Vitamin K3 analogs may have potential as clinical therapeutic agents for NB.
BackgroundClopidogrel and aspirin are antiplatelet agents that are recommended to reduce the risk of recurrent stroke and other cardiovascular events. Dual antiplatelet therapy with clopidogrel and aspirin has been shown to increase the risk of hemorrhage, but the effects of the drugs on laboratory parameters have not been well studied in real-world clinical settings. Therefore, we evaluated and compared the effects of combination therapy with clopidogrel plus aspirin and aspirin monotherapy on laboratory parameters.MethodsWe used data from the Nihon University School of Medicine Clinical Data Warehouse obtained between November 2004 and May 2011 to identify cohorts of new users (n = 130) of clopidogrel (75 mg/day) plus aspirin (100 mg/day) and a propensity score matched sample of new users (n = 130) of aspirin alone (100 mg/day). We used a multivariate regression model to compare serum levels of creatinine, aspartate aminotransferase, and alanine aminotransferase, as well as hematological parameters including hemoglobin level, hematocrit, and white blood cell, red blood cell, and platelet counts up to 2 months after the start of administration of the study drugs.ResultsThere were no significant differences for any characteristics and baseline laboratory parameters between users of clopidogrel plus aspirin and users of aspirin alone. Reductions in white blood cell and red blood cell counts, hemoglobin levels, and hematocrit in users of clopidogrel plus aspirin were significantly greater than those in users of aspirin alone.ConclusionOur findings suggest that adverse hematological effects may be greater with combination clopidogrel plus aspirin therapy than with aspirin monotherapy.
The number of all patients, intoxicated patients, the rate of the number and types of used injection drugs were investigated. Also the number of cases of drug information pharmacists gave to physicians or nurses whether orally or in writing was investigated. In this study the proportion of intoxicated patients to all patients was 25 (6.7%) in group 9-17, 27 (8.4%) in group 17-1, and 28 (14.1%) in group 1-9, indicating group 1-9 was significantly higher than group 9-17. The majority (73 cases (54%)) of information supplied in the initial treatment was about intoxication. In emergency and critical care, patients are admitted at anytime. Furthermore, intoxicated patients are more likely to be admitted at nighttime. Moreover, drug information about intoxication, drug dose and effects are needed. Therefore, it is suggested that pharmacists 24-hour participation in initial treatment is necessary and pharmacists are required to participate more in emergency and critical care.
The absorption of gefitinib is dependent on gastric pH. However, an increase in gastric pH via the use of antacids such as proton pump inhibitors (PPI) and histamine H2 receptor antagonists may reduce the bioavailability and efficacy of gefitinib.In this study, we report the influence of the concurrent use of antacids with gefitinib on the efficacy in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). Our subjects were 68 patients with NSCLC who were treated with gefitinib at our hospital between 2008 and 2015.In the study, we compared time to treatment failure (TTF), overall survival (OS), response rate, disease control rate and adverse effect rates in patients receiving antacids in combination as well as (AC; n = 29) with those only receiving gefitinib (no AC; n = 34). The patients in the AC group exhibited a significant difference in TTF (409 days (95%CI: 1.00-4.22) vs 901 days (95%CI: 0.24-0.99), P = 0.0492) as compared to the no AC group. But then the OS, response rate, disease control rate and adverse effects rate were not significant between each group. Therefore, this study suggests that, as long as the combination of gefitinib with antacids is avoided, the combination with antacids should not impair the clinical efficacy of gefitinib. From the results of the sub-analysis, this study suggests that, in particular men, less than 75 years old, PS≧2, pulmonary metastasis, it is preferable to avoid the combination of gefitinib and antacids. Key words -non-small cell lung cancer, gefitinib, histamine H2 receptor antagonist, proton pump inhibitor, drug interaction 緒 言 Gefitinib は上皮成長因子受容体 ( epidermal growth factor receptor: EGFR )を特異的かつ可逆的に阻 害して恒常的に活性化した EGFR 下流シグナル を抑制することで抗腫瘍効果を発揮する.IPASS 試験において非小細胞肺がんに対する標準化学療 法( carboplatin/paclitaxel )と比較し,無増悪生存 期間( progression free survival: PFS )を有意に延 長させる. 1) 特に EGFR 遺伝子変異陽性の集団で はより効果が担保される報告に基づき NCCN ガ イドライン( 2017 年第 3 版 -2016 年 11 月 16 日
Maintaining Average Relative Dose Intensity (ARDI) in neo adjuvant chemotherapy and adjuvant chemotherapy in breast cancer leads to an improved therapeutic effect, but few patients have clear indicators.In the study we report the effect of ARDI on the treatment effect in EC followed by weekly nab-PTX therapy. Our subjects were 48 patients with breast cancer who received EC followed by weekly nab-PTX therapy in neo adjuvant chemotherapy and adjuvant chemotherapy at Nihon University Itabashi Hospital between 2012 and 2017.In the study we compared Disease-free survival (DFS) and adverse effect rates between the two groups of the ARDI ≥ 90% group and ARDI < 90% group. The patients in the ARDI ≥ 90% group exhibited signi cant difference in 2 years DFS and 3 years DFS (2 years DFS: P = 0.0095, 3 years DFS: P = 0.0019) as compared to the ARDI < 90% group. In terms of the adverse effect incidence rate, pathological subtype by type DFS, there was no difference between the two groups. Maintaining ARDI at 90% or higher in this study leads to improvement of the therapeutic effect.
Purpose: Chronic pain is a common symptom that is suffered by 20% of the overall population in Japan. Although pharmacotherapy is critical for the treatment of chronic pain, there are no reports on the pharmacies. In the present study, we examined the effect of hospital–community pharmacy cooperative training on improving drug-taking compliance, pain relief, anxiety, insomnia, and motor function in patients with chronic pain. Patients and methods: The subject sample included 87 patients with chronic pain who were examined for the first time at the outpatient services department of Nihon University Itabashi Hospital. Patients were interviewed to obtain information regarding drugs used before and after the treatment, habitually used community pharmacies, presence of cooperative training with Itabashi Hospital, drug-taking compliance, and side effects. We compared treatment outcomes before and after consultation using the Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS), EuroQol Group measure (EQ-5D) for quality of life, Athens Insomnia Scale, and Locomo 25 scale for motor function. Results: In patients who used community pharmacies that perform training, drug-taking compliance was significantly better, and a significant improvement was observed in the scores of BPI, HADS Anxiety, Athens Insomnia, and Locomo 25. Conclusion: Pharmacotherapy is essential for the treatment of chronic pain. To this end, appropriate drugs with proper drug management guidance are indispensable. In this study, the use of community pharmacies that have undergone cooperative training with hospitals improves pain and anxiety. This is achieved through proper drug management guidance, shared awareness of drug information, and achievement of better drug-taking compliance. To improve the quality of treatment for chronic pain, involvement of community pharmacies such as by providing accurate information is essential. In the future, expanding cooperative training with hospitals may further help reassure patients, facilitate drug-taking, and improve the quality of treatment for chronic pain.
Docetaxel is an extensively used taxane, frequently associated with hypersensitivity reactions (HSR). We examined whether the dilution concentration affects the incidence rate of HSR, and set up a concentration that can control HSR. We also established management of HSR that were caused by docetaxel. Retrospective analysis was performed at a single institution in 471 consecutive patients treated with the regimen, including docetaxel for breast cancer, gastric cancer, non-small-cell lung cancer, prostate cancer and skin cancer from 2006 to 2011. Among 471 patients, 90 were in the 250 mL group and 381 were in the 500 mL group. The rate of HSR was 14.4% in the 250 mL group vs 2.4% in the 500 mL group (P<0.01). Regarding the duration of HSR, there was no significant difference between the two groups (1.69 ± 0.75 cycles vs 2.22 ±1.71 cycles). The seriousness of HSR was similar in the two groups (250 mL groups; G1:61.5%, G2:30.8%, G3/G4:7.7% vs 500 mL groups; G1:77.8%, G2:11.1%, G3/G4:11.1%). Moreover, no difference was found in the rate of HRS below 0.02 w/v% standard concentration, when all patients were divided into another two groups (above the standard concentration; Above Group, below the standard concentration; Below Group). In conclusion, our present data suggest that the dilution concentration of docetaxel strongly affects the rate of HSR. Moreover, if the dilution concentration of docetaxel is below 0.02 w/v% (cutoff value), it is suggest that HSR can be controlled. These findings show that the dilution concentration of docetaxel can become a tool that for controlling HRS in addition to the existing premedication.
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