Journal of Clinical Pharmacy and Therapeutics最新文献

{"title":"Development and Internal Validation of Machine Learning Algorithms for Determining Sodium Valproate Concentrations below the Standard Level Using a Risk Prediction Model of Children with Epilepsy","authors":"Yinhui Yao,&nbsp;Jingyi Zhao,&nbsp;Ying Wang,&nbsp;Wei Qiu,&nbsp;Yingxue Lin,&nbsp;Yaru Zang","doi":"10.1155/2023/9996553","DOIUrl":"10.1155/2023/9996553","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. There is a narrow therapeutic window for sodium valproate, and the blood concentration is too low to control epilepsy, while it is easy to poison the body if the concentration is too high. It is therefore necessary to monitor drug concentration reasonably in order to control epilepsy. The purpose of this study was to establish a model for predicting concentrations of sodium valproate below 50 <i>μ</i>g/mL in children with epilepsy. <i>Methods</i>. The clinical data and biochemical examination results of children with epilepsy treated in the pediatric outpatient department of our hospital from June 2019 to March 2022 were retrospectively collected and divided into a development group and a validation group according to a patient ratio of 8 to 2. Five machine learning algorithms were used to identify the key variable factors, and a risk prediction model for sodium valproate blood concentrations lower than the standard concentration was established. The area under the curve (AUC), calibration curve, GiViTi calibration band, and clinical influence curve were used to evaluate the diagnostic efficacy and clinical application value of the model. <i>Results</i>. A total of 525 children with epilepsy were enrolled. In the development group, the random forest algorithm performed best in predicting that the blood concentration of sodium valproate was lower than the standard concentration, showing the highest AUC (1.00). Six factors were determined as a nomogram to predict the incidence of low concentrations. In the validation group and the development group, the calibration curve, GiViTi calibration band, and clinical influence curve all performed well in the evaluation of the diagnostic efficacy and clinical application value of the model. <i>Conclusions</i>. This finding highlights the importance of examining biochemical indices in patients when data regarding the blood concentration of sodium valproate are lacking.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/9996553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136061432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Diagnostic Value of KIM-1, NGAL, and NLR in Acute Kidney Injury Caused by Diquat Poisoning","authors":"Tiezhen Liu,&nbsp;Qian Liu,&nbsp;Hongna Qi,&nbsp;Wenpin Xu,&nbsp;Xun Gao,&nbsp;Weizhan Wang,&nbsp;Baoyue Zhu","doi":"10.1155/2023/8213247","DOIUrl":"10.1155/2023/8213247","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The kidney is the main excretory organ after diquat absorption. Acute kidney injury (AKI) is a common complication in diquat poisoning patients. <i>Objectives</i>. To identify the value of combined detection of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and neutrophil-lymphocyte ratio (NLR) in the early diagnosis of diquat-induced AKI. <i>Materials and Methods</i>. The retrospective cohort study included 42 diquat poisoning patients. <i>Results</i>. Forty-two patients with diquat poisoning were included, of which 20 had fulminant poisoning (47.6%). At admission (0 h), levels of KIM-1, NGAL, NLR, and acute physiology and chronic health evaluation (APACHE) II scores in the fulminant poisoning group were higher than that of the moderate to severe poisoning group (<i>P</i> &lt; 0.05), and they were all higher than in the control group (<i>P</i> &lt; 0.05), while blood urea nitrogen (BUN) and uric acid (UA) levels did not significantly differ across the three groups (<i>P</i> &gt; 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores of patients in the fulminant poisoning group were higher than those in the moderate to severe poisoning group (<i>P</i> &lt; 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h (<i>P</i> &lt; 0.05). Among 42 patients with diquat poisoning, 28 had AKI (66.7%). At 0 h, the AKI group had higher levels of KIM-1, NGAL, NLR, and APACHE II scores than in the non-AKI (NAKI) group (<i>P</i> &lt; 0.05), while there was no significant difference in BUN and UA levels between the two groups (<i>P</i> &gt; 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores in the AKI group were higher than those in the NAKI group (<i>P</i> &lt; 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h (<i>P</i> &lt; 0.05). KIM-1, NGAL, and NLR are independent risk markers for AKI in diquat poisoning patients. At admission (0 h), the combined application of KIM-1, NGAL, and NLR’s sensitivity, specificity, and area under the curve (AUC) for predicting AKI in diquat poisoning patients was 0.893, 0.859, and 0.903, respectively. <i>Conclusions</i>. KIM-1, NGAL, and NLR can be employed as early diagnostic indicators for the clinical prediction of AKI in diquat poisoning patients. Our findings may help clinicians reduce the occurrence of AKI.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/8213247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Vancomycin Utilization in the Medical and Gynecology Wards of Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia","authors":"Baye Yrga Adugna,&nbsp;Zewdu Yilma Dlie,&nbsp;Biset Asrade Mekonnen,&nbsp;Abebe Tarekegn Kassaw","doi":"10.1155/2023/2335694","DOIUrl":"10.1155/2023/2335694","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Drug use evaluation is an approach that focuses on evaluating and optimizing drug use practices to achieve the best possible patient outcomes. The purpose of this study was to assess the appropriateness of vancomycin usage patterns and their practical application in hospitalized patients. <i>Methods</i>. An institutional-based descriptive retrospective cross-sectional study design was carried out among 265 hospitalized patients from May 1, 2022, to July 30, 2022. The study participants were selected using a simple random sampling method. <i>Result</i>. Among the 265 study participants, 60.4% were male respondents, while 86.8% of vancomycin was administered for treatment; however, 13.2% was administered for prophylaxis. In addition, 41.9% and 27.5% of vancomycin were ordered for treatment of meningitis and pneumonia, respectively. The culture was performed for only 17.4% of patients, and 82.6% of vancomycin was used for empiric therapy. Most (66.8%) of vancomycin was given in the dose range of 800–1000 mg. The finding indicates that 57.36% and 39.25% were due to incorrect doses and durations, respectively. Only 17.4% of patients had sensitivity tests. <i>Conclusions</i>. Vancomycin inappropriateness was common with the indication, dose, frequency, and duration of therapy according to the guidelines. Vancomycin was mostly indicated as empiric therapy, even though the sensitive test was performed in a small amount. Given the widespread use of vancomycin as an empiric drug, its utilization should be monitored closely. Therefore, the usual sensitive test is recommended to identify those intermediate and resistant results and to predict the outcomes of the treatment.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/2335694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135060518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the 90% Effective Dose of Remimazolam Inhibiting Responses to Upper Gastrointestinal Endoscopy Insertion in Adults: A Double-Blind Study Utilizing a Biased Coin Up-and-Down Sequential Method","authors":"Pengfei Yin,&nbsp;Xian Zhao,&nbsp;Chaoliang Zhang,&nbsp;Yi Shi,&nbsp;Weiwei Sheng,&nbsp;Binwei Hu,&nbsp;Hui Li,&nbsp;Mi Wang,&nbsp;Xianhui Kang","doi":"10.1155/2023/9391407","DOIUrl":"10.1155/2023/9391407","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Remimazolam, a benzodiazepine sedative with clinical advantages, is used for anesthesia during GI endoscopy. However, the accurate clinical dosage remains understudied. This study aims to investigate the 90% effective dose (ED90) of remimazolam in inhibiting responses to upper GI endoscopy insertion and evaluate its efficacy and safety for upper GI endoscopic diagnosis and treatment. <i>Methods</i>. A total of 54 adult patients undergoing upper GI endoscopy under procedural sedation were included, and they were anesthetized with an intravenous bolus of remimazolam. The first patient was given a dose of 0.3 mg/kg of remimazolam and was next randomized according to a biased coin design (BCD) method, and each patient received a dose of remimazolam depending on the response of the previous patient. A positive reaction was defined as no choking cough, nausea and vomiting, and/or motor response during placement of the upper GI endoscope into pharyngeal cavity or within 3 minutes after placement; otherwise, it was a negative reaction. If positive, randomize the next patient’s dose of remimazolam to be unchanged or decrease by 0.05 mg/kg. If negative, increase the next patient’s dose of remimazolam by 0.05 mg/kg. According to the study protocol, at least 45 patients with positive reactions were needed to suspend the trial while monitoring anesthesia-related adverse events. <i>Results</i>. The ED90 of remimazolam for upper gastrointestinal endoscopy insertion was 0.556 mg/kg (95% CI: 0.399–0.578). All patients maintained stable circulation and no serious adverse events were observed during sedation. Patient satisfaction was 4.89 ± 0.69 points, anesthesiologist satisfaction was 4.57 ± 0.96 points, and endoscopist satisfaction was 4.67 ± 0.87 points (full score 5 points, minimum 1 point). <i>Conclusion</i>. The use of remimazolam for upper gastrointestinal endoscopy was safe and effective, with a single intravenous bolus at an ED90 dose of 0.556 mg/kg inhibiting responses to the procedure.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/9391407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of irAEs after Immune Checkpoint Inhibitor Rechallenge: An Updated Meta-Analysis","authors":"Jiaqin Cai,&nbsp;Wenhua Wu,&nbsp;Jie Zhuang,&nbsp;Guifeng Zhang,&nbsp;Xiaoxia Wei,&nbsp;Hong Sun","doi":"10.1155/2023/9963927","DOIUrl":"10.1155/2023/9963927","url":null,"abstract":"<div>\u0000 <p><i>What Is Known? and Objective</i>. Immune checkpoint inhibitors (ICIs) play an important role in various cancers. The efficacy and safety of rechallenge with ICIs after immune-related adverse events (irAEs) were not well known. Accumulating studies report inconsistent findings. Thus, we conducted an updated meta-analysis by including more studies. <i>Methods</i>. We searched PubMed, Web of Science, Embase, and Cochrane Library for studies reporting the rechallenge of ICIs after irAEs. The evaluation outcomes included the incidence of irAEs, objective response rate (ORR), and disease control rate (DCR). <i>Results and Discussion</i>. A total of 896 ICI rechallenge cases from 24 studies were included. Compared to the initial treatment with ICIs, rechallenge showed a higher incidence of all-grade irAEs (OR, 2.78; 95% CI, 1.51–5.10; <i>p</i> = 0.001) and high-grade irAEs (OR, 1.88; 95% CI, 1.27–2.78; <i>p</i> = 0.002), but ORR (OR, 1.01; 95% CI, 0.55–1.84; <i>p</i> = 0.97) and DCR (OR, 1.21; 95% CI, 0.68–2.15; <i>p</i> = 0.52) were not further improved after the rechallenge of ICIs. <i>What Is New? and Conclusion</i>. More studies are included in this paper to compare and analyze the efficacy and safety of ICIs after rechallenge, so as to update the previous meta-analyses, and finally get different conclusions from the previous meta-analyses in terms of safety. Our results suggest that rechallenged ICIs after irAEs showed similar efficacy and lower safety than initial ICIs. However, these results need to be further verified by high-quality studies with large samples. In addition, we added subgroup analysis not available in previous meta-analyses to explore the association of cancer type, age, and gender factors with the incidence of irAE after ICI rechallenge.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/9963927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49061321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Daphnetin on Experimental Acute Pancreatitis-Associated Acute Lung Injury in Mice","authors":"Tao Chen,&nbsp;Ou Chen,&nbsp;Ming Zhao,&nbsp;Xia Chen","doi":"10.1155/2023/9822900","DOIUrl":"10.1155/2023/9822900","url":null,"abstract":"<div>\u0000 <p><i>Background and Aim</i>. Daphnetin, an active monomer ingredient extracted from <i>D. marginata</i>, is proved to have anti-inflammatory and antioxidant effect. The aim of this study is to explore the effect and possible mechanism of daphnetin on acute lung injury (ALI) associated with acute pancreatitis (AP) in mice. <i>Methods</i>. A total of 36 mice were randomly assigned into three groups: control group, AP group, and daphnetin group. The mouse model of AP was induced by caerulein and lipopolysaccharide. Animals were sacrificed at 6 and 12 h after daphnetin treatment, respectively. The pathological changes of lung and pancreas were determined by hematoxylin-eosin staining and the pathological scores. Levels of IL-1<i>β</i>, IL-6, and TNF-<i>α</i> in serum and lung and the activity of myeloperoxidase (MPO) in lung tissue homogenate were detected by ELISA. The protein level of toll-like receptor 4 (TLR4), phospho-nuclear factor-kappa B p65 (p-NF-<i>κ</i>B p65), nuclear factor-kappa B p65 (NF-<i>κ</i>B p65), and hypoxia-inducible factor 1 alpha (HIF-1<i>α</i>) in the lung was detected by Western blot. <i>Results</i>. Results showed extensive neutrophil infiltration, hemorrhage, and edema in the pancreas tissues or lung tissues in mice with AP. The daphnetin treatment improved pathological changes in the lung tissues of AP mice. The MPO activity and the levels of inflammatory cytokines including IL-1<i>β</i>, TNF-<i>α</i>, and IL-6 of lung tissues and serum in the AP group were significantly higher than those in the control group (<i>P</i> &lt; 0.05), and daphnetin intervention significantly reversed the changes (<i>P</i> &lt; 0.05). Compared with the control mice, the protein levels of TLR4, p-NF-<i>κ</i>B p65, and HIF-1<i>α</i> were significantly higher in the lung tissue of the AP mice (<i>P</i> &lt; 0.05), while daphnetin treatment decreased these protein expression levels. No significant difference was observed in the NF-<i>κ</i>B p65 level among control, AP, and daphnetin groups (<i>P</i> &gt; 0.05). <i>Conclusions</i>. Daphnetin exerted a protective effect on the acute lung injury induced by SAP in mice. The mechanism may be related to the regulation of TLR4/NF-<i>κ</i>B/HIF-1<i>α</i> pathway to reduce the release of inflammatory factors.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/9822900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46979969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Sofosbuvir/Daclatasvir in a Single Tablet for Treating Chronic Viral Hepatitis C","authors":"Nabil Debzi,&nbsp;Saadi Berkane,&nbsp;Chafika Manouni,&nbsp;Nassima Amani,&nbsp;Sonia Hemmam,&nbsp;Mohamed Yousfi,&nbsp;Ayoub Taleb,&nbsp;Nawal Guessab,&nbsp;Ahlem Sarah Moulay Brahim,&nbsp;Sarah Helal,&nbsp;Ismahane Benbitour,&nbsp;Lynda Noual,&nbsp;Rafik Kerbouche,&nbsp;Ibtissem Ouled Cheikh,&nbsp;Othmane Drir,&nbsp;Hibat Allah Belimi,&nbsp;Samir Gourari,&nbsp;Issam Frigga,&nbsp;Ahmed Kassah-laouar,&nbsp;Mouna Khaberi,&nbsp;Nawal Afredj","doi":"10.1155/2023/8297332","DOIUrl":"10.1155/2023/8297332","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Published data regarding the real-life application of the combination sofosbuvir/daclatasvir in Algeria are lacking. Therefore, we conducted an observational study to assess the efficacy and safety of this regimen in Algerian patients with chronic hepatitis C. <i>Methods</i>. We carried out a multicentric, observational, open-label study to assess the efficacy and safety of the generic fixed-dose combination (FDC) sofosbuvir/daclatasvir in patients with chronic hepatitis C. We included 100 patients with all genotypes for 12 or 24 weeks of treatment without ribavirin. The primary outcome was the proportion of patients with a sustained virologic response (SVR) 12 weeks after treatment cessation. The secondary outcome assessed the safety and occurrence of adverse events. This study is registered with ClinicalTrials.gov identifier: NCT05138523. <i>Results</i>. The full analysis set included 99 patients with a mean age of 51.4 ± 14.4 years and a sex ratio of M/F = 0.86. Our patients were infected with HCV genotype 1b (<i>n</i> = 47), 2 (<i>n</i> = 17), 1a (<i>n</i> = 3), 2a/2c (<i>n</i> = 2), 3 (<i>n</i> = 2), and 4 (<i>n</i> = 1). A total of 27 patients had missing genotype data. Most patients were naive noncirrhotic (<i>n</i> = 70) and took 12 weeks of treatment, 19 patients had cirrhosis, of which 68.42% (<i>n</i> = 13) were classified as Child–Pugh A, and 5 patients were treatment-experienced. Both cirrhotic and treatment-experienced patients took 24 weeks of treatment. Efficacy analysis was conducted on 95 patients, and the results showed that 91 patients achieved SVR12 with a response rate of 95.8% (95% CI: 92–100%). Six adverse events occurred and were minor and manageable. <i>Conclusion</i>. Our results demonstrate the efficacy and safety of sofosbuvir/daclatasvir in single tablets in treating Algerian HCV patients without ribavirin for 12 or 24 weeks. The promising results of this study warrant further trials to assess the efficacy and safety of this combination in treating special populations.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/8297332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42426849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review and Meta-Analysis: Safety and Efficacy of Cediranib in the Treatment of Cancer Patients","authors":"Yan Wang,&nbsp;Yan Cai,&nbsp;Qi-Ming Wang","doi":"10.1155/2023/9245663","DOIUrl":"10.1155/2023/9245663","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. Tyrosine kinase inhibitors are exciting new anticancer strategies. As one of the most promising oral tyrosine kinase inhibitors, cediranib has been proven effective in treating various solid malignant tumors. This study aimed to evaluate the efficacy and safety of cediranib in cancer patients. <i>Methods</i>. A comprehensive literature review was conducted for phase II and phase III randomized controlled trials (RCTs) up to June 31, 2021, using databases from PubMed, Cochrane Library, Embase, and Web of Science. Relevant clinical trials reporting the efficacy and toxicity characteristics of cediranib in cancer patients were analyzed using Stata 15.1. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to assess the strength of the evidence. <i>Results</i>. The systematic review yielded 14 eligible trials, comprising 4,387 patients with solid malignant tumors. The analysis results of RCTs showed that the cediranib-containing group had a significantly better PFS than the control group (HR: 0.75; 95% CI 0.69–0.82; <i>P</i> &lt; 0.001), and the pooled OS of the cediranib-containing group was significantly higher than that of the control group (HR: 0.91; 95% CI 0.84–1.00; <i>P</i> = 0.041). The sensitivity analysis revealed that the pooled HR was stable and excluding a single study had no effect on the significance of the pooled HR. In addition, the meta-analysis passed Begg’s and Egger’s tests, indicating no publication bias. Regarding safety, the most common adverse events were diarrhea, nausea, hypertension, fatigue, sensory neuropathy, dyspnea, vomiting, headache, neutropenia, thrombocytopenia, and leukopenia. <i>Conclusion</i>. Cediranib treatment responds better than noncediranib therapy but can increase the risk of specific treatment-related toxicities.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/9245663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135671095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practicality of STAT3 Gene Polymorphisms and Sorafenib Trough Concentration as Biomarkers for Sorafenib-Induced Hand-Foot Skin Reaction in Hepatocellular Carcinoma","authors":"Hirokazu Takatsuka,&nbsp;Takato Sugawara,&nbsp;Masashi Uchida,&nbsp;Shingo Yamazaki,&nbsp;Takaaki Suzuki,&nbsp;Naoya Kanogawa,&nbsp;Sadahisa Ogasawara,&nbsp;Yuki Shiko,&nbsp;Yohei Kawasaki,&nbsp;Naoya Kato,&nbsp;Itsuko Ishii","doi":"10.1155/2023/6682459","DOIUrl":"10.1155/2023/6682459","url":null,"abstract":"<div>\u0000 <p><i>Introduction</i>. The aim of this study was to evaluate the practicality of the signal transducer and activator of transcription (STAT) 3 polymorphisms as a predictive biomarker and sorafenib trough concentration as a monitoring biomarker for hand-foot skin reaction (HFSR) in patients with hepatocellular carcinoma (HCC). <i>Methods</i>. In total, 43 Japanese HCC patients were included. Sorafenib concentrations were measured, if possible, on days 8, 29, 35, and 57. The sorafenib concentration on day 8 (<i>C</i>_day8) was used for the analysis of HFSR occurring up to day 29. The median concentration for each patient (<i>C</i>_median) was used for HFSR occurring up to day 57 (study period). The <i>STAT3</i> single nucleotide polymorphism (SNP) rs4796793 was determined using cell-free DNA extracted from plasma. <i>Result</i>. The <i>C</i>_day8 tended to be higher in the HFSR onset or grade ≥ 2 HFSR severity group than in the non-HFSR or grade ≤ 1 HFSR severity group. The <i>C</i>_median was significantly higher in the HFSR onset or grade ≥ 2 group than in the non-HFSR or grade ≤ 1 HFSR group. The <i>C</i>_median thresholds for predicting HFSR onset and severity were 3.62 <i>μ</i>g/mL and 6.10 <i>μ</i>g/mL, respectively. There was no association between <i>STAT3</i> rs4796793 and HFSR onset or severity. In multivariate analysis, <i>C</i>_median values ≥ 3.62 <i>μ</i>g/mL and &gt;6.10 <i>μ</i>g/mL were associated with the increased risk of HFSR onset (odds ratio: 16.6, <i>p</i> <i>&lt;</i> 0.01) and severity (odds ratio: 15.7, <i>p</i> &lt; 0.01), respectively. <i>Conclusion</i>. Monitoring of the sorafenib trough concentration may be practical for avoiding HFSR.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/6682459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44141107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Arterial Disease and the Pharmacist’s Role in Management","authors":"Zachary Stacy","doi":"10.1155/2023/2352051","DOIUrl":"10.1155/2023/2352051","url":null,"abstract":"<div>\u0000 <p><i>Purpose</i>. Atherosclerosis of arteries in the legs leads to peripheral arterial disease (PAD), increasing the risk of future cardiovascular events. Worldwide prevalence estimates indicate &gt;200 million people have PAD, but this is likely underestimated given the variability in symptoms and lack of awareness by patients and clinicians. Antiplatelet therapy is recommended to reduce cardiovascular risk, but anticoagulation therapy may also be beneficial. This narrative review examined scientific literature for the burden and medical management of PAD, including use of anticoagulants in this population, and provides perspectives on the role of pharmacists to improve outcomes of PAD. <i>Summary</i>. A variety of antiplatelet therapies has been studied in patients with PAD, and treatment is recommended for those with symptomatic disease. The use of dual antiplatelet therapy is limited to patients with symptomatic PAD after revascularization. Anticoagulation with warfarin in combination with antiplatelet therapy did not improve efficacy over antiplatelet therapy alone and increased bleeding. In contrast, the direct factor Xa inhibitor rivaroxaban, when used in combination with low-dose aspirin, has been shown to significantly reduce the risk of cardiovascular death, myocardial infarction (MI), or stroke by 28% in patients with PAD compared with aspirin alone. Similarly, in patients with PAD who have undergone revascularization, rivaroxaban plus aspirin reduced the risk of acute limb ischemia, major amputation, MI, stroke, or cardiovascular death by 15% versus aspirin alone. Major bleeding was significantly increased with rivaroxaban plus aspirin, but with no differences in fatal bleeding, nonfatal intracranial hemorrhage, or symptomatic bleeding into a critical organ between groups. Pharmacist-led interventions for patients with PAD include identifying at-risk patients through medication reviews and clinical assessments, education and monitoring use of prescription and over-the-counter medications, and appropriate counseling on lifestyle modifications. <i>Conclusion</i>. Rivaroxaban plus aspirin reduces the risk of major cardiovascular events, including major adverse limb events and amputation, in patients with PAD. Pharmacists can play an integral role in identifying, screening, and managing patients with PAD to achieve favorable outcomes.</p>\u0000 </div>","PeriodicalId":15381,"journal":{"name":"Journal of Clinical Pharmacy and Therapeutics","volume":"2023 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2023/2352051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49328700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}