International Journal of Clinical Pharmacy最新文献

{"title":"Learnings from research on artificial intelligence enabled solutions in clinical pharmacy practice and education.","authors":"Kreshnik Hoti, Anita E Weidmann, Derek Stewart","doi":"10.1007/s11096-025-01982-4","DOIUrl":"https://doi.org/10.1007/s11096-025-01982-4","url":null,"abstract":"","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of 35 mg of recombinant human prourokinase for thrombolysis in acute ischemic stroke: a meta-analysis of randomized controlled trials.","authors":"Ping He, Suhong Wang, Jie Chen, Haodong Zhou, Haibin Dai","doi":"10.1007/s11096-025-01973-5","DOIUrl":"https://doi.org/10.1007/s11096-025-01973-5","url":null,"abstract":"<p><strong>Background: </strong>Compared with alteplase, recombinant human prourokinase (rhPro-UK)-a next-generation specific plasminogen activator-offers advantages such as weight-independent dosing and cost effectiveness. While a 35-mg dose of rhPro-UK has been recommended in previous randomized controlled trials (RCTs), its efficacy and safety profile have yet to be fully elucidated, as no relevant systematic reviews or meta-analyses have been conducted to date.</p><p><strong>Aim: </strong>This meta-analysis aimed to evaluate the safety and efficacy of 35 mg of rhPro-UK compared with those of control treatments, including 50 mg of rhPro-UK and alteplase monotherapy, in patients with acute ischemic stroke (AIS).</p><p><strong>Method: </strong>Two independent reviewers systematically searched the PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov electronic databases up to May 24, 2025, to identify RCTs assessing the effects of 35 mg rhPro-UK versus control therapies in AIS patients. Study quality was assessed using the Cochrane RoB 2 tool. A random effects model was employed for the meta-analysis using Stata 18.0.</p><p><strong>Results: </strong>Four RCTs involving 2412 patients were included. The 35-mg dose of rhPro-UK demonstrated comparable safety and efficacy to those of the other treatments. Notably, this dose was associated with the potential advantages of increasing early neurological recovery at 24 h (SMD = - 0.29, 95% CI - 0.55 to - 0.03, P = 0.03) and reducing systemic bleeding risk at 90 days (RR = 0.59, 95% CI 0.48-0.73, P < 0.001). Subgroup analysis suggested that 35 mg of rhPro-UK might be associated with lower odds of SAEs than 50 mg of rhPro-UK (I² = 0%, P = 0.039); however, there was no significant difference in rt-PA (I² = 0%, P = 0.413) at 90 days.</p><p><strong>Conclusion: </strong>This meta-analysis suggested that 35 mg of rhPro-UK does not significantly differ from 50 mg of rhPro-UK or alteplase in terms of clinical outcomes among AIS patients. However, the 35-mg dose of rhPro-UK has the potential advantages of enhancing early neurological recovery and reducing the risk of systemic bleeding. Subgroup analysis revealed that 35 mg of rhPro-UK might be associated with a lower risk of SAEs than 50 mg of rhPro-UK.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning model exploring the relationship between chronic medication and COVID-19 clinical outcomes.","authors":"Berta Miró, Natalia Díaz González, Juan-Francisco Martínez-Cerdá, Clara Viñas-Bardolet, Alex Sánchez-Pla, Adrián Sánchez-Montalvá, Marta Miarons","doi":"10.1007/s11096-025-01955-7","DOIUrl":"https://doi.org/10.1007/s11096-025-01955-7","url":null,"abstract":"<p><strong>Background: </strong>The impact of chronic medication on COVID-19 outcomes has been a topic of ongoing debate since the onset of the pandemic. Investigating how specific long-term treatments influence infection severity and prognosis is essential for optimising patient management and care.</p><p><strong>Aim: </strong>This study aimed to investigate the association between chronic medication and COVID-19 outcomes, using machine learning to identify key medication-related factors.</p><p><strong>Method: </strong>We analysed 137,835 COVID-19 patients in Catalonia (February-September 2020) using eXtreme Gradient Boosting to predict hospitalisation, ICU admission, and mortality. This was complemented by univariate logistic regression analyses and a sensitivity analysis focusing on diabetes, hypertension, and lipid disorders.</p><p><strong>Results: </strong>Participants had a mean age of 53 (SD 20) years, with 57% female. The best model predicted mortality risk in 18 to 65-year-olds (AUCROC 0.89, CI 0.85-0.92). Key features identified included the number of prescribed drugs, systemic corticoids, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, and hypertension drugs. A sensitivity analysis identified that hypertensive participants over 65 taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) had lower mortality risk (OR 0.78 CI 0.68-0.92) compared to those on other antihypertensive medication (OR 0.8 CI 0.68-0.95). Treatment with inhibitors of dipeptidyl peptidase 4 was associated to higher mortality in participants aged 18-65, while metformin showed a protective effect in those over 65 (OR 0.79, 95% CI 0.68-0.92).</p><p><strong>Conclusion: </strong>Machine learning models effectively distinguished COVID-19 outcomes. Patients under ACEi or ARBs or biguanides should continue their prescribed medications, which may offer protection over alternative treatments.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of benmelstobart-anlotinib-chemotherapy in extensive-stage small-cell lung cancer: A comparative analysis across United States and Chinese healthcare systems.","authors":"Junjie Wan, Yizhou Xu, Bin Wan, Haixia Ding","doi":"10.1007/s11096-025-01968-2","DOIUrl":"https://doi.org/10.1007/s11096-025-01968-2","url":null,"abstract":"<p><strong>Introduction: </strong>Benmelstobart and anlotinib plus etoposide-carboplatin (EC) group has demonstrated substantial clinical efficacy in improving survival outcomes for patients with extensive-stage small-cell lung cancer (ES-SCLC). However, the high treatment cost raises concerns regarding its affordability and cost-effectiveness across healthcare systems with heterogeneous pricing and reimbursement mechanisms.</p><p><strong>Aim: </strong>This study aimed to evaluate the cost-effectiveness of benmelstobart and anlotinib plus EC group compared to EC alone group and anlotinib plus EC group from both US and Chinese payer perspectives. The findings are intended to inform value-based pricing strategies and evidence-based reimbursement decision-making.</p><p><strong>Method: </strong>A partitioned survival model (PSM) with a lifetime horizon and 21-day cycles was constructed using clinical data from the ETER701 trial. Direct medical costs and health utility inputs were obtained from national databases, local hospitals, and published literature. The primary outcome was the incremental cost-effectiveness ratio (ICER), calculated by comparing costs and quality-adjusted life years (QALYs) between treatment strategies. Scenario analyses, including drug price simulations and deterministic and probabilistic sensitivity analyses, were conducted to evaluate model robustness. Willingness-to-pay (WTP) thresholds were set at $100,000/QALY and $150,000/QALY (US) and $40,011/QALY (China).</p><p><strong>Results: </strong>In the US, the benmelstobart and anlotinib plus EC group yielded ICER of $121,560.40/QALY versus EC alone group and $127,579.09/QALY versus anlotinib plus EC group, both below the $150,000/QALY threshold. However, at the $100,000/QALY threshold, cost-effectiveness would require reducing benmelstobart's price to $1316.12/600 mg. In China, the ICER of $117,667.17/QALY exceeded the local threshold. Price simulations suggested that cost-effectiveness could be achieved if prices were reduced below $2230.60/600 mg (US) and $328.47/600 mg (China). Sensitivity analyses identified progression-free survival (PFS) utility and benmelstobart pricing as major cost drivers. Probabilistic analysis indicated a 75.1% probability of cost-effectiveness at $150,000/QALY in the US. However, the probability of cost-effectiveness is 0% at WTP thresholds of $100,000/QALY in the US and $40,011/QALY in China.</p><p><strong>Conclusion: </strong>Benmelstobart plus anlotinib and EC group is likely to be cost-effective in the US at a WTP threshold of $150,000/QALY, but not in China at current prices. An 80% price reduction in China would be necessary to align with its WTP threshold, emphasizing the need for policy interventions in drug pricing and reimbursement to improve patient access.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioural theories, models and frameworks to underpin clinical pharmacy and pharmacy practice research: guidance from the European Society of Clinical Pharmacy.","authors":"Anita E Weidmann, Cathal Cadogan, Daniela Fialová, Ankie Hazen, Martin C Henman, Betul Okuyan, Francesca Wirth, Abdikarim Abdi, Silvana A M Urru, Lotte Sig Nørgaard","doi":"10.1007/s11096-025-01966-4","DOIUrl":"https://doi.org/10.1007/s11096-025-01966-4","url":null,"abstract":"<p><p>The scope of clinical pharmacy practice and research has expanded to encompass behavioural, economic and humanistic dimensions alongside clinical responsibilities. The influence of behaviour on the efficacy of clinical services justifies the application of behaviour change theories to clinical pharmacy and practice research. This facilitates a deeper understanding of human behaviour in relation to health interventions and the provision of clinical pharmacy services. This commentary provides a summary of key concepts that researchers need to consider when using behavioural and/or social theories to underpin their research, outlining: (1) why this is important to support development of the pharmacist's role in patient care; (2) definitions of theories, models and frameworks; (3) a description of the UK Medical Research Council Framework; (4) an overview of the most commonly used behavioural theories, models and frameworks (supplemented by implementation, communication and other relevant humanistic and social theories); (5) lessons for clinical pharmacy and pharmacy practice researches. The comment aims to assist pharmacy practice and health research colleagues to improve the quality and rigour of theory underpinned research. The guidance in this paper is part of the commitment of the European Society of Clinical Pharmacy to stimulate innovative and high-quality research in all areas of clinical pharmacy.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversational agents for pharmaceutical use: insights from the eCCo database.","authors":"Mara Pereira Guerreiro, Helga Rafael Henriques, Elena Mugellini, Leonardo Angelini","doi":"10.1007/s11096-025-01948-6","DOIUrl":"https://doi.org/10.1007/s11096-025-01948-6","url":null,"abstract":"<p><p>Conversational agents are computer programmes designed to replicate bidirectional human conversation through spoken or written language, potentially supplemented with nonverbal features. The eCCo database is a searchable repository of primary studies on conversational agents in health and well-being. It catalogs 657 papers currently, published between 1991 and 2022; 51 address the use of medicines. Most of these papers focus on usability rather than rigorous effectiveness or implementation research, underscoring a need for more robust evaluation. The largest category of conversational agents for pharmaceutical use consists of non-embodied agents (n = 24), followed by virtual embodiment only (n = 19), most using virtual humans (n = 16). This database facilitates the comparison and appraisal of existing research in this field, while contributing to a more nuanced understanding of this technology through multidimensional attributes. We aim to enhance the database accuracy and expand its completeness beyond 2022 with the support of the global research community.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of the Beers Criteria (2023) versus the STOPP (v3) in detecting potentially inappropriate medications in older adults with heart failure: a retrospective cross-sectional study.","authors":"Suyan Zhu, Xiaomeng Zheng, Miao Fan, Yiyi Jin, Chunyan Chen, Mengjing Cheng","doi":"10.1007/s11096-025-01964-6","DOIUrl":"https://doi.org/10.1007/s11096-025-01964-6","url":null,"abstract":"<p><strong>Introduction: </strong>The American Geriatrics Society (AGS) Beers Criteria and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) criteria are extensively utilized in identifying potentially inappropriate medications (PIMs) among older adults. Older adults with heart failure (HF) confront the dual challenge of polypharmacy and inadequate adherence to evidence-based medications, which further complicates their medication management and clinical outcomes.</p><p><strong>Aim: </strong>To assess the effectiveness of the AGS Beers (2023) Criteria and the STOPP (v3) criteria in identifying PIMs among older adults with HF and to analyze patterns of polypharmacy and evidence-based medications.</p><p><strong>Method: </strong>This retrospective study was conducted at a tertiary academic medical center in China and involved 1578 outpatients aged ≥ 65 years with HF who received at least one outpatient prescription between January 1 and December 31, 2023. Data on demographics, comorbidities, and prescribed medications were extracted from the hospital's electronic medical record (EMR) system. PIMs were identified with the AGS Beers (2023) Criteria and the STOPP (v3) criteria. The data were analyzed using descriptive statistics in Microsoft Excel.</p><p><strong>Results: </strong>Polypharmacy and hyperpolypharmacy were prevalent among the patients, affecting 65.3% and 15.7% of the cohort, respectively. PIMs were identified in 75.5% of patients (1192/1578), with a total of 2128 PIM cases observed according to the Beers Criteria, with the most common PIM being rivaroxaban (32.3%). The STOPP (v3) criteria identified PIMs in 28.9% of patients (n = 471), with the most frequent PIMs being statin use in frail patients aged ≥ 85 years (26.8%) and prolonged use of proton-pump inhibitors (16.6%). Among all patients in our study, 61.6% received either an angiotensin-converting enzyme inhibitor, angiotensin-II receptor blocker, or angiotensin receptor-neprilysin inhibitor (ACEI/ARB/ARNI); 57.0% were prescribed β-blockers; and 32.6% used a sodium-glucose cotransporter 2 inhibitor.</p><p><strong>Conclusion: </strong>While the Beers Criteria identified a greater number of PIMs in this study, both tools have differing strengths in detecting medication-related risks. Their combined use may provide a more holistic assessment of prescribing appropriateness. The widespread use of PIMs in older adults with HF, coupled with the frequent underuse of beneficial therapies, calls for systematic interventions. Pharmacist-led interventions and electronic decision-support systems that integrate evidence-based prescribing, deprescribing, and regular medication reviews are crucial for optimizing therapeutic outcomes in older adults with HF.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment and validation of a predictive nomogram for voriconazole-associated liver injury in lung transplant patients.","authors":"Wenwen Du, Wenqian Chen, Dan Zhang, Shu Li, Bo Li, Xianbo Zuo, Pengmei Li, Xiaoxing Wang","doi":"10.1007/s11096-025-01946-8","DOIUrl":"https://doi.org/10.1007/s11096-025-01946-8","url":null,"abstract":"<p><strong>Introduction: </strong>Voriconazole serves as a cornerstone antifungal therapy for lung transplant (LTx) patients; however, its use is associated with a notable risk of hepatotoxicity.</p><p><strong>Aim: </strong>This study aimed to identify potential prognostic factors and develop a robust prediction nomogram for voriconazole-associated liver injury (VALI) in this population.</p><p><strong>Method: </strong>This retrospective observational study included 97 LTx patients treated with voriconazole between 2017 and 2024. Patients were randomly divided into a training cohort and a validation cohort, with a ratio of 75:25. Voriconazole blood concentrations were measured, and genetic polymorphisms related to voriconazole metabolism were analyzed. Potential prognostic factors associated with VALI were identified by using univariate and multivariate Cox proportional hazard models. The nomogram was evaluated by C-index, calibration curve and clinical utility.</p><p><strong>Results: </strong>The overall incidence of VALI was 30.9%. In the multivariate analysis, voriconazole concentration (HR 1.318, 95% CI 1.052-1.650, p = 0.016), voriconazole dose (HR 1.005, 95% CI 1.001-1.008, p = 0.006), concomitant mycophenolate mofetil (MMF) use (HR 0.320, 95% CI 0.116-0.885, p = 0.028), and rs4244285 polymorphism (HR 2.466, 95% CI 0.936-6.498, p = 0.068) were identified as independent predictive factors for VALI. The C-indexes of the nomogram were 0.807 (95% CI 0.725-0.889) for the training cohort and 0.82 (95% CI 0.681-0.959) for the validation cohort. Furthermore, the nomogram demonstrated excellent calibration and clinical applicability. Receiver operating characteristic (ROC) curve analysis determined the voriconazole cut-off trough concentration for hepatotoxicity stratified by MMF use. Stratified analysis indicated that the optimal voriconazole trough thresholds for minimizing VALI risk were 2.8 ng/mL in MMF users (AUC 0.769, p < 0.001) and 2.6 ng/mL in non-users (AUC 0.795, p = 0.011).</p><p><strong>Conclusion: </strong>This study highlights the significance of therapeutic drug monitoring for voriconazole in stratifying the risk probability of VALI among LTx patients. Additionally, we have established a predictive nomogram to aid clinicians and pharmacists in assessing the likelihood of VALI following voriconazole administration in this patient population. However, before clinical implementation, external validation in independent cohorts and prospective utility studies are imperative to confirm the generalizability and clinical efficacy of this model.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' perspectives on medication adherence feedback interventions for managing long-term medications: a systematic review of qualitative evidence.","authors":"Barbara Kobson, Janet Hanley, Alpana Mair, Alexandra L Dima, Nicola Rea, Ruth E Paterson","doi":"10.1007/s11096-025-01958-4","DOIUrl":"https://doi.org/10.1007/s11096-025-01958-4","url":null,"abstract":"<p><strong>Introduction: </strong>Optimising medication usage is a worldwide challenge. While numerous feedback interventions have been developed to address this issue, understanding patients' perspectives on the use of such interventions to optimise adherence provides opportunities for successful development and implementation.</p><p><strong>Aim: </strong>To synthesise qualitative evidence on patients' views on medication adherence feedback interventions to support adherence behaviour.</p><p><strong>Method: </strong>CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were systematically searched from database inception to February 2023 with searches updated to February 2025. Additionally, Google Scholar was used to identify any potentially relevant grey literature or supplementary sources. Eligible studies included qualitative or mixed-methods research that explored adult patients' perspectives on medication adherence feedback interventions for long-term conditions, specifically those aimed at self-management within community settings. The review was conducted according to ENTREQ and reported following PRISMA guidelines. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analysed using thematic synthesis, with findings presented narratively.</p><p><strong>Results: </strong>Of the 1270 studies screened, 11 met the inclusion criteria and evaluated participants' views on therapeutic drug monitoring and digital adherence interventions across conditions including asthma, human immunodeficiency virus (HIV), coronary heart disease, hypertension, type 2 diabetes, and opioid use disorder. Three themes were identified; balancing support and autonomy in feedback interventions, maintaining patient-provider relationship and enhancing engagement through tailored design. Interventions were considered acceptable when they were easy to use, offered users control over personal data, incorporated audio-visual cues, and provided emotional or motivational support. Trust and shared decision-making between patients and providers facilitated uptake, while tailored interventions were considered essential for supporting engagement.</p><p><strong>Conclusion: </strong>Medication adherence feedback interventions are acceptable, however further improvements will enhance user engagement and optimise adherence. Future research should prioritise co-designed interventions that address user needs, improve patient-provider communication, deliver accurate adherence feedback, and support cost-effective scalability.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedative co-medication patterns across frailty states in people with HIV: a network-based study.","authors":"Henry Ukachukwu Michael, Marie-Josée Brouillette, Robyn Tamblyn, Lesley K Fellows, Nancy E Mayo","doi":"10.1007/s11096-025-01963-7","DOIUrl":"https://doi.org/10.1007/s11096-025-01963-7","url":null,"abstract":"<p><strong>Introduction: </strong>People with HIV are living longer, but frailty may increase vulnerability to adverse drug interactions, particularly with sedative medications.</p><p><strong>Aim: </strong>To describe sedative co-medication patterns across frailty states using network-based analysis, and to identify key medications driving interaction complexity.</p><p><strong>Method: </strong>This cross-sectional study analyzed 321 participants using sedatives from the Positive Brain Health Now Cohort (mean age: 53 years), categorized as robust (30.2%), prefrail (47.0%), or frail (22.7%). Sedative use was classified using the Sedative Load Model, and frailty was assessed with a modified Fried Frailty Phenotype. Co-medication networks were constructed for robust, prefrail, and frail groups, with metrics such as Neighborhood Shift Scores (NESH) and ΔBetweenness used to evaluate network dynamics. Edge-level Observed-to-Expected ratios highlighted significant drug pairings and interaction risks.</p><p><strong>Results: </strong>Frail individuals exhibited the most interconnected sedative network (graph density: 0.24; average degree: 7.31) followed by prefrail (graph density: 0.18; average degree: 6.67) and robust groups (graph density: 0.13; average degree: 4.61). Medications with high network influence included mirtazapine (robust-to-prefrail: NESH = 2.05; ΔBetweenness = 0.23), gabapentin (robust-to-frail: NESH = 2.46, ΔBetweenness = 0.10), and pregabalin (prefrail-to-frail: NESH = 2.55; ΔBetweenness = 0.71). High-risk sedative pairs in frail individuals included hydromorphone-clonazepam (Observed-to-Expected ratio: 3.07; interaction severity: D), amitriptyline-oxycodone (Observed-to-Expected ratio: 1.92; severity: D), and quetiapine-citalopram (Observed-to-Expected ratio: 2.12; severity: D). Prefrail individuals had intermediate-risk combinations, including clobazam-levetiracetam (Observed-to-Expected ratio: 81.5; severity: C), and gabapentin-hydroxyzine (Observed-to-Expected ratio: 3.58; severity: D). Robust individuals showed fewer and lower-risk patterns, such as amitriptyline-pregabalin (Observed-to-Expected ratio: 4.00; severity: C). Network differences reflect increasing polypharmacy and adverse interaction risks with advancing frailty.</p><p><strong>Conclusion: </strong>Sedative co-medication patterns vary meaningfully across frailty states in people with HIV. Frailty is associated with more complex networks and a greater likelihood of high-risk drug interactions. Medications influencing these patterns can help identify opportunities for safer prescribing. The prefrail stage may offer a timely window for interventions aimed at minimizing polypharmacy and improving safety in middle-aged and older adults with HIV.</p>","PeriodicalId":13828,"journal":{"name":"International Journal of Clinical Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}