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Augmented renal clearance （ARC）refers to the significant enhancement of patients ’renal function ，which is manifested by the significant increase of glomerular filtration rate ，which increases the clearance of drugs ，and the effective blood drug concentration cannot be achieved under the conventional dose. The efficacy of antibiotics is closely related to the concentration. The influence of renal dysfunction on drug metabolism is an important factor that clinicians should consider when determining the dosage. This article reviews the definition ，risk factors ，occurrence mechanism ，evaluation methods of ARC ，as well as its impact on the pharmacokinetics/pharmacodynamics of antibiotics and administration methods. It is found that ARC widely exists in critically ill patients ，and the risk factors include age （≤50 years old ），brain trauma ，sepsis，multiple trauma ， etc. When using antibiotics in ARC patients ，the therapeutic effect of drugs can be improved by increasing the dosage ，prolonging the duration of administration and increasing the frequency of administration. However ，in order to prevent adverse reactions caused by high concentration accumulation of drugs ，it is recommended to try to combine treatment drug monitoring.
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OBJECTIVE：To provide reference for choosing a more economical first-line treatment for advanced or recurrent squamous cell NSCLC and reducting patients ’cost burden. METHODS ：Based on a published high-quality phase Ⅲ randomized clinical controlled trial ，Markov model was established according to the disease development process. The disease development process of patients with squamous cell NSCLC was divided into non-progressive free survival state ，disease progress state and death state. The cost-effectiveness analysis of ND regimen containing nedaplatin and CD regimen containing cisplatin was carried out on the basis of the treatment cost data of our hospital. The uncertainty of the results was evaluated with single factor sensitivity analysis and probability sensitivity analysis. RESULTS ：According to the results of analysis Markov model ，the cost-effectiveness in ND regimen was 54 995.58 yuan/QALYs，in CD regimen was 50 274.36 yuan/QALYs，and incremental cost-effectiveness ratio was 86 327.27 yuan/QALYs，which was lower than the willing payment threshold （193 932.00 yuan/QALYs）. The results of single factor sensitivity analysis showed that non-progressive free survival of patients accepted two regimens had the greatest influence on the cost-effectiveness analysis results. The probability sensitivity analysis showed that with the increase of per capita GDP in China ， the probability of cost-effectiveness of ND regimen increased gradually. CONCLUSIONS ：Compared with CD regimen ，ND regimen is more cost-effective in the treatment of advanced or recurrent squamous cell NSCLC.
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OBJECTIVE： To mine the data of azathioprine related death events based on FDA Adverse Event Report System （FAERS）， and to provide reference safe use of azathioprine in clinic. METHODS： Totally 60 quarters of FARES data were downloaded from 2004Q1 to 2018Q4. After drug names standardized by Medex_UIMA_1.3.7 and adverse events classified by MedDRA， death events related to azathioprine were extracted. The safety signals were detected by using ROR and PRR methods. The death events related to azathioprine were analyzed in respects of patient’s general information， reporter’s information， time and country distribution of reports， signal detection results， dose and drug combination of direct and indirect death， reported frequency of indirect deaths. RESULTS： A total of 39 695 azathioprine related death events were gathered， including 707 direct death reports and 3 219 indirect death reports. The media age was 55 years in dead. Physicians and other health professionals reports took up 77.38％. Azathioprine administered orally took up 90.40％ （647/715） in reported cases of known route of adiministration. “Fetal death” （ROR＝4.16， PRR＝4.16） and “neonatal death” （ROR＝4.99， PRR＝4.99） were detected as signal. About 30 percent of the death reports were the old patients. There were cases using azathioprine beyond contraindications or maximum dosage. Among drug combination， immunosuppressive drugs were used most frequently. Infection events were reported most frequently in indirect deaths （3 122 reports）. CONCLUSIONS： The potential death risk of azathioprine should be paid attention to， and the contraindications and dosage of azathioprine should be strictly controlled. Great importance should be paid attention to medication for special population of the elderly and children. It is suggested that genetic testing and precise drug use should be perfected before using azathioprine.
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OBJECTIVE： To collect and summarize the pharmacoeconomic studies of adalimumab in the treatment of ankylosing spondylitis， and to explore the economics of adamumab in the treatment of ankylosing spondylitis. METHODS：Retrieved from Medline， Embase， Web of Science， VIP， CJFD and Wanfang databases， Chinese search terms included “adalimumab” “humira” “ankylosing spondylitis” “cost effectiveness” “pharmacoeconomic evaluation” “cost utility” “cost efficacy” etc. English search terms included “Adalimumab” “Humira” “Ankylosing spondylitis” “AS” “Cost effectiveness” “Pharmaceutical economic evaluation” “Pharmacoeconomics” “Cost utility” “Cost efficacy”， etc. The language is Chinese or English.The retrieval time was from January 2002 to May 2019. The pharmacoeconomic studies of adalimumab vs. traditional treatment，adalimumab vs. other biological agents in the treatment of ankylosing spondylitis were collected， including cost analysis， cost-effectiveness analysis， cost-effectiveness analysis and cost-benefit analysis.The included studies were summarized in terms of countires， research method and economic evluation results. RESULTS：Six papers were included， involving six studies. The literature was mainly distributed in the UK， Canada and the Netherlands. The Markov model was most commonly used.The incremental cost-effectiveness ratio of adalimumab in the treatment of ankylosing spondylitis was￡19 275-26 556 in UK， and adalimumab had cost-effectiveness advantage. The cost-effectiveness advantage between adalimumab and other biological agents was varied in different studies. CONCLUSIONS： Compared with conventional therapy， adalimumabhas economic advantages in the treatment of ankylosing spondylitis in UK. But there was lack of relevant research in China， which needs to be carried out urgently.
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Objective:To evaluate the effectiveness and safety of butyl phthalide capsules combined with Xueshuantong injection in the treatment of acute cerebral infarction (ACI). Methods: Cochrane Library, Medline, Embase, SCI, CBM, CNKI, VIP and Wanfang databases were searched from the building time to May 2016. The enrolled randomized controlled trails were studied by using Cochrane system evaluation methods to perform methodological quality assessment, and RevMan 5. 2 software was used to carry out Me-ta-analysis. Results:A total of 7 randomized controlled trails including 640 patients were enrolled. The results of Meta-analysis dem-onstrated that the effective rate of butylphthalide capsules combined with Xueshuantong injection was superior to that of Xueshuantong injection (RR=1. 33, 95%CI:1. 16-1. 52, P<0. 0001), butylphthalide (RR=1. 45, 95%CI:1. 15-1. 83, P=0. 002) and blank control (RR=1. 31, 95%CI:1. 08-1. 57, P=0. 005). NHISS of butylphthalide capsules combined with Xueshuantong injection was higher than that of Xueshuantong injection (MD=4. 63, 95%CI:3. 38-5. 87, P<0. 00001) and blank control (MD=6. 85, 95%CI:4. 90-8. 80, P<0. 00001). There was no significant difference in adverse drug reactions. Conclusion: Butylphthalide capsules combined with Xueshuantong injection is effective for the therapy of ACI. However, due to the limited quantity and quality of the in-cluded studies, larger scale trials are needed.
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Objective To evaluate the intervention effectiveness of collaboration among physicians, nurses and pharmacists for elderly people. Methods Randomized controlled trails ( RCT) of collaboration among physicians,nurses and pharmacists for elderly people were gathered from MEDLINE,EMbase,CENTRAL,CNKI,VIP and Wanfang. The retrieved studies were screened according to the inclusion and exclusion criteria, evaluated the quality of included studies, and then performed meta-analyses with The Cochrane Collaboration ' s Revman 5. 3. 0 software. Results Four randomized controlled trials of collaboration among physicians,nurses and pharmacists for elderly people were included. The results of meta-analyses showed that the hospitalization rate, emergency admission rate, mortality and potentially inappropriate medication use were not significantly better in the collaboration group than in the standard of care group [RR=1.02,95%CI (0.93,1.11),P=0.69;RR=0.97,95%CI (0.89,1.05),P=0.42;RR=1.03,95%CI (0.87,1.21),P=0.75;and RR=1.09,95%CI (0.84,1.41),P=0.51,respectively]. There were no statistically significant differences between the collaboration group and the standard of care group. Conclusion Collaboration among physicians, nurses and pharmacists is not therapeutically effective for elderly people. But its long-term efficacy still needs to be confirmed by performing more high quality,large sample RCTs with long term follow-up.
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OBJECTIVE:To analyze the clinical features and correlation factors of ADR caused by second generation antihistamine drugs for references of clinical rational drug use.METHODS:A total of 128 cases ADR cases induced by second generation antihistamine drugs that met our criteria were obtained by retrieving the domestic literature database between 1986 and 2006,which were categorized and analyzed in accordance with the ADR categorization stipulated by WHO international drug monitoring cooperation center.RESULTS:Of the 128 ADR cases,more were seen in male than in female,38 presented cardiovascular system lesions,accounting for 29.69%,followed by lesions of skin and its appendants(28.13%) and systemic reactions(20 cases,15.63%).However,the prognosis of these ADR was satisfactory.CONCLUSION:The ADR caused by second generation antihistamine drugs are associated to many factors such as patients’ sex and physical condition as well as drug combination etc.Clinic should be alert to such ADR such as allergic shock and arhythmia in patients treated with second generation antihistamine drugs.
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OBJECTIVE:To analyze the utilization status and developing trend of drugs in Chengdu area. METHODS:Data regarding the drug variety,consumption quantity and sum of money in 16 hospitals of Chengdu area between 2001 and 2006 were analyzed retrospectively. RESULTS:The drug consumption sum in 16 Hospitals of Chengdu area from 2001 to 2006 increased by 19.56%,27.19%,17.84%,15.08% and 10.40%,respectively,assuming an downtrend. Among the top 14 chief drug categories on the list of consumption sum,the sequence of anti-infective agents,cardiovascular agents,antineoplastic agents and nervous system agents experienced no obvious changes. CONCLUSION:The drug utilization in Chengdu area tends to be rational and standard.
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OBJECTIVE:To discuss the influencing factors of anticoagulation with warfarin in patients who had undergone artificial mechanical heart valve replacement and the relation between dosage regimens and international normalized ratio(INR).METHODS:123 patients who had undergone artificial valve replacement patients were followed-up.The patients were treated with warfarin therapy for anticoagulation after surgery,and given a regular follow-up.Patients' age,gender,and INR value etc were recorded and the adverse events including bleeding,embolism and death were observed.RESULTS:No death case was reported;femoral vein thrombosis occurred in 1 case;gingival bleeding occurred in 11 cases and urinary tract bleeding was noted in 3 case.The incidence of anticoagulation-associated ADR was close to that reported in overseas literature.CONCLUSION:According to INR,individual dose of warfarin should be administered on day 5 after artificial valve replacement.Maintaning INR at 1.5～2.0 can achieve certain anticoagulation efficacy and is relatively safe.
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OBJECTIVE:To review the curative efficacy and safety of itopride vs. domperidone in the treatment of functional dyspepsia(FD). METHODS:Randomized controlled trails(RCTs)of itopride vs. domperidone in the treatment of FD were enrolled and retrieved from Cochrane Library,PubMed,EMBASE,SCI,CBM,CNKI,VIP and Wanfang Database. Other retrieval was carried out by hand. Methodological quality evaluation and meta-analysis of RCTs were carried out. RESULTS:Of total 18 RCTs enrolled,11 RCTs were graded B and 7 RCTs graded C. Itopride group were superior to domperidone group in respect of total response rate,the relief rate of nausea,abdominal distention,belching,vomiting,epigastric pain and sour regurgitation. There was no statistical significance. The incidence of ADR in itopride group was lower than in domperidone group. There was no statistical significance in difference between two groups. The relief rate of anorexia and early satiety in itopride group were superior to domperidone group. Statistical significance was noted in difference between two groups. CONCLUSION:Recent study shows itopride has better effect than domperidone on FD,which should be confirmed by high quality study.
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OBJECTIVE:To study the clinical characteristics and related of the adverse drug reactions(ADR) induced by carbamazepine,and propose preventive solutions.METHODS: 102 cases of carbamazepine-induced ADR,reported in medical journals of China from January 2001 to December 2005,were collected and analyzed.RESULTS:Skin and its appendages received most impairment from carbamazepine-induced adverse reactions(representing 35.3%),followed by general impairment of the body and impairment of the blood & hematopoietic system.Combined use of drugs is liable to induce adverse reactions,indicated by the fact that 16.7% of the sufferers received treatment by combined use of multiple drugs.Most of the ADR occurred 1h after administration.CONCLUSION:Individual differences of patients and combined use of drugs are among the factors that result in carbamazepine-induced adverse reactions.
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OBJECTIVE:To discuss the thoughts and methods for the formation of solid Chinese traditional medicine preparation.METHODS: The thoughts and methods for the formation of solid Chinese traditional medicine preparation were introduced and summarized.RESULTS & CONCLUSION: The design for the formation of solid Chinese traditional medicine preparation was an important part in the preparation process of Chinese materia medica preparations,which should be consummated in the future study so as to enhance the quality of the solid Chinese traditional medicine preparations and facilitate the modernization of traditional Chinese medicine.