1
|
Baltzer Houlind M, Hansen L, Iversen E, Rasmussen HB, Larsen JB, Jørgensen S, Dalhoff K, Damkier P, Walls AB, Vermehren C, Andersen TRH, Kallemose T, Christrup L, Westergaard N. Pharmacogenetic testing of CYP2D6, CYP2C19 and CYP2C9 in Denmark: Agreement between publicly funded genotyping tests and the subsequent phenotype classification. Basic Clin Pharmacol Toxicol 2024; 134:756-763. [PMID: 38403838 DOI: 10.1111/bcpt.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Luise Hansen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Roskilde, Denmark
| | | | - Steffen Jørgensen
- Centre for Engineering and Science, University College Absalon, Naestved, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per Damkier
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne B Walls
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Vermehren
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Lona Christrup
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
2
|
Buhl Rasmussen AS, Andersen CL, Weimann A, Yang T, Tron C, Gandemer V, Dalhoff K, Rank CU, Schmiegelow K. Therapeutic drug monitoring of imatinib - how far are we in the leukemia setting? Expert Rev Clin Pharmacol 2024; 17:225-234. [PMID: 38345044 DOI: 10.1080/17512433.2024.2312256] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have revolutionized survival rates of chronic myeloid leukemia (CML) and Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) and replaced hematopoietic stem cell transplantation (hSCT) as the key treatment option for these patients. More recently, the so-called Philadelphia chromosome-like (Ph-like) ALL has similarly benefitted from TKIs. However, many patients shift from the first generation TKI, imatinib, due to treatment-related toxicities or lack of treatment efficacy. A more personalized approach to TKI treatment could counteract these challenges and potentially be more cost-effective. Therapeutic drug monitoring (TDM) has led to higher response rates and less treatment-related toxicity in adult CML but is rarely used in ALL or in childhood CML. AREAS COVERED This review summarizes different antileukemic treatment indications for TKIs with focus on imatinib and its pharmacokinetic/-dynamic properties as well as opportunities and pitfalls of TDM for imatinib treatment in relation to pharmacogenetics and co-medication for pediatric and adult Ph+/Ph-like leukemias. EXPERT OPINION TDM of imatinib adds value to standard monitoring of ABL-class leukemia by uncovering non-adherence and potentially mitigating adverse effects. Clinically implementable pharmacokinetic/-dynamic models adjusted for relevant pharmacogenetics could improve individual dosing. Prospective trials of TDM-based treatments, including both children and adults, are needed.
Collapse
Affiliation(s)
- Anna Sofie Buhl Rasmussen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Allan Weimann
- Pediatric Oncology Research Laboratory, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tianwu Yang
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Camille Tron
- Department of Biological Pharmacology, Rennes University Hospital, Rennes, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, Rennes University Hospital, Rennes, France
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Utke Rank
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Iversen E, Bengaard AK, Leegaard Andersen A, Tavenier J, Nielsen RL, Juul-Larsen HG, Jørgensen LM, Bornæs O, Jawad BN, Aharaz A, Walls AB, Kallemose T, Dalhoff K, Nehlin JO, Hornum M, Feldt-Rasmussen B, Damgaard M, Andersen O, Houlind MB. Performance of Panel-Estimated GFR Among Hospitalized Older Adults. Am J Kidney Dis 2023; 82:715-724. [PMID: 37516299 DOI: 10.1053/j.ajkd.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/16/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Older adults represent nearly half of all hospitalized patients and are vulnerable to inappropriate dosing of medications eliminated through the kidneys. However, few studies in this population have evaluated the performance of equations for estimating the glomerular filtration rate (GFR)-particularly those that incorporate multiple filtration markers. STUDY DESIGN Cross-sectional diagnostic test substudy of a randomized clinical trial. SETTING & PARTICIPANTS Adults≥65 years of age presenting to the emergency department of Copenhagen University Hospital Amager and Hvidovre in Hvidovre, Denmark, between October 2018 and April 2021. TESTS COMPARED Measured GFR (mGFR) determined using 99mTc-DTPA plasma clearance compared with estimated GFR (eGFR) calculated using 6 different equations based on creatinine; 3 based on creatinine and cystatin C combined; and 2 based on panels of markers including creatinine, cystatin C, β-trace protein (BTP) and/or β2-microglobulin (B2M). OUTCOME The performance of each eGFR equation compared with mGFR with respect to bias, relative bias, inaccuracy (1-P30), and root mean squared error (RMSE). RESULTS We assessed eGFR performance for 106 patients (58% female, median age 78.3 years, median mGFR 62.9mL/min/1.73m2). Among the creatinine-based equations, the 2009 CKD-EPIcr equation yielded the smallest relative bias (+4.2%). Among the creatinine-cystatin C combination equations, the 2021 CKD-EPIcomb equation yielded the smallest relative bias (-3.4%), inaccuracy (3.8%), and RMSE (0.139). Compared with the 2021 CKD-EPIcomb, the CKD-EPIpanel equation yielded a smaller RMSE (0.136) but larger relative bias (-4.0%) and inaccuracy (5.7%). LIMITATIONS Only White patients were included; only a subset of patients from the original clinical trial underwent GFR measurement; and filtration marker concentration can be affected by subclinical changes in volume status. CONCLUSIONS The 2009 CKD-EPIcr, 2021 CKD-EPIcomb, and CKD-EPIpanel equations performed best and notably outperformed their respective full-age spectrum equations. The addition of cystatin C to creatinine-based equations improved performance, while the addition of BTP and/or B2M yielded minimal improvement. FUNDING Grants from public sector industry (Amgros I/S) and government (Capital Region of Denmark). TRIAL REGISTRATION Registered at ClinicalTrials.gov with registration number NCT03741283. PLAIN-LANGUAGE SUMMARY Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
Collapse
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre.
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | | | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Capital Region Pharmacy, Herlev, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| |
Collapse
|
4
|
Haslund-Krog S, Barry JM, Birnbaum AK, Dalhoff K, Brink Henriksen T, Sherwin CMT, Avachat C, Poulsen S, Christensen U, Remmel RP, Wilkins D, van den Anker JN, Holst H. Pharmacokinetics and safety of prolonged paracetamol treatment in neonates: An interventional cohort study. Br J Clin Pharmacol 2023; 89:3421-3431. [PMID: 37353311 DOI: 10.1111/bcp.15834] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
AIMS To investigate the pharmacokinetics and safety of prolonged paracetamol use (>72 h) for neonatal pain. METHODS Neonates were included if they received paracetamol orally or intravenously for pain treatment. A total of 126 samples were collected. Alanine aminotransferase and bilirubin were measured as surrogate liver safety markers. Paracetamol and metabolites were measured in plasma. Pharmacokinetic parameters for the parent compound were estimated with a nonlinear mixed-effects model. RESULTS Forty-eight neonates were enrolled (38 received paracetamol for >72 h). Median gestational age was 38 weeks (range 25-42), and bodyweight at inclusion was 2954 g (range 713-4750). Neonates received 16 doses (range 4-55) over 4.1 days (range 1-13.8). The median (range) dose was 10.1 mg/kg (2.9-20.3). The median oxidative metabolite concentration was 14.6 μmol/L (range 0.12-113.5) and measurable >30 h after dose. There was no significant difference (P > .05) between alanine aminotransferase and bilirubin measures at <72 h or >72 h of paracetamol treatment or the start and end of the study. Volume of distribution and paracetamol clearance for a 2.81-kg neonate were 2.99 L (% residual standard error = 8, 95% confidence interval 2.44-3.55) and 0.497 L/h (% residual standard error = 7, 95% confidence interval 0.425-0.570), respectively. Median steady-state concentration from the parent model was 50.3 μmol/L (range 30.6-92.5), and the half-life was 3.55 h (range 2.41-5.65). CONCLUSION Our study did not provide evidence of paracetamol-induced liver injury nor changes in metabolism in prolonged paracetamol administration in neonates.
Collapse
Affiliation(s)
- Sissel Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
| | - Jessica M Barry
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
| | - Tine Brink Henriksen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Pediatrics, Dayton Children's Hospital, Dayton, Ohio, USA
| | - Charul Avachat
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susanne Poulsen
- Neonatal Intensive Care Unit, Rigshospitalet, Copenhagen Ø, Denmark
| | - Ulla Christensen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Rory P Remmel
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Diana Wilkins
- Division of Medical Laboratory Sciences, Department of Pathology, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - John N van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, District of Columbia, USA
- Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Helle Holst
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen NV, Denmark
| |
Collapse
|
5
|
Henrik Kristensen J, Amalie Wistisen Koczulab C, Anton Frandsen E, Bo Hasselbalch R, Strandkjær N, Jørgensen N, Østergaard M, Hasse Møller-Sørensen P, Christian Nilsson J, Afzal S, Rørbæk Kamstrup P, Dahl M, Bor MV, Frikke-Schmidt R, Rye Jørgensen N, Rode L, Holmvang L, Kjærgaard J, Evi Bang L, Forman J, Dalhoff K, Bundgaard H, Karmark Iversen K. Kinetics of cardiac troponin and other biomarkers in patients with ST elevation myocardial infarction. Int J Cardiol Heart Vasc 2023; 48:101250. [PMID: 37602285 PMCID: PMC10432699 DOI: 10.1016/j.ijcha.2023.101250] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
Objective To examine changes in concentration, time-to-peak and the ensuing half-life of cardiac biomarkers in patients with myocardial infarction. Methods Blood sampling was performed every third hour within 24 h after percutaneous coronary intervention (PCI) on a cohort of patients with ST elevation myocardial infarction. Cardiac troponin (cTn) was measured by the Dimension Vista, Vitros, Atellica, and Alinity high-sensitivity (hs) cTnI assays, and the Elecsys hs-cTnT assay. Further, creatine kinase (CK), myoglobin, creatine kinase MB (CKMB) and other biomarkers were analyzed. Results A total of 36 patients completed blood sampling (median age 60 years, IQR 56.4-66.5 years; seven women, 19.4%). Hs-cTnI measured by the Vitros assay was the first hs-cTn to peak at 9.1 h (95%-CI 6.2-10.1) after PCI and 11.7 h (95%-CI 10.4-14.8) after symptoms onset. There were no notable differences between hs-cTn assays in regard to time-to-peak. Also, Vitros hs-cTnI reached the highest median ratio of concentration to upper reference level of nearly 2,000. The median half-life from peak concentration ranged from 7.6 h for myoglobin (CI 6.8-8.6) to 17.8 h for CK (CI 6.8-8.6). For hs-cTn assays the median T½ ranged from 12.4 h for the Vista hs-cTnI assay (95%-CI 11.0-14.1 h) to 17.3 h for the Elecsys hs-cTnT (95%-CI 14.9-20.8 h). Conclusions This study updates knowledge on the kinetics of cardiac biomarkers in current clinical use. There was no notable difference in trajectories, time-to-peak or half-life between hs-cTn assays.
Collapse
Affiliation(s)
- Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Clara Amalie Wistisen Koczulab
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Emil Anton Frandsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Morten Østergaard
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens Christian Nilsson
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Pia Rørbæk Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Morten Dahl
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Zealand University Hospital – Køge, Lykkebækvej 1, 4600 Køge, Denmark
| | - Mustafa Vakur Bor
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Julie Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| |
Collapse
|
6
|
Eliasen A, Kornholt J, Mathiasen R, Brok J, Rechnitzer C, Schmiegelow K, Dalhoff K. Risk factors associated with nausea and vomiting in children with cancer receiving chemotherapy. J Oncol Pharm Pract 2023; 29:1361-1368. [PMID: 36039521 DOI: 10.1177/10781552221122026] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite treatment with antiemetic medications, nausea remains uncontrolled for many children receiving chemotherapy. One reason is that risk factors for nausea in children remain poorly explored. The purpose of this study was to identify risk factors for chemotherapy-induced nausea (CIN) in children. METHODS Prospective, observational study including 101 children (median age 6.4 years, range 0.8-17.9) with cancer receiving moderately or highly emetogenic chemotherapy. Primary endpoints were complete control of acute and delayed CIN, defined as no nausea in the acute phase 0-24 h after chemotherapy and in the delayed phase starting after the acute phase and ending 5 days later. Multivariable analyses included age, sex, cancer type, susceptibility to motion sickness, chemotherapy duration, numbers of antiemetics, co-administration with opioids or tricyclic antidepressants, and previously uncontrolled nausea or vomiting. RESULTS Acute CIN was associated with susceptibility to motion sickness (odds ratio [OR] 5.73, 95% confidence interval [CI] 1.36-33.7) and older age (OR 4.19, 95% CI 1.30-14.7), comparing age group 8-18 years with 0-3 years. Delayed CIN was associated with uncontrolled acute nausea or vomiting (OR 10.3, 95% CI 2.65-50.9), highly emetogenic chemotherapy (OR 8.26, 95% CI 1.17-76.8), and having a hematologic cancer type (OR 7.81, 95% CI 1.05-79.2). CONCLUSIONS Susceptibility to motion sickness and age can influence the risk of acute CIN. More research is needed on how best to integrate risk information in preventive antiemetic strategies. Sufficient acute nausea and vomiting control are crucial to prevent delayed CIN.
Collapse
Affiliation(s)
- Astrid Eliasen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Kornholt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Mathiasen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - J Brok
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Tamene S, Dalhoff K, Schwarz P, Backer V, Aanaes K. Systemic corticosteroids in treatment of chronic rhinosinusitis-A systematic review. Eur Clin Respir J 2023; 10:2240511. [PMID: 37554567 PMCID: PMC10405757 DOI: 10.1080/20018525.2023.2240511] [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: 03/19/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
Purpose When first-line chronic rhinosinusitis (CRS) treatment fails, patients can either be treated with oral or injected systemic corticosteroids. Although the EPOS and international guidelines for CRS do not mention injected corticosteroids, it is commonly used by ear, nose, and throat specialists. While the risks of systemic corticosteroids, in general, are known, the pros and cons of injected and oral corticosteroids (OCS) in CRS treatment are unclear. Methods A systematic review of studies that report the effects and/or side effects of injected and oral corticosteroids in the treatment of CRS was made according to the PRISMA guidelines. Results Altogether, 48 studies were included, only five studies reported on injected corticosteroids, and five attended with side effects. Three studies found beneficial effects of OCS perioperatively on sinus surgery, while four articles found no effect. Nineteen articles reported that OCS resulted in an improvement in symptoms. Two articles presented a longer-lasting effect of injected corticosteroids than OCS. Three studies reported adverse side effects of systemic corticosteroids, while two studies showed no adverse side effects. One study showed less adrenal suppression after injected corticosteroids compared to OCS. The evidence is not strong but shows a positive effect of systemic corticosteroids that lasts longer with injections. Conclusion Although systemic corticosteroids are widely used to treat CRS, there is a lack of studies comparing the OCS and injected corticosteroids. The evidence is sparse, however, injected steroids show longer effects with fewer side effects. An RCT study is needed to compare OCS and injected corticosteroids.
Collapse
Affiliation(s)
- Sarah Tamene
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark, Copenhagen
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Physical Activity Research (CFAS), Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Kasper Aanaes
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Jensen TL, Tejlbo Frost M, Dalhoff K, Studsgaard Petersen T. Repeated poisonings in Denmark - a nationwide study. Clin Toxicol (Phila) 2023; 61:392-399. [PMID: 37171194 DOI: 10.1080/15563650.2023.2205006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Poisonings contribute significantly to morbidity and mortality of patients. Some patients have numerous contacts to a poison information center, indicating repeated poisoning exposures. Information on the involved substances is necessary to explore methods to prevent self-harm and reduce mortality. The objective of this study was to characterize the patient population with repeated poison exposures in Denmark and identify the substances involved. METHODS This study was a retrospective cohort study of enquiries to the nationwide Danish Poison Information Centre and the Danish National Patient Registry. The databases were used to identify patients with more than five individual poisoning episodes within a 12-month-period between 1 January 2013, and 31 December 2017. RESULTS One hundred and thirty-seven patients and 995 patients met the inclusion criteria in the Danish Poison Information Centre and the Danish National Patient Registry, respectively. The majority were women (82.5% and 66.3% for the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively). The mean age was 24.7 and 29.5 years. Psychiatric comorbidities were frequent with 74.5% and 67.0% suffering from personality disorders and 70.1% and 54.5% from affective disorders in the Danish Poison Information Centre and the Danish National Patient Registry cohorts, respectively. One thousand seven hundred and fifty-two poisoning episodes were identified in the Danish Poison Information Centre database, and the most common types of substance were 'pharmaceuticals' (1,420 episodes). The most common medications ingested were quetiapine, paracetamol and cyclizine. Median number of contacts to the Danish Poison Information Centre was 10. Patients with one or more poisoning episodes involving cyclizine had on average 11.4 poisoning episodes involving cyclizine. In the Danish National Patient Registry cohort 80.9% were alive after 10 years compared to 97.7% in the background population. CONCLUSION AND IMPLICATIONS Most poisonings were intentional and occurred among younger women. Psychiatric comorbidity was frequent. Most often, pharmaceuticals were the toxic substance, mainly quetiapine, paracetamol and cyclizine. Changing the status of cyclizine from over the counter to prescription only medication, and implementing stricter rules for prescribing quetiapine, could limit future poisoning incidences.
Collapse
Affiliation(s)
- Thomas Leth Jensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Matilde Tejlbo Frost
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tonny Studsgaard Petersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Windfeld‐Mathiasen J, Christoffersen T, Strand NAW, Dalhoff K, Andersen JT, Horwitz H. Psychiatric morbidity among men using anabolic steroids. Depress Anxiety 2022; 39:805-812. [PMID: 36281632 PMCID: PMC10092709 DOI: 10.1002/da.23287] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the psychiatric morbidity among men with abuse of anabolic steroids. METHODS The design is a retrospectively matched cohort study. Five hundred and fourty-five males, who tested positive for anabolic steroids in Danish fitness centers during the period January 3, 2006 to March 1, 2018, were matched with 5450 randomly chosen male controls. Data was cross-referenced with seven national registers pertaining to information about education, employment status, and psychiatric comorbidity. Main outcomes and measures were prescription of psychopharmacological treatment. RESULTS The incidence of treatment with anxiolytics (HR: 2.34, 95% CI: 1.62-3.38) and antipsychotics (HR: 2.69, 95% CI: 1.99-3.63) displayed a remarkable increase in the years following doping sanction, compared to the control group. The prevalence of antidepressant use was already markedly elevated several years before doping sanction, but also displayed a higher incidence in the years following sanction (HR: 1.65, 95% CI: 1.28-2.13). The associations remained highly significant after controlling for socioeconomic factors. CONCLUSION Anabolic steroids use is strongly associated with psychiatric morbidity.
Collapse
Affiliation(s)
| | - Thea Christoffersen
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalCopenhagenDenmark
| | | | - Kim Dalhoff
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jon Trærup Andersen
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Horwitz
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
10
|
Tyron JM, Eliasen A, Dalhoff K, Nørgaard MM. [The efficacy and safety of proton pump inhibitors in infants with reflux]. Ugeskr Laeger 2022; 184:V08210634. [PMID: 35410647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Proton pump inhibitors (PPIs) are widely used in Denmark as a treatment for gastrooesophageal reflux disease (GERD) in infants under 12 months of age. In this review, we investigated the efficacy and safety of treatment with PPI against GERD in infants. We found that PPIs increased ventricular pH in infants but without a decline in symptoms of GERD compared with placebo. More frequent and serious adverse effects were observed after PPI treatment than after placebo. The available published evidence indicates that PPIs cannot be recommended as a treatment for GERD in infants.
Collapse
Affiliation(s)
- Josephine Meyer Tyron
- Klinisk Farmakologisk Afdeling, K#248;benhavns Universitetshospital - Bispebjerg og Frederiksberg Hospital
| | - Astrid Eliasen
- Klinisk Farmakologisk Afdeling, K#248;benhavns Universitetshospital - Bispebjerg og Frederiksberg Hospital
| | - Kim Dalhoff
- Klinisk Farmakologisk Afdeling, K#248;benhavns Universitetshospital - Bispebjerg og Frederiksberg Hospital
| | - Mia Muusfeldt Nørgaard
- Klinisk Farmakologisk Afdeling, K#248;benhavns Universitetshospital - Bispebjerg og Frederiksberg Hospital
| |
Collapse
|
11
|
Gregersen R, Fox Maule C, Husum Bak-Jensen H, Linneberg A, Nielsen OW, Thomsen SF, Meyhoff CS, Dalhoff K, Krogsgaard M, Palm H, Christensen H, Porsbjerg C, Antonsen K, Rungby J, Haugaard SB, Petersen J, Nielsen FE. Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark. Clin Epidemiol 2022; 14:409-424. [PMID: 35387318 PMCID: PMC8979568 DOI: 10.2147/clep.s338149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]). Conclusion Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.
Collapse
Affiliation(s)
- Rasmus Gregersen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Correspondence: Rasmus Gregersen, Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark, Email
| | - Cathrine Fox Maule
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henriette Husum Bak-Jensen
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian S Meyhoff
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Krogsgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Palm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedics, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Antonsen
- Executive Board, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørgen Rungby
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Steen B Haugaard
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
12
|
Eliasen A, Kornholt J, Mathiasen R, Wadt K, Stoltze U, Brok J, Rechnitzer C, Schmiegelow K, Dalhoff K. Background sensitivity to chemotherapy-induced nausea and vomiting and response to antiemetics in paediatric patients: a genetic association study. Pharmacogenet Genomics 2022; 32:72-78. [PMID: 34750329 DOI: 10.1097/fpc.0000000000000460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) remains a common adverse effect for children with cancer. In children, chemotherapy emetogenicity and patient factors such as susceptibility to motion sickness and age group determine a patient's risk of CINV. Besides known risk factors, genetic factors may play a role in interindividual variation in the occurrence of CINV. We investigated the influence of candidate gene polymorphisms on the efficacy of antiemetics and on the background sensitivity to CINV in children. This prospective study included 100 children with cancer (median age 6.4 years, range 0.8-17.9) who received moderately to highly emetogenic chemotherapy. Participants registered nausea and vomiting episodes in a mobile app. Genotypes were determined by whole-genome sequencing (n = 79) or Sanger sequencing (n = 21) for 71 genetic polymorphisms involved in motion sickness and antiemetic pathways. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate associations between acute CINV and genotypes adjusting for susceptibility to motion sickness and age group. Rs3782025 in the 5-hydroxytryptamine type 3 (5-HT3) receptor gene (HTR3B) [minor allele frequency (MAF): 0.48] affected response to 5-HT3 receptor antagonists; acute CINV occurred in 76% of patients with GA/AA genotypes and in 41% of patients with GG genotype (OR 5.59; 95% CI 1.74-17.9, dominant genetic model). Rs2975226 in the dopamine transporter gene (SLC6A3) (MAF: 0.54) was associated with acute CINV (OR 5.79; 95% CI 1.09-30.67, recessive genetic model). Polymorphisms in HTR3B and SLC6A3 may contribute to the variability in response to antiemetic prophylaxis for CINV in children.
Collapse
Affiliation(s)
- Astrid Eliasen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen
| | - Jonatan Kornholt
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
| | - Karin Wadt
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Stoltze
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
- Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Brok
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen
| |
Collapse
|
13
|
Jakobsen HN, Vermehren C, Andersen JT, Dalhoff K. Drug poisoning in nursing homes: a retrospective study of data from the Danish Poison Information Centre. Drugs Ther Perspect 2021. [DOI: 10.1007/s40267-021-00841-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
14
|
Haslund-Krog SS, Jorgensen IM, Henriksen TB, Dalhoff K, Debes NM, van den Anker J, Holst H. Challenges in conducting paediatric trials with off-patent drugs. Contemp Clin Trials Commun 2021; 23:100783. [PMID: 34258467 PMCID: PMC8253945 DOI: 10.1016/j.conctc.2021.100783] [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: 09/28/2020] [Revised: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction For more than two decades several initiatives have emerged to increase recruitment of paediatric patients in drug trials. While trials of newly approved drugs have successfully included paediatric patients in their drug development plan, the collection of safety and efficacy data in paediatric patients treated with off-patent drugs poses a major challenge. Aim This paper aims to draw attention to problems and solutions across countries in investigator-initiated trials with off-patent drugs and recommendations for improvement. Discussion Off-patent drugs represent a particular challenge when they are included in a paediatric trial; these trials are frequently investigator-initiated and have limited resources, off-patent drugs are used in clinical settings and the trial protocol must accommodate e.g. flexible dosing and specimen sampling schedules, off-patent drugs typically exist in few formulations and concentrations which necessitates special or imported formulations. Paediatric trials are in some countries confined by e.g. consent from both parents, regardless of whether the Investigational Medicinal Product (IMP) is a well-known drug or a new experimental drug. Conclusion Facilitation of research in off-patent drugs can improve evidence-based and safe treatment for the paediatric population. The following supportive initiatives are recommended: Harmonised regulatory change that improves the consent process in low risk trials to prevent inadequate recruitment. Pharmaceutical expertise should be prioritized to secure the best choice of IMP and supply. Constant focus on flexibility in design to accommodate a multifaceted paediatric population and ensure that trial protocols fit in well with routine clinical care and family life.
Collapse
Affiliation(s)
- S S Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - I M Jorgensen
- Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - T B Henriksen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - N M Debes
- Department of Paediatric and Adolescent Medicine, Herlev Hospital, Borgmester Ib Juuls Vej 25C, 2730, Herlev, Denmark
| | - J van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, 20010, USA.,Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Switzerland
| | - H Holst
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| |
Collapse
|
15
|
Braeken DCW, Essig A, Panning M, Hoerster R, Nawrocki M, Dalhoff K, Suttorp N, Welte T, Pletz MW, Witzenrath M, Rohde GGU, Rupp J. Shift in bacterial etiology from the CAPNETZ cohort in patients with community-acquired pneumonia: data over more than a decade. Infection 2021; 49:533-537. [PMID: 33774804 PMCID: PMC8159805 DOI: 10.1007/s15010-021-01605-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/13/2020] [Accepted: 03/09/2021] [Indexed: 12/25/2022]
Abstract
To determine the most relevant pathogens for CAP in Germany, patients with radiologically confirmed pulmonary infiltrates and at least one clinical sign of lung infection were prospectively recruited within the CAPNETZ cohort from 2004 until 2016. In 990 out of 4.672 patients (21%) receiving complete diagnostics the most prominent change of pathogens was a decrease of S. pneumoniae (58% in 2004 to 37.5% in 2016; p ≤ 0.001, ρ = − 0.148) and an increase of H. influenzae (12.2% to 20.8%; p = 0.001, ρ = 0.104).
Collapse
Affiliation(s)
- D C W Braeken
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - A Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - M Panning
- Institute of Virology, University Medical Center-University of Freiburg, Freiburg, Germany
| | - R Hoerster
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - K Dalhoff
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - N Suttorp
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Infectious Diseases and Pulmonary Medicine and Division of Pulmonary Inflammation, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Welte
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Pneumology and German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - M W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany.,Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - M Witzenrath
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Infectious Diseases and Pulmonary Medicine and Division of Pulmonary Inflammation, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G G U Rohde
- CAPNETZ STIFTUNG, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany
| | - J Rupp
- CAPNETZ STIFTUNG, Hannover, Germany. .,Department of Infectious Diseases and Microbiology, University Hospital of Schleswig-Holstein/Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | | |
Collapse
|
16
|
Johansson KS, Høgberg LCG, Christensen MB, Petersen TS, Dalhoff K, Bøgevig S. [Local anaesthetic systemic toxicity]. Ugeskr Laeger 2020; 182:V11190656. [PMID: 33317687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Local anaesthetic systemic toxicity (LAST) gives rise to symptoms from the central nervous and cardiovascular systems. Knowledge about symptoms and risk factors is crucial in preventing LAST. Treatment of severe symptoms should often include vasopressors and sodium bicarbonate. In cardiac arrest the guidelines for advance life support including high-quality cardiopulmonary resuscitation (CPR) should be followed - emphasising prolonged CPR and extracorporeal life support (ECLS) in case of LAST. The conclusion of this review is that intravenous lipid emulsion should only be considered, when other interventions fail, and ECLS is unavailable.
Collapse
|
17
|
Morthorst BR, Erlangsen A, Chaine M, Eriksson F, Hawton K, Dalhoff K, Nordentoft M. Restriction of non-opioid analgesics sold over-the-counter in Denmark: A national study of impact on poisonings. J Affect Disord 2020; 268:61-68. [PMID: 32158008 DOI: 10.1016/j.jad.2020.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Self-poisoning with non-opioid analgesics presents a growing challenge to health care providers. We aimed to assess the impact of an 18-year age restriction of OTC sales and a pack size restriction of non-opioid analgesics sold OTC in pharmacies on hospital-treated poisonings and poisoning severity measured using biomarkers. METHODS We applied a before and after design using interrupted time series analysis. Data on all poisonings recorded as hospital admissions were obtained during 2002-2015 and biochemical parameters from laboratory databases during 2011-2015, both covering the entire Danish population. RESULTS The age restriction was followed by a 17% level reduction in admissions for non-opioid analgesic poisoning among young people age 10-17 years (RR 0.830; 95% CI 0.697-0.988; p < 0.036). After the pack size restriction, an instant level reduction of 18.5% (RR 0.815; 95% CI 0.729-0.912; p < 0.001) was observed for the entire population. A 27% decrease in the number of poisonings with alanine transaminase levels (ALT) ≥ 210 U/L was observed (RR 0.734; 95% CI 0.579-0.931; p = 0.011) followed by 40% decrease in biomarkers indicative of liver failure (RR 0.597; 95% CI 0.421-0.847; p = 0.004). We also observed similar reductions for other poisonings such as psychotropics. LIMITATIONS Although declines in poisonings were observed after implementation of means restrictive measures, a causal link cannot be inferred. CONCLUSION Age and pack size restriction were assiociated with a reduction in the numbers of poisonings. This was also observed for pharmaceutical poisonings in general, which might suggest a non-specific or spill-over effect.
Collapse
Affiliation(s)
- Britt Reuter Morthorst
- Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Child & Adolescent Mental Health Services Capital Region of Denmark, Gentofte Hospitalsvej 15, DK - 2900 Hellerup.
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Center for Mental Health Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Oxford University, Oxford, UK
| | - Kim Dalhoff
- Department of Clinical Pharmacology and Clinical Toxicology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Nordentoft
- Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Eliasen A, Dalhoff K, Mathiasen R, Schmiegelow K, Rechnitzer C, Schelde AB, Perwitasari DA, Tsuji D, Brok J. Pharmacogenetics of antiemetics for chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 149:102939. [PMID: 32259776 DOI: 10.1016/j.critrevonc.2020.102939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/27/2019] [Accepted: 03/09/2020] [Indexed: 01/21/2023] Open
Abstract
A substantial proportion of cancer patients experience chemotherapy-induced nausea and vomiting (CINV) despite the use of antiemetic drugs. Prevalent genetic polymorphisms involved in antiemetic drug metabolism, drug transport and receptor pathways likely affect the effectiveness of antiemetics. Knowledge on which polymorphisms to integrate into individualised clinical care is needed. We did a systematic review evaluating the association between polymorphisms and effectiveness of antiemetics in cancer patients receiving moderately to highly emetogenic chemotherapy. Twenty studies n = 2331 evaluated eight polymorphisms in five candidate genes involved in 5-HT3 antagonist pathways. HTR3C C1214G increased the risk of acute chemotherapy-induced vomiting in the dominant model (odds ratio (OR) = 2.67, 95 % confidence interval (CI): 1.08-6.63). ABCB1 C3435T reduced the risk of acute CINV in the recessive model (OR = 0.60, 95 % CI: 0.44-0.81). Future studies should evaluate candidate genes that affect pharmacogenetics of other antiemetics beside 5-HT3 antagonists.
Collapse
Affiliation(s)
- Astrid Eliasen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Astrid Blicher Schelde
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Daiki Tsuji
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Jesper Brok
- Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
19
|
Gade C, Sverrisdóttir E, Dalhoff K, Sonne J, Johansen MØ, Christensen HR, Burhenne J, Mikus G, Holm JC, Lund TM, Holst H. Midazolam Pharmacokinetics in Obese and Non-obese Children and Adolescents. Clin Pharmacokinet 2019; 59:643-654. [DOI: 10.1007/s40262-019-00838-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
20
|
Wong A, Graudins A, Heard K, Dalhoff K, Sivilotti ML. Improving the management of the paracetamol poisoned patient. EClinicalMedicine 2019; 12:10. [PMID: 31388658 PMCID: PMC6677687 DOI: 10.1016/j.eclinm.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anselm Wong
- Victorian Poisons Information Centre, Emergency Department and Austin Toxicology Unit, Austin Health, Heidelberg, Victoria 3084, Australia
- School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Centre for Integrated Critical Care, University of Melbourne, Victoria, Australia
- Corresponding author.
| | - Andis Graudins
- Monash Toxicology Service and Monash Emergency Research Collaborative, Dandenong Hospital, Victoria, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Kennon Heard
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Kim Dalhoff
- Department of Clinical Medicine, Bispebjerg-Frederiksberg Hospital -, Bispebjerg, Denmark
| | - Marco L.A. Sivilotti
- Departments of Emergency and of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
21
|
Stage C, Dalhoff K, Rasmussen HB, Schow Guski L, Thomsen R, Bjerre D, Ferrero-Miliani L, Busk Madsen M, Jürgens G. The impact of human CES1 genetic variation on enzyme activity assessed by ritalinic acid/methylphenidate ratios. Basic Clin Pharmacol Toxicol 2019; 125:54-61. [PMID: 30801959 DOI: 10.1111/bcpt.13212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/14/2018] [Accepted: 02/04/2019] [Indexed: 01/29/2023]
Abstract
The present clinical trial investigated the impact of selected SNPs in CES1 on the metabolic activity of the enzyme. For this purpose, we used methylphenidate (MPH) as a pharmacological probe and the d-RA/d-MPH (metabolite/parent drug) ratios as a measure of enzymatic activity. This metabolic ratio (MR) was validated against the AUC ratios (AUCd -RA /AUCd -MPH ). CES1 SNPs from 120 volunteers were identified, and 12 SNPs fulfilling predefined inclusion criteria were analysed separately, comparing the effect of each genotype on the metabolic ratios. The SNP criteria were as follows: presence of Hardy-Weinberg equilibrium, a minor allele frequency ≥ 0.01 and a clearly interpretable sequencing result in at least 30% of the individuals. Each participant ingested 10 mg of racemic methylphenidate, and blood samples were drawn prior to and 3 hours after drug administration. The SNP analysis confirmed the considerable impact of rs71647871 (G143E) in exon 4 on drug metabolism. In addition, three volunteers with markedly lower median MR, indicating decreased CES1 activity, harboured the same combination of three SNPs in intron 5. The median MR for these SNPs was 8.2 for the minor allele compared to 16.4 for the major alleles (P = 0.04). Hence, one of these or the combination of these SNPs could be of clinical significance considering that the median MR of the G143E group was 5.4. The precise genetic relationship of this finding is currently unknown, as is the clinical significance.
Collapse
Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ragnar Thomsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Majbritt Busk Madsen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| |
Collapse
|
22
|
Haslund-Krog SS, Hertel S, Dalhoff K, Poulsen S, Christensen U, Wilkins D, van den Anker J, Brink Henriksen T, Holst H. Interventional cohort study of prolonged use (>72 hours) of paracetamol in neonates: protocol of the PARASHUTE study. BMJ Paediatr Open 2019; 3:e000427. [PMID: 31206077 PMCID: PMC6542439 DOI: 10.1136/bmjpo-2018-000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Anticipated or actual pain in neonates results in use of paracetamol for prolonged pain relief in many neonatal intensive care units. Clinical trials examining safety of paracetamol exposure in neonates have been of short duration (1-3 days) and hepatic biomarkers and paracetamol metabolism are rarely reported in the same studies.We aim to investigate the safety (hepatic tolerance) and effectiveness of prolonged paracetamol exposure in neonates by measuring hepatic biomarkers, plasma concentrations of paracetamol and its metabolites and pain scores. In addition, we study a possible interaction between ethanol and paracetamol. METHODS AND ANALYSIS A multicentre interventional cohort study.Neonates of any gestational age and up to 44 weeks postmenstrual age, treated with oral or intravenous paracetamol can be included.Alanine aminotransferase (ALT) and bilirubin are measured at baseline or within 24 hours after treatment initiation. P-paracetamol and metabolites are measured at steady state and every 2 days (opportunistically) together with ALT and bilirubin and lastly after discontinuation of treatment. COMFORT neo pain scores are collected longitudinally. COMFORT neo pain scores and population pharmacokinetic analysis of paracetamol samples will be analysed simultaneously using non-linear mixed effects models. One and two compartment models with first-order elimination will be tested for disposition. In addition, plasma ethanol is measured if the patient receives concomitant treatment with intravenous or oral phenobarbital containing ethanol as an excipient. ETHICS AND DISSEMINATION Inclusion of patients can be postponed 24 hours after the first paracetamol dose. This is intended to make the inclusion process less stressful for parents. This study uses standard dosing strategies. The potential risks are additional blood samples, which are collected opportunistically to reduce additional heel pricks. TRIAL REGISTRATIONNUMBER Ethics Comittee: H-17027244, EudraCT no: 2017-002724-25, BFH-2017-106, 05952.
Collapse
Affiliation(s)
| | - Steen Hertel
- Neonatal Intensive Care Unit, Rigshospitalet, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Susanne Poulsen
- Neonatal Intensive Care Unit, Rigshospitalet, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Pediatrics, Neonatal Intensive Care Unit, Aarhus Universitetshospital, Aarhus, Denmark
| | - Diana Wilkins
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA.,Division of Pediatric Pharmacology and Pharmacometrics, Universitat Basel, Basel, BS, Switzerland
| | - Tine Brink Henriksen
- Department of Pediatrics, Neonatal Intensive Care Unit, Aarhus Universitetshospital, Aarhus, Denmark
| | - Helle Holst
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
23
|
Gade C, Dalhoff K, Petersen T, Riis T, Schmeltz C, Chabanova E, Christensen HR, Mikus G, Burhenne J, Holm JC, Holst H. Obesity-induced CYP2E1 activity in children. Br J Clin Pharmacol 2018; 85:458-459. [PMID: 30537026 DOI: 10.1111/bcp.13813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Christina Gade
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Tonny Petersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Troels Riis
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Camilla Schmeltz
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark
| | - Elizaveta Chabanova
- Department of Radiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Hanne Rolighed Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Gerd Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Juergen Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Jens Christian Holm
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark.,Novo Nordisk Foundation Centre for Basic Metabolic Research, Denmark
| | - Helle Holst
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
24
|
Dalhoff K, Bøgevig S. [Not Available]. Ugeskr Laeger 2018; 180:V69662. [PMID: 29886884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
25
|
Gade C, Dalhoff K, Petersen TS, Riis T, Schmeltz C, Chabanova E, Christensen HR, Mikus G, Burhenne J, Holm JC, Holst H. Higher chlorzoxazone clearance in obese children compared with nonobese peers. Br J Clin Pharmacol 2018; 84:1738-1747. [PMID: 29618168 DOI: 10.1111/bcp.13602] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/26/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS To test the in vivo activity of Cytochrome P450 (CYP) 2E1 in obese children vs. nonobese children, aged 11-18 years. Secondly, whether the activity of CYP2E1 in these patients is associated with NALFD, diabetes or hyperlipidaemia. METHODS Seventy children were divided into groups by body mass index (BMI) standard deviation score (SDS). All children received 250 mg oral chlorzoxazone (CLZ) as probe for CYP2E1 activity. Thirteen blood samples and 20-h urine samples were collected per participant. RESULTS Obese children had an increased oral clearance and distribution of CLZ, indicating increased CYP2E1 activity, similar to obese adults. The mean AUC0-∞ value of CLZ was decreased by 46% in obese children compared to nonobese children. The F was was increased twofold in obese children compared to nonobese children, P < 0.0001. Diabetic biomarkers were significantly increased in obese children, while fasting blood glucose and Hba1c levels were nonsignificant between groups. Liver fat content was not associated with CLZ Cl. CONCLUSION Oral clearance of CLZ was increased two-fold in obese children vs. nonobese children aged 11-18 years. This indicates an increased CYP2E1 activity of clinical importance, and dose adjustment should be considered for CLZ.
Collapse
Affiliation(s)
- C Gade
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - T S Petersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - T Riis
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - C Schmeltz
- Children's Obesity Clinic, European Center of Management (EASO). Department of Pediatrics, Zealand University Hospital, Holbaek, Denmark
| | - E Chabanova
- Faculty of Health and Medical Sciences, Copenhagen University, Department of Radiology, Herlev and Gentofte Hospital, Denmark
| | - H R Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - G Mikus
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - J Burhenne
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - J C Holm
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark.,Novo Nordisk Foundation Centre for Basic Metabolic Research, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - H Holst
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| |
Collapse
|
26
|
Schmidt LE, Rasmussen DN, Petersen TS, Macias-Perez IM, Pavliv L, Kaelin B, Dart RC, Dalhoff K. Fewer adverse effects associated with a modified two-bag intravenous acetylcysteine protocol compared to traditional three-bag regimen in paracetamol overdose. Clin Toxicol (Phila) 2018; 56:1128-1134. [DOI: 10.1080/15563650.2018.1475672] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lars E. Schmidt
- Rigshospitalet and Glostrup University Hospital, Copenhagen, Denmark
| | | | - Tonny S. Petersen
- Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Leo Pavliv
- Cumberland Pharmaceuticals Inc., Nashville, Tennessee
| | - Byron Kaelin
- Cumberland Pharmaceuticals Inc., Nashville, Tennessee
| | | | - Kim Dalhoff
- Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| |
Collapse
|
27
|
Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heußel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72:15-63. [PMID: 29341032 DOI: 10.1055/s-0043-121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
Collapse
Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - M Abele-Horn
- Institut für Hygiene und Mikrobiologie der Universität Würzburg, Würzburg
| | - S Andreas
- Lungenfachklinik Immenhausen, Immenhausen
| | - M Deja
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene am Klinikum der Universität München, München
| | - C P Heußel
- Thoraxklinik Heidelberg gGmbH, Abteilung für Diagnostische und Interventionelle Radiologie
| | - G Höffken
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - M Kolditz
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - E Kramme
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - H Kühl
- St. Bernhard-Hospital Kamp-Lintfort GmbH, Klinik für Radiologie, Kamp-Lintfort
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Borstel
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Pneumologie und Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | | | - M Panning
- Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - M Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - P-M Rath
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Essen
| | - G Rohde
- Klinikum der Johann Wolfgang Goethe-Universität, Pneumologie/Allergologie, Medizinische Klinik 1, Frankfurt am Main
| | - S Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Pneumologisches Beatmungszentrum, Bad Belzig
| | - B Schaaf
- Klinikum Dortmund gGmbH, Medizinischen Klinik, Pneumologie und Infektiologie, Dortmund
| | - D Schreiter
- Helios Park-Klinikum Leipzig GmbH und Herzzentrum Leipzig GmbH, Universitätsklinik, Leipzig
| | - H Schütte
- Klinikum Ernst von Bergmann gGmbH, Klinik für Pneumologie, Potsdam
| | - H Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Köln
| | - C Spies
- Charitè, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
| | | | | | | | | | | |
Collapse
|
28
|
Jansen T, Hoegberg LCG, Eriksen T, Haarmark C, Dalhoff K, Belhage B. Advanced Electrocardiogram Analysis in the Amitriptyline-poisoned Pig Treated with Activated Charcoal Haemoperfusion. Basic Clin Pharmacol Toxicol 2017; 122:442-447. [DOI: 10.1111/bcpt.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tejs Jansen
- Department of Anaesthesiology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| | - Lotte C. G. Hoegberg
- Department of Anaesthesiology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinical Sciences; Faculty of Health and Medical Sciences; University Hospital for Companion Animals; University of Copenhagen; Copenhagen Denmark
| | - Christian Haarmark
- Department of Clinical Physiology and Nuclear Medicine; Copenhagen University Hospital Herlev and Gentofte; Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| | - Bo Belhage
- Department of Anaesthesiology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| |
Collapse
|
29
|
Stage C, Jürgens G, Guski LS, Thomsen R, Bjerre D, Ferrero-Miliani L, Lyauk YK, Rasmussen HB, Dalhoff K. The Pharmacokinetics of Enalapril in Relation to CES1
Genotype in Healthy Danish Volunteers. Basic Clin Pharmacol Toxicol 2017. [DOI: 10.1111/bcpt.12835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit; Zealand University Hospital; Roskilde Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
| | - Ragnar Thomsen
- Department of Forensic Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Yassine Kamal Lyauk
- Clinical Pharmacological Unit; Zealand University Hospital; Roskilde Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
| | | |
Collapse
|
30
|
Berendt L, Petersen LG, Bach KF, Poulsen HE, Dalhoff K. Barriers towards the publication of academic drug trials. Follow-up of trials approved by the Danish Medicines Agency. PLoS One 2017; 12:e0172581. [PMID: 28486523 PMCID: PMC5423601 DOI: 10.1371/journal.pone.0172581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 02/07/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To characterize and quantify barriers towards the publication of academic drug trials. Study design We identified academic drug trials approved during a 3-year period (2004–2007) by the Danish Medicines Agency. We conducted a survey among the trial sponsors to describe the rates of initiation, completion, and publication, and the reasons for the failure to reach each of these milestones. Information on size and methodological characteristics of the trials was extracted from the EudraCT database, a prospective register of all approved clinical drug trials submitted to European medicines agencies since 2004. Results A total of 181 academic drug trials were eligible for inclusion, 139 of which participated in our survey (response rate: 77%). Follow-up time ranged from 5.1 to 7.9 years. Most trials were randomized controlled trials (73%, 95% CI 65–81%). Initiation and completion rates were 92% (95% CI: 88–97%) and 93% (95% CI: 89–97%) respectively. The publication rate of completed trials was 73% (95% CI: 62–79%). RCTs were published faster than non-RCTs (quartile time to publication 2.9 vs. 3.1 years, p = 0.0412). Conclusions Many academic drug trials are left unpublished. Main barriers towards publication were related to the process from completion to publication. Hence, there is much to gain by facilitating the process from analysis to publication. Research institutions and funders should actively influence this process, e.g. by requiring the publication of trial results within a given time after completion.
Collapse
Affiliation(s)
- Louise Berendt
- The GCP Unit at Copenhagen University Hospital, Bispebjerg University Hospital, Copenhagen, Denmark
- Medicines Development & Clinical Trials, Danish Medicines Agency, Copenhagen, Denmark
- * E-mail:
| | - Lene Grejs Petersen
- Medicines Development & Clinical Trials, Danish Medicines Agency, Copenhagen, Denmark
| | - Karin Friis Bach
- The GCP Unit at Copenhagen University Hospital, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark
- Laboratory of Clinical Pharmacology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark
| |
Collapse
|
31
|
Jansen T, Petersen H, Malskaer CM, Gabel-Jensen C, Dalhoff K, Eriksen T, Belhage B, Hoegberg LCG. Activated Charcoal Haemoperfusion in the Treatment of Experimental Amitriptyline Poisoning in Pigs - The Effect on Amitriptyline Plasma Concentration and Haemodynamic Parameters. Basic Clin Pharmacol Toxicol 2017; 120:491-497. [PMID: 27863000 DOI: 10.1111/bcpt.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/06/2016] [Indexed: 12/15/2022]
Abstract
Coated activated charcoal haemoperfusion (CAC-HP) is a well-known treatment modality. Case reports have revealed conflicting results about the efficacy of CAC-HP in the treatment of amitriptyline (AT) poisoning, and no randomized clinical trials have been identified in the literature. This study aimed at quantifying the efficacy of modern CAC-HP as an adjunctive treatment of AT intoxication compared with standard care alone. Fourteen female Danish landrace pigs were randomized to either standard care or standard care plus 4 hr of CAC-HP. The pigs were anaesthetized, and vital parameters were continuously recorded. Amitriptyline infusion (7.5 mg/kg) was completed in 20 min. Thirty minutes after AT infusion, activated charcoal was instilled orally in both groups. In the intervention group, CAC-HP was initiated 60 min. after AT infusion. Blood and urine samples were collected as were vital parameters at specific time intervals. The protocol was approved by the Danish Experimental Animal Expectorate and complied with the NIH guide for care and use of laboratory animals. Data were managed according to the ARRIVE guidelines. No statistical significant differences between intervention and control groups were found when analysing for differences in AT levels in plasma at any time-point. Furthermore, significant differences between the control and intervention groups in regard to vital parameters could not be found either. In our animal model, the addition of CAC-HP did not improve the clearance of AT compared with standard treatment alone. We suggest that the effect of modern CAC-HP as a treatment modality in AT-poisoned human patients may be inadequate.
Collapse
Affiliation(s)
- Tejs Jansen
- Department of Anaesthesiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Petersen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie M Malskaer
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Gabel-Jensen
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinic and Animal Sciences, University Hospital for Companion Animals, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Belhage
- Department of Anaesthesiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lotte C G Hoegberg
- Department of Anaesthesiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
32
|
Schultz ANØ, Høiby N, Nielsen XC, Pressler T, Dalhoff K, Duno M, Buchard A, Johansen HK, Wang H, Dalbøge CS. Individual pharmacokinetic variation leads to underdosing of ciprofloxacin in some cystic fibrosis patients. Pediatr Pulmonol 2017; 52:319-323. [PMID: 28221736 DOI: 10.1002/ppul.23638] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/15/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022]
Abstract
Ciprofloxacin (CIP) is frequently used when treating cystic fibrose (CF) patients with intermittent Pseudomonas aeruginosa (P. aeruginosa) lung colonization. However, approximately 20% of the patients progress to chronic infection despite early intervention. The aim of this study, was to investigate the pharmacokinetics of CIP, to evaluate if CYP3A4-related metabolism is involved and to find the optimal dose needed to eradicate intermittently colonizing bacteria in the lungs of CF patients. Methods An open-label, prospective pharmacokinetic study was performed. Twenty-two adult CF-patients were each given 500 mg CIP orally. One blood sample was taken at t = 0, and the following 12 hr, nine blood samples were collected. The optimal dose and interval was then calculated by Monte Carlo simulation. CYP3A4-activity was mesured using the Erythromycin Breath Test (ERMBT). Results A 14-fold variation in AUC for the 500 mg CIP (median 473.5 µg/ml × min), and a 30-fold variation in Cmax for CIP (median 2 µg/ml) was found. For CYP3A4-activity the variation was 8-fold. No correlation was found between the CYP3A4-activity and CIP-concentrations. The probability of eradicating intermittent P. aeruginosa colonization in the lungs of CF patients was found to be 57% (3 doses/day), when 500 mg CIP was given. It was calculated to be 89% (2 doses/day) and 94% (3 doses/day), respectivly if 750 mg CIP had been given. Conclusion A large pharmacokinetic difference of CIP in CF patiens was found, not explained by CYP3A4 variation. CIP should be given at 750 mg two or three times daily to adult CF patients with intermittently colonization. Pediatr Pulmonol. 2017;52:319-323. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- A N Ø Schultz
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
| | - N Høiby
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark.,Insitute of Immunology and Microbiology, University of Copenhagen, Denmark
| | - X C Nielsen
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
| | - T Pressler
- Cystic Fibrosis Center, Rigshospitalet, University of Copenhagen, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Duno
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Denmark
| | - A Buchard
- Department of Forensic Medicine, University of Copenhagen, Denmark
| | - H K Johansen
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
| | - H Wang
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
| | - C S Dalbøge
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
| |
Collapse
|
33
|
Stage C, Jürgens G, Guski LS, Thomsen R, Bjerre D, Ferrero-Miliani L, Lyauk YK, Rasmussen HB, Dalhoff K. The impact of CES1 genotypes on the pharmacokinetics of methylphenidate in healthy Danish subjects. Br J Clin Pharmacol 2017; 83:1506-1514. [PMID: 28087982 DOI: 10.1111/bcp.13237] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 05/22/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS This study investigated the influence of CES1 variations, including the single nucleotide polymorphism (SNP) rs71647871 (G143E) and variation in copy number, on the pharmacokinetics of a single oral dose of 10 mg methylphenidate. METHODS CES1 genotype was obtained from 200 healthy Danish Caucasian volunteers. Based on the genotype, 44 (19 males and 25 females) were invited to participate in an open, prospective trial involving six predefined genotypes: three groups with two, three and four CES1 copies, respectively; a group of carriers of the CES1 143E allele; a group of individuals homozygous for CES1A1c (CES1VAR); and a group having three CES1 copies, in which the duplication, CES1A2, had increased transcriptional activity. Plasma concentrations of methylphenidate and its primary metabolites were determined at scheduled time points. RESULTS Median AUC of d-methylphenidate was significantly larger in the group carrying the 143E allele (53.3 ng ml-1 h-1 , range 38.6-93.9) than in the control group (21.4 ng ml-1 h-1 , range 15.7-34.9) (P < 0.0001). Median AUC of d-methylphenidate was significantly larger in the group with four CES1 copies (34.5 ng ml-1 h-1 , range 21.3-62.8) than in the control group (P = 0.01) and the group with three CES1 copies (23.8 ng ml-1 h-1 , range 15.3-32.0, P = 0.03). There was no difference between the groups with two and three copies of CES1. CONCLUSIONS The 143E allele resulted in an increased AUC, suggesting a significantly decreased CES1 enzyme activity. Surprisingly, this was also the case in subjects with homozygous duplication of CES1, perhaps reflecting an undiscovered mutation affecting the activity of the enzyme.
Collapse
Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ragnar Thomsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yassine Kamal Lyauk
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
34
|
Jensen L, Børsting C, Dalhoff K, Morling N. Evaluation of the iPLEX® ADME PGx Pro Panel and allele frequencies of pharmacogenetic markers in Danes. Clin Biochem 2016; 49:1299-1301. [DOI: 10.1016/j.clinbiochem.2016.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/19/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
|
35
|
Jensen LL, Rømsing J, Dalhoff K. A Danish Survey of Antihistamine Use and Poisoning Patterns. Basic Clin Pharmacol Toxicol 2016; 120:64-70. [DOI: 10.1111/bcpt.12632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/08/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Louise Line Jensen
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Janne Rømsing
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen Denmark
| |
Collapse
|
36
|
Schoenfeld N, Haas W, Richter E, Bauer T, Boes L, Castell S, Hauer B, Magdorf K, Matthiessen W, Mauch H, Reuss A, Schenkel K, Ruesch-Gerdes S, Zabel P, Dalhoff K, Schaberg T, Loddenkemper R. Recommendations of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the Diagnosis and Treatment of Non-tuberculous Mycobacterioses. Pneumologie 2016; 70:250-76. [PMID: 27064418 DOI: 10.1055/s-0041-111494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Non-tuberculous mycobacterioses comprise a group of diseases caused by mycobacteria which do not belong to the Mycobacterium (M.) tuberculosis-complex and are not ascribed to M. leprae. These mycobacteria are characterized by a broad variety as to environmental distribution and adaptation. Some of the species may cause specific diseases, especially in patients with underlying immunosuppressive diseases, chronic pulmonary diseases or genetic predisposition, respectively. Worldwide, a rising prevalence and significance of non-tuberculous mycobacterioses is recognized. The present recommendations summarise current aspects of epidemiology, pathogenesis, clinical aspects, diagnostics - especially microbiological methods including susceptibility testing -, and specific treatment for the most relevant species. Diagnosis and treatment of non-tuberculous mycobacterioses during childhood and in HIV-infected individuals are described in separate chapters.
Collapse
Affiliation(s)
- N Schoenfeld
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - W Haas
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin
| | - E Richter
- Head of TB laboratory; MVZ Labor Dr. Limbach & Kollegen GbR
| | - T Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - L Boes
- German Central Committee against Tuberculosis, Berlin
| | - S Castell
- German Central Committee against Tuberculosis, Berlin
| | - B Hauer
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin
| | - K Magdorf
- Department of Pediatrics, Subspecialty Pneumology and Immunology, Charité Universitäts-Medizin Berlin, Stiftung Oskar-Helene-Heim, Berlin
| | - W Matthiessen
- Coswig Specialist Hospital, Center for Pneumology and Thoracic Surgery
| | - H Mauch
- Department of Microbiology, Immunology and Laboratory Medicine, Helios Klinikum Emil von Behring, Berlin
| | - A Reuss
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin
| | - K Schenkel
- German Central Committee against Tuberculosis, Berlin
| | - S Ruesch-Gerdes
- Microbiologist consultant, Reinbek, member of the WHO GLI Europe
| | - P Zabel
- Research Center Borstel, Medical Clinic, Borstel
| | - K Dalhoff
- Department of Medicine III (Pulmonology), University Hospital of Schleswig-Holstein, Luebeck Campus
| | - T Schaberg
- Center for Pneumology, Agaplesion Diakonie Hospital, Rotenburg
| | | |
Collapse
|
37
|
Ewig S, Höffken G, Kern W, Rohde G, Flick H, Krause R, Ott S, Bauer T, Dalhoff K, Gatermann S, Kolditz M, Krüger S, Lorenz J, Pletz M, de Roux A, Schaaf B, Schaberg T, Schütte H, Welte T. Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016. Pneumologie 2016; 70:151-200. [DOI: 10.1055/s-0042-101873] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - G. Höffken
- Medizinische Klinik und Poliklinik 1. Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden
| | - W. Kern
- Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg
| | - G. Rohde
- Maastricht University Medical Center, Department of Respiratory Medicine, Maastricht, Niederlande
| | - H. Flick
- Klinische Abteilung für Pulmonologie, LKH-Universitätsklinikum Graz, Graz, Österreich
| | - R. Krause
- Sektion Infektiologie und Tropenmedizin, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - S. Ott
- Universitätsklinik für Pneumologie, Universitätsspital (Inselspital) und Universität Bern, Bern, Schweiz
| | - T. Bauer
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - K. Dalhoff
- Medizinische Klinik III, Pneumologie und Infektiologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - S. Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - M. Kolditz
- Medizinische Klinik und Poliklinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden
| | - S. Krüger
- Klinik für Pneumologie, Kardiologie und Internistische Intensivmedizin, Florence-Nightingale-Krankenhaus und Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum, Düsseldorf
| | - J. Lorenz
- Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Klinikum Lüdenscheid, Lüdenscheid
| | - M. Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - A. de Roux
- Lungenfachärztliche Gemeinschaftspraxis, Berlin
| | - B. Schaaf
- Medizinische Klinik, Pneumologie und Infektiologie, Klinikum Dortmund, Dortmund
| | - T. Schaberg
- Zentrum für Pneumologie, Agaplesion Diakonieklinikum Rotenburg, Rotenburg
| | - H. Schütte
- Klinik für Pneumologie, Klinikum Ernst von Bergmann; Akademisches Lehrkrankenhaus der Humboldt-Universität zu Berlin (Charité), Potsdam
| | - T. Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Hannover
| |
Collapse
|
38
|
Berendt L, Callréus T, Petersen LG, Bach KF, Poulsen HE, Dalhoff K. From protocol to published report: a study of consistency in the reporting of academic drug trials. Trials 2016; 17:100. [PMID: 26895826 PMCID: PMC4761223 DOI: 10.1186/s13063-016-1189-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 09/28/2015] [Accepted: 01/20/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unacknowledged inconsistencies in the reporting of clinical trials undermine the validity of the results of the trials. Little is known about inconsistency in the reporting of academic clinical drug trials. Therefore, we investigated the prevalence of consistency between protocols and published reports of academic clinical drug trials. METHODS A comparison was made between study protocols and their corresponding published reports. We assessed the overall consistency, which was defined as the absence of discrepancy regarding study type (categorized as either exploratory or confirmatory), primary objective, primary endpoint, and--for confirmatory trials only--hypothesis and sample size calculation. We used logistic regression, χ(2), and Fisher's exact test. RESULTS A total of 282 applications of academic clinical drug trials were submitted to the Danish Health and Medicines Authority in 1999, 2001, and 2003, 95 of which fulfilled the eligibility criteria and had at least one corresponding published report reporting data on trial subjects. Overall consistency was observed in 39% of the trials (95% CI: 29 to 49%). Randomized controlled trials (RCTs) constituted 72% (95% CI: 63 to 81%) of the sample, and 87% (95% CI: 80 to 94%) of the trials were hospital based. CONCLUSIONS Overall consistency between protocols and their corresponding published reports was low. Motivators for the inconsistencies are unknown but do not seem restricted to economic incentives.
Collapse
Affiliation(s)
- Louise Berendt
- The GCP Unit at Copenhagen University Hospital, Bispebjerg University Hospital, Copenhagen, Denmark. .,Medicines Development & Clinical Trials, Danish Health and Medicines Authority, Copenhagen, Denmark. .,Present affiliation: Novo Nordisk A/S, Copenhagen, Denmark. .,, Nybro Vænge 3, Kongens Lyngby, DK-2800, Denmark.
| | - Torbjörn Callréus
- Medicines Development & Clinical Trials, Danish Health and Medicines Authority, Copenhagen, Denmark. .,Present affiliation: Division of Pharmacovigilance and Medical Devices, Danish Health and Medicines Authority, Copenhagen, Denmark.
| | - Lene Grejs Petersen
- Medicines Development & Clinical Trials, Danish Health and Medicines Authority, Copenhagen, Denmark.
| | - Karin Friis Bach
- The GCP Unit at Copenhagen University Hospital, Bispebjerg University Hospital, Copenhagen, Denmark. .,Present affiliation: Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark. .,Laboratory of Clinical Pharmacology, Rigshospitalet, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
39
|
Dalhoff K. [Not Available]. Ugeskr Laeger 2015; 177:1144. [PMID: 26554062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
40
|
Schultz A, Høiby N, Nielsen X, Pressler T, Dalhoff K, Duno M, Buchard A, Johansen H, Dalbøge C. 116 Pharmacokinetic variability of ciprofloxacin in cystic fibrosis – is CYP3A4 involved? J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
41
|
Rasmussen HB, Bjerre D, Linnet K, Jürgens G, Dalhoff K, Stefansson H, Hankemeier T, Kaddurah-Daouk R, Taboureau O, Brunak S, Houmann T, Jeppesen P, Pagsberg AK, Plessen K, Dyrborg J, Hansen PR, Hansen PE, Hughes T, Werge T. Individualization of treatments with drugs metabolized by CES1: combining genetics and metabolomics. Pharmacogenomics 2015; 16:649-65. [PMID: 25896426 DOI: 10.2217/pgs.15.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
CES1 is involved in the hydrolysis of ester group-containing xenobiotic and endobiotic compounds including several essential and commonly used drugs. The individual variation in the efficacy and tolerability of many drugs metabolized by CES1 is considerable. Hence, there is a large interest in individualizing the treatment with these drugs. The present review addresses the issue of individualized treatment with drugs metabolized by CES1. It describes the composition of the gene encoding CES1, reports variants of this gene with focus upon those with a potential effect on drug metabolism and provides an overview of the protein structure of this enzyme bringing notice to mechanisms involved in the regulation of enzyme activity. Subsequently, the review highlights drugs metabolized by CES1 and argues that individual differences in the pharmacokinetics of these drugs play an important role in determining drug response and tolerability suggesting prospects for individualized drug therapies. Our review also discusses endogenous substrates of CES1 and assesses the potential of using metabolomic profiling of blood to identify proxies for the hepatic activity of CES1 that predict the rate of drug metabolism. Finally, the combination of genetics and metabolomics to obtain an accurate prediction of the individual response to CES1-dependent drugs is discussed.
Collapse
Affiliation(s)
- Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, 2 Boserupvej, DK-4000 Roskilde, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Nygaard B, Saedder EA, Dalhoff K, Wikkelsoe M, Jürgens G. Levothyroxine Poisoning - Symptoms and Clinical Outcome. Basic Clin Pharmacol Toxicol 2015; 117:280-5. [PMID: 25816846 DOI: 10.1111/bcpt.12401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Abstract
Levothyroxine (LT), T4, poisoning is rarely associated with a severe outcome. However, cases with significant complications have been reported. The aim of this study was to identify factors associated with symptoms of poisoning including late-onset symptoms. All enquiries to the Danish Poison Information Centre (DPIC) concerning LT poisoning between March 2007 and September 2012 were reviewed and the following parameters were recorded: age, dose, time from ingestion, multiple drug intake and symptoms. To evaluate the frequency of late-onset symptoms, a subgroup of patients without initial symptoms were contacted. A total of 181 patients were registered (112 children). Ingested LT dose ranged from 10 to 9000 mcg (median 275 mcg). A total of 29 of 181 (16%) patients were symptomatic at the time of enquiry, and there was no difference in ingested LT dose between asymptomatic and symptomatic patients, neither in children nor in adults (age 16-92 years) (p < 0.68 and p < 0.47, respectively). In total, 153 of 181 (85%) patients did not have symptoms of poisoning at the time of enquiry; however, in 9 of 21 (43%) patients, we were able to contact, late-onset symptoms existed. In none of the cases, hospital contact was needed and there were no reports of long-term sequelae. Acute LT poisoning often follows a benign course. The occurrence of symptoms appears not to be dose dependent. Late-onset symptoms seem to be common. However, all symptoms resolved spontaneously without need of medical care.
Collapse
Affiliation(s)
- Birgitte Nygaard
- Department of Clinical Pharmacology and Toxicology, Copenhagen University Hospital, Bispebjerg, Denmark.,Department of Geriatrics, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Eva A Saedder
- Department of Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology and Toxicology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Mette Wikkelsoe
- Department of Clinical Pharmacology and Toxicology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Gesche Jürgens
- Department of Clinical Pharmacology and Toxicology, Copenhagen University Hospital, Bispebjerg, Denmark.,Clinical Pharmacological Unit, Roskilde University Hospital, Roskilde, Denmark
| |
Collapse
|
43
|
Wilpsbäumer D, Rohmann K, Rupp J, Zabel P, Marwitz S, Goldmann T, Dalhoff K, Drömann D. Nontypeable Haemophilus influenzae (NTHi) reguliert die TGF-β-Signaltransduktion durch Induktion des TGF-β-Pseudorezeptors BAMBI im Lungengewebe und in respiratorischen Zellen. Pneumologie 2015. [DOI: 10.1055/s-0035-1548639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Kaufhold I, Osbahr S, Drömann D, Marwitz S, Goldmann T, Dalhoff K, Rupp J. Nontypeable Haemophilus influenzae infection differently modulates E-cadherin expression under changing environmental oxygen concentrations. Pneumologie 2015. [DOI: 10.1055/s-0035-1548640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
45
|
Rohmann K, Rupp J, Goldmann T, Dalhoff K, Droemann D. Viral-bakterielle Koinfektionen führen zu einer verstärkten Aktivierung des NLRP3-Inflammasoms in Makrophagen und Alveolarepithelzellen. Pneumologie 2015. [DOI: 10.1055/s-0035-1548633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
46
|
Gieseler M, Rohmann K, Drömann D, Dalhoff K. Infektion mit nontypeable Haemophilus influenzae (NTHi) führt in primären humanen Bronchialepithelzellen (pBEC) zur Expression von Markern und Produkten mesenchymaler Zellen. Pneumologie 2015. [DOI: 10.1055/s-0035-1544605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
47
|
Kopeleva O, Parschke P, Wallis S, Bohnet S, Drömann D, Dalhoff K. Retentionspneumonie bei Lungenkarzinom – Inzidenz und prädiktiver Wert der bronchoskopischen Infektionsdiagnostik. Pneumologie 2015. [DOI: 10.1055/s-0035-1544613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
48
|
Gregers J, Gréen H, Christensen IJ, Dalhoff K, Schroeder H, Carlsen N, Rosthoej S, Lausen B, Schmiegelow K, Peterson C. Polymorphisms in the ABCB1 gene and effect on outcome and toxicity in childhood acute lymphoblastic leukemia. Pharmacogenomics J 2015; 15:372-9. [PMID: 25582575 PMCID: PMC4762905 DOI: 10.1038/tpj.2014.81] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/12/2014] [Accepted: 11/05/2014] [Indexed: 01/16/2023]
Abstract
The membrane transporter P-glycoprotein, encoded by the ABCB1 gene, influences the pharmacokinetics of anti-cancer drugs. We hypothesized that variants of ABCB1 affect outcome and toxicity in childhood acute lymphoblastic leukemia (ALL). We studied 522 Danish children with ALL, 93% of all those eligible. Risk of relapse was increased 2.9-fold for patients with the 1199GA variant versus 1199GG (P=0.001), and reduced 61% and 40%, respectively, for patients with the 3435CT or 3435TT variants versus 3435CC (overall P=0.02). The degree of bone marrow toxicity during doxorubicin, vincristine and prednisolone induction therapy was more prominent in patients with 3435TT variant versus 3435CT/3435CC (P=0.01/P<0.0001). We observed more liver toxicity after high-dose methotrexate in patients with 3435CC variant versus 3435CT/TT (P=0.03). In conclusion, there is a statistically significant association between ABCB1 polymorphisms, efficacy and toxicity in the treatment of ALL, and ABCB1 1199G>A may be a new possible predictive marker for outcome in childhood ALL.
Collapse
Affiliation(s)
- J Gregers
- 1] Clinical Pharmacology, Faculty of Health Sciences, Division of Drug Research, Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden [2] Laboratory of Molecular Medicine, Department of Clinical Immunology 7631, Rigshospitalet, University Hospital in Copenhagen, Copenhagen, Denmark
| | - H Gréen
- 1] Clinical Pharmacology, Faculty of Health Sciences, Division of Drug Research, Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden [2] Science for Life Laboratory, Division of Gene Technology, School of Biotechnology, KTH Royal Institute of Technology, Solna, Sweden [3] Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | | | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - H Schroeder
- Department of Pediatric, University Hospital in Skejby, Aarhus, Denmark
| | - N Carlsen
- Department of Pediatric, University Hospital in Odense, Odense, Denmark
| | - S Rosthoej
- Department of Pediatric, University Hospital in Aalborg, Aalborg, Denmark
| | - B Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - K Schmiegelow
- 1] Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark [2] The Medical Faculty, Institute of Gynecology, Obstetrics and Pediatrics, University of Copenhagen, Copenhagen, Denmark
| | - C Peterson
- Clinical Pharmacology, Faculty of Health Sciences, Division of Drug Research, Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden
| |
Collapse
|
49
|
Dalbøge C, Nielsen X, Dalhoff K, Alffenaar J, Duno M, Buchard A, Uges D, Jensen A, Jürgens G, Pressler T, Johansen H, Høiby N. Pharmacokinetic variability of clarithromycin and differences in CYP3A4 activity in patients with cystic fibrosis. J Cyst Fibros 2014; 13:179-85. [DOI: 10.1016/j.jcf.2013.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/08/2013] [Accepted: 08/20/2013] [Indexed: 01/02/2023]
|
50
|
Wilpsbäumer D, Rohmann K, Rupp J, Zabel P, Marwitz S, Goldmann T, Dalhoff K, Drömann D. Induktion des TGF-ß-Pseudorezeptors BAMBI durch Nontypeable Haemophilus influenzae (NTHi) und Auswirkungen auf TGF-ß vermittelte Effekte. Pneumologie 2014. [DOI: 10.1055/s-0034-1367846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|