ABSTRACT
Abstract Background Anthracyclines-based regimen (5-fluorouracil, doxorubicin, and cyclophosphamide (FAC); cyclophosphamide, epirubicin, and 5-fluorouracil [CEF]) and non-anthracycline based regimens (cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]) are widely used as neoadjuvant chemotherapy for breast cancer patients. Objective The present study was conducted to observe the effects of FAC, CEF, and CMF regimen on cognition and circulatory proinflammatory cytokines (interleukin 6 [IL-6] and interleukin 1β [IL-1β]) for the duration of three cycles of chemotherapy in breast cancer patients. Methods Eighty newly diagnosed HER-2 negative breast cancer patients were enrolled and divided into 3 groups as FAC- (n= 27), CEF- (n= 26), and CMF- (n= 27) receiving patients. Serum IL-6 and IL-1β levels were measured by using enzyme-linked immunosorbent assay (ELISA), and cognition was assessed using the Mini-Mental State examination (MMSE) questionnaire. Results Anthracycline-based regimen was found to increase the levels of IL-6, IL-1β, and decreased MMSE scores compared with CMF regimen (p< 0.05). Conclusion Anthracycline-based regimen caused comparatively higher peripheral inflammation, which could be the reason for more decline in cognition in anthracycline-receiving patients than non-anthracycline group.
Resumo Antecedentes Regime baseado em antraciclinas (5-fluorouracil, doxorrubicina e ciclofosfamida [FAC]; ciclofosfamida, epirrubicina e 5-fluorouracil [CEF]) e regimes não baseados em antraciclina (ciclofosfamida, metotrexato e 5-fluorouracil (CMF]) são amplamente utilizados como quimioterapia neoadjuvante para pacientes com câncer de mama. Objetivo O presente estudo foi realizado para observar os efeitos do regime FAC, CEF e CMF na cognição e citocinas pró-inflamatórias circulatórias (interleucina 6 [IL-6] e interleucina 1β [IL-1β]) durante três ciclos de quimioterapia em pacientes com câncer de mama. Métodos Oitenta pacientes recém-diagnosticadas com câncer de mama HER-2 negativo foram recrutadas e divididas em 3 grupos de pacientes que receberam FAC (n= 27), CEF (n= 26) ou CMF (n= 27). Os níveis séricos de IL-6 e IL-1β foram medidos por enzyme-linked immunosorbent assay (ELISA) e a cognição foi avaliada por meio do questionário Mini-Mental State Examination (MMSE). Resultados O regime baseado em antraciclinas aumentou os níveis de IL-6, IL-1β e diminuiu os escores do MMSE em comparação com o regime CMF (p< 0,05). Conclusão O regime baseado em antraciclinas causou inflamação periférica comparativamente mais alta, o que pode ser a razão para maior declínio na cognição em pacientes que receberam antraciclinas do que no grupo que não recebeu antraciclina.
ABSTRACT
Background: Drug utilization studies (DUS) defined by World Health Organization as the marketing, distribution, prescription and use of drugs in a society, considering its consequences, either medical, social, and economic. The increasing importance of DUS as a valuable investigation resource in pharmacoepidemiology has been linking it with other health related areas, such as public health, pharmacovigilance, pharmacoeconomics, and pharmacogenetics. Methods: The study was a prospective DUS carried out in medicine OPD of Indian Institute of Technology Hospital, New Delhi, India in which a total of 595 prescriptions of hypertensive and diabetic patients were reviewed. All diabetic and/or hypertensive patients; irrespective of age, gender; who had least one drug in the prescription were included. Data were collected by screening of physician’s prescribing record and patient medication profile. Results: A total of 595 prescriptions were recorded. 57.31% were males as compared to 42.69% females. 54.62% patients were hypertensive (325 prescription); 14.78% patients were diabetic (88 prescription) whilst 30.58% had both the diseases. Of 507 prescriptions having antihypertensive drugs, combination therapy was utilized (40.8%) in the prescriptions and out of 270 prescriptions having antidiabetic drugs, 143 (52.96%) prescription were of combination therapy. Among antihypertensive drugs, angiotensin-converting enzyme inhibitors were the most frequently prescribed class of drugs (19.18%). The combination most commonly prescribed was amlodipine and atenolol (14.05%). Antidiabetic drugs made up for 11.05% of the total drugs prescribed. 28.78% of all hypoglycemic agents were sulfonylurea. Glimepiride and metformin combination was the most prescribed anti-diabetic drugs combination (16.16%). Conclusion: Both hypertension and diabetes are considered to be lifestyle diseases. Hence, apart from optimal and appropriate prescribing, there is a need for lifestyle modification to obtain improved outcomes. Combination therapy was observed in a high percentage of prescriptions. Though monotherapy is associated with improved compliance and fewer side effects, combination therapy is desirable for synergistic actions and to overcome complications.