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Abman SH, Fox NR, Malik MI, Kelkar SS, Corman SL, Rege S, Bhaloo J, Shah R, Shei RJ, Saporito D, Shamseddine N, DeBoer E, Wan GJ. Real-world use of inhaled nitric oxide therapy in patients with COVID-19 and mild-to-moderate acute respiratory distress syndrome. Drugs Context 2022; 11:dic-2022-1-4. [PMID: 35462641 PMCID: PMC9007062 DOI: 10.7573/dic.2022-1-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Inhaled nitric oxide (iNO) has been studied in patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19 when it may be too late to impact disease course. This article aims to describe real-world iNO use and outcomes in patients with COVID-19 with mild-to-moderate ARDS in the United States. Methods This was a retrospective medical chart review study that included patients who were ≥18 years old, hospitalized for COVID-19, met the Berlin ARDS definition, received iNO for ≥24 hours continuously during hospitalization, and had a partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F ratio) of >100 to ≤300 mmHg at iNO initiation. Outcomes included oxygenation parameters, physician-rated Clinical Global Impression–Improvement (CGI-I) scale scores, and adverse events. Response to iNO was defined as >20% improvement in P/F ratio. Results Thirty-seven patients at six sites were included. A P/F ratio of ≤100 was the most common reason for exclusion (n=146; 83% of excluded patients). The mean P/F ratio (SD) increased from 136.7 (34.4) at baseline to 140.3 (53.2) at 48 hours and 151.8 (50.0) at 72 hours after iNO initiation. The response rate was 62% (n=23). During hospitalization, no patient experienced adverse events, including methemoglobinaemia, airway injury, or worsening pulmonary oedema associated with iNO. At discharge, 54.0% (n=20) of patients improved or remained stable according to the CGI-I. Conclusion In patients hospitalized with COVID-19 and mild-to-moderate ARDS, iNO was associated with improvement in the P/F ratio with no reported toxicity. This study provides additional evidence supporting a favourable benefit–risk profile for iNO in the treatment of mild-to-moderate ARDS in patients with COVID-19 infection.
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Hernández-Rivas JÁ, Arnao M, Arguiñano Pérez JM, Rubio A, García EG, de Miguel D, Cherepanov D, Romanus D, Verleger K, Johnson C, Corman SL, Grande M, Persona EP. Treatment patterns and outcomes among nontransplant newly diagnosed multiple myeloma patients in Spain. Future Oncol 2021; 17:3465-3476. [PMID: 34342494 DOI: 10.2217/fon-2021-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe treatment patterns and outcomes in nontransplant newly diagnosed multiple myeloma (NDMM) patients in Spain. Methods: This retrospective study included two cohorts of NDMM patients diagnosed between 1 January 2012 to 31 December 2013 and 1 April 2016 to 31 March 2017. Results: Among 113 patients, proteasome inhibitor (PI) + alkylator combinations (49%) and PI-based regimens without an alkylator (30%) were the most common first-line (1L) therapies. Use of PI + immunomodulatory drug-based regimens increased between the cohorts; PI-based regimens without an alkylator/immunomodulatory drug decreased. Use of 1L oral regimens was low but increased over time; use of maintenance therapy was low across both periods. Median 1L duration of treatment was 6.9 months. Conclusion: Short 1L duration of treatment and low use of 1L oral regimens and maintenance therapy highlight unmet needs in NDMM.
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Affiliation(s)
| | - Mario Arnao
- Department of Hematology, Hospital La Fe, Valencia 46026, Spain
| | | | - Araceli Rubio
- Department of Hematology, Hospital Miguel Servet, Zaragoza, 50009, Spain
| | | | - Dunia de Miguel
- Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | | | - Dorothy Romanus
- Takeda Pharmaceutical Company Limited, Cambridge, MA 02139, USA
| | | | | | | | - Marta Grande
- Takeda Farmaceutica España, Madrid 28046, Spain.,Universidad de Alcalá, Alcalá de Henares, Madrid 28801, Spain
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Yuen MF, Liu SH, Seto WK, Mak LY, Corman SL, Hsu DC, Lee MYK, Khan TK, Puenpatom A. Cost-Utility of All-Oral Direct-Acting Antiviral Regimens for the Treatment of Genotype 1 Chronic Hepatitis C Virus-Infected Patients in Hong Kong. Dig Dis Sci 2021; 66:1315-1326. [PMID: 32385703 PMCID: PMC7990846 DOI: 10.1007/s10620-020-06281-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are entering the hepatitis C virus (HCV) treatment landscape in Hong Kong, prompting the need for cost-effectiveness evaluations of these interventions to enable optimal use of healthcare resources. AIMS This study aimed to compare the cost-effectiveness of DAAs to standard-of-care pegylated interferon plus ribavirin (RBV) in treatment-naïve patients without significant liver fibrosis and to compare different DAAs in patients who are treatment-experienced and/or have advanced liver disease. METHODS A Markov model was constructed to evaluate cost-effectiveness over a lifetime time horizon from the payer perspective. The target population was treatment-naïve and treatment-experienced HCV genotype 1 patients, stratified by degree of liver fibrosis. The model consists of 16 health states encompassing METAVIR fibrosis score (F0-F4), treatment success or failure, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related death. The proportions of patients achieving sustained virologic response were obtained from clinical trials. Other inputs were obtained from published and local data. The primary outcome was incremental cost-utility ratio for each DAA versus pegylated interferon + ribavirin and among different DAAs. RESULTS In treatment-naïve F0-2 HCV patients, all DAAs were cost-effective in genotype 1a and daclatasvir + asunaprevir, elbasvir/grazoprevir, ledipasvir/sofosbuvir, and glecaprevir/pibrentasvir were cost-effective compared to pegylated interferon + ribavirin in genotype 1b. In genotypes 1a and 1b, treatment-experienced patients, and F3-4 patients, elbasvir/grazoprevir was the least costly DAA and economically dominant over most other DAAs. CONCLUSIONS DAAs can be a cost-effective option for the treatment of genotype 1 HCV patients in Hong Kong, and elbasvir/grazoprevir is cost-effective.
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Affiliation(s)
- Man-Fung Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
- State Key Laboratory of Liver Disease, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sze-Hang Liu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai-Kay Seto
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
- State Key Laboratory of Liver Disease, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Lung-Yi Mak
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Shelby L Corman
- Pharmerit International, 4350 East-West Highway Suite 1100, Bethesda, MD, 20814, USA.
| | - Danny C Hsu
- Merck Sharp & Dohme (Asia) Ltd., Hong Kong, Hong Kong
| | - Mary Y K Lee
- Merck Sharp & Dohme (Asia) Ltd., Hong Kong, Hong Kong
| | - Tsz K Khan
- Merck Sharp & Dohme (Asia) Ltd., Hong Kong, Hong Kong
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Shah R, Nwankwo C, Kwon Y, Corman SL. Economic and Humanistic Burden of Cervical Cancer in the United States: Results from a Nationally Representative Survey. J Womens Health (Larchmt) 2020; 29:799-805. [PMID: 31967943 PMCID: PMC7307680 DOI: 10.1089/jwh.2019.7858] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To measure the economic and humanistic burden of cervical cancer in the United States. Materials and Methods: This was a retrospective analysis of Medical Expenditure Panel Survey data (2006–2015). Cervical cancer cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code “180” or clinical classification software code “26”. The control group included women without any cancer diagnosis. Study outcomes included health care resource use (institutional inpatient and outpatient, emergency room, and physician office visits), costs, limitations in activities of daily living, and quality of life (general health status, 12-Item Short Form Health Survey [SF-12] physical and mental component summary [MCS], EuroQol-5D and Short-Form Six-Dimension health utility, and Patient Health Questionnaire-2 depression severity). Generalized linear models, controlling for sociodemographic and clinical covariates, were conducted to compare outcomes between cases and controls. Results: The analytic cohort included 275,246 cervical cancer cases and 146,061,609 noncancer controls. Cases were significantly older (mean age [years]: 42.03 vs. 36.98) and had a higher Charlson comorbidity burden (mean score: 1.06 vs. 0.46) versus controls. Multivariate analyses suggested that compared to controls, cancer cases had significantly higher costs: institutional outpatient ($1,610 vs. $502), physician visit ($2,422 vs. $1,321), and total health care ($10,031 vs. $4,913). Cases were 1.99 (odds ratio [OR]: 1.991; 95% confidence interval [CI]: 1.23–3.22) and 2.56 (OR: 2.562; 95% CI: 1.78–3.68) times as likely to report activity limitations and poor general health versus controls. Cervical cancer patients had significantly lower SF-12 physical and MCS score, health utility, and higher depression severity. Conclusions: Cervical cancer is associated with significant economic burden, activity limitations, and quality of life impairment among ambulatory women in the United States.
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Patel AM, Corman SL, Chaplin S, Raimundo K, Sidonio RF. Economic impact model of delayed inhibitor development in patients with hemophilia a receiving emicizumab for the prevention of bleeding events. J Med Econ 2019; 22:1328-1337. [PMID: 31530050 DOI: 10.1080/13696998.2019.1669614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 01/22/2023]
Abstract
Aims: Cumulative exogenous factor VIII (FVIII) exposure is an important predictor of developing neutralizing antibodies (inhibitors) to FVIII in patients with persons with hemophilia A (PwHA). The aim of this study was to model the costs of emicizumab versus FVIII prophylaxis and total treatment costs for patients with severe HA.Materials and Methods: An Excel-based decision model was developed to calculate cumulative costs in PwHA over a 20-year time horizon from the US payer perspective. The model considered persons with severe HA beginning at age 12 months with no prior FVIII exposure and initiating prophylaxis with emicizumab or FVIII. PwHA could develop inhibitors on accumulation of 20 FVIII exposure days. PwHA with inhibitors replaced FVIII with bypassing agents until inhibitors resolved spontaneously, following immune tolerance induction (ITI), or at the end of the time horizon. The primary model outcome was the difference in emicizumab versus FVIII treatment costs in 2019 USD. Sensitivity analyses were performed to test the robustness of results.Results: Total incremental cost over 20 years was -$1,945,480 (emicizumab arm, $4,919,058; FVIII arm, $6,864,538). Prophylaxis costs (emicizumab arm, $4,096,105; FVIII arm, $6,290,919) comprised the majority of costs in both groups, followed by breakthrough bleed treatment for the FVIII arm ($342,652) and ITI costs for the emicizumab arm ($733,671). Higher costs in the FVIII group reflected earlier inhibitor development (FVIII, 4 months; emicizumab, 162 months) and switch to bypassing agents.Limitations: The model design reflects a simplified treatment pathway for patients with severe HA who initiate FVIII or emicizumab prophylaxis. In the absence of clinical data, a key conservative assumption of the model is that patients receiving emicizumab and FVIII prophylaxis have the same risk of developing inhibitors.Conclusions: This study suggests that prophylaxis with emicizumab results in cost savings compared to FVIII prophylaxis in HA.
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MESH Headings
- Antibodies, Bispecific/economics
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/therapeutic use
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/immunology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Coagulants/administration & dosage
- Coagulants/immunology
- Coagulants/therapeutic use
- Factor VIII/administration & dosage
- Factor VIII/immunology
- Factor VIII/therapeutic use
- Hemophilia A/drug therapy
- Hemorrhage/prevention & control
- Humans
- Models, Economic
- Severity of Illness Index
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Affiliation(s)
| | | | | | | | - Robert F Sidonio
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
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Nwankwo C, Corman SL, Shah R, Kwon Y. HSR19-102: Direct and Indirect Economic Burden of Cervical Cancer (CxCa) in the United States in 2015: A Mixed-Methods Analysis. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: An estimated 12,820 women in the United States will be diagnosed with CxCa in 2018, with 4,210 deaths from the disease. The economic burden of CxCa, both in terms of healthcare costs and lost productivity, has not been adequately studied. Methods: This was a mixed-methods study that evaluated the direct and indirect costs of CxCa using data from the Medical Expenditure Panel Survey (MEPS) for prevalent CxCa cases and the National Center for Health Statistics (NCHS) for deaths due to CxCa. Total healthcare costs and number of work days missed were compared between CxCa cases and controls in MEPS, using propensity scores calculated from baseline demographics and comorbidities. Missed work was converted to costs using the average hourly wage for women in 2015. Per-patient incremental healthcare and lost work productivity costs were then multiplied by the number of prevalent cases of CxCa in 2015 obtained from the Surveillance, Epidemiology, and End Results Program (SEER). NCHS data on the age-stratified number of CxCa deaths per year (1935–2015) and life expectancy data from the Social Security Administration were then used to calcluate the number of women who would be alive in 2015 if they had not died from CxCa and the lost earnings resulting from early mortality. The primary study outcome was the total direct and indirect cost of CxCa in 2015, calculated as the sum of the incremental direct healthcare costs, incremental lost productivity costs due to missed work, and lost productivity costs resulting from early death due to CxCa. Results: An estimated 257,524 women were alive with CxCa in 2015. Total healthcare costs were $4,221 higher, and an additional 0.37 work days were missed in women with CxCa compared to propensity-matched controls. Of the 488,475 women who died of CxCa prior to 2015, 108,832 would be alive in 2015 and 38,540 would be part of the workforce. Lost earnings in 2015 attributable to these deaths totaled $2.19 billion. The total economic burden of CxCa in the United States in 2015 was thus estimated at $3.3 billion (Table 1). Conclusions: CxCa was responsible for nearly $3.3 billion in direct and indirect costs in 2015. Early death among women with CxCa was the biggest driver of total economic burden.
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Nwankwo C, Corman SL, Elbasha EH. Projected impact of elbasvir/grazoprevir in patients with hepatitis C virus genotype 1 and chronic kidney disease in Vietnam. J Infect Public Health 2019; 12:502-508. [PMID: 30711348 DOI: 10.1016/j.jiph.2019.01.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/24/2018] [Revised: 12/06/2018] [Accepted: 01/13/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD). The objective of this study was to predict the impact of EBR/GZR on the incidence of liver and kidney related complications compared with no treatment (NoTx) and pegylated interferon plus ribavirin (pegIFN/RBV) in patients with CKD stage 4/5 in Vietnam. METHODS We developed a mathematical model of the natural history of chronic HCV, CKD, and liver disease. Efficacy of EBR/GZR and pegIFN/RBV were derived from the C-SURFER trial and a meta-analysis, respectively. We calculated lifetime cumulative morbidity and mortality rates, including incidence of decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and life expectancy. RESULTS Estimated lifetime incidence of DC was significantly reduced in patients receiving EBR/GZR (3.47%) compared to NoTx (18.14%) and pegIFN/RBV (9.01%). Estimated incidence of HCC was 1.02%, 21.64%, and 8.90%, and 1.02% in patients receiving EBR/GZR, NoTx, and pegIFN/RBV. EBR/GZR was estimated to extend life expectancy by 4.2 and 2.0 years compared with NoTx and pegIFN/RBV. CONCLUSIONS Our model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV GT1 infection and CKD compared with NoTx or pegIFN/RBV.
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Affiliation(s)
- Chizoba Nwankwo
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Shelby L Corman
- Health Economics and Outcomes Research, Pharmerit International, Bethesda, MD, USA.
| | - Elamin H Elbasha
- Predictive and Economic Modeling, Merck & Co., Inc., North Wales, PA, USA
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Bröckelmann PJ, Zagadailov EA, Corman SL, Chirikov V, Johnson C, Macahilig C, Seal B, Dalal MR, Illidge T. Brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma who are Ineligible for autologous stem cell transplant: A Germany and United Kingdom retrospective study. Eur J Haematol 2017; 99:553-558. [PMID: 28949403 DOI: 10.1111/ejh.12973] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate licensed for the treatment of relapsed/refractory Hodgkin lymphoma (rrHL) following autologous stem cell transplant (ASCT) or at least two prior therapies when ASCT or multiagent chemotherapy is not an option. The objective of this study was to describe real-world outcomes with BV in patients with rrHL considered ASCT ineligible or who refuse ASCT. METHODS This was a retrospective medical chart review study that enrolled patients ≥18 years old who were initially diagnosed with HL between January 1, 2008 and June 30, 2014, considered ASCT ineligible, and treated in routine care with BV for progressive disease after multidrug chemotherapy regimens. Clinical outcomes included best response to treatment, progression-free survival (PFS), overall survival (OS), and adverse events. RESULTS A total of 136 patients were included, with a median age of 70 years at initial HL diagnosis. The most common reasons for ASCT ineligibility were comorbidities (74%) and age (57%). Overall response rate was 74%, and PFS and OS were 15.1 and 17.8 months, respectively. Peripheral neuropathy was observed in 9.6% of patients. CONCLUSION The results of this study provide real-world evidence on the feasibility and effectiveness of BV in elderly or frail ASCT-ineligible patients with rrHL in a real-world setting.
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Affiliation(s)
- Paul J Bröckelmann
- Department I of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital of Cologne, Cologne, Germany
| | - Erin A Zagadailov
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | | | | | | | - Mehul R Dalal
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Tim Illidge
- Institute of Cancer Sciences, Christie Hospital, University of Manchester, Manchester, UK
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Moghnieh R, Alothman AF, Althaqafi AO, Matar MJ, Alenazi TH, Farahat F, Corman SL, Solem CT, Raghubir N, Macahilig C, Stephens JM. Epidemiology and outcome of invasive fungal infections and methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and complicated skin and soft tissue infections (cSSTI) in Lebanon and Saudi Arabia. J Infect Public Health 2017; 10:849-854. [PMID: 28487208 DOI: 10.1016/j.jiph.2017.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/28/2016] [Accepted: 01/28/2017] [Indexed: 10/19/2022] Open
Abstract
The objectives of this retrospective medical chart review study were to document the inpatient incidence, treatment, and clinical outcomes associated with invasive fungal infections (IFI) due to Candida and Aspergillus species, Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and MRSA complicated skin and soft tissue infections (cSSTI) in the Middle East. This study evaluated 2011-2012 data from 5 hospitals in Saudi Arabia and Lebanon with a combined total of 207,498 discharges. Hospital medical chart data were abstracted for a random sample of patients with each infection type (102 patients - IFI, 93 patients - MRSA pneumonia, and 87 patients-MRSA cSSTI). Descriptive analysis found that incidence of IFI (per 1000 hospital discharges) was higher than MRSA cSSTI and MRSA pneumonia (IFI: 1.95 and 2.57; MRSA cSSTI: 2.01 and 0.48; and MRSA pneumonia 0.59 and 0.55 for Saudi Arabia and Lebanon, respectively). Median time from hospital admission to diagnosis and from admission to initiation of active therapy were 6 and 7 days, respectively, in IFI patients; median time from admission to diagnosis was 2days for both MRSA pneumonia and cSSTI, with a median of 4 and 2days from admission to MRSA-active antibiotic start, respectively. The mean hospital LOS was 32.4days for IFI, 32.4days for MRSA pneumonia and 26.3days for MRSA cSSTI. Inpatient mortality was higher for IFI (42%) and MRSA pneumonia (30%) than for MRSA cSSTI (8%). At discharge, 33% of patients with IFI and 27% and 9% of patients with MRSA pneumonia and cSSTI, respectively, were considered to have failed therapy. In conclusion, there is a significant burden of these serious infections in the Middle East, as well as opportunity for hospitals to improve the delivery of patient care for difficult-to-treat infections by promoting expedited diagnosis and initiation of appropriate antimicrobial therapy.
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Affiliation(s)
- Rima Moghnieh
- Makassed General Hospital, Department of Internal Medicine, Beirut, Lebanon
| | - Adel F Alothman
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Department of Medicine, King Abdulaziz Medical City, Riyadh-NGHA, Saudi Arabia
| | - Abdulhakeem O Althaqafi
- King Saud bin AbdulAziz University for Health Sciences, King Abdullah Medical Research Center, Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Madonna J Matar
- Centre Hospitalier Universitaire -Notre Dame de Secours Hospital, Department of Infectious Diseases, Jbeil, Lebanon
| | - Thamer H Alenazi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Department of Medicine, King Abdulaziz Medical City, Riyadh-NGHA, Saudi Arabia
| | - Fayassal Farahat
- King Saud bin AbdulAziz University for Health Sciences, King Abdullah Medical Research Center, Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Abstract
OBJECTIVE: To examine the evidence of a pharmacodynamic interaction between aspirin and nonsteroidal antiinflammatory drugs (NSAIDs); specifically, to determine whether a deleterious relationship exists with respect to the cardioprotective effects of aspirin. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966—May 2004). Search terms included aspirin, nonsteroidal antiinflammatory drug, drug interaction, mortality, myocardial infarction, and stroke. STUDY SELECTION AND DATA EXTRACTION: All prospective and retrospective studies conducted in human subjects and investigating the potential interaction between aspirin and NSAIDs were included. DATA SYNTHESIS: Several controlled pharmacodynamic studies indicate that the sustained inhibition of cyclooxygenase activity by aspirin is blunted in the presence of some NSAIDs. While these data are fairly consistent, they are limited in that they rely on surrogate markers and not clinical outcomes. Observational studies have shown conflicting results regarding the effect of combination NSAID and aspirin therapy on mortality risk and incidence of myocardial infarction. CONCLUSIONS: Pharmacodynamic data indicating an interaction between aspirin and NSAIDs have not translated to a consistent clinical effect in observational studies. In the absence of a randomized, controlled, clinical outcomes study, there is insufficient evidence to dictate a change in therapy.
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Affiliation(s)
- Shelby L Corman
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213-2500, USA.
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Skledar SJ, Corman SL, Smitherman T. Addressing innovative off-label medication use at an academic medical center. Am J Health Syst Pharm 2015; 72:469-77. [DOI: 10.2146/ajhp140306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Susan J. Skledar
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, and Clinical Pharmacy Specialist, Health System Formulary Management and Drug Use Policy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA; at the time of the project described herein, she was Director, Drug Use and Disease State Management Program, UPMC–Presbyterian, Pittsburgh
| | - Shelby L. Corman
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, and Clinical Pharmacy Specialist, Health System Formulary Management and Drug Use Policy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA; at the time of the project described herein, she was Director, Drug Use and Disease State Management Program, UPMC–Presbyterian, Pittsburgh
| | - Thomas Smitherman
- Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, and Clinical Pharmacy Specialist, Health System Formulary Management and Drug Use Policy, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA; at the time of the project described herein, she was Director, Drug Use and Disease State Management Program, UPMC–Presbyterian, Pittsburgh
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Tarhini A, Corman SL, Rao S, Margolin K, Ji X, Mehta S, Botteman MF. Healthcare Resource Utilization and Associated Costs in Patients with Advanced Melanoma Receiving First-Line Ipilimumab. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jct.2015.610091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Melatonin is an endogenous indolamine produced by the pineal gland which may have a role in the biological regulation of circadian rhythms, sleep, and mood. Melatonin receptor activation in the hypothalamus likely regulates circadian rhythms. In the United States, melatonin is marketed as a dietary supplement. Clinical trials in children and adults have shown modest clinical benefit in the treatment of insomnia. Adverse events reported in patients receiving melatonin were not significantly different in type or occurrence from those reported in patients receiving placebo. Considering the potential for benefit, lack of significant adverse events, and lack of abuse potential, melatonin may be considered a valid therapeutic option for improving outcomes in certain pediatric and adult patients with insomnia.
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Abstract
STUDY OBJECTIVE To identify predictors of persistent posttransplant anemia that appear within the first week after kidney transplantation in order to determine the high-risk patients who might receive the most benefit from erythropoiesis-stimulating agents. STUDY DESIGN Retrospective cohort study. SETTING University-affiliated hospital and outpatient clinic. PATIENTS One hundred sixty-four adult kidney transplant recipients (January 1, 2002-June 30, 2007) with anemia on posttransplant day 7 who were followed at the clinic for at least 2 months after transplantation. MEASUREMENTS AND MAIN RESULTS Data from deidentified electronic medical records of the kidney transplant recipients were collected and included demographic characteristics, primary cause of renal failure, pertinent laboratory data, and donor information. To detect early predictors of persistent anemia, patients with persistent posttransplant anemia, defined as a hemoglobin level below 11 g/dl for 2 months (day 60) after transplantation, were compared with those who had nonpersistent posttransplant anemia, defined as a hemoglobin level below 11 g/dl on day 7 but 11 g/dl or greater on day 60. Of the 164 patients classified as having anemia on posttransplant day 7, 39 (23.8%) had persistent posttransplant anemia on day 60. In univariate analyses, hemoglobin level of 9 g/dl or below on day 7, donor age younger than 10 years, and female sex were variables associated with increased risk of persistent posttransplant anemia. In a multivariate analysis, donor age younger than 10 years was the most significant predictor of persistent posttransplant anemia, followed by hemoglobin level of 9 g/dl or below. CONCLUSION Patients receiving transplants from donors younger than 10 years and those with hemoglobin levels of 9 g/dl or below on postoperative day 7 were found to be at highest risk for persistent posttransplant anemia and may receive the most benefit from early initiation of erythropoiesis-stimulating agent therapy. In most of the kidney transplant recipients, posttransplant anemia resolved without the use of these agents.
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Affiliation(s)
- Kristine S Schonder
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.
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15
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Lavsa SM, Fabian TJ, Saul MI, Corman SL, Coley KC. Influence of medications and diagnoses on fall risk in psychiatric inpatients. Am J Health Syst Pharm 2010; 67:1274-80. [DOI: 10.2146/ajhp090611] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Stacey M. Lavsa
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - Tanya J. Fabian
- Schools of Pharmacy and Medicine, University of Pittsburgh (UP), Pittsburgh, and Director of Pharmacy Research and Pharmacy Services, Western Psychiatric Institute and Clinic, UPMC
| | | | - Shelby L. Corman
- School of Pharmacy, UP, and Clinical Specialist, Drug Information, UPMC
| | - Kim C. Coley
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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16
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Abstract
OBJECTIVE To review the pharmacology and pharmacokinetics and evaluate the safety and efficacy of eltrombopag for the treatment of chronic immune (idiopathic) thrombocytopenic purpura (ITP) and thrombocytopenia associated with hepatitis C virus (HCV) cirrhosis. DATA SOURCES A Cochrane Controlled Trial Register, clinicaltrials.gov, EMBASE, and MEDLINE search was performed (January 1966-March 2010) using the key terms eltrombopag and SB-497115-GR. Searches were limited to published English-language studies in humans and a reference review of the pertinent literature was conducted. STUDY SELECTION AND DATA EXTRACTION Published pharmacokinetic data and safety and efficacy trials, case reports, and case series on the use of eltrombopag were selected for inclusion. DATA SYNTHESIS Eltrombopag is a novel second-generation thrombopoietin receptor agonist that was approved by the Food and Drug Administration for the treatment of chronic ITP in patients who had an insufficient response to corticosteroids, intravenous immune globulin, or splenectomy. Eltrombopag has been shown to be superior to placebo in increasing platelet counts, with more patients achieving counts >50 x 10(3)/microL. One study has also shown eltrombopag to be effective in the treatment of thrombocytopenia associated with HCV cirrhosis. Eltrombopag has a boxed warning related to risk of hepatotoxicity, with criteria for discontinuation in patients with elevated liver enzyme levels or clinical signs of liver damage. As such, close monitoring of laboratory parameters is required, and patients must be registered with the PROMACTA CARES program. CONCLUSIONS Eltrombopag is effective in increasing platelet counts in patients with chronic ITP and in patients with HCV cirrhosis. In the treatment of ITP, eltrombopag has been studied only for short durations and is more expensive than first-line oral corticosteroids; therefore, it should be considered a second-line agent. More studies are needed to identify a place in therapy for eltrombopag in the treatment of thrombocytopenia associated with HCV cirrhosis.
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Affiliation(s)
- Shelby L Corman
- School of Pharmacy, University of Pittsburgh, Drug Information, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Lavsa SM, Corman SL, Verrico MM, Pummer TL. Effect of Drug Information Request Templates on Pharmacy Student Compliance with the Modified Systematic Approach to Answering Drug Information Questions. Ann Pharmacother 2009; 43:1795-801. [DOI: 10.1345/aph.1m293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The modified systematic approach to answering drug information questions is a technique used in drug information practice and in teaching pharmacy students to effectively provide drug information. Drug information request templates were developed to prompt students and other trainees to ask appropriate background questions and perform an effective search. Objective: An evaluation was conducted to determine whether use of drug information templates by fourth-year pharmacy students during their drug information experiential rotation improved compliance with the modified systematic approach. Methods: Fifty documented drug information requests, including 25 prior to template implementation (August 2005–August 2006) and 25 after template implementation (August 2007–August 2008), were randomly selected for evaluation. Each question was evaluated for completeness of background information obtained, categorization and identification of the ultimate question, completeness of references searched, and formulation of a concise response and an evidence-based recommendation. Results: Background information was complete in 16% of pre-template questions and 92% of post-template questions (p < 0.001). Eighty-four percent of pre-template questions and 96% of post-template questions were appropriately categorized (p = 0.349). The requestor's ultimate question was clearly identified in 68% of pre-template questions and 92% of post-template questions (p = 0.074). All necessary references were searched in 36% of pre-template questions and 88% of post-template questions (p < 0.001). A concise response was documented in 80% of pre-template questions and 92% of post-template questions (p = 0.417). In questions determined to require a specific recommendation among the pre-template (n = 20) and post-template groups (n = 14), a clear and evidence-based recommendation was described in 40% (p = 0.038) and 79% (p = 0.038), respectively. Conclusions: Use of drug information request templates improves students' compliance with the modified systematic approach, most notably in obtaining background information and searching necessary references including primary literature.
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Affiliation(s)
| | - Shelby L Corman
- School of Pharmacy, University of Pittsburgh; Clinical Specialist, Drug Information, University of Pittsburgh Medical Center
| | - Margaret M Verrico
- School of Pharmacy, University of Pittsburgh; Clinical Specialist, Drug Information, University of Pittsburgh Medical Center
| | - Tara L Pummer
- School of Pharmacy, University of Pittsburgh; Clinical Specialist, Drug Information, University of Pittsburgh Medical Center
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Kelley LR, Corman SL, Weber RJ. A Pharmacy Director's Primer on the American Recovery and Reinvestment Act of 2009. Hosp Pharm 2009. [DOI: 10.1310/hpj4409-813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face, while also providing information that will foster growth in pharmacy leadership and patient safety. Previous articles in this series have discussed the many different aspects of pharmacy management and leadership challenges. This feature addresses the impact of the American Recovery and Reinvestment Act (the Stimulus Program) on hospital pharmacy practices.
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Affiliation(s)
| | - Shelby L. Corman
- University of Pittsburgh School of Pharmacy; Clinical Specialist, Drug Information, University of Pittsburgh Medical Center
| | - Robert J. Weber
- University of Pittsburgh Medical Center, Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Hall DL, Corman SL, Drab SR, Meyer SM, Smith RB. Instructor satisfaction with a technology-based resource for diabetes education. Am J Pharm Educ 2009; 73:45. [PMID: 19564988 PMCID: PMC2703282 DOI: 10.5688/aj730345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/08/2008] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate instructor use patterns and satisfaction with DM Educate, a comprehensive, Web-based diabetes course. METHODS Instructors completed a post-course survey instrument to assess their use of course materials and components, as well as satisfaction with the course content, design, and technology utilized, and to solicit their suggestions for additional content areas. RESULTS Thirty-eight percent of respondents utilized DM Educate as a standalone elective and 62% had integrated materials into existing courses. The pharmacotherapy module was the most utilized at 91% and slide sets were the most utilized course components at 63%. All instructors stated that they would use the course again the following year. Suggestions for improvement included incorporation of more active-learning activities and patient cases. CONCLUSION Instructors' were highly satisfied with the course materials and technology used by DM Educate, a Web-based diabetes education course, and indicated they were able to customize the course materials both to establish new courses and supplement existing courses. All instructors planned to use the course again.
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Affiliation(s)
- Deanne L Hall
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15261, USA.
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Abstract
OBJECTIVE To evaluate the use of lipid emulsion for reversal of local anesthetic-induced toxicity. DATA SOURCES Literature was accessed through PubMed and OVID (1966-May 2007) using the search terms lipid emulsion and local anesthetic. Reference lists were consulted to identify additional publications. STUDY SELECTION AND DATA EXTRACTION All articles published in English were evaluated for inclusion. Publications describing the use of lipid emulsion for reversal of local anesthetic in either humans or animals were included. DATA SYNTHESIS It has been suggested that lipid emulsion (Intralipid) may reverse local anesthetic toxicity by extracting lipophilic local anesthetics from aqueous plasma or tissues or by counteracting local anesthetic inhibition of myocardial fatty acid oxygenation. Studies in rats and dogs have shown that lipid emulsion is effective in resuscitating animals who are asystolic after the administration of intravenous bupivacaine. Three case reports support the use of lipid emulsion to reverse systemic toxicity, including seizures, electrocardiogram abnormalities, and cardiac arrest, resulting from the administration of levobupivacaine, ropivacaine, bupivacaine, or mepivacaine. The regimens used in these cases consisted of bolus doses of 1.2-2 mL/kg followed by continuous infusions of 0.25-0.5 mL/kg/min. All of the patients recovered fully with no neurologic sequelae. CONCLUSIONS Literature describing animal studies and human case reports suggests that lipid emulsion is effective in the reversal of local anesthetic toxicity. The potential risks of administering the relatively high doses of this agent are uncertain, and the optimal dose has not been established. In light of these uncertainties, it is appropriate to administer lipid emulsion only after advanced cardiac life support has failed and prior to cardiopulmonary bypass.
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Affiliation(s)
- Shelby L Corman
- Drug Information Center, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Abstract
PURPOSE Guidelines were developed for grading the quality, quantity, and consistency of drug literature in support of formulary recommendations. METHODS Four developmental steps were taken to create a comprehensive literature evaluation system. The first step identified the attributes of a body of literature that were most reflective of its applicability to patient care. The next step defined each domain (quality, quantity, consistency), as determined by the Agency of Healthcare Research and Quality (AHRQ), in terms of the specific qualities to be assessed; a value was assigned to those qualities. Also, a literature search was conducted to identify strategies for evaluating bodies of literature employed in published assessment tools. Following the analysis of previously published systems, which were evaluated with respect to their inclusion of the AHRQ-identified domains, the next step was the development of specific domains and definitions to get a composite grade (with "better" evidence earning more points) for formulary recommendations. The final step was the creation of a system that aggregated the final score for the recommendation. The recommendation was categorized according to quality, quantity, and consistency of supporting evidence, and the total number of points was calculated and the recommendation given letter and numerical grades. RESULTS The guidelines that were developed allow the user to accurately, consistently, and easily determine the strength of recommendations for a body of literature that may be conflicting. The addition of criteria for quantity and consistency to previously-published grading systems has made the guidelines more objective. CONCLUSION A system that accounts for the quality, quantity, and consistency of drug literature was developed to assist in making formulary decisions.
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Affiliation(s)
- Shelby L Corman
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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22
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Abstract
STUDY OBJECTIVES To describe changes in renal function occurring after long-term treatment with tacrolimus in clinically stable liver transplant recipients, and to identify risk factors for a clinically significant decline in renal function in these patients. DESIGN Retrospective cohort study. Setting. University medical center. Patients. Four hundred thirty-two patients aged 18 years or older who underwent liver transplantation between January 1, 1996, and December 31, 2000, and received tacrolimus as part of their immunosuppressive treatment regimen. MEASUREMENTS AND MAIN RESULTS Six hundred patients were identified from an electronic records review. Those who received multiorgan transplants, were not receiving their first liver transplant, or died during the hospitalization were excluded from the study. Outcomes measured were change in mean glomerular filtration rate (GFR) up to 5 years after transplantation, and proportion of patients with a decline in GFR of 30% or greater from baseline to the last recorded serum creatinine level. Covariates that affected this decline were identified using a logistic regression model. Patients were followed for a mean +/- SD of 3.7 +/- 2.0 years. Mean GFR showed a statistically significant decline from baseline to end of follow-up (67.7 +/- 25.6 vs 58.4 +/- 26.5 ml/min/1.73 m(2), p<0.001). The GFR declined by 30% or more in 154 (35.6%) patients. Increasing age (odds ratio [OR] = 1.03, p=0.020), female sex (OR = 1.92, p=0.006), higher baseline GFR (OR = 1.03, p<0.001), and diagnosis of diabetes mellitus (OR = 1.74, p=0.059) were identified as predictors of this outcome. CONCLUSION After the acute posttransplantation period, liver transplant recipients given long-term treatment with tacrolimus experienced only small changes in GFR over time. Patients with diabetes and women had the highest risk of experiencing a clinically significant decline in renal function.
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Affiliation(s)
- Shelby L Corman
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Corman SL, Fedutes BA, Culley CM. Atomoxetine: The First Nonstimulant for The Management of Attention-Deficit/Hyperactivity Disorder. Am J Health Syst Pharm 2004; 61:2391-9. [PMID: 15581262 DOI: 10.1093/ajhp/61.22.2391] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [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: 11/14/2022] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, clinical efficacy, safety, drug interactions, dosage and administration, and place in therapy of atomoxetine in the treatment of attention-deficit/hyperactivity disorder (ADHD) are reviewed. SUMMARY Atomoxetine is a methylphenoxy-benzenepropanamine derivative with antidepressant activity and is thought to enhance noradrenergic function via selective inhibition of the presynaptic norepinephrine transporter. Atomoxetine is rapidly absorbed from the gastrointestinal tract, reaching peak levels in 1.83 hours in pediatric patients and 1-1.5 hours in adults. The clinical efficacy of atomoxetine in the treatment of ADHD has been evaluated in six published clinical trials of children and adolescents and two studies enrolling only adults. Clinical trial data indicate that atomoxetine is safe and well tolerated for the treatment of ADHD; however, safety data about long-term use (greater than one year) are unavailable. Adverse events reported in clinical trials were mainly mild to moderate and transient in nature. Recommended dosing of atomoxetine is weight based, and dosages should be adjusted to a target dosage of 1.2 mg/kg/day in children and adolescents weighing 70 kg or less and to 80 mg/day in children and adolescents weighing over 70 kg and adults. While current guidelines from the American Academy of Pediatrics recommend stimulants and behavior modification as first-line therapy for the management of ADHD, atomoxetine offers those patients who do not respond to or cannot tolerate one or more stimulants an alternative treatment option. CONCLUSION Atomoxetine, the first non-stimulant approved for the management of ADHD in children, adolescents, and adults, provides patients who have not responded to or cannot tolerate one or more stimulants an alternative treatment option.
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Affiliation(s)
- Shelby L Corman
- Drug Information Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Abstract
OBJECTIVE To evaluate the use of low-dose granisetron in postoperative nausea and vomiting prophylaxis. DATA SOURCES Clinical trials available through PubMed and OVID (1966—July 2003), as well as information supplied by the drug manufacturer, were accessed. DATA SYNTHESIS Safety concerns associated with droperidol and limited availability of other agents have created a need to restructure prophylaxis guidelines for postoperative nausea and vomiting. It has recently been proposed that granisetron may be effective at a dose that is one-tenth of the Food and Drug Administration—approved dose. Conflicting evidence for this regimen is evaluated. CONCLUSIONS Based on the scarcity of supporting data, this regimen is not recommended for prophylaxis in patients at risk for postoperative nausea and vomiting.
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Affiliation(s)
- Shelby L Corman
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582, USA.
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