European Journal of Clinical Pharmacology最新文献

{"title":"Is nivolumab alone or in combination with ipilimumab more effective for treating lung cancer? a meta-analysis.","authors":"Qasi Najah, Nereen A Almosilhy, Thoria Ibrahim Essa Ghanm","doi":"10.1007/s00228-024-03789-0","DOIUrl":"10.1007/s00228-024-03789-0","url":null,"abstract":"<p><strong>Background: </strong>Nivolumab and ipilimumab combination immunotherapy has become a standard treatment option for certain cancers. However, the benefits of combination therapy compared to nivolumab monotherapy in lung cancer patients are not entirely clear. We aimed to evaluate whether nivolumab plus ipilimumab improves clinical outcomes in lung cancer patients compared to nivolumab monotherapy.</p><p><strong>Methods: </strong>A literature search was performed on PubMed, Web of Science, and Scopus from inception until November 2024 to identify relevant randomized controlled trials. The Cochrane risk of bias tool was used to assess the risk of bias, the hazard ratio (HR) was calculated for survival, risk ratios (RRs) were calculated for response rate and safety outcomes, and a random effects model meta-analysis was performed to estimate the safety and efficacy of the treatments.</p><p><strong>Results: </strong>Seven trials comprising 2134 patients were included. Compared with patients receiving nivolumab monotherapy, non-small cell lung cancer patients who received combination therapy had better progression-free survival (HR = 0.82, 95% CI 0.71; 0.93, P < 0.01, low certainty), and there were no significant differences in overall survival (HR = 0.95, 95% CI 0.86; 1.0, P = 0.31, moderate certainty), or objective response rate (RR = 1.36, 95% CI 0.91; 2.02, P = 0.14 very low certainty). The combination group had a significantly greater risk of grade 3-4 adverse events (RR = 2.77, 95% CI 1.38; 5.56, P < 0.01, low certainty).</p><p><strong>Conclusion: </strong>Although combination treatment significantly improved progression-free survival in NSCLC patients, it was also associated with a greater risk of adverse events and treatment-related mortality than nivolumab monotherapy. The current evidence is insufficient for choosing combination treatment over nivolumab monotherapy.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"269-278"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the study of nebulized tranexamic acid for pulmonary hemorrhage.","authors":"Ping Zhang, Jiaoni Zheng, Xuefeng Shan, Bo Zhou","doi":"10.1007/s00228-024-03784-5","DOIUrl":"10.1007/s00228-024-03784-5","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary hemorrhage is a life-threatening condition characterized by blood leakage into lung tissues, leading to severe respiratory distress. Nebulized tranexamic acid (TXA) has emerged as a promising treatment option for pulmonary hemorrhage due to its localized hemostatic effects and minimal systemic side effects. This review aims to summarize the research progress on the effectiveness and safety of nebulized TXA in pulmonary hemorrhage.</p><p><strong>Methods: </strong>A comprehensive search of the Embase, PubMed, and Scopus databases was conducted to identify relevant studies published between the date of inception of each database and November 2023. A comprehensive search was conducted in the PubMed, Embase, Scopus, and Google Scholar databases using the following keywords: \"hemoptysis,\" \"haemoptysis,\" \"pulmonary hemorrhage,\" \"tranexamic acid,\" \"antifibrinolytic,\" \"nebulize,\" and \"inhale.\" Additional articles were identified by reviewing the references of the retrieved studies. Studies were selected based on their focus on the application of nebulized TXA for pulmonary hemorrhage. The authors and dates of publication, study type, patients, diseases, intervention and main outcomes of these papers are tabulated. This consisted of two randomized controlled trials (RCTs), six case series, and nine case reports.</p><p><strong>Results: </strong>The commonly used dosage of nebulized TXA in the studies reviewed was 500 mg/5 ml, administered 3-4 times daily. Evidence suggests that nebulized TXA effectively controls bleeding in pulmonary hemorrhage with a hemostatic efficacy comparable to systemic administration, but with a lower risk of venous thrombosis. Safety data indicates that nebulized TXA is generally well-tolerated, with no significant systemic adverse reactions reported. Local reactions, such as bronchospasm, were rare and resolved with short-term bronchodilator treatment.</p><p><strong>Conclusion: </strong>Nebulized TXA appears to be an innovative and minimally invasive therapy for pulmonary hemorrhage, providing targeted hemostatic effects with a favorable safety profile. However, the predominance of small-scale studies and case reports highlights the need for large-scale, high-quality research to establish standardized guidelines.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"237-246"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral edema induced by isosorbide mononitrate in an elderly patient: A case study of dose-related risks and drug interactions.","authors":"Akansha A Pandit, Bhargavi V Desai, Bhavin A Vyas","doi":"10.1007/s00228-024-03787-2","DOIUrl":"10.1007/s00228-024-03787-2","url":null,"abstract":"<p><p>Adverse drug reactions (ADRs) in elderly patients are frequently attributed to age-related altered pharmacokinetics and the complexities of polypharmacy to manage multiple chronic conditions, making elderly patients more susceptible to ADRs. The following is a case report of an 80-year-old female patient with systemic symptoms of chest pain, low blood sugar, mouth ulcers, and concentrates on peripheral edema due to nitrate vasodilator isosorbide mononitrate (ISMN). She had hypertension, diabetes, ischemic heart disease, and chronic obstructive pulmonary disease (COPD).On the third day of therapy, she exhibited peripheral edema, prompting the initiation of furosemide and the cessation of ISMN; the patient's condition markedly improved. ISMN primarily reduces preload by inducing venodilation, which leads to blood pooling and hence peripheral edema. The simultaneous administration of other contributing drugs like antifungal agent fluconazole which can potentiate the ADR by elevating plasma levels of ISMN, leading to an enhanced vasodilatory impact. The evaluation conducted using the modified Schumock and Thornton scale classified the adverse medication response as likely, of moderate intensity, and avoidable. This example emphasizes the need of vigilant monitoring of adverse drug responses in the elderly patients, with importance of dosage modifications as well as highlights cautious prescribing of contributing drugs to prevent ADRs.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"333-336"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging machine learning in limited sampling strategies for efficient estimation of the area under the curve in pharmacokinetic analysis: a review.","authors":"Abdullah Alsultan, Abdullah Aljutayli, Abdulrhman Aljouie, Ahmed Albassam, Jean-Baptiste Woillard","doi":"10.1007/s00228-024-03780-9","DOIUrl":"10.1007/s00228-024-03780-9","url":null,"abstract":"<p><strong>Objective: </strong>Limited sampling strategies are widely employed in clinical practice to minimize the number of blood samples required for the accurate area under the curve calculations, as obtaining these samples can be costly and challenging. Traditionally, the maximum a posteriori Bayesian estimation has been the standard method for the area under the curve estimation based on limited samples. However, machine learning is emerging as a promising alternative for this purpose. Here, we review studies that utilize machine learning approaches to develop limited sampling strategies and compare the strengths and weaknesses of these machine learning methods.</p><p><strong>Methods: </strong>We searched the literature for studies that used machine learning to estimate the area under the curve using a limited sampling strategy approach.</p><p><strong>Results: </strong>We identified ten studies that developed machine learning models to estimate the area under the curve for six different drugs. Several of these models demonstrated good accuracy and precision in area under the curve estimation in reference to the traditional Bayesian approach, highlighting the potential of machine learning models in precision dosing.</p><p><strong>Conclusions: </strong>Despite these promising early results, the development of machine learning for limited sampling strategies is still in its early stages. Further research might be needed to validate machine learning models with larger, high-quality clinical datasets to ensure their reliability and applicability in clinical settings.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"183-201"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacotherapeutic actions related to drug interaction alerts - a questionnaire study among Swedish hospital interns and residents in family medicine.","authors":"Carina Tukukino, Naldy Parodi López, Johan Lönnbro, Susanna M Wallerstedt, Staffan A Svensson","doi":"10.1007/s00228-024-03785-4","DOIUrl":"10.1007/s00228-024-03785-4","url":null,"abstract":"<p><strong>Purpose: </strong>To explore how hospital interns and residents specialising in family medicine act on drug interaction alerts in a specific patient case, and on interaction alerts in general.</p><p><strong>Methods: </strong>A 4-page questionnaire, including a fictional patient case (73-year-old woman; 10 drugs in the medication list triggering 11 drug interaction alerts) and questions regarding the use of interaction alerts in general, was distributed to interns and residents during educational sessions (November‒December 2023). The respondents were instructed to consider what actions they would take \"a normal day at work\" due to the risk of interactions between the patients' drugs. In the general questions, the respondents were asked how often they access the detailed interaction information (from 1 = never to 5 = always) provided by the knowledge resource, in relation to the alert classification (D = clinically significant, should be avoided; C = clinically significant, can be handled by, e.g., dose adjustment).</p><p><strong>Results: </strong>The questionnaire was completed by 55 interns and 69 residents (response rate: 98%). In the patient case, the respondents acted on a median of 4 (range: 0‒8) drugs, most often concerning repaglinide (in a D interaction alert with clopidogrel; 96% of the interns and 96% of the residents suggested action), and omeprazole (in three C interaction alerts with citalopram, clopidogrel, and levothyroxine, respectively; 71% and 83% suggested action). Among the respondents who answered the questions about how often (rated 4/5) they access more detailed information about interactions, 56 (59%) did so for D versus 29 (31%) for C alerts (P < 0.001).</p><p><strong>Conclusion: </strong>Physicians act on drug interaction alerts selectively, and the alert classifications seem to guide how they are used.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"301-308"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between sodium-glucose cotransporter-2 inhibitor and adverse events in patients with moderate to severe chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.","authors":"Satoru Mitsuboshi, Kotaro Hitoshi, Ai Ominato, Teruhisa Kinoshita, Yuka Sugimoto, Ayami Kajiwara-Morita, Motoki Urata, Koji Sato, Toshiyuki Sakamaki","doi":"10.1007/s00228-024-03779-2","DOIUrl":"10.1007/s00228-024-03779-2","url":null,"abstract":"<p><strong>Purpose: </strong>Although there is concern about the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with musculoskeletal pain, hypovolemia, and urinary tract infection in patients with severe chronic kidney disease (CKD), information on these adverse events is insufficient. The aim of this systematic review and meta-analysis was to assess whether SGLT2i increases the risk of urinary tract infection, hypovolemia, and musculoskeletal pain in these patients.</p><p><strong>Methods: </strong>MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov website were comprehensively searched to extract all relevant studies. Randomized controlled trials (RCTs) were selected that compared SGLT2i versus placebo, and the study populations consisted of patients with CKD stage 3 or higher.</p><p><strong>Results: </strong>Eleven studies were eligible for inclusion. SGLT2i tended to increase the risk of hypovolemia [risk ratio (RR) 1.15, 95% confidence interval (CI) 0.98-1.35, P = 0.08, high certainty] but did not increase the risk of urinary tract infection (RR 1.03, 95% CI 0.94-1.12, P = 0.56, high certainty) or musculoskeletal pain (RR 0.69, 95% CI 0.41-1.17, P = 0.17, high certainty). Subgroup analysis of patients with heart disease was performed for the outcome of hypovolemia, and the results showed a significant difference in hypovolemia (RR 1.21, 95% CI 1.06-1.39, P < 0.01, moderate certainty) between SGLT2i and placebo.</p><p><strong>Conclusion: </strong>This meta-analysis suggests that SGLT2i may increase the risk of hypovolemia in patients with moderate to severe CKD and heart disease but is not associated with urinary tract infection or musculoskeletal pain.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"217-225"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study Of the effect of Sex on drug dosing, concentrations, and pharmacogenomics in the Montreal Heart Institute Hospital Cohort (SOS-PGx): methodology and research progress.","authors":"Marc-Olivier Pilon, Jessica Hindi, Isabelle St-Jean, Martin Jutras, Maxime Meloche Brouillette, Ian Mongrain, Caroline Lagacé, Karla Vazquez, Sylvie Provost, Louis-Philippe Lemieux Perreault, Essaid Oussaid, David Busseuil, Marie-Christyne Cyr, Jean-Claude Tardif, Marie-Pierre Dubé, Grégoire Leclair, Simon de Denus","doi":"10.1007/s00228-024-03786-3","DOIUrl":"10.1007/s00228-024-03786-3","url":null,"abstract":"<p><strong>Background: </strong>Women are underrepresented in drug development trials and there is no sex-tailored drug regimen for most medications. It has been repeatedly shown that women have more adverse drug reactions than men for several medications. These differences could be explained by higher dose-adjusted drug concentrations in women. Thus, we aim to identify sex-related differences and to characterize the clinical and genetic predictors of these differences in drug concentrations, dosing, and adherence for 47 commonly used drugs in a large cohort. The objective of this article is to present an overview of the methods and characteristics of the study population.</p><p><strong>Methods: </strong>We performed a cross-sectional study that included 10,082 men and women of European ancestry aged ≥ 18 years from the Montreal Heart Institute Hospital Cohort taking at least one of the 47 medications regularly.</p><p><strong>Results: </strong>Of the 10,082 participants included, 36% were women. Women had lower weight, height, waist girth, and body mass index than men, but they had higher hip girth (all p < 0.001). Men had a higher level of education and annual income and were more likely to be employed full-time compared to women. Furthermore, men had a higher prevalence of hypertension, type 2 diabetes, dyslipidemia, and myocardial infarction (all p < 0.001) and were more likely receiving lipid-lowering agents, beta-blockers, antidiabetic drugs, and angiotensin-converting enzyme inhibitors. Conversely, proton pump inhibitors were more prevalent in women. Interestingly, nearly half of the women had a history of drug allergy or intolerance, compared with less than one-third of the men (p < 0.001).</p><p><strong>Conclusion: </strong>This study has a high potential in understanding eventual sex differences in drug dosing requirements and will most likely provide useful information to personalize drug regimens in women.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"321-332"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient referrals to a specialist falls and syncope service: prevalence of STOPPFall FRIDs and review of deprescribing patterns.","authors":"D O'Donnell, T Zainal, K Malomo, N Fitzpatrick, C Rice, L Byrne, R Briggs, C Cunningham, R A Kenny, A H Lavan","doi":"10.1007/s00228-024-03776-5","DOIUrl":"10.1007/s00228-024-03776-5","url":null,"abstract":"<p><strong>Purpose: </strong>Falls are the commonest cause of accidental death in older people and the most frequent reason for their presentation to hospital. The Screening Tool of Older Persons Prescriptions in older adults with high falls risk (STOPPFall) facilitates deprescribing by providing a clear consensus on which medications are considered fall-risk-increasing drugs (FRIDs). This study aimed to determine the prevalence of STOPPFall FRIDs in inpatients referred to a falls and syncope service (FASS). Additionally, we aimed to analyse the impact of a dedicated FASS on deprescribing, both of FRIDs and of non-FRID medications.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of all FASS inpatient consultations over a 6-month period (March-August 2021). Patients ≥ 65 years old were included. Medications on admission and discharge (following FASS assessment) were reviewed, with FRIDs identified using the STOPPFall deprescribing tool. The prevalence of FRIDs was defined as the proportion of patients who had at least one regular FRID prescribed on admission.</p><p><strong>Results: </strong>In total, 162 patients were included for review: 54.94% were (n = 89) female. The mean age of patients was 79.26 years (SD 7.45). STOPPFall FRIDs were prevalent, with 74.07% (120/162) on at least 1 regular FRID. Antidepressants (37.04%, n = 60) and diuretics (27.78%, n = 45) were the most frequently prescribed FRID classes. Of patients with a fracture, the mean number of FRIDs was 2.44 versus 1.56 in those without fracture (p = 0.01). At least one FRID was stopped in 35. 8% (n = 58) of patients. Following FASS review, 28.6% (n = 79) of all admission FRIDs were discontinued.</p><p><strong>Conclusion: </strong>STOPPFall FRIDs are prevalent in patients referred for inpatient FASS consultations. Presentations with acute fracture are associated with higher number of FRIDs on admission. Review by a dedicated hospital falls service leads to a reduction in FRIDs and deprescribing of anti-hypertensive medications.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"291-299"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of drugs on the oxygen dissociation curve-a scoping review.","authors":"Thomas Haller, Lukas Lesser, Simon Woyke","doi":"10.1007/s00228-024-03781-8","DOIUrl":"10.1007/s00228-024-03781-8","url":null,"abstract":"<p><strong>Purpose: </strong>The shape and position of the hemoglobin-oxygen dissociation curve (ODC) is of critical importance in medicine, as it determines the uptake of O₂ in the lungs and the delivery of O₂ to the tissues. Numerous reports have identified affinity-modulating effects of drugs in humans. Such effects may be relevant to conditions such as pulmonary diffusion disorders, peripheral vascular disease, or coronary artery disease. The aim of this scoping review was to assess and summarize the current evidence on these effects.</p><p><strong>Methods: </strong>The review was based on the PRISMA-ScR guidelines. We searched PubMed and the Cochrane Library and only included papers with free full-text access. The search covers all papers published before September 2024 and used the following keywords: \"Oxygen affinity\" or \"oxygen dissociation curve\" in combination with > 100 substance classes that should cover most drugs in clinical use.</p><p><strong>Results: </strong>The search returned 2447 hits of which 80 were selected for further full text review. In terms of discipline, cardiology accounted for the largest proportion, and in terms of effect quality, a right-ward shift resulting in improved tissue oxygenation was most common. For example, quantitative data show an increase in P₅₀ of 6.1-12.4% and 25-53% for propranolol and RSR13, respectively.</p><p><strong>Conclusion: </strong>Despite a substantial body of data, the effects of the vast majority of drugs on the ODC have not been studied or have not been studied in sufficient detail. The undeniable potential for medical interventions to alter the ODC calls for revival of this area of research.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"227-236"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of rivaroxaban plus aspirin versus aspirin alone in patients with stable coronary artery disease or peripheral artery disease: a systematic review.","authors":"Jalal Arabloo, Mohammad Ali Rezaei, Vahid Makhtoumi, Zahra Mollaei Sadiani, Aziz Rezapour","doi":"10.1007/s00228-024-03794-3","DOIUrl":"10.1007/s00228-024-03794-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD).</p><p><strong>Methods: </strong>A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs). The methodological quality of the included studies was assessed utilizing the validated Quality of Health Economics Studies (QHES) checklist. Subsequently, a qualitative analysis was performed to synthesize the collected data. We converted the incremental cost-effectiveness ratios (ICERs) into the equivalent amount in US dollars for the year 2024.</p><p><strong>Results: </strong>Out of 315 identified articles, 11 met inclusion criteria and were included in the review. RIV + ASA was generally found to be cost-effective, with ICERs falling within acceptable willingness-to-pay (WTP) thresholds. However, substantial variation in ICERs was observed across studies due to differences in healthcare systems, drug pricing, and WTP thresholds. In these studies, ICERs per quality-adjusted life-year (QALY) were (in 2024 US dollars) US$4939 to $29,162 for all patients, $10,385 to $85,394 for CAD, and $1013 to $40,244 for PAD in different studies. RIV + ASA was more cost-effective in high-risk subgroups, such as patients with PAD. Key drivers of cost-effectiveness included mortality rates, the cost of rivaroxaban, and utility scores.</p><p><strong>Conclusions: </strong>RIV + ASA appears to be a cost-effective treatment option for patients with CAD or PAD or both. Future research should address geographical biases, consider societal perspectives, and explore alternative treatment options to optimize resource allocation and improve patient outcomes in the management of CVDs. Future research should also consider evaluating the cost-effectiveness of alternative new oral anticoagulants (NOACs) to provide a broader perspective on treatment options for CVD.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"279-290"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}