Niraparib is a poly ADP-ribose polymerase inhibitor used to treat ovarian cancer. In this study, we examined the incidence of adverse effects of niraparib in patients aged 75 years and older to clarify the tolerability of niraparib in elderly patients. The study included patients with ovarian cancer who received niraparib at Ogaki Municipal Hospital between January 2020 and March 2024. The patients were divided into two groups: OG (n = 7) and YG (n = 20). Adverse events, relative dose intensity (RDI), incidence of adverse events in patients with renal impairment, and reasons for treatment discontinuation were compared using retrospectively collected medical records. Regarding the reasons for discontinuation, progressive disease (PD) was more common in the YG group (nine patients) than in the OG group (one patient) (P = 0.036). The median RDI (range) was 59.9％ (50 – 100) in the OG group and 56.9％ (16.3 – 100) in the YG group (P = 0.904). Grade 3 or higher thrombocytopenia occurred in four patients (14.8％) with a stage 3b or higher chronic kidney disease (CKD) severity and in one patient (3.7％) with a stage 3b or lower CKD severity (P = 0.017). In conclusion, older patients (>75 years of age) were less likely to tolerate niraparib than younger patients.

As reported, the occurrence of side effects affects a patientʼs willingness to take treatment, causing a decline in medication adherence. Moreover, because there may be individual differences in the level of understanding of the term “side effects,” we conducted a questionnaire survey to clarify the differences in the perception of “side effects” between pharmacists and patients. We conducted a questionnaire survey and received 270 responses (ie, 210 pharmacy visitors and 60 pharmacists). When comparing the side effect symptoms that pharmacists explained in advance to patients taking antipyretic analgesics with those that visitors considered as side effects, significantly more pharmacists (80.0％) explained gastrointestinal symptoms than visitors (48.6％) recognized as side effects (P < 0.05). This indicates that patientsʼ understanding of the medication guidance provided by pharmacists was low, and that pharmacists and patients have different perceptions of side effects. As regards patientsʼ experience on side effects (all answers: 87), 21 (24.1％) answered that they did not tell their medical staff, while eight (9.2％) answered that they stopped taking the drug after the symptom onset. In other words, medication was discontinued without the knowledge of the medical staff because of the decreased adherence triggered by the side effects. To prevent a decrease in the medication adherence, it is important to provide patients with information, confirm that the patient understands the medication instruction, monitor the development of side effects by pharmacists, and pay attention to the difference in the perception of side effects between pharmacists and patients.

Candidemia is associated with high mortality; therefore, early and appropriate treatment is important. This study evaluated the effectiveness of a pharmacist-led rapid intervention system based on the candidemia treatment bundle (bundle) on clinical outcomes. The study cohort was divided into preintervention (January 1, 2012 to December 31, 2013) and postintervention (April 1, 2014 to December 31, 2021) groups involving hospitalized patients with Candida species detected in blood cultures and treated with antifungal drugs. The bundle comprised six elements: early initiation of antifungal therapy, appropriate selection of the initial antifungal drug, early control of the infection focus, follow-up of blood cultures, appropriate treatment duration, and investigation of intraocular inflammation. The primary outcome focused on the compliance rate with the bundle, and the secondary outcome included 30-day mortality rates and clinical outcomes. The preintervention group comprised 21 cases, while the postintervention group involved 71 cases. The overall bundle compliance increased significantly from 9.5％ preintervention to 53.5％ postintervention (P < 0.001). The compliance rates for the follow-up of blood cultures increased significantly from 71.4％ to 98.6％ (P = 0.005). Although the other elements increased, they did not reach statistical significance. No significant difference was found in the 30-day mortality between interventions (28.6％ vs 23.9％, P = 0.775). Pharmacists taking a central role and intervening early based on the bundle contribute to improving the quality of candidemia treatment.

Effective antiviral agents were unavailable in the initial stages of the coronavirus disease 2019 (COVID-19) pandemic. Favipiravir (FPV) was expected to be a therapeutic drug. Despite the higher EC₅₀ for severe acute respiratory syndrome coronavirus 2 compared to that for the influenza virus and the high variability in the FPV plasma concentrations, the FPV dosage was determined based on that for influenza. We explored the relationship between FPV trough concentrations and efficacy and evaluated factors affecting the FPV trough plasma concentrations.

This single-center, retrospective, observational study included 20 Japanese patients with COVID-19 (age ≥15 years) treated with FPV between April 2020 and August 2021. The relationship between the FPV trough plasma concentrations and serum ferritin and the C-reactive protein levels, body surface area (BSA), and change in uric acid levels were investigated. The FPV efficacy was defined as the time taken to simultaneously achieve a National Institute of Allergy and Infectious Diseases Ordinal Scale (NIAID-OS) ≤3 and fever resolution (≥24 h). The analysis of covariance with serum ferritin levels as a covariate showed that BSA and change in the uric acid levels are significantly associated with the FPV trough plasma concentrations. The cumulative incidence function revealed that the FPV trough plasma concentrations ≥40 μg/mL significantly shortened the days to simultaneously achieve NIAID-OS ≤3 and fever resolution (P = 0.038). The BSA or change in the uric acid levels with ferritin as a covariate is a useful predictor of the FPV trough plasma concentrations, and appropriate dosing may contribute to clinical improvement.