Clinical Pharmacy[JOURNAL]
Sun
200 papers
Severe cutaneous adverse reactions linked to medications in children and adolescents: a pharmacovigilance study based on the FDA Adverse Event Reporting System database.
Xiao Y, Guo H, Deng L … +2 more , Huang J, Sun Q
Int J Clin Pharm · 2026 Feb · PMID 41335163 · Publisher ↗
INTRODUCTION: Severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening. Children and adolescents are especially vulnerable due to developmental pharmacology, immature immune systems, and limit...
INTRODUCTION: Severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening. Children and adolescents are especially vulnerable due to developmental pharmacology, immature immune systems, and limited premarketing safety data. However, large-scale evidence of drug-specific SCAR patterns in pediatric populations remains limited. AIM: To investigate the epidemiology, clinical features, drug associations, and safety signals of SCARs in children and adolescents using the FDA Adverse Event Reporting System (FAERS). METHOD: Reports of SCARs in patients aged ≤ 18 years were retrieved from FAERS from Q1 2004 to Q2 2024 and identified using narrow-scope Standardised MedDRA Queries (SMQs). Data cleaning followed the FDA-recommended procedures. Disproportionality analysis was performed using four methods: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN; yielding Information Component, IC), Multi-item Gamma Poisson Shrinker (MGPS), and empirical Bayes geometric mean (EBGM). Drug-label reviews were used to compare the signal detection results with existing safety warnings. RESULTS: A total of 7183 pediatric SCAR reports were included. The number of reports has increased over time, with adolescents (13-17 years) and school-aged children (7-12 years) accounting for 68% of cases. The most frequently reported Preferred Terms were drug reaction with eosinophilia and systemic symptoms (DRESS; 32.5%), Stevens-Johnson syndrome (SJS; 27.9%), and toxic epidermal necrolysis (TEN; 19.0%). Hospitalization occurred in 64.5% of cases, and 6.3% were fatal. Among the 2005 cases with available onset time, 82.7% developed within 30 days of drug exposure. Thirty-eight drugs showed positive signals, including lamotrigine, phenytoin, sulfamethoxazole, and phenobarbital. Four drugs, ranitidine, anakinra, clonazepam, and rifampin, showed signals without corresponding warnings in the FDA pediatric labeling. CONCLUSION: SCARs in children and adolescents show distinct patterns, high hospitalization and mortality, and strong links with antiepileptics and anti-infectives. Strengthening pediatric pharmacovigilance, implementing risk-alert systems, and promoting genotype-guided prescribing may help prevent these severe reactions.
Multilevel determinants of medication adherence among Chinese patients with chronic diseases: an ecological analysis based on the health ecology model.
Yang L, Wu Y, Gu Z … +3 more , Cao Q, Zhang Z, He Y
Int J Clin Pharm · 2026 Jun · PMID 41324742 · Full text
INTRODUCTION: Medication adherence is essential for the effective management of chronic diseases; however, adherence among patients remains suboptimal in China. Understanding the multidimensional determinants of adherenc...
INTRODUCTION: Medication adherence is essential for the effective management of chronic diseases; however, adherence among patients remains suboptimal in China. Understanding the multidimensional determinants of adherence is critical in designing interventions to improve treatment outcomes. The health ecology model (HEM) provides a comprehensive framework that integrates individual, behavioral, social, and environmental influences on health behaviors. AIM: This study aimed to identify the multilevel determinants of medication adherence among Chinese patients with chronic diseases using an ecological framework based on the HEM and to provide evidence to inform pharmacist- and policy-driven strategies to enhance adherence. METHOD: Data were derived from the 2021 Psychology and Behavior Investigation of Chinese Residents, a nationally representative survey of 1162 adults with chronic diseases. Medication adherence was assessed using the Medication Adherence Rating Scale. Independent variables were categorized into five hierarchical levels according to the HEM: personal traits, behavioral characteristics, interpersonal networks, working and living conditions, and policy environment. Binary logistic regression analyses were performed sequentially to identify factors associated with good medication adherence. RESULTS: Among the participants, 23.8% demonstrated good adherence to medication. In the final regression model (AUC = 0.721; Hosmer-Lemeshow p = 0.790; R = 0.168), higher adherence was significantly associated with older age (OR 1.616, p < 0.01), lower depression levels (OR 0.663-0.869, p < 0.05), absence of alcohol use (OR 1.485, p < 0.05), being married OR 1.829, p < 0.01), higher education (OR 1.784, p < 0.05), higher income (OR 1.679, p < 0.01), and eligibility for medical subsidies (OR 1.763, p < 0.01). CONCLUSION: This nationwide study demonstrated that medication adherence among Chinese patients with chronic diseases is influenced by interconnected personal, psychosocial, and socioeconomic factors. Multifaceted interventions, including pharmacist involvement in adherence monitoring, family-based support, mental health screening, and the expansion of subsidy programs, may improve medication adherence and optimize chronic disease management.
Pharmacist input to depression screening and management in patients with diabetes: a systematic review.
Al-Hawamdeh MI, Al Raisi F, Al-Aladawi RM … +2 more , Abu-Huwaij R, Tonna AP
Int J Clin Pharm · 2026 Apr · PMID 41313582 · Full text
INTRODUCTION: Depression affects approximately 5% of the global adult population, and its clinical and economic burden is particularly pronounced among individuals with chronic conditions such as diabetes mellitus, where...
INTRODUCTION: Depression affects approximately 5% of the global adult population, and its clinical and economic burden is particularly pronounced among individuals with chronic conditions such as diabetes mellitus, where it is frequently underdiagnosed and inadequately managed. Pharmacists play an important role in managing chronic diseases, including depression, through screening and medication management. AIM: This systematic review aimed to critically appraise and synthesize evidence on pharmacist input in screening and managing depression among patients with diabetes, either as sole providers or as part of a multidisciplinary team, and assess their impact on clinical outcomes and quality of life. METHOD: A systematic literature search was conducted in March 2023 and updated in March 2025 across Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA) databases, and reported in accordance with the PRISMA 2020 guidelines. Studies, irrespective of their design and published in English, reporting any pharmacist input in screening and managing depression among patients with diabetes, were included. No date restrictions were applied. Data extraction was based on Donabedian's quality-of-care model, which categorizes findings into structure, process, and outcome. The results were presented in both narrative and tabular formats. Quality was assessed by two independent researchers via the Mixed Methods Appraisal Tool. RESULTS: Among the 1,852 records screened, 10 studies met the inclusion criteria. The studies described pharmacist input in depression screening n = 4, medication therapy management n = 6, telehealth services n = 2, and shared medical appointments n = 1. The most reported setting was outpatient clinics, n = 5. All studies demonstrated the positive impact of pharmacists on depression screening, treatment initiation, and medication adherence., Some interventions failed to significantly improve clinical parameters such as HbA1c levels or depressive symptoms. Barriers included limited physicians' response to screening results and a lack of structured care models. CONCLUSION: The positive impact of pharmacist interventions on this patient cohort is evident despite the variability across settings and intervention designs, reflecting the adaptability of pharmacist services. Results also suggest the need for standardized models of care and consistent outcome reporting.
Correction: Optimizing tacrolimus dosage in post‑renal transplantation using DoseOptimal framework: profiling CYP3A5 genetic variants for interpretability.
Raval CU, Makwana A, Patel S … +2 more , Hemani R, Pandey SN
Int J Clin Pharm · 2026 Feb · PMID 41307813 · Publisher ↗
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Correction: European Society of Clinical Pharmacy: 'From interprofessional education to interprofessional practice'.
Bedouch P, Lutters M, Bardet JD
Int J Clin Pharm · 2026 Feb · PMID 41307812 · Publisher ↗
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Evaluation of high dose post-dialytic versus daily beta-lactam dosing in hemodialysis patients using Monte Carlo simulation.
Bauman AJ, Caiazza OG, Wan N … +4 more , Payer S, Pauly OG, Shoemaker S, Lewis SJ
Int J Clin Pharm · 2026 Apr · PMID 41296203 · Full text
INTRODUCTION: Daily intravenous dosing of cefepime, meropenem and ceftazidime/avibactam is recommended in patients receiving intermittent hemodialysis (IHD), but requires hospitalization or frequent clinic visits. High d...
INTRODUCTION: Daily intravenous dosing of cefepime, meropenem and ceftazidime/avibactam is recommended in patients receiving intermittent hemodialysis (IHD), but requires hospitalization or frequent clinic visits. High dose post-HD administration may offer a more convenient outpatient alternative, but supporting data is limited. AIM: To evaluate the feasibility by assessing predicted pharmacokinetic/pharmacodynamic (PK/PD) target attainment and neurotoxicity risk of high-dose post-HD versus daily dosing strategies for cefepime, meropenem, and ceftazidime/avibactam in patients receiving thrice-weekly IHD, using the Monte Carlo simulation (MCS) techniques. METHOD: One-compartment pharmacokinetic models were developed using published data to simulate drug exposure in anuric patients receiving 4-h IHD thrice-weekly. MCS (Crystal Ball, Oracle) assessed the probability of target attainment (PTA) and neurotoxicity risk of various post-HD and daily dosing regimens in 5,000 virtual cohorts for one week. The PK/PD targets were ≥ 60% fT > MIC for cefepime, ≥ 40% fT > MIC for meropenem and ≥ 50% fT > MIC for ceftazidime with ≥ 50% fT > 1 g/mL for avibactam, assuming Pseudomonas aeruginosa or Enterobactarales infections. A PTA ≥ 90% was considered optimal for PK/PD target attainment. Safety was also assessed using the neurotoxicity thresholds. RESULTS: All daily regimens achieved PTA ≥ 90% on all simulated days. High-dose post-HD cefepime (1-2 g) and meropenem (2 g) maintained acceptable PTA over 2-day interdialytic periods, but failed to sustain targets through the 3-day period. Ceftazidime/avibactam post-HD dosing (0.94 g-0.94 g-2.5 g) maintained ≥ 90% PTA for ceftazidime throughout the week, though avibactam fell slightly below target on the final day. Predicted neurotoxicity risk was negligible for meropenem and ceftazidime/avibactam, but elevated with higher cefepime doses (1-2 g post-HD and 1 g daily). Cefepime 0.5 g daily, meropenem 0.25-1 g daily, and ceftazidime/avibactam 0.94 g daily or 0.94 g-0.94 g-2.5 g post-HD attained both PK/PD targets and safety targets. CONCLUSION: High-dose post-HD dosing appears feasible for ceftazidime/avibactam but may be inadequate for cefepime and meropenem over a 3-day interdialytic period. Elevated neurotoxicity risk predicted with higher cefepime doses highlights the importance of cautious dosing and consideration of therapeutic drug monitoring.
Identification of factors associated with non-adherence to oral endocrine therapy in breast cancer patients of low socioeconomic status: a single centre retrospective study.
Kalyani G, Ma C, Pruneda PS … +5 more , Fatima B, Sheriff R, Abughosh S, Ozuna R, Trivedi MV
Int J Clin Pharm · 2026 Feb · PMID 41288895 · Publisher ↗
INTRODUCTION: The standard treatment for Hormone Receptor-Positive breast cancer (BC) is Oral Endocrine Therapy (OET). OET reduces BC recurrence rates by ~ 50%, and non-adherence to OET leads to worse outcomes. However,...
INTRODUCTION: The standard treatment for Hormone Receptor-Positive breast cancer (BC) is Oral Endocrine Therapy (OET). OET reduces BC recurrence rates by ~ 50%, and non-adherence to OET leads to worse outcomes. However, OET adherence remains suboptimal, particularly among low socioeconomic status populations. AIM: This study assessed 12-month OET adherence and identified factors associated with non-adherence among BC patients at a multispecialty hospital in Edinburg, Texas in the Rio Grande Valley region. METHOD: A 12-month single-center retrospective study of BC patients taking OET was conducted. Information on patient demographics, tumor characteristics, and prescription details was gathered from electronic medical records. Inclusion criteria included patients 18 years or older who filled at least one OET prescription. OET adherence was assessed using the proportion of Days Covered. Differences between the adherent and non-adherent groups were analyzed using chi-square and Student's t-tests, while multivariable logistic regression was employed to identify factors associated with non-adherence. RESULTS: Of the total 346 adult female patients, 322 (93%) were Hispanic/Latino. The mean age was 60.8 years, and the mean body mass index was 30.7. Only 122 (35.3%) patients were adherent at 12 months. Patients with diabetes were less likely to be adherent (odds ratio, 0.44; 95% confidence interval: 0.25-0.80). Longer duration of therapy was associated with higher OET adherence, which was estimated to increase 1.84-fold with each additional year of therapy. CONCLUSION: Approximately two-thirds of BC patients were non-adherent to OET. Diabetes and shorter time on therapy predicted poorer adherence. These results present the urgent need to address barriers to OET adherence among BC patients in the underserved area of South Texas.
Toward standardized outcome reporting in pneumonia: an overview of systematic reviews of antimicrobial therapy.
Cao H, Tan S, Zhang R … +10 more , Zhao H, Hu L, Wang J, Lan J, Sun S, Yang Z, He R, Zheng W, Li X, Zhang J
Int J Clin Pharm · 2026 Feb · PMID 41284209 · Publisher ↗
INTRODUCTION: Pneumonia is a leading cause of morbidity and mortality worldwide, with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) representing the two most common subtypes. Antimicrobials are...
INTRODUCTION: Pneumonia is a leading cause of morbidity and mortality worldwide, with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) representing the two most common subtypes. Antimicrobials are central to treatment; however, systematic reviews (SRs) evaluating their use have reported highly variable outcomes, limiting evidence synthesis and comparability. The development of a core outcome set (COS) may address this gap. AIM: To summarize the primary outcomes reported in SRs of antimicrobials for adult pneumonia and to construct an preliminary list of candidate outcomes to inform COS development. METHOD: A systematic search was performed in PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, and China Science and Technology Journal Database from inception to December 2024. Eligible studies included SRs or meta-analyses that evaluated antimicrobial therapy in adults (≥ 18 years) with CAP or HAP. Two reviewers independently screened the studies, extracted data on the study characteristics, pneumonia type, severity assessment tools, and outcomes. The Corrected Covered Area (CCA) was calculated to quantify the overlap in primary outcome reporting. Outcomes were grouped by pneumonia type and severity and categorized into five domains following the COMET taxonomy. RESULTS: A total of 97 SRs were included. Twenty-one distinct primary outcomes were identified, with limited overlap. Mortality and clinical success were the most frequently reported outcomes, though inconsistently defined across studies. Significant variability was noted in the definitions and time points of outcomes, as well as in severity assessment tools. Registered SRs reported fewer outcomes than non-registered ones. CONCLUSION: There is considerable variation in primary outcome reporting in antimicrobial SRs for adult pneumonia. Mortality and clinical success are the most commonly reported outcomes, but their definitions lack consistency. Developing subtype- and severity-specific COS is crucial for standardizing outcome reporting and improving evidence synthesis.
Through the lens: photovoice reveals the role of pharmacists in primary care.
Grant CC, Ellis AW, Fine S … +4 more , Valier HKQ, Hunt GI, Bradford JL, Johnson BR
Int J Clin Pharm · 2026 Feb · PMID 41284208 · Publisher ↗
INTRODUCTION: Physician burnout, marked by emotional exhaustion, depersonalization, and diminished professional efficacy, poses a significant threat to healthcare quality and workforce sustainability. Clinical pharmacist...
INTRODUCTION: Physician burnout, marked by emotional exhaustion, depersonalization, and diminished professional efficacy, poses a significant threat to healthcare quality and workforce sustainability. Clinical pharmacists are increasingly recognized for their potential to enhance patient outcomes, reduce costs, and alleviate physician workload. Despite growing interest in embedding pharmacists within primary care teams, limited research explores pharmacists' own perspectives on their role in mitigating burnout and the conditions that support successful integration. AIM: This study aimed to explore pharmacists' perceptions and experiences of working within primary care teams, focusing on their roles, daily activities, and the barriers and facilitators influencing integration. METHOD: Using photovoice, a participatory qualitative method, six pharmacists from Tennessee Heart Health Network (TN-HHN) clinics documented their experiences through photographs and captions over four weeks. These visual narratives captured aspects of team dynamics, implementation challenges, successes, and patient-centered care. A virtual focus group followed, where participants discussed their images. The session was transcribed and analyzed using thematic coding, with respondent validation ensuring accuracy. RESULTS: Six pharmacists from the University of Tennessee Health Science Center's Tennessee Heart Health Network, representing four healthcare systems, participated in the study. Participants submitted 40 photographs, reflecting six key areas of integration. Five themes emerged: (1) Transition from skepticism to advocacy, highlighting evolving physician trust and role clarity; (2) Integration through visibility and accessibility, emphasizing relationship-building and strategic placement; (3) Role expansion from administrative tasks to clinical leadership, enabling physicians to focus on broader care; (4) Safety and quality improvements via innovation and standardization; and (5) Enhanced patient experience through education and co-visits, particularly in chronic disease management. CONCLUSION: Pharmacists in primary care settings contribute significantly to team-based care, improving clinical workflows, patient outcomes, and physician well-being. Their integration fosters collaborative environments where all clinicians practice at the top of their license. Despite structural barriers such as reimbursement limitations, findings suggest that pharmacist visibility, trust-building, and role clarity are critical to successful implementation. This study underscores the value of engaging pharmacists in care teams and offers practical insights for scaling integrated models to address workforce challenges and improve care quality.
Bibliometric analysis of anti-angiogenic therapy in gastric cancer: research hotspots, trends, and emerging frontiers.
Zhang G, Lin G, Zhou Z … +4 more , Huang B, Lu M, Jiang L, Zhang W
Int J Clin Pharm · 2026 Feb · PMID 41284207 · Publisher ↗
INTRODUCTION: Anti-angiogenic therapy has demonstrated therapeutic potential for several malignancies; however, its clinical efficacy in gastric cancer (GC) remains limited. To better understand the evolution of this fie...
INTRODUCTION: Anti-angiogenic therapy has demonstrated therapeutic potential for several malignancies; however, its clinical efficacy in gastric cancer (GC) remains limited. To better understand the evolution of this field, comprehensive bibliometric analysis is required to map research trends, identify key contributors, and highlight emerging hotspots. AIM: This study aimed to systematically map the research landscape of anti-angiogenic therapy for gastric cancer and identify key trends, hotspots, and emerging fronts using a bibliometric analysis. METHOD: Publications related to anti-angiogenic therapy in GC were retrieved from the Science Citation Index Expanded (SCIE) and the Social Science Citation Index (SSCI) within the Web of Science Core Collection (WoSCC), covering 2000 to 2024. Microsoft Excel 365 was used to plot annual publication trends. VOSviewer was used to construct collaboration networks between countries/regions, institutions, authors, and co-cited references. CiteSpace was used to conduct keyword co-occurrence and burst analysis. RESULTS: In total, 916 publications were identified, comprising 698 articles and 218 reviews. The annual output increased steadily after 2003, peaking at 63 publications by 2021. China was the most productive country, followed by the USA, and both countries demonstrated a close collaborative relationship. The leading publishing institutions are primarily Chinese, including Shanghai Jiao Tong University, Nanjing Medical University, and Sun Yat-sen University. The most productive authors were Masakazu Yashiro, followed by Giuseppe Aprile, and Jin Li. The co-citation analysis identified landmark references by Fuchs (Lancet 383:31-39, 2014, 153 citations), Wilke (Lancet Oncol 15:1224-1235, 2014, 143 citations), and Ohtsu (J Clin Oncol 29:3968-3976, 2011, 133 citations) as central to the field. Keyword analysis revealed that early research has focused on "gastric cancer," "angiogenesis," and "bevacizumab." More recent hotspots shifted toward targeted therapy and clinical trial terminology, such as "first-line therapy," "randomized phase III," "supportive care," and "chemotherapy." Citation burst analysis highlighted emerging strategies, with frequent bursts for "nivolumab," "open label," and "plus chemotherapy," reflecting the integration of immunotherapy and multimodal regimens. CONCLUSION: This bibliometric mapping provides a comprehensive overview of global research on anti-angiogenic therapy for GC from 2000 to 2024. These findings delineate influential contributors, evolving research priorities, and emerging therapeutic strategies, and offer valuable guidance for future basic and clinical studies in this rapidly advancing field.
Future pharmacists and climate action: a qualitative study of students' views on environmental sustainability in education and practice.
Rajiah K, McArthur A
Int J Clin Pharm · 2026 Apr · PMID 41273659 · Full text
INTRODUCTION: Awareness of planetary health has grown across healthcare professions, and the pharmacy sector, responsible for the lifecycle of medicines from production to disposal, plays a significant role in both perpe...
INTRODUCTION: Awareness of planetary health has grown across healthcare professions, and the pharmacy sector, responsible for the lifecycle of medicines from production to disposal, plays a significant role in both perpetuating and mitigating environmental harm. However, pharmacy education omits environmental sustainability as a structured component. AIM: To explore pharmacy students' perceptions of environmental sustainability within their education and future professional roles, focusing on their awareness, attitudes, and perceived barriers or enablers to integrating sustainability in pharmacy education and practice. METHOD: A qualitative study was conducted at a university in Northern Ireland, utilising semi-structured interviews with pharmacy students across all four years of their studies. Purposive sampling was used. Interviews were transcribed verbatim and analysed inductively using Braun and Clarke's six-phase approach to thematic analysis. RESULTS: Sixteen students were interviewed, with data saturation reached at the 14th interview and confirmed through researcher consensus and transcript review. Six themes emerged (mean interview length = 45 ± 10 min): (1) Sustainability as an overlooked area - limited or fragmented curricular coverage; (2) Narrow understanding of waste - awareness focused on disposal and packaging, with little recognition of wider pharmaceutical impacts; (3) Pharmacy as both waste generator and sustainability site - examples included medicines returns, digitalisation, and hospital "green teams"; (4) Integrating sustainability into education - preference for interactive, experiential learning (e.g., guest speakers, placements); (5) Barriers to change - patient resistance, behavioural inertia, and competing curricular demands; (6) Policy, incentives, and leadership as enablers - systemic and financial support deemed essential for sustainable practice. CONCLUSION: Pharmacy students recognise the importance of environmental sustainability but perceive significant gaps in both education and practice. While they value opportunities for experiential learning and see potential for pharmacy to contribute positively, systemic barriers and limited curricular integration hinder progress. Embedding sustainability into pharmacy education, supported by leadership, policy, and incentives, will be critical to preparing future pharmacists as both healthcare providers and environmental stewards.
Co-creating mental health education with students: a qualitative case study in pharmacy.
McCormack Z, O'Sullivan E, Rajesh S … +3 more , Sweeney FF, Keating D, Strawbridge J
Int J Clin Pharm · 2026 Jun · PMID 41264080 · Full text
INTRODUCTION: Given that medication is often utilised to treat mental health conditions, pharmacists across sectors are well placed to provide enhanced care to patients beyond their knowledge of medicines. However, this...
INTRODUCTION: Given that medication is often utilised to treat mental health conditions, pharmacists across sectors are well placed to provide enhanced care to patients beyond their knowledge of medicines. However, this requires pharmacists to be appropriately educated about mental health. This study explores the priorities of pharmacy students for learning about mental health. AIM: This study aimed to explore the ideas and priorities of fourth year pharmacy students for mental health education under the following categories: (1) Content to be included. (2) What knowledge, skills and attitudes students wish to develop. (3) The teaching and learning approaches associated with developing these knowledge, skills and attitudes. METHOD: An exploratory case study design was conducted in 2024 within an elective 'Education and Training' module for undergraduate pharmacy students in Ireland. Eighteen students participated in the study and engaged in three different focus groups. The study was designed with student partners who supported the facilitation of focus groups and analysis of the data. Data analysis was conducted using thematic analysis on Nvivo software with a student partner. Final themes were agreed with the wider research team. RESULTS: Four main themes emerged from thematic analysis of focus group transcripts: (1) the pharmacist and pharmacy as a safe space, (2) adaptable communication skills, (3) integration of physical and mental health challenges across curricula, and (4) seeking authenticity in teaching and learning approaches. Students also gave insights into what makes a contact-based learning experience worthwhile for them, and expressed a desire for integration of patient and public involvement into education in order to create a more authentic learning experience. CONCLUSION: Pharmacy students find value in authentic learning methods, and appreciate when patients and patient groups are involved in education. Additionally, they see each other as an important learning resource and value small group work. These learning methods have been integrated into our mental health module in the form of patient speakers, simulation practice, and small group work activities.
Genetic variation in anti-diabetic drug targets and risk of atrial fibrillation: a drug-target mendelian randomization study.
Rong JC, Zheng XY, Gu ZC … +1 more , Ge H
Int J Clin Pharm · 2026 Feb · PMID 41264079 · Publisher ↗
INTRODUCTION: Atrial fibrillation (AF) is a common cardiac arrhythmia with limited options for upstream prevention. While several anti-diabetic drugs have shown cardiovascular benefits, their potential role in modifying...
INTRODUCTION: Atrial fibrillation (AF) is a common cardiac arrhythmia with limited options for upstream prevention. While several anti-diabetic drugs have shown cardiovascular benefits, their potential role in modifying AF risk remains unclear. AIM: This study aimed to evaluate the causal relationship between genetically proxied antidiabetic drug targets and the risk of AF using a drug-target Mendelian randomization (MR) approach. METHOD: A two-sample MR analysis was conducted to investigate the association between genetic variants related to antidiabetic drug targets and AF. Thirty-eight FDA-approved glucose-lowering agents were identified, and their targets were extracted from the ChEMBL (Chemical Biology Database and Information System) database. Protein quantitative trait loci (pQTL) data from a large plasma proteome GWAS (Genome-Wide Association Study) were used to construct instrumental variables. Positive control testing was conducted to confirm that the selected drug targets were significantly associated with diabetes, using summary statistics from the UK Biobank, FinnGen, and other GWAS datasets. Causal effects on AF were evaluated using multiple independent GWAS cohorts for replication. MR methods included inverse-variance weighted (IVW), MR-Egger, and weighted median approaches with sensitivity analyses for pleiotropy and heterogeneity. RESULTS: The alpha-glucosidase inhibitor miglitol was causally associated with a reduced risk of AF. Specifically, miglitol was shown to inhibit lactase (LCT), a protein whose elevated levels were associated with increased AF risk (IVW, OR = 1.013; 95%CI, 1.007-1.018; P = 2.37 × 10⁻). This association was confirmed using MR-Egger and weighted median methods and validated across multiple datasets. Sensitivity analyses did not reveal evidence of pleiotropy or confounding factors, supporting the robustness of the findings. CONCLUSION: This study provides novel genetic evidence suggesting that miglitol may reduce AF risk through lactase inhibition. These findings highlight a potential opportunity for drug repurposing for cardiovascular prevention, particularly for clinical pharmacists managing patients with higher risks in cardiovascular outcomes meanwhile with type 2 diabetes. Further mechanistic and clinical studies are warranted to confirm these observations and explore their translational value in practice.
Inherited immune traits and cisplatin-induced ototoxicity in cancer patients: a Mendelian randomization study.
Zheng Y, Yang X, Hua S … +2 more , Fang Q, Li D
Int J Clin Pharm · 2026 Feb · PMID 41264078 · Publisher ↗
INTRODUCTION: Cisplatin is a cornerstone chemotherapeutic agent frequently associated with dose-limiting ototoxicity. Increasing evidence suggests that immune-mediated mechanisms may influence interindividual susceptibil...
INTRODUCTION: Cisplatin is a cornerstone chemotherapeutic agent frequently associated with dose-limiting ototoxicity. Increasing evidence suggests that immune-mediated mechanisms may influence interindividual susceptibility to this adverse effect; however, the role of inherited immune traits remains poorly understood. AIM: This study aimed to evaluate the causal relationship between 33 inherited immune traits and cisplatin-induced ototoxicity using Mendelian randomization (MR), and to identify age-stratified susceptibility markers in pediatric and adult cancer survivors. METHOD: MR was used to assess the causal effects of genetically predicted immune traits on cisplatin-induced ototoxicity. Single-nucleotide polymorphisms associated with immune traits were selected from large-scale genome-wide association study datasets. The primary analysis used the inverse variance weighted method with MR-Egger, weighted median, weighted mode, and MR-PRESSO as the sensitivity approaches. Bidirectional MR and sensitivity analyses were conducted to assess robustness and rule out reverse causation. Bonferroni correction was employed to minimize potential false-positive findings (P < 0.05/165 ≈ 0.0003). RESULTS: Transforming Growth Factor-beta principal component analysis (TGF-β PCA) showed an age-stratified effect: it was associated with increased risk of hearing loss in pediatric patients (OR (95% CI): 1.0 × 10 (1.6 × 10-6.6 × 10), P = 0.014) but conferred strong protection against Speech Recognition Threshold (SRT) impairment (OR (95% CI): 2.8 × 10⁻ (1.4 × 10⁻-5.3 × 10⁻), P = 0.00012) and hearing loss (OR (95% CI): 4.7 × 10⁻ (2.7 × 10⁻-8.1 × 10⁻), P = 0.006) in adults. Additional protective associations have been identified for T Central Memory (TCM) cells and Programmed Cell Death Protein-1 (PD-1) in adults. Reverse MR analysis excluded significant reverse causation. Following Bonferroni correction, the association between TGF-β PCA and SRT remained statistically significant (P < 0.0003) in the adult cohort. However, all other associations in adults and the entire pediatric cohort demonstrated only nominal significance (0.0003 ≤ P < 0.05). CONCLUSION: Inherited immune traits, particularly TGF-β PCA, PD-1, and TCM cells, exhibit age-stratified causal effects on cisplatin-induced ototoxicity. These findings suggest the use of immunogenetic profiling for risk prediction and personalized strategies in oncology pharmacy practice.
Immunogenicity phenotypes and reversal of pharmacokinetic impact in anti-TNF-treated immune-mediated diseases: a real-world study.
Guzmán-Laiz R, Iniesta-Navalón C, Ríos-Saorín M … +4 more , Rentero-Redondo L, Garcia-Masegosa I, Añez-Castaño R, Urbieta-Sanz E
Int J Clin Pharm · 2026 Feb · PMID 41240271 · Publisher ↗
INTRODUCTION: The development of anti-drug antibodies against tumor necrosis factor inhibitors, such as infliximab and adalimumab, is a major cause of therapeutic failure in patients with immune-mediated inflammatory dis...
INTRODUCTION: The development of anti-drug antibodies against tumor necrosis factor inhibitors, such as infliximab and adalimumab, is a major cause of therapeutic failure in patients with immune-mediated inflammatory diseases (IMIDs). However, immunogenicity responses are heterogeneous, and drug exposure can be restored in selected cases through individualized management. AIM: To evaluate the clinical management and pharmacokinetic (PK) outcomes of immunogenicity in IMIDs treated with infliximab or adalimumab, by assessing its prevalence and phenotypes, associated factors, and the effectiveness of therapeutic interventions in reversing its PK impact. METHOD: This retrospective cohort study included 997 patients treated with infliximab (n = 278) or adalimumab (n = 719). Immunogenicity was defined by detectable anti-drug antibodies and/or undetectable serum drug levels. Patients were stratified into three phenotypes based on anti-drug antibody titers and serum concentrations. Therapeutic drug monitoring guided clinical decision-making in cases of suspected treatment failure, immunogenicity, or subtherapeutic exposure, in accordance with institutional protocols. PK reversal was defined as the reappearance of detectable drug levels after intervention without switching therapy. RESULTS: Immunogenicity was identified in 240 patients (24.1%), more frequently among those treated with infliximab (28.4%) than with adalimumab (22.4%; p = 0.064). Multivariable analysis confirmed treatment with infliximab (OR: 1.43; 95% CI: 1.04-1.97) and prior immunogenicity (OR: 3.69; 95% CI: 1.50-9.11) as risk factors, while concomitant immunosuppressants were protective (OR: 0.62; 95% CI: 0.45-0.84). Among 77 patients managed actively, PK reversal was achieved in 76.7%. The rate of reversal was higher with adalimumab (80.0%) than with infliximab (62.5%; p = 0.039), and in patients with undetectable antibodies and low drug concentrations (Group 3) than in those with low-level antibodies (77.5% vs 50.0%; p = 0.024). Dose intensification and supervised administration were effective in achieving PK reversal (79.2% and 70.8%, respectively). Median serum drug concentrations increased significantly after intervention in both groups (p < 0.001). CONCLUSION: Therapeutic drug monitoring-guided interventions tailored to immunogenicity phenotype can restore drug exposure in a substantial proportion of patients treated with tumor necrosis factor inhibitors. Recognition of reversible immunogenicity is essential for optimizing long-term therapeutic success and avoiding premature drug discontinuation.
Post-marketing safety profile of cladribine in multiple sclerosis: a disproportionality analysis based on the FDA adverse event reporting system.
Hu Y, He J, Tu Z … +7 more , Ye H, Zhuang C, Jin Z, Hu H, Zhao Y, Zheng Y, Yao Q
Int J Clin Pharm · 2026 Apr · PMID 41240270 · Full text
INTRODUCTION: Cladribine has been widely recognized as a therapeutic option for relapsing-remitting multiple sclerosis (MS), but there is still a dearth of real-world data regarding its safety profile. AIM: This study ai...
INTRODUCTION: Cladribine has been widely recognized as a therapeutic option for relapsing-remitting multiple sclerosis (MS), but there is still a dearth of real-world data regarding its safety profile. AIM: This study aimed to assess adverse events (AEs) linked to cladribine in MS patients, utilizing data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). METHOD: AE reports identifying cladribine as the primary suspect drug were extracted from the U.S. FAERS, covering the period from the first quarter of 2019 to the third quarter of 2024. Four disproportionality methods-reporting odds ratio (ROR), proportional reporting ratio, Bayesian confidence propagation neural network, and empirical Bayes geometric mean-were employed to evaluate the association between cladribine and AEs. Furthermore, the Weibull distribution model was applied to analyze time-to-onset patterns, and subgroup analyses were conducted based on sex and age. RESULTS: After screening 4,833 cladribine-related reports, 113 preferred terms (PTs) were identified as positive across all four disproportionality methods. Known AEs such as pneumonia (n = 190, ROR 2.85), lymphopenia (n = 111, ROR 4.19), and drug-induced liver injury (n = 22, ROR 5.94). Unexpected events, including rheumatoid arthritis (ROR 5.64), hypothyroidism (ROR 5.04), eye hemorrhage (ROR 6.88), uveitis (ROR 4.86), retinal detachmen (ROR 4.37), brain edema (ROR 6.12), acute myocardial infarction (ROR 3.70), and completed suicide (ROR 7.46), were also reported. Stratified analysis revealed that females were at a higher risk of nausea, alopecia, and migraine, while males were more susceptible to gait disturbance and sepsis. Older adults (≥ 65 years) faced increased risks of leukopenia and urinary tract infections (UTIs). The median onset of AEs was 152 days, with the highest proportion (28.18%) reported in the first month. Weibull analysis indicated an early peak (shape parameter 0.72). CONCLUSION: This study not only corroborates previously established risks associated with cladribine but also uncovers new potential safety signals, highlighting the importance of vigilance for early acute toxicity.
Estimation of carbon emissions from inhaled respiratory medicines in Ireland: a cross-sectional study from a national pharmacy claims database from 2020 to 2022.
Kanwal H, Umm-E-Kalsoom, Khan A … +3 more , Ryan T, Quinn J, Ryan C
Int J Clin Pharm · 2026 Feb · PMID 41239014 · Publisher ↗
INTRODUCTION: Inhaled therapies are essential for managing asthma and chronic obstructive pulmonary disease (COPD), but device choice carries environmental consequences. Inhaler devices influence climate impact; propella...
INTRODUCTION: Inhaled therapies are essential for managing asthma and chronic obstructive pulmonary disease (COPD), but device choice carries environmental consequences. Inhaler devices influence climate impact; propellant-based metered-dose inhalers (MDIs) have substantially higher carbon footprints than non-propellant inhalers (NPIs). Ireland has committed to net-zero greenhouse gas emissions by 2050, making prescribing practices a relevant focus for mitigation. AIM: To describe national dispensing patterns of inhaled respiratory medicines and estimate associated CO₂-equivalent (CO₂e) emissions in Irish primary care, 2020-2022. METHOD: We analysed Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) dispensing data for inhaled respiratory medicines (ATC R03) products. Items were classified as MDIs or NPIs. Trends of inhalers use were expressed as year-on-year inhalers dispensed. We conducted scenario analysis in which 10%, 25%, and 50% of 2022 MDIs use were replaced with NPIs to calculate the reduction in carbon emissions. Notably, PCRS schemes cover ~ 43% of the Irish population (predominantly older adults and a lower income group). RESULTS: Between 2020 and 2022, a total of 9.94 million inhalers were dispensed under HSE-PCRS schemes, with annual volumes rising from 3.04 million (2020) to 3.60 million (2022). MDIs increased from 1.50 million (2020) to 1.79 million (2021) and 1.95 million (2022), while NPIs declined - 15.7% in 2021 and then rebounded + 26.8% in 2022. The MDIs share of all inhalers changed from 49.2% (2020) to 57.9% (2021) to 54.2% (2022) for which estimated MDIs carbon emissions were 28.6, 34.6, and 37.6 kt CO₂e, respectively. This emission was accounted for 95-96% of inhaler-related emissions annually. In scenario analyses, replacing 10%, 25%, and 50% of 2022 MDIs use with NPIs resulted in estimated emission reduction of ~ 3.6, 8.9, and 17.9 kt CO₂e, respectively. CONCLUSION: The results show how MDIs influence the carbon footprint of the health sector and they encourage healthcare providers to support sustainable alternatives. When clinically appropriate, choosing sustainable devices provides significant, short-term CO2 savings without sacrificing treatment.
Efficacy and safety of IL-23p19 antagonists versus placebo in inflammatory bowel disease: a systematic review and meta‑analysis of randomized controlled trials.
Peng XY, Du W, Miao J … +8 more , Shi L, Li W, Ge MW, Shen LT, Feng R, Zhong K, Gao SQ, Chen HL
Int J Clin Pharm · 2025 Dec · PMID 41231362 · Publisher ↗
INTRODUCTION: IL-23p19 antagonists, selectively blocking IL-23 signaling via p19 targeting without affecting IL-12, represent a novel therapeutic class for inflammatory bowel disease (IBD). While multiple randomized cont...
INTRODUCTION: IL-23p19 antagonists, selectively blocking IL-23 signaling via p19 targeting without affecting IL-12, represent a novel therapeutic class for inflammatory bowel disease (IBD). While multiple randomized controlled trials (RCTs) have evaluated their efficacy and safety in IBD, findings remain fragmented and exhibit significant heterogeneity. AIM: This updated meta-analysis was designed to evaluate the efficacy and safety of IL-23p19 antagonists compared with placebo for induction and maintenance therapy in patients with IBD. METHOD: Systematic searches of PubMed, Embase, Web of Science, Scopus, and OVID were conducted until May 13, 2025 for IBD RCTs evaluating IL-23p19 antagonists. Methodological quality was assessed using the Cochrane RoB tool. The data collected included details on study design, participant characteristics, and study outcomes. The risk ratio (RR) and corresponding 95% confidence intervals (95%CI) were calculated using the random-effects model. RESULTS: The review includes 14 publications involving 8,463 IBD patients. Significantly higher rates of clinical remission (RR 2.18, 95% CI 1.87-2.54), clinical response (RR 1.74, 95% CI 1.54-1.96), endoscopic remission (RR 2.94, 95% CI 2.33-3.70), and endoscopic response (RR 2.71, 95% CI 2.28-3.23) were observed in IBD patients receiving IL-23p19 inhibitors compared to placebo. Safety analyses revealed comparable overall adverse events with active therapy (RR 0.96, 95% CI 0.92-1.01); however, significant reductions occurred in serious adverse events (RR 0.51, 95% CI 0.41-0.64), treatment discontinuations due to adverse events (RR 0.36, 95% CI 0.28-0.47), and serious infections (RR 0.62, 95% CI 0.41-0.96) versus placebo. CONCLUSION: This meta-analysis confirms robust therapeutic benefits and acceptable safety of IL-23p19 inhibitors in IBD patients. Subgroup analyses showed IL-23p19 inhibitors maintained comparable efficacy regardless of prior biologic use, disease duration, or baseline C-reactive protein levels, indicating consistent efficacy across these clinical subgroups. Future longitudinal investigations should evaluate durability of treatment response and extended safety outcomes.
Effectiveness of ketamine/esketamine in alleviating postoperative fatigue: a systematic review.
Liu Q, Liu Y, Fu Q … +7 more , Gao B, Ji C, Xie J, Yang B, Xie J, Alwesabi AK, Liu Y
Int J Clin Pharm · 2026 Apr · PMID 41222605 · Full text
INTRODUCTION: Postoperative fatigue (POF) is a clinically significant complication. Numerous studies have found that ketamine and esketamine show potential in alleviating POF. However, there is currently no systematic ev...
INTRODUCTION: Postoperative fatigue (POF) is a clinically significant complication. Numerous studies have found that ketamine and esketamine show potential in alleviating POF. However, there is currently no systematic evidence to assess its exact effectiveness. AIM: This study aimed to evaluate the effectiveness of perioperative ketamine/esketamine in alleviating POF in surgical patients. METHOD: A systematic review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The study protocol was prospectively registered in the PROSPERO Registry (CRD420251060988). We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to May 31, 2025, using a combination of MeSH terms and free-text keywords related to "ketamine", "esketamine", "surgery", "anaesthesia" and "fatigue". Eligible studies were prospective or retrospective clinical studies comparing ketamine/esketamine with control in surgical patients, reporting fatigue-related outcomes. Two reviewers independently screened studies, another two reviewers independently extracted data and assessed risk of bias. A narrative synthesis was performed due to clinical and methodological heterogeneity. RESULTS: In total, 556 studies were identified. Nine studies (n = 1606) were included in this review, among which seven were randomized controlled trials (RCTs) and two were observational studies. Four RCTs had low risk of bias, while the remaining three had some concerns. The two cohort studies were of moderate quality. The included studies encompassed various surgical procedures: colorectal cancer resection (n = 2), gastric surgery (n = 1), hysterectomy (n = 1), breast surgery (n = 2), orthopedic surgery (n = 1), and gastrointestinal endoscopy (n = 2). The outcomes varied according to the type of surgery. In studies of major abdominal surgeries, ketamine/esketamine has demonstrated certain potential in improving POF, but the certainty of evidence was graded as low. In contrast, no significant benefits were observed in breast or orthopedic surgeries. In the two studies on gastrointestinal endoscopy, the results were inconsistent. CONCLUSION: Current evidence suggests that ketamine/esketamine may be effective in alleviating POF, particularly in major abdominal surgeries. These findings should be interpreted cautiously due to the heterogeneity in study designs, variations in fatigue assessment tools and time, and the limited sample sizes of the included studies. Future high-quality RCTs are needed to confirm these observations and establish the optimal dosing regimens.
Cost-effectiveness of omadacycline versus moxifloxacin as the initial treatment for community-acquired bacterial pneumonia in China.
Wang X, Fu Y, Duan G … +1 more , Kong W
Int J Clin Pharm · 2026 Feb · PMID 41222604 · Publisher ↗
INTRODUCTION: Clinical studies have shown that omadacycline is non-inferior to moxifloxacin, a widely used respiratory fluoroquinolone, in terms of efficacy. However, the higher acquisition cost of omadacycline raises qu...
INTRODUCTION: Clinical studies have shown that omadacycline is non-inferior to moxifloxacin, a widely used respiratory fluoroquinolone, in terms of efficacy. However, the higher acquisition cost of omadacycline raises questions regarding its economic value, particularly in resource-limited healthcare systems such as China. AIM: This study evaluated the cost-effectiveness of omadacycline versus moxifloxacin as initial treatment for CABP in China. METHOD: A decision-tree model was constructed using TreeAge Pro 2020 to assess sequential intravenous (IV)-to-oral omadacycline versus moxifloxacin in adult patients with non-severe CABP. Parameter values were obtained from published literature, public databases, and medical service pricing datas. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed to assess model robustness. A regimen was considered cost-effective if the ICER fell below the willingness-to-pay (WTP) threshold of $19,012 per quality-adjusted life year (QALY). RESULTS: In the base-case analysis, omadacycline provided an additional 0.004 QALY at an incremental cost of $597.8, resulting in an ICER of $148,700/QALY-substantially exceeding the $19,012 threshold. The cost of oral and IV omadacycline were the most influential parameters. Omadacycline was optimal in 7.6% of 10,000 Monte Carlo simulations at the $19,012/QALY threshold. Province-specific WTP thresholds showed cost-effectiveness probabilities ranging from 1.1% (Gansu) to 16.2% (Beijing). CONCLUSION: Omadacycline is not cost-effective compared to moxifloxacin as the initial treatment for CABP in China, unless significant price reductions are achieved.
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