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Laville SM, Gras-Champel V, Hamroun A, Moragny J, Lambert O, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Bieber B, Stengel B, Alencar De Pinho N, Massy ZA, Liabeuf S. Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD. Am J Kidney Dis 2024; 83:601-614.e1. [PMID: 37951340 DOI: 10.1053/j.ajkd.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/16/2023] [Accepted: 09/11/2023] [Indexed: 11/13/2023]
Abstract
RATIONALE & OBJECTIVE Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate to advanced CKD. PREDICTORS Demographic and biological data (including eGFR), medication prescriptions. OUTCOME ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. ANALYTICAL APPROACH Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype). RESULTS During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhage (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death and 22 associated with a life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. The risk of acute kidney injury was 2.2% higher and risk of bleeding ADRs was 8% higher for each 1mL/min/1.73m2 lower baseline eGFR. LIMITATIONS The results cannot be extrapolated to patients who are not being treated by a nephrologist. CONCLUSIONS ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor. PLAIN-LANGUAGE SUMMARY Patients with chronic kidney disease (CKD) have complex clinical presentations, take multiple medications, and often receive inappropriate prescriptions. Using data from a large, prospective CKD cohort, we found a high incidence of serious adverse drug reactions (ADRs). The 2 most common serious ADRs were drug-induced acute kidney injury and bleeding. A large proportion of serious ADRs required hospital admission, and 11% led to death or were life threatening. Lower kidney function was a major risk factor for serious ADRs. Many of these serious ADRs were determined to be partly preventable through greater adherence to prescription guidelines. This report enhances our understanding of the potential toxicity of drugs taken by patients with moderate to advanced CKD. It emphasizes the importance of monitoring kidney function when prescribing drugs, particularly for high-risk medications such as antithrombotic agents.
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Affiliation(s)
- Solène M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens
| | - Valérie Gras-Champel
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Aghilès Hamroun
- Nephrology Department, Lille Regional University Medical Center, Lille; Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Julien Moragny
- Pharmacovigilance Center, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Marie Metzger
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Biomedecine Agency, Saint Denis La Plaine
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux; INSERM, U1026, Université Bordeaux Segalen, Bordeaux
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite; Université de Lyon, Carmen INSERM 1060, Lyon
| | | | - Luc Frimat
- Nephrology Department, CHRU de Nancy, Vandoeuvre-lès-Nancy; Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bénédicte Stengel
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Natalia Alencar De Pinho
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Université Paris-Saclay, Université Versailles Saint Quentin, Villejuif; Department of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt/Paris
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, Amiens; MP3CV Laboratory, Jules Verne University of Picardie, Amiens.
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Durand M, Castelli C, Roux-Marson C, Kinowski JM, Leguelinel-Blache G. Evaluating the costs of adverse drug events in hospitalized patients: a systematic review. HEALTH ECONOMICS REVIEW 2024; 14:11. [PMID: 38329561 PMCID: PMC10851489 DOI: 10.1186/s13561-024-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Adverse drug events (ADEs) are not only a safety and quality of care issue for patients, but also an economic issue with significant costs. Because they often occur during hospital stays, it is necessary to accurately quantify the costs of ADEs. This review aimed to investigate the methods to calculate these costs, and to characterize their nature. METHODS A systematic literature review was conducted to identify methods used to assess the cost of ADEs on Medline, Web of Science and Google Scholar. Original articles published from 2017 to 2022 in English and French were included. Economic evaluations were included if they concerned inpatients. RESULTS From 127 studies screened, 20 studies were analyzed. There was a high heterogeneity in nature of costs, methods used, values obtained, and time horizon chosen. A small number of studies considered non-medical (10%), indirect (20%) and opportunity costs (5%). Ten different methods for assessing the cost of ADEs have been reported and nine studies did not explain how they obtained their values. CONCLUSIONS There is no consensus in the literature on how to assess the costs of ADEs, due to the heterogeneity of contexts and the choice of different economic perspectives. Our study adds a well-deserved overview of the existing literature that can be a solid lead for future studies and method implementation. TRIAL REGISTRATION PROSPERO registration CRD42023413071.
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Affiliation(s)
- Maxime Durand
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France.
| | - Christel Castelli
- Department of Law and Health Economics, Faculty of Pharmacy, Univ Montpellier, Montpellier, France
- Department of Innovation, Communication and Market, Univ Montpellier, Montpellier, France
- Department of Clinical Research, AESIO SANTE Méditerranée Beau Soleil Clinic, Montpellier, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Department of Law and Health Economics, Faculty of Pharmacy, Univ Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
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Herledan C, Falandry C, Huot L, Poletto N, Baudouin A, Cerfon MA, Lorsche L, Bret J, Ranchon F, Rioufol C. Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer. J Am Geriatr Soc 2024; 72:567-578. [PMID: 37818698 DOI: 10.1111/jgs.18585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. METHOD RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. RESULTS From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). CONCLUSIONS The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Claire Falandry
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM U1060/ INRAE U1397/Université Lyon 1, Université de Lyon, Pierre-Bénite, France
| | - Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Inserm U1290 Research on Healthcare Performance (RESHAPE), Université Lyon 1, Lyon, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurie Lorsche
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Judith Bret
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
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Rispoli P, Scandiuzzi Piovesan T, Decorti G, Stocco G, Lucafò M. iPSCs as a groundbreaking tool for the study of adverse drug reactions: A new avenue for personalized therapy. WIREs Mech Dis 2024; 16:e1630. [PMID: 37770042 DOI: 10.1002/wsbm.1630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/10/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
Induced pluripotent stem cells (iPSCs), obtained by reprogramming different somatic cell types, represent a promising tool for the study of drug toxicities, especially in the context of personalized medicine. Indeed, these cells retain the same genetic heritage of the donor, allowing the development of personalized models. In addition, they represent a useful tool for the study of adverse drug reactions (ADRs) in special populations, such as pediatric patients, which are often poorly represented in clinical trials due to ethical issues. Particularly, iPSCs can be differentiated into any tissue of the human body, following several protocols which use different stimuli to induce specific differentiation processes. Differentiated cells also maintain the genetic heritage of the donor, and therefore are suitable for personalized pharmacological studies; moreover, iPSC-derived differentiated cells are a valuable tool for the investigation of the mechanisms underlying the physiological differentiation processes. iPSCs-derived organoids represent another important tool for the study of ADRs. Precisely, organoids are in vitro 3D models which better represent the native organ, both from a structural and a functional point of view. Moreover, in the same way as iPSC-derived 2D models, iPSC-derived organoids are appropriate personalized models since they retain the genetic heritage of the donor. In comparison to other in vitro models, iPSC-derived organoids present advantages in terms of versatility, patient-specificity, and ethical issues. This review aims to provide an updated report of the employment of iPSCs, and 2D and 3D models derived from these, for the study of ADRs. This article is categorized under: Cancer > Stem Cells and Development.
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Affiliation(s)
- Paola Rispoli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Giuliana Decorti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Gabriele Stocco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marianna Lucafò
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Lattard C, Baudouin A, Larbre V, Herledan C, Cerutti A, Cerfon MA, Kimbidima R, Caffin AG, Vantard N, Schwiertz V, Ranchon F, Rioufol C. Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review. J Cancer Res Clin Oncol 2023; 149:7905-7924. [PMID: 36853384 DOI: 10.1007/s00432-023-04630-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs. METHODS A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact. RESULTS Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact. CONCLUSION Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France.
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Cao Y, Hao W, Wu Y, Qiao J, Xie M, Jin H, Zhang J, Sun G, Sun H. Epidemiological investigation of emergency infusion adverse drug reactions in Nanjing, China: a prospective cross-sectional study. Expert Opin Drug Saf 2023; 22:871-879. [PMID: 37294710 DOI: 10.1080/14740338.2023.2223945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/26/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Little is known about the morbidity and mortality of infusion Adverse drug reactions (ADRs) in the emergency department. We sought to evaluate the epidemiology of emergency infusion ADRs. MATERIALS AND METHODS This was a prospective study of infusion ADRs in the emergency infusion unit (EIU) of a tertiary hospital from 1 January 20201 January 2020, to 31 December 2021w31 December 2021. Emergency infusion ADRs were identified as intravenous drug-related ADRs that the causality was determined using the Naranjo algorithm. The incidence, severity and preventability of these ADRs were assessed using other standard criteria. RESULTS A total of 327 ADRs were recorded for 320 participants, antibiotics were the class of drugs most commonly involved, and 76.15% of ADRs occurred within the first hour. The most common symptoms observed were skin manifestations, accounting for 46.04% of ADRs. Mild reactions accounted for 85.32% based on the Hartwig and Siegel scale. In 89.30% of the reports, the ADRs were evaluated as not preventable based on the modified Schumock and Thornton scale. The causality and severity of ADRs were related to Charlson Comorbidity Index score and age (P < 0.05). CONCLUSION This epidemiological study described the pattern of emergency infusion ADRs in East China in detail. These findings may be useful to compare patterns among different centers.
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Affiliation(s)
- Yun Cao
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - WeiWen Hao
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YuXuan Wu
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Qiao
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Xie
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Jin
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - JinSong Zhang
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Institute of Poisoning, Nanjing Medical University, Nanjing, P. R. China
| | - GuoZhen Sun
- School of Nursing, Nanjing Medical University, Nanjing, China
- Department of Cardiovascular, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Sun
- Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Institute of Poisoning, Nanjing Medical University, Nanjing, P. R. China
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Lacroix C, Maurier A, Largeau B, Destere A, Thillard EM, Drici M, Micallef J, Jonville-Bera AP. Sex differences in adverse drug reactions: Are women more impacted? Therapie 2023; 78:175-188. [PMID: 36283857 DOI: 10.1016/j.therap.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
Pharmacovigilance and pharmacoepidemiology studies regarding the sex difference in adverse drug reactions are numerous, and it is now a challenge to take them into account in order to increase drug safety. Here, we present an overview of this topic through data on epidemiology, mechanisms, and methods used for assessing sex differences in drug safety. Because the literature is extensive, we choose to expose a few examples of studies for cardiovascular drugs, anti-infectious, psychotropics, antidiabetics, anticancer drugs and some specific drugs to illustrate our purpose. Many studies show a higher risk in women for most of drugs involving in sex differences. However, physiological, methodological and subjective points have to be taken into account to interpret these results. Clinical trials must also enroll more women to better evaluate sex differences both in efficacy and pharmacovigilance. Nevertheless, when there is a pharmacological rationale underlying the observed association between sex and drug safety profile, it is now unavoidable to think about its consideration for a personalized prescription.
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Affiliation(s)
- Clémence Lacroix
- Department of Clinical Pharmacology and Pharmacovigilance, Regional Pharmacovigilance Center, and Aix Marseille Univ, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, 13005 Marseille, France
| | - Anaïs Maurier
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Bérenger Largeau
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance Regional Center of Nice, University Hospital of Nice, 06000 Nice, France
| | - Eve-Marie Thillard
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre Val de Loire, University Hospital of Tours, 37000 Tours, France
| | - Milou Drici
- Department of Pharmacology and Pharmacovigilance Regional Center of Nice, University Hospital of Nice, 06000 Nice, France
| | - Joëlle Micallef
- Department of Clinical Pharmacology and Pharmacovigilance, Regional Pharmacovigilance Center, and Aix Marseille Univ, AP-HM, Inserm, Inst Neurosci Syst, UMR 1106, 13005 Marseille, France
| | - Annie Pierre Jonville-Bera
- Department of Pharmacosurveillance, Pharmacovigilance Regional Center of Centre Val de Loire, University Hospital of Tours, 37000 Tours, France.
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Laroche ML, Gautier S, Polard E, Rabier MB, Chouchana L, Lebrun-Vignes B, Faillie JL, Petitpain N, Lagarce L, Jonville-Bera AP. Incidence and preventability of hospital admissions for adverse drug reactions in France: A prospective observational study (IATROSTAT). Br J Clin Pharmacol 2023; 89:390-400. [PMID: 36002314 PMCID: PMC10087906 DOI: 10.1111/bcp.15510] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS In the last French study in 2007, the incidence of hospital admissions (HAs) related to adverse drug reactions (ADRs) was 3.6%. The objective was to assess the current ADR-HA incidence in France and to describe both its characteristics and preventability. METHODS A prospective multicentre study was conducted among randomly selected French public hospital medical wards (April-July 2018). Patients admitted during a week period were included. ADR-HA cases were collected by the French Regional Pharmacovigilance Centres network. An independent committee validated potential cases and ADR preventability. RESULTS ADR-HA incidence was 8.5% (95% confidence interval [CI]: 7.6-9.4%), increasing with age (3.3% [95%CI: 1.8-5.5%] ≤16 y vs. 10.6% [95%CI: 9.3-12.0%] ≥65 y). The most common ADRs were haemorrhagic events (8.8%), haematological disorders (6.5%), acute renal failure (6.3%), fluid and electrolyte disorders (6.0%), and falls (5.2%). New drugs were involved: targeted therapies (22.8% of antineoplastics), direct oral anticoagulants (29.6% of antithrombotics) and incretin-based drugs (20.0% of antidiabetics). ADRs were preventable in 16.1% of cases because the drugs involved had not been used in accordance with monographies, package leaflets or other therapeutic guidelines. The main situations of noncompliance addressed either dose or duration of use (27.9%), warning (23.2%), use precaution (18.6%) and inappropriate self-medication or misuse by patients (11.6%). CONCLUSION In France, ADR-HA incidence dramatically increased over the last decade. A significant proportion was related to new pharmacological classes and considered as preventable. These findings should lead to in-depth thought on preventive actions on at-risk drug classes.
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Affiliation(s)
- Marie-Laure Laroche
- Regional Pharmacovigilance Centre of Limoges, Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Limoges, Limoges, France.,UR 24134 (VieSanté- Vieillissement, Fragilité, Prévention, e-Santé), IFR OMEGA HEALTH, Université de Limoges, Limoges, France
| | - Sophie Gautier
- Regional Pharmacovigilance Centre of Lille, Pharmacology Department, CHU Lille, Lille, France
| | - Elisabeth Polard
- Regional Pharmacovigilance Centre of Rennes, CHU Rennes, Rennes, Francie, France
| | | | - Laurent Chouchana
- Regional Pharmacovigilance Centre of Cochin, Pharmacology Department, AP-HP. Centre - Université Paris Cité, Paris, France
| | - Bénédicte Lebrun-Vignes
- Regional Pharmacovigilance Centre of Pitié and Saint Antoine Hospital, APHP Sorbonne Université, Paris, France
| | - Jean-Luc Faillie
- Regional Pharmacovigilance Centre of Montpellier, CHU Montpellier, Montpellier, France.,IDESP, Univ. Montpellier, INSERM, Montpellier, France
| | - Nadine Petitpain
- Regional Pharmacovigilance Centre of Nancy, CHRU Nancy, Nancy, France
| | - Laurence Lagarce
- Department of Pharmacology-Toxicology and Pharmacovigilance, CHU Angers, Regional Pharmacovigilance Centre of Angers, Angers, France
| | - Annie-Pierre Jonville-Bera
- Regional Pharmacovigilance Centre - Centre-Val de Loire, Pharmacosurveillance Unit, CHRU Tours, Tours, France
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Liu Y, Yang M, Ding Y, Wang H, Zhang H, Wang D, Zhuang T, Ji M, Cui Y, Wang H. Clinical significance of potential drug-drug interactions in older adults with psychiatric disorders: a retrospective study. BMC Psychiatry 2022; 22:563. [PMID: 35996119 PMCID: PMC9394082 DOI: 10.1186/s12888-022-04207-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Polypharmacy increases the risk of potential drug-drug interactions (pDDIs). This retrospective analysis was conducted to detect pDDIs and adverse drug reactions (ADRs) among older adults with psychiatric disorder, and identify pDDIs with clinical significance. METHODS A retrospective analysis was carried out based on the medical records of older adults with psychiatric disorders. Data on demographic characteristics, substance abuse, medical history, and medications were extracted. The Lexi-Interact online database was used to detect pDDIs. The minimal clinically important difference (MCID) was set as the change in the Treatment Emergent Symptom Scale (TESS) score between admission and discharge. The median and interquartile ranges were used for continuous variables, and frequencies were calculated for dichotomous variables. Poisson regression was implemented to determine the factors influencing the number of ADR types. The influencing factors of each ADR and the clinical significance of the severity of the ADR were analysed using binary logistic regression. P < 0.05 was considered statistically significant. RESULTS A total of 308 older adults were enrolled, 171 (55.52%) of whom had at least 1 pDDI. Thirty-six types of pDDIs that should be avoided were found, and the most frequent pDDI was the coadministration of lorazepam and olanzapine (55.5%). A total of 26 ADRs induced by pDDIs were identified, and the most common ADR was constipation (26.05%). There was a 9.4 and 10.3% increase in the number of ADR types for each extra medical diagnosis and for each extra drug, respectively. There was a 120% increase in the number of ADR types for older adults hospitalized for 18-28 days compared with those hospitalized for 3-17 days. There was an 11.1% decrease in the number of ADR types for each extra readmission. The length of hospitalization was a risk factor for abnormal liver function (P < 0.05). The use of a large number of drugs was a risk factor for gastric distress (P < 0.05) and dizziness and fainting (P < 0.05). None of the four pDDIs, including coadministrations of olanzapine and lorazepam, quetiapine and potassium chloride, quetiapine and escitalopram, and olanzapine and clonazepam, showed clinical significance of ADR severity (P > 0.05). CONCLUSIONS pDDIs are prevalent in older adults, and the rate is increasing. However, many pDDIs may have no clinical significance in terms of ADR severity. Further research on assessing pDDIs, and possible measures to prevent serious ADRs induced by DDIs is needed to reduce the clinical significance of pDDIs.
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Affiliation(s)
- Yu Liu
- grid.89957.3a0000 0000 9255 8984Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province P.R. China 211166 ,grid.89957.3a0000 0000 9255 8984Department of Nursing Management, Kangda College, Nanjing Medical University, Lianyungang, Jiangsu Province P.R. China 222000
| | - Man Yang
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, Affiliated to Kangda College, Nanjing Medical University, Lianyungang, Jiangsu Province P.R. China 222003
| | - Yaping Ding
- grid.89957.3a0000 0000 9255 8984Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province P.R. China 211166
| | - Huanqiang Wang
- grid.89957.3a0000 0000 9255 8984Department of Occupational Medicine and Environmental Health, Kangda College, Nanjing Medical University, Lianyungang, Jiangsu Province P.R. China 222000
| | - Hailin Zhang
- grid.460072.7Department of Nursing, The First People’s Hospital of Lianyungang, Affiliated to Kangda College, Nanjing Medical University, Lianyungang, Jiangsu Province P.R. China 222061
| | - Dandan Wang
- grid.89957.3a0000 0000 9255 8984Department of Fundamental Nursing, Kangda College, Nanjing Medical University, Lianyungang, Jiangsu Province, P.R. China 222000
| | - Tianchi Zhuang
- grid.89957.3a0000 0000 9255 8984Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province P.R. China 211166
| | - Minghui Ji
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China, 211166.
| | - Yan Cui
- Department of Fundamental and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China, 211166.
| | - Hong Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China, 210029.
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