Management of drug supply chain information based on "artificial intelligence + vendor managed inventory" in China: perspective based on a case study.

Objectives: To employ a drug supply chain information system to optimize drug management practices, reducing costs and improving efficiency in financial and asset management. Methods: A digital artificial intelligence + vendor managed inventory (AI+VMI)-based system for drug supply chain information management in hospitals has been established. The system enables digitalization and intelligentization of purchasing plans, reconciliations, and consumption settlements while generating purchase, sales, inventory reports as well as various query reports. The indicators for evaluating the effectiveness before and after project implementation encompass drug loss reporting, inventory discrepancies, inter-hospital medication retrieval frequency, drug expenditure, and cloud pharmacy service utilization. Results: The successful implementation of this system has reduced the hospital inventory rate to approximately 20% and decreased the average annual inventory error rate from 0.425‰ to 0.025‰, significantly boosting drug supply chain efficiency by 42.4%. It has also minimized errors in drug application, allocation, and distribution while increasing adverse reaction reports. Drug management across multiple hospital districts has been standardized, leading to improved access to medicines and enhanced patient satisfaction. Conclusion: The AI+VMI system improves drug supply chain management by ensuring security, reducing costs, enhancing efficiency and safety of drug management, and elevating the professional competence and service level of pharmaceutical personnel.

Association and mechanism of montelukast on depression: A combination of clinical and network pharmacology study.

BACKGROUND: Post-marketing surveillance found montelukast use was associated with an increased risk of depression. However, results of observational studies are inconsistent. OBJECTIVE: This study aimed to assess whether montelukast exposure is associated with depression and elucidate the possible molecular mechanism. METHOD: We conducted a cross-sectional study of 9508 adults from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Multivariable regression was used to evaluate the association between montelukast exposure and depression. Network pharmacology was conducted to identify the mechanisms of montelukast on depression. RESULTS: Montelukast exposure had a higher prevalence of depression (37.4 %). In a multivariable logistic regression model adjusted for sociodemographic, behavioural, and health characteristics, montelukast exposure was associated with depression (odds ratio [OR]: 1.61; confidence interval [CI]: 1.18-2.19). Network pharmacology was identified 69 key targets of montelukast on depression. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested montelukast mainly works through multiple pathways in endocrine resistance, chemical carcinogenesis-receptor activation, estrogen signaling pathway, etc. LIMITATIONS: Cross-sectional data. CONCLUSIONS: The study implies a potential positive association between long-term montelukast exposure and depression through multi-faceted mechanisms. It is suggested that attention be given to the possibility of depression in patients undergoing prolonged montelukast therapy.

Prioritization of drug targets for thyroid cancer: a multi-omics Mendelian randomization study.

OBJECTIVES: Recurrence or tumor metastasis and drug resistance remain the major challenge in the treatment of thyroid cancer. It is needed to identify novel drug targets for thyroid cancer. METHODS: Summary data-based Mendelian randomization (SMR) and colocalization analysis were performed to evaluate the associations between gene methylation, expression, protein levels with thyroid cancer. We additionally performed protein-protein interaction (PPI) network, gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) analyses to further explore the potential roles of identified genes in thyroid cancer. RESULTS: SDCCAG8 and VCAM1 genes were associated with risk of thyroid cancer with tier 1 evidence, while TCN2 gene was with tier 3 evidence. SDCCAG8 gene was associated with risk of papillary thyroid cancer with tier 1 evidence. At the level of circulating proteins, genetically predicted higher levels of SDCCAG8 (OR = 0.46, 95% CI 0.34-0.64) and VCAM1 (OR = 0.21, 95% CI 0.10-0.45) were inversely associated with thyroid cancer risk; higher level of TCN2 was associated with an increased risk of thyroid cancer (OR = 1.30, 95% CI 1.15-1.47); and the higher level of SDCCAG8 (OR = 0.40, 95% CI 0.28-0.58) was associated with a decreased risk of papillary thyroid cancer. The bioinformatics analysis showed that SDCCAG8, VCAM1 and TCN2 might play roles in immune-related pathways. CONCLUSION: SDCCAG8, VCAM1 and TCN2 genes were associated with thyroid cancer risk with evidence at multi-omics levels. There were potential roles of SDCCAG8, VCAM1 and TCN2 in immune-related pathways. Our findings might improve the understanding of the pathogenesis of thyroid cancer and discovery of novel potential drug targets for this disease.

Leukotriene-modifying agents may increase the risk of depression: A cross-sectional study.

INTRODUCTION: Post-market monitoring has shown a potential link between the use of leukotriene-modifying agents (LTRAs) and an increased risk of neuropsychiatric events, such as depression. However, observational studies have produced inconsistent findings, offering no definitive conclusions. OBJECTIVE: To assess the potential correlation between LTRAs exposure and depression in US adults. METHOD: This cross-sectional study, based on population data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016 cycle. The Patient Health Questionnaire-9 was used to assess depression. Multivariable regression was used to evaluate the association between LTRAs exposure and depression. Sensitivity and subgroup analyses were conducted, with the calculation of the E-value. Network pharmacology was employed to investigate the influence of LTRAs on mechanisms of depression. RESULTS: Among the 9414 participants, 595 (6.3 %) were classified as having depression. LTRAs exposure was associated with a higher prevalence of depression (16.9 % vs. 6.0 %). The multivariable logistic regression results showed that LTRAs use increased the risk of depression (OR = 1.70; 95 % CI, 1.05-2.75). An association between LTRAs exposure and depression was found in sensitivity analyses conducted regardless of multivariable linear regression with the PHQ-9 score as a continuous variable (ß = 0.97; 95 % CI, 0.44-1.50) or multivariable logistic regression with the PHQ-9 cut-off of 5 (OR = 1.52; 95 % CI, 1.08-2.14). The association between LTRAs and depression was stable in the different subgroups. CONCLUSION: LTRAs exposure is positively associated with depression in US adults. Therefore, the risk for depression in patients receiving long-term LTRAs treatment should be considered.

Efficacy and Safety of Immune Checkpoint Inhibitors Combined With Chemotherapy as First-line Treatment for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Different clinical trials for recurrent or metastatic nasopharyngeal carcinoma have studied different combinations of immuno-oncology in first-line treatment, but the optimal choice has not been determined. OBJECTIVE: To systematically examine and compare the efficacy and safety of different immune checkpoint inhibitors (ICIs) combined with chemotherapy as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma. METHODS: Several electronic databases were systematically searched up to February 2023. Articles meeting the inclusion criteria were included. RESULTS: Three RCTs were eligible in the study. Compared with placebo plus gemcitabine-cisplatin (GP), toripalimab plus GP (HR = 0.59, 95% CI: 0.37-0.95) was significantly associated with a better OS. Tislelizumab plus GP generated best progression-free survival (PFS) benefit (HR = 0.50, 95% CI: 0.37-0.67), greatest improvement in 1-year PFS rate (RR = 3.00, 95% CI: 1.84-5.22), and objective response rate (ORR) (RR = 1.26, 95% CI: 1.04-1.53) over the placebo plus GP. Furthermore, tislelizumab plus GP appeared to be safer than toripalimab plus GP and camrelizumab plus GP in terms of adverse events (AEs)-grade ≥3, treatment-related AEs (TRAEs)-grade ≥3, serious AEs (SAEs), treatment-related SAEs (TRSAEs), and AEs leading to discontinuation of treatment. CONCLUSION AND RELEVANCE: In recurrent or metastatic nasopharyngeal carcinoma, programmed death 1 (PD-1) inhibitors plus GP as first-line treatment have better survival outcomes than placebo plus GP with comparable toxicity. Toripalimab plus GP shows the best OS benefit over placebo plus GP, while tislelizumab plus GP generates the best PFS, 1-year PFS rate, ORR, and safety. Tislelizumab plus GP could be the best choice among the ICIs combined with chemotherapy regimens as first-line treatment in recurrent or metastatic nasopharyngeal carcinoma.

Incidence of Adverse Events Induced by Atropine in Myopic Children: A Meta-Analysis.

A large number of studies have evaluated the efficacy of low-dose atropine in preventing or slowing myopic progression. However, it is challenging to evaluate the ocular safety from these studies. We aimed to evaluate the incidence of adverse events induced by atropine in children with myopia. We performed a systematic literature search in several databases for studies published until November 2022. The incidence of adverse events induced by atropine was pooled by a common-effect (fixed-effect) or random-effects model. Subgroup analyses were conducted according to drug doses, types of adverse events, and ethnicity. A total of 31 articles were ultimately included in the study. The overall incidence of adverse events for atropine was 5.9%, and the incidence of severe adverse events was 0.0%. The most commonly reported adverse events were photophobia (9.1%) and blurred near vision (2.9%). Other adverse events including eye irritation/discomfort, allergic reactions, headache, stye/chalazion, glare, and dizziness occurred in less than 1% of the patients. The incidence of atropine-induced adverse events varied depending on the drug doses. A lower dose of atropine was associated with a lower incidence of adverse events. There was no significant difference in the incidence of adverse events for low-dose atropine between Asian and White children. Our study suggests photophobia and blurred near vision are the most frequently reported adverse events induced by atropine. Low-dose atropine is safer than moderate- and high-dose atropine. Our study could provide a safe reference for ophthalmologists to prescribe atropine for myopic children.

COVID-19 vaccine response and safety in patients with cancer: An overview of systematic reviews.

Background: To date, the COVID-19 pandemic does not appear to be overcome with new variants continuously emerging. The vaccination against COVID-19 has been the trend, but there are multiple systematic reviews on COVID-19 vaccines in patients with cancer, resulting in redundant and sub-optimal systematic reviews. There are still some doubts about efficacy and safety of the COVID-19 vaccine in cancer patients. Purpose: To identify, summarize and synthesize the available evidence of systematic reviews on response and COVID-19 vaccine safety in patients with cancer. Methods: Multiple databases were searched from their inception to May 1, 2022 to fetch the relevant articles. Study quality was assessed by AMSTAR2. The protocol of this study was registered on PROSPERO (CRD42022327931). Results: A total of 18 articles were finally included. The seroconversion rates after first dose were ranged from 37.30-54.20% in all cancers, 49.60-62.00% in solid cancers and 33.30-56.00% in hematological malignancies. The seroconversion rates after second dose were ranged from 65.30-87.70% in all cancers, 91.60-96.00% in solid cancers and 58.00-72.60% in hematological malignancies. Cancer types and types of therapy could influence vaccine response. COVID-19 vaccines were safe and well-tolerated. Conclusions: This study suggests COVID-19 vaccine response is significantly lower in cancer patients. Number of received doses, cancer types and treatment strategies could influence response of COVID-19 vaccine in cancer patients. COVID-19 vaccines are safe and well-tolerated. Considering the emergence of several new variants of SARS-CoV-2 with potential influence on ongoing vaccination programs, there is a need for booster doses to increase the effectiveness of COVID-19 vaccines. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022327931, identifier CRD42022327931.

Artificial intelligence-based internet hospital pharmacy services in China: Perspective based on a case study.

Background: Recently, internet hospitals have been emerging in China, saving patients time and money during the COVID-19 pandemic. In addition, pharmacy services that link doctors and patients are becoming essential in improving patient satisfaction. However, the existing internet hospital pharmacy service mode relies primarily on manual operations, making it cumbersome, inefficient, and high-risk. Objective: To establish an internet hospital pharmacy service mode based on artificial intelligence (AI) and provide new insights into pharmacy services in internet hospitals during the COVID-19 pandemic. Methods: An AI-based internet hospital pharmacy service mode was established. Initially, prescription rules were formulated and embedded into the internet hospital system to review the prescriptions using AI. Then, the "medicine pick-up code," which is a Quick Response (QR) code that represents a specific offline self-pick-up order, was created. Patients or volunteers could pick up medications at an offline hospital or drugstore by scanning the QR code through the window and wait for the dispensing machine or pharmacist to dispense the drugs. Moreover, the medication consultation function was also operational. Results: The established internet pharmacy service mode had four major functional segments: online drug catalog search, prescription preview by AI, drug dispensing and distribution, and AI-based medication consultation response. The qualified rate of AI preview was 83.65%. Among the 16.35% inappropriate prescriptions, 49% were accepted and modified by physicians proactively and 51.00% were passed after pharmacists intervened. The "offline self-pick-up" mode was preferred by 86% of the patients for collecting their medication in the internet hospital, which made the QR code to be fully applied. A total of 426 medication consultants were served, and 48.83% of them consulted outside working hours. The most frequently asked questions during consultations were about the internet hospital dispensing process, followed by disease diagnosis, and patient education. Therefore, an AI-based medication consultation was proposed to respond immediately when pharmacists were unavailable. Conclusion: The established AI-based internet hospital pharmacy service mode could provide references for pharmacy departments during the COVID-19 pandemic. The significance of this study lies in ensuring safe/rational use of medicines and raising pharmacists' working efficiency.

Adverse drug reaction reporting quality among different health professionals and the contribution of clinical pharmacists: A pilot study.

WHAT IS KNOWN AND OBJECTIVE: Adverse drug reaction (ADR) reporting is generally of poor quality, which may delay post-marketing regulatory actions. Here, we evaluated the quality of ADR reporting at our institution and examined the roles of clinical pharmacists in this process. METHODS: We retrospectively reviewed ADR reports at our hospital between 2017 and 2019 to assess the number, source, drugs, and routes of administration. The quality assessment of ADR case reports form issued by the China Adverse Drug Reaction Monitoring Centre was used to assess the quality of ADR reports. Quality scores of ADR reports from pharmacists and nonpharmacists were assessed before and after review by clinical pharmacists. RESULTS AND DISCUSSION: Reports of adverse drug reaction reporting by healthcare professionals increased annually, with 59, 77 and 82 reports submitted in 2017, 2018 and 2019, respectively. The numbers of new or serious ADR reports by healthcare professionals in 2017, 2018, and 2019 were 5 (8.47%), 77 (11.69%) and 82 (10.98%), respectively. New or serious ADR reports accounted for approximately 10% (23/218) of all reported cases, and more than 70% (158/218) of the reports were from pharmacists. Systemic administration accounted for more than 80% (233/265) of adverse reactions, whereas ADRs due to topical drug use were rarely reported. The drugs that reportedly triggered ADRs were mainly antibacterial and patented Chinese medicines and accounted for more than half of all reported cases. The scores of ADR reports from pharmacists and nonpharmacists before modification by clinical pharmacists were 86.69 ± 8.12 and 68.36 ± 5.94, respectively, and the scores of ADR reports from pharmacists and nonpharmacists after modification by clinical pharmacists were 91.14 ± 6.64 and 90.02 ± 5.63, respectively. WHAT IS NEW AND CONCLUSION: In a real-world setting, pharmacists are commonly responsible for most ADR reports. The quality of ADR reports from pharmacists and nonpharmacists before review did not reach the standard of excellence. An audit of clinical pharmacists may improve the overall quality of ADR reports. However, under-reporting of adverse reactions still occurs.

The use of fixed dose drug combinations for glaucoma in clinical settings: a retrospective, observational, single-centre study.

BACKGROUND: The aim of study was to understand anti-glaucoma fixed dose drug combination use in real-world settings, focussing on drug selection, repeated prescription of the same active ingredient, and administration of fixed dose combinations, thus providing a reference for doctors during prescription and pharmacists during prescription review, ultimately educating patients on medication. METHODS: A retrospective, observational, single-centre study was conducted. Outpatient prescriptions for anti-glaucoma eye drops from 01 January to 31 March 2021 were extracted. The prescriptions containing anti-glaucoma fixed dose combinations were analysed, and the rationale for each prescription was reviewed. RESULTS: There were 10,947 ophthalmic patients with anti-glaucoma eye drop prescriptions in the study period. Of these, 4002 (36.5%) were prescribed anti-glaucoma fixed dose drug combinations. Approximately 80% of the patients were prescribed brinzolamide/timolol, while about 10% received prostaglandin analogues/timolol eye drops. Less than 40% of prescriptions were for monotherapy with fixed dose combinations. The most commonly duplicated drug class was ß-receptor antagonists. An increase in prescribing drugs containing the same ingredient was observed for regimens containing various medicines. CONCLUSION: More than 60% of the combinations were used together with other anti-glaucoma drugs. The advantages of these fixed dose combinations in improving patient compliance need to be reassessed in real-word settings. Prescriptions containing duplicated ingredients were common. However, they were not necessarily considered unreasonable because the dosage forms were administered at different times. For prescriptions containing repetitive ingredients, pharmacists should judge the rationale by evaluating the dosing frequency and drug indications and explain the appropriate administration to patients.

Survey about the use of clarithromycin in an ENT outpatient department of a tertiary hospital.

We undertook this survey about the use of clarithromycin in the Ear, Nose, and Throat (ENT) Outpatient Department of Fudan University Hospital to understand its utilization patterns and rational use. A survey of prescriptions given to outpatients was carried out, and detailed information of the patients, including age, sex, diagnosis, combined medication, and other information, was recorded in Excel spreadsheets. The rationale for each prescription was evaluated retrospectively. Based on our analysis, 82.5% of the clarithromycin prescriptions were for the treatment of rhinosinusitis. It was found that the parameters for the diagnosis of this condition were surprisingly broad and should have been more specific. In addition, the clarithromycin dosage regimen varied in clinical practice. For chronic rhinosinusitis, the duration of treatment was between 8 and 16 days, which was not sufficient. Moreover, clarithromycin was prescribed along with considerable numbers of pharmacotherapeutic anti-allergic drugs. Our survey indicated that improvements in the quality of clarithromycin prescriptions in otolaryngology outpatients should be made. Furthermore, the importance of medical education to patients should be emphasized. In addition, the interaction between clarithromycin and other anti-allergic drugs requires further investigation.

[Pharmacokinetics of flavonoids from xiexin decoction in rats].

To study the pharmacokinetics of flavonoids from Xiexin decoction in rats. SD rats were given a single ig dose of Xiexin decoction 12 g x kg(-1), plasma and urine were collected before and after dosing. Flavonoids components in plasma and urine were measured by HPLC. Pharmacokinetic parameters were determined from the plasma concentration-time data and urinary excretion-time data with the DAS software package. Baicalin was incubated with the rat renal homogenate to investigate its metabolism in vitro. After oral administration of Xiexin decoction baicalin and wogonoside were quickly absorbed and exhibited double peak phenomena in their plasma concentrations. The first peaks in plasma concentrations of baicalin and wogonoside reached Cmax1 of (10 +/- 8) and (1.5 +/- 0.5) mg x L(-1) at Tmax1 of (0.27 +/- 0.09) and (0.17 +/- 0.00) h, while the second peaks reached Cmax2 of (3. 9 0. 5) and (0. 74 +/- 0.11) mg x L(-1) at Tmax2 of (7.6 +/- 2.6) and (16.0 +/- 0.0) h, respectively. The T(1/2) of baicalin and wogonoside were (7 +/- 3) and (6.4 +/- 2.1) h, AUC(0-infinity) were (57 +/- 12) and (15 +/- 3) mg x h x L(-1), respectively. After oral administration of Xiexin decoction, not only baicalin and wogonoside but also baicalein and wogonin can be detected in the urine. The amounts of baicalin, wogonoside, baicalein and wogonin excreted from urine during 0-72 h were (1.4 +/- 0.3), (3.4 +/- 1.3), (2.2 +/- 0.97), (10 +/- 4)% of dose given in rats, respectively. The excretion T(1/2) of the four flavonoids were (6.9 +/- 2.1), (9 +/- 4) , (8.2 +/- 2.0) and (7.2 +/- 1.8) h, respectively. Baicalin was metabolized into baicalein in the rat renal homogenate in vitro, and the kinetic parameters were measured as Vmax = 702 nmol x min(-1) x g(-1) (protein) and Km=135 micromol x L(-1). After oral administration of Xiexin decoction, flavonoids can be absorbed quickly. Only a small quantity of baicalin, wogonoside, baicalein and wogonin were excreted from urine. Baicalin may be metabolized into baicalein in the rat kidney.