Pharmacotherapy最新文献

{"title":"Efficacy and safety of factor Xa inhibitors in low body weight patients.","authors":"Yingcong Tan, Cynthia Hubbard, Holly Owens, James Pitt, Christopher Giuliano, Bradley Haan, Thomas Breeden, Dumitru Sirbu, Kelsey Pena, Trevlyn Haddox, Stephanie B Edwin","doi":"10.1002/phar.2888","DOIUrl":"10.1002/phar.2888","url":null,"abstract":"<p><strong>Study objective: </strong>The purpose of this study is to provide evidence for the safety and efficacy of factor Xa inhibitors in patients with a weight ≤60 kg or BMI < 18.5 kg/m² .</p><p><strong>Design: </strong>Multicenter, retrospective, cohort study.</p><p><strong>Setting: </strong>Twenty-two Ascension Health hospitals.</p><p><strong>Patients: </strong>Low-body-weight adult patients (weight ≤ 60 kg or BMI < 18.5 kg/m² ) receiving treatment for atrial fibrillation or venous thromboembolism.</p><p><strong>Intervention: </strong>Factor Xa inhibitors (apixaban or rivaroxaban) or warfarin.</p><p><strong>Measurements and main results: </strong>This study included 2538 patients between the factor Xa inhibitors (n = 1695) and warfarin (n = 843) groups with a mean weight of 53.5 ± 5.5 kg and BMI of 20.7 ± 3.1 kg/m² . No significant difference in time to major bleeding was noted after controlling for potential confounders (HR 1.03, 95% CI 0.70-1.53, p = 0.87); similar results were seen following propensity score matching. Thromboembolism (5.3% vs. 6.2%, p = 0.38), composite major + clinically relevant nonmajor bleeding (9.8% vs. 11.5%, p = 0.18), and all-cause mortality (10.7% vs. 12.8%, p = 0.12) were similar between patients receiving factor Xa inhibitors versus warfarin.</p><p><strong>Conclusion: </strong>No differences in safety or effectiveness were noted between factor Xa inhibitors versus warfarin. These findings provide encouraging evidence to support the use of factor Xa inhibitors in low-body-weight patients.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71484925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comment on \"International consensus recommendations for the use of prolonged-infusion β-lactams endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of American (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists\".","authors":"Lisa T Hong, Kevin J Downes, Alireza FakhriRavari, Jacinda C Abdul-Mutakabbir, Joseph L Kuti, Sarah Jorgensen, David C Young, Mohammad H Alshaer, Matteo Bassetti, Robert A Bonomo, Mark Gilchrist, Soo Min Jang, Thomas Lodise, Jason A Roberts, Thomas Tängdén, Athena Zuppa, Marc H Scheetz","doi":"10.1002/phar.2907","DOIUrl":"10.1002/phar.2907","url":null,"abstract":"","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect.","authors":"Shupeng Zou, Mengling Ouyang, Qian Cheng, Xuan Shi, Minghui Sun","doi":"10.1002/phar.2899","DOIUrl":"10.1002/phar.2899","url":null,"abstract":"<p><strong>Background and aims: </strong>Acid-suppressive drugs (ASDs) are widely used in many gastric acid-associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton-pump inhibitors (PPIs) and H₂ -receptor antagonists (H2RAs). Potassium-competitive acid blockers (P-CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid-inhibitory effects, using a network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>To compare the effectiveness of major ASDs, a Bayesian network meta-analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA).</p><p><strong>Results: </strong>Fifty-five RCTs were conducted with 2015 participants. In terms of nocturnal acid-inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB.</p><p><strong>Conclusions: </strong>This is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid-inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover-RCT), age (≤40 years), BMI (18.5-24.9 kg/m² ), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night-time), the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the safety and tolerability of intravenous undiluted levetiracetam at a pediatric institution.","authors":"Lily Price, Lisa Garrity, Sarah Stiehl","doi":"10.1002/phar.2898","DOIUrl":"10.1002/phar.2898","url":null,"abstract":"<p><strong>Study objective: </strong>Recent studies suggest rapid administration of high-dose, undiluted levetiracetam is safe in adults; however, no information exists in pediatric patients. The purpose of this study was to evaluate the safety and tolerability of undiluted levetiracetam at a pediatric institution.</p><p><strong>Design: </strong>Retrospective, single-center, cohort study.</p><p><strong>Setting: </strong>Pediatric Academic Medical Center.</p><p><strong>Patients: </strong>All patients who received high-dose >60 mg/kg (-10%) up to 4500 mg undiluted or diluted intravenous levetiracetam were included.</p><p><strong>Intervention: </strong>Rapid intravenous administration of undiluted versus diluted levetiracetam.</p><p><strong>Measurements and main results: </strong>A total of 776 levetiracetam doses were included, 358 doses administered and 418 doses wasted. The doses administered (61 undiluted and 297 diluted) accounted for a total of 252 patients (39 received undiluted, and 213 received diluted levetiracetam) (median [minimum-maximum range] age, 2 years [1 day to 32.7 years]; mean (standard deviation [SD]) weight, 20.1 kg [22.1 kg]). The incidence of hemodynamic disturbances and infusion-related reactions was not statistically significant between undiluted (24.6%) and diluted (26.3%) groups (p = 0.87). The median (interquartile range [IQR]) time difference between first-line antiseizure medication and levetiracetam administration in patients with status epilepticus was 18 min (10.5-30.5) in the undiluted group versus 36.5 min (21.8-67.3) in the diluted group (p < 0.01). Additionally, there was a significant amount of drug waste from dispensed but not administered doses of the diluted bag compared to undiluted vials (57.6% diluted vs. 18.7% undiluted, p < 0.001).</p><p><strong>Conclusion: </strong>Undiluted levetiracetam was not associated with an increased incidence of adverse effects compared to diluted levetiracetam in high-doses, up to 4500 mg given over 5 min in pediatric patients.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of risdiplam in spinal muscular atrophy: A systematic review and meta-analysis.","authors":"Carlos Pascual-Morena, Vicente Martínez-Vizcaíno, Iván Cavero-Redondo, Irene Martínez-García, Nerea Moreno-Herráiz, Celia Álvarez-Bueno, Alicia Saz-Lara","doi":"10.1002/phar.2866","DOIUrl":"10.1002/phar.2866","url":null,"abstract":"<p><p>This systematic review and meta-analysis aimed to assess the efficacy and safety of risdiplam on motor and respiratory function in spinal muscular atrophy (SMA). We systematically searched Medline, Scopus, Web of Science, and the Cochrane Library from inception to March 2023. We included pre-post studies that determined the effect of risdiplam on the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), the 32-item Motor Function Measure (MFM32), the Revised Upper Limb Module (RULM), the Hammersmith Functional Motor Scale - Expanded (HFMSE), respiratory function, and the proportion of risdiplam-related adverse events in a population with SMA (phenotypes 1 and 2/3). Meta-analyses were also performed where possible. Eleven studies were included. After 12 months of treatment, 57% of participants with SMA1 achieved a CHOP-INTEND score ≥ 40 points, and more than half were able to feed orally and had head control. In SMA2/3, MFM32, RULM, and HFMSE increased by 2.09 (1.17, 3.01), 1.73 (1.25, 2.20), and 1.00 (0.40, 1.59) points, respectively. Efficacy on respiratory function in SMA2/3 was inconsistent. Finally, 16% of participants experienced adverse events, but serious adverse events could not be quantified due to a lack of cases. The limited available evidence suggests that risdiplam is an effective and safe drug for the treatment of SMA. In addition, long-term clinical benefit may be partly determined by the stage of disease at which treatment is initiated.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10021397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid resuscitation and relation to respiratory support escalation in patients with and without pulmonary hypertension with sepsis.","authors":"Mary J Fronrath, Laura Hencken, Carolyn R Martz, Bryan Kelly, Zachary R Smith","doi":"10.1002/phar.2879","DOIUrl":"10.1002/phar.2879","url":null,"abstract":"<p><strong>Study objective: </strong>To compare guideline-based fluid resuscitation and need for respiratory support escalation in septic patients with pulmonary hypertension (PH) to those without PH.</p><p><strong>Design: </strong>Single-center, retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary care academic medical center in Detroit, Michigan.</p><p><strong>Patients: </strong>Adult patients with or without PH hospitalized and diagnosed with sepsis from November 1, 2013 through December 31, 2019. Patients with sepsis were assigned to one of two groups based on a previous PH diagnosis or no PH diagnosis.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was incidence of respiratory support escalation within 72 h from sepsis time zero. Respiratory support escalation included high-flow nasal cannula, bilevel positive airway pressure, or intubation. One-hundred and four patients were included with 52 patients in each study group. Patients with PH were more likely to require escalation of respiratory support compared to non-PH patients (32.7% vs. 11.5%; p = 0.009). Fewer patients with PH received 30 mL/kg of crystalloid within 6 h of time zero compared with non-PH patients (3.8% vs. 42.3%; p < 0.001). Vasopressor initiation was more common in patients with PH compared with the non-PH group (40.4% vs. 19.2%; p = 0.018). PH diagnosis was the only independent predictor of respiratory support escalation.</p><p><strong>Conclusions: </strong>During initial sepsis management when compared with patients without PH, patients with PH had increased instances of respiratory support escalation within 72 h of sepsis time zero despite lower fluid resuscitation volumes.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41126411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroquinolone-associated adverse events of interest among hospitalized veterans affairs patients with community-acquired pneumonia who were treated with a fluoroquinolone: A focus on tendonitis, Clostridioides difficile infection, and aortic aneurysm.","authors":"Nimish Patel, Allison Gorseth, Gina Belfiore, Nicholas Stornelli, Colleen Lowry, Lodise Thomas","doi":"10.1002/phar.2877","DOIUrl":"10.1002/phar.2877","url":null,"abstract":"<p><strong>Study objective: </strong>The objectives of this study were to (i) quantify the incidence of three concerning fluoroquinolone adverse events of interest (FQAEI, i.e., adverse tendon event (TE), clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), (ii) identify the patient-level factors that predict these events, and (iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Upstate New York Veterans' Healthcare Administration from 2011 to 2016.</p><p><strong>Patients: </strong>Hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011 to 2016.</p><p><strong>Intervention: </strong>N/A.</p><p><strong>Measurements: </strong>The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI.</p><p><strong>Main results: </strong>The study population consisted of 1071 patients. The overall incidence of FQAEI, TE, AAD, and CDI was 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous healthcare exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI.</p><p><strong>Conclusions: </strong>Individual frequencies of three important FQAEIs were quantified, and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum potassium response to single-dose sodium zirconium cyclosilicate for the treatment of asymptomatic hyperkalemia in hospitalized patients.","authors":"Haley Lewis, Benton Stamper, Alyssa Claudio Yungkurth","doi":"10.1002/phar.2854","DOIUrl":"10.1002/phar.2854","url":null,"abstract":"<p><strong>Study objective: </strong>To assess the efficacy of single-dose sodium zirconium cyclosilicate (SZC) compared to the FDA approved three times daily (TID) dosing and to single-dose sodium polystyrene sulfonate (SPS) for the management of asymptomatic hyperkalemia in hospitalized patients.</p><p><strong>Design: </strong>Single-center retrospective chart review.</p><p><strong>Setting: </strong>University of Florida Health Jacksonville, a 695-bed academic medical center in Jacksonville, FL, between June 15, 2018 and August 15, 2021.</p><p><strong>Patients: </strong>Three hundred fifty-one adult patients who were admitted to any hospital unit in the specified timeframe and received one of three interventions for asymptomatic hyperkalemia (serum potassium ≥4.7 mmol/L) were included in this study.</p><p><strong>Intervention: </strong>The interventions compared were single-dose SZC 10 g, SZC 10 g × 3 doses (30 g total) within 24 h, or SPS 15-30 g once.</p><p><strong>Measurements and main results: </strong>The primary outcome was the proportion of patients achieving normokalemia (K⁺ 3.3-4.6 mmol/L) within 12-30 h of the first study dose. Secondary outcomes included average change in potassium within 12-30 h and 3-54 h from the first dose. The primary outcome was met in 68 patients (58.1%) in the SZC 10 g group, 51 (43.6%) in the SZC 10 g × 3 doses group, and 81 (69.2%) in the SPS 15-30 g group (p < 0.01). The average reduction in potassium in 12-30 h was 0.70 mmol/L, 0.78 mmol/L, and 0.99 mmol/L in the SZC 10 g, SZC 10 g × 3 doses, and SPS 15-30 g groups, respectively (p < 0.01).</p><p><strong>Conclusions: </strong>SZC 10 g once resulted in more patients achieving normokalemia compared to SZC 10 g × 3 doses but less than SPS (p < 0.01). Single-dose SZC may be a reasonable option to manage asymptomatic hyperkalemia in the hospital setting, but achieving normokalemia with one dose may be less likely in patients with higher baseline potassium concentrations and impaired renal function.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9878609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin removal and pharmacokinetics during accelerated venovenous hemofiltration.","authors":"Natasha D Lopez, Michael Griggs, Jonathan H Sin, Russel J Roberts, Andrew S Allegretti","doi":"10.1002/phar.2885","DOIUrl":"10.1002/phar.2885","url":null,"abstract":"<p><strong>Introduction: </strong>Vancomycin pharmacokinetics are affected by renal replacement therapy and physiologic changes in critically ill patients. Literature regarding vancomycin removal and pharmacokinetics during accelerated venovenous hemofiltration (AVVH), a form of prolonged intermittent renal replacement therapy, is limited.</p><p><strong>Objective: </strong>To describe the removal and pharmacokinetics of vancomycin during AVVH.</p><p><strong>Methods: </strong>Eighteen critically ill adults receiving vancomycin and AVVH were included. Vancomycin serum concentrations were obtained within 4 h before and 2-6 h after the AVVH session. Patients' serum concentrations were plotted against time, and individual pharmacokinetic parameters were determined by a one-compartmental analysis. Continuous data are reported as a median (interquartile range [IQR]) and categorical data as a percentage.</p><p><strong>Results: </strong>The median AVVH effluent rate was 39.3 mL/kg/h (IQR 35.5-48 mL/kg/h) for a duration of 9 h (IQR 8-9.75 h). AVVH decreased vancomycin concentrations by 29.8% (IQR 24.9%-35.9%), at a rate of 3.4% per hour (IQR 3.1%-4.3% per hour) of AVVH. The vancomycin elimination rate constant and half-life were 0.039 h^-1 (IQR 0.036-0.053 h^-1 ) and 17.6 h (IQR 13.1-18.8 h), respectively. The area under the curve during AVVH was 171.7 mg*h/L (IQR 149.1-190 mg*h/L). The volume of distribution in 10 patients was 1 L/kg (IQR 0.73-1.1 L/kg). After AVVH, vancomycin 1000 mg (IQR 750-1000 mg) was needed to maintain a serum trough concentration ≥15 mg/L.</p><p><strong>Conclusion: </strong>Vancomycin is significantly removed by AVVH, which requires supplemental dosing after completion of the AVVH session to maintain desired serum concentrations. Therapeutic drug monitoring of vancomycin serum concentrations is recommended for patients undergoing AVVH.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41105924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a model to predict acute kidney injury following high-dose methotrexate in patients with lymphoma.","authors":"Mikhaila L Rice, Erin F Barreto, Andrew D Rule, Catherine E Martin, Huong L Truong, Kristin C Mara, Kianoush B Kashani, Carrie A Thompson, Thomas E Witzig, Jason N Barreto","doi":"10.1002/phar.2889","DOIUrl":"10.1002/phar.2889","url":null,"abstract":"<p><strong>Study objective: </strong>To develop and validate a model for predicting acute kidney injury (AKI) after high-dose methotrexate (HDMTX) exposure.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Setting: </strong>Multisite integrated health system throughout Minnesota and Wisconsin.</p><p><strong>Patients: </strong>Adult patients with lymphoma who received HDMTX as a 4-h infusion.</p><p><strong>Measurements and main results: </strong>LASSO methodology was used to identify factors available at the outset of therapy that predicted incident AKI within 7 days following HDMTX. The model was then validated in an independent cohort. The incidence of AKI within 7 days following HDMTX was 21.6% (95% confidence interval (CI) 18.4%-24.8%) in the derivation cohort (435 unique patients who received a total of 1642 doses of HDMTX) and 15.6% (95% CI 5.3%-24.8%) in the validation cohort (55 unique patients who received a total of 247 doses of HDMTX). Factors significantly associated with AKI after HDMTX in the multivariable model included age ≥ 55 years, male sex, and lower HDMTX dose number. Other factors that were not found to be significantly associated with AKI on multivariable analysis, but were included in the final model, were body surface area, Charlson Comorbidity Index, and estimated glomerular filtration rate. The c-statistic of the model was 0.72 (95% CI 0.69-0.75) in the derivation cohort and 0.72 (95% CI 0.60-0.84) in the validation cohort.</p><p><strong>Conclusion: </strong>This model utilizing identified sociodemographic and clinical factors is predictive of AKI following HDMTX administration in adult patients with lymphoma.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71484924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}