Drug-induced Adverse Events

Safety update: metformin and vitamin B<sub>12</sub>
Drug Ther Bull. 2022 Jul 28:dtb-2022-000039. doi: 10.1136/dtb.2022.000039. Online ahead of print.
ABSTRACT
Overview of: Medicines and Healthcare products Regulatory Agency. Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk. Drug Safety Update 2022;15(11):2-5.
PMID:35902109 | DOI:10.1136/dtb.2022.000039
Absolute and relative benefits of statins
Drug Ther Bull. 2022 Jul 28:dtb-2022-000040. doi: 10.1136/dtb.2022.000040. Online ahead of print.
ABSTRACT
Overview of: Byrne P, Demasi M, Jones M, et al Evaluating the association between low-density lipoprotein cholesterol reduction and relative and absolute effects of statin treatment: a systematic review and meta-analysis. JAMA Intern Med 2022;182:474-81.
PMID:35902108 | DOI:10.1136/dtb.2022.000040
▼Bempedoic acid: another cholesterol-lowering drug
Drug Ther Bull. 2022 Aug;60(8):120-124. doi: 10.1136/dtb.2022.000035.
NO ABSTRACT
PMID:35902099 | DOI:10.1136/dtb.2022.000035
Safety update: pregabalin during pregnancy
Drug Ther Bull. 2022 Aug;60(8):117. doi: 10.1136/dtb.2022.000037.
ABSTRACT
Overview of: Medicines and Healthcare products Regulatory Agency. Pregabalin (Lyrica): findings of safety study on risks during pregnancy. Drug Safety Update 2022;15(9):2-6.
PMID:35902098 | DOI:10.1136/dtb.2022.000037
Effectiveness and safety of weekly paclitaxel and cetuximab as a salvage chemotherapy following immune checkpoint inhibitors for recurrent or metastatic head and neck squamous cell carcinoma: A multicenter clinical study
PLoS One. 2022 Jul 28;17(7):e0271907. doi: 10.1371/journal.pone.0271907. eCollection 2022.
ABSTRACT
OBJECTIVES: The benefit of sequential therapy after immune checkpoint inhibitor (ICI) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has been recently reported. Furthermore, there is a growing interest in the impact of cetuximab (Cmab)-containing salvage chemotherapy (SCT) and the therapeutic efficacy and adverse events (AEs) of Cmab administration prior to ICI administration.
MATERIALS AND METHODS: We retrospectively reviewed the medical records of 52 patients with R/M HNSCC treated with SCT (weekly paclitaxel [PTX], n = 7, or weekly PTX and Cmab [PC], n = 45).
RESULTS: The objective response rate (ORR) and a disease control rate (DCR) was 53.3% and 91.1% in the PC group and 42.9% and 57.1% in the PTX group, respectively. There was a significant difference in the DCR between the PC and PTX groups (p = 0.0143). The overall survival (OS) and progression-free survival were significantly better in the PC group than in the PTX group. On the other hand, the incidence of drug-induced interstitial pneumonia (DI-IP) in R/M HNSCC patients who received SCT was 21.2%. Patients in the PC group were divided according to whether they received Cmab (Group A) or did not receive Cmab (Group B) as palliative therapy prior to ICIs. Group B had a significantly better OS than Group A. Furthermore, our findings suggest that the incidence rate of DI-IP during SCT might be higher in Group B.
CONCLUSION: Although PC following ICIs shows dramatic efficacy, careful monitoring of AEs, including DI-IP, is recommended.
PMID:35901098 | DOI:10.1371/journal.pone.0271907
Oral Adverse Events Following COVID-19 Vaccination: Analysis of VAERS Reports
Front Public Health. 2022 Jul 11;10:952781. doi: 10.3389/fpubh.2022.952781. eCollection 2022.
ABSTRACT
BACKGROUND: Oral adverse events (AEs) following COVID-19 vaccination have been sporadically reported during the previous months, warranting further investigation for their prevalence and suspected relationship with vaccine-elicited immune response.
METHODS: A retrospective analysis using the Vaccine Adverse Event Reporting System (VAERS) data was conducted to evaluate AEs within the oral cavity (mucosa, tongue, lips, palate, dentition, salivary glands) and AEs involving taste and other sensations. Oral AEs reported after receiving COVID-19 vaccination (test group) and seasonal influenza vaccination (control group) were extracted and cross-tabulated to assess their relative prevalence.
RESULTS: Among the 128 solicited (suspected) oral AEs, oral paresthesia (0.872%) was most reported after receiving COVID-19 vaccines, followed by the swelling of lips (0.844%), ageusia (0.722%), oral hypoesthesia (0.648%), swollen tongue (0.628%), and dysgeusia (0.617%). The reported prevalence of oral AEs was higher in the COVID-19 vaccine group than in the seasonal influenza group. The distribution pattern of the most reported oral AEs was similar for both COVID-19 and seasonal influenza vaccines. Female sex, older age (>39 years old), primer doses, and mRNA-based COVID-19 vaccines exhibited a higher reported prevalence of oral AEs.
CONCLUSION: Within the limitations of this study, COVID-19 vaccines were found to be associated with rare oral AEs that are predominantly similar to those emerging following seasonal influenza vaccines. The most commonly reported oral AEs were oral paraesthesia (mouth-tingling), lip swelling, and ageusia, representing various pathophysiologic pathways that remain unclear. Taste-related AEs should be acknowledged in the context of the COVID-19 pandemic and the public should be adequately informed about a potential taste dysfunction after receiving the COVID-19 vaccination. Dentists and dental teams need to be aware of the prevalence, severity, and prognosis of oral AEs to inform their patients and increase public confidence in vaccines.
PMID:35899169 | PMC:PMC9309565 | DOI:10.3389/fpubh.2022.952781
Sales of "COVID kit" drugs and adverse drug reactions reported by the Brazilian Health Regulatory Agency
Cad Saude Publica. 2022 Jul 25;38(7):e00001022. doi: 10.1590/0102-311XEN001022. eCollection 2022.
ABSTRACT
Off-label use of azithromycin, hydroxychloroquine, and ivermectin (the "COVID kit") has been suggested for COVID-19 treatment in Brazil without clinical or scientific evidence of efficacy. These drugs have known adverse drug reactions (ADR). This study aimed to analyze if the sales of drugs in the "COVID kit" are correlated to the reported number of ADR after the COVID-19 pandemic began. Data was obtained from the Brazilian Health Regulatory Agency (Anvisa) website on reported sales and ADRs for azithromycin, hydroxychloroquine, and ivermectin for all Brazilian states. The period from March 2019 to February 2020 (before the pandemic) was compared to that from March 2020 to February 2021 (during the pandemic). Trend adjustment was performed for time series data and cross-correlation analysis to investigate correlation between sales and ADR within the same month (lag 0) and in the following months (lag 1 and lag 2). Spearman's correlation coefficient was used to assess the magnitude of the correlations. After the pandemic onset, sales of all investigated drugs increased significantly (69.75% for azithromycin, 10,856,481.39% for hydroxychloroquine, and 12,291,129.32% for ivermectin). ADR levels of all medications but azithromycin were zero before the pandemic, but increased after its onset. Cross-correlation analysis was significant in lag 1 for all drugs nationwide. Spearman's correlation was moderate for azithromycin and hydroxychloroquine but absent for ivermectin. Data must be interpreted cautiously since no active search for ADR was performed. Our results show that the increased and indiscriminate use of "COVID kit" during the pandemic correlates to an increased occurrence of ADRs.
PMID:35894360 | DOI:10.1590/0102-311XEN001022
Sociodemographic and Health-Related Factors Influencing Drug Intake among the Elderly Population
Int J Environ Res Public Health. 2022 Jul 19;19(14):8766. doi: 10.3390/ijerph19148766.
ABSTRACT
Excessive drugs intake among the elderly population, including self-medication, constitutes an important public health problem. Polypharmacy may lead to numerous adverse health effects, which become more prevalent when combined with biological changes in seniors. In this cross-sectional study, 500 Polish adults aged ≥60 years (M = 67.9 ± 4.2) were asked to complete a questionnaire via telephone calls, allowing us to identify sociodemographic and health-related factors influencing the daily medications consumption. Our findings revealed that all of the participants were receiving medications; 60.2% of them receive at least 1 to 3 drugs per day (301/500). The most commonly used medications included antihypertensive drugs and analgesics (51.0% and 46.0%, respectively). Taking into account clinical conditions, independent predictors of receiving over 3 medications per day turned out to be (1) coronary artery disease (OR = 6.77; CI 95%, 2.86-16.1), (2) diabetes (OR = 3.23, CI 95%, 1.75-5.95), (3) asthma (OR = 4.87, CI 95%, 2.13-11.1), (4) heart failure (OR = 3.38, CI 95%, 1.59-7.19) and (5) gastroesophageal reflux disease (OR = 1.93, CI 95%, 1.03-3.62). Participants suffering from depression were more likely to take drugs for hypertension (OR = 1.70, CI 95%, 1.04-2.78), while those with anxiety and social loneliness took more painkillers (OR = 2.59, CI 95%, 1.58-4.26 and OR = 2.08, CI 95%, 1.38-3.13, respectively). The most significant sociodemographic factors increasing the drugs intake among the population included in our study were high body mass and subsequent increased BMI values (OR = 2.68, CI 95%, 1.50-4.77). Furthermore, living in a city with over 400,000 inhabitants increased the likelihood of taking antidepressants (OR = 2.18, CI 95%, 1.20-3.94). Our study revealed factors increasing the risk of excessive medications intake and hence, increased susceptibility to some iatrogenic diseases among the elderly population. These factors should be considered by primary care physicians while prescribing appropriate drugs to elderly patients.
PMID:35886617 | DOI:10.3390/ijerph19148766
Identification of New Toxicity Mechanisms in Drug-Induced Liver Injury through Systems Pharmacology
Genes (Basel). 2022 Jul 21;13(7):1292. doi: 10.3390/genes13071292.
ABSTRACT
Among adverse drug reactions, drug-induced liver injury presents particular challenges because of its complexity, and the underlying mechanisms are still not completely characterized. Our knowledge of the topic is limited and based on the assumption that a drug acts on one molecular target. We have leveraged drug polypharmacology, i.e., the ability of a drug to bind multiple targets and thus perturb several biological processes, to develop a systems pharmacology platform that integrates all drug-target interactions. Our analysis sheds light on the molecular mechanisms of drugs involved in drug-induced liver injury and provides new hypotheses to study this phenomenon.
PMID:35886075 | DOI:10.3390/genes13071292
Shortcomings of Administrative Data to Derive Preventive Strategies for Inhospital Drug-Induced Acute Kidney Failure-Insights from Patient Record Analysis
J Clin Med. 2022 Jul 23;11(15):4285. doi: 10.3390/jcm11154285.
ABSTRACT
Structured analyses of hospital administrative data may detect potentially preventable adverse drug events (ADE) and therefore are considered promising sources to prevent future harm and estimate cost savings. Whether results of these analyses indeed correspond to ADE that may be preventable in clinical routines needs to be verified. We exemplarily screened all adult inpatients admitted to a German University Hospital (n = 54,032) for International Classification of Diseases-10th revision (ICD-10) diagnoses coding for drug-induced kidney injury (AKI). In a retrospective chart review, we checked the coded adverse events (AE) for inhospital occurrence, causality to drug exposure, and preventability in all identified cases and calculated positive predictive values (ppv). We identified 69 inpatient cases of whom 41 cases (59.4%) experienced the AE in the hospital (ppv-range 0.43-0.80). Causality assessment revealed a rather likely causal relationship between AE and drug exposure in 11 cases (15.9, 11/69, ppv-range 0.17-0.22) whereby preventability measures could be postulated for seven cases (10.1%, 7/69). Focusing on drug-induced AKI, this study exemplarily underlines that ICD-10-code-based ADE prevention efforts are quite limited due to the small identification rate and its high proportion of primarily outpatient events. Furthermore, causality assessment revealed that cases are often too complex to benefit from generic prevention strategies. Thus, ICD-10-code-based calculations might overestimate patient harm and economic losses.
PMID:35893376 | DOI:10.3390/jcm11154285
Prioritisation of Adverse Drug Events Leading to Hospital Admission and Occurring during Hospitalisation: A RAND Survey
J Clin Med. 2022 Jul 22;11(15):4254. doi: 10.3390/jcm11154254.
ABSTRACT
(1) Adverse drug events (ADEs) are a common cause of emergency department visits and occur frequently during hospitalisation. Instruments that facilitate the detection of the most relevant ADEs could lead to a more targeted and efficient use of limited resources in research and practice. (2) We conducted two consensus processes based on the RAND/UCLA appropriateness method, in order to prioritise ADEs leading to hospital admission (panel 1) and occurring during hospital stay (panel 2) for inclusion in future ADE measurement instruments. In each panel, the experts were asked to assess the "overall importance" of each ADE on a four-point Likert scale (1 = not important to 4 = very important). ADEs with a median rating of ≥3 without disagreement were defined as "prioritised". (3) The 13 experts in panel 1 prioritised 38 out of 65 ADEs, while the 12 experts in panel 2 prioritised 34 out of 63 ADEs. The highest rated events were acute kidney injury and hypoglycaemia (both panels), as well as Stevens-Johnson syndrome in panel 1 and rhabdomyolysis in panel 2. (4) The survey led to a set of ADEs for which there was consensus that they were of particular importance as presentations of acute medication-related harm, thereby providing a focus for further medication safety research and clinical practice.
PMID:35893345 | DOI:10.3390/jcm11154254
The Gender-Specific Association of DRD2 Polymorphism with Metabolic Syndrome in Patients with Schizophrenia
Genes (Basel). 2022 Jul 23;13(8):1312. doi: 10.3390/genes13081312.
ABSTRACT
BACKGROUND: Metabolic syndrome is widespread in patients with schizophrenia receiving long-term antipsychotic therapy. Dopamine D2 receptors play an important role in mediating both the therapeutic actions of antipsychotics and their side effects. The present study examined the association of two polymorphisms of the DRD2 gene with metabolic syndrome in patients with schizophrenia.
METHODS: We examined 517 patients from several regions of Siberia (Russia) with a clinical diagnosis of schizophrenia. Genotyping of two single nucleotide polymorphisms rs1799732 and rs4436578 of the dopamine D2 receptor gene (DRD2) was performed in a population of 471 patients. The results were analyzed using chi-square tests.
RESULTS: Functional polymorphism rs1799732 of the DRD2 gene is associated with drug-induced metabolic syndrome in women with schizophrenia.
CONCLUSIONS: Our results show that the DRD2 gene may be involved in the pathogenesis of metabolic disorders in patients with schizophrenia. Further analysis of possible genetic markers will allow for personalized treatment with minimal side effects and optimal efficacy. This which seems relevant in light of the recent focus on improving the quality of life and ensuring a high level of social adaptation of patients with schizophrenia.
PMID:35893053 | DOI:10.3390/genes13081312
Post-Vaccinal Encephalitis with Early Relapse after BNT162b2 (COMIRNATY) COVID-19 Vaccine: A Case Report
Vaccines (Basel). 2022 Jul 1;10(7):1065. doi: 10.3390/vaccines10071065.
ABSTRACT
We describe the case of a 72-year-old man who received the first dose of the BNT162b2 (COMIRNATY) vaccine against COVID-19 on 18 May 2021, and the second dose on 9 September 2021. One day after receiving the first dose, he cursed with malaise, headache, fever, confusion, aggressiveness, and gait alterations. We performed serum and cerebrospinal fluid (CSF) tests (finding elevated proteins in CSF) with negative results for infectious, systemic, and neoplastic causes. We performed brain nuclear magnetic resonance imaging (MRI), finding circumscribed encephalitis at the anterior frontal and bilateral temporal lobes. We were unable to perform a panel of antineuronal antibodies. The patient was readmitted due to early clinical relapse four days after receiving his second dose. We found sequelae lesions at the frontal level but with new demyelinating lesions at the left temporal level in brain MRI. We indicated methylprednisolone, and he presented a favorable improvement. We report an encephalitis case of probable autoimmune etiology after vaccination with BNT162b2, which presented early clinical relapse after receiving the second dose and presented a favorable response to methylprednisolone.
PMID:35891229 | DOI:10.3390/vaccines10071065
The Safety of Long-Term Proton Pump Inhibitor Use on Cardiovascular Health: A Meta-Analysis
J Clin Med. 2022 Jul 15;11(14):4096. doi: 10.3390/jcm11144096.
ABSTRACT
INTRODUCTION: Proton pump inhibitors (PPIs) are one of the most prescribed classes of drugs worldwide as a first-line treatment of acid-related disorders. Although adverse effects are rare and rapidly reversible after a short exposure, concerns have been recently raised about a greater toxicity on cardiovascular health after a longer exposure, especially when combined with clopidogrel. We aimed to evaluate the safety of long-term PPI use on cardiovascular health in patients with known atheromatous cardiovascular disease.
METHODS: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases and grey literature in April 2022. Articles published between 2014 and 2022 were considered relevant if they were designed as randomized controlled trials (RCTs) that included post hoc analyses or prospective observational studies and if they investigated clinical cardiovascular outcomes associated with PPI use for 6 months or more in patients suffering from cardiovascular disease requiring antiplatelet agent therapy and/or coronary angioplasty. Statistical analyses were performed using RevMan 5.4 software (Computer program, the Cochrane Collaboration, 2020, London, UK). The risk of bias was assessed using the Cochrane risk-of-bias tool for the RCTs and the Newcastle-Ottawa scale for the observational studies.
RESULTS: A total of 10 full-text articles involving 53,302 patients were included. Substantial heterogeneity was found among the 10 included studies. The primary analysis showed no significant differences between the PPI group and the control group for the risks of major adverse cardiovascular events (MACEs), all-cause death (ACD), or target vessel revascularization (TVR) using a random-effects model (OR 1.15, 95% CI 0.98-1.35, p = 0.08, I2 = 73%; OR 1.24, 95% CI 0.94-1.65, p = 0.13, I2 = 63%; and OR 1.19, 95% CI 0.76-1.87, p = 0.45, I2 = 61%, respectively). The primary analysis yielded similar results for the risks of myocardial infarction (MI), stroke, and cardiovascular death (CVD) using a fixed-effects model (OR 0.98, 95% CI 0.88-1.09, p = 0.66, I2 = 0%; OR 1.02, 95% CI 0.90-1.17, p = 0.73, I2 = 0%; and OR 1.04, 95% CI 0.94-1.16, p = 0.44, I2 = 35%, respectively). Likewise, a subgroup analysis based on eight randomized controlled trials failed to identify any association between PPI use and the risks of MACEs, MI, stroke, TVR, ACD, or CVD using a fixed-effects model (overall pooled OR 1.01, 95% CI 0.96-1.06; p = 0.66; I2 = 0%). The pulled data from the two included observational studies (OS) demonstrated a significantly increased risk of MACEs in the PPI group (OR 1.42, 95% CI [1.29-1.57], p <0.001; I2 = 0%). In another subgroup analysis, no evidence of an increased risk of adverse cardiovascular events in the co-therapy PPI/clopidogrel versus clopidogrel alone groups was found with the exception of the risk of ACD (OR 1.50, 95% CI 1.23-1.82, p = 0.001, I2 = 0%). Nevertheless, after performing a sensitivity analysis reaching heterogeneity I2 = 0%, the co-prescription of PPIs and clopidogrel was at increased risk of MACEs (p < 0.001), CVD (p = 0.008), and TVR (p < 0.001) but remained statistically non-significant for the risk of MI (p = 0.11).
CONCLUSIONS: The overall results of this meta-analysis showed that long-term PPI use was not associated with an increased risk of adverse cardiovascular events. However, inconsistent results were found for combined PPI/clopidogrel therapy. These results should be considered with caution in light of the significant heterogeneity, the limited number of included studies, and the lack of adjustment for potential confounders.
PMID:35887860 | DOI:10.3390/jcm11144096
Pathogenesis of Paradoxical Reactions Associated with Targeted Biologic Agents for Inflammatory Skin Diseases
Biomedicines. 2022 Jun 23;10(7):1485. doi: 10.3390/biomedicines10071485.
ABSTRACT
Targeted biologic agents have dramatically changed the therapeutic landscape for immune-mediated inflammatory diseases, particularly in rheumatology and dermatology. Their introduction has resulted in a paradigm shift, i.e., they produce significant clinical improvements in most patients with such diseases. Nevertheless, a variety of adverse reactions associated with these agents have been observed, including so-called paradoxical reactions (PRs), which are a new class of adverse events. PRs involve the de novo development or worsening of immune-mediated inflammatory disease during treatment with a targeted biologic agent that is commonly used to treat the idiopathic counterpart of the drug-induced reaction. In addition, the efficacy of biologic agents targeting individual cytokines and the existence of PRs to them have provided proof that cytokines are key drivers of various immune-mediated inflammatory diseases and helped researchers elucidate the molecular pathways underlying the pathophysiology of these diseases. Here, a comprehensive review of the targeted biologic agents used to treat immune-mediated inflammatory diseases, particularly psoriasis and atopic dermatitis, is provided, with a specific focus on biologic agents that inhibit cytokine signaling involving tumor necrosis factor-α, interleukin (IL)-12/23 (p40), IL-17A (and the IL-17 receptor [R]), IL-23 (p19), and the IL-4Rα, and their associated PRs. The characteristic clinical manifestations and potential immunological mechanisms of the PRs induced by these biologic agents are also reviewed.
PMID:35884790 | DOI:10.3390/biomedicines10071485
Genetika+: precision medicine solutions for mental health
Pharmacogenomics. 2022 Jul;23(10):571-574. doi: 10.2217/pgs-2022-0053. Epub 2022 Jul 26.
ABSTRACT
Genetika+ is developing a precision medicine tool to optimize the treatment of depression by helping physicians find the best drug therapy for their patients. The tool builds on traditional pharmacogenetics, introducing a 'brain-in-a-dish' screening platform for each patient that will overcome the challenge of limited pharmacodynamic knowledge of pharmacogenetics (PGx). In addition to PGx, our platform integrates patient data with innovative blood-derived patient neurons to test all categories of antidepressants and predict the best drug for each patient. This offers patients optimal drug treatment, allowing a faster response, fewer side effects and lower dosing.
PMID:35880563 | DOI:10.2217/pgs-2022-0053
Part Four: Identifying, Managing, and Preventing Adverse Effects of Diabetes Medications
Sr Care Pharm. 2022 Aug 1;37(8):310-316. doi: 10.4140/TCP.n.2022.310.
ABSTRACT
Background An 81-year-old woman with type 2 diabetes, residing in a long-term care facility, has experienced a fall after medication changes, and a few days of irregular eating. Assessment This patient may be experiencing one or more common potential adverse events related to her diabetes medications. There is a need to create individualized treatment goals in this case. Outcome After a revision of treatment goals for hypertension and diabetes, and adjustments to the medication regimen, there have been no subsequent falls and this patient reports that she feels better. Conclusion As the person with diabetes ages, quality of life should be considered when setting treatment goals. Older people can be more at risk for adverse effects of medications to treat diabetes, so a clinician should be vigilant in the identification, management, and prevention of such adverse events. Inter-professional communication is key to the safe and effective treatment of diabetes.
PMID:35879847 | DOI:10.4140/TCP.n.2022.310
Medication errors in a children's inpatient antineoplastic chemotherapy facility
Bol Med Hosp Infant Mex. 2022;79(3):180-186. doi: 10.24875/BMHIM.21000175.
ABSTRACT
BACKGROUND: Due to many antineoplastic drugs' toxicity and narrow therapeutic window, medication errors are a health concern in pediatric oncology patients. This study aimed to identify and classify medication errors in a pediatric inpatient chemotherapy facility and evaluate the outcomes of these medication errors.
METHODS: We conducted an observational retrospective study over 5 months in a chemotherapy facility for pediatric patients. The evaluation consisted of the review of the available medical records. The medication errors detected were manually recorded in a medical logbook. The International Classification for Patient Safety was adjusted to our clinical setting for the analysis, the terminology, and the classification system. A descriptive analysis was performed.
RESULTS: A total of 286 medical records were reviewed; one type of medication error was noted in at least 97.6%, and 962 errors were identified totally, with an overall rate of 3.36 errors per visit. Most errors occurred in the documentation stage (643; 66.8%), followed by the administration stage (227; 23.6%). Of all medication errors, 37.2% had the potential to cause injury, but only five reached the patient (0.5%), and only two (0.2%) resulted in a severe harmful incident.
CONCLUSIONS: Medication errors were common, especially at the documentation stage. Better documentation strategies need to be implemented to reduce the rate of near misses and prevent potential adverse events.
PMID:35882027 | DOI:10.24875/BMHIM.21000175
Antihypertensive Deprescribing in Older Adults: a Practical Guide
Curr Hypertens Rep. 2022 Jul 26. doi: 10.1007/s11906-022-01215-3. Online ahead of print.
ABSTRACT
PURPOSE OF REVIEW: To summarise evidence on both appropriate and inappropriate antihypertensive drug withdrawal.
RECENT FINDINGS: Deprescribing should be attempted in the following steps: (1) identify patients with several comorbidities and significant functional decline, i.e. people at higher risk for negative outcomes related to polypharmacy and lower blood pressure; (2) check blood pressure; (3) identify candidate drugs for deprescribing; (4) withdraw medications at 4-week intervals; (5) monitor blood pressure and check for adverse events. Although evidence is accumulating regarding short-term outcomes of antihypertensive deprescribing, long-term effects remain unclear. The limited evidence for antihypertensive deprescribing means that it should not be routinely attempted, unless in response to specific adverse events or following discussions between physicians and patients about the uncertain benefits and harms of the treatment.
PERSPECTIVES: Clinical controlled trials are needed to examine the long-term effects of deprescribing in older subjects, especially in those with comorbidities, and significant functional decline.
PMID:35881225 | DOI:10.1007/s11906-022-01215-3
Expert consensus on the diagnosis and treatment of anticancer drug-induced interstitial lung disease
Zhonghua Zhong Liu Za Zhi. 2022 Jul 23;44(7):693-702. doi: 10.3760/cma.j.cn112152-20220412-00244.
ABSTRACT
Drug-induced interstitial lung disease (DILD) is the most common pulmonary adverse events caused by anti-cancer treatment. In recent years, with the development of clinical oncology, a large amount of novel anti-cancer drugs have been approved and widely used in clinical practice, and the incidence of anti-cancer drug related DILD is gradually increasing. DILD lacks specific clinical manifestations or diagnostic criteria. If not treated properly, it may leads to interruption or discontinuation of anti-cancer treatment, or even become life threat in severe cases. Therefore, the Anti-cancer Drug-induced Interstitial Lung Disease Management Group have reached a consensus on the diagnosis and management of anti-cancer DILD after several rounds of discussion. This consensus aims to improve clinicians' awareness of anti-cancer drug related-DILD and proposes an algorithm for the diagnosis and treatment of this disease, and to improve patients' prognosis and quality of life.
PMID:35880334 | DOI:10.3760/cma.j.cn112152-20220412-00244