Journal of Pharmaceutical Health Care and Sciences最新文献

{"title":"Correction: Association between the incidence of infusion-related reactions by obinutuzumab and the dose of corticosteroid as premedication: a multicenter retrospective cohort study.","authors":"Tatsuya Ohtsubo, Kazuhiro Yamamoto, Saori Matumoto, Kaori Ito, Yuzuka Sasa, Kosuke Tomishima, Satoshi Dote, Katsuya Makihara, Yoshinori Wakasugi, Tsutomu Mitsuie, Kouhei Yamagiwa, Kazuo Sato, Hiroki Hasegawa, Nobuhiko Uoshima, Yumi Kitahiro, Kanji Tomogane","doi":"10.1186/s40780-026-00605-y","DOIUrl":"10.1186/s40780-026-00605-y","url":null,"abstract":"","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of medication alert systems and pharmacist satisfaction: a questionnaire-based study.","authors":"Takashi Omoto, Manato Inagaki, Junichi Asaka, Kenzo Kudo","doi":"10.1186/s40780-026-00611-0","DOIUrl":"10.1186/s40780-026-00611-0","url":null,"abstract":"<p><strong>Background: </strong>As a component of clinical decision support systems, medication alert systems (MAS) play an important role in preventing medication errors. However, their effectiveness is often limited by alert fatigue. Comprehensive data on the implementation and use of specific MAS functions in clinical practice in Japan are limited. Therefore, this study aimed to clarify the implementation of specific MAS functions and identify challenges in real-world use.</p><p><strong>Methods: </strong>This was a questionnaire-based study conducted among pharmacists at 65 hospitals in Iwate Prefecture, Japan. This questionnaire assessed MAS implementation, functionality, and pharmacists' satisfaction with MAS, while distinguishing between alerts for physicians (primary alerts) and pharmacists (secondary alerts). Satisfaction was assessed using a 7-point Likert scale. Responses were summarized using medians and interquartile ranges (IQR).</p><p><strong>Results: </strong>Of the 65 hospitals, 41 responded to the questionnaire (response rate: 63.1%). 85.4% of hospitals implemented a primary alert system, and 80.5% implemented a secondary alert system. Drug-drug contraindication checks were widely implemented for primary and secondary alerts (91.4% and 97.0%, respectively), whereas variations in the implementation of disease contraindication checks and drug allergy checks were observed between primary and secondary alerts (51.4% vs. 33.3%, and 91.4% vs. 36.4%, respectively). The median overall satisfaction score among pharmacists for secondary alerts was 5 (IQR: 3-5). Lower satisfaction scores were observed for disease contraindication (median: 2; IQR: 1.5-4) and drug allergy checks (median: 2.5; IQR: 2-3.5). Excessive alerts, discrepancies between alert content and clinical judgment, and system-related limitations were the most common reasons for dissatisfaction.</p><p><strong>Conclusions: </strong>Although MAS were widely implemented, variations in alert functions and their use were observed across hospitals and between physicians and pharmacists. Pharmacists commonly reported excessive alerts, discrepancies between alert results and clinical judgment, and system-related limitations as reasons for dissatisfaction. Lower satisfaction was observed for disease contraindication and drug allergy checks, suggesting that these functions require further improvement. These findings highlight the need to optimize alert settings, improve system integration, and enhance the clinical relevance of alerts. Addressing these challenges may help promote the effective use of MAS and improve medication safety in clinical practice.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-onset duodenal perforation during bevacizumab-containing chemotherapy in a patient with ovarian cancer: a case report.","authors":"Satoshi Nagase, Keisuke Taguchi, Takanori Yoshida, Shokei Matsumoto, Yoko Toda, Hiroshi Kanno","doi":"10.1186/s40780-026-00608-9","DOIUrl":"https://doi.org/10.1186/s40780-026-00608-9","url":null,"abstract":"<p><strong>Background: </strong>Bevacizumab-induced gastrointestinal perforation is a potentially fatal adverse event. However, duodenal perforations are rare. Conversely, patients with cancer often have concomitant rheumatoid arthritis and may be treated with a combination of anti-rheumatic drugs and symptomatic medications; however, the effects of these concomitant medications on bevacizumab-related perforation remain understudied. This report describes the case of a patient with ovarian cancer and a history of anti-rheumatic drug treatment who developed early-onset duodenal perforation during bevacizumab-containing chemotherapy, highlighting the importance of assessing the risk of duodenal perforation and the provision of multidisciplinary management.</p><p><strong>Case presentation: </strong>The patient was a woman in her 50s with ovarian cancer that metastasized to the para-aortic lymph nodes. She was diagnosed with platinum-sensitive recurrence, and combination therapy with gemcitabine, carboplatin, and bevacizumab was initiated. She was also taking iguratimod and methotrexate for rheumatoid arthritis treatment. The patient developed sudden abdominal pain during the second course of chemotherapy and presented to the emergency department. A computed tomography (CT) scan revealed free gas, raising the suspicion of gastrointestinal perforation. Emergency laparotomy confirmed a duodenal perforation that was surgically covered with the ligamentum teres hepatis. A perforation of <1 cm was found in the anterior wall of the duodenal bulb, but the postoperative course was uneventful. The patient was discharged on postoperative day 7 and continued chemotherapy without bevacizumab. Postoperative upper endoscopy revealed an H2 stage ulcer.</p><p><strong>Conclusions: </strong>When administering bevacizumab to patients with ovarian cancer and multiple perforation risk factors, careful consideration should be given to evaluating existing ulcers, appropriately using concomitant medications, and modifying perforation risk factors to avoid serious adverse events. Therefore, collaboration between a multidisciplinary team, including oncologists, rheumatologists, and pharmacists, is crucial for appropriate drug use and continuous monitoring.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability evaluation of the Functional Assertiveness Scale for community pharmacists: a cross-sectional study.","authors":"Mitsuaki Ishii, Sachiko Ozone, Shoichi Masumoto, Reiko Mizutani, Toshinari Mitsuoka","doi":"10.1186/s40780-026-00609-8","DOIUrl":"https://doi.org/10.1186/s40780-026-00609-8","url":null,"abstract":"<p><strong>Background: </strong>Interprofessional collaboration between physicians and pharmacists is important for ensuring medication safety. Community pharmacists play a vital role in this process through prescription recommendations to physicians. Assertiveness, defined as a communication style that attempts to enhance mutual understanding while respecting both oneself and others, is recognized as useful for making prescription recommendations. Based on the concept of assertiveness, \"functional assertiveness,\" which focuses on achieving tasks while maintaining interpersonal relationships, has been proposed and the Functional Assertiveness Scale (FAS) was developed to evaluate it. Although functional assertiveness has been reported to be useful for achieving the task of ensuring medication safety while maintaining professional relationships with physicians, its applicability to community pharmacists has not been verified. This study aimed to investigate the reliability and validity of the FAS for Japanese community pharmacists and evaluate its utility.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using an online questionnaire targeting 2,190 community pharmacists between July and September 2025. Structural validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed using Cronbach's α coefficient. Construct validity was verified by calculating Spearman's rank correlation coefficients between FAS scores and the Assertive Self-expression (AS) score of the Interprofessional Assertiveness Scale.</p><p><strong>Results: </strong>Analysis was performed on 415 participants (mean age 41.0 years; 54.9% women). EFA confirmed a two-factor structure consistent with the original scale. CFA showed good model fit based on SRMR (0.048); however, CFI (0.893) and TLI (0.867) were slightly below conventional thresholds. Cronbach's α for the total FAS was 0.85, indicating good internal consistency. Construct validity was supported by a significant positive correlation between FAS total score and AS score (rho = 0.34, p < 0.01).</p><p><strong>Conclusions: </strong>FAS demonstrated sufficient reliability and a clear two-factor structure for application among Japanese community pharmacists. Our findings suggest that FAS serves as a useful tool for objectively measuring functional assertiveness among community pharmacists. On the other hand, the CFA results indicate the need for future item optimization specifically tailored to pharmacy practice. Further studies are needed to develop a pharmacist-specific version to contribute to evaluating educational programs and enhance interpersonal communication in pharmacy practice.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Markedly elevated blood concentrations of everolimus during concomitant posaconazole therapy in a liver transplant recipient: a case report.","authors":"Machiko Hirai, Keisuke Umemura, Yoshiki Katada, Yusuke Kojima, Hiroki Ishimura, Yurie Katsube, Daiki Hira, Shoichi Kageyama, Masahiro Tsuda, Shunsaku Nakagawa, Etsuro Hatano, Tomohiro Terada","doi":"10.1186/s40780-026-00610-1","DOIUrl":"https://doi.org/10.1186/s40780-026-00610-1","url":null,"abstract":"<p><strong>Background: </strong>Everolimus (EVL) is widely used as an immunosuppressive agent in combination with calcineurin inhibitors, including tacrolimus (TAC), after liver transplantation. Posaconazole (PSCZ) is a triazole antifungal agent used for the treatment and prophylaxis of invasive fungal infections. Because PSCZ is a potent inhibitor of cytochrome P450 (CYP) 3A4, clinically significant drug-drug interactions with CYP3A substrates may occur. Although both EVL and TAC are primarily metabolized by CYP3A4, quantitative clinical data regarding the relationship between EVL and PSCZ remain limited.</p><p><strong>Case presentation: </strong>We report the case of a living-donor liver transplant patient receiving EVL and TAC who was treated with PSCZ for suspected allergic bronchopulmonary mycosis. During PSCZ therapy, the concentration/dose (C/D) ratios of EVL and TAC increased by approximately 15-fold and 6-fold, respectively. The PSCZ trough concentration reached 8.8 µg/mL, and the serum potassium level decreased 2.5 mmol/L. Both the magnitude of increase in TAC exposure and increase in EVL exposure were more pronounced than those reported previously. Excessive PSCZ exposure may have augmented CYP3A inhibition, and the greater dependence of EVL metabolism on CYP3A compared to TAC likely contributed to the marked elevation in EVL exposure.</p><p><strong>Conclusions: </strong>This case suggests that the drug-drug interaction between EVL and PSCZ may be more pronounced than that between TAC and PSCZ in certain cases with high PSCZ concentrations. When PSCZ is co-administered with EVL, close monitoring of the EVL concentration is recommended. Therapeutic drug monitoring of PSCZ may also be considered in selected cases to optimize safety and avoid excessive exposure, particularly when adverse events are suspected or clinically significant drug-drug interactions are anticipated.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An eight-year national follow-up study on the employment trajectories of early-career pharmacists in Japan up to 2020.","authors":"Takahito Ando, Takeru Shiroiwa, Shinobu Imai, Kiyohide Fushimi, Masato Yasuhara","doi":"10.1186/s40780-026-00602-1","DOIUrl":"https://doi.org/10.1186/s40780-026-00602-1","url":null,"abstract":"<p><strong>Background: </strong>Geographic and sectoral maldistribution of pharmacists has become a critical challenge for Japan's healthcare system. While the number of community pharmacists continues to rise, the chronic shortage of hospital pharmacists persists. This study aimed to clarify longitudinal career trajectories, inter-sector mobility, and predictors of leaving employment among early‑career pharmacists in Japan, using nationwide census‑based data covering all licensed pharmacists.</p><p><strong>Methods: </strong>We conducted an eight‑year longitudinal cohort study using individual‑level data from the Statistics of Physicians, Dentists and Pharmacists from 2012 to 2020. The cohort included 7,242 pharmacists (3,458 men and 3,784 women) who obtained their pharmacist license in 2011-2012 and were continuously identified in all five survey waves. Employment sectors were categorized into 10 groups. Using generalized estimating equations (GEE), we analyzed the odds of being \"unemployed\" (defined as having no institutional affiliation), adjusting for gender, survey year, and age.</p><p><strong>Results: </strong>At baseline (2012), hospital and community pharmacists accounted for 84.6% of the cohort. By 2020, the proportion of community pharmacists had increased, whereas the proportion of hospital pharmacists had substantially declined. Among those initially employed in hospitals, 34.5% left the hospital sector within eight years, and 83.6% of these individuals transitioned to community pharmacies. In contrast, 88.9% of community pharmacists remained in the same sector throughout the study period. The proportion unemployed among men remained below 1.0%, while the rate among women increased from 0.4% to 3.7%. GEE analysis demonstrated that women had a significantly higher ratio of being unemployed over time compared with men, independent of age (adjusted odds ratio 1.203, 95% CI: 1.118-1.293, p < 0.001).</p><p><strong>Conclusions: </strong>A substantial outflow from hospitals to community pharmacies was observed among early‑career pharmacists in Japan, suggesting that the hospital pharmacist shortage results not only from recruitment challenges but also from significant retention issues during the career continuation process. Additionally, women exhibited a distinctively higher ratio of career interruption. Policies that enhance retention through incentives for specialization in hospitals, along with targeted support for women's career continuity, are essential for sustaining the pharmacist workforce.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of community pharmacists' knowledge, attitudes, awareness, and practice-related responses regarding oral anticoagulants in the Northern West Bank, Palestine: a cross-sectional study.","authors":"Hanan M Alayyad, Saja W Abu Arqoub, Malak A Abuobaid, Lina H Amer, Amer A Koni, Dania Abuhalima, Samah W Al-Jabi, Banan M Aiesh, Sa'ed H Zyoud","doi":"10.1186/s40780-026-00607-w","DOIUrl":"https://doi.org/10.1186/s40780-026-00607-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Oral anticoagulants, including warfarin and direct oral anticoagulants (DOACs), are widely used for the prevention and treatment of thromboembolic disorders. Community pharmacists are accessible healthcare professionals who may support safe use through counselling on adherence, interactions, adverse effects, and monitoring requirements. This study assessed community pharmacists' knowledge, attitudes, awareness, and practice-related responses regarding warfarin and DOACs and examined factors associated with knowledge scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study was conducted among community pharmacists working in the northern West Bank, Palestine, between October 2022 and March 2023. A total of 340 pharmacists were approached, and 329 completed the questionnaire (response rate: 96.8%). Data were collected using a structured 70-item questionnaire covering sociodemographic and professional characteristics, knowledge, awareness and attitudes, and practice-related items. Descriptive statistics were used to summarize participant characteristics and questionnaire responses. Knowledge scores were compared across subgroups using Mann-Whitney U and Kruskal-Wallis tests, and multivariable linear regression was used to examine independent associations with knowledge scores. A p value &lt; 0.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 329 pharmacists with a mean age of 33.64 years; 70.5% were women and 80.9% held a bachelor's degree in pharmacy. Warfarin (Coumadin 5 mg) was available in 87.8% of participating pharmacies. Across knowledge items, 49.1% of responses were correct. Only 48.6% correctly recognized that missing a single DOAC dose could worsen a patient's condition, and 49.2% selected \"do not know\" regarding the interaction of apixaban or rivaroxaban with St. John's wort. For warfarin, 84.8% recognized potential dietary interactions and 84.2% recognized the importance of international normalized ratio (INR) monitoring, whereas only 35.3% identified vitamin K as a reversal option for excessive warfarin anticoagulation or bleeding. In univariable analyses, no statistically significant differences in knowledge scores were observed according to sociodemographic or professional characteristics (all p &gt; 0.05). Consistent with these findings, the multivariable model was not statistically significant, and no independent predictors of knowledge score were identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Community pharmacists in the northern West Bank showed suboptimal knowledge regarding oral anticoagulants, with important gaps related to DOAC reversal agents, drug and herbal interactions, and missed-dose counselling. No independent predictors of knowledge score were identified, suggesting that educational needs are broadly distributed among pharmacists. Targeted continuing education focused on practical anticoagulant counselling and medication-safety issues ","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syndrome of inappropriate antidiuretic hormone secretion following immune effector cell-associated neurotoxicity syndrome during blinatumomab therapy: a case report.","authors":"Misato Yoshihara, Satoshi Yuyama, Osamu Yasumuro, Ryohkan Funakoshi","doi":"10.1186/s40780-026-00606-x","DOIUrl":"https://doi.org/10.1186/s40780-026-00606-x","url":null,"abstract":"<p><strong>Background: </strong>Blinatumomab (BLINA) causes immune-related toxicities, such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS). Although hyponatremia associated with interleukin (IL)-6-mediated vasopressin secretion has been reported with chimeric antigen receptor T-cell therapy, similar reports with bispecific antibodies are scarce.</p><p><strong>Case presentation: </strong>A woman in her 60s with B-cell acute lymphoblastic leukemia developed grade 3 ICANS on day 3 of the second BLINA cycle. On day 13, the patient experienced grade 4 hyponatremia (serum sodium, 106 mmol/L). Treatment with 3% saline and tolvaptan improved symptoms. No other causes, such as central nervous system disease, adrenal insufficiency, or thyroid dysfunction, were identified. Based on the clinical findings and the exclusion of other etiologies, BLINA-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) was diagnosed. After confirming a decrease in IL-6 levels, tolvaptan was tapered and discontinued, and no recurrence of hyponatremia was observed.</p><p><strong>Conclusions: </strong>BLINA may be involved in SIADH development, potentially via increased central IL-6 levels following ICANS treatment, which may promote arginine vasopressin secretion. In patients who develop ICANS during BLINA therapy, close monitoring of serum sodium levels may be a useful part of neurological assessment. If hyponatremia occurs, clinicians should promptly consider SIADH and initiate the appropriate management.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum KL-6 and eGFR predict everolimus-associated KL-6 elevation in heart transplant recipients: a retrospective observational study.","authors":"Yuhei Suzuki, Toyohito Oriyama, Takehito Yamamoto, Masaru Hatano, Eisuke Amiya, Masaki Tsuji, Chie Bujo, Norihiko Takeda, Masahiko Ando, Minoru Ono, Tappei Takada","doi":"10.1186/s40780-026-00603-0","DOIUrl":"https://doi.org/10.1186/s40780-026-00603-0","url":null,"abstract":"<p><strong>Background: </strong>Everolimus (EVR), which is widely used in heart transplant recipients, has been associated with drug-induced lung injury. Although EVR-associated lung injury has been reported in patients with malignancies and recipients of other solid organ transplants, its incidence and risk factors in heart transplant recipients remain unclear. Krebs von den Lungen-6 (KL-6) is a serum biomarker widely used in the assessment of interstitial lung diseases and may reflect pulmonary involvement, including drug-induced lung injury. This study aimed to determine the incidence and risk factors for KL-6 elevation after EVR administration in heart transplant recipients.</p><p><strong>Methods: </strong>This retrospective observational study included patients who received a heart transplant at the University of Tokyo Hospital from June 2006 to April 2021. The patients were categorized into two groups: those who received EVR after heart transplantation (EVR group) and those who did not (non-EVR group). Multivariable logistic regression analysis was performed in the EVR group to identify independent risk factors for KL-6 elevation (defined as a peak level ≥ 500 U/mL). Receiver operating characteristic (ROC) analysis was used to determine optimal cutoff values, and a composite risk score was constructed. Event-free survival was evaluated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Seventy-three patients were included (58 in the EVR group and 15 in the non-EVR group). Peak serum KL-6 levels were significantly higher in the EVR group than in the non-EVR group (320 [235-509] vs. 157 [127-263] U/mL, p = 0.002). KL-6 elevation occurred in 27.6% and 6.7% of patients in the EVR and non-EVR groups, respectively. Within the EVR group, higher baseline KL-6 levels and lower eGFR were independently associated with KL-6 elevation. ROC analysis identified cutoff values of baseline KL-6 > 268 U/mL and eGFR < 60 mL/min/1.73 m². Higher composite risk scores were associated with a greater incidence of KL-6 elevation, and patients with both risk factors experienced earlier KL-6 elevation.</p><p><strong>Conclusions: </strong>EVR administration was associated with KL-6 elevation in heart transplant recipients. Elevated baseline KL-6 levels and impaired renal function before EVR initiation were independent predictors of KL-6 elevation. Assessment of these parameters may help earlier detection of EVR-associated KL-6 elevation.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk modifiers of immune-related adverse events in patients with NSCLC undergoing immunotherapy: a retrospective cohort study.","authors":"Takashi Watanabe, Naoto Suzuki, Masahito Yamauchi, Naoki Iinuma, Makoto Shiozawa, Yotaro Arima, Takanobu Sasaki, Hideki Shimodaira, Syu-Ichi Kanno, Kouji Okada","doi":"10.1186/s40780-026-00604-z","DOIUrl":"https://doi.org/10.1186/s40780-026-00604-z","url":null,"abstract":"<p><strong>Background: </strong>To investigate immune-related adverse events (irAEs) in patients with non-small cell lung cancer receiving immune checkpoint inhibitor (ICI) therapy, and to identify clinical factors associated with irAE onset, thus supporting safer immunotherapy through effective monitoring.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at Tohoku Medical and Pharmaceutical University Hospital over approximately 5 years. Hospitalized patients with non-small cell lung cancer who received immune checkpoint inhibitors for the first time were included. Physicians and pharmacists evaluated the occurrence, severity, and timing of irAEs. Cox proportional hazards regression and Fine-Gray competing risk analyses were performed to identify factors associated with irAE development.</p><p><strong>Results: </strong>Among the 203 enrolled patients, 92 (45.3%) experienced irAEs, totaling 110 events. The most common irAE was interstitial lung disease (23 cases, 20.9%), followed by thyroid dysfunction (20 cases, 18.2%). In multivariable Cox regression analysis, comorbid heart failure was significantly associated with a reduced risk of irAE development (hazard ratio, 0.299; 95% confidence interval [CI], 0.135-0.663; p = 0.003), and this association remained significant in the Fine-Gray competing risk model (subdistribution hazard ratio, 0.335; 95% CI, 0.147-0.766; p = 0.009). To address potential multicollinearity, an alternative model incorporating regular use of renin-angiotensin-aldosterone system inhibitors in place of comorbid heart failure also demonstrated a significant association with irAE incidence.</p><p><strong>Conclusions: </strong>In this Japanese non-small cell lung cancer cohort, comorbid heart failure emerged as a potential modifier of irAE incidence, suggesting that baseline cardiac conditions may influence susceptibility to immune‑related toxicity. These findings underscore the importance of incorporating comorbidity profiles into individualized irAE monitoring strategies during cancer immunotherapy.</p>","PeriodicalId":16730,"journal":{"name":"Journal of Pharmaceutical Health Care and Sciences","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}