Annals of Pharmacotherapy最新文献

{"title":"Comparative Dose Response of Diazepam, Lorazepam, and Phenobarbital for Alcohol Withdrawal in the Emergency Department.","authors":"Jacob A Lebin, Elizabeth M Goldberg, Kathryn F Hawk, Ellen L Burnham, Jason A Hoppe","doi":"10.1177/10600280251364898","DOIUrl":"10.1177/10600280251364898","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"521-523"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032539","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":"Retrospective, Single-Center Cohort Study of Bivalirudin Compared to Unfractionated Heparin in Patients Receiving Extracorporeal Membrane Oxygenation.","authors":"Thomas Lofy, Janelle Juul, Brittney Duewell, Stephanie Tchen, Bethanne Held-Godgluck, Ruta Brazauskas, Joel Feih","doi":"10.1177/10600280251371081","DOIUrl":"10.1177/10600280251371081","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO), a form of temporary mechanical circulatory support, causes a prothrombotic state due to activation of inflammatory processes via exposure of blood to the circuit. Systemic anticoagulation is recommended to prevent thrombosis. Unfractionated heparin (UFH) and direct thrombin inhibitors (DTIs) are anticoagulant agents that inactivate thrombin; however, UFH requires antithrombin III (ATIII) for its activity, and patients supported by ECMO are at risk for acquired ATIII deficiency. In addition, heparin may cause heparin-induced thrombocytopenia, complicating therapy. Guidelines on anticoagulant use in ECMO reference UFH as a recommended agent with DTIs as an alternative option. Meta-analyses comparing the 2 agents in ECMO have evaluated efficacy and safety; however, discordant results prompt the need for additional research.</p><p><strong>Objective: </strong>The objective of this study is to evaluate differences in bleeding and thrombotic events between UFH and bivalirudin for anticoagulation during ECMO support.</p><p><strong>Methods: </strong>This study is a retrospective, single-center cohort study conducted at a primary ECMO center and a tertiary academic medical center.</p><p><strong>Results: </strong>Bleeding and systemic thrombosis rates were not different between bivalirudin and UFH (30 vs 33 events, hazard ratio [HR] = 0.89; 95% confidence interval [CI] = 0.55-1.47, <i>P</i> = 0.7; 12 vs 17 events, HR = 0.68; 95% CI = 0.32-1.42, <i>P</i> = 0.3); however, when controlled for covariates, device thrombosis was lower with bivalirudin (30.2% vs 43.4%, <i>P</i> = 0.017). Time in therapeutic range (TTR) was higher with bivalirudin (69.98% vs 55.5%, <i>P</i> < 0.001).</p><p><strong>Conclusion and relevance: </strong>When compared to heparin, bivalirudin for anticoagulation in ECMO was associated with a decreased rate of device thrombosis and greater TTR.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"455-465"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237749","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":"Safety Evaluation of Weight-Tiered, Anti-Xa-Guided Versus Fixed-Dose Enoxaparin Prophylaxis in Traumatic IntraCranial Hemorrhage (SAFE-ICH): A Retrospective Cohort Study.","authors":"Brittany Michele Curran, Carolyn D Philpott, Madeline Foertsch, Christopher A Droege, Kiranpal Sangha, Lauren M Dehne, Laura B Ngwenya, Amy T Makley, Molly E Droege","doi":"10.1177/10600280251366325","DOIUrl":"10.1177/10600280251366325","url":null,"abstract":"<p><strong>Background: </strong>Traumatic intracranial hemorrhage (tICH) increases venous thromboembolism (VTE) risk counterbalanced by a life-threatening bleed in a critical organ space. Weight-tiered and anti-Xa-guided enoxaparin dosing may reduce VTE incidence, but current literature is limited regarding safety in patients with tICH.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the progression of tICH in trauma patients on fixed-dose (FD) versus weight-tiered, anti-Xa-guided enoxaparin for VTE prophylaxis.</p><p><strong>Methods: </strong>This single-center, retrospective study included adult patients admitted to an academic, level 1 trauma center between January 2013 and October 2022. Inclusion criteria were acute tICH and ≥1 prophylactic enoxaparin dose given within 7 days of admission. Groups were FD enoxaparin 30 mg every 12 hours versus weight-tiered, anti-Xa dose-adjusted (DA) enoxaparin per institutional protocols. The primary endpoint was tICH expansion, defined as new or enlarging tICH on computed tomography (CT) or need for neurologic operative intervention within 14 days from chemoprophylaxis initiation. The secondary endpoint compared VTE incidence. A multivariate logistic regression identified risk factors for tICH expansion.</p><p><strong>Results: </strong>A total of 595 patients were included (119 FD; 476 DA). Baseline characteristics were well-matched between groups, including time from stable head CT to chemoprophylaxis initiation. The FD cohort received a lower weight-based dose compared with the DA cohort (0.40 [0.33-0.47] mg/kg/dose vs 0.45 [0.37-0.53] mg/kg/dose, <i>P</i> = 0.001). Traumatic ICH expansion was significantly higher in the FD cohort compared with DA (5 [4.2%] vs 5 [1.1%], <i>P</i> = 0.017). There were similar rates of VTE (2.5% vs 3.6%, <i>P</i> = 0.57) between groups. No independent risk factors were identified for progression of tICH, but higher body mass index was associated with reduced risk.</p><p><strong>Conclusion and relevance: </strong>Higher initial enoxaparin doses and anti-Xa-driven adjustment were not associated with greater rates of tICH expansion in this study, albeit an overall low incidence. These findings highlight the multifactorial nature of TBI and tICH expansion.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"435-446"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249491","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":"Duration of Concurrent Oxycodone and Selective Serotonin Reuptake Inhibitors Use and the Risk of Opioid Overdose.","authors":"Chijioke Okeke, Olajumoke Olateju, Ismaeel Yunusa, Prachet Bhatt, James Douglas Thornton","doi":"10.1177/10600280251372646","DOIUrl":"10.1177/10600280251372646","url":null,"abstract":"<p><strong>Background: </strong>Concurrent use of oxycodone and strong cytochrome P450 2D6 (CYP2D6)-inhibiting selective serotonin reuptake inhibitors (SSRIs), specifically paroxetine and fluoxetine, is associated with the risk of opioid overdose.</p><p><strong>Objective: </strong>This study assessed the association between the duration of concurrent oxycodone and CYP2D6-inhibiting SSRI use and overdose risk.</p><p><strong>Methods: </strong>A retrospective cohort study conducted using the Merative MarketScan claims database from January 1, 2017, to December 31, 2019. Adults aged ≥18 years with private insurance who initiated both oxycodone and SSRIs were included. Patients were grouped as (1) oxycodone with other SSRIs (reference); (2) oxycodone with paroxetine or fluoxetine with <14 days of overlap; and (3) oxycodone with paroxetine or fluoxetine with ≥14 days of overlap. The primary outcome was opioid overdose. Cox proportional hazards models estimated adjusted hazard ratios (HRs), adjusting for demographics, comorbidities, and prior medication use.</p><p><strong>Results: </strong>A total of 97 446 patients met inclusion criteria (mean age 46.4 years; 73.6% female). Among these, 26 967 (27.7%) used oxycodone with CYP2D6-inhibiting SSRIs; 86% of them had <14 days of overlapping therapy. The risk of overdose increased with longer durations of overlapping oxycodone and CYP2D6-inhibiting SSRI use. Compared with patients using other SSRIs, the adjusted HR for opioid overdose was 0.98 (95% CI, 0.65-1.01) for <14 days of concurrent use, and 1.24 (95% CI, 1.03-1.50) for ≥14 days.</p><p><strong>Conclusion and relevance: </strong>Prolonged concurrent use (≥14 days) of oxycodone with paroxetine or fluoxetine was associated with an increased risk of opioid overdose compared with use with other SSRIs.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"425-434"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249423","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":"Toripalimab and Penpulimab: Targeting PD-1 in Recurrent or Metastatic Nasopharyngeal Carcinoma.","authors":"Josie J Hockett, Molly E Keller, David J Reeves","doi":"10.1177/10600280251391430","DOIUrl":"10.1177/10600280251391430","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this review is to evaluate clinical data regarding use of toripalimab and penpulimab use in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) and to assess their impact on patient care.</p><p><strong>Data sources: </strong>A literature search of PubMed, Cochrane library, and clinicaltrials.gov was performed using <i>toripalimab, Loqtorzi, JS001</i>, <i>penpulimab</i>, <i>and AK105</i>.</p><p><strong>Study selection and data extraction: </strong>Inclusion was limited to English-language publications evaluating toripalimab and penpulimab for RM-NPC management.</p><p><strong>Data synthesis: </strong>Toripalimab and penpulimab are the first US Food and Drug Administration (FDA)-approved immune checkpoint inhibitors for RM-NPC. Both agents block the PD-1/PD-L1 interaction between tumor and T cells, enhancing anti-tumor immune responses. In the first-line setting, toripalimab plus chemotherapy achieved a median progression-free survival (PFS) of 21.4 months and overall response rate (ORR) of 78.8%. Penpulimab plus chemotherapy demonstrated a median PFS of 9.6 months and ORR of 68.1%. Toripalimab/chemotherapy was associated with an improved overall survival (hazard ratio [HR] = 0.63, <i>P</i> = .008); penpulimab/chemotherapy overall survival data were not yet mature. As monotherapies, ORRs were 20.5% for toripalimab and 28.0% for penpulimab. Common adverse effects include immune-related adverse effects such as hypothyroidism and rash.Relevance to patient care and clinical practice in comparison to existing drugs:These agents offer crucial new therapeutic options for RM-NPC, previously managed primarily with chemotherapy. The data supporting toripalimab use are currently more mature; however, penpulimab may offer an alternative for patients unable to tolerate cisplatin due being studied in combination with carboplatin.</p><p><strong>Conclusion: </strong>Toripalimab and penpulimab significantly improve outcomes in RM-NPC. Their use is anticipated to expand into additional settings and malignancies as research matures.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"500-511"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647121","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":"Predictive Value of Methicillin-Resistant <i>Staphylococcus aureus</i> Nasal Swab PCR Assay for MRSA Pneumonia in Critically Ill Stroke Patients.","authors":"Mikayla K Gerdes, Jacob P Counts, Hera A Kamdar, Junan Li, Casey C May","doi":"10.1177/10600280251372245","DOIUrl":"10.1177/10600280251372245","url":null,"abstract":"<p><strong>Background: </strong>Ischemic and hemorrhagic strokes are associated with significant morbidity and mortality, with secondary complications such as stroke-associated pneumonia (SAP) contributing to increased mortality rates. Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) is a key pathogen associated with poor outcomes in this patient population. While MRSA polymerase chain reaction (PCR) nasal swabs have demonstrated high negative predictive value (NPV) in other critically ill populations, their diagnostic utility in stroke patients remains uncharacterized.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the diagnostic performance of MRSA PCR nasal swabs in predicting culture-confirmed MRSA pneumonia in critically ill stroke patients.</p><p><strong>Methods: </strong>This single-center, retrospective study included adult neurocritical care patients between January 1, 2018, and July 31, 2024, who had confirmed ischemic or hemorrhagic stroke, inclusive of aneurysmal subarachnoid hemorrhage, and underwent both MRSA PCR nasal swab and lower respiratory culture testing. The primary outcome was to define the NPV, positive predictive value (PPV), sensitivity, and specificity of MRSA PCR nasal swabs in predicting culture-confirmed MRSA pneumonia. Secondary outcomes included defining the NPV, PPV, sensitivity, and specificity of methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA) in predicting culture-confirmed MSSA pneumonia.</p><p><strong>Results: </strong>Four hundred and thirty-seven patients were screened for inclusion, and of those, 299 were included. The MRSA PCR nasal swab demonstrated an NPV of 100% and a PPV of 34.6% with a sensitivity of 100% and a specificity of 94.1% for culture-confirmed MRSA pneumonia. The MSSA PCR nasal swabs yielded an NPV of 96.6% and a PPV of 32.8% with a specificity of 81.6% and a sensitivity of 75.9%.</p><p><strong>Conclusion and relevance: </strong>The MRSA PCR nasal swabs appear to be a highly reliable diagnostic tool for ruling out MRSA pneumonia in critically ill stroke patients. The 100% NPV and 100% sensitivity demonstrate its potential for allowing safe and timely de-escalation of empiric antibiotic therapy targeting MRSA.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"447-454"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249409","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":"Persistence Within 6P Medicine Model Has Value for Clinical Decision Only When Adherence Is Assessed.","authors":"Joaquín Borrás-Blasco, Esther Ramírez-Herráiz, Andrés Navarro-Ruiz","doi":"10.1177/10600280251363950","DOIUrl":"10.1177/10600280251363950","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"528-529"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862019","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":"Reply: Comparative Dose-Response of Diazepam, Lorazepam, and Phenobarbital for Alcohol Withdrawal in the Emergency Department.","authors":"Jacob A Lebin, Elizabeth M Goldberg, Kathryn F Hawk, Ellen L Burnham, Jason A Hoppe","doi":"10.1177/10600280251390918","DOIUrl":"10.1177/10600280251390918","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"526-527"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487474","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":"Re: Evaluation of Symptom-Triggered Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in Trauma-Surgical Intensive Care Patients.","authors":"Taylor M Law","doi":"10.1177/10600280261444365","DOIUrl":"https://doi.org/10.1177/10600280261444365","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261444365"},"PeriodicalIF":2.3,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759818","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":"Response to \"Evaluation of Symptom-Triggered Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in Trauma-Surgical Intensive Care Patients\".","authors":"Mark K Su, Heather Brunette","doi":"10.1177/10600280261444366","DOIUrl":"https://doi.org/10.1177/10600280261444366","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261444366"},"PeriodicalIF":2.3,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759786","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}