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Lv X, Ren W, Ran S, Zhao Y, Zhang J, Chen J, Zhang N. Trends and prescribing patterns of oral anti-neoplastic drugs: a retrospective longitudinal study. Front Public Health 2023; 11:1294126. [PMID: 38074729 PMCID: PMC10701268 DOI: 10.3389/fpubh.2023.1294126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Cancer as a global public health problem, imposes a heavy disease burden. With the rapid development of oral anti-neoplastic drugs, there has been a paradigm shift in the treatment of cancer from intravenous to oral administration. Objective This study was conducted to investigate the trends and prescribing patterns of oral anti-neoplastic drugs in an academic tertiary hospital in China. Methods A single-center and retrospective analysis was performed based on the prescriptions of outpatients treated with oral anti-neoplastic drugs from 2017 to 2022. Yearly prescriptions and expenditure were calculated according to their pharmacological classes, and trends were further analyzed. Defined daily doses (DDDs) and defined daily cost (DDC) of oral targeted anti-neoplastic drugs were also determined. Results Both the number of prescriptions and expenditure of oral anti-neoplastic drugs increased progressively. There was a significant upward trend in the number and proportion of prescriptions for the older adult group, male group, and patients with gynecologic/genitourinary and respiratory cancer. Hormonal therapy agents accounted for the highest proportion of prescriptions, and letrozole was initially the most frequently prescribed drug. The number of DDDs of total oral targeted anti-neoplastic drugs showed a continuously ascending trend, primarily driven by the usage of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and BCR-ABL TKIs. Conclusion The prescriptions and expenditure of oral anti-neoplastic drugs, and the number of DDDs of oral targeted anti-neoplastic drugs all showed a progressively ascending trend. Further studies are needed to evaluate the long-term health and financial outcomes, and the factors influencing these prescribing patterns.
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Affiliation(s)
- Xiaoqun Lv
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Weifang Ren
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shan Ran
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yuhan Zhao
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jihong Zhang
- Research Center for Clinical Medicine, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ning Zhang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
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Hashimoto H, Takeuchi M, Kawakami K. Association between dose reduction of renin-angiotensin-aldosterone system inhibitors before coronary artery angiography and acute kidney injury: a propensity score-matched study. Curr Med Res Opin 2023; 39:893-899. [PMID: 37083484 DOI: 10.1080/03007995.2023.2205794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the association between dose reduction of renin-angiotensin-aldosterone system inhibitors (RAASis) and Acute kidney injury (AKI). AKI, which is commonly observed in hospitalized patients, increases mortality. Although RAASis and coronary artery angiography (CAG) are reported to be risk factors for AKI, whether dose reduction of RAASis can prevent AKI after CAG remains unknown. METHODS In this retrospective propensity score (PS)-matched cohort from the RWD database, which includes 20 million patients from 190 hospitals in Japan, we examined the impact of dose reduction of RAASis on the development of AKI after CAG. The subjects were patients with an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73 m2, and the exposure of interest was the presence of a dose reduction in RAASis within 3 days before CAG was performed. Propensity score matching was performed with 19 baseline characteristics using a logistic regression model. RESULTS We identified 3329 patients who were prescribed RAASis at least one month before admission and underwent CAG. Six hundred seventy-four patients had a dose reduction 3 days prior to undergoing CAG, and 2655 patients did not. AKI was observed in 34 (5.0%) patients in the reduction group and 137 (5.2%) patients in the control group. There was no significant difference in the primary outcome between the two groups in the PS-matched cohort (OR: 1.08, 95% CI: 0.70-1.66). CONCLUSIONS A reduction in the dose of RAASis did not prevent the development of AKI among patients undergoing CAG.
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Affiliation(s)
- Hiroyuki Hashimoto
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Liu J, Zhang X, Wang B, Dai H, Dou D, Fang W. Trends in anti-HER2 drugs consumption and influencing factors. Front Public Health 2022; 10:944071. [PMID: 36159303 PMCID: PMC9493110 DOI: 10.3389/fpubh.2022.944071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023] Open
Abstract
Background Human epidermal growth factor receptor 2 (HER2) inhibitors have been approved to treat various cancers with HER2 amplification. The Chinese government has made great efforts to improve the availability and affordability of these drugs. This study aimed to analyze the trends in anti-HER2 drug consumptions in Nanjing from 2012 to 2021, and explore influencing factors. Methods Data about use of anti-HER2 drugs in 2012-2021 were extracted from Jiangsu Medicine Information Institute. Six types of anti-HER2 drugs were included. Drug consumption was expressed as defined daily doses (DDDs) and expenditure. Time series analysis was adopted to find trends in consumption, while interrupted time series was used in analyzing the impact of policy on consumption. The correlation between DDDs and defined daily cost (DDC) was analyzed by Pearson's correlation test. Results The DDC, DDDs, and expenditure of anti-HER2 drugs changed little from 2012 to 2016. The DDC decreased intermittently, while the DDDs and expenditure of these drugs grew continuously from 2017 to 2021. The anti-HER2 monoclonal antibodies contributed to the majority of total consumption in 2012-2019. The DDDs of anti-HER2 tyrosine kinase inhibitors surpassed the DDDs of monoclonal antibodies in 2020-2021. Trastuzumab was the predominantly prescribed drug in 2012-2019, but the DDDs of pyrotinib surpassed the DDDs of trastuzumab in 2020-2021. The ln value of DDC or self-paid DDC of trastuzumab was negatively correlated with the ln value of its DDDs. The national health insurance coverage (NHIC) and national drug price negotiation policy about anti-HER2 drugs were initiated in 2017. Low-price generics and biosimilar of trastuzumab came into the market in 2020 and 2021, separately. Interrupted time series analysis showed that the DDDs increased significantly after the implementation of NHIC, price negotiation or generic drug replacement. Conclusion The consumption of anti-HER2 drugs has significantly increased and their DDC has decreased after the implementation of NHIC, price negotiation, or low-price generic drug replacement since 2017. Further efforts are needed to translate the high consumption into clinical benefits.
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Affiliation(s)
- Jie Liu
- Department of Pharmacy, Nanjing Pukou Central Hospital, Pukou Branch of Jiangsu Province Hospital, Nanjing, China
| | - Xiaolei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Biao Wang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, China
| | - Dahai Dou
- Department of Pharmacy, Nanjing Pukou Central Hospital, Pukou Branch of Jiangsu Province Hospital, Nanjing, China,Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wentong Fang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Wentong Fang
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Wu D, Xie J, Dai H, Fang W. Consumption and cost trends of EGFR TKIs: influences of reimbursement and national price negotiation. BMC Health Serv Res 2022; 22:431. [PMID: 35365136 PMCID: PMC8973903 DOI: 10.1186/s12913-022-07868-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used in the treatment of EGFR mutation non-small-cell lung cancer. The Chinese government has made great efforts to improve the availability and affordability of these drugs. The aim of this study was to investigate the trends in the consumption and cost of EGFR TKIs in Nanjing, a developed city in China, and evaluate the influence of health insurance coverage and national price negotiation on drug consumption. Methods Data about EGFR TKIs applications in 2010–2019 were extracted from Jiangsu Medicine Information Institute. Five types of EGFR TKIs were included. Consumption was expressed in defined daily doses (DDDs) and expenditure. The correlation between defined daily cost (DDC) and DDDs was analyzed by Pearson's correlation test. Results The DDC, number of DDDs and expenditure of EGFR TKIs changed little from 2010 to 2015. National price negotiation was initiated as a policy and low-price generic gefitinib came into the market in 2016. Three types of EGFR TKIs moved into the coverage of the national health insurance since 2017. Hence, the DDC decreased, and the number of DDDs increased significantly year by year since 2016. The first generation TKIs always made up of comprised the majority of the total consumption. The predominantly prescribed TKIs were gefitinib and icotinib. DDC was negatively correlated with the number of DDDs. The number of DDDs increased significantly after health insurance enrollment, price negotiation and generic drug replacement. Conclusion The consumption of EGFT TKIs has increased and the DDC of EGFR TKIs has decreased since 2016. These trends may be attributed to drug reimbursement, price negotiation and generic drug replacement. Further efforts are needed to translate the high consumption of EGFR TKIs into clinical benefits. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07868-9.
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Affiliation(s)
- Di Wu
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Jianxiang Xie
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, 210029, China
| | - Wentong Fang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China.
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Lou G, Yu Z, Chen L, Zhou Y, Zhang L. Trends in Prescriptions for Insomnia in a Province in China Between 2015 and 2019. Front Psychiatry 2022; 13:915823. [PMID: 35795021 PMCID: PMC9251053 DOI: 10.3389/fpsyt.2022.915823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The inappropriate use of pharmacological treatments for insomnia may increase patients' risk of serious adverse events. However, few epidemiological studies on the use of medications for insomnia in China have been conducted to date. OBJECTIVE We aimed to investigate the current pharmacological treatments for insomnia and guide the rational use of drugs. METHODS The prescription data of outpatients with insomnia between 2015 and 2019 in Zhejiang province were extracted from the Hospital Prescription Analysis Cooperative Project of China and evaluated. The demographic characteristics of insomnia and the proportion and prescription trends of different drugs were analyzed along with multidrug combinations for insomnia. RESULTS The number of patients with insomnia who were prescribed medications for insomnia increased from 2,385 in 2015 to 3,919 in 2019, with an increase of 64.32%, whereas the mean age of these patients decreased from 64.07 years to 60.94 years. There were nearly 1.42 times as many female patients prescribed medications for insomnia as male patients, and female patients tended to be younger than male patients. Benzodiazepines (53.99%) were the most common type of medicine for insomnia. The incidence of benzodiazepine usage decreased significantly yearly (P < 0.01), whereas the incidences of non-benzodiazepine receptor agonist (nBZRA) and antidepressant usage increased (P < 0.05). The most common benzodiazepine, nBZRA, antidepressant, and antipsychotic were estazolam, zolpidem, trazodone, and olanzapine, respectively. A total of 13.97% of outpatients with insomnia were prescribed multiple drugs for insomnia, even though nearly half of the drug combinations had similar pharmacological mechanisms. CONCLUSIONS Benzodiazepines remained the most common medication for insomnia, but the prescription rates of nBZRAs and antidepressants increased. Attention should be paid to multidrug combinations for insomnia, which may lead to an increased risk of serious adverse effects.
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Affiliation(s)
- Guodong Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liying Chen
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yiting Zhou
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Hu X, Zhang X, Wang Y, Xie X. Cross-sectional study on the drug utilization and evaluation indicator of antibiotics used in pediatric population. BMC Health Serv Res 2021; 21:1091. [PMID: 34645451 PMCID: PMC8515659 DOI: 10.1186/s12913-021-06727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/01/2021] [Indexed: 12/27/2022] Open
Abstract
Background The lack of medication standards is a serious problem in paediatrics mainly because of age-related differences in organ development and physiological functions in children. Consequently, dosage measurement becomes inaccurate. For this reason, methods for evaluating and monitoring rational paediatric medications should be developed. Drug use indicators, such as those similar to the drug utilisation index (DUI) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) and widely used for the assessment of appropriate dosage in adults, should be explored in terms of their applicability to children. Methods A total of 5,538 prescriptions of antibiotics selected from a general teaching hospital were included. Drug, dose, frequency and treatment duration were obtained from each prescription. The prescription daily dose (PDD) of each antibiotic drug was calculated as the average of the daily doses. Underdose and overdose were determined in terms of the PDD/DDD ratio for each prescription. Children’s DUI (cDUI) was explored in terms of the appropriate dosage for children as follows: the meaning of children’s DDD (cDDD) and the evaluation of paediatric drug dosage. Results The top five antibiotics and their utilisation rates were as follows: cefmetazole sodium injection (18.47 %), erythromycin lactobionate injection (15.07 %), amoxicillin/clavulanate potassium injection (10.72 %), ceftriaxone sodium injection (9.50 %) and azithromycin dry suspension (8.02 %). The ratio of cDUI and PDD/cDDD was mostly not close to 1. Conclusions The establishment of a cDUI system is an effective means of paediatric dosage evaluation. In addition to DDDs, cDUI and PDD/cDDD should be used to analyse the utilisation of antibiotics in children.
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Affiliation(s)
- Xu Hu
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Xueting Zhang
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Yao Wang
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China
| | - Xuefeng Xie
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China. .,Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, People's Republic of China.
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Gujar A, Gulecha DV, Zalte DA. Drug utilization studies using WHO prescribing indicators from India: A systematic review. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Amaha ND, Weldemariam DG, Berhe YH. Antibiotic consumption study in two hospitals in Asmara from 2014 to 2018 using WHO's defined daily dose (DDD) methodology. PLoS One 2020; 15:e0233275. [PMID: 32614832 PMCID: PMC7332034 DOI: 10.1371/journal.pone.0233275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022] Open
Abstract
This study compares the antibiotic consumption rates over a period of five years in two hospitals in Eritrea, Orotta National Referral and Teaching Hospital (ONRTH) and Hazhaz Zonal Referral Hospital (HZRH). Antibiotic consumption is an important parameter in the study of antibiotic use. However, no published data on consumption rates exist for these two hospitals, thus the aim of the study is to measure and compare a five year antibiotic consumption trends of the two hospitals' medical wards using Defined Daily Dose per 100 bed-days (DDD/100-BD). Antibiotics dispensed from January 2014 to December 2018 were considered. Non-parametric Pearson's correlation coefficient was used for comparison of consumption, while non-parametric Friedman's test measured annual rates. The total antibiotic consumption in the HZRH was almost double that of ONRTH. The analysis showed that antibiotic consumption in ONRTH was significantly decreased from 2014 to 2018 while there was no significant difference in consumption in HZRH. Benzyl penicillin was the most consumed antibiotic in HZRH and ONRTH throughout the study period at 87.8DDD/100-BD and 35.4 DDD/100-BD respectively. Ceftriaxone and ciprofloxacin were among the most commonly consumed antibiotics in both hospitals. Establishment of Antibiotic stewardship program would benefit both hospitals greatly, and further studies need to be done to establish the national antibiotic consumption baseline.
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Affiliation(s)
- Nebyu Daniel Amaha
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Ying J, Li LC, Wu CY, Yu ZW, Kan LD. The status of proton pump inhibitor use: a prescription survey of 45 hospitals in China. REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS 2019; 111. [DOI: 10.17235/reed.2019.6155/2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Zheng B, Li N, Hu Z, Liu M. From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics. BMC Pharmacol Toxicol 2018; 19:55. [PMID: 30185217 PMCID: PMC6126037 DOI: 10.1186/s40360-018-0245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. METHODS Utilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred. RESULTS The indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels. CONCLUSIONS The ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.
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Affiliation(s)
- Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Zhijian Hu
- Department of Information, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
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Sugimoto S, Naganuma M, Kanai T. Indole compounds may be promising medicines for ulcerative colitis. J Gastroenterol 2016; 51:853-61. [PMID: 27160749 DOI: 10.1007/s00535-016-1220-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023]
Abstract
Indole compounds are extracted from indigo plants and have been used as blue or purple dyes for hundreds of years. In traditional Chinese medicine, herbal agents in combination with Qing-Dai (also known as indigo naturalis) have been used to treat patients with ulcerative colitis (UC) and to remedy inflammatory conditions. Recent studies have noted that indole compounds can be biosynthesized from tryptophan metabolites produced by various enzymes derived from intestinal microbiota. In addition to their action on indole compounds, the intestinal microbiota produce various tryptophan metabolites that mediate critical functions through distinct pathways and enzymes. Furthermore, some indole compounds, such as indigo and indirubin, act as ligands for the aryl hydrocarbon receptor. This signaling pathway stimulates mucosal type 3 innate lymphoid cells to produce interleukin-22, which induces antimicrobial peptide and tight junction molecule production, suggesting a role for indole compounds during the mucosal healing process. Thus, indole compounds may represent a novel treatment strategy for UC patients. In this review, we describe the origin and function of this indole compound-containing Chinese herb, as well as the drug development of indole compounds.
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Affiliation(s)
- Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Bachhav SS, Kshirsagar NA. Systematic review of drug utilization studies & the use of the drug classification system in the WHO-SEARO Region. Indian J Med Res 2015; 142:120-9. [PMID: 26354209 PMCID: PMC4613433 DOI: 10.4103/0971-5916.164223] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Information available on drug consumption is inadequate in most low and middle income countries. This systematic review was conducted to analyse published work on drug utilization research/studies (DUR) in the SEARO region of WHO for study objectives, methodology, results and recommendations and to identify the need for improving DUR and the use of the ATC/DDD system. METHODS A literature search for DUR was carried out in biomedical databases (PubMed, Scirus, Scopus and Google Scholar) up to May 2012. Publications were selected if those were in the English language, describing DUR or prescription practices, and study conducted in the WHO-SEARO countries. RESULTS A total of 318 publications were included in the review. Of these, 67 per cent were from India and 13 per cent were from Thailand. Majority of the publications were hospital based; only 16 per cent were community based. The ATC/DDD system was used in only 20 per cent of the publications, of which 73 per cent publications used DDD indicators. Several publications focused on antibiotics (31%). Publications that recommended the need for a policy or intervention to improve prescription practices/rational drug use amounted to 35 per cent. INTERPRETATION & CONCLUSIONS Drug utilization studies using ATC/DDD system need to be promoted and carried out on an ongoing basis. DUR is important for rational use of drugs. Its relevance to policy making and resource allocation needs to be emphasized.
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Affiliation(s)
- Sagar S. Bachhav
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology (Former UDCT), Matunga, Mumbai 400 019, Maharashtra, India
| | - Nilima A. Kshirsagar
- National Institute for Research in Reproductive Health (ICMR), J.M. Street, Parel, Mumbai 400 012, Maharashtra, India
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Zeng W, Zhen J, Feng M, Campbell SM, Finlayson AE, Godman B. Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction. J Comp Eff Res 2015; 3:371-86. [PMID: 25275234 DOI: 10.2217/cer.14.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. OBJECTIVE Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. METHODS Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. RESULTS Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. CONCLUSION Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, Chongqing, China
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Shridhar DP, Anitha KB, Rai M, Fernandes A. Reserve drug indent form and its impact on antimicrobial consumption and sensitivity pattern in the medical intensive care unit of a tertiary care hospital. J Clin Diagn Res 2015; 9:FC05-9. [PMID: 25859466 DOI: 10.7860/jcdr/2015/10974.5593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES A world without effective antibiotics is a terrifying but a real prospect. Overuse or misuse especially of newer and higher antimicrobials (AM) is of particular concern, as this contributes to development of resistance among microorganisms. To check this trend, the Reserve Drug Indent Form (RDIF) was introduced in our hospital and its impact on AM consumption, cost of therapy and the sensitivity pattern was studied in the medical intensive care unit (MICU). MATERIALS AND METHODS A retrospective descriptive study in the medical ICU of a tertiary care hospital from July 2012 to August 2013. From March 2013, RDIF was made mandatory to be filled up prior to prescribing reserve antimicrobials. AM consumption (expressed as DDD/100 bed days) and sensitivity pattern (expressed in percentage) six months prior to and six months after implementation of the form were analysed. RESULTS The total Reserve AM consumption was 125.79 per 100 bed days during the study period. Average occupancy index was 0.50 and length of ICU stay was 6 days. The total consumption reduced from 85.55/100 to 40.24/100 bed days after the introduction of the RDIF. However, Imipenem usage increased from 11.35/100 to 23.94/100 bed days, which can be attributed to sensitivity profile to Imipenem (82.1%) compared to Meropenem (65.7%). Cost of therapy reduced from Rs 6,27,951 to 4,20,469. CONCLUSION Reserve AM consumption showed a declining trend after introduction of the RDIF. Hence, the RDIF served as an important tool to combat inappropriate use, reducing the cost burden and also helped to improve the sensitivity to reserve drugs.
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Affiliation(s)
- Deepthi P Shridhar
- Postgraduate, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - K B Anitha
- Professor, Department of Microbiology & Co-ordinator HICC, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - Mohandas Rai
- Professor and Head, Department of Pharmacology, A.J. Institute of Medical Sciences and Research Centre , Mangalore, India
| | - Anisha Fernandes
- Clinical Microbiologist (HICC), Department of Microbiology, A.J. Institute of Medical Sciences and research centre , Mangalore, India
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Zeng W, Finlayson AE, Shankar S, de Bruyn W, Godman B. Prescribing efficiency of proton pump inhibitors in China: influence and future directions. BMC Health Serv Res 2015; 15:11. [PMID: 25609265 PMCID: PMC4308879 DOI: 10.1186/s12913-014-0638-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/08/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables. METHODS Observational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China. RESULTS Appreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (-34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (-19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%. CONCLUSIONS Encouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing, 400074, China.
| | | | - Sushma Shankar
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX3 9DU, UK.
| | - Winnie de Bruyn
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SE-141 86, Sweden. .,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK. .,Liverpool Health Economics Centre, Liverpool University, Chatham Street, Liverpool, L69 7ZH, UK.
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16
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Zeng W, Gustafsson LL, Bennie M, Finlayson AE, Godman B. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history. Expert Rev Pharmacoecon Outcomes Res 2014; 15:157-69. [PMID: 25348709 DOI: 10.1586/14737167.2015.963557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pharmaceutical expenditure is rising by 16% per annum in China and is now 46% of total expenditure. Initiatives to moderate growth include drug pricing regulations and encouraging international non-proprietary name prescribing. However, there is no monitoring of physician prescribing quality and perverse incentives. OBJECTIVES Assess changes in angiotensin receptor blocker (ARB) utilization and expenditure as more generics become available; compare findings to Europe. METHODOLOGY Observational retrospective study of ARB utilization and expenditure between 2006 and 2012 in the largest hospital in Chongqing district. RESULTS Variable and low use of generics versus originators with a maximum of 31% among single ARBs. Similar for fixed dose combinations. Prices typically reduced over time, greatest for generic telmisartan (-54%), mirroring price reductions in some European countries. However, no preferential increase in prescribing of lower cost generics. Accumulated savings of 33 million CNY for this large provider if they adopted European practices. CONCLUSION Considerable opportunities to improve prescribing efficiency in China.
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Affiliation(s)
- Wenjie Zeng
- School of Management, Chongqing Jiaotong University, No.66 Xuefu Road, Nan'an District, Chongqing 400074, China
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Tao J, Zhang T, Xu J, Wu C. Analysis of the Current Situation of Antibiotics Use in China: A Hospital-Based Perspective. Ther Innov Regul Sci 2013; 47:23-31. [PMID: 30227489 DOI: 10.1177/0092861512466397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the present situation of antibiotics use in selected hospitals in China according to 2 indicators: hospital-based market sales and frequency of usage; based on this information, to assess the government's containment policies toward antibiotics overuse. METHODS Marketing and clinical usage data of antibiotics in 420 selected hospitals from 21 major cities and 1 district in China during 2008-2011 were collected and analyzed. Usage frequency was measured by the defined daily dose (DDD) analytic approaches recommended by World Health Organization (WHO), and the growth rate of DDDs per patient was compared for 3 categories of antibiotics: nonlimited (first line), limited (second line), and specially controlled (third line). RESULTS During the period studied, an obvious slowdown was observed in both sales value and the growth of sales volume for the 3 categories. With respect to frequency, both limited-level and specially controlled level antibiotics with high cost and low safety and effectiveness showed an evident decline in the growth rate of DDDs per patient ( P < .05). However, no significant decline was found for nonlimited antibiotics ( P > .05). CONCLUSION The Chinese government's containment policies toward antibiotics overuse are beginning to take effect, and antibiotics usage has become more measured in major cities. However, China still has a long way to go before it can win the battle against antibiotics overuse and drug resistance.
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Affiliation(s)
- Jianhong Tao
- 1 School of Pharmaceutical Science, Sun Yat-sen University, Guangzhou, China.,2 Southern Medicine Economic Institute, State Food and Drug Administration, Guangzhou, China.,Co-first author. These two authors contribute the same to this article Submitted 06-Sep-2012; accepted 30-Sep-2012
| | - Tiantian Zhang
- 1 School of Pharmaceutical Science, Sun Yat-sen University, Guangzhou, China.,Co-first author. These two authors contribute the same to this article Submitted 06-Sep-2012; accepted 30-Sep-2012
| | - Jun Xu
- 3 College of Medicine, Jinan University, Guangzhou, China
| | - Chuanbin Wu
- 1 School of Pharmaceutical Science, Sun Yat-sen University, Guangzhou, China
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Hörbrand F, Bramlage P, Fischaleck J, Hasford J, Brunkhorst R. A population-based study comparing biosimilar versus originator erythropoiesis-stimulating agent consumption in 6,117 patients with renal anaemia. Eur J Clin Pharmacol 2012; 69:929-36. [DOI: 10.1007/s00228-012-1412-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/14/2012] [Indexed: 12/12/2022]
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