The association between antibiotic use and risk of cancer development is unclear, and clinical trials are lacking. We performed a systematic review and meta-analysis of observational studies to assess the association between antibiotic use and risk of cancer. PubMed, the Cochrane Library and EMBASE were searched from inception to 24 February 2019 for studies reporting antibiotic use and subsequent risk of cancer. We included observational studies of adult subjects with previous exposure to antibiotics and available information on incident cancer diagnoses. For each of the eligible studies, data were collected by three reviewers. Risk of cancer was pooled to provide an adjusted odds ratio (OR) with a 95% confidence interval (CI). The primary outcome was the risk of developing cancer in ever versus non-antibiotic users. Cancer risk’s association with antibiotic intake was evaluated among 7,947,270 participants (n = 25 studies). Overall, antibiotic use was an independent risk factor for cancer occurrence (OR 1.18, 95%CI 1.12–1.24, p < 0.001). The risk was especially increased for lung cancer (OR 1.29, 95%CI 1.03–1.61, p = 0.02), lymphomas (OR 1.31, 95%CI 1.13–1.51, p < 0.001), pancreatic cancer (OR 1.28, 95%CI 1.04–1.57, p = 0.019), renal cell carcinoma (OR 1.28, 95%CI 1.1–1.5, p = 0.001), and multiple myeloma (OR 1.36, 95%CI 1.18–1.56, p < 0.001). There is moderate evidence that excessive or prolonged use of antibiotics during a person’s life is associated with slight increased risk of various cancers. The message is potentially important for public health policies because minimizing improper antibiotic use within a program of antibiotic stewardship could also reduce cancer incidence.
Background: Hypertension is usually associated with increased cardiovascular mortality. Uncertainty exists about the possible role of hypertension as a poor prognostic factor for cancer-specific mortality (CSM). To assess the association between preexisting hypertension and the risk of mortality and relapse after a diagnosis of cancer, we performed a systematic review and meta-analysis of published studies. Methods: PubMed, Scopus, Web of Science, the Cochrane Library and EMBASE were searched from inception until May 2020, without language restrictions, for observational studies reporting the prognosis of patients with hypertension and cancer.The primary outcome of the study refers to CSM in hypertensive vs nonhypertensive patients, and secondary endpoints were overall mortality (OM) and progression-or relapse-free survival. The effect size was reported as hazard ratios (HRs) with 95% CIs.Results: Mortality and relapse associated with hypertension in patients with various cancers were evaluated among 1 603 437 participants (n = 66 studies). Overall, diagnosis of cancer and hypertension was associated with an increased independent risk of OM (HR = 1.2 [95% CI, 1.13-1.27], P < .01) and CSM (HR = 1.12 [95% CI, 1.04-1.21], P < .01) but not of relapse (HR = 1.08 [95% CI, 0.98-1.19], P = .14). Conclusions: Among cancer patients, those with pre-existing hypertension have a poorer outcome, probably due to multifactorial reasons. Adequate control of lifestyle, more intensive follow-ups, monitoring for hypertension-and anticancer-related cardiovascular complications, and establishing multidisciplinary cardio-oncology units can be useful measures for reducing mortality and improving care in this setting.
Olaparib is a first-in-class PARP inhibitor that has demonstrated efficacy as maintenance therapy in patients with ovarian cancer. It has been approved as a capsule formulation and after the publication of data from SOLO2 study became available also as tablet formulation. Due to different pharmacokinetic properties, these different formulations cannot be considered bioequivalent nor interchangeable. The tablet formulation has improved bioavailability, reducing pill burden and offering a more convenient dosage regimen. Furthermore, olaparib tablet formulation had a manageable tolerability profile if compared to capsule one, with most of adverse events of mild or moderate severity. Under this light, olaparib tablet formulation is a useful maintenance strategy for recurrent, platinum-sensitive ovarian cancer, providing a more convenient dosing option than the capsule formulation.
BackgroundThe elderly are a high risk population, especially because they are often receiving polytherapy. The use of two or more drugs increases the risk of drug-drug interactions that can easily cause an adverse drug reaction. Pharmacokinetic interactions concern absorption, distribution, metabolism and elimination of drugs: the most common site of interaction is hepatic metabolism and the various subtypes of cytochrome P450.PurposeTo analyse the number of prescriptions containing possible pharmacokinetic interactions. The prescriptions were verified for both hepatic metabolism and P-glycoprotein (PgP, or MDR1) interactions.Material and methodsWe evaluated discharge prescriptions from the medical area (cardiology, rehabilitation, neurology and medicine) from 1 January 2014 to 30 June 2014. We used two websites to check the cytochrome P450 isozymes responsible for drug metabolism and its possible induction/inhibition. The same websites gave us information about possible interactions mediated by the PgP.ResultsWe analysed 833 discharge prescriptions, 176 of which contained theoretical drug-drug interactions (21.13%). 55.68% of these prescriptions came from the cardiology unit (98 of 176). This unit prescribed 45 times (15.05% of 299 cardiology prescriptions) clopidogrel with pantoprazole: this proton pump inhibitor reduces the concentration of the active metabolite of clopidogrel by 20% through inhibition of CYP2C19. Digoxin and warfarin are drugs with a low therapeutic index. Physicians showed good prescribing behaviour: 11.93% (21) of 176 prescriptions contained possible interactions, respectively, 14 and 7. A risky interaction occurred between warfarin and prednisone that enhanced CYP3A4 action, reducing warfarin blood levels. 29 prescriptions (3.48%) included possible interactions at the PgP level with various active principles, such as spironolactone, atorvastatin, prednisone and amiodarone. 19 (65.52%, 19 of 29) interactions concerned atorvastatin. Analysing the prescriptions of the medicine unit (20), 11 (55%) contained quinolones and glucocorticosteroids:co-administration of these two drugs may increase the risk of tendon rupture.ConclusionThis study focused on the pharmacokinetic interactions evaluable at discharge of patients. It intended to check if physicians are aware of the pharmacokinetic interactions by analysing their discharge prescriptions, and by evaluating the most common interactions.References and/or Acknowledgements No conflict of interest.
BackgroundWhile verifying the dosage and pharmaceutical form, the pharmacist also has to check the correct compilation of the prescription. Dispensing the first cycle of therapy at discharge, the hospital pharmacist should always verify whether the physician has correctly completed all fields of the prescription. Agenzia Italiana FArmaco (AIFA) developed a tool to simplify this process: a set of’ ‘notes’, initially conceived as an instrument for government expenditure on pharmaceuticals that is now a means of ensuring the pertinent use of drugs.PurposeTo evaluate both the characteristics of the population to whom the prescription is addressed and the respective prescription, paying attention to errors/gap in AIFA notes. We also evaluated the number of prescriptions containing drugs out of the hospital formulary (FN) and drugs not reimbursed by the National Health Service (C drugs).Material and methodsThis retrospective study was performed to evaluate discharge prescriptions from 1 January 2014 to 30 June 2014 to obtain data about the patient (sex, age) and the use of AIFA note methodology. The evaluated units were cardiology, rehabilitation, neurology and medicine.ResultsOur pharmacists dispensed about 90 active principles and the drugs distributed most frequently were enoxaparine (15%), pantoprazole (11%) and ramipril (7%). We analysed 833 prescriptions, 471 for men and 362 for women. The average age obtained from the prescription was 72.50 years (70.65 for men, 74.35 for women). 349 prescriptions (41.90%) contained active ingredients that do not need AIFA notes and 373 contained the right notes. The prescriptions with incorrect or incomplete notes were 110, respectively, 11.64% (97) and 1.56% (13). The most frequently incorrect notes concerned proton pump inhibitors (note 1 and 48, 53.61%) and cholesterol lowering drugs (note 13, 11.34%). 130 prescriptions contained FN drugs (15.61%), of which 53 (40.77%) were C drugs.ConclusionThis analysis shows how physicians’ prescribing could be improved; 13.20% of prescriptions had wrong or incomplete notes. The study also underlines an increase in the number of prescriptions containing C drugs, highlighting the need for better information about the formulary to physicians.References and/or AcknowledgementsLegge 16 November 2001, p. 405 No conflict of interest.
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