Impact of pharmacists' interventions on the pharmacotherapy of patients with complex needs monitored in multidisciplinary primary care teams.

Int J Pharm Pract. 2020 Feb;28(1):75-83

Authors: Samir Abdin M, Grenier-Gosselin L, Guénette L

Abstract
OBJECTIVES: Recently, pharmacists have joined multidisciplinary healthcare teams within family medicine groups (FMG) in Quebec Province, Canada. This study assessed the impact of their interventions on the pharmacotherapy of patients with complex needs monitored in FMGs.
METHODS: We performed a pre/post real-life intervention study among patients with complex needs referred to the FMG pharmacist in four FMGs in Quebec City. Pharmacists collected data at baseline, during follow-up and up to 6 months after the first encounter. They recorded all drug-related problems (DRPs) identified, interventions made and recommendations that were accepted by physicians. The researchers used the data collected to compare the medication regimen complexity index (MRCI) and medication adherence (using the proportion of days covered (PDC)) before and after the pharmacist's interventions. Descriptive statistics and paired sample t-tests were computed.
KEY FINDINGS: Sixty-four patients (median age: 74.5 years) were included; four patients were lost to follow-up. Pharmacists detected 300 DRPs (mean: 7.2 per patient) during the study period for which they made an intervention. The most common DRP was 'drug use without indication' (27%). The physicians accepted 263 (87.7%) of those interventions. The mean number of prescribed drugs per patient decreased from 13.8 (95% confidence interval (CI): 12.24 to 15.29) to 12.4 (95% CI: 10.92 to 13.90). The mean MRCI decreased from 47.18 to 41.74 (-5.44; 95% CI: 1.71 to 9.17), while the mean PDC increased from 84.4% to 90.0% (+5.6%; 95% CI: 2.7% to 8.4%).
CONCLUSION: Family medicine groups pharmacists can detect and resolve DRPs and can reduce medication regimen complexity and non-adherence to treatment in patients with complex needs monitored in FMGs.

PMID: 31468599 [PubMed - indexed for MEDLINE]

Discovering Links Between Side Effects and Drugs Using a Diffusion Based Method.

Sci Rep. 2019 07 18;9(1):10436

Authors: Timilsina M, Tandan M, d'Aquin M, Yang H

Abstract
Identifying the unintended effects of drugs (side effects) is a very important issue in pharmacological studies. The laboratory verification of associations between drugs and side effects requires costly, time-intensive research. Thus, an approach to predicting drug side effects based on known side effects, using a computational model, is highly desirable. To provide such a model, we used openly available data resources to model drugs and side effects as a bipartite graph. The drug-drug network is constructed using the word2vec model where the edges between drugs represent the semantic similarity between them. We integrated the bipartite graph and the semantic similarity graph using a matrix factorization method and a diffusion based model. Our results show the effectiveness of this integration by computing weighted (i.e., ranked) predictions of initially unknown links between side effects and drugs.

PMID: 31320740 [PubMed - indexed for MEDLINE]

Sweet Syndrome as an Adverse Reaction to Tyrosine Kinase Inhibitors: a review.

Dermatol Ther. 2020 Oct 28;:

Authors: Yang JJ, Maloney NJ, Nguyen KA, Worswick S, Smogorzewski J, Bach DQ

Abstract
Tyrosine kinase inhibitors are a class of targeted anticancer drugs that inhibit cancer cell proliferation by inactivating proteins involved in signal transduction cascades. Various cutaneous adverse events have been observed after tyrosine kinase inhibitor administration, including Sweet syndrome. We queried the PubMed database to identify fourteen cases of Sweet syndrome thought to be secondary to tyrosine kinase inhibitors. Tyrosine kinase inhibitor-induced Sweet syndrome had a median of 2 months latency following drug administration. All cases but one had morphologic features classic for Sweet syndrome (erythematous and tender papules, plaques, or nodules). All cases also had classic histopathologic findings (dermal neutrophilic infiltrate without vasculitis or necrosis). Using diagnostic criteria for drug-induced Sweet syndrome and the Naranjo Drug Reaction Probability Scale for a drug-induced cutaneous eruption, we found that six cases favored a drug-induced etiology over malignancy, two cases favored a malignancy-associated Sweet syndrome, and the remaining eight met drug-induced Sweet syndrome criteria but had low Naranjo scores. Nine cases resulted in medication discontinuation, while five cases continued anticancer therapy and were treated only with corticosteroids with quick resolution of skin lesions. Dermatologists should be aware of this adverse cutaneous reaction to tyrosine kinase inhibitors and should treat on a case-by-case basis, though limited evidence in this review suggests that oncologic therapy may safely be continued with prompt corticosteroid treatment. This article is protected by copyright. All rights reserved.

PMID: 33112465 [PubMed - as supplied by publisher]

[CME: Chronic Generalized Pruritus without Dermatological Cause].

Praxis (Bern 1994). 2020;109(14):1099-1107

Authors: Petruse L, Kiesel H, Rampini SK

Abstract
CME: Chronic Generalized Pruritus without Dermatological Cause Abstract. Chronic generalized pruritus is a common symptom. Dermatological causes must be distinguished from non-dermatological causes. Non-dermatological chronic pruritus has many causes, such as systemic, infectious, neurological, psychogenic disorders, and drug-related side effects, some of which may be associated with significant morbidity. The possibility of a systemic disease should be considered in patients with generalized pruritus and no signs of primary skin lesions. In addition to a careful history and physical examination, selected laboratory examinations can be helpful in making a diagnosis. Pruritus can be the first sign of a malignant hematological disease. Pruritus associated with solid tumors is not that rare. This article offers an approach to chronic generalized pruritus in adults without concomitant skin changes with a viable clarification strategy and consideration of the most important differential diagnoses.

PMID: 33108994 [PubMed - in process]

Toxicological aspects of increased use of surface and hand disinfectants in Croatia during the COVID-19 pandemic: a preliminary report.

Arh Hig Rada Toksikol. 2020 Sep 01;71(3):261-264

Authors: Babić Ž, Turk R, Macan J

Abstract
All COVID-19 prevention strategies include regular use of surface disinfectants and hand sanitisers. As these measures took hold in Croatia, the Croatian Poison Control Centre started receiving phone calls from the general public and healthcare workers, which prompted us to investigate whether the risk of suspected/symptomatic poisonings with disinfectants and sanitisers really increased. To that end we compared their frequency and characteristics in the first half of 2019 and 2020. Cases of exposures to disinfectants doubled in the first half of 2020 (41 vs 21 cases in 2019), and exposure to sanitisers increased about nine times (46 vs 5 cases in 2019). In 2020, the most common ingredients of disinfectants and sanitisers involved in poisoning incidents were hypochlorite/glutaraldehyde, and ethanol/isopropyl alcohol, respectively. Exposures to disinfectants were recorded mostly in adults (56 %) as accidental (78 %) through ingestion or inhalation (86 %). Fortunately, most callers were asymptomatic (people called for advice because they were concerned), but nearly half reported mild gastrointestinal or respiratory irritation, and in one case severe symptoms were reported (gastrointestinal corrosive injury). Reports of exposure to hand sanitisers highlighted preschool children as the most vulnerable group. Accidental exposure through ingestion dominated, but, again, only mild symptoms (gastrointestinal or eye irritation) developed in one third of the cases. These preliminary findings, however limited, confirm that increased availability and use of disinfectants and sanitisers significantly increased the risk of poisoning, particularly in preschool children through accidental ingestion of hand sanitisers. We therefore believe that epidemiological recommendations for COVID-19 prevention should include warnings informing the general public of the risks of poisoning with surface and hand disinfectants in particular.

PMID: 33074170 [PubMed - indexed for MEDLINE]

Adaptive dose-finding based on safety and feasibility in early-phase clinical trials of adoptive cell immunotherapy.

Clin Trials. 2020 04;17(2):157-165

Authors: Wages NA, Fadul CE

Abstract
BACKGROUND/AIMS: Dose feasibility is a challenge that may arise in the development of adoptive T cell therapies for cancer. In early-phase clinical trials, dose is quantified either by a fixed or per unit body weight number of cells infused. It may not be feasible, however, to administer a patient's assigned dose due to an insufficient number of cells harvested or functional heterogeneity of the product. The study objective becomes to identify the maximum tolerated dose with high feasibility of being administered. This article describes a new dose-finding method that adaptively accounts for safety and feasibility endpoints in guiding dose allocation.
METHODS: We propose an adaptive dose-finding method that integrates accumulating feasibility and safety data to select doses for participant cohorts in early-phase trials examining adoptive cell immunotherapy. We sequentially model the probability of dose-limiting toxicity and the probability of feasibility using independent beta-binomial models. The probability model for toxicity borrows information across all dose levels using isotonic regression, allowing participants infused at a lower dose than his or her planned dose to contribute safety data to the dose-finding algorithm. We applied the proposed methodology in a single simulated trial and evaluated its operating characteristics through extensive simulation studies.
RESULTS: In simulations conducted for a phase I study of adoptive immunotherapy for newly diagnosed glioblastoma, the proposed method demonstrates the ability to identify accurately the feasible maximum tolerated doses and to treat participants at and around these doses. Over 10 hypothesized scenarios studied, the percentage of correctly selecting the true feasible and maximum tolerated dose ranged from 50% to 90% with sample sizes averaging between 21 and 24 participants. A comparison to the only known existing method accounting for safety and feasibility yields competitive performance.
CONCLUSION: We have developed a new practical adaptive dose-finding method to assess feasibility in early-phase adoptive cell therapy trials. A design that incorporates feasibility, as a function of the quantity and quality of the product manufactured, in addition to safety will have an impact on the recommended phase II doses in studies that evaluate patient outcomes.

PMID: 31856602 [PubMed - indexed for MEDLINE]

Improving the Safety of Medicines in the European Union: From Signals to Action.

Clin Pharmacol Ther. 2020 03;107(3):521-529

Authors: Potts J, Genov G, Segec A, Raine J, Straus S, Arlett P

Abstract
Pharmacovigilance and risk minimization must be planned during drug development and forms a critical part of the regulator's decision on whether a medicinal product can be authorized. Pharmacovigilance systems should ensure proactive monitoring of all authorized medicines throughout their lifecycle in clinical use. Signal detection and management are core activities in pharmacovigilance, rapidly delivering new information on the safety of medicines in real-world use which helps to fill knowledge gaps. The first 6 years of the European Union (EU) signal management system resulted in 453 recommendations issued by the Pharmacovigilance Risk Assessment Committee (PRAC), of which more than half were for drug labeling changes. The EU pharmacovigilance network has demonstrated its ability to detect and evaluate new drug safety signals. This has resulted in new warnings to guide the safe and effective use of medicines in Europe.

PMID: 31621897 [PubMed - indexed for MEDLINE]

Identifying characteristics of drug-related problems in critically ill patients with decompensated liver cirrhosis.

Eur J Gastroenterol Hepatol. 2019 Dec;31(12):1569-1576

Authors: Aghili M, Neelathahalli Kasturirangan M

Abstract
OBJECTIVES: Characteristics of drug-related problems and related patient harm has not been evaluated in critically ill patients with decompensated cirrhosis. Our objectives were to identify characteristics and incidence rate of drug-related problems and related preventable harm in critically ill patients with decompensated liver cirrhosis.
PATIENTS AND METHODS: A prospective observational study was conducted from February 2018 to January 2019 in 10-bed medical intensive care unit of a tertiary care hospital. Medication charts of 78 patients diagnosed with decompensated cirrhosis were reviewed by the clinical pharmacist. Pharmaceutical care-related standard tools were applied for classification of drug-related problems and their severity of outcomes.
RESULTS: A total of 394 drug-related problems with an incidence rate of 298.48 per 1000 patient medical intensive care unit-day were identified. Most common drug-related problems were drug-drug interaction (48.7%) followed by guideline nonconformity (15.5%), inappropriate drug form (11.9%), and contraindication (9.6%). Approximately 27% of drug-related problems induced preventable harm, which included temporary harm (19.8%), permanent harm (5.8%), and death (0.8%). The incidence rate of preventable harm was found to be 78.78 per 1000 patient medical intensive care unit-day. Nonsteroidal anti-inflammatory drugs were the most common medications involved in drug-drug interaction, guideline nonconformity, and contraindication which led to gastrointestinal bleeding (24%) and worsening of renal function (11.5%).
CONCLUSION: Drug-related problems occurred commonly in critically ill patients with decompensated liver cirrhosis and induced preventable harm which jeopardized the safety of these vulnerable patients. Clinical pharmacist's intervention is essential for identification of drug-related problems and related preventable harm among these patients.

PMID: 31464786 [PubMed - indexed for MEDLINE]

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in a paediatric patient taking zonisamide.

Eur J Hosp Pharm. 2020 Oct 26;:

Authors: Trivedi A, Sharma S, Govindan R

Abstract
We describe the case of an 11-year-old male patient who presented with a new onset of rash after a recent introduction of zonisamide. Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a very serious but rare adverse effect of anticonvulsants such as carbamazepine and phenytoin; however, the reported incidence on zonisamide is scant. DRESS syndrome is complex in its presentation. This patient presented with rash, fever, lymphadenopathy, severe skin erythema, oedema and reduced Glasgow Coma Scale (GCS). He was successfully treated with pulsed intravenous methylprednisolone and intravenous immunoglobulin. The patient was discharged home well after a 3-week admission.

PMID: 33106284 [PubMed - as supplied by publisher]

Minimum information about clinical artificial intelligence modeling: the MI-CLAIM checklist.

Nat Med. 2020 09;26(9):1320-1324

Authors: Norgeot B, Quer G, Beaulieu-Jones BK, Torkamani A, Dias R, Gianfrancesco M, Arnaout R, Kohane IS, Saria S, Topol E, Obermeyer Z, Yu B, Butte AJ

PMID: 32908275 [PubMed - indexed for MEDLINE]

A Real-World Evidence Framework for Optimizing Dosing in All Patients With COVID-19.

Clin Pharmacol Ther. 2020 11;108(5):921-923

Authors: Peck RW, Weiner D, Cook J, Robert Powell J

Abstract
Potential treatments for coronavirus disease 2019 (COVID-19) are being investigated at unprecedented speed, and successful treatments will rapidly be used in tens or hundreds of thousands of patients. To ensure safe and effective use in all those patents it is essential also to develop, at unprecedented speed, a means to provide frequently updated, optimal dosing information for all patient subgroups. Success will require immediate collaboration between drug developers, academics, and regulators.

PMID: 32445484 [PubMed - indexed for MEDLINE]

Effectiveness and safety of Ustekinumab for the treatment of Crohn's disease in real-life experiences: a meta-analysis of observational studies.

Expert Opin Biol Ther. 2020 02;20(2):193-203

Authors: Macaluso FS, Maida M, Ventimiglia M, Cottone M, Orlando A

Abstract
Background: The aim of this meta-analysis was to estimate the effectiveness and safety of Ustekinumab in Crohn's disease (CD) reported by observational studies.Research design and methods: PubMed/Medline and Embase were systematically searched through September 2019. Only real-life observational studies were included.Results: Thirteen studies comprising 1450 patients met the inclusion criteria. Ustekinumab was administered subcutaneously at induction among 7 studies, while in 6 studies the intravenous formulation was used. At induction (8-16 weeks), the pooled estimate rates of clinical response and remission were 56% (95% CI: 43-68%; range: 16-94%; I2 = 94%) and 34% (95% CI: 25-45%; range: 15-58%; I2 = 90%), respectively. The rate of clinical response was higher among studies which employed the subcutaneous compared with the intravenous induction (68% vs. 38%, p = 0.01). At maintenance, the pooled estimate rates of clinical response, clinical remission, endoscopic response, and endoscopic remission were 62% (95% CI: 50-73%; range: 42-89%; I2 = 89%), 40% (95% CI: 28-54%; range: 26-73%; I2 = 90%), 56% (95% CI: 37-73%; range: 20-77%; I2 = 87%), and 19% (95% CI: 11-30%; range: 7-31%; I2 = 67%), respectively.Conclusions: Ustekinumab is an effective treatment in patients with CD with a reassuring safety profile. The subcutaneous induction seems to be superior to the intravenous one.

PMID: 31859538 [PubMed - indexed for MEDLINE]

Antibody prodrugs for cancer.

Expert Opin Biol Ther. 2020 02;20(2):163-171

Authors: Kavanaugh WM

Abstract
Introduction: The toxicity of potent new biological therapies for cancer has limited their utility. By improving tumor specificity, antibody prodrugs can widen or even create a therapeutic window for anticancer agents that are difficult or impossible to use otherwise because of poor tolerability.Areas covered: This review will describe the current status of the field of antibody prodrugs, focusing on ProbodyTM therapeutics, including the principles behind their design, application to a variety of different antibody-based therapies, preclinical examples of their activity and safety, and early results of Phase 1 trials.Expert opinion: Proof of concept for the antibody prodrug approach, which is defined as demonstration of potent antitumor activity with improved safety, has been extensively established preclinically as well as preliminarily in early clinical trials in human patients. However, experience with antibody prodrugs is limited, and important challenges remain. Principal among them are how to design the molecules to provide the most effective protection from toxicities while preserving efficacy, how to optimize clinical pharmacology, and how to determine which among the many possible clinical applications is the best use of this promising technology.

PMID: 31779489 [PubMed - indexed for MEDLINE]

Adaptation of potentially preventable medication-related hospitalisation indicators for Indigenous populations in Australia using a modified Delphi technique.

BMJ Open. 2019 11 19;9(11):e031369

Authors: Spinks JM, Kalisch Ellett LM, Spurling G, Theodoros T, Williamson D, Wheeler AJ

Abstract
OBJECTIVES: One of the outcomes of a medication review service is to identify and manage medication-related problems (MRPs). The most serious MRPs may result in hospitalisation, which could be preventable if appropriate processes of care were adopted. The aim of this study was to update and adapt a previously published set of clinical indicators for use in assessing the effectiveness of a medication review service tailored to meet the needs of Indigenous people, who experience some of the worst health outcomes of all Australians.
DESIGN: A modified Delphi technique was used to: (i) identify additional indicators for consideration, (ii) assess whether the original indicators were relevant in the context of Indigenous health and (iii) reach consensus on a final set of indicators. Three rounds of rating were used via an anonymous online survey, with 70% agreement required for indicator inclusion.
SETTING: The indicators were designed for use in Indigenous primary care in Australia.
PARTICIPANTS: Thirteen panellists participated including medical specialists, general practice doctors, pharmacists and epidemiologists experienced in working with Indigenous patients.
RESULTS: Panellists rated 101 indicators (45 from the original set and 57 newly identified). Of these, 41 were accepted unchanged, seven were rejected and the remainder were either modified before acceptance or merged with other indicators. A final set of 81 indicators was agreed. Conclusions This study provides a set of clinical indicators to be used as a primary outcome measure for medication review services for Indigenous people in Australia and as a prompt for pharmacists and doctors conducting medication reviews.
TRIAL REGISTRATION NUMBER: The trial registration for the Indigenous Medication Review Service feasibility study is ACTRN12618000188235.

PMID: 31748302 [PubMed - indexed for MEDLINE]

The Impact of Immune Interventions: A Systems Biology Strategy for Predicting Adverse and Beneficial Immune Effects.

Front Immunol. 2019;10:231

Authors: Meijerink M, van den Broek T, Dulos R, Neergaard Jacobsen L, Staudt Kvistgaard A, Garthoff J, Knippels L, Knipping K, Houben G, Verschuren L, van Bilsen J

Abstract
Despite scientific advances it remains difficult to predict the risk and benefit balance of immune interventions. Since a few years, network models have been built based on comprehensive datasets at multiple molecular/cellular levels (genes, gene products, metabolic intermediates, macromolecules, cells) to illuminate functional and structural relationships. Here we used a systems biology approach to identify key immune pathways involved in immune health endpoints and rank crucial candidate biomarkers to predict adverse and beneficial effects of nutritional immune interventions. First, a literature search was performed to select the molecular and cellular dynamics involved in hypersensitivity, autoimmunity and resistance to infection and cancer. Thereafter, molecular interaction between molecules and immune health endpoints was defined by connecting their relations by using database information. MeSH terms related to the immune health endpoints were selected resulting in the following selection: hypersensitivity (D006967: 184 genes), autoimmunity (D001327: 564 genes), infection (parasitic, bacterial, fungal and viral: 357 genes), and cancer (D009369: 3173 genes). In addition, a sequence of key processes was determined using Gene Ontology which drives the development of immune health disturbances resulting in the following selection: hypersensitivity (164 processes), autoimmunity (203 processes), infection (187 processes), and cancer (309 processes). Finally, an evaluation of the genes for each of the immune health endpoints was performed, which indicated that many genes played a role in multiple immune health endpoints, but also unique genes were observed for each immune health endpoint. This approach helps to build a screening/prediction tool which indicates the interaction of chemicals or food substances with immune health endpoint-related genes and suggests candidate biomarkers to evaluate risks and benefits. Several anti-cancer drugs and omega 3 fatty acids were evaluated as in silico test cases. To conclude, here we provide a systems biology approach to identify genes/molecules and their interaction with immune related disorders. Our examples illustrate that the prediction with our systems biology approach is promising and can be used to find both negatively and positively correlated interactions. This enables identification of candidate biomarkers to monitor safety and efficacy of therapeutic immune interventions.

PMID: 30828334 [PubMed - indexed for MEDLINE]

15 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2020/10/27

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Oral once-daily berotralstat for the prevention of hereditary angioedema attacks: a randomized, double-blind, placebo-controlled phase 3 trial.

J Allergy Clin Immunol. 2020 Oct 21;:

Authors: Zuraw B, Lumry WR, Johnston DT, Aygören-Pürsün E, Banerji A, Bernstein JA, Christiansen SC, Jacobs JS, Sitz KV, Gower RG, Gagnon R, Wedner HJ, Kinaciyan T, Hakl R, Hanzlíková J, Anderson JT, McNeil DL, Fritz SB, Yang WH, Tachdjian R, Busse PJ, Craig TJ, Li HH, Farkas H, Best JM, Clemons D, Cornpropst M, Dobo SM, Iocca HA, Kargl D, Nagy E, Murray SC, Collis P, Sheridan WP, Maurer M, Riedl MA

Abstract
BACKGROUND: Berotralstat (BCX7353) is an oral, once-daily inhibitor of plasma kallikrein in development for the prophylaxis of hereditary angioedema (HAE) attacks.
OBJECTIVE: To determine the efficacy, safety, and tolerability of berotralstat in patients with HAE over a 24-week treatment period (the phase 3 APeX-2 trial).
METHODS: APeX-2 was a double-blind, parallel-group study that randomized patients at 40 sites in 11 countries 1:1:1 to once-daily berotralstat 110 mg, 150 mg, or placebo (Clinicaltrials.gov, NCT03485911). Patients aged ≥12 years with HAE due to C1 inhibitor deficiency and ≥2 investigator-confirmed HAE attacks in the first 56 days of a prospective run-in period were eligible. The primary efficacy endpoint was the rate of investigator-confirmed HAE attacks during the 24-week treatment period.
RESULTS: One-hundred twenty-one patients were randomized, and 120 received ≥1 dose of study drug (N=41, 40, and 39 for the berotralstat 110-mg, 150-mg, and placebo groups, respectively). Berotralstat demonstrated a significant reduction in attack rate at both 110 mg (1.65 attacks/month; p=0.024) and 150 mg (1.31 attacks/month; p<0.001) relative to placebo (2.35 attacks/month). The most frequent treatment-emergent adverse events (TEAEs) that occurred more with berotralstat than placebo were abdominal pain, vomiting, diarrhea, and back pain. No drug-related serious TEAEs occurred.
CONCLUSION: Both the 110-mg and 150-mg doses of berotralstat reduced HAE attack rates compared with placebo and were safe and generally well tolerated. The most favorable benefit-to-risk profile was observed at a dose of 150 mg/day.

PMID: 33098856 [PubMed - as supplied by publisher]

Pediatric lung transplantation as standard of care.

Clin Transplant. 2020 Oct 23;:e14126

Authors: Werner R, Benden C

Abstract
For infants, children, and adolescents with progressive advanced lung disease, lung transplantation represents the ultimate therapy option. Fortunately, outcomes after pediatric lung transplantation have improved in recent years now producing good long-term outcomes, no less than comparable to adult lung transplantation. The field of pediatric lung transplantation has rapidly advanced; thus, this review aims to update on important issues such as transplant referral and assessment, and extra-corporal life support as "bridge to transplantation". In view of the ongoing lack of donor organs limiting the success of pediatric lung transplantation, donor acceptability criteria and surgical options of lung allograft size reduction are discussed. Post-transplant, immunosuppression is vital for prevention of allograft rejection; however, evidence-based data on immunosuppression are scarce. Drug-related side effects are frequent, close therapeutic drug monitoring is highly advised with an individually tailored patient approach. Chronic lung allograft dysfunction (CLAD) remains the Achilles' heel of pediatric lung transplant limiting its long-term success. Unfortunately, therapy options for CLAD are still restricted. The last option for progressive CLAD would be consideration for lung re-transplant; however, numbers of pediatric patients undergoing lung re-transplantation are very small and its success depends highly on the optimal selection of the most suitable candidate.

PMID: 33098188 [PubMed - as supplied by publisher]

19 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2020/10/24

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Clozapine-induced antineutrophil cytoplasmic antibody-associated vasculitis: a case report.

Mod Rheumatol Case Rep. 2020 Jan;4(1):70-73

Authors: Fujimoto S, Ueda N, Nishimura N, Naito A, Hiura J, Mashiba K, Ikai A, Marutsuka K, Mizuno K

Abstract
Clozapine is the most effective antipsychotic medication for refractory schizophrenia, but it has many possible serious side effects, including antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, the rare case reports available have not presented sufficient characteristic features of drug-induced AAV. Herein, we report a case of a 48-year-old Japanese woman with schizophrenia who presented with fever, arthralgia, myalgia and skin rash after 2 years of clozapine treatment. Her C-reactive protein (CRP) level increased, myeloperoxidase ANCA was positive and skin biopsy revealed leukocytoclastic vasculitis. Initially, steroid administration achieved remission, but her symptoms and high CRP levels relapsed every time the steroid dosage was tapered down. Upon discontinuation of clozapine, her symptoms and elevated CRP level immediately improved and the steroid was successfully tapered and discontinued. This outcome suggested that clozapine was the main cause of AAV.

PMID: 33086971 [PubMed - in process]