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OBJECTIVE：To ev aluate pha rmacoeconomics of magnesium isoglycyrrhizinate preventing liver damage induced by chemotherapeutic drugs for gastric cancer ，and to provide reference for rational use of liver-protecting drugs. METHODS ：Totally 200 inpatient medical records were collected from our hospital retrospectively during Jan. 2018-Feb. 2020，and then divided into group A （prophylactic use of magnesium isoglycolate ，50 cases），group B （prophylactic use of magnesium isoglycolate combined with TCM prescriptions ，50 cases），group C （prophylactic use of polyene phosphatidylcholine ，50 cases） and group D （non-prophylactic use of liver-protection drugs ，50 cases）. The effects （total response rate ）of four plans preventing liver damage were evaluated. Pharmacoeconomic evaluation was analyzed by cost-minimization analysis and cost-effectiveness method ， sensitivity analysis was carried out at the same time . RESULTS ：Total response rates of group A ，B，C and D were 94.00％， 96.00％，82.00％ and 72.00％. The total response rates of group A and B had no statistical significance （P＞0.05），but were significantly higher than those of group C and D （P＜0.05）；total response rate of group C was significantly higher than that of group D （P＜0.05）. The costs of groups A ，B，C and D were 1 936.70，2 086.96，1 800.91，2 975.42 yuan. The cost-minimization analysis was used to compare the therapeutic plan of group A and B ，and plan of group A was more economical. The cost-effectiveness method was used to compare therapeutic plan between group C and D ，and the plan of group C was more economical. The cost-effectiveness method was used to compare therapeutic plan between group A and C ，and the cost-effectiveness ratio of 2 groups were 2 060.32 and 2 196.2 3，incremental cost-effectiveness ratio was 1 131.58，and the plan of group A was more economical. Above conclusion were supported by the results of sensitivity analysis. CONCLUSIONS ：The cost-effectiveness of magnesium isoglycyrrhizinate preventing liver damage induced by chemotherapeutic drugs for gastric cancer is better than magnesium isoglycyrrhizinate combined with TCM prescription ， polyene phosphatidylcholine and non-prophylactic use of liver-protecting drugs ，showing economical advantage.
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Resumen Objetivos: elaborar un listado actualizado de medicamentos causantes de hepatotoxicidad e identificar, de acuerdo con la evidencia científica, los medicamentos con mayor probabilidad de causar hepatotoxicidad. Método: se realizó una búsqueda en PubMed/Medline utilizando términos Mesh: "liver disease" y "drug-induced liver injury". La búsqueda se filtró por: reportes de casos, revisiones, ensayos clínicos, metaanálisis y cartas, hasta diciembre de 2015, en inglés, español y francés. Se incluyeron artículos con evidencia de hepatotoxicidad causada por medicamentos y referencias relevantes; fueron excluidos artículos sin relación con los objetivos de la búsqueda, relacionados con hepatotoxicidad por agentes diferentes, concernientes a otras causas de enfermedad hepática o relacionados con ensayos predictivos o células madre. Algunos aspectos de los medicamentos hepatotóxicos fueron: aparición de hepatotoxicidad, tipo de lesión, mecanismos de hepatotoxicidad, factores de riesgo y manifestaciones clínicas. Para valorar la probabilidad de aparición de hepatotoxicidad y del tipo de lesión se establecieron 3 categorías: definida, probable y posible. Resultados: se identificaron 610 artículos de los cuales se eligieron 402, se excluyeron 208 artículos. Se elaboró un listado con 181 medicamentos y 17 formas farmacéuticas combinadas o regímenes terapéuticos con probabilidad de causar hepatotoxicidad; de estos, 6 medicamentos tuvieron probabilidad definida (metotrexato, minociclina, vancomicina, everolimus, isoniazida y tamoxifeno). Conclusiones: se identificaron más de 180 medicamentos hepatotóxicos, 6 tienen una probabilidad definida, mientras que para la mayoría es posible. La consolidación de la información demostró que diversas categorías de medicamentos tienen mayor probabilidad de ser causantes de hepatotoxicidad.
Abstract Objectives: The aim of this study was to prepare an updated list of drugs that cause hepatotoxicity and identify drugs most likely to cause hepatotoxicity according to scientific evidence. Method: A search of PubMed/Medline was conducted using the MeSH terms: "Liver disease" and "Drug-induced Liver Injury". The search was filtered by case reports, reviews, clinical trials, metaanalyses and letters until December 2015. The search was limited to articles in English, Spanish and French. Articles with evidence of hepatotoxicity caused by medications and relevant references were included. Articles not related to the objectives of the search were excluded. These include articles related to hepatotoxicity due to other agents, articles about other causes of liver disease and/or articles related to predictive tests or stem cells. Some aspects of hepatotoxic drugs were appearance of hepatotoxicity, type of injury, mechanisms of hepatotoxicity, risk factors and clinical manifestations. Three categories, definite, probable and possible, were established to assess probability of hepatotoxicity and type of lesion. Results: Six hundred ten articles were identified, 402 articles were chosen, and 208 articles were excluded. A list was prepared with 181 drugs and 17 combined pharmaceutical forms or therapeutic regimens likely to cause hepatotoxicity. Of these, methotrexate, minocycline, vancomycin, everolimus, isoniazid, and tamoxifen were categorized as definite probabilities. Conclusions: More than 180 hepatotoxic drugs were identified, six were categorized as definite probabilities, and most were categorized as possibilities. The consolidation of information shows that diverse categories of drugs are likely to cause liver toxicity.
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Toxicity , Chemical and Drug Induced Liver InjuryABSTRACT
OBJECTIVE:To observe the preventive effects and safety of 3 kinds of drugs on chemotherapy-induced liver dam-age in patients with gastrointestinal tumors,and to evaluate economics. METHODS:A total of 128 patients with gastrointestinal malignant tumor and systemic chemotherapy indication selected from our hospital during 2014-2015 were divided into group A(42 cases),B(46 cases)and C(40 cases)according to random number table. Since the first day of chemotherapy,group A,B and C were given Reduced glutathione for injection(1.2 g),Magnesium isoglycyrrhizinate injection(100 mg)and Polyene phosphati-dylcholine injection(465 mg)for preventing chemotherapy-induced liver damage respectively,for 7 d. The preventive effects and ADR occurrence were observed in 3 groups,and the economic analysis was conducted. RESULTS:Total response rates of group A,B and C were 90.48%,97.83% and 87.50%,and that of group B was significantly higher than other 2 groups,with statistical significance(P<0.05). But there was no statistical significance between group A and C(P>0.05). The costs of group A,B and C were 1 465.86,1 518.94,1 554.04 yuan,and cost-minimization analysis was adopted to evaluate the plans of group A and C. The plan of group A was more economical. Cost-effectiveness analysis was used to evaluate the plans of group A and B,cost-effectiveness ratio of group A and B were 1 620.09 and 1 552.63;incremental cost-effectiveness ratio was 722.18, and the plan of group B was more economical. The above conclusion was supported by the results of sensitivity analysis. Three patients in group B suffered from transient elevated blood pressure and then recovered 2-3 d after drug withdrawal. CONCLU-SIONS:The preventive effects and economics of Magnesium isoglycyrrhizinate injection is better than Reduced glutathione for injection and Polyene phosphatidylcholine injection for chemotherapy-induced liver damage in patients with gastrointestinal tu-mors. The blood pressure of patients should be monitored closely during application. Reduced glutathione for injection is more suitable for patients with primary hypertensive disease.
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OBJECTIVE:To observe the preventive effects and safety of 3 kinds of drugs on chemotherapy-induced liver dam-age in patients with gastrointestinal tumors,and to evaluate economics. METHODS:A total of 128 patients with gastrointestinal malignant tumor and systemic chemotherapy indication selected from our hospital during 2014-2015 were divided into group A(42 cases),B(46 cases)and C(40 cases)according to random number table. Since the first day of chemotherapy,group A,B and C were given Reduced glutathione for injection(1.2 g),Magnesium isoglycyrrhizinate injection(100 mg)and Polyene phosphati-dylcholine injection(465 mg)for preventing chemotherapy-induced liver damage respectively,for 7 d. The preventive effects and ADR occurrence were observed in 3 groups,and the economic analysis was conducted. RESULTS:Total response rates of group A,B and C were 90.48%,97.83% and 87.50%,and that of group B was significantly higher than other 2 groups,with statistical significance(P<0.05). But there was no statistical significance between group A and C(P>0.05). The costs of group A,B and C were 1 465.86,1 518.94,1 554.04 yuan,and cost-minimization analysis was adopted to evaluate the plans of group A and C. The plan of group A was more economical. Cost-effectiveness analysis was used to evaluate the plans of group A and B,cost-effectiveness ratio of group A and B were 1 620.09 and 1 552.63;incremental cost-effectiveness ratio was 722.18, and the plan of group B was more economical. The above conclusion was supported by the results of sensitivity analysis. Three patients in group B suffered from transient elevated blood pressure and then recovered 2-3 d after drug withdrawal. CONCLU-SIONS:The preventive effects and economics of Magnesium isoglycyrrhizinate injection is better than Reduced glutathione for injection and Polyene phosphatidylcholine injection for chemotherapy-induced liver damage in patients with gastrointestinal tu-mors. The blood pressure of patients should be monitored closely during application. Reduced glutathione for injection is more suitable for patients with primary hypertensive disease.
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OBJECTIVE:To systematically review the efficacy and safety of Magnesium isoglycyrrhizinate injection versus 4 comnon medicines in the treatment of drug-induced liver damage,and to provide evidence-based reference for clinic treatment. METHODS:Retrieved from PubMed,EMBase,Cochrane Library,CBM,CJFD,Wanfang Database and VIP Database,random-ized controlled trials (RCT) about Magnesium isoglycyrrhizinate injection versus other medicines in the treatment of drug-induced liver damage were enrolled. Meta-analysis was performed by using Rev Man 5.3 software after literature selection,data extract and quality assessment. RESULTS:A total of 13 RCTs were included,involving 1 093 patients. Results of Meta-analysis showed clini-cal effective in magnesium isoglycyrrhizinate group was significantly higher than tiopronin group[RD=0.29,95%CI(0.17,0.42), P<0.001] and diammonium glycyrrhizinate group [RD=0.07,95%CI(0.01,0.12),P=0.02],compared with glutathione group and compound ammonium glycyrrhetate group,there were no significant differences ;incidence of adverse reactions in magnesium iso-glycyrrhizinate group was significantly lower than diammonium glycyrrhizinate group [RD=-0.07,95%CI(-0.11,-0.03),P<0.001] and compound ammonium glycyrrhetate group[RD=-0.21,95%CI(-0.38,-0.04),P=0.02],compared with triopro-nin group and glutathione group,there were no significant differences among 3 groups. CONCLUSIONS:Magnesium isoglycyrrhiz-inate injection has better efficacy and safety than other 4 commons hepatoprotective medicines in the treatment of drug-induced liver damage. Due to the limit of methodological quality,more large-scale and long-term follow-up studies with strict designed are need-ed for the further verification of the conclusion.
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Objective:To study the effects of cyclosporine A coadministrated with azathioprine,mycophenolate, mizorihine,rapamycin and/or prednisone on liver function in renal transplant recipients.Method:The drug history records of 600 renal transplant recipients in 1995 to 2005 were retrospectively investigated.Biochemical indexes before and after the treatment with cyclosporine A coadministrated with other immunosuppressants were analyzed.Result:The liver damage was found in 109 cases(18.2%)among 600 cases.The blood concentrations of cyclosporine A in the group with abnormal liver functions were significantly higher than those in the group with normal liver functions(P
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Objective To explore the protective effect of herbal medicine to tonify qi and strengthen the spleen on liver damage induced by antituberculotic according to the TCM theory "reinforce the earth to reduce the wood".Methods The 100 tuberculosis patients randomized into two groups,50 in each,all took antituberculosis drugs with the liver-protecting medicine,Tiopronin,and the herbal medicines to nourish qi and strengthen the spleen were administered to those in the treatment group.Incidence of liver damage and the changes of liver function including serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TBiL) were observed for four weeks.Results In the treatment group,the incidence of liver damage was significantly lower than that in the control group(P
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OBJECTIVE:To establish a way to monitor drug-induced liver damage by using hospital centralized management system for monitoring ADR.METHODS:Using self-designed computer program,the data of inpatients with abnormal ALT,AST and TBIL,admitted in the period from Dec. 2001 to Feb. 2002,were extracted from hospital HIS system of databa_se,and ADR and irrational drug-use were retrospectively analysed.RESULTS:There were 50 ADR incidents concerned with 30 kinds of drug and 11 cases receiving irrational medication concerned 10 kinds of drug.CONCLUSION:By this way,we can timely get the information of drug-induced liver damage and set up a new way for developing centralized ADR monitoring in hospital.