Annals of Pharmacotherapy最新文献

{"title":"Appropriate Statin Use in Patients With Newly Diagnosed Acute Ischemic Stroke or Myocardial Infarction at a Tertiary County Teaching Hospital.","authors":"Soomin Woo, Charles F Seifert","doi":"10.1177/10600280241305436","DOIUrl":"10.1177/10600280241305436","url":null,"abstract":"<p><strong>Background: </strong>Statins are the mainstay of therapy in patients suffering an acute ischemic stroke (AIS) or myocardial infarction (MI); however, several studies have shown that prescribing is not optimal.</p><p><strong>Objective: </strong>The main objective of this study was to evaluate the percentage of patients prescribed appropriate statin therapy upon discharge after an AIS or MI.</p><p><strong>Methods: </strong>This is a single-center retrospective cohort study conducted at a tertiary, county, teaching hospital in patients aged 18 to 89 years who were newly diagnosed with AIS or MI, from September 2017 to September 2022.</p><p><strong>Results: </strong>Six hundred thirty-six individuals were hospitalized for AIS or MI according to ICD-10 codes. Of these, 389 patients were excluded, and 247 were included in the analysis. Although 85% of AIS and MI patients were at very high risk of future ASCVD events, over 25% were not discharged on appropriate statin therapy. Patients who had been taking high-intensity statins or were statin-naïve prior to admission (156/194, 80.4%) were significantly more likely to be discharged with appropriate statin therapy compared to those who had been taking low or moderate-intensity statins at home (27/53, 50.9%, p<0.0001, OR = 3.41, 95% CI = 1.71 to 6.79).</p><p><strong>Conclusion and relevance: </strong>The treatment of patients with statin therapy following an AIS and MI remains suboptimal, despite most of these patients being at very high risk for further ASCVD events. Significantly more patients on high-intensity statins or were statin naïve on admission were discharged on appropriate therapy.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"694-702"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998831","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":"Pharmacist-Directed Transition of Care Services Decrease Readmissions at a Safety-Net Hospital.","authors":"Shannon Carboni, Monika Tawfik, Brooke Menon, Heather Rhodes, Ann Brigino","doi":"10.1177/10600280241310862","DOIUrl":"10.1177/10600280241310862","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist describing the influence of pharmacist-led transition of care (TOC) services in safety-net hospital settings.</p><p><strong>Objective: </strong>This analysis assessed the impact of pharmacist-led TOC services on hospital readmissions in a high-risk managed Medicaid population impacted by housing instability, substance use disorder (SUD), and mental health issues.</p><p><strong>Methods: </strong>A retrospective evaluation of patients who received safety-net hospital-based TOC pharmacy services between January 1, 2022, and December 31, 2022, was conducted. Patients 18 years and older, insured by a select managed Medicaid plan, and admitted to an inpatient medicine service were included. Patients were excluded if they were admitted from or discharged to a facility or hospice, discharged before medically ready, or died within 30 days of discharge. Interventions included an initial visit, discharge medication delivery and education, and a post-discharge follow-up phone call within 24 to 72 hours. Patients were provided with a number to call for medication-related questions post-discharge. The primary outcome was 30-day hospital readmissions. Secondary outcomes included time to and reason for readmission and a description of TOC services.</p><p><strong>Results: </strong>There were 292 patients engaged in pharmacist-led TOC services. Nearly 1 in 6 patients were experiencing homelessness and almost 40% were struggling with SUD during the index admission. The median readmission performance in the target population 6 months prior to TOC service implementation was 20.2% and fell to 12.3% post-intervention. Substance use disorder was the leading contributor to re-hospitalization, accounting for 58% of readmissions. Six (16.7%) readmissions were medication-related; 5 of 6 were complicated by SUD. There were no preventable medication-related readmissions. There are limitations to this study; not all patients received all TOC program components. Prospective, randomized-controlled studies are needed to show cause and effect.</p><p><strong>Conclusion and relevance: </strong>This evaluation suggests pharmacist-led TOC discharge services may lead to hospital readmission reduction in a socially complex managed Medicaid population in a safety-net hospital setting.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"736-742"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035978","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":"Evaluation of the Toxicity and Outcomes of the Combination of Midostaurin and CLAG-M in Patients With FLT3-Mutated Acute Myeloid Leukemia (AML): A Multicenter Retrospective Analysis.","authors":"Ashley Chen, Grace Baek, Kathryn Russell, Carole Shaw, Megan Othus, Jonathan Cohen, Shannon Palmer, Jack Rasmussen, Joseph Bubalo, Tenzin Tsomo, Tenley Schwarz, Swathi Namburi, Anna Halpern","doi":"10.1177/10600280241305608","DOIUrl":"10.1177/10600280241305608","url":null,"abstract":"<p><strong>Background: </strong>Addition of midostaurin to standard \"7+3\" (cytarabine and anthracycline) significantly prolongs overall and event-free survival. At University of Washington/Fred Hutchinson Cancer Center (UW/FHCC), the standard regimen for newly diagnosed (ND) and relapsed/refractory (R/R) AML is cladribine, high-dose cytarabine, GCSF, and mitoxantrone (CLAG-M); midostaurin is added if FLT3-mutated. There is limited data on the use of FLT3-inhibitors with high-dose cytarabine regimens in AML.</p><p><strong>Objective: </strong>This study aimed to evaluate the safety and efficacy of the combination of midostaurin with CLAG-M versus midostaurin plus 7+3 in FLT3-mutated AML patients.</p><p><strong>Methods: </strong>This is a retrospective, multicenter review including FLT3-mutated AML patients undergoing (re)induction chemotherapy with either CLAG-M or 7+3 at UW/FHCC, Oregon Health & Science University, and Swedish Cancer Institute. The primary outcome was incidence of adverse events. Secondary outcomes included disease response per ELN2017 criteria and 28-day mortality. Excluded were patients on clinical trials or who started midostaurin 30 days after chemotherapy.</p><p><strong>Results: </strong>Eighty patients treated from September 2016 to December 2023 were included; 36 patients received CLAG-M, and 44 patients 7+3. Baseline characteristics were similar across all institutions. Adverse event rates were similar between the 2 cohorts, except diarrhea and bleeding which were more common in the 7+3 cohort. The rate of complete remission (CR) plus CR with incomplete blood count recovery did not significantly differ between the 2 cohorts: CLAG-M, 86% versus 7+3, 70% (<i>P</i> = 0.11).Conclusion & relevance:The toxicity profile of CLAG-M combined with midostaurin is comparable with the combination of 7+3 with midostaurin, and induces high remissions rates in adults with FLT3-mutated AML.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"703-713"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969451","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":"Correspondence: Exogenous Thyroid Hormones and Dementia Symptoms.","authors":"Minh-Hoang Tran, Kim-Huong Truong-Nguyen","doi":"10.1177/10600280241310434","DOIUrl":"https://doi.org/10.1177/10600280241310434","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":"59 8","pages":"776-777"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504670","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":"Therapeutic Drug Monitoring of Voriconazole: Unbound Concentration With Clinical Efficacy and Adverse Events.","authors":"Tiantian Zhang, Zhicong Qiu, Wenhao Chu, Wenli Li, Xikun Wu, Yuxin Wang, Yishuo Zhai, Wei Zhang, Zhiqing Zhang","doi":"10.1177/10600280251352876","DOIUrl":"https://doi.org/10.1177/10600280251352876","url":null,"abstract":"<p><strong>Background: </strong>Voriconazole is widely used for patients with fungal infections, but the correlations between the unbound concentration (C_free) of voriconazole in plasma and clinical outcomes remains unclear.</p><p><strong>Objective: </strong>The aim of this study was to analyze the correlation between C_free and clinical outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted at the Second Hospital of Hebei Medical University from February 2021 to March 2024 (Shijiazhuang, China). Patients who received voriconazole with at least one measured concentration in our center were enrolled. Based on determined the C_free of voriconazole, factors that might affect C_free were analyzed in conjunction with patient characteristics, and the correlations between voriconazole C_free and the clinical efficacy as well as AEs in patients were investigated.</p><p><strong>Results: </strong>A total of 60 blood samples were collected from 56 patients. Voriconazole C_free was positive correlation with creatinine, while negative correlation with creatinine clearance. The C_free of patients in the clinical effective group was significantly higher than that in the clinical ineffective group, and the C_free of patients in the group with AEs was significantly higher than that in the group without AEs (<i>P</i> = 0.006, 0.025). Voriconazole C_free (odds ratio [OR] = 2.617, 95% confidence interval [CI]:1.142-6.000, <i>P</i> = 0.023) and albumin level (OR = 1.085, 95% CI: 1.000-1.177, <i>P</i> = 0.050) were independent influencing factors of clinical efficacy, the receiver operating characteristic (ROC) cut off for C_free and efficacy was 0.8 μg·mL^-1. Voriconazole C_free (OR = 1.979, 95% CI: 1.008-3.888, <i>P</i> = 0.048) was an independent risk factor for AEs, the ROC cut off for C_free and AEs was 1.2 μg·mL^-1.</p><p><strong>Conclusions and relevance: </strong>Voriconazole C_free was positively correlated with clinical efficacy and the incidence of AEs in patients.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251352876"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697437","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":"Early Clinical Response is Associated With a Decreased Risk of Recurrent <i>Pseudomonas aeruginosa</i> Ventilator-Associated Pneumonia.","authors":"Alex S Huang, Jing J Zhao, Ryan Gumbleton, Marco R Scipione","doi":"10.1177/10600280251355630","DOIUrl":"https://doi.org/10.1177/10600280251355630","url":null,"abstract":"<p><strong>Background: </strong>Current data suggest that short-course therapy for <i>Pseudomonas aeruginosa</i> ventilator-associated pneumonia (PA-VAP) may increase the risk of recurrent pneumonia. To decrease antibiotic exposure without adversely impacting clinical outcomes, risk stratification based on clinical response may identify optimal candidates for short-course therapy.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether early response to therapy correlated with the risk of recurrence in patients with PA-VAP.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with PA-VAP admitted to the Detroit Medical Center from January 2020 to July 2022. Those with improvements in at least 2 out of 3 objective measures of clinical response (PaO₂/FiO₂, fever, and leukocyte count) at 72 hours after therapy initiation were classified as early responders. The primary outcome was PA-VAP recurrence within 28 days of initial VAP onset.</p><p><strong>Results: </strong>A total of 73 patients were included in the analysis: early response (n = 43) and delayed response (n = 30). Patients with an early response had a significantly decreased risk of 28-day PA-VAP recurrence compared to those with a delayed response (21% vs 43%, <i>P</i> = 0.04). Multivariable logistic regression found that PaO₂/FiO₂ > 240 mm Hg at 72 hours was associated with a decreased risk of 28-day PA-VAP recurrence (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.07 to 0.90), whereas duration of antibiotics ≤8 days was associated with an increased risk of 28-day PA-VAP recurrence (OR = 4.74, 95% CI = 1.31 to 17.18).</p><p><strong>Conclusion and relevance: </strong>This study found that early clinical response and improvement in PaO₂/FiO₂ were associated with a decreased risk of PA-VAP recurrence. Individualized treatment durations based on clinical response may allow clinicians to safely utilize shorter antibiotic courses for PA-VAP.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355630"},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625278","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":"What's Your C. diff-erential? Evaluating Clinical Management of Discordant <i>Clostridioides difficile</i> Two-Step Testing.","authors":"Adam Siddique, Nicolas Daoura, Punit J Shah","doi":"10.1177/10600280251357424","DOIUrl":"https://doi.org/10.1177/10600280251357424","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251357424"},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615797","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":"Roflumilast and the Changing Landscape of Seborrheic Dermatitis Treatment.","authors":"Jimmy Dhillon, Aryan Mahajan, Joy Xie, Madeline Tchack, Babar K Rao","doi":"10.1177/10600280251355662","DOIUrl":"https://doi.org/10.1177/10600280251355662","url":null,"abstract":"<p><strong>Objective: </strong>This article reviews clinical trial data that assess the safety, efficacy, and clinical application of roflumilast, a phosphodiesterase-4 inhibitor, for the treatment of seborrheic dermatitis.</p><p><strong>Data sources: </strong>A review of the literature was conducted in MEDLINE (Pubmed) and Clinicaltrials.gov from January 1, 1950 to April 13, 2025 using the search terms: \"Roflumilast\" and \"seborrheic dermatitis.\"</p><p><strong>Study selection and data extraction: </strong>Relevant articles in English relating to the safety, efficacy, pharmacodynamics, and pharmacokinetics were included.</p><p><strong>Data synthesis: </strong>In one phase IIa clinical trial, 73.8% of patients treated with roflumilast achieved Investigator Global Assessment (IGA) success, compared with 40.9% in the vehicle group at 8 weeks (<i>P</i> < 0.001). A phase III trial found 79.5% of patients in the roflumilast group achieved IGA success at week 8, compared with 58.0% in the vehicle group (<i>P</i> < 0.001). Furthermore, there were statistically significant reductions in erythema, scaling, and itch severity in the roflumilast group. Roflumilast was well tolerated, with adverse events comparable with vehicle foam.Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:Roflumilast is the first phosphodiesterase-4 inhibitor approved by the Food and Drug Administration for the treatment of seborrheic dermatitis. Based on 2 clinical trials, roflumilast has a positive safety profile, is efficacious, and is easy to apply, highlighting its utility in treating seborrheic dermatitis.</p><p><strong>Conclusion: </strong>Roflumilast is effective in treating seborrheic dermatitis. Future trials should compare its safety and efficacy with other drugs.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355662"},"PeriodicalIF":2.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599177","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":"Hydrocortisone Dosing Frequency in Intensive Care Unit Patients With Septic Shock: A Comparison of 2 Regimens.","authors":"Abigail Danos, Alyssa Lear, Erin Roach, Nicholas J Quinn","doi":"10.1177/10600280251355619","DOIUrl":"https://doi.org/10.1177/10600280251355619","url":null,"abstract":"<p><strong>Background: </strong>In patients with septic shock, intravenous (IV) hydrocortisone is recommended when there is an ongoing vasopressor requirement. Guidelines recommend IV hydrocortisone 200 mg/day administered as a continuous infusion or 50 mg every 6 hours. To prevent waste during a hydrocortisone shortage and reduce cost, our institution implemented a dosing regimen of 100 mg every 12 hours.</p><p><strong>Objectives: </strong>The primary objective of this study was to compare the impact of hydrocortisone 100 mg IV every 12 hours vs 50 mg IV every 6 hours on clinical outcomes in patients with septic shock.</p><p><strong>Methods: </strong>This was a retrospective, multicenter study that evaluated patients admitted from April 2022 to September 2023 to a Greater Charlotte Atrium Health facility. Adult patients diagnosed via the <i>International Statistical Classification of Diseases and Related Health Problems 10th Revision</i> (ICD-10) codes with sepsis, severe sepsis, or septic shock receiving ≥15 mcg/min of norepinephrine equivalents requiring ≥ 24 hours of hydrocortisone were included. The primary outcome was time to shock reversal. Secondary outcomes included in-hospital mortality, hospital and intensive care unit (ICU) length of stay, and hyperglycemia.</p><p><strong>Results: </strong>Of 446 screened patients, 111 were included. Median Sequential Organ Failure Assessment scores and Charlson Comorbidity Index were similar among groups. The median time to shock reversal was 56 [34-81] hours in the every 12 hours group compared to 65 [39-101] hours in the every 6 hours group (<i>P</i> = 0.21). In-hospital mortality was comparable between the every 6 hours group and the every 12 hours group (51.9% vs 45.6%, <i>P</i> = 0.51). There was no difference in hospital or ICU length of stay nor in incidence of hyperglycemic episodes between groups.</p><p><strong>Conclusion and relevance: </strong>There was no difference in the primary outcome of time to shock reversal or any secondary outcome between hydrocortisone groups. This alternative hydrocortisone dosing strategy may warrant further evaluation in large, prospective studies.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355619"},"PeriodicalIF":2.3,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567003","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: Impact of Remdesivir on Heart Rate and Bradycardia Incidence Among Hospitalized Adults With COVID-19.","authors":"Wesley D Kufel, Robert W Seabury, Sarah A Spinler","doi":"10.1177/10600280251354862","DOIUrl":"https://doi.org/10.1177/10600280251354862","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251354862"},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567004","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}