Ulcerative colitis (UC) is an intractable inflammatory disease of unknown etiology, with no effective radical cure. The treatment is centered on drug therapy. The first-line drug for the induction and maintenance of remission in mild to moderate UC is 5-aminosalicylic acid (5-ASA). The goal of treatment is to maintain long-term remission by selecting a suitable treatment method based on the pathological condition and symptom control. Patient adherence is considered an important factor in improving the therapeutic effect for maintaining remission. Therefore, to examine the patient approach and medication guidance measures taken by pharmacists to improve medication adherence, we explained the current status of compliance of patients receiving 5-ASA medication and requirements for pharmacists to take necessary actions. An attitude survey was also conducted. Responses were obtained from all 32 patients prescribed with oral 5-ASA medication. Incomplete adherence was observed in 19 patients, accounting for more than half of the patients. Factors that influence medication adherence may be related to patient age. In addition, more than half of patients with incomplete medication adherence preferred a single daily dose before or after breakfast. Half of the patients (n=16) reported that they had received a request for treatment from a pharmacist. The most selected item was the continuous administration of medication observed in 9 patients (60.0 %), whereas the number of medication advice, provided to 8 patients (50.0 %), was ranked second.
The pharmacist's approach to improving medication adherence in patients with UC ensures continuous management and guidance of medication, and plays the role of a family pharmacist and pharmacies in providing the required patient care. The most suitable drug is selected according to the number of doses and the duration of administration depending on the stage and lifestyle of the patient. Therefore, it was considered important to make proactive prescription proposals to doctors. In particular, attention should be paid to young patients requiring long-term continuous administration of medication.
Background: Guidelines in the United States and Europe recommend the addition of olanzapine to the standard triple antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC). However, no meta-analysis has directly compared the efficacy and safety of standard triple antiemetic therapy with the addition of olanzapine for CINV in patients only receiving HEC. This study aimed to conduct such a meta-analysis of randomized controlled trials.
Methods: We searched the MEDLINE, Cochrane Library, and Igaku Chuo Zasshi databases for articles published between 1966 and October 2021 for randomized controlled trials (RCTs) that compared the efficacy and safety of the two therapies for CINV in patients receiving HEC.
Results: Among the 1041 relevant articles, five RCTs were eligible for inclusion in the meta-analysis. The add-on olanzapine therapy was significantly more effective than the standard triple antiemetic therapy; the odds ratio [95% confidence interval] of complete response, no nausea, no vomiting, and the use of rescue medications were 2.30 [1.80 to 2.95], 1.84 [1.22 to 2.78], 2.71 [1.59 to 4.61], and 0.59 [0.48 to 0.74], respectively. The add-on olanzapine therapy was associated with mild somnolence more frequently than the standard triple therapy (2.20 [1.26 to 3.85]); however, it did not affect the treatment continuation. The incidence of insomnia was significantly low (0.72 [0.54 to 0.95]) with additional olanzapine therapy, and that of hyperglycemia was comparable between the two groups (2.33 [0.34 to 15.91]).
Conclusions: The present meta-analysis would endorse that the add-on olanzapine therapy demonstrated significantly higher efficacy and tolerability than standard triple antiemetic therapy in CINV patients receiving HEC.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors exhibit an insulin-independent antihyperglycemic effect and are used as therapeutic agents for the treatment of diabetes. Recently, they have been shown to exert additional effects, such as prevention of heart failure and protection of renal function. Specifically, empagliflozin (10 mg) has been used to treat chronic heart failure even in patients without diabetes. However, SGLT2 inhibitors are associated with natriuresis and osmotic diuresis, and the Japan Association for Diabetes Society made a series of recommendations regarding the proper use of these drugs. In this study, we investigated the use of empagliflozin for the treatment of heart failure and examined how pharmacists should be involved for its proper use.
The ages and values of laboratory tests of patients who were prescribed empagliflozin for either the treatment of heart failure (heart failure group, n=15) or diabetes (diabetic group, n=19) were compared. The median age was considerably higher in the heart failure than in the diabetic group (76.4 ± 11.6 vs 57.7 ± 14.3 years). In contrast, HbA1c was markedly lower value in the heart failure than in the diabetic group (6.9% ± 1.0 vs 9.0% ± 1.6). Additionally, estimated glomerular filtration rate (eGFR) was substantially lower value in the heart failure than in the diabetic group (52.1 ± 17.6 vs 74.6 ± 24.6 mL/min/1.73m2). Blood levels of sodium (Na) and potassium (K) were significantly lower value in the heart failure than in the diabetic group, although both were within normal limits (Na: 138.4 ± 0.83 vs 139.7 ± 2.1 mmol/L; K: 4.0 ± 0.59 vs 4.4 ± 0.25 mmol/L). When empagliflozin is prescribed for the treatment of other pathologies than diabetes, such as heart failure, it is important to check the age and the values of biochemical parameters such as eGFR and electrolyte levels to ensure the appropriate therapeutic efficacy and prevent side effects.
Within Japan, national medical costs are continuing to increase owing to the aging population and advances in medical technologies. The market share occupied by generic drugs is still low compared with other countries. We investigated trends in the use of generic drugs (tablets) with introduced authorized generics (AGs) using National Database of Japan (NDB) Open Data. We evaluated the impact of introducing AGs on the transition to generic drugs. We found that more than 80% of drugs with AGs had generic usage rates exceeding 70%. AGs are often used to treat chronic diseases, such as hypertension. Branded drug manufacturer-approved AGs are considered associated with less negative perceptions; however, despite this, it remains difficult to say whether the introduction of AGs has promoted the use of generic drugs overall. Furthermore, we inferred that the timing of introduction to the market is vital for AGs. Considering the tight medical financial situation in Japan, shifting to the use of generic drugs, including AGs, would be favorable after patents for branded drugs expire. It is also necessary to conduct a detailed analysis of trends in the use of generic drugs, including AGs.