ABSTRACT
OBJECTIVE To establish the path-based management mode of 5-hydroxytryptamine-3 receptor antagonist （5- HT3RA） in chemotherapy patients， and to improve the rationality of medication in chemotherapy patients. METHODS 5-HT3RA standardized drug use control rules were formulated， with the help of medical intelligence and decision support （MINDS） system， path-based management was carried out for chemotherapy patients using 5-HT3RA in the form of whole-process information capture and prescription pre-review， and whole-process intervention was implemented on medication indications， usage and dosage， course of treatment， etc. The intervention effect was analyzed by comparing the changes in the use of 5-HT3RA without indication， unreasonable usage and dosage， repeated medication， unreasonable course of treatment， and per capita drug cost before and after the implementation of path-based management. RESULTS A total of 9 181 patients were included. After the implementation of path- based management， the proportion of unindicated drugs decreased by 0.48%， and the rate of unreasonable single dosage， unreasonable frequency， repeated medication， unreasonable treatment course （5-HT3RA still used 3 days after chemotherapy） decreased by 10.48%， 0.65%， 1.33% and 0.34%； per capita cost of 5-HT3RA decreased by 13.72 yuan； there were statistical significance （P＜0.05）. CONCLUSIONS 5-HT3RA path-based management mode effectively improves the rationality of medication and provides a new idea for rational clinical drug use.
ABSTRACT
OBJECTIVE：To provide reference for clinical decision-making related to chemotherapy-induced nausea and vomiting（CINV）. METHODS ：The medical records of patients diagnosed as malignant tumor receiving multi-day cisplatin-containing chemotherapy in our hospital were collected by hospital information system from Jan.-Dec. 2012. The medical records were divided into tropisetron group ，ramosetron group and palonosetron group according to different schemes of 5-hydroxytryptamine-3 receptor antagonist. The covariates of 3 groups were balanced by propensity score matching method ；cost-utility analysis was conducted for the 3 matched antiemetic schemes ；one-way sensitivity analysis and sampling uncertainty analysis were also conducted. RESULTS ： The results of cost-utility analysis showed that treatment cost of one observation period of tropisetron group was 237.71 yuan and utility were 0.054 68 QALYs；that of ramosetron group was 242.37 yuan and utility were 0.055 26 QALYs，and that of palonosetron group was 319.24 yuan and utility were 0.055 76 QALYs. Compared with tropisetron group ，the ICER of palonosetron group was 75 155.69 yuan/QALY；Compared with ramosetron group ，the ICER of palonosetron group was 152 062.07 yuan/QALY. Both of them were lower than 3 times of China ’s 2020 per capita GDP （217 341 yuan/QALY）. The results of sensitivity analysis and sampling uncertainty analysis demonstrated that the results of basic analysis were robust. CONCLUSIONS ：Under the current drug price，the antiemetic regimen based on palonosetron is more economical for the prevention of CINV caused by multi-day chemotherapy containing cisplatin.
ABSTRACT
Mosapride accelerates gastric emptying by acting on 5-hydroxytryptamine type 4 (5-HT₄) receptor and is frequently used in the treatment of gastrointestinal (GI) disorders requiring gastroprokinetic efficacy. We tested the effect of mosapride on 5-hydroxytryptamine type 3 (5-HT₃) receptor currents because the 5-HT₃ receptors are also known to be expressed in the GI system and have an important role in the regulation of GI functions. Using the whole-cell voltage clamp method, we compared the currents of the 5-HT₃ receptors when 5-HT was applied alone or was co-applied with mosapride in cultured NCB-20 cells known to express 5-HT₃ receptors. The 5-HT₃ receptor current amplitudes were inhibited by mosapride in a concentration-dependent manner. Mosapride blocked the peak currents evoked by the application of 5-HT in a competitive manner because the EC₅₀ shifted to the right without changing the maximal effect. The rise slopes of 5-HT₃ receptor currents were decreased by mosapride. Pre-application of mosapride before co-application, augmented the inhibitory effect of mosapride, which suggests a closed channel blocking mechanism. Mosapride also blocked the opened 5-HT₃ receptor because it inhibited the 5-HT₃ receptor current in the middle of the application of 5-HT. It accelerated desensitization of the 5-HT₃ receptor but did not change the recovery process from the receptor desensitization. There were no voltage-, or use-dependency in its blocking effects. These results suggest that mosapride inhibited the 5-HT₃ receptor through a competitive blocking mechanism probably by binding to the receptor in closed state, which could be involved in the pharmacological effects of mosapride to treat GI disorders.