Cts-Clinical and Translational Science最新文献

Pharmacogenetic testing provides patient genotype information which could influence medication selection and dosing for optimal patient care. Insurance coverage for pharmacogenetic testing varies widely. A better understanding of the commonly used medications with clinically important pharmacogenetic recommendations can inform which medications and/or genes should be prioritized for coverage and reimbursement in the context of finite healthcare resources. The aim of this scoping review was to collate previous studies that investigated the utilization rate of medications that could be guided by pharmacogenetic testing. Included studies utilized electronic medical records or claims data to assess pharmacogenetic medication prescription rates for older adults (≥ 65 years old). Identified pharmacogenetic medications were classified according to therapeutic class and assessed for actionability based on the Clinical Pharmacogenetics Implementation Consortium guidelines. Across the 31 included studies, analgesic (n = 29), psychotropic (n = 29), and cardiovascular (n = 27) therapeutic classes were most commonly investigated. Study populations were primarily generalized (48%); however, some studies focused on specific populations, such as, cancer (n = 6), mental health (n = 1), and nursing home (n = 2) cohorts. A total of 215 unique pharmacogenetic medications were reported, of which, 82 were associated with actionable pharmacogenetic recommendations. The most frequent genes implicated in potential drug–gene interactions with these actionable pharmacogenetic drugs were CYP2D6 (25.6%), CYP2C19 (18.3%), and CYP2C9 (11%). Medications most frequently prescribed included pantoprazole (range 0%–49.6%), simvastatin (range 0%–54.9%), and ondansetron (range 0.1%–62.6%). Overall, the frequently prescribed medications and associated genes identified in this review could guide pharmacogenetic testing implementation into clinical practice, including insurer subsidization.

Receptor-interacting serine/threonine kinase 1 (RIPK1) regulates inflammatory signaling and induces apoptosis and necroptosis. Pharmacological inhibition of RIPK1 kinase activity has demonstrated efficacy in animal models of neurodegenerative, autoimmune and inflammatory diseases. SIR9900 is a potent and selective novel small molecule RIPK1 inhibitor. This first-in-human, phase I, randomized, double-blind, placebo-controlled study evaluated the safety, pharmacokinetics, and pharmacodynamics of single (3–200 mg) and multiple (3–60 mg daily for 10 days) ascending oral doses of SIR9900 in healthy adult (18–64 years, n = 80) and elderly participants (≥ 65 years, multiple doses 30 mg, n = 8). The study included a food effect component. Overall, SIR9900 was safe and well tolerated with no concerning dose-dependent trends in safety observed. SIR9900 was rapidly absorbed with a plasma maximum concentration time (T_max) of 3.0–4.0 h and plasma half-life (t_1/2) of 31.92–37.75 h following single doses. Similar T_max and t_1/2 results were observed following multiple doses. Systemic exposure to SIR9900 increased in a dose-proportional manner and was similar between adult and elderly participants. No appreciable food effect was observed. The cerebrospinal fluid to unbound plasma ratio was 1.15. A robust pharmacodynamic effect was demonstrated with approximately 90% peripheral target engagement at 3 h post-dose, and sustained RIPK1 inhibition over the 10-day treatment period. The promising safety, pharmacokinetic, and pharmacodynamic profile of SIR9900 with central nervous system penetrating potential in healthy adult and elderly participants supports its further clinical development in patients with inflammatory and degenerative diseases, particularly in the central nervous system.

This study aimed to evaluate the effects of the concomitant administration of TPN171 and alcohol on hemodynamic and pharmacokinetic characteristics in healthy Chinese male subjects. Fifteen eligible subjects were randomly assigned to one of three sequences, each comprising three treatments: Treatment A (placebo +0.5 g/kg alcohol), Treatment B (TPN171 + 0.5 g/kg alcohol), and Treatment C (TPN171 + placebo). Enrolled subjects were administered with 10 mg TPN171 and/or 0.5 g/kg alcohol in fasting state in a randomized crossover design. Blood pressure, pulse rate (PR), blood samples, and breath alcohol test were measured at designated time points for hemodynamic and pharmacokinetic analyses. Compared with 10 mg TPN171 alone, administration of 10 mg TPN171 + 0.5 g/kg alcohol significantly lowered the area under the effect–time curve from 0 to 4 h (AUEC_0-4h) of systolic blood pressure (95% confidence interval [CI]: −29.75 to −0.83, p = 0.039) and significantly increased AUEC_0–4h of PR (95% CI: 7.47–28.92, p = 0.003). Compared with 0.5 g/kg alcohol alone, administration of 10 mg TPN171 + 0.5 g/kg alcohol contributed to significantly higher maximal increase of PR (95% CI: 2.78–9.44, p = 0.002) and AUEC_0-4h of PR (95% CI: 1.08–24.52, p = 0.035). Alcohol had no influence on the pharmacokinetics of TPN171, and vice versa. Though the concomitant administration of TPN171 and alcohol induced a more pronounced increase in PR, this did not result in clinical symptoms or heart rate increase-related adverse events, indicating that the combined use was generally safe and well-tolerated.

Adherence in digital health studies with extended observation periods (≥ 12 months) is limited, and participant retention considerably reduces with time. The US Food and Drug Administration has issued guidelines for improving participant engagement, adherence, and diversity in digital health studies combined with decentralized procedures. A decentralized digital health study on well-being was designed with protocolized procedures to study the feasibility of participant engagement and technology support to facilitate adherence (wearing the smartwatch ≥ 70% of time) sustained over a 12-month period. At the end of the study, participants were asked about their ease of participation and free-response questions about how wearing the smartwatches impacted their physical wellness. An inductive thematic analysis (ITA) was performed to assess themes of those responses and association with adherence. A total of 298 participants were recruited between 2022 and 2023 (n = 129 in Cohort A in October 22, n = 169 in Cohort B in April 23), with 23% non-white participants accrued. Among the 298 participants accrued, 273 (92% of accrued participants) completed the 12-month study with an average overall adherence of 77.4% (SD = 32.64) wear-time across 12 months. Median adherence of participants whose responses exemplified an ITA theme encompassing perceived behavior changes in sleep and physical activity was higher than those who did not have a response exemplifying that theme. Conversely, those expressing perceived discomfort or intrusiveness of the smartwatch had a statistically lower adherence. These results highlight the crucial roles of technology support and robust engagement efforts to enable sustained adherence over extended follow-up periods in decentralized digital health studies.

Selection of rational antagonists of P2Y₁₂ receptor for CAD patients who inherit CYP2C19 LoF alleles remains still conflicting. This study compared the clinical outcomes in CAD patients inheriting CYP2C19 LoF alleles undergoing PCI and treated with clopidogrel against alternative antagonists of P2Y₁₂ receptor. A thorough literature search was performed across multiple scientific databases following the PRISMA guidelines and PICO model. Setting the statistical significance at p < 0.05 and RevMan software was used to calculate the risk ratios (RRs). Estimation of the pooled analysis revealed a significant 62% increased risk of major adverse cardiovascular events (MACE) in CAD patients inheriting CYP2C19 LoF alleles and treated with clopidogrel against those treated with alternative P2Y₁₂ receptor antagonists such as prasugrel or ticagrelor (RR 1.62; 95% CI 1.42–1.86; p < 0.00001). In addition, Asian CAD patients were found at a significantly higher risk of MACE (RR 1.93; 95% CI: 1.49–2.49; p < 0.00001) juxtaposed to CAD patients of other ethnicities (RR 1.51; 95% CI: 1.29–1.78; p < 0.00001). Conversely, between these two treatment groups, taking clopidogrel against prasugrel/ticagrelor, who possess CYP2C19 LoF alleles, no significant differences in bleeding events were observed (RR 0.94; 95% CI 0.79–1.11; p = 0.47). CAD patients undergoing PCI who inherited CYP2C19 LoF alleles and treated with clopidogrel were associated with significantly higher risk of MACE against those treated with alternative antagonists of P2Y₁₂ receptor, that is, prasugrel or ticagrelor.

This study aimed to analyse the value of author order across countries, within the ‘Medicine General Internal’ and ‘Surgery’ fields, to enhance transparency and fairness in academic evaluations, particularly in international collaborative research. A cross-sectional bibliometric study was conducted using data from 2,845,748 papers published in 2022 across over 18,000 journals listed on Web of Science. The study focused on 124,736 papers from the ‘Medicine General Internal’ and ‘Surgery’ fields published in the top 19 countries. The analysis examined the position of the corresponding author relative to other co-authors by country and specialty. Hierarchical clustering was applied to identify patterns and group countries based on author order. Three distinct clusters were identified with regard to the corresponding author's position. In Cluster A (South Korea, China and Taiwan), the corresponding author was often the last author. In Cluster B (India, Japan, Italy, Türkiye and Spain), the corresponding author was frequently the second author. Cluster C (the United States, England and Germany) included countries where the corresponding author was typically the first author. The findings underscore the need for clear, internationally accepted author order standards. Establishing such standards is crucial for promoting fairness, transparency and efficiency in international collaborative research and for ensuring equitable scientific communication.

Remdesivir is an RNA polymerase inhibitor of severe acute respiratory syndrome coronavirus 2 administered intravenously (IV) that is approved for the treatment of coronavirus disease 2019 in hospitalized and nonhospitalized patients. The clinical dosing regimen is a single loading dose of 200 mg on Day 1 followed by once-daily maintenance doses of 100 mg from Day 2, for a total duration of up to 10 days. The prodrug, remdesivir, undergoes metabolic activation inside the cell to form the intracellular active metabolite (GS-443902) along with two plasma metabolites (GS-704277 and GS-441524). The pharmacokinetics and safety of a single IV 100-mg dose of remdesivir were evaluated in a Phase 1, open-label, multicenter study in participants with moderate (n = 10) or severe (n = 6) hepatic impairment (Child–Pugh–Turcotte Class B or C, respectively) and participants with normal liver function (n = 16). Compared with the normal hepatic function group, plasma exposures (geometric least squares mean ratios of area under the concentration–time curve extrapolated to infinity and maximum concentration) of remdesivir, GS-704277, and GS-441524 were similar in the moderate hepatic impairment group and up to 1.56-fold, 2.41-fold, and 1.48-fold higher, respectively, in the severe hepatic impairment group. Remdesivir was generally safe and well tolerated in hepatically impaired individuals, and the modest exposure increases of remdesivir and its metabolites were not associated with adverse events. Based on these findings, no dose adjustment of remdesivir is recommended for patients with mild, moderate, or severe hepatic impairment.

Macrophage activation syndrome (MAS) is a life-threatening form of secondary haemophagocytic lymphohistiocytosis (HLH) associated with rheumatic diseases, most commonly Still's disease. This study aimed to develop a population pharmacokinetic (PK)/pharmacodynamic (PD) model for emapalumab, a fully human monoclonal antibody that targets interferon-gamma (IFNγ), in patients with MAS associated with Still's disease. A two-compartment disposition model based on data from patients with primary HLH administered emapalumab (1 mg/kg every 3 days, with possible increases to 3, 6 or 10 mg/kg) was re-estimated for patients with MAS administered emapalumab (6 mg/kg, then 3 mg/kg every 3 days until day 15 and twice weekly until day 28). An exploratory population PK/PD analysis comprising patients' PD data for total IFNγ, chemokine C-X-C motif ligand 9 (CXCL9) and ferritin was performed. Emapalumab clearance was generally linear and independent of total IFNγ levels in patients with MAS (n = 14). Estimated baseline levels of CXCL9 (a marker of IFNγ activity), soluble interleukin-2 receptor α (sIL-2Rα; a marker of hyperinflammation) and ferritin (a clinical marker of MAS disease activity) were 8400, 6550 and 15,300 μg/L, respectively. All three PD markers responded rapidly to changes in emapalumab concentration. Emapalumab almost completely suppressed CXCL9, sIL2-Rα, and ferritin production (estimated reduction in synthesis rate: 98.3%, 87%, and 99.6%, respectively). Population PK/PD modeling indicated that emapalumab rapidly suppresses markers of hyperinflammation in patients with MAS associated with Still's disease. Emapalumab dosing regimen used in clinical trials in patients with MAS is unlikely to need adjustment.

Schizophrenia is a serious mental disorder with high disability rates, and antipsychotics, especially second-generation ones like aripiprazole, are the cornerstone of treatment. As a novel formulation, oral soluble films (OSF) offer an alternative to tablets or capsules, improving patient compliance. This study aimed to assess the bioequivalence, pharmacokinetic (PK) properties, and safety of aripiprazole OSF and aripiprazole orally disintegrating tablets (ODT) in healthy Chinese participants. A single-dose, randomized, open-label, and crossover study was conducted. Participants received 10 mg of test aripiprazole OSF (Qilu Pharmaceutical) and reference aripiprazole ODT (Otsuka Pharmaceutical) under fasting and fed states. The fasting trial comprised a three-sequence, three-period design, while the fed trial comprised a two-sequence, two-period design. In the fasting trial, after single oral dosing of aripiprazole OSF (with water), aripiprazole OSF (without water), and aripiprazole ODT, C_max were 55 ± 10 ng/mL, 54 ± 10 ng/mL, and 48 ± 13 ng/mL, respectively; the AUC_0-72h were 1857 ± 377 h·ng/mL, 1823 ± 350 h·ng/mL, and 1745 ± 405 h·ng/mL, respectively. In the fed trial, after single oral dosing of aripiprazole OSF and ODT with water, the C_max were 43 ± 9 ng/mL and 43 ± 10 ng/mL, respectively; AUC_0-72h were 2024 ± 387 h·ng/mL and 1994 ± 426 h·ng/mL, respectively. In terms of bioequivalence evaluation, the 90% confidence intervals of the geometric mean ratio of the main PK parameters of aripiprazole OSF and ODT in the fasting and fed states were all within the acceptable equivalence range (80%–125%). Both formulations were well-tolerated. In conclusion, aripiprazole OSF and ODT reached bioequivalence, and aripiprazole OSF demonstrates significant potential for application in the treatment of psychiatric disorders.

COVID-19 caused a worldwide pandemic resulting in break of demand–supply chain in all aspects of healthcare, high mortality rates, and a constant quest for effective treatment modalities. Based on historical and recent evidences of anti-inflammatory effects of low dose of ionizing radiation, several healthcare professionals proposed low-dose radiation therapy (LDRT) along with ongoing pharmacological treatment for COVID-19 pneumonia. A positive response in a few initial studies led to systematic trials by increasing the number of patients in the range of 0.5–1.5 Gy. However, the concerns of radiation-induced risks were also raised in parallel. In the present article, we have highlighted the basis of LDRT for COVID-19 therapy. We have reviewed the available literature, specifically for outcomes on various clinical trials carried out with LDRT. Meta-analysis was performed to identify if any survival benefits are offered by addition of LDRT over pharmacological treatment alone among COVID-19 pneumonia patients. Other clinical recovery parameters such as intubation rates, oxygenation status, anti-inflammatory response have also been compared. Overall data trends favored LDRT with standard pharmacological treatment against control cohort which received standard treatment alone at all the endpoints in majority studies. LDRT addition resulted in significantly higher odds of survival than control cohort. Among critical and/or mechanically ventilated patients, LDRT did not show any promising outcomes over the control group. In conclusion, LDRT may serve as a promising complementary treatment modality with a potential of better prognosis, provided the patient selection criteria are critically identified and implemented.