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Imbalzano E, Orlando L, Dattilo G, Gigliotti De Fazio M, Camporese G, Russo V, Perrella A, Bernardi FF, Di Micco P. Update on the Pharmacological Actions of Enoxaparin in Nonsurgical Patients. Medicina (Kaunas) 2024; 60:156. [PMID: 38256416 DOI: 10.3390/medicina60010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Low-molecular-weight heparins are a class of drugs derived from the enzymatic depolymerization of unfractionated heparin that includes enoxaparin. Several studies have been performed on enoxaparin in recent years, in particular for the prevention and treatment of venous thromboembolism and for the treatment of acute coronary syndrome. Furthermore, the use of enoxaparin has been extended to other clinical situations that require antithrombotic pharmacological prevention, such as hemodialysis and recurrent abortion. In this review, we report the main clinical experiences of using enoxaparin in the prevention of VTE in nonsurgical patients.
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Affiliation(s)
- Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Luana Orlando
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | | | - Giuseppe Camporese
- General Medicine Department, Thrombotic and Haemorrhagic Disorders Unit, Department of Internal Medicine, University Hospital of Padua, 35131 Padua, Italy
| | - Vincenzo Russo
- Department of Translational Science, University Vanvitelly, 81025 Caserta, Italy
| | - Alessandro Perrella
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy
| | - Francesca Futura Bernardi
- Department of Experimental Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80100 Naples, Italy
| | - Pierpaolo Di Micco
- AFO Medicina, P.O. Santa Maria delle Grazie, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
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Perrella A, Rinaldi L, Guarino I, Bernardi FF, Castriconi M, Antropoli C, Pafundi PC, Di Micco P, Sarno M, Capoluongo N, Minei G, Perrella M, Frangiosa A, Capuano A. Sepsis Outcome after Major Abdominal Surgery Does Not Seem to Be Improved by the Use of Pentameric Immunoglobulin IgM: A Single-Center Retrospective Analysis. J Clin Med 2023; 12:6887. [PMID: 37959352 PMCID: PMC10648891 DOI: 10.3390/jcm12216887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Sepsis still represents a major public health issue worldwide, and the immune system plays a main role during infections; therefore, its activity is mandatory to resolve this clinical condition. In this report, we aimed to retrospectively verify in a real-life setting the possible usefulness of pentameric IgM plus antibiotics in recovering patients with sepsis after major abdominal surgery. MATERIALS/METHODS We reviewed, from January 2013 until December 2019, all adult patients admitted to the ICU for sepsis or septic shock (2) after major abdominal surgery. Among these patients, were identified those that, according to legal indication and licenses in Italy, were treated with pentameric IgM plus antibiotics (Group A) or with antibiotics alone (Group B). The following parameters were evaluated: blood gas analysis, lactate, CRP, procalcitonin, endotoxin activity, liver and renal function, coagulation and blood cell count at different time points (every 48 h for at least 7 days). Differences between groups were analyzed using Fisher's exact test or a chi-square test for categorical variables. A Mann-Whitney U test or Kruskal-Wallis test were instead been performed to compare continuous variables. Univariate and multivariate analysis were also performed. RESULTS Over a period of 30 months, 24 patients were enrolled in Group A and 20 patients in Group B. In those subjects, no statistical differences were found in terms of bacterial or fungal infection isolates, when detected in a blood culture test, or according to inflammatory index, a score, lactate levels and mortality rate. A 48 h response was statistically more frequent in Group B than in Group A, while no differences were found in other clinical and laboratory evaluations. CONCLUSIONS Based on our results, the use of pentameric IgM does not seem to give any clinical advantages in preventing sepsis after major abdominal surgery.
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Affiliation(s)
- Alessandro Perrella
- Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (M.P.)
| | - Luca Rinaldi
- Department of Medicine and Health Sciences, “Vincenzo Tiberio” Università degli Studi del Molise, 86000 Campobasso, Italy; (L.R.); (P.C.P.)
| | - Ilaria Guarino
- Intensive Care Unit, AORN A. Cardarelli, 80131 Naples, Italy
| | | | | | | | - Pia Clara Pafundi
- Department of Medicine and Health Sciences, “Vincenzo Tiberio” Università degli Studi del Molise, 86000 Campobasso, Italy; (L.R.); (P.C.P.)
| | | | - Marina Sarno
- Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (M.P.)
| | - Nicolina Capoluongo
- Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (M.P.)
| | - Giuseppina Minei
- Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (M.P.)
| | - Marco Perrella
- Department of Emerging Infectious Disease at High Countagiousness, AORN Ospedali dei Colli, P.O.D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (M.P.)
| | - Antonio Frangiosa
- Post Operative Intensive Care Division, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy;
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Capoluongo N, Mascolo A, Bernardi FF, Sarno M, Mattera V, di Flumeri G, Pustorino B, Spaterella M, Trama U, Capuano A, Perrella A. Retrospective Analysis of a Real-Life Use of Tixagevimab-Cilgavimab plus SARS-CoV-2 Antivirals for Treatment of COVID-19. Pharmaceuticals (Basel) 2023; 16:1493. [PMID: 37895964 PMCID: PMC10609705 DOI: 10.3390/ph16101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Tixagevimab-cilgavimab is effective for the treatment of early COVID-19 in outpatients with risk factors for progression to severe illness, as well as for primary prevention and post-exposure prophylaxis. We aimed to retrospectively evaluate the hospital stay (expressed in days), prognosis, and negativity rate for COVID-19 in patients after treatment with tixagevimab-cilgavimab. We enrolled 42 patients who were nasal swab-positive for SARS-CoV-2 (antigenic and molecular)-both vaccinated and not vaccinated for COVID-19-hospitalized at the first division of the Cotugno Hospital in Naples who had received a single intramuscular dose of tixagevimab-cilgavimab (300 mg/300 mg). All patient candidates for tixagevimab-cilgavimab had immunocompromised immune systems either due to chronic degenerative disorders (Group A: 27 patients) or oncohematological diseases (Group B: 15 patients). Patients enrolled in group A came under our observation after 10 days of clinical symptoms and 5 days after testing positivite for COVID-19, unlike the other patients enrolled in the study. The mean stay in hospital for the patients in Group A was 21 ± 5 days vs. 25 ± 5 days in Group B. Twenty patients tested negative after a median hospitalization stay of 16 days (IQR: 18-15.25); of them, five (25%) patients belonged to group B. Therefore, patients with active hematological malignancy had a lower negativization rate when treated 10 days after the onset of clinical symptoms and five days after their first COVID-19 positive nasal swab.
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Affiliation(s)
- Nicolina Capoluongo
- UOC Emerging Infectious Disease with High Contagiousness, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy; (N.C.); (M.S.); (G.d.F.); (B.P.)
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (A.M.); (M.S.); (A.C.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 81100 Napoli, Italy
| | | | - Marina Sarno
- UOC Emerging Infectious Disease with High Contagiousness, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy; (N.C.); (M.S.); (G.d.F.); (B.P.)
| | - Valentina Mattera
- UOSD Pharmacovigilance, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy;
| | - Giusy di Flumeri
- UOC Emerging Infectious Disease with High Contagiousness, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy; (N.C.); (M.S.); (G.d.F.); (B.P.)
| | - Bruno Pustorino
- UOC Emerging Infectious Disease with High Contagiousness, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy; (N.C.); (M.S.); (G.d.F.); (B.P.)
| | - Micaela Spaterella
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (A.M.); (M.S.); (A.C.)
| | - Ugo Trama
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.)
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Napoli, Italy; (A.M.); (M.S.); (A.C.)
- Department of Experimental Medicine—Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, 81100 Napoli, Italy
| | - Alessandro Perrella
- UOC Emerging Infectious Disease with High Contagiousness, AORN Ospedali dei Colli P.O. C Cotugno, 80131 Naples, Italy; (N.C.); (M.S.); (G.d.F.); (B.P.)
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Bernardi FF, Mascolo A, Sarno M, Capoluongo N, Trama U, Ruggiero R, Sportiello L, Fusco GM, Bisogno M, Coscioni E, Iervolino A, Di Micco P, Capuano A, Perrella A. Thromboembolic Events after COVID-19 Vaccination: An Italian Retrospective Real-World Safety Study. Vaccines (Basel) 2023; 11:1575. [PMID: 37896978 PMCID: PMC10611339 DOI: 10.3390/vaccines11101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Real-world safety studies can provide important evidence on the thromboembolic risk associated with COVID-19 vaccines, considering that millions of people have been already vaccinated against COVID-19. In this study, we aimed to estimate the incidence of thromboembolic events after COVID-19 vaccination and to compare the Oxford-AstraZeneca vaccine with other COVID-19 vaccines. METHODS We conducted a retrospective real-world safety study using data from two different data sources: the Italian Pharmacovigilance database (Rete Nazionale di Farmacovigilanza, RNF) and the Campania Region Health system (Sistema INFOrmativo saNità CampanIA, SINFONIA). From the start date of the COVID-19 vaccination campaign (27 December 2021) to 27 September 2022, information on COVID-19 vaccinations and thromboembolic events were extracted from the two databases. The reporting rate (RR) and its 95% confidence interval (95%CI) of thromboembolic events for 10,000 doses was calculated for each COVID-19 vaccine. Moreover, the odds of being vaccinated with the Oxford-AstraZeneca vaccine vs. the other COVID-19 vaccines in cases with thromboembolic events vs. controls without thromboembolic events were computed. RESULTS A total of 12,692,852 vaccine doses were administered in the Campania Region, of which 6,509,475 (51.28%) were in females and mostly related to the Pfizer-BioNtech vaccine (65.05%), followed by Moderna (24.31%), Oxford-AstraZeneca (9.71%), Janssen (0.91%), and Novavax (0.02%) vaccines. A total of 641 ICSRs with COVID-19 vaccines and vascular events were retrieved from the RNF for the Campania Region, of which 453 (70.67%) were in females. Most ICSRs reported the Pfizer-BioNtech vaccine (65.05%), followed by Oxford-AstraZeneca (9.71%), Moderna (24.31%), and Janssen (0.91%). A total of 2451 events were reported in the ICSRs (3.8 events for ICSRs), of which 292 were thromboembolic events. The higher RRs of thromboembolic events were found with the Oxford-AstraZeneca vaccine (RR: 4.62, 95%CI: 3.50-5.99) and Janssen vaccine (RR: 3.45, 95%CI: 0.94-8.82). Thromboembolic events were associated with a higher likelihood of exposure to the Oxford-AstraZeneca vaccine compared to Pfizer-BioNtech (OR: 6.06; 95%CI: 4.22-8.68) and Moderna vaccines (OR: 6.46; 95%CI: 4.00-10.80). CONCLUSION We observed a higher reporting of thromboembolic events with viral-vector-based vaccines (Oxford-AstraZeneca and Janssen) and an increased likelihood of being exposed to the Oxford-AstraZeneca vaccine compared to the mRNA vaccines (Pfizer-BioNtech and Moderna) among thromboembolic cases.
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Affiliation(s)
- Francesca Futura Bernardi
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Marina Sarno
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Nicolina Capoluongo
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
| | - Ugo Trama
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Rosanna Ruggiero
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Giovanni Maria Fusco
- Directorate-General for Health Protection, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.); (G.M.F.)
| | - Massimo Bisogno
- Regional Special Office for Digital Transformation, Campania Region, 80100 Naples, Italy;
| | - Enrico Coscioni
- Division of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy;
| | - Anna Iervolino
- Directorate-General AORN Ospedali dei Colli, Campania Region, 80131 Naples, Italy;
| | - Pierpaolo Di Micco
- General Medicine, Santa Maria delle Grazie Hospital, ASL NA2 Nord, 80078 Pozzuoli, Italy;
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (R.R.); (L.S.); (A.C.)
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Naples, Italy
| | - Alessandro Perrella
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, 80131 Naples, Italy; (M.S.); (N.C.); (A.P.)
- Regional Observatory for Infectious Disease, Campania Region, 80131 Naples, Italy
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Liguori V, Zinzi A, Gaio M, Riccardi C, Di Costanzo L, Gargano F, Carpentieri C, D’Elia M, Bernardi FF, Trama U, Capuano A, Rafaniello C. Multisystem Inflammatory Syndrome in Children Following COVID-19 Vaccination: A Sex-Stratified Analysis of the VAERS Database Using Brighton Collaboration Criteria. Pharmaceuticals (Basel) 2023; 16:1231. [PMID: 37765039 PMCID: PMC10535674 DOI: 10.3390/ph16091231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-c) is an uncommon, but serious, inflammatory response that occurs after SARS-CoV-2 infection. As time went by, MIS-c was also reported as a potential adverse event following COVID-19 vaccination. A descriptive analysis was performed of Individual Case Safety Reports (ICSRs) associated with anti COVID-19 vaccines and related to the pediatric population from 2020 to 2022. The present pharmacovigilance study aimed to describe cases of MIS-c following COVID-19 vaccination, stratified by sex, reported in the Vaccine Adverse Events Reporting System (VAERS) and meeting the Brighton Collaboration criteria for case definition. We assessed all suspected cases through the case definition and classification of the Brighton Collaboration Group, and only definitive, probable, and possible cases were included in the analysis. The Reporting Odds Ratio (ROR) with 95% Confidence Interval (CI) was computed to assess if males have a lower/higher probability of reporting ICSRs with MIS-c compared with females. Overall, we found 79 cases of potentially reported MIS-c following vaccination. This study demonstrated that MIS-c following vaccination was more commonly reported for male subjects with a median age of 10 years (IQR 10.0-11.4), especially after the first dose of anti COVID-19 vaccines with a median time to onset of 27 days. Even so, the rate of occurrence of MIS-c following anti COVID-19 vaccines is lower (0.12/100,000 vaccinated subjects; 95% CI, 0.12-0.13). Overall, all ICSRs were serious and caused or prolonged hospitalization. Finally, disproportionality analysis showed that males had a higher reporting probability of MIS-c compared with females following immunization with mRNA COVID-19 vaccines. Since only a few years of marketing are available, further data from real-life contexts are needed.
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Affiliation(s)
- Valerio Liguori
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Alessia Zinzi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Mario Gaio
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Consiglia Riccardi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Luigi Di Costanzo
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Francesca Gargano
- Regional Direction for Health Management, Pharmaceutical Unit, 80131 Naples, Italy; (F.G.); (C.C.); (M.D.); (F.F.B.); (U.T.)
| | - Claudia Carpentieri
- Regional Direction for Health Management, Pharmaceutical Unit, 80131 Naples, Italy; (F.G.); (C.C.); (M.D.); (F.F.B.); (U.T.)
| | - Maria D’Elia
- Regional Direction for Health Management, Pharmaceutical Unit, 80131 Naples, Italy; (F.G.); (C.C.); (M.D.); (F.F.B.); (U.T.)
| | - Francesca Futura Bernardi
- Regional Direction for Health Management, Pharmaceutical Unit, 80131 Naples, Italy; (F.G.); (C.C.); (M.D.); (F.F.B.); (U.T.)
| | - Ugo Trama
- Regional Direction for Health Management, Pharmaceutical Unit, 80131 Naples, Italy; (F.G.); (C.C.); (M.D.); (F.F.B.); (U.T.)
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; (V.L.); (M.G.); (C.R.); (A.C.); (C.R.)
- Section of Pharmacology “L. Donatelli”, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
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Pandico F, Citarella A, Cammarota S, Bernardi FF, Claar E, Coppola C, Cozzolino M, De Rosa F, Di Gennaro M, Fogliasecca M, Giordana R, Pacella D, Russo A, Salerno V, Scafa L, Trama U. Rifaximin Use, Adherence and Persistence in Patients with Hepatic Encephalopathy: A Real-World Study in the South of Italy. J Clin Med 2023; 12:4515. [PMID: 37445550 DOI: 10.3390/jcm12134515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Real-world data on the therapeutic management of hepatic encephalopathy (HE) patients are limited. The aim of this study was to evaluate the HE medications prescribed in an Italian cohort of HE patients post-discharge and to assess the real-world rifaximin adherence and persistence over 1 year. An observation retrospective study was conducted using data retrieved from outpatient pharmaceutical databases and hospital discharge records of the Campania region. For all subjects hospitalized for HE during 2019 (cohort 1), the HE medications prescribed within 60 days after discharge were evaluated. Adherence (proportion of days covered, PDC) and persistence were estimated for rifaximin 550 mg incident users over 1 year (cohort 2). Patients with PDC ≥80% were considered adherents. Persistence was defined as the period of time from the first rifaximin prescription to the date of discontinuation. Discontinuation was assessed using the permissible gap method. In cohort 1, 544 patients were identified; 58.5% received rifaximin while 15.6% only received non-absorbable disaccharides and 25.9% did not receive any HE medications. In cohort 2, 650 users were selected; only 54.5% were adherents and 35% were persistent users at 1 year. This real-world study highlights that quality improvement in therapeutic management is needed to potentially improve the outcomes of HE patients.
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Affiliation(s)
- Fulvio Pandico
- Department of Territorial Pharmaceuticals, Local Health Authority of Caserta, 81100 Caserta, Italy
| | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy
| | - Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy
| | | | - Ernesto Claar
- Internal Medicine and Hepatology Unit, Ospedale Evangelico Betania, 80147 Naples, Italy
| | - Carmine Coppola
- Unit of Hepatology and Interventional Ultrasonography, Department of Internal Medicine, OORR Area Stabiese, 80054 Gragnano, Italy
| | - Marianna Cozzolino
- Department of Territorial Pharmaceuticals, Local Health Authority of Caserta, 81100 Caserta, Italy
| | - Federica De Rosa
- Postgraduate School in Clinical Pharmacology and Toxicology, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Massimo Di Gennaro
- Innovation and Data Analytics (So.Re.Sa), Campania Region, 80143 Naples, Italy
| | - Marianna Fogliasecca
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy
| | - Roberta Giordana
- Monitoring of Public Healthcare System (So.Re.Sa), Campania Region, 80143 Naples, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Alessandro Russo
- Monitoring of Public Healthcare System (So.Re.Sa), Campania Region, 80143 Naples, Italy
| | - Vito Salerno
- Monitoring of Public Healthcare System (So.Re.Sa), Campania Region, 80143 Naples, Italy
| | - Luca Scafa
- Monitoring of Public Healthcare System (So.Re.Sa), Campania Region, 80143 Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, 80143 Naples, Italy
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Di Micco P, Bernardi FF, Camporese G, Biglietto M, Perrella A, Ciarambino T, Russo V, Imbalzano E. Nattokinase historical sketch on experimental and clinical evidence. Ital J Med 2023; 17. [DOI: 10.4081/itjm.2023.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Nattokinase (NK) is a protease derived from food used mainly in the Japanese diet that has several properties. The main activity is related to improving fibrinolytic activities. Other activities have been demonstrated in the regulation of blood pressure by the action toward angiotensin proteases and in the antiplatelet activities. NK can be given orally and reaches its maximal concentration after 12 hours. In addition, an antithrombotic activity based on various NK activities has been proposed. First, increased fibrinolytic activity increases thrombus dissolution and/or the formation of atherosclerotic plaques; second, its enhanced antiplatelet action adds to clot dissolution. All activities have been studied in animals and humans in vitro and in vivo. Relevant adverse effects of NK therapy have not been described, however clinical experience is restricted to case series and volunteers and is not based on clinical studies, thus clinical trials are required to confirm.
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Pandico F, Cammarota S, Citarella A, Bernardi FF, Cozzolino M, De Rosa F, Di Gennaro M, Fogliasecca M, Giordana R, Russo A, Salerno V, Scafa L, Trama U. [Real-world analysis of the use of rifaximin 200 mg in the Campania Region.]. Recenti Prog Med 2023; 114:284-289. [PMID: 37114610 DOI: 10.1701/4032.40077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Since its approval in Italy in 1987, rifaximin has been licensed in over 30 countries for the treatment of a wide range gastrointestinal diseases. The aim of the study was to analyze the real world use of rifaximin 200 mg in the Campania region. METHODS An observation retrospective study was conducted analysing the prescriptions of rifaximin received by the subjects ≥18 years old resident in the Campania Region. For each user the first rifaximin prescription in 2019 was defined as index date. All the prescriptions during the 12 months following the index date were analyzed. The subjects were categorized according to the number of packages/year received (1-4, 5-12, 13-24, >24). RESULTS 231,207 subjects received at least one package/year of rifaximin 200 mg with a prevalence of use of 4.9% and a total annual expenditure of 9.2 million euros. The 73.9% of users received 1-4 packages/year, 16.4% between 5-12 packages/year and 7.7% between 13-24 packages/year. The 2.0% of the users received more than 24 packages/year with an incidence on total expenditure equal to 14.8% (5% is due to those who received more than 40 packages/year). DISCUSSION About two thirds of rifaximin users received no more than three packages, presumably for the treatment of the infectious gastroenteritis or diarrheal syndromes, while 24% received 5-24 packages/year probably for the relapsing chronic intestinal pathologies. The 15% of the expenditure and consumption is related to subjects receiving more than 24 packages/year, probably due to the treatment of chronic liver diseases. CONCLUSIONS The use of rifaximin 200 mg should be further investigated in different recurrent chronic diseases, especially to verify which schemes and dosages are used in real life compared to those tested in clinical trials.
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Affiliation(s)
- Fulvio Pandico
- Uoc Farmaceutica territoriale convenzionata e Dpc, Asl di Caserta
| | - Simona Cammarota
- LinkHealth Health economics, outcomes & epidemiology srl, Napoli
| | - Anna Citarella
- LinkHealth Health economics, outcomes & epidemiology srl, Napoli
| | - Francesca Futura Bernardi
- Direzione generale per la Tutela della salute e il coordinamento del Servizio sanitario regionale, Politica del farmaco e dispositivi, Regione Campania, Napoli
| | | | - Federica De Rosa
- Scuola di specializzazione in Farmacologia clinica e tossicologia, Dipartimento di medicina, chirurgia e odontoiatria "Scuola Medica Salernitana", Università di Salerno
| | - Massimo Di Gennaro
- Innovazione, logistica integrata e sanità digitale, Soresa spa, Regione Campania, Napoli
| | | | - Roberta Giordana
- Monitoraggio del Servizio sanitario regionale, Soresa spa, Regione Campania, Napoli
| | - Alessandro Russo
- Monitoraggio del Servizio sanitario regionale, Soresa spa, Regione Campania, Napoli
| | - Vito Salerno
- Monitoraggio del Servizio sanitario regionale, Soresa spa, Regione Campania, Napoli
| | - Luca Scafa
- Monitoraggio del Servizio sanitario regionale, Soresa spa, Regione Campania, Napoli
| | - Ugo Trama
- Direzione generale per la Tutela della salute e il coordinamento del Servizio sanitario regionale, Politica del farmaco e dispositivi, Regione Campania, Napoli
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9
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Perrella A, Fortinguerra F, Pierantozzi A, Capoluongo N, Carannante N, Lo Vecchio A, Bernardi FF, Trotta F, Cangini A. Hospital Antibiotic Use during COVID-19 Pandemic in Italy. Antibiotics (Basel) 2023; 12:antibiotics12010168. [PMID: 36671369 PMCID: PMC9854455 DOI: 10.3390/antibiotics12010168] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Antimicrobial resistance (AMR) represents a major issue in healthcare being correlated to global inappropriate use of antibiotics. The aim of this study was to compare the data on hospital antibiotic consumption in 2020-2021 with those related to 2019 in order to evaluate the impact of the COVID-19 pandemic on antibiotic prescriptions and appropriate use at national level and in the different geographical areas. To estimate the consumption of antibiotics, two indicators were calculated: "number of DDD per 1000 inhabitants per day" and "number of DDD per 100 hospitalisation days". Consumption data on antibiotics dispensed in public health facilities were based on the Italian "traceability of medicines" information flow. Data on hospitalisation days were extracted from the Italian "hospital discharge form" flow. Pearson correlation analysis was performed between the number of patients hospitalised for COVID-19 and the consumption of antibiotics in public healthcare facilities. During 2020, about 1.7 DDD/1000 inhabitants per day (12.3% of the overall consumption of reimbursed antibiotics) were dispensed exclusively in Italian hospitals (+0.8% compared to 2019). Considering the number of DDD per 100 hospitalisation days, consumption increased by 19.3% in 2020 compared to 2019. Comparing the first semester of 2020 and 2019, a decrease of DDD/1000 inhabitants per day was observed (-1.6%) at national level, with opposite trends in the different geographical areas; an increase in the use of azithromycin and carbapenems was also observed, with a stable consumption of third-generation cephalosporins. The use of antibiotics in the second semester of 2020 compared to the same period of 2019 showed a clear reduction at national level (-8.5%), appreciable to a similar extent in all geographic areas. In the first semester of 2021 compared to the same period of 2020, there was a huge reduction (-31.4%) in consumption at national level. However, the variations were heterogeneous between different geographical areas. To our knowledge, this study represents the most comprehensive analysis performed on antibiotic consumption data in hospital settings in Italy during the COVID-19 pandemic to date. Despite international and national guideline recommendations, a substantial overall increase in antibiotic prescriptions was observed during the COVID-19 pandemic, with variability in terms of geographical distribution and prescription strategies. These findings may be related to the dichotomy between perceived and real significance of guidelines, expert panels, or consensus. Therefore, new approaches or strategies to antimicrobial stewardship should be proposed.
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Affiliation(s)
- Alessandro Perrella
- I Division Emerging Infectious Disease and High Contagiousness, D. Cotugno Hospital, 80131 Naples, Italy
- Correspondence: (A.P.); (F.F.)
| | | | | | - Nicolina Capoluongo
- I Division Emerging Infectious Disease and High Contagiousness, D. Cotugno Hospital, 80131 Naples, Italy
| | - Novella Carannante
- I Division Emerging Infectious Disease and High Contagiousness, D. Cotugno Hospital, 80131 Naples, Italy
| | - Andrea Lo Vecchio
- Pediatric Unit, AOU Federico II Medical School University, 80131 Naples, Italy
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10
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Citarella A, Cammarota S, Bernardi FF, Caliendo L, D’Andrea A, Fimiani B, Fogliasecca M, Pacella D, Pagnotta R, Trama U, Zito GB, Cillo M, Vercellone A. Exploring Contemporary Data on Lipid-Lowering Therapy Prescribing in Patients Following Discharge for Atherosclerotic Cardiovascular Disease in the South of Italy. J Clin Med 2022; 11:jcm11154344. [PMID: 35893434 PMCID: PMC9369296 DOI: 10.3390/jcm11154344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023] Open
Abstract
Current international guidelines strongly recommend the use of high-intensity lipid-lowering therapy (LLT) after hospitalization for atherosclerotic cardiovascular disease (ASCVD) events. With this study, our aim was to evaluate LLT prescribing in a large Italian cohort of patients after discharge for an ASCVD event, exploring factors associated with a lower likelihood of receiving any LLT and high-intensity LLT. Individuals aged 18 years and older discharged for an ASCVD event in 2019-2020 were identified using hospital discharge abstracts from two local health units of the Campania region. LLT treatment patterns were analyzed in the 6 months after the index event. Logistic regression models were developed for estimating patient predictors of any LLT prescription and to compare high-intensity and low-to-moderate-intensity LLT. Results: A total of 8705 subjects were identified. In the 6 months post-discharge, 56.7% of patients were prescribed LLT and, of those, 48.7% were high-intensity LLT. Female sex, older age, and stroke/TIA or PAD conditions were associated with a higher likelihood of not receiving high-intensity LLT. Similar predictors were found for LLT prescriptions. LLT utilization and the specific use of high-intensity LLT remain low in patients with ASCVD, suggesting a substantial unmet need among these patients in the contemporary real-world setting.
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Affiliation(s)
- Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy; (S.C.); (M.F.)
- Correspondence: ; Tel.: +39-349-154-9284
| | - Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy; (S.C.); (M.F.)
| | | | - Luigi Caliendo
- Department of Cardiology, Santa Maria della Pietà Hospital, Nola, 80035 Naples, Italy;
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Care Unit, Umberto I Hospital, Nocera Inferiore, 84014 Salerno, Italy;
| | - Biagio Fimiani
- Cardiology Service, Local Health Unit (LHU) Salerno, Associazioni Regionali Cardiologi Ambulatoriali (ARCA), 84129 Salerno, Italy;
| | - Marianna Fogliasecca
- LinkHealth Health Economics, Outcomes & Epidemiology S.R.L., 80143 Naples, Italy; (S.C.); (M.F.)
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Rita Pagnotta
- Department of Management Control, Local Health Unit (LHU) Naples 3 South, 80053 Naples, Italy;
| | - Ugo Trama
- Regional Pharmaceutical Unit, Campania Region, 80143 Naples, Italy; (F.F.B.); (U.T.)
| | - Giovanni Battista Zito
- Cardiology Service, Local Health Unit (LHU) Naples 3 South, Associazioni Regionali Cardiologi Ambulatoriali (ARCA), 80045 Naples, Italy;
| | - Mariarosaria Cillo
- Pharmaceutical Department, Local Health Unit (LHU) Salerno, 84124 Salerno, Italy;
| | - Adriano Vercellone
- Pharmaceutical Department, Local Health Unit (LHU) Naples 3 South, 80053 Naples, Italy;
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11
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Scavone C, Mascolo A, Bernardi FF, Aiezza ML, Saturnino P, Morra G, Simonelli M, Massa M, Pomicino A, Minei G, Pisapia R, Spatarella M, Trama U, Guglielmi G, Capuano A, Perrella A. Hypernatremia During Intravenous Treatment With Fosfomycin: A Retrospective Medical Record Review Study and an Analysis of Spontaneous Reports in the EudraVigilance Database. Front Pharmacol 2022; 13:844122. [PMID: 35422698 PMCID: PMC9001889 DOI: 10.3389/fphar.2022.844122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Hypernatremia is a serious event that can occur during intravenous (IV) treatment with fosfomycin, and it can also be caused by a wrong drug preparation. Considering the clinical significance of hypernatremia, we decided to carry out two studies by using two different data sources with the aim to evaluate cases of IV fosfomycin-induced hypernatremia. Methods: A retrospective medical record review was performed from June 2017 to June 2019 using data from two hospitals in Southern Italy. The information collected was related to the patients, the antibiotic treatment regimen, type of adverse drug reaction (ADR), hypernatremia severity classification, and drug withdrawal due to ADRs. Moreover, a pharmacovigilance study was performed from the date of the European marketing authorization of fosfomycin to October 11, 2021, using data reported on the European website of suspected ADRs. Information related to the patient characteristics, treatment, hypernatremia, and type of reporter was retrieved. Results: From the retrospective medical record review, a total of 62 patients (48 men and 14 women) in treatment with fosfomycin were identified, of which 17 experienced ADRs. Specifically, 11 patients experienced hypernatremia. During the period from June 2017 to June 2018, a total of 63.7% of hypernatremia events were related to the wrong reconstitution of the drug. According to these results, a surveillance and training campaign about the correct drug reconstitution was managed. However, from June 2018 to June 2019, we still had four new hypernatremia cases. Drug withdrawal occurred in only one patient with hypernatremia. From the pharmacovigilance study, a total of 25 cases of IV fosfomycin-induced hypernatremia were retrieved. No substantial difference was found for patients’ distribution by sex. Most cases were classified as serious (68%) and reported “Recovered/resolved” as the outcome (44%). In the majority of cases, fosfomycin was the only suspected drug reported (72%). Conclusion: Our results show that training campaigns on the correct drug preparation need to be strengthened to allow a reduction of hypernatremia cases. Moreover, when close monitoring and management is performed by the infectious disease (ID) specialist and hospital pharmacist, there also is a reduction in antibiotic withdrawal due to hypernatremia.
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Affiliation(s)
- Cristina Scavone
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | - Gaia Morra
- Hospital Pharmacy-AORN A. Cardarelli, Naples, Italy
| | | | - Marida Massa
- Hospital Pharmacy-AORN A. Cardarelli, Naples, Italy
| | - Andrea Pomicino
- Unit Emerging Infectious Disease, Ospedali dei Colli, Naples, Italy
| | - Giuseppina Minei
- Unit Emerging Infectious Disease, Ospedali dei Colli, Naples, Italy
| | | | - Micaela Spatarella
- Hospital Pharmacy - Pharmacovigilance Unit, Ospedali dei Colli, Naples, Italy
| | - Ugo Trama
- Regional Direction for Health Management, Pharmaceutical Unit, Naples, Italy
| | | | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Naples, Italy.,Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
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12
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Scavone C, Mascolo A, Rafaniello C, Sportiello L, Trama U, Zoccoli A, Bernardi FF, Racagni G, Berrino L, Castaldo G, Coscioni E, Rossi F, Capuano A. Therapeutic strategies to fight COVID-19: Which is the status artis? Br J Pharmacol 2021; 179:2128-2148. [PMID: 33960398 PMCID: PMC8239658 DOI: 10.1111/bph.15452] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
COVID‐19 is a complex disease, and many difficulties are faced today especially in the proper choice of pharmacological treatments. The role of antiviral agents for COVID‐19 is still being investigated and evidence for immunomodulatory and anti‐inflammatory drugs is quite conflicting, whereas the use of corticosteroids is supported by robust evidence. The use of heparins in hospitalized critically ill patients is preferred over other anticoagulants. There are conflicting data on the use of convalescent plasma and vitamin D. According to the World Health Organization (WHO), many vaccines are in Phase III clinical trials, and some of them have already received marketing approval in European countries and in the United States. In conclusion, drug repurposing has represented the main approach recently used in the treatment of patients with COVID‐19. At this moment, analysis of efficacy and safety data of drugs and vaccines used in real‐life context is strongly needed.
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Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Concetta Rafaniello
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, U.O.D. 06 Politica del Farmaco e Dispositivi, Naples, Italy
| | - Alice Zoccoli
- Clinical Innovation Office, Università Campus Bio-Medico, Rome, Italy
| | - Francesca Futura Bernardi
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Regional Pharmaceutical Unit, U.O.D. 06 Politica del Farmaco e Dispositivi, Naples, Italy
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, University of Napoli Federico II, Naples, Italy.,CEINGE-Advanced Biotechnology Scarl, Naples, Italy
| | - Enrico Coscioni
- Agenzia nazionale per i servizi sanitari regionali, Rome, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Clinical Innovation Office, Università Campus Bio-Medico, Rome, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Università degli studi della Campania 'Luigi Vanvitelli', Naples, Italy
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13
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Perrella A, Trama U, Bernardi FF, Russo G, Monastra L, Fragranza F, Orlando V, Coscioni E. Editorial - COVID-19, more than a viral pneumonia. Eur Rev Med Pharmacol Sci 2020; 24:5183-5185. [PMID: 32432786 DOI: 10.26355/eurrev_202005_21216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- A Perrella
- Hospital Health Direction, Infectious Disease Unit, A. Cardarelli Hospital, Naples, Italy.
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14
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Danova M, Pronzato P, Ingrasciotta Y, Antonuzzo A, Trama U, Tondini C, Bernardi FF. Recent advances in the management of chemotherapy-induced neutropenia: biosimilar granulocyte colony-stimulating factor use in Italy. Future Oncol 2020; 16:891-897. [PMID: 32329365 DOI: 10.2217/fon-2020-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During the National Congress of the Italian Association of Medical Oncology, which was held in Rome, Italy, October 2019, experts met to discuss advantages of febrile neutropenia prevention based on biosimilar G-CSF. This issue is of paramount importance in oncology as recent biological products may be of great benefit, provided that costs are sustainable.
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Affiliation(s)
- Marco Danova
- Department of Internal Medicine & Medical Oncology, ASST of Pavia, Pavia, Italy
| | | | - Ylenia Ingrasciotta
- Department of Biomedical & Dental Sciences & Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Andrea Antonuzzo
- UO Oncologia 1 SSN Polo Oncologico, Azienda Ospedaliero, Universitaria Pisana, Ambulatorio Terapie di Supporto, Pisa, Italy
| | - Ugo Trama
- General Direction of Health Care & Regional Health System Coordination, Drug & Device Politics, Campania, Italy
| | - Carlo Tondini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Futura Bernardi
- General Direction of Health Care & Regional Health System Coordination, Drug & Device Politics, Campania, Italy
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15
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Scavone C, Di Mauro C, Ruggiero R, Bernardi FF, Trama U, Aiezza ML, Rafaniello C, Capuano A. Severe Cutaneous Adverse Drug Reactions Associated with Allopurinol: An Analysis of Spontaneous Reporting System in Southern Italy. Drugs Real World Outcomes 2019; 7:41-51. [PMID: 31848905 PMCID: PMC7060978 DOI: 10.1007/s40801-019-00174-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Allopurinol can induce severe cutaneous adverse reactions (SCARs), including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Aims and Methods We analyzed the Individual Case Safety Reports (ICSRs) sent from January 2001 until April 2019 to the Campania regional Center of Pharmacovigilance (Southern Italy) that reported allopurinol as suspected, with a focus on those reporting at least one serious cutaneous adverse drug reaction (ADR). This study was aimed to describe the main characteristics of all ADRs associated with allopurinol, analyze the proportion of serious cutaneous ADRs of total ICSRs related to allopurinol and to compare the main features (age, sex, seriousness and outcome) of ICSRs that reported serious cutaneous ADRs with those that did not. Results The Campania regional Center of Pharmacovigilance received 108 ICSRs that reported allopurinol as suspected. ADRs occurred more frequently in the elderly (median age: 71 years) and female patients (53.7%). Fifty-seven percent of all ADRs were classified as serious and 58% had a favorable outcome. Fifty-six ICSRs reported at least one serious cutaneous ADR; among these ICSRs, 37 cases of SCARs were found [DRESS syndrome (n = 3; 5.4%), SJS (n = 8; 14.3%) and TEN (n = 26; 46.4%)]. Serious cutaneous ADRs commonly occurred in the elderly (median age: 73 years) and female patients (62.5%). They frequently required hospitalization (75%) and had an unfavorable outcome (46%). No statistically significant differences were found between ICSRs that reported serious cutaneous ADRs and ICSRs that did not report serious cutaneous ADRs except for the seriousness degree “Hospitalization or its prolongation” and the outcome degrees “Unfavorable” and “Favorable”. Conclusion This study found that 52% (56/108) of all ICSRs having allopurinol as a suspected drug were serious cutaneous ADRs. Serious cutaneous ADRs associated with allopurinol frequently required hospitalization or prolonged hospitalization, and almost half had an unfavorable outcome.
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Affiliation(s)
- Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Cristina Di Mauro
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Rosanna Ruggiero
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Francesca Futura Bernardi
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy.,Regional Pharmaceutical Unit, Naples, Campania Region, Italy
| | - Ugo Trama
- Regional Pharmaceutical Unit, Naples, Campania Region, Italy
| | | | - Concetta Rafaniello
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy.
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16
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Sessa M, Bernardi FF, Vitale A, Schiavone B, Gritti G, Mascolo A, Bertini M, Scavone C, Sportiello L, Rossi F, Capuano A. Adverse drug reactions during hepatitis C treatment with direct-acting antivirals: The role of medication errors, their impact on treatment discontinuation and their preventability. New insights from the Campania Region (Italy) spontaneous reporting system. J Clin Pharm Ther 2018; 43:867-876. [PMID: 30014479 DOI: 10.1111/jcpt.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/22/2018] [Indexed: 12/14/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Medication errors, such as unnecessary treatment discontinuation during treatment with direct-acting antivirals (DAAs), can lead to imbalances in the benefit-to-risk ratio. This risk is especially high when the medication error leads to adverse drug reactions (ADRs). However, to date, evidence on the frequency of this phenomenon is scarce. This study aims to provide better insight into ADRs possibly due to medication errors leading to DAA discontinuation and their preventability. METHODS The Italian Pharmacovigilance Network database was used to extract individual case safety reports (ICSRs) generated from July 2012 to March 2017 via the Campania Region (Italy) spontaneous reporting system. ICSRs that included ledipasvir/sofosbuvir, ombitasvir/paritaprevir/ritonavir, dasabuvir, daclatasvir, sofosbuvir, simeprevir or elbasvir/grazoprevir as suspected drugs were included in this study. A preventability assessment was then performed utilizing the "P-Method," an algorithm that evaluates known risk factors due to medication errors that can be detected in ICSRs. RESULTS AND DISCUSSION Of the 355 cases included in this study, 6 (1.69%) were classified as preventable and 52 (14.6%) were classified as potentially preventable. The most frequently identified critical criteria (risk factor) for preventable or potentially preventable cases were drug-drug interactions and incorrect drug dosing as part of the antiviral treatment scheme. In total, 89 of the 355 cases (25.1%) discontinued use of the DAAs due to ADRs, of which 20 of the 89 cases (22.5%) were due to an unimportant medical event as classified by the European Medicine Agency important medical event list. WHAT IS NEW AND CONCLUSION This study found a proportion of preventable/potentially preventable ADRs involving DAA, which could be improved in the Campania Region (Italy). Additionally, the study identified a high proportion of seemingly unnecessary DAA discontinuations among patients who experienced ADRs.
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Affiliation(s)
- Maurizio Sessa
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Andrea Vitale
- Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Giulia Gritti
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Michele Bertini
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "L. Vanvitelli,", Naples, Italy
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Rafaniello C, Sessa M, Bernardi FF, Pozzi M, Cheli S, Cattaneo D, Baldelli S, Molteni M, Bernardini R, Rossi F, Clementi E, Bravaccio C, Radice S, Capuano A. The predictive value of ABCB1, ABCG2, CYP3A4/5 and CYP2D6 polymorphisms for risperidone and aripiprazole plasma concentrations and the occurrence of adverse drug reactions. Pharmacogenomics J 2017; 18:422-430. [PMID: 28719598 DOI: 10.1038/tpj.2017.38] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 06/07/2017] [Indexed: 01/07/2023]
Abstract
We investigated in ninety Caucasian pediatric patients the impact of the main polymorphisms occurring in CYP3A, CYP2D6, ABCB1 and ABCG2 genes on second-generation antipsychotics plasma concentrations, and their association with the occurrence of adverse drug reactions. Patients with the CA/AA ABCG2 genotype had a statistically significant lower risperidone plasma concentration/dose ratio (Ct/ds) (P-value: 0.007) and an higher estimated marginal probability of developing metabolism and nutrition disorders as compared to the ABCG2 c.421 non-CA/AA genotypes (P-value: 0.008). Multivariate analysis revealed that the ABCG2 c.421 CA/AA genotype was found associated to a higher hazard (P-value: 0.004) of developing adverse drug reactions classified as metabolism and nutrition disorders. The ABCB1 2677TT/3435TT genotype had a statistically significant lower aripiprazole Ct/ds if compared with patients with others ABCB1 genotypes (P-value: 0.026). Information obtained on ABCB1 and ABCG2 gene variants may result useful to tailor treatments with these drugs in Caucasian pediatric patients.
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Affiliation(s)
- C Rafaniello
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - M Sessa
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - F F Bernardi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - M Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - S Cheli
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - D Cattaneo
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - S Baldelli
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - M Molteni
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - R Bernardini
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Catania, Italy
| | - F Rossi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
| | - E Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.,Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - C Bravaccio
- Department of Translational Medical Sciences, Section of Neuropsychiatry, University "Federico II", Naples, Italy
| | - S Radice
- Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Unit of Clinical Pharmacology, CNR Institute of Neuroscience, University of Milan, Milan, Italy
| | - A Capuano
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy
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Sportiello L, Rafaniello C, Sullo MG, Nica M, Scavone C, Bernardi FF, Colombo DM, Rossi F. No substantial gender differences in suspected adverse reactions to ACE inhibitors and ARBs: results from spontaneous reporting system in Campania Region. Expert Opin Drug Saf 2017; 15:101-107. [PMID: 27875922 DOI: 10.1080/14740338.2016.1225720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Today, there is a poor knowledge about gender differences in adverse drug reactions (ADRs) to cardiovascular drugs such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Therefore, the aim of this study was to analyze spontaneous reports of suspected ADRs induced by ACE-inhibitors and ARBs, between January 2001 and June 2015, recorded in a Region of Southern Italy (Campania Region). METHODS We performed a descriptive gender-related analysis of regional safety data, obtained from the spontaneous reporting system. RESULTS In the considered period, 772 suspected ADRs to ACE inhibitors and ARBs (in monotherapy or in combination) were reported with a slightly higher frequency in men compared with women. In both genders, the most involved category was ARBs in combination, whereas the most prescribed active substance was ramipril. General and administration site conditions, vascular disorders and modification of laboratory parameters were more common in men, while respiratory disorders were most common in women. In 88.2% of cases, not serious ADRs were described more by men than women. CONCLUSIONS This analysis suggested no substantial gender differences. Further studies such as randomized population studies or meta-analysis of ACE inhibitors and ARBs randomized studies are needed to clarify whether gender differences exist in the safety profile of these drugs.
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Affiliation(s)
- Liberata Sportiello
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
| | - Concetta Rafaniello
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
| | - Maria Giuseppa Sullo
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
| | - Mihaela Nica
- b Novartis Farma Italia , Value & Access Department , Varese , Italy
| | - Cristina Scavone
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
| | - Francesca Futura Bernardi
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
| | | | - Francesco Rossi
- a Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
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Falvella FS, Caporale M, Cheli S, Martinetti A, Berenato R, Maggi C, Niger M, Ricchini F, Bossi I, Di Bartolomeo M, Sottotetti E, Bernardi FF, de Braud F, Clementi E, Pietrantonio F. Undetected toxicity risk in pharmacogenetic testing for dihydropyrimidine dehydrogenase. Int J Mol Sci 2015; 16:8884-95. [PMID: 25906475 PMCID: PMC4425114 DOI: 10.3390/ijms16048884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/30/2015] [Accepted: 04/13/2015] [Indexed: 12/22/2022] Open
Abstract
Fluoropyrimidines, the mainstay agents for the treatment of colorectal cancer, alone or as a part of combination therapies, cause severe adverse reactions in about 10%–30% of patients. Dihydropyrimidine dehydrogenase (DPD), a key enzyme in the catabolism of 5-fluorouracil, has been intensively investigated in relation to fluoropyrimidine toxicity, and several DPD gene (DPYD) polymorphisms are associated with decreased enzyme activity and increased risk of fluoropyrimidine-related toxicity. In patients carrying non-functional DPYD variants (c.1905+1G>A, c.1679T>G, c.2846A>T), fluoropyrimidines should be avoided or reduced according to the patients’ homozygous or heterozygous status, respectively. For other common DPYD variants (c.496A>G, c.1129-5923C>G, c.1896T>C), conflicting data are reported and their use in clinical practice still needs to be validated. The high frequency of DPYD polymorphism and the lack of large prospective trials may explain differences in studies’ results. The epigenetic regulation of DPD expression has been recently investigated to explain the variable activity of the enzyme. DPYD promoter methylation and its regulation by microRNAs may affect the toxicity risk of fluoropyrimidines. The studies we reviewed indicate that pharmacogenetic testing is promising to direct personalised dosing of fluoropyrimidines, although further investigations are needed to establish the role of DPD in severe toxicity in patients treated for colorectal cancer.
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Affiliation(s)
- Felicia Stefania Falvella
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan 20157, Italy.
| | - Marta Caporale
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Stefania Cheli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan 20157, Italy.
| | - Antonia Martinetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Rosa Berenato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Claudia Maggi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Francesca Ricchini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Ilaria Bossi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Elisa Sottotetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Francesca Futura Bernardi
- Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Faculty of Medicine and Surgery, Second University of Naples, Naples 80138, Italy.
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
| | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco 23842, Italy.
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital "Luigi Sacco", Università di Milano, Milan 20157, Italy.
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milan 20133, Italy.
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