Annals of Pharmacotherapy最新文献

{"title":"Comparison of Train-of-Four Versus No Train-of-Four Monitoring of Neuromuscular Blockade on Drug Consumption for Acute Respiratory Distress Syndrome.","authors":"Kayleigh N Yaeger, Ryan M Rivosecchi, Julie N Clarkson, Phillip E Lamberty, Lara M Groetzinger","doi":"10.1177/10600280251414669","DOIUrl":"10.1177/10600280251414669","url":null,"abstract":"<p><strong>Background: </strong>There is limited data regarding the use of clinical assessment alone for neuromuscular blockade (NMB) titrations in the setting of acute respiratory distress syndrome (ARDS).</p><p><strong>Objective: </strong>To compare the amount of cisatracurium (CIS) consumed when utilizing train-of-four (TOF)-guided NMB titrations or clinical assessment alone without TOF for continuous infusion (CI) administration.</p><p><strong>Methods: </strong>A retrospective analysis was performed evaluating TOF-guided titrations compared with clinical assessment alone (non-TOF) for CI NMB with CIS. Individuals within the TOF group were assessed from January 2013 to December 2018 while those within the clinical assessment alone group were assessed from January 2021 to December 2024. Patients were excluded if they were less than 18 years old, had documentation of COVID-19 infection, were receiving extracorporeal membrane oxygenation, or had NMB initiated at an outside hospital. The primary objective was assessing drug utilization between groups.</p><p><strong>Results: </strong>A total of 1047 and 553 individuals were screened resulting in 99 and 65 included for analysis in the TOF and non-TOF groups, respectively. The median cumulative CIS dose was 665 (472, 927) mg in the TOF group and 536 (400, 699) mg in the clinical assessment alone group, <i>P</i> = 0.011. The median infusion rate was 32% higher in the TOF group: 2.5 (1.8, 3.6) versus 1.9 (1.8, 2.4) µg/kg/min, <i>P</i> < 0.001, despite similar starting rates. Median drug costs were also significantly reduced when comparing the TOF group with the non-TOF group: $178 (126, 247) versus $143 (107, 187), <i>P</i> = 0.011.</p><p><strong>Conclusion and relevance: </strong>This study assesses drug utilization when comparing TOF-guided NMB titration with clinical assessment alone in the modern ARDS era. Utilization of clinical assessment alone without TOF monitoring for CI CIS resulted in significantly reduced drug utilization and costs. Further studies are needed to assess the impact of clinical assessment alone on improvement of oxygenation.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"979-985"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103571","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":"Risk Factors Associated With Incident Opioid Prescription Among Attention-Deficit/Hyperactivity Disorder Patients Prescribed Stimulants.","authors":"Mina Shrestha, Chijioke M Okeke, Chan Shen, Dong-Won Kang, Douglas Leslie, Tyler Varisco, Olajumoke Olateju, Matthew Wanat, J Douglas Thornton","doi":"10.1177/10600280251413628","DOIUrl":"10.1177/10600280251413628","url":null,"abstract":"<p><strong>Background: </strong>Pharmacotherapy with stimulant or nonstimulant medications is recommended as first-line treatment for attention-deficit/hyperactivity disorder (ADHD). Among patients prescribed stimulants, concomitant opioid use may increase the risk of drug dependence, exacerbate comorbid conditions, and compromise treatment adherence. However, limited evidence exists on the risk factors for initial opioid prescription in this population.</p><p><strong>Objective: </strong>To identify factors associated with incident opioid prescriptions among patients with ADHD prescribed stimulant therapy.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Merative® MarketScan® Commercial Claims and Encounters Database (2010-2020). We identified patients with ADHD who initiated stimulant therapy and followed them for 1 year to assess incident opioid prescription. Cox proportional hazards models were used to evaluate factors associated with opioid initiation.</p><p><strong>Results: </strong>Among 380 494 patients with ADHD initiating stimulants (mean age: 21.2 years; 56.5% male), 14.2% received an opioid prescription within 1 year. Factors significantly associated with incident opioid prescription included age ≥35 years (adjusted hazard ratio [aHR]: 10.84; 95% CI: 10.43-11.26), gender(aHR [female]:1.29; 95% CI: 1.27-1.31), geographic region (aHR [West]: 1.58; 95% CI: 1.52-1.64), multiple chronic conditions (aHR: 1.61; 95% CI: 1.54-1.67), anxiety (aHR: 1.19; 95% CI: 1.17-1.22), depression (aHR: 1.16; 95% CI: 1.14-1.19), severe mental illnesses (aHR: 1.18; 95% CI: 1.13-1.23), substance use disorders (SUDs) (aHR: 1.69; 95% CI: 1.63-1.75). Receipt of behavioral therapy before ADHD pharmacotherapy (aHR: 0.89; 95% CI: 0.87-0.92) was associated with a lower risk of receiving incident opioid prescriptions.</p><p><strong>Conclusions and relevance: </strong>Several demographic factors (e.g., age, gender, geographic region) and clinical factors (e.g., history of mental health conditions and SUDs) are associated with opioid initiation among stimulant-treated patients with ADHD. These findings may inform clinical strategies to mitigate unnecessary opioid exposure and associated harms.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"942-949"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997003","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":"Elinzanetant: A Novel Approach to Management of Vasomotor Menopausal Symptoms.","authors":"Jordan M Rowe, Ian Coffman, Kylie N Barnes","doi":"10.1177/10600280261426643","DOIUrl":"10.1177/10600280261426643","url":null,"abstract":"<p><strong>Objective: </strong>To review the efficacy and safety of elinzanetant for the management of vasomotor symptoms (VMS) associated with menopause.</p><p><strong>Data sources: </strong>Literature was identified using PubMed (1966 to January 2026), EMBASE (1973 to January 2026), and clinicaltrials.gov. Search terms included elinzanetant, VMS, and menopause, limiting trials to those published in English.</p><p><strong>Study selection and data extraction: </strong>Articles selected for inclusion included trials evaluating elinzanetant for the treatment of VMS.</p><p><strong>Data synthesis: </strong>Elinzanetant was evaluated for reduction in frequency and severity of moderate-to-severe VMS associated with menopause in 3 phase 3 trials (OASIS 1, 2, and 3) and 1 phase 3 trial in patients receiving endocrine therapy for breast cancer (OASIS 4). All studies showed significant improvements in symptom frequency at week 12 compared to placebo (<i>P</i> < .001). Improvement in sleep disturbances and quality of life was also significant in OASIS 1, 2, and 4. Elinzanetant was well-tolerated, with headache, fatigue, dizziness, somnolence, abdominal pain, and rash reported as the most frequent drug-associated adverse effects.Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:Elinzanetant is the first dual neurokinin-1 and neurokinin-3 receptor antagonist approved for moderate-to-severe VMS associated with menopause. Elinzanetant offers a nonhormonal treatment option with favorable tolerability, representing a promising alternative for patients who cannot or prefer not to use hormonal therapy.</p><p><strong>Conclusion: </strong>The U.S. Food and Drug Administration approval of elinzanetant provides an additional nonhormonal option for managing moderate-to-severe VMS of menopause in patients for whom hormonal therapy is contraindicated or undesired.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"1002-1011"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497374","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":"Lenalidomide-Associated Myocardial Injury Despite Nondiagnostic Cardiac Magnetic Resonance Imaging.","authors":"Michael Pamonag, Maja Wichhart Donzo, Nuha Zackariya","doi":"10.1177/10600280261490111","DOIUrl":"https://doi.org/10.1177/10600280261490111","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261490111"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079477","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":"Effect of Temporary Methotrexate Discontinuation on Vaccine Immunogenicity and Disease Flare in Rheumatoid Arthritis: A Systematic Review.","authors":"Ayesha Tahir, Ammara Iftikhar, Kashaw Kumar, Yusra Nawaz, Pakeeza Fatima, Muhammad Saeed, Shaheer Suhail Sarwar, Fatima Khalid, Ayesha Javaid, Bushra Akhtar, Bisma Zafar, Abdullah Ahmad, Erum Siddiqui, Muhammad Saad Khan, Muhammad Mohsin Khan","doi":"10.1177/10600280261489586","DOIUrl":"https://doi.org/10.1177/10600280261489586","url":null,"abstract":"<p><strong>Background: </strong>Methotrexate (MTX) is a cornerstone disease-modifying antirheumatic drug for rheumatoid arthritis (RA); however, it may attenuate vaccine-induced immune responses. Temporary MTX interruption around vaccination has been proposed to improve immunogenicity, but concerns remain regarding disease flare and safety.</p><p><strong>Objective: </strong>To evaluate whether temporary MTX discontinuation or delayed initiation around vaccination improves vaccine immunogenicity in adults with RA, while assessing its effects on disease activity, flare risk, and safety.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, Embase, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) and observational studies comparing MTX continuation with temporary discontinuation or delayed initiation around vaccination in adults with RA. Outcomes included vaccine response rate, neutralizing antibody response, geometric mean antibody titers, disease activity, disease flare, and adverse events. Because of heterogeneity, findings were synthesized narratively.</p><p><strong>Results: </strong>Five studies were included: 4 RCTs and 1 retrospective observational cohort. Temporary MTX interruption or delayed initiation improved vaccine immunogenicity across influenza, COVID-19, and pneumococcal vaccines. The most consistent benefit was observed when MTX was withheld during the early post-vaccination period. Improved responses included higher seroconversion rates, increased neutralizing capacity, and antibody titers. Safety findings were generally acceptable, although repeated 2-week interruptions after closely spaced COVID-19 vaccine doses increased clinical disease activity index (CDAI)-defined flare rates in 1 trial. Risk-of-bias assessment suggested generally reliable evidence, with the observational cohort rated high quality and randomized trials largely showing low overall risk of bias.</p><p><strong>Conclusion and relevance: </strong>Temporary MTX interruption, particularly after vaccination, may enhance vaccine immunogenicity in adults with RA. These findings provide clinically relevant evidence to guide MTX management around vaccination in adults with RA. However, this strategy should be individualized according to baseline disease activity, flare risk, vaccine type, and clinical context and should not be extrapolated to pediatric patients, for whom evidence was not identified in this review.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261489586"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079504","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":"Probable Increase of Free Valproic Acid Concentrations Associated With Heparin in the Intensive Care Unit: A Case Report.","authors":"Emily K Alsbury, Hannah M Lenik, Ian R McGrane","doi":"10.1177/10600280261489827","DOIUrl":"https://doi.org/10.1177/10600280261489827","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261489827"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073355","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":"Development and Validation of a Nomogram for Predicting Oral Ibuprofen Treatment Failure in Preterm Infants With Hemodynamically Significant Patent Ductus Arteriosus.","authors":"Wenjing Song, Meilin Yang, Jiawei Chai, Xianzhi Liang, Wenli Zhou","doi":"10.1177/10600280261483265","DOIUrl":"https://doi.org/10.1177/10600280261483265","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamically significant patent ductus arteriosus (hsPDA) is common in extremely and very preterm infants and has been associated with pulmonary overcirculation, systemic hypoperfusion, and adverse neonatal outcomes. However, the optimal timing and selection of pharmacologic treatment remain controversial, highlighting the need for tools that can help identify infants who are unlikely to respond to oral ibuprofen.</p><p><strong>Objective: </strong>Hemodynamically significant patent ductus arteriosus remains a frequent and critical complication in preterm infants. Due to the lack of clinical consensus, management strategies vary significantly, often leading to inconsistent treatment outcomes. This study aimed to develop and validate a risk prediction model for oral ibuprofen treatment failure in extremely and very preterm infants with hsPDA.</p><p><strong>Methods: </strong>We conducted a retrospective study of extremely and very preterm infants (gestational age <32 weeks, birth weight <1500 g) diagnosed with hsPDA between January 2020 and August 2024. Patients were categorized into treatment-effective and treatment-ineffective groups based on their response to oral ibuprofen. Clinical and echocardiographic parameters were compared using univariate analysis, and clinically relevant candidate predictors were entered into a multivariable logistic regression model using the enter method to develop the prediction model. A predictive nomogram was constructed; its performance was evaluated using discrimination, calibration, and decision curve analysis to determine clinical utility.</p><p><strong>Results: </strong>Among 165 eligible infants, 143 with complete candidate predictor data were included in model development. Six clinically relevant predictors were included in the final model: gestational age, hypertensive disorders of pregnancy, pretreatment hemoglobin level, lung ultrasound score, patent ductus arteriosus diameter, and ratio of left atrial diameter to aortic root diameter ratio. The model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.889 (95% CI, 0.826-0.952), and acceptable calibration.</p><p><strong>Conclusion and relevance: </strong>This nomogram may help identify infants who are less likely to respond to oral ibuprofen and support individualized decision-making when pharmacologic treatment is being considered. External validation is needed before routine clinical implementation.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261483265"},"PeriodicalIF":2.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073415","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":"Five Tools, One Patient: Toward a Common Output Standard for Periprocedural Anticoagulation Decision Support.","authors":"Edward L Carter","doi":"10.1177/10600280261489740","DOIUrl":"https://doi.org/10.1177/10600280261489740","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261489740"},"PeriodicalIF":2.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057093","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":"Comment: Efficacy and Safety of Levetiracetam vs Sodium Valproate in Pediatric Epilepsy: A Systematic Review and Meta-analysis.","authors":"Taha Ibrahim, Jawaria Ibrahim, Munir Shakeel","doi":"10.1177/10600280261489280","DOIUrl":"https://doi.org/10.1177/10600280261489280","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261489280"},"PeriodicalIF":2.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057067","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":"Beyond the Drug: Pharmacist-Led Central Line Stewardship.","authors":"Rajan Desai, Punit J Shah","doi":"10.1177/10600280261490934","DOIUrl":"https://doi.org/10.1177/10600280261490934","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280261490934"},"PeriodicalIF":2.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057099","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}