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Minoc EM, Villain C, Chrétien B, Benbrika S, Heraudeau M, Lafont C, Béchade C, Lobbedez T, Lelong-Boulouard V, Dolladille C. Association between antidepressant drugs and falls in older adults: A mediation analysis in the World Health Organization's pharmacovigilance database. Therapie 2025:S0040-5957(25)00024-1. [PMID: 40037976 DOI: 10.1016/j.therap.2025.01.004] [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: 09/02/2024] [Revised: 01/23/2025] [Accepted: 01/29/2025] [Indexed: 03/06/2025]
Abstract
OBJECTIVES The objective is to investigate the association between antidepressant drugs intake and falls reporting, as well as the potential mediators in-between, in older adults. METHODS In VigiBase®, the World Health Organization's pharmacovigilance database, we performed a disproportionality analysis to probe the putative associations between each antidepressant drugs class (non-selective monoamine reuptake inhibitors [NSMRIs], selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], alpha-2-adrenergic receptor antagonists, and "other antidepressants") and reports of falls in people aged 65 and over (NCT05628467). The reporting odds ratios and their 95% confidence interval were derived from logistic regression models with adjustment for confounders. We studied the falls-inducing mechanisms (delirium, hyponatremia, hypotension) by using causal mediation analyses and by using a disproportionality analysis for the co-occurrence of falls and these events. RESULTS Our main analysis included 86,200 cases of falls reporting in older adults (of which 57% were 75 and over). A significant association was found between falls and every antidepressant drugs class, except for NSMRIs. According to causal mediation analysis, a direct effect on the falls reports was shown for alpha-2-adrenergic receptor antagonists and for "other antidepressants". According to the co-reports analyses, all antidepressant drugs classes except SNRIs were associated with the co-event fall-delirium; SSRIs, alpha-2-adrenergic receptor antagonists, and "other antidepressants" with fall-hypotension; all antidepressant drugs classes except NSMRIs with fall-hyponatremia. CONCLUSIONS In multivariate disproportionality analyses, all antidepressant drugs classes were associated with signals of disproportionate reporting of falls in older adults, except for NSMRIs. In mediation analyses, a direct effect on the falls reports was only found for alpha-2-adrenergic receptor antagonists. Single-mediators based models seem insufficient to explain the diversity of clinical settings resulting in falls. These findings underline the necessity of a comprehensive analysis of all clinical and pharmacological features in older falling adults treated with antidepressant drugs.
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Affiliation(s)
- Elise-Marie Minoc
- Geriatric Department, CHU de Caen, 14000 Caen, France; UNICAEN, Inserm COMETE, U1075, Normandie University, 14000 Caen, France.
| | - Cédric Villain
- Geriatric Department, CHU de Caen, 14000 Caen, France; UNICAEN, Inserm COMETE, U1075, Normandie University, 14000 Caen, France
| | | | - Soumia Benbrika
- Psychiatric Department, CHU de Caen, 14000 Caen, France; UNICAEN, Inserm, UMR 1237, Normandie University, 14000 Caen, France
| | - Marie Heraudeau
- UNICAEN, Inserm COMETE, U1075, Normandie University, 14000 Caen, France; Pharmacology Department, CHU de Caen, 14000 Caen, France
| | - Claire Lafont
- Geriatric Department, CHU de Caen, 14000 Caen, France
| | - Clémence Béchade
- Nephrology Department, CHU de Caen, 14000 Caen, France; UNICAEN, Inserm, ANTICIPE, U1086, Normandie University, 14000 Caen, France
| | - Thierry Lobbedez
- Nephrology Department, CHU de Caen, 14000 Caen, France; UNICAEN, Inserm, ANTICIPE, U1086, Normandie University, 14000 Caen, France
| | - Véronique Lelong-Boulouard
- UNICAEN, Inserm COMETE, U1075, Normandie University, 14000 Caen, France; Pharmacology Department, CHU de Caen, 14000 Caen, France
| | - Charles Dolladille
- Pharmacology Department, CHU de Caen, 14000 Caen, France; Psychiatric Department, CHU de Caen, 14000 Caen, France
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Di J, Qi L, Liu L, Xing X, Liu Y, Xiang C. From common to unreported: a real-world study of adverse events to duloxetine in the treatment of osteoarthritis. Expert Opin Drug Saf 2024:1-14. [PMID: 39283632 DOI: 10.1080/14740338.2024.2393470] [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: 05/19/2024] [Accepted: 07/11/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND In a review of drug guidelines published by the International Association for the Study of Osteoarthritis, it is recommended to support the conditional use of duloxetine in patients with osteoarthritis. However, there is a lack of comprehensive research on the adverse events of duloxetine for the treatment of osteoarthritis populations. RESEARCH DESIGN AND METHODS We used the reporting odds ratio (ROR) to determine the strength of the adverse event signal. In addition, we investigated trends in the occurrence of adverse events using the Weibull shape parameter (WSP) test. RESULTS The results showed that 50 and 14 adverse events were detected in both Asian and American populations. Four new adverse events, Mouth ulceration, femoral neck fracture, incontinence, long QT syndrome, were identified. There was a difference in the time of adverse event induction between the North American and Asian populations (p < 0.0001). The Weibull shape parameter (WSP) test showed that the incidence of AE decreased over time. CONCLUSION Our study contributes to an in-depth understanding of the safety of duloxetine in the treatment of osteoarthritis.
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Affiliation(s)
- Jingkai Di
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Likun Qi
- School of Basic Medical Sciences, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lujia Liu
- School of Basic Medical Sciences, The Stomatological Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinglong Xing
- School of Basic Medical Sciences, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yaru Liu
- School of Basic Medical Sciences, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Chuan Xiang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, China
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Minoc EM, Villain C, Benbrika S, Chrétien B, Descatoire P, Heraudeau M, Sassier M, Pierre M, Martinaud O, Dolladille C, Lelong-Boulouard V. Association between antidepressant use and delirium in older adults: an analysis of the World Health Organization's global pharmacovigilance database. BMC Geriatr 2024; 24:600. [PMID: 38997635 PMCID: PMC11241964 DOI: 10.1186/s12877-024-05022-0] [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: 01/06/2024] [Accepted: 04/29/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Psychoactive drugs frequently cause delirium adverse events in older adults. However, few data on the relationship between antidepressants and delirium are available. Here, we investigated the association between antidepressant prescription and pharmacovigilance reports of delirium in older adults. METHODS Using the World Health Organization's VigiBase® global pharmacovigilance database from 1967 to 2022, we performed a disproportionality analysis in order to probe the putative associations between each antidepressant class (non-selective monoamine reuptake inhibitors (NSMRIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), alpha-2-adrenergic receptor antagonists, and other antidepressants) and reports of delirium in people aged 65 or over. We calculated the reporting odds ratios (r-OR) and their 95% confidence interval ([95%CI]) with logistic regression models before and after adjustment for confounding factors. Secondary analyses were performed for each drug and within each class by age group (65-74, and 75 and over). We also studied the reports of concomitant delirium and hyponatremia. RESULTS Our main analysis included 87,524 cases of delirium. After adjustment for confounders, a significant association was found between delirium and all antidepressant classes other than SNRIs. Intraclass disparities were found for the association between the most frequently prescribed antidepressants and reports of delirium. An elevated risk of reports of concomitant delirium and hyponatremia was found for SSRIs (4.46 [4.01-4.96]), SNRIs (1.25 [1.07-1.46]), MAOIs (1.72 [1.41-2.09]), and the "other antidepressants" class (1.47 [1.30-1.65]). CONCLUSIONS There was a significant association between reports of delirium and antidepressant classes (other than SNRIs). However, this association varied from one drug to another within a given antidepressant class. Moreover, this association could not always be explained by antidepressant-induced hyponatremia.
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Affiliation(s)
- Elise-Marie Minoc
- Geriatric Department, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France.
- Normandie Univ, UNICAEN, INSERM COMETE, U1075, F-14000, Caen, France.
| | - Cédric Villain
- Geriatric Department, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM COMETE, U1075, F-14000, Caen, France
| | - Soumia Benbrika
- Psychiatric Department, CHU de Caen, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, UMR 1077, 14000, Caen, France
| | | | - Pablo Descatoire
- Geriatric Department, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Marie Heraudeau
- Normandie Univ, UNICAEN, INSERM COMETE, U1075, F-14000, Caen, France
| | - Marion Sassier
- Pharmacology Department, CHU de Caen, 14000, Caen, France
| | - Mélissa Pierre
- Geriatric Department, CHU de Caen, Avenue de La Côte de Nacre, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, UMR 1077, 14000, Caen, France
| | - Olivier Martinaud
- Neurology Department, CHU de Caen, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, UMR 1077, 14000, Caen, France
| | - Charles Dolladille
- Pharmacology Department, CHU de Caen, 14000, Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, U1086, F-14000, Caen, France
| | - Véronique Lelong-Boulouard
- Normandie Univ, UNICAEN, INSERM COMETE, U1075, F-14000, Caen, France
- Pharmacology Department, CHU de Caen, 14000, Caen, France
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Sarno DL, Silver EM, Goldstein R, Frontera WR, Silver JK. Rehabilitation clinical trials in global registries: reporting of participant inclusion by sex, age, race and ethnicity. Disabil Rehabil 2024; 46:2946-2954. [PMID: 37448349 DOI: 10.1080/09638288.2023.2231844] [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: 12/28/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Registries of clinical trials exist in part to standardize data for the scientific community. Studies in the United States demonstrated gaps in reporting on ClinicalTrials.gov. The purpose of this cross-sectional study was to evaluate clinical trial participation among global registries. METHODS This study identified registries with results reported and assessed available results for physical and rehabilitation medicine (PRM) diagnosis, intervention, primary outcome, and the International Classification of Functioning, Disability and Health (ICF) categories. Participant characteristics including sex, age, and race/ethnicity were assessed. RESULTS A total of 93 rehabilitation trials from eight registries met inclusion criteria. Most trials included persons with musculoskeletal disorders (50.5%), technology such as robotics (25.8%) and outcomes in ICF category of body functions and structures (54.7%). Sex was reported in 61.3% of trials and varied among registries (0 to 100%). Participation of women in trials showed variability from 0 to 75%. Reporting of age of the participants was not uniform and six registries did not include age in all trials. Information about race/ethnicity was absent in most trials and registries. CONCLUSIONS Based on trials registered with accessible results, these findings may reveal either a gap in reporting results or a lack of trials investigating important PRM diagnoses, interventions, and outcomes.Implications for RehabilitationThis study contributes to the growing body of evidence that there are gaps in standardization of rehabilitation results reported on clinical trials registries.The uniform reporting of results is an important component of advancing rehabilitation science and may be a factor in high-quality study design and improved transparency.
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Affiliation(s)
- Danielle L Sarno
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily M Silver
- Department of Psychology, University of Chicago, Chicago, IL, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
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Coelho T, Rosendo I, Seiça Cardoso C. Evaluation of deprescription by general practitioners in elderly people with different levels of dependence: cross-sectional study. BMC PRIMARY CARE 2024; 25:78. [PMID: 38431577 PMCID: PMC10908147 DOI: 10.1186/s12875-024-02299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Polypharmacy is easily achieved in elderly patients with multimorbidity and it is associated with a higher risk of potentially inappropriate medication use and worse health outcomes. Studies have shown that deprescription is safe, however, some barriers have been identified. The aim of this study was to analyse Portuguese General Practitioners (GP) deprescription's attitudes using clinical vignettes. METHODS Cross-sectional study using an online survey with 3 sections: demographic and professional characterization; two clinical vignettes with an elderly patient with multimorbidity and polypharmacy in which the dependency level varies; barriers and factors influencing deprescription. Frequencies, means, and standard deviations were calculated to describe the GPs. Analysis of the deprescription attitude, globally and for each drug, for each clinical vignette applying the McNeemar's test. RESULTS A sample of 396 GP was obtained with a mean age of 38 years, most of them female. A statistically significant difference (p < 0.01) was observed in deprescribing according to the patient dependency level, with more GPs (80.4% versus 75.3%) deprescribing in the most dependent patient. A statistically significant difference was found for all drugs except for antihypertensive drugs. All medications were deprescribed more often in dependent patients except for anti-dementia drugs. More than 70% of the participants considered life expectancy and quality of life as "very important" factors for deprescription and more than 90% classified the existence of guidelines and the risks and benefits of medication as "very important" or "important". In the open question, the factors most reported by the GP were those related to the patient (52,9%). CONCLUSIONS This is the largest study on this topic carried out in Portugal using clinical vignettes, with a representative sample of Portuguese GP. The level of dependence significatively influenced the deprescription attitude of Portuguese GPs. The majority of the GPs classified the quality of life, life expectancies, potential negative effects and the existence of guidelines as "very important" or "important" while deprescribing. It is important to develop and test deprescribing in real life studies to analyze if these attitudes are the same in daily practice.
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Affiliation(s)
- Tânia Coelho
- Unidade de Saúde Familiar VitaSaurium, Soure, Coimbra, Portugal.
| | - Inês Rosendo
- CINTESIS - Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Coimbra Centro, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carlos Seiça Cardoso
- Unidade de Saúde Familiar Condeixa, Condeixa, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Chen Y, Yang S, Yu K, Zhang J, Wu M, Zheng Y, Zhu Y, Dai J, Wang C, Zhu X, Dai Y, Sun Y, Wu T, Wang S. Spatial omics: An innovative frontier in aging research. Ageing Res Rev 2024; 93:102158. [PMID: 38056503 DOI: 10.1016/j.arr.2023.102158] [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: 08/28/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
Disentangling the impact of aging on health and disease has become critical as population aging progresses rapidly. Studying aging at the molecular level is complicated by the diverse aging profiles and dynamics. However, the examination of cellular states within aging tissues in situ is hampered by the lack of high-resolution spatial data. Emerging spatial omics technologies facilitate molecular and spatial analysis of tissues, providing direct access to precise information on various functional regions and serving as a favorable tool for unraveling the heterogeneity of aging. In this review, we summarize the recent advances in spatial omics application in multi-organ aging research, which has enhanced the understanding of aging mechanisms from multiple standpoints. We also discuss the main challenges in spatial omics research to date, the opportunities for further developing the technology, and the potential applications of spatial omics in aging and aging-related diseases.
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Affiliation(s)
- Ying Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Shuhao Yang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Kaixu Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinjin Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Meng Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yongqiang Zheng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Yun Zhu
- Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N. Rutledge, P.O. Box 19628, Springfield, IL 62702, USA
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Chunyan Wang
- College of Science & Engineering Jinan University, Guangzhou, China
| | - Xiaoran Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China
| | - Yunhong Sun
- Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China.
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; National Clinical Research Center for Obstetrical and Gynecological Diseases, Wuhan, China; Ministry of Education, Key Laboratory of Cancer Invasion and Metastasis, Wuhan, China.
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Reeves S, Bertrand J, Obee SJ, Hunter S, Howard R, Flanagan RJ. A population pharmacokinetic model to guide clozapine dose selection, based on age, sex, ethnicity, body weight and smoking status. Br J Clin Pharmacol 2024; 90:135-145. [PMID: 36793249 DOI: 10.1111/bcp.15691] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS Guidance on clozapine dosing in treatment-resistant schizophrenia is based largely on data from White young adult males. This study aimed to investigate the pharmacokinetic profiles of clozapine and N-desmethylclozapine (norclozapine) across the age range, accounting for sex, ethnicity, smoking status and body weight. METHODS A population pharmacokinetic model, implemented in Monolix, that linked plasma clozapine and norclozapine via a metabolic rate constant, was used to analyse data from a clozapine therapeutic drug monitoring service, 1993-2017. RESULTS There were 17 787 measurements from 5960 patients (4315 male) aged 18-86 years. The estimated clozapine plasma clearance was reduced from 20.2 to 12.0 L h-1 between 20 and 80 years. Model-based dose predictions to attain a predose plasma clozapine concentration of 0.35 mg L-1 was 275 (90% prediction interval 125, 625) mg day-1 in nonsmoking, White males weighing 70 kg and aged 40 years. The corresponding predicted dose was increased by 30% in smokers, decreased by 18% in females, and was 10% higher and 14% lower in otherwise analogous Afro-Caribbean and Asian patients, respectively. Overall, the predicted dose decreased by 56% between 20 and 80 years. CONCLUSION The large sample size and wide age range of the patients studied allowed precise estimation of dose requirements to attain predose clozapine concentration of 0.35 mg L-1 . The analysis was, however, limited by the absence of data on clinical outcome and future studies are required to determine optimal predose concentrations specifically in those aged over 65 years.
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Affiliation(s)
- Suzanne Reeves
- Division of Psychiatry, University College London, London, UK
| | - Julie Bertrand
- Institute of Genetics, University College London, London, UK
- UMR 1137 Infection, Antimicrobials, Modelling, Evolution (IAME) French Institute for Medical Research (INSERM), University of Paris, Paris, France
| | - Stephen John Obee
- Precision Medicine, Networked Services, Bessemer Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Samora Hunter
- Precision Medicine, Networked Services, Bessemer Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | - Robert James Flanagan
- Precision Medicine, Networked Services, Bessemer Wing, King's College Hospital NHS Foundation Trust, London, UK
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In 't Veld AE, Grievink HW, van der Plas JL, Eveleens Maarse BC, van Kraaij SJW, Woutman TD, Schoonakker M, Klarenbeek NB, de Kam ML, Kamerling IMC, Jansen MAA, Moerland M. Immunosuppression by hydroxychloroquine: mechanistic proof in in vitro experiments but limited systemic activity in a randomized placebo-controlled clinical pharmacology study. Immunol Res 2023; 71:617-627. [PMID: 36811819 PMCID: PMC9945836 DOI: 10.1007/s12026-023-09367-3] [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: 09/26/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
Based on its wide range of immunosuppressive properties, hydroxychloroquine (HCQ) is used for the treatment of several autoimmune diseases. Limited literature is available on the relationship between HCQ concentration and its immunosuppressive effect. To gain insight in this relationship, we performed in vitro experiments in human PBMCs and explored the effect of HCQ on T and B cell proliferation and Toll-like receptor (TLR)3/TLR7/TLR9/RIG-I-induced cytokine production. In a placebo-controlled clinical study, these same endpoints were evaluated in healthy volunteers that were treated with a cumulative dose of 2400 mg HCQ over 5 days. In vitro, HCQ inhibited TLR responses with IC50s > 100 ng/mL and reaching 100% inhibition. In the clinical study, maximal HCQ plasma concentrations ranged from 75 to 200 ng/mL. No ex vivo HCQ effects were found on RIG-I-mediated cytokine release, but there was significant suppression of TLR7 responses and mild suppression of TLR3 and TLR9 responses. Moreover, HCQ treatment did not affect B cell and T cell proliferation. These investigations show that HCQ has clear immunosuppressive effects on human PBMCs, but the effective concentrations exceed the circulating HCQ concentrations under conventional clinical use. Of note, based on HCQ's physicochemical properties, tissue drug concentrations may be higher, potentially resulting in significant local immunosuppression. This trial is registered in the International Clinical Trials Registry Platform (ICTRP) under study number NL8726.
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Affiliation(s)
- Aliede E In 't Veld
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Hendrika W Grievink
- Centre for Human Drug Research, Leiden, The Netherlands
- Division of BioTherapeutics, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Johan L van der Plas
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Boukje C Eveleens Maarse
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Sebastiaan J W van Kraaij
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | | | | | - Ingrid M C Kamerling
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, The Netherlands.
- Leiden University Medical Centre, Leiden, The Netherlands.
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Hamed K, Engelhardt M, Kovanda LL, Huang JJ, Yan J, Aram JA. Post-hoc analysis of the safety and efficacy of isavuconazole in older patients with invasive fungal disease from the VITAL and SECURE studies. Sci Rep 2023; 13:6730. [PMID: 37185921 PMCID: PMC10127179 DOI: 10.1038/s41598-023-31788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
Isavuconazole is a triazole with broad-spectrum antifungal activity. In this post-hoc analysis of two prospective clinical trials (VITAL and SECURE), the safety and efficacy of isavuconazole in patients aged ≥ 65 years with invasive fungal diseases were evaluated. Patients were divided into two subgroups (≥ 65 and < 65 years). Adverse events (AEs); all-cause mortality; and overall, clinical, mycological, and radiological response were assessed. A total of 155 patients ≥ 65 years were enrolled in both trials. Most patients reported AEs. In the isavuconazole arm of both studies, serious AEs (SAEs) were greater in patients ≥ 65 versus < 65 years: 76.7% versus 56.9% (VITAL); 61.9% versus 49.0% (SECURE). In SECURE, SAE rates were similar in the ≥ 65 years subgroup of both treatment arms (61.9% vs 58.1%), while in the < 65 years subgroup the SAE rate was lower in the isavuconazole arm (49.0% vs 57.4%). In VITAL, all-cause mortality through day 42 (30.0% vs 13.8%) was higher, and overall response at end of treatment (27.6% vs 46.8%) was lower in patients ≥ 65 years versus < 65 years. In SECURE, all-cause mortality was similar between both subgroups, and isavuconazole (20.6% vs 17.9%) and voriconazole (22.6% vs 19.4%) treatment arms. The overall response was lower in the ≥ 65 years than the < 65 years subgroup in the isavuconazole (23.7% vs 39.0%) and voriconazole (32.0% vs 37.5%) arms. The safety and efficacy of isavuconazole were better in patients < 65 versus ≥ 65 years, and the safety profile was more favorable than that of voriconazole in both subgroups.Clinicaltrials.gov identifier NCT00634049 and NCT00412893.
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Affiliation(s)
- Kamal Hamed
- Basilea Pharmaceutica International Ltd., Allschwil, Switzerland
| | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd., Allschwil, Switzerland.
| | - Laura L Kovanda
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Jin Ju Huang
- Pfizer, 10645848 PBG China Medical, Beijing, China
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10
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McCartney D, Kevin RC, Suraev AS, Sahinovic A, Doohan PT, Bedoya-Pérez MA, Grunstein RR, Hoyos CM, McGregor IS. How long does a single oral dose of cannabidiol persist in plasma? Findings from three clinical trials. Drug Test Anal 2023; 15:334-344. [PMID: 36478641 DOI: 10.1002/dta.3419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
A growing number of clinical trials (CTs) are investigating the therapeutic potential of cannabidiol (CBD), a non-intoxicating phytocannabinoid found in Cannabis sativa. These CTs often use crossover experimental designs requiring 'washout' (clearance) periods. However, the length of time CBD persists in plasma (its 'window of detection') is unclear and could be significant. Indeed, the structurally related phytocannabinoid, Δ9 -tetrahydrocannabinol (THC), has a long window of detection in plasma. We investigated the extent to which CBD and its major metabolites persist in plasma. Data from three CTs that measured plasma cannabinoid concentrations ≥7 days after administering a single oral dose of CBD were pooled. The CBD doses were as follows: CT #1: 300 mg; CT #2: 200 mg (and 10 mg THC); and CT #3: 15, 300 and 1500 mg (one per treatment session). Thirty-two participants were included in the analysis, 17 of whom (from CT #3) provided repeated measures. Overall, 0% (15 mg), 60% (200 mg), 28% (300 mg) and 100% (1500 mg) of participants had detectable concentrations (i.e., >0.25 ng·ml-1 ) of CBD in plasma ≥7 days post-treatment (some, several weeks post-treatment). A zero-inflated negative binomial mixed-effects regression analysis (R2 m = 0.44; R2 c = 0.73) predicted that, on average, a 13 day washout period would reduce plasma CBD concentrations to 'zero' (i.e., <0.25 ng·ml-1 ) if a single oral dose of 300 mg was consumed. Higher doses require longer washout periods; concomitant medications may also affect clearance. In conclusion, CBD has a long window of detection in plasma. Crossover studies involving CBD should, therefore, be conducted with caution, particularly when higher doses and/or chronic dosing regimens are used.
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Affiliation(s)
- Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard C Kevin
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anastasia S Suraev
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Ayshe Sahinovic
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter T Doohan
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Miguel A Bedoya-Pérez
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.,RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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11
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In silico identification of the potential molecular mechanisms involved in protective effects of prolactin on motor and memory deficits induced by 1,2-Diacetylbenzene in young and old rats. Neurotoxicology 2022; 93:45-59. [PMID: 36100143 DOI: 10.1016/j.neuro.2022.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023]
Abstract
We aimed to identify the molecular mechanisms through which prolactin protects against 1,2-Diacetylbenzene (DAB)-induced memory and motor impairments. The gene expression omnibus database (no. GSE119435), transcriptomic data, GeneMANIA, ToppGeneSuite, Metascape, STRING database, Cytoscape, and Autodock were used as the core tools in in-silico analyses. We observed that prolactin may improve memory and motor deficits caused by DAB via 13 genes (Scn5a, Lmntd1, LOC100360619, Rgs9, Srpk3, Syndig1l, Gpr88, Egr2, Ctxn3, Drd2, Ttr, Gpr6, and Ecel1) in young rats and 9 genes (Scn5a, Chat, RGD1560608, Ucma, Lrrc31, Gpr88, Col1a2, Cnbd1, and Ttr) in old rats. Almost all of these genes were downregulated in both young and old rats given DAB, but they were increased in both young and old rats given prolactin. Co-expression interactions were identified as the most important interactions (83.2 % for young rats and 100 % for old rats). The most important mechanisms associated with prolactin's ability to counteract DAB were identified, including "learning and memory," and "positive regulation of ion transport" in young rats, as well as "acetylcholine related pathways," "inflammatory response pathway," and "neurotransmitter release cycle" in old rats. We also identified several key miRNAs associated with memory and motor deficits, as well as prolactin and DAB exposure (rno-miR-141-3p, rno-miR-200a-3p, rno-miR-124-3p, rno-miR-26, and rno-let-7 families). The most significant transcription factors associated with differentially expressed gene regulation were Six3, Rxrg, Nkx26, and Tbx20. These findings will contribute to our understanding of the processes through which prolactin's beneficial effects counteract DAB-induced memory and motor deficits.
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12
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Rudolph KE, Russell M, Luo SX, Rotrosen J, Nunes EV. Under-representation of key demographic groups in opioid use disorder trials. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100084. [PMID: 36187300 PMCID: PMC9524855 DOI: 10.1016/j.dadr.2022.100084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
Background The extent to which clinical trials of medications for opioid use disorder (MOUD) are representative or not is unknown. Some patient characteristics modify MOUD effectiveness; if these same characteristics differ in distribution between the trial population and usual-care population, this could contribute to lack of generalizability-a discrepancy between trial and usual-care effectiveness. Our objective was to identify interpretable, multidimensional subgroups who were prescribed MOUD in substance use treatment programs in the US but who were not represented or under-represented by clinical trial participants. Methods This was a secondary descriptive analysis of trial and real-world data. The trial data included twenty-seven US opioid treatment programs in the National Drug Abuse Treatment Clinical Trials Network, N = 2,199 patients. The real-world data included US substance use treatment programs that receive public funding, N = 740,015 patients. We characterized real-world patient populations who were non-represented and under-represented in the trial data in terms of sociodemographic and clinical characteristics that could modify MOUD effectiveness. Results We found that 10.7% of MOUD patients in TEDS-A were not represented in the three clinical trials. As expected, pregnant MOUD patients (n = 19,490) were not represented. Excluding pregnancy, education and marital status from the characteristics, 2.6% of MOUD patients were not represented. Patients aged 65 years and older (n = 11,204), and those 50-64 years who identified as other (non-White, non-Black, and non-Hispanic) race/ethnicity or multi-racial (n = 7,281) were under-represented. Conclusions Quantifying and characterizing non- or under-represented subgroups in trials can provide the data necessary to improve representation in future trials and address research-to-practice gaps.
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Affiliation(s)
- Kara E Rudolph
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States
| | - Matthew Russell
- Department of Epidemiology, Columbia University, 722 W 168th St, Room 522, New York, NY 10032, United States
| | - Sean X Luo
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, United States
| | - Edward V Nunes
- Department of Psychiatry, School of Medicine, Columbia University, and New York State Psychiatric Institute, New York, New York, United States
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13
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Arita T, Suzuki S, Yagi N, Otsuka T, Kishi M, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Matsuhama M, Iida M, Yajima J, Yamashita T. Association between number of medications and mortality among older adult patients in a specialized cardiology hospital. Geriatr Gerontol Int 2021; 21:985-995. [PMID: 34549500 DOI: 10.1111/ggi.14275] [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: 05/23/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
AIM Although polypharmacy has been associated with poor clinical outcomes, whether taking an increased number of medications is harmful or beneficial for older adult patients treated for cardiovascular diseases might require further discussion. METHODS We analyzed data of 2089 patients aged ≥75 years in a single hospital-based cohort. The study population was divided into three groups according to the tertiles of the number of medications at baseline: <3 (n = 647), 3-7 (n = 707) and ≥8 (n = 735). RESULTS The cumulative incidences of all-cause death at 3 years among patients taking less than three, three to seven and eight or more medications were 3.7%, 4.1% and 7.8%, respectively (log-rank test P = 0.015). In a Cox regression analysis, taking eight or more total medications (vs 0-2) was independently associated with all-cause death (hazard ratio 1.67, 95% CI 1.01-2.78). For predicting mortality using the number of medications, the maximum Youden Index was 7. In subgroups with certain heart diseases, no regular tendency of an increase in the risk of all-cause death was observed with an increase in the number of medications. CONCLUSIONS The number of medications taken was independently associated with mortality among older adult patients, with a relatively high cut-off point. This association was not observed in patients with certain heart diseases, possibly indicating the merit - rather than the harm - of medical treatment in the cardiovascular field. Geriatr Gerontol Int 2021; 21: 985-995.
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Affiliation(s)
- Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikio Kishi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Minoru Matsuhama
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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14
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Lynch A, Arndt S, Acion L. Late- and Typical-Onset Heroin Use Among Older Adults Seeking Treatment for Opioid Use Disorder. Am J Geriatr Psychiatry 2021; 29:417-425. [PMID: 33353852 DOI: 10.1016/j.jagp.2020.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Analyze 10-year trends in opioid use disorder with heroin (OUD-H) among older persons and to compare those with typical-onset (age <30 years) to those with late (age 30+) onset. DESIGN Naturalistic observation using the most recent (2008-2017) Treatment Episode Data Set-Admissions (TEDS-A). SETTING Admission records in TEDS-A come from all public and private U.S. programs for substance use disorder treatment receiving public funding. PARTICIPANTS U.S. adults aged 55 years and older entering treatment for the first time between 2008 and 2017 to treat OUD-H. MEASUREMENTS Admission trends, demographics, substance use history. RESULTS The number of older adults who entered treatment for OUD-H nearly tripled between 2007 and 2017. Compared to those with typical-onset (before age 30), those with late-onset heroin use were more likely to be white, female, more highly educated, and rural. Older adults with late-onset were more likely to be referred to treatment by an employer and less likely to be referred by the criminal justice system. Those with late-onset were more likely to use heroin more frequently but less likely to inject heroin than those with typical-onset. Those with typical onset were more likely to receive medication for addiction treatment than those with late-onset. CONCLUSION Late-onset heroin use is increasing among older U.S. adults. Research is needed to understand the unique needs of this population better. As this population grows, geriatric psychiatrists may be increasingly called upon to provide specialized care to people with late-onset OUD-H.
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Affiliation(s)
- Alison Lynch
- Department of Psychiatry (AL, SA), University of Iowa, Iowa City, IA
| | - Stephan Arndt
- Department of Psychiatry (AL, SA), University of Iowa, Iowa City, IA.
| | - Laura Acion
- Instituto de Cálculo, Universidad de Buenos Aires - CONICET (LA), Argentina
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15
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Min L, Ha JK, Aubert CE, Hofer TP, Sussman JB, Langa KM, Tinetti M, Kim HM, Maciejewski ML, Gillon L, Larkin A, Chan CL, Kerr EA, Bravata D, Cushman WC. A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data. JAMA Netw Open 2021; 4:e2034059. [PMID: 33449097 PMCID: PMC7811181 DOI: 10.1001/jamanetworkopen.2020.34059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/28/2020] [Indexed: 12/27/2022] Open
Abstract
Importance Simple measures of hypertension treatment, such as achievement of blood pressure (BP) targets, ignore the intensity of treatment once the BP target is met. High-intensity treatment involves increased treatment burden and can be associated with potential adverse effects in older adults. A method was previously developed to identify older patients receiving intense hypertension treatment by low BP and number of BP medications using national Veterans Health Administration and Medicare Part D administrative pharmacy data to evaluate which BP medications a patient is likely taking on any given day. Objective To further develop and validate a method to more precisely quantify dose intensity of hypertension treatment using only health system administrative pharmacy fill data. Design, Setting, and Participants Observational, cross-sectional study of 319 randomly selected older veterans in the national Veterans Health Administration health care system who were taking multiple BP-lowering medications and had a total of 3625 ambulatory care visits from July 1, 2011, to June 30, 2013. Measure development and medical record review occurred January 1, 2017, through November 30, 2018, and data analysis was conducted from December 1, 2019, to August 31, 2020. Main Outcomes and Measures For each BP-lowering medication, a moderate hypertension daily dose (HDD) was defined as half the maximum dose above which no further clinical benefit has been demonstrated by that medication in hypertension trials. Patients' total HDD was calculated using pharmacy data (pharmacy HDDs), accounting for substantial delays in refills (>30 days) when a patient's pill supply was stretched (eg, cutting existing pills in half). As an external comparison, the pharmacy HDDs were correlated with doses manually extracted from clinicians' visit notes (clinically noted HDDs). How well the pharmacy HDDs correlated with clinically noted HDDs was calculated (using C statistics). To facilitate interpretation, HDDs were described in association with the number of medications. Results A total of 316 patients (99.1%) were male; the mean (SD) age was 75.6 (7.2) years. Pharmacy HDDs were highly correlated (r = 0.92) with clinically noted HDDs, with a mean (SD) of 2.7 (1.8) for pharmacy HDDs and 2.8 (1.8) for clinically noted HDDs. Pharmacy HDDs correlated with high-intensity, clinically noted HDDs ranging from a C statistic of 92.8% (95% CI, 92.0%-93.7%) for 2 or more clinically noted HDDs to 88.1% (95% CI, 85.5%-90.6%) for 6 or more clinically noted HDDs. Conclusions and Relevance This study suggests that health system pharmacy data may be used to accurately quantify hypertension regimen dose intensity. Together with clinic-measured BP, this tool can be used in future health system-based research or quality improvement efforts to fine-tune, manage, and optimize hypertension treatment in older adults.
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Affiliation(s)
- Lillian Min
- Veterans Affairs Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Medical Center, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jin-Kyung Ha
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Carole E. Aubert
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare, University of Bern, Bern, Switzerland
| | - Timothy P. Hofer
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Jeremy B. Sussman
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Kenneth M. Langa
- Veterans Affairs Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Medical Center, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Mary Tinetti
- Section of Geriatrics, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Hyungjin Myra Kim
- Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor
- Department of Biostatistics, University of Michigan Medical School, Ann Arbor
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs Healthcare System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Leah Gillon
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
| | - Angela Larkin
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
| | - Chiao-Li Chan
- Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Eve A. Kerr
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Center of Innovation, Ann Arbor, Michigan
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Dawn Bravata
- Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis
- Department of Neurology, Indiana University School of Medicine, Indianapolis
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
- Medical Service, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
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Birder L. Commentary on "Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms". Int Neurourol J 2020; 24:295. [PMID: 33017901 PMCID: PMC7538282 DOI: 10.5213/inj.2040286.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/23/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lori Birder
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
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Risk of Kidney Dysfunction from Polypharmacy among Older Patients: A Nested Case-Control Study of the South Korean Senior Cohort. Sci Rep 2019; 9:10440. [PMID: 31320704 PMCID: PMC6639333 DOI: 10.1038/s41598-019-46849-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/03/2019] [Indexed: 12/20/2022] Open
Abstract
Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service - Senior Cohort (NHIS-SC, 2009-2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case's event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492-1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876-2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139-1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303-1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.
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Tousen Y, Takebayashi J, Kondo T, Fuchino H, Kawano N, Inui T, Yoshimatsu K, Kawahara N, Ishimi Y. Safety and Efficacy Assessment of Isoflavones from Pueraria (Kudzu) Flower Extract in Ovariectomised Mice: A Comparison with Soy Isoflavones. Int J Mol Sci 2019; 20:ijms20122867. [PMID: 31212773 PMCID: PMC6627882 DOI: 10.3390/ijms20122867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/24/2023] Open
Abstract
Numerous Foods with Function Claims that contain the extract of Pueraria flower (kudzu) isoflavones (PFI) are available in the Japanese market. These are labelled with function claims of reducing visceral fat. However, these foods have not undergone proper safety assessment such as the evaluation of their oestrogenic activity and effects on drug-metabolising enzymes (cytochrome P-450: CYP) in the liver. This study evaluated the estrogenic effect and the hepatic CYP activity and mRNA expression in normal female mice as a safety assessment of PFI (Experiment 1). In addition, the bone mineral density and visceral fat weight in ovariectomised mice (OVX) compared to soy isoflavones (SI) was evaluated to assess the efficacy of PFI (Experiment 2). OVX control fed a control diet, OVX fed a PFI diet (the recommended human intake of PFI), OVX fed a PFI20 diet (20- times the recommended PFI), OVX fed an SI diet (the recommended human intake of SI), and OVX fed an SI20 diet (20 -times the recommended intake of SI) for 28 days in Experiment 2. Body, liver, and visceral fat weights were not affected by the PFI, PFI20, SI, or SI20 diets. The hepatic CYP1A and CYP3A activities were elevated by the SI20 treatment. Ovariectomy-induced bone loss was inhibited by the SI20 treatment, but not by the PFI20 treatment. These results suggest that (1) PFI intake in human doses had no oestrogenic properties and did not affect CYP activity in the liver; (2) there was no evidence that PFI affects the amount of visceral fat in OVX mice.
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Affiliation(s)
- Yuko Tousen
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
| | - Jun Takebayashi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
| | - Takashi Kondo
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
| | - Hiroyuki Fuchino
- Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition,1-2 Hachimandai Tsukuba-shi, Ibaraki 305-0843, Japan.
| | - Noriaki Kawano
- Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition,1-2 Hachimandai Tsukuba-shi, Ibaraki 305-0843, Japan.
| | - Takayuki Inui
- Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition,1-2 Hachimandai Tsukuba-shi, Ibaraki 305-0843, Japan.
| | - Kayo Yoshimatsu
- Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition,1-2 Hachimandai Tsukuba-shi, Ibaraki 305-0843, Japan.
| | - Nobuo Kawahara
- Research Center for Medicinal Plant Resources, National Institutes of Biomedical Innovation, Health and Nutrition,1-2 Hachimandai Tsukuba-shi, Ibaraki 305-0843, Japan.
| | - Yoshiko Ishimi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
- Tokyo University of Agriculture, NODAI Research Institute, 1-1-1, Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan.
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Inhibitory and Inductive Effects of Opuntia ficus indica Extract and Its Flavonoid Constituents on Cytochrome P450s and UDP-Glucuronosyltransferases. Int J Mol Sci 2018; 19:ijms19113400. [PMID: 30380747 PMCID: PMC6274835 DOI: 10.3390/ijms19113400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 12/26/2022] Open
Abstract
Opuntia ficus indica (OFI) is grown abundantly in arid areas and its fruits are regarded as an important food and nutrient source owing to the presence of flavonoids, minerals, and proteins. The previous report that OFI exerts phytoestrogenic activity makes it plausible for OFI-containing supplements to be used as alternative estrogen replacement therapy. In the case of polypharmacy with the consumption of OFI-containing botanicals in post- or peri-menopausal women, it is critical to determine the potential drug-OFI interaction due to the modulation of drug metabolism. In the present study, the modulating effects on the hepatic drug metabolizing enzymes (DMEs) by OFI and its flavonoid constituents (kaempferol, quercetin, isorhamnetin, and their glycosidic forms) were investigated using the liver microsomal fractions prepared from ovariectomized (OVX) rats, human liver microsomes, and human hepatocarcinoma cell line (HepG2). As a result, the oral administration of extracts of OFI (OFIE) in OVX rats induced hepatic CYP2B1, CYP3A1, and UGT2B1. OFIE, hydrolyzed (hdl) OFIE, and several flavonols induced the transcriptional activities of both CYP2B6 and CYP3A4 genes in HepG2 cells. Finally, OFIE did not inhibit activities of cytochrome P450 (CYPs) or uridine diphosphate (UDP)-glucuronosyltransferases (UGTs), whereas hdl OFIE or flavonol treatment inhibited CYP1A2 and CYP3A1/3A4 in rat and human liver microsomes. Our data demonstrate that OFIE may induce or inhibit certain types of DMEs and indicate that drug-OFI interaction may occur when the substrate or inhibitor drugs of specific CYPs or UGTs are taken concomitantly with OFI-containing products.
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Alsalami MO, Forder PM, Milton AH, McEvoy MA, Byles JE. Associations Between Medication Use and Mental Health in Older Women: A Cross-Sectional Analysis of 5,502 Women Aged 76 to 81. J Am Geriatr Soc 2015; 63:1254-5. [DOI: 10.1111/jgs.13497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maha O. Alsalami
- Research Centre for Gender Health and Ageing; School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - Peta M. Forder
- Research Centre for Gender Health and Ageing; School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - Abul H. Milton
- Centre for Clinical Epidemiology and Biostatistics; School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - Mark A. McEvoy
- Centre for Clinical Epidemiology and Biostatistics; School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - Julie E. Byles
- Research Centre for Gender Health and Ageing; School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
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Gesing A, Masternak MM, Lewinski A, Karbownik-Lewinska M, Kopchick JJ, Bartke A. Decreased levels of proapoptotic factors and increased key regulators of mitochondrial biogenesis constitute new potential beneficial features of long-lived growth hormone receptor gene-disrupted mice. J Gerontol A Biol Sci Med Sci 2013; 68:639-51. [PMID: 23197187 PMCID: PMC3708518 DOI: 10.1093/gerona/gls231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/19/2012] [Indexed: 01/06/2023] Open
Abstract
Decreased somatotrophic signaling is among the most important mechanisms associated with extended longevity. Mice homozygous for the targeted disruption of the growth hormone (GH) receptor gene (GH receptor knockout; GHRKO) are obese and dwarf, are characterized by a reduced weight and body size, undetectable levels of GH receptor, high concentration of serum GH, and greatly reduced plasma levels of insulin and insulin-like growth factor-I, and are remarkably long lived. Recent results suggest new features of GHRKO mice that may positively affect longevity-decreased levels of proapoptotic factors and increased levels of key regulators of mitochondrial biogenesis. The alterations in levels of the proapoptotic factors and key regulators of mitochondrial biogenesis were not further improved by two other potential life-extending interventions-calorie restriction and visceral fat removal. This may attribute the primary role to GH resistance in the regulation of apoptosis and mitochondrial biogenesis in GHRKO mice in terms of increased life span.
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Affiliation(s)
- Adam Gesing
- Department of Oncological Endocrinology, Medical University of Lodz, Lodz, Poland.
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Jacobson PA, Schladt D, Oetting WS, Leduc R, Guan W, Matas AJ, Israni A. Lower calcineurin inhibitor doses in older compared to younger kidney transplant recipients yield similar troughs. Am J Transplant 2012; 12:3326-36. [PMID: 22947444 PMCID: PMC3513646 DOI: 10.1111/j.1600-6143.2012.04232.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The number of older adults undergoing kidney transplantation has increased, yet little is known about calcineurin inhibitor (CNI) metabolism in this group. We studied CNI troughs and doses to determine if there were age-related differences in metabolism and dose requirements. We studied 348 young (18-34 years), 1831 middle (35-64 years) and 374 older (65-84 years) adult kidney transplant recipients enrolled in a seven-center prospective study. Troughs were obtained from each patient 2×/week in weeks 1-8 and 2×/month in months 3-6. A multivariable linear-mixed model examined the effect of age on log dose and weight normalized troughs. Older recipients had higher normalized tacrolimus troughs than middle or young age adults despite receiving doses a median of 1-2 mg/day lower. Age and CYP3A5*1 genotype had the largest effect on tacrolimus troughs. Older recipients also had higher normalized cyclosporine troughs than middle or young adults despite receiving median doses 100 mg/day lower. After normalization for dose and weight, CNI troughs were more than 50% higher in older adults than young adults. These data support age-related changes in CNI metabolism. Further studies are needed to determine optimal dosing of CNIs in the elderly.
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Affiliation(s)
- Pamala A. Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 7-151 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455
| | - David Schladt
- Division of Biostatistics, University of Minnesota, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414
| | - William S. Oetting
- Department of Experimental and Clinical Pharmacology and Institute of Human Genetics, University of Minnesota, 14-255 Moos Tower, 515 Delaware Street SE, Minneapolis, MN 55455
| | - Robert Leduc
- Division of Biostatistics, University of Minnesota, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414
| | - Weihau Guan
- Division of Biostatistics, University of Minnesota, 14-255 Moos Tower, 515 Delaware Street, S.E. Minneapolis, MN 55455
| | - Arthur J. Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, 11-200 PWB, 516 Delaware St SE, Minneapolis, MN 55455
| | - Ajay Israni
- Department of Medicine, Nephrology Division, Hennepin County Medical Center, 5th Floor HFA Shapiro Building, 701 Park Avenue, Minneapolis, MN 55415
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Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012; 65:989-95. [DOI: 10.1016/j.jclinepi.2012.02.018] [Citation(s) in RCA: 741] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/25/2012] [Accepted: 02/09/2012] [Indexed: 11/25/2022]
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Morgan D, Mitzelfelt JD, Koerper LM, Carter CS. Effects of morphine on thermal sensitivity in adult and aged rats. J Gerontol A Biol Sci Med Sci 2011; 67:705-13. [PMID: 22193548 DOI: 10.1093/gerona/glr210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There are contradictory data regarding older individuals' sensitivity to pain stimulation and opioid administration. Adult (12-16 months; n = 10) and aged (27-31 months; n = 7) male F344xBN rats were tested in a thermal sensitivity procedure where the animal chooses to remain in one of two compartments with floors maintained at various temperatures ranging from hot (45°C) through neutral (30°C) to cold (15°C). Effects of morphine were determined for three temperature comparisons (ie, hot/neutral, cold/neutral, and hot/cold). Aged rats were more sensitive to cold stimulation during baseline. Morphine produced antinociception during hot thermal stimulation, but had no effect on cold stimulation. The antinociceptive (and locomotor-altering) effects of morphine were attenuated in aged rats. These data demonstrate age-related differences in baseline thermal sensitivity and responsiveness to opioids. Based on behavioral and physiological requirements of this procedure, it is suggested that thermal sensitivity may provide a relevant animal model for the assessment of pain and antinociception.
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Affiliation(s)
- Drake Morgan
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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