Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences)
Online ISSN : 1882-1499
Print ISSN : 1346-342X
ISSN-L : 1346-342X
Volume 45, Issue 12
Displaying 1-7 of 7 articles from this issue
Regular Articles
  • Yudai Ishikawa, Eiji Yoneyama, Akiyoshi Takaki, Norimasa Takahashi, At ...
    2019 Volume 45 Issue 12 Pages 659-666
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    Immune checkpoint inhibitors (ICIs) play an important role in oncology, as they generate novel toxicities known as immune-related adverse events (irAE) which affect multiple organ systems. Since irAEs have been reported to have potential clinical benefits for patients, retreatment using ICIs following recovery from irAEs is sometimes attempted, though there are limited data about the safety of using this strategy on patients with a serious irAE history. Here, the safety of retreatment after irAE across patients with different cancer types was evaluated. Fifty-three patients experienced treatment interruption because of irAEs; of these, 31 patients were then retreated with ICIs. Endocrine disorder as the initial irAE was observed more often in patients who were retreated; conversely, pneumonitis was observed more often in patients who were not retreated with ICIs. Manageable flare-up or novel irAEs occurred in 19 patients, while irAEs did not occur after retreatment in 12 patients. The number of days from the beginning of ICI treatment to the first irAE (within 100 days) as well as patient gender were found to be risk factors that were significantly related to relapses or new onsets of irAE. In 19 patients who experienced flare-up or new irAEs, the secondary irAE grade increase did not differ significantly compared to that of the initial irAE. The results of this study are important in helping to evaluate the risk of retreating patients with ICIs.

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  • Shunsuke Hayashi, Nami Suda, Takashi Kawakubo, Naohito Shimoyama
    2019 Volume 45 Issue 12 Pages 667-673
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    Opioids are associated with adverse events, such as constipation, nausea/vomiting and sedation. These side effects can directly reduce the patient's quality of life. Naldemedine improved symptoms in patients with opioid-induced constipation (OIC). However, no comparison has been made for the single treatment and combined treatment of naldemedine for OIC. Also, there are no reports on whether naldemedine suppresses opioid-induced nausea/vomiting. In the present study, the suppression effect of naldemedine single treatment for OIC is the same as that for the combined treatment of naldemedine. This result suggests that single treatment of naldemedine is useful for OIC. Naldemedine suppresses opioid-induced nausea/vomiting, but there is no significant difference between naldemedine and prochlorperazine. This result suggests that naldemedine is useful for opioid-induced nausea/vomiting. Therefore, the present study suggests that naldemedine may be a new option in mitigating the side effects of opioids.

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Notes
  • Retrospective Comparison Study Using Propensity Scores
    Yuki Yamashita, Kazuya Hiura, Momoko Arakawa, Ayaka Miura, Hiroki Tana ...
    2019 Volume 45 Issue 12 Pages 674-681
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    The biologics infliximab (IFX) and adalimumab (ADA) have high therapeutic efficacy for Crohn's disease, and are used to treat many patients. However, randomized controlled trials (RCT) have not been conducted to compare their efficacy in biologic treatment-naive patients. Although RCT are not feasible, we used the propensity score (PS) matching to compare the efficacy of both drugs. We evaluated the short-term efficacy (CRP change three months after the start of treatment) and the long-term efficacy (treatment continuation rate). Among all patients (IFX: 101, ADA: 76), there were significantly more cases of fever in the IFX group and many cases of fistula and abdominal mass. There was no significant difference in CRP variation (P = 0.98). Treatment continuation rates were evaluated by two methods: the cumulative treatment continuation rate (end point: drug withdrawal) and non-event treatment continuation rate (end point: drug withdrawal, dose increase, or enterectomy). There was no significant difference in the cumulative treatment continuation rate between the IFX and ADA groups, but the IFX group had a slightly higher continuation rate (P = 0.054). There was no significant difference in the non-event treatment continuation rate (P = 0.42).

    Sixty patients in each group were extracted by PS matching. There were no significant differences in CRP variation (P = 0.69), the cumulative treatment continuation rate (P = 0.15), or the non-event treatment continuation rate (P = 0.32) between the IFX and ADA groups. Our study suggests that there is no difference in efficacy between IFX and ADA.

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  • Yuichi Ishizuka, Keisuke Yamamoto, Shohei Sawa, Yuichi Takaoka, Daisuk ...
    2019 Volume 45 Issue 12 Pages 682-687
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    Internal medicine cannot be used to treat insomnia for inpatients with dysphagia if tube administration is not possible. In such cases, injectable benzodiazepine with a high level of safety is often used in Japan. While a benzodiazepine antagonist is available, there is insufficient data on safe administration methods. Therefore, a survey was conducted to identify the usage status of intravenous injections of flunitrazepam, which is frequently used among injectable benzodiazepines. The survey covered all patients admitted to our hospital between April 1, 2017 and March 31, 2018 on whom intravenous injections of flunitrazepam were used, except for those whose SpO2 was 95% or less prior to the intravenous injections of flunitrazepam. For the subjected 45 patients, the median of the maximum daily dose for intravenous injections of flunitrazepam was 1 mg (0.3 - 2); the incidence of respiratory depression (SpO2 was less than 90%) was 33.3% (15 patients). Twenty-six patients (57.8%) were able to take a meal or use internal medicines with flunitrazepam. An abnormal value of aspartate aminotransferase (AST) was extracted as a factor independently affecting the incidence of respiratory depression (OR = 15.10, 95%CI: 1.610 - 142.0, P = 0.018). As a safe method of administration for intravenous injections of flunitrazepam, it is necessary to appropriately evaluate, before administration, whether or not internal medicine can be used, and if possible, to recommend internal medicine that can be adapted. When administering flunitrazepam by intravenous injection, pay particular attention to patients with an abnormal AST value and it is desirable to monitor their respiratory status during administration.

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  • Ayaka Suzuki, Manako Hanya, Hiroyuki Kamei
    2019 Volume 45 Issue 12 Pages 688-697
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    The medical system has been changing from medical institutions to home medical care with an increase in the number of elderly persons. Home medical care is a type of interprofessional team care, requiring pharmacists' participation. However, insufficient cooperation with other occupations makes participation difficult under some circumstances. In this study, we interviewed 5 pharmacists who had participated in home medical care in Aichi Prefecture with respect to the involvement of pharmacists in home medical care and opinions regarding multi-occupational cooperation (semi-structured interview), and qualitatively analyzed their responses using the Grounded theory approach. Concerning the involvement of pharmacists in home medical care, two characteristics were extracted: “pharmacists' viewpoint required for home medical care” and “relationship with other occupations”. In the field of home medical care, the number of requests for the management of terminal-stage patients has increased, and pharmacists must perform “viewpoint of medical staff”-based management, such as sterile preparation and emergency management. On the other hand, pharmacists' “viewpoint of living people” to support patients' feelings or lifestyle and “view of life and death” were required for the management of terminal-stage patients. With respect to the relationship with other occupations, the results showed that pharmacists' low-level recognition of the contents of home service affected cooperative work, suggesting the necessity of presenting the pharmacists' position to contribute to other occupations and establishing a face-to-face relationship.

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  • Takeshi Tomida, Kazuhiro Yamamoto, Kazuhiko Yamashita, Nobuko Omoto, H ...
    2019 Volume 45 Issue 12 Pages 698-705
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    We began to print the laboratory data of each patient on their in-hospital prescription in April, 2010 and further introduced a prescription checking system associated with laboratory data in December, 2014. This study evaluated the changed prescriptions based on prescription queries and the usefulness of using prescriptions with laboratory data as well as the prescription checking system. We examined the number of changed in-hospital prescriptions after the prescription queries in three periods: before and after using prescriptions with laboratory data (from June, 2009 to November, 2009 and from June, 2010 to November, 2010, respectively), and after the introduction of the prescription checking system (from September, 2016 to August, 2017). Although there were no changed prescriptions based on the laboratory data before using prescriptions with laboratory data, 6.6% of changed prescriptions were based on laboratory data after using prescriptions with laboratory data. In addition, the changed prescription ratio based on laboratory data significantly increased after the introduction of the prescription checking system compared with that after using prescriptions with laboratory data (8.9% versus 6.6%, P = 0.015). In conclusion, using prescriptions with laboratory data and the prescription checking system associated with laboratory data were useful for checking prescriptions effectively in order to avoid adverse drug reactions.

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  • Yusuke Nakagawa, Hiroyuki Ogura, Tatsuya Isezaki, Osamu Yasumuro, Hiro ...
    2019 Volume 45 Issue 12 Pages 706-713
    Published: December 10, 2019
    Released on J-STAGE: December 11, 2020
    JOURNAL FREE ACCESS

    Daratumumab (DARA) is a treatment for relapsed or refractory multiple myeloma. The MMY 3003 trial compared DARA, lenalidomide, and dexamethasone combination therapy (DLd therapy) with lenalidomide and dexamethasone combination therapy (Ld therapy). There were 283 cases in which DARA is included in the group, among which there are only 20 cases in Japan, with limited information on efficacy and safety in the Japanese population. Another characteristic of DARA adverse events is the Infusion Related Reaction (IRR). The risk factors associated with DARA's IRR have not been identified yet, and there are concerns about their impact on treatment.

    Therefore, we retrospectively examined the safety of DARA in Japanese patients who received DARA and investigated the risk factors for IRR expression in multiple myeloma patients at our hospital. With regard to adverse events, we have experienced cases in which hematologic toxicity is Grade 3 or higher, but in non-hematologic toxicity, no case has resulted in serious outcomes of Grade 3 or higher. Any adverse event that occurred during the survey period could be managed with coping therapy, and safety was secured when DARA was administered. Although IRR has frequently occurred in DARA administration, there have been no reports on the risk factors for IRR expression to date. However, in this study, cases with “IMiDs refractory” as a risk factor for IRR were significantly affected. It is shown that “IMiDs refractory” cases can cope with IRR earlier by responding to risk factors.

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