小,使作者无法检验已确定的差异是否具有统计学意义。结论。根据研究结果,他汀类药物具有可靠的安全性。充分和患者特异性选择他汀类药物剂量和预防不良反应是临床医生的重要责任。
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引用次数: 0
Opportunities and Prospects for Preclinical Drug Safety Assessment Using Alternative Methods: Experience from the Toxicology in the 21st Century (Tox21) Programme in the USA 使用替代方法进行临床前药物安全性评估的机会和前景:来自美国21世纪毒理学(Tox21)计划的经验
Pub Date : 2023-09-26 DOI: 10.30895/2312-7821-2023-379
V. N. Perfilova
Scientific relevance. The Tox21 (Toxicology in the 21st Century) programme was developed by the US Tox21 Consortium with the aim to replace animal-based toxicity assessments of chemicals with a wide range of in vitro and in silico testing approaches and has since been successfully applied in practice. Aim. The study aimed to review information on alternative in vitro models developed as part of the Tox21 programme for testing the toxicity of chemical compounds. Discussion. According to the information provided by the National Toxicology Program, Environmental Protection Agency, National Center for Advancing Translational Sciences, and other Tox21 Consortium members on their official websites and in the literature, the Tox21 Consortium has developed a quantitative high-throughput screening technology for testing the safety of chemicals and created the Tox21 10K library of chemical compounds using this screening technology. The library has been successfully used to create models that predict the toxicity of chemicals prior to preclinical studies. Researchers have proposed new approaches to studying the safety of chemical compounds in human cell lines to replace in vivo studies. Innovative organ-on-chip, multi-organ-on-chip, and organoid models are free from the drawbacks and limitations of cell-line models and offer more accurate representations of complex cell–matrix and organ–organ interactions. Developed under the Tox21 programme to search for new chemical toxicity biomarkers and gene signatures, novel transcriptomics (toxicogenomics) technologies can be used to classify toxicants according to their health risks and to identify potential side effects long before discovering any pathological changes in the body. The Interagency Coordinating Committee on the Validation of Alternative Methods conducts technical evaluation of alternative testing methods and promotes their implementation into regulatory practice. Conclusions. Thus, new tools and technologies provide an opportunity for switching from in vivo toxicity testing of candidate medicinal products to in silico and in vitro methods.
科学的相关性。Tox21(21世纪毒理学)计划由美国Tox21联盟开发,旨在用广泛的体外和计算机测试方法取代基于动物的化学物质毒性评估,并已成功应用于实践。的目标。这项研究的目的是审查作为Tox21计划的一部分开发的用于测试化合物毒性的替代体外模型的信息。讨论。根据美国国家毒理学计划、美国环境保护署、美国国家促进转化科学中心和其他Tox21联盟成员在其官方网站和文献中提供的信息,Tox21联盟开发了一种用于测试化学品安全性的定量高通量筛选技术,并使用该筛选技术创建了Tox21 10K化合物库。该文库已被成功地用于在临床前研究之前创建预测化学物质毒性的模型。研究人员提出了新的方法来研究化合物在人类细胞系中的安全性,以取代体内研究。创新的器官芯片、多器官芯片和类器官模型摆脱了细胞系模型的缺点和局限性,能够更准确地表征复杂的细胞基质和器官-器官相互作用。新型转录组学(毒物基因组学)技术是在Tox21计划下开发的,旨在寻找新的化学毒性生物标志物和基因特征,可用于根据毒物的健康风险对其进行分类,并在发现体内任何病理变化之前很久就识别潜在的副作用。替代方法验证机构间协调委员会对替代测试方法进行技术评估,并促进其在监管实践中的实施。结论。因此,新的工具和技术为从候选药物的体内毒性测试转向计算机和体外方法提供了机会。
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引用次数: 0
Statin-Induced Myopathy Statin-Induced肌病
Pub Date : 2023-09-26 DOI: 10.30895/2312-7821-2023-11-3-252-270
D. A. Sychev, T. M. Ostroumova, O. D. Ostroumova, A. I. Kochetkov, S. V. Batyukina, E. V. Mironova
Scientific relevance . Being the main class of medicinal products for dyslipidaemia treatment, statins are widely used in clinical practice in various patient populations. However, statins can cause statin-associated muscle symptoms (SAMS), which are the most frequent and, in some cases, even life-threatening adverse reactions associated with these medicinal products. Aim. The study aimed to perform a systematic review of the epidemiology, classification, and physiological pathogenesis of SAMS, risk factors for this complication, and clinical guidelines for primary care physicians regarding the identification and treatment of patients with SAMS. Discussion. SAMS is an umbrella term that covers various forms of myopathies associated with satin therapy. According to the published literature, the prevalence of SAMS varies considerably and may depend on the study design, inclusion criteria, and the medicinal product used. SAMS has multiple putative pathogenic pathways that include genetically determined processes, abnormalities in mitochondrial function, defects in intracellular signalling and metabolic pathways, and immune-mediated reactions. The main known risk factors for developing SAMS include high-dose statins, drug–drug interactions, genetic polymorphisms, female sex, older age, Asian race, history of kidney, liver, and muscle disease, and strenuous physical activity. Given the lack of universally recognised algorithms for diagnosing SAMS, clinicians should consider the clinical presentation and the temporal relationship between statin therapy and symptoms. Other factors to consider include changes in muscle-specific enzyme levels and, in some cases, the results of blood tests for antibodies to 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase. Conclusions. To ensure the safety of statin therapy, it is essential to raise clinicians’ awareness of the risk factors for SAMS, indicative clinical and laboratory findings, and the need for dynamic patient monitoring, including the involvement of clinical pharmacologists.
科学相关性。他汀类药物作为治疗血脂异常的主要药物,广泛应用于各种患者群体的临床实践中。然而,他汀类药物可引起他汀类药物相关肌肉症状(SAMS),这是与这些药物相关的最常见的,在某些情况下甚至是危及生命的不良反应。的目标。本研究旨在对SAMS的流行病学、分类、生理发病机制、该并发症的危险因素以及初级保健医生鉴别和治疗SAMS患者的临床指南进行系统回顾。讨论。SAMS是一个总称,涵盖了各种形式的肌病与缎治疗。根据已发表的文献,SAMS的患病率差异很大,可能取决于研究设计、纳入标准和使用的药品。SAMS具有多种假定的致病途径,包括遗传决定的过程、线粒体功能异常、细胞内信号传导和代谢途径缺陷以及免疫介导的反应。已知发生SAMS的主要危险因素包括高剂量他汀类药物、药物相互作用、基因多态性、女性、年龄较大、亚洲种族、肾脏、肝脏和肌肉疾病史以及剧烈体育活动。由于缺乏公认的SAMS诊断算法,临床医生应考虑临床表现和他汀类药物治疗与症状之间的时间关系。其他需要考虑的因素包括肌肉特异性酶水平的变化,在某些情况下,3-羟基-3-甲基-戊二酰辅酶A还原酶抗体的血液检测结果。结论。为了确保他汀类药物治疗的安全性,必须提高临床医生对SAMS危险因素、指示性临床和实验室结果的认识,以及对患者动态监测的必要性,包括临床药理学家的参与。
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引用次数: 0
A Case of Diabetes Mellitus after COVID-19 Vaccination in a Patient with Impaired Glucose Metabolism 糖代谢受损患者接种COVID-19疫苗后发生糖尿病1例
Pub Date : 2023-09-11 DOI: 10.30895/2312-7821-2023-372
I. V. Maiborodin, V. I. Maiborodina, M. G. Klinnikova, E. L. Lushnikova
Scientific relevance. The clinical features of COVID-19 in patients with comorbidities, including diabetes mellitus (DM), have already been discussed in the medical literature. However, the available data on blood glucose levels in patients with DM during SARS-CoV-2 infection and after COVID-19 vaccination are clearly insufficient to estimate the importance of the changes taking place. Aim. The study aimed to show that patients with DM or impaired glucose metabolism need glycaemic monitoring during COVID-19 disease and after COVID-19 vaccination, drawing on the example of a clinical case. Materials and methods. The study analysed the medical records of a 58-year-old male patient newly diagnosed with DM. He received inpatient and outpatient treatment after COVID-19 vaccination and SARS-CoV-2 infection in February–November 2021. In 2014, the patient was diagnosed with impaired glucose metabolism, including fasting hyperglycaemia (≤ 9 mmol/L), which was corrected by diet. Results. After vaccination with Gam-COVID-Vac component 1 in February 2021, the patient developed polydipsia, polyuria, and arterial hypertension. His laboratory findings were as follows: blood glucose, 25 mmol/L; glycated haemoglobin, 10.7%; fasting insulin, 28.4 μIU/mL; calcium, 2.45 mmol/L; and 25-hydroxyvitamin D, 21 ng/mL. The patient was diagnosed with new-onset type 2 DM, admitted to the endocrinology department of a multidisciplinary hospital, and discharged when his condition stabilised after 14 days of treatment. After vaccination with Gam-COVID-Vac component 2, the patient’s glucose levels did not change. In November 2021, the patient was diagnosed with SARS-CoV-2 infection. Even though all symptoms had resolved within 3 days, the virus persisted in the blood for 12 days without clinical manifestations of the disease. This was confirmed by repeated polymerase chain reaction testing. The patient had moderate hyperglycaemia despite antidiabetic treatment; his glucose levels were restored to normal without hospitalisation. Conclusions. Timely vaccination against COVID-19 in patients with DM, hypertension, and obesity contributes to a mild course of COVID-19 and helps avoid complications in the lungs and other organs. For patients with DM or glucose metabolism disorders, blood glucose monitoring is advisable for detecting and correcting possible hyperglycaemia after vaccination and/or recovery from COVID-19.
科学的相关性。医学文献已经讨论了合并糖尿病(DM)等合并症患者的COVID-19临床特征。然而,关于糖尿病患者在SARS-CoV-2感染期间和COVID-19疫苗接种后血糖水平的现有数据显然不足以估计正在发生的变化的重要性。的目标。本研究以临床病例为例,旨在表明糖尿病或糖代谢受损患者在COVID-19疾病期间和COVID-19疫苗接种后需要血糖监测。材料和方法。该研究分析了一名新诊断为糖尿病的58岁男性患者的医疗记录,该患者在2021年2月至11月接种COVID-19疫苗并感染SARS-CoV-2后接受了住院和门诊治疗。2014年诊断为糖代谢异常,包括空腹高血糖(≤9 mmol/L),通过饮食予以纠正。结果。2021年2月接种Gam-COVID-Vac组分1后,患者出现烦渴、多尿和动脉高血压。他的实验室结果如下:血糖,25 mmol/L;糖化血红蛋白,10.7%;空腹胰岛素28.4 μIU/mL;钙,2.45 mmol/L;25-羟基维生素D 21 ng/mL。患者被诊断为新发2型糖尿病,住进多学科医院内分泌科,治疗14天后病情稳定出院。接种Gam-COVID-Vac组分2后,患者的血糖水平没有变化。2021年11月,该患者被诊断为SARS-CoV-2感染。尽管所有症状在3天内消失,但病毒在血液中持续存在12天,未出现该病的临床表现。反复的聚合酶链反应试验证实了这一点。尽管进行了抗糖尿病治疗,患者仍有中度高血糖;他的血糖水平在没有住院治疗的情况下恢复正常。结论。糖尿病、高血压和肥胖患者及时接种COVID-19疫苗有助于COVID-19的轻度病程,并有助于避免肺部和其他器官的并发症。对于患有糖尿病或糖代谢障碍的患者,建议在接种疫苗和/或COVID-19康复后进行血糖监测,以发现和纠正可能的高血糖。
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引用次数: 0
ПРОБЛЕМЫ ПРАВОВОГО РЕГУЛИРОВАНИЯ ТРУДОВЫХ ОТНОШЕНИЙ ГРАЖДАН НА ГОСУДАРСТВЕННОЙ ГРАЖДАНСКОЙ СЛУЖБЕ
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_327
Б.В. Брынцев
{"title":"ПРОБЛЕМЫ ПРАВОВОГО РЕГУЛИРОВАНИЯ ТРУДОВЫХ ОТНОШЕНИЙ ГРАЖДАН НА ГОСУДАРСТВЕННОЙ ГРАЖДАНСКОЙ СЛУЖБЕ","authors":"Б.В. Брынцев","doi":"10.33580/9785001289388_327","DOIUrl":"https://doi.org/10.33580/9785001289388_327","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74266123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ЭКОЛОГИЧЕСКИЕ ПРОБЛЕМЫ ИСПОЛЬЗОВАНИЯ АВИАЦИОННОГО ТРАНСПОРТА 航空运输利用环境问题
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_199
У.А. Абдуллаева
{"title":"ЭКОЛОГИЧЕСКИЕ ПРОБЛЕМЫ ИСПОЛЬЗОВАНИЯ АВИАЦИОННОГО ТРАНСПОРТА","authors":"У.А. Абдуллаева","doi":"10.33580/9785001289388_199","DOIUrl":"https://doi.org/10.33580/9785001289388_199","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72529881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ПРОБЛЕМЫ ПРАВОВОГО РЕГУЛИРОВАНИЯ КРАУДФАНДИНГА В РОССИЙСКОЙ ФЕДЕРАЦИИ
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_157
Калимат Гасановна Сапарова
{"title":"ПРОБЛЕМЫ ПРАВОВОГО РЕГУЛИРОВАНИЯ КРАУДФАНДИНГА В РОССИЙСКОЙ ФЕДЕРАЦИИ","authors":"Калимат Гасановна Сапарова","doi":"10.33580/9785001289388_157","DOIUrl":"https://doi.org/10.33580/9785001289388_157","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77631155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
АКТУАЛЬНЫЕ ВОПРОСЫ ПРИРОДОПОЛЬЗОВАНИЯ
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_252
Рисалат Магдибеговна Магомедова
{"title":"АКТУАЛЬНЫЕ ВОПРОСЫ ПРИРОДОПОЛЬЗОВАНИЯ","authors":"Рисалат Магдибеговна Магомедова","doi":"10.33580/9785001289388_252","DOIUrl":"https://doi.org/10.33580/9785001289388_252","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81086898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
СРАВНИТЕЛЬНО-ПРАВОВОЙ АНАЛИЗ ИНСТИТУТА ПРЕДСТАВИТЕЛЬСТВА В ГРАЖДАНСКОМ ПРОЦЕССЕ И СУБЪЕКТОВ, УКАЗАННЫХ В СТАТЬЯХ 45, 46 ГПК РФ
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_45
Анна Сергеевна Кислицкая, А.Б. Алиева
{"title":"СРАВНИТЕЛЬНО-ПРАВОВОЙ АНАЛИЗ ИНСТИТУТА ПРЕДСТАВИТЕЛЬСТВА В ГРАЖДАНСКОМ ПРОЦЕССЕ И СУБЪЕКТОВ, УКАЗАННЫХ В СТАТЬЯХ 45, 46 ГПК РФ","authors":"Анна Сергеевна Кислицкая, А.Б. Алиева","doi":"10.33580/9785001289388_45","DOIUrl":"https://doi.org/10.33580/9785001289388_45","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82372252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
СУДЕБНОЕ ПРЕДСТАВИТЕЛЬСТВО В ГРАЖДАНСКОМ ПРОЦЕССЕ 民事诉讼中的司法代表
Pub Date : 2021-01-01 DOI: 10.33580/9785001289388_19
А. Р. Алиева, А.Б. Алиева
{"title":"СУДЕБНОЕ ПРЕДСТАВИТЕЛЬСТВО В ГРАЖДАНСКОМ ПРОЦЕССЕ","authors":"А. Р. Алиева, А.Б. Алиева","doi":"10.33580/9785001289388_19","DOIUrl":"https://doi.org/10.33580/9785001289388_19","url":null,"abstract":"","PeriodicalId":32736,"journal":{"name":"Bezopasnost'' i risk farmakoterapii","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88345429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
期刊
Bezopasnost'' i risk farmakoterapii
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