British journal of clinical pharmacology最新文献

{"title":"Sentinel dosing: A proposed algorithm to guide decision making on which cohorts in early phase clinical pharmacology trials should use this approach.","authors":"Jules A A C Heuberger, Perry de Jongh, Ewoud-Jan van Hoogdalem, Wim Tamminga, Pieter de Graeff, Geert Jan Groeneveld","doi":"10.1002/bcp.70090","DOIUrl":"https://doi.org/10.1002/bcp.70090","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this paper is to describe a proposal for an algorithm to guide decision making on which cohorts in early phase pharmacology trials should employ a sentinel approach, thereby standardising and harmonising practices, and improving decision making around sentinel dosing. Sentinel dosing is an approach described in EMA guidelines; however, the guidance does not provide detail on which cohorts or dose levels sentinel dosing applies.</p><p><strong>Methods: </strong>This algorithm was designed using the expertise of senior scientific staff from the largest clinical research organisations in the Netherlands and after consultation with members of the ethics committee handling most early phase clinical drug trials in the Netherlands.</p><p><strong>Results: </strong>The algorithm describes a decision tree considering different aspects of the design of the trial, the IMP, and the prior knowledge of the IMP based on (pre)clinical data, to be used by investigators and regulators. Hereby the decision-making process on sentinel cohorts will be tailored to the specific IMP and information available. Starting in 2024, all three expert Phase 1 units that co-authored this paper are using the algorithm as guidance for decision-making on the implementation of sentinels in trials that are submitted to the EC Stichting BEBO.</p><p><strong>Conclusion: </strong>The algorithm provides further guidance and specification on when to implement sentinel dosing in early phase clinical trials, thereby creating a standardised and harmonised approach, which will improve the protection of subject safety and trial efficiency.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076151","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":"Pharmacology and relevant drug interactions of metamizole.","authors":"David J Brinkman, Linda C Hendriksen, Irma M Rigter, Markus W Hollmann","doi":"10.1002/bcp.70101","DOIUrl":"https://doi.org/10.1002/bcp.70101","url":null,"abstract":"<p><p>Metamizole is a frequently prescribed analgesic because of its favourable benefit/risk ratio compared with classic NSAIDs. However, increasing research shows that metamizole displays several drug interactions that are relevant to clinical practice. We reviewed the literature to summarize the pharmacology and most clinically relevant drug interactions of metamizole. Metamizole has a fast analgesic effect but a short half-life and duration of action. The exact mechanism of action of metamizole is currently not fully known. Studies showed that metamizole appears to be a moderate to strong inductor of the enzymes CYP3A4, CYP2B6 and CYP2C19; a weak inductor of CYP2C9; and a moderate inhibitor of CYP1A2. Furthermore, metamizole inhibits the effect of acetylsalicylic acid when taken simultaneously. Metamizole should be cautiously used together with other drugs that can cause agranulocytosis. If metamizole is prescribed in a high dosage (1000 mg three or four times daily) for more than 1 day, these pharmacokinetic and dynamic interactions should be taken into account.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076040","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":"Genetic causal association between heart failure, frailty and poisoning by narcotics and psychodysleptics: A two-sample Mendelian randomization.","authors":"Bing Wang, Hong Yu, Meng Cai, Xianqiao Xie","doi":"10.1002/bcp.70091","DOIUrl":"https://doi.org/10.1002/bcp.70091","url":null,"abstract":"<p><strong>Aims: </strong>Observational studies have suggested associations between heart failure (HF), frailty and poisoning by narcotics and psychodysleptics (PNP). However, establishing causal relationships has been challenging. This study used a two-sample Mendelian randomization (MR) approach to investigate the genetically proxied causality between HF, frailty and PNP.</p><p><strong>Methods: </strong>Summary-level data from genome-wide association studies (GWAS) were utilized to investigate the causal relationship between frailty index (FI) and PNP risk, PNP and HF risk, as well as the bidirectional relationship between FI and HF. Various MR methods, including inverse-variance weighted (IVW), MR-Egger, weighted median and weighted mode, were employed. Horizontal pleiotropy, heterogeneities and the robustness of genetic variants were assessed using MR-Egger intercept tests, Cochran's Q test and leave-one-out analyses. The MR-PRESSO outlier test was applied to identify and remove outlier variants to mitigate potential pleiotropy.</p><p><strong>Results: </strong>Significant genetic causal associations were observed between FI and HF (IVW: OR = 1.42, 95% CI: 1.16-1.74) and between HF and FI (IVW: OR = 1.09, 95% CI: 1.05-1.14). However, no causal relationships were found between other variables. Sensitivity analyses demonstrated no evidence of horizontal pleiotropy or heterogeneity, confirming the robustness of the results.</p><p><strong>Conclusions: </strong>This MR study provides genetic evidence of a bidirectional causal relationship between FI and HF, highlighting the intertwined nature of frailty and heart failure. No genetically proxied causal associations were observed between FI and PNP or between PNP and HF. Further research, including age-stratified and longitudinal studies, is needed to validate these findings and explore the underlying mechanisms.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982066","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":"Patient, carer and healthcare professional perspectives on deprescribing in surgical wards: A mixed methods study.","authors":"Bonnie M Liu, Janani Thillainadesan, Aili Langford, Kenji Fujita, Danijela Gnjidic, Sarah N Hilmer","doi":"10.1002/bcp.70088","DOIUrl":"https://doi.org/10.1002/bcp.70088","url":null,"abstract":"<p><strong>Aims: </strong>The perspectives of patients and healthcare professionals regarding deprescribing in surgical wards within hospital settings are unknown. The aim of this study was to explore current practices, attitudes and the enablers and barriers to deprescribing in hospital for older surgical inpatients from the perspectives of doctors, pharmacists, patients and carers.</p><p><strong>Methods: </strong>A mixed methods study was performed. Two surveys were administered Australia-wide (revised Patients' Attitudes Towards Deprescribing questionnaire for patients/carers and Deprescribing Self-Efficacy Survey for doctors/pharmacists). Interviews, focus groups and observations of ward rounds were conducted with participants from five Australian hospitals. Quantitative data were analysed descriptively, while qualitative data were examined using a combined inductive and deductive approach, with results triangulated.</p><p><strong>Results: </strong>There were 109 survey participants (58 doctors/pharmacists and 51 patients/carers), 28 interview/focus group participants (15 doctors/pharmacists and 13 patients/carers) and eight ward round participants. Doctors and pharmacists reported low to moderate levels of confidence in deprescribing. While most patients and carers were satisfied with their medications, they expressed a willingness to consider deprescribing. Five themes were identified from the interviews, focus groups and ward round observations: (1) deprescribing is not a priority, (2) medication review occurs in response to triggers, (3) knowledge about deprescribing is limited, (4) deprescribing requires a team effort and (5) trust, rapport and communication are essential for successful deprescribing.</p><p><strong>Conclusions: </strong>Doctors working on surgical wards are unlikely to proactively deprescribe medications. A collaborative patient-centred approach involving geriatricians, clinical pharmacologists and pharmacists, along with educational interventions may facilitate deprescribing for surgical patients.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980757","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":"Pharmacokinetic-pharmacodynamic (PK/PD) modelling of cotadutide effect in patients with chronic kidney disease and type 2 diabetes mellitus.","authors":"Hongtao Yu, Victoria Parker, Viknesh Selvarajah, Lars Hansen, Darren Robertson, Bengt Hamrén, Anis Khan, Joanna Parkinson","doi":"10.1002/bcp.70093","DOIUrl":"https://doi.org/10.1002/bcp.70093","url":null,"abstract":"<p><strong>Aims: </strong>Cotadutide is a dual glucagon-like peptide-1/glucagon receptor agonist. The objective of the analysis was to develop a pharmacokinetic-pharmacodynamic (PK/PD) model to describe the relationship between cotadutide exposure and response on urine albumin-to-creatinine ratio (UACR), urinary albumin (UALB), and body weight in participants with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) using data from a Phase2b study (NCT04515849).</p><p><strong>Methods: </strong>A total of 247 participants with CKD and T2DM were randomized and titrated to either 100, 300 or 600 μg cotadutide, 1 mg semaglutide or placebo. UACR was measured biweekly from either morning void (Weeks 14 and 26) or spot urine (other visits). The analysis was implemented using a longitudinal non-linear mixed-effect model. The potential impact of covariates on efficacy in participants was quantified.</p><p><strong>Results: </strong>PK/PD models were developed, and a significant relationship was identified between cotadutide exposure and PD biomarkers of UACR, UALB and body weight. The models described the data adequately; greater changes in PD responses were observed with higher cotadutide doses. Baseline mean blood pressure and baseline UALB were found to affect the reductions in UACR and UALB, respectively. Model-predicted relative change from placebo in UACR, UALB and body weight after 26 weeks of 600 μg cotadutide treatment were -45.6% (-52.4%, -38.7%), -47.2% (-56.0%, -39.9%) and -5.3% (-7.6%, -4.1%), respectively.</p><p><strong>Conclusions: </strong>This modelling assessment was successfully applied for cotadutide to understand the relationship between cotadutide dosing regimen and the response in UACR, UALB and body weight. These models have general application in analysing and interpreting data from CKD/diabetic kidney disease (DKD) studies.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976648","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":"Comprehensive analysis of adverse event profile changes with pertuzumab addition to trastuzumab-based breast cancer therapy: Disproportionality analysis using VigiBase.","authors":"Tatsuaki Takeda, Jun Matsumoto, Tomonori Sakai, Naohiro Iwata, Hirofumi Hamano, Toshihiro Koyama, Noritaka Ariyoshi, Yoshito Zamami","doi":"10.1002/bcp.70094","DOIUrl":"https://doi.org/10.1002/bcp.70094","url":null,"abstract":"<p><strong>Aims: </strong>Pertuzumab is used in combination with trastuzumab-based therapy for HER2-positive breast cancer. However, real-world safety information on pertuzumab remains limited. This study assessed the safety of adding pertuzumab to trastuzumab-based therapy for HER2-positive breast cancer using real-world data.</p><p><strong>Methods: </strong>VigiBase, the World Health Organization's global database of adverse events (AEs), containing reports from November 1967 to December 2023, was used. Signals for pertuzumab-associated AEs in breast cancer cases were detected using the reporting odds ratio (ROR).</p><p><strong>Results: </strong>Signals of trastuzumab plus pertuzumab relative to trastuzumab alone were detected in gastrointestinal disorders (ROR: 1.45, 95% confidence interval: 1.26-1.67), including diarrhoea (3.49, 2.83-4.30); infections and infestations (1.54, 1.24-1.91); and skin and subcutaneous tissue disorders (ROR: 1.63, 1.40-1.90), including pruritus (1.96, 1.51-2.55) and rash (1.63, 1.20-2.23). Further, signals of trastuzumab plus docetaxel plus pertuzumab relative to those of trastuzumab plus docetaxel were detected in gastrointestinal disorders (1.63, 1.38-1.93), including nausea (1.72, 1.24-2.39) and vomiting (1.48, 1.01-2.17), and in nervous system disorders (1.50, 1.20-1.87), including paraesthesia (2.60, 1.33-5.08) and peripheral sensory neuropathy (5.94, 1.79-19.71). The frequency of AEs causing or prolonging hospitalization was increased with trastuzumab plus pertuzumab compared to that with trastuzumab alone (1.18, 1.00-1.38).</p><p><strong>Conclusions: </strong>AE profiles after the addition of pertuzumab to trastuzumab-based therapy were comprehensively identified. The findings in this study highlight the importance of considering these AEs when selecting pertuzumab combination therapy to ensure the safety of patients with breast cancer.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964767","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":"From cradle to cane-(Dis)similarities between paediatric and geriatric clinical pharmacology: A commentary arising from the 2024 International Union of Basic and Clinical Pharmacology (IUPHAR) World Smart Medication Day.","authors":"Karel Allegaert, Sarah N Hilmer","doi":"10.1002/bcp.70092","DOIUrl":"https://doi.org/10.1002/bcp.70092","url":null,"abstract":"","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953748","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":"Association between oral anticoagulant therapy and in-hospital complications and mortality.","authors":"Juliana Lagrave, Laia Domingo, Jaime Barceló-Vidal, Mercè Comas, Carmen Jimenez, Olivia Ferrández, Xavier Castells, Maria Sala","doi":"10.1002/bcp.70087","DOIUrl":"https://doi.org/10.1002/bcp.70087","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to identify patterns of direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) use in hospitalized patients and to examine their association with in-hospital haemorrhagic complications and mortality.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted among hospitalized patients ≥18 years from 2018 to 2022. Data on hospital discharges were obtained from the minimum data set and were matched with pharmacy records to identify patients treated with DOACs or VKAs. In-hospital haemorrhagic complications and mortality rates were calculated for study groups. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs), adjusting for age, sex and comorbidities. Analyses were stratified by medical and surgical profiles. Statistical significance was set at .05.</p><p><strong>Results: </strong>The study included 74 190 patients, with 4774 receiving DOACs and 1768 VKAs. During the study period, DOAC use increased by 45.11%. DOAC-treated patients had lower complication rates than those treated with VKAs (1.9 vs. 2.8%, respectively; P = .032). DOAC use was linked to a lower risk of haemorrhagic complications in surgical patients (OR = 0.65; 95%CI: 0.35-0.91), while in medical patients, the reduction in risk was not statistically significant (OR = 0.59; 95%CI: 0.33-1.10). No effect on mortality risk was observed among medical and surgical patients.</p><p><strong>Conclusions: </strong>The increased use of DOACs among hospitalized patients showed a protective effect against haemorrhagic complications in surgical patients, supporting their increasing use in hospital settings.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976708","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":"Drug-drug interaction profile of ritlecitinib as perpetrator and victim through cytochrome P450.","authors":"Vivek S Purohit, Yeamin Huh, Martin E Dowty, Anna Plotka, Alexandre Lejeune, Hindu Kalluru, Brian Hee","doi":"10.1002/bcp.70069","DOIUrl":"https://doi.org/10.1002/bcp.70069","url":null,"abstract":"<p><strong>Aims: </strong>To assess the effect of a potent cytochrome P450 (CYP) 3A inhibitor and CYP inducer on the pharmacokinetics of ritlecitinib, a JAK3/TEC family kinase inhibitor, and assess the effect of ritlecitinib on the pharmacokinetics of CYP substrates (midazolam, efavirenz, tolbutamide, caffeine and oral contraceptives [ethinyl oestradiol and levonorgestrel]) in healthy adults.</p><p><strong>Methods: </strong>Seven clinical drug-drug interaction studies were analysed. Pharmacokinetic parameters for drugs as measured in blood plasma were used to estimate the drug interaction potential with ritlecitinib as a perpetrator or victim.</p><p><strong>Results: </strong>Midazolam exposure (area under plasma concentration-time curve from time 0 to infinity [AUC_inf]) and peak exposure (maximum concentration [C_max]) were increased by ≈169% and ≈80.1%, respectively, in the presence of ritlecitinib. Efavirenz exposure (AUC_0-72) and peak exposure (C_max) were similar in the presence and absence of ritlecitinib coadministration. Tolbutamide pharmacokinetic parameters (AUC_inf and C_max) were not affected by multiple ritlecitinib doses. In the presence of ritlecitinib, AUC_inf and C_max of caffeine increased by ≈165% and ≈10%, respectively. AUC_inf and C_max of ethinyl oestradiol decreased by ≈18% and ≈12%, respectively, following coadministration of multiple ritlecitinib 200 mg once-daily doses, but no relevant change was observed following multiple 50 mg once-daily doses. Ritlecitinib doses did not affect the pharmacokinetics of levonorgestrel. Coadministration following multiple itraconazole doses increased ritlecitinib AUC_inf by ≈15%. Coadministration following multiple rifampicin doses decreased AUC_inf of ritlecitinib by ≈45%.</p><p><strong>Conclusions: </strong>Ritlecitinib is a moderate inhibitor of CYP3A and CYP1A2. Strong CYP inducers can reduce ritlecitinib concentrations, but not to clinically relevant levels leading to lack of benefit.</p>","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977308","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":"Comment on: 'Effects of age, sex, daily dose, comorbidity and co-medication on venlafaxine-associated cardiovascular adverse events: A pharmacovigilance analysis of the FDA adverse event reporting system database'.","authors":"Rikuto Masuda, Yoshihiro Noguchi, Ryo Kobayashi, Tomoaki Yoshimura","doi":"10.1002/bcp.70089","DOIUrl":"https://doi.org/10.1002/bcp.70089","url":null,"abstract":"","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964763","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}