Aims: This study aimed to assess the impact of pharmacist-led medication therapy management (MTM) for ambulatory elderly patients with chronic diseases. Methods: Consecutive patients were enrolled from pharmacist outpatient clinics from January 2016 to June 2018. Eligible subjects were performed with MTM services by the pharmacists and had clinical data for at least 2 clinic visits within a consecutive 12-month period after the first MTM visit. The drug-related problems (DRPs) and recommendations were evaluated using The Pharmaceutical Care Network Europe (PCNE) Classification for Drug related problems V8.03. Results: A total of 525 DRPs were identified during the study period. Treatment effectiveness P1 (53.71%) was the most common problems of DRPs. The most frequently recommended intervention was changing the drug (48.76%). These interventions were accepted by the patients in 92.38% and were completely implemented in 90.48%. The number of drugs taken was the significant associated factor for DRPs. Post-intervention group showed lower levels in systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the pre-intervention group. There were statistically significant changes in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) between the pre- and post-intervention group. The average cost of medications per patient for every month decreased from 387.72 Ren Min Bi (RMB) to 355.17 RMB (P=0.009). Conclusion: We confirmed that pharmacists has a valuable role to perform MTM services for ambulatory elderly patients, not only in identifying and solving the DRPs, but also in improving clinical outcomes (BP and lipid level) and cost saving.

Purpose: The classical taxanes (paclitaxel, docetaxel), the newer taxane cabazitaxel and the nanoparticle-bound nab-paclitaxel are among the most widely used anticancer drugs. Still, the optimal use and the value of pharmacological personalization of the taxanes is still controversial. Methods: We give an overview on the pharmacological properties of the taxanes, including metabolism, pharmacokinetics-pharmacodynamic relations and aspects in the clinical use of taxanes. The latter includes the ongoing debate on the most effective and safe regimen, the recommended initial dose, and pharmacological dosing individualization. Conclusions: The taxanes are among the most widely used anticancer drugs in patients with solid malignancies. Despite their longtime use in clinical routine, the optimal dosing strategy (weekly versus 3-weekly) or optimal average dose (cabazitaxel, nab-paclitaxel) has not been fully resolved, as it may differ per tumor entity and line of treatment. The value of pharmacological individualization of the taxanes (TDM, TCI) has partly been explored for 3-weekly paclitaxel and docetaxel, but remains mostly unexplored for cabazitaxel and nab-paclitaxel at present.

Aims: To determine if the combination of exercise and statin could normalize postprandial triglyceridemia (PPTG) in hypercholesteraemic individuals. Mehods: Eight hypercholesteraemic (blood cholesterol 182±38 mg·dL-1; LDL-c 102±32 mg·dL-1) overweight (BMI 30±4 kg·m-2) individuals with metabolic syndrome (i.e., Met Synd) were compared to a group of eight metabolically healthy controls (i.e., MetH, blood cholesterol 149±23 mg·dL-1; LDL-c 77±23 mg·dL-1, and BMI 23±2 kg·m-2). Each group underwent two PPTG tests, either 14-h after a bout of intense exercise (EXER) or without previous exercise (REST). Additionally, Met Synd individuals were tested 96 h after withdrawal of their habitual statin medication (PLAC trials) to study medication effects. Results: A bout of exercise before the test meal did not reduce PPTG in Met Synd (P=0.347), but reduced PPTG by 46% in MetH (224±142 to 413±267 mg·dL-1·for 5 h iAUC; P=0.02). In both trials (i.e., REST and EXER) statin withdrawal in Met Synd greatly increased PPTG (average 65%; P<0.01), mean LDL-c (average 25%; P<0.01), total cholesterol (average 16%; P<0.01) and Apo B48 (24%; P<0.01), without interference from exercise. However, Apo B100 was not affected by statin withdrawal. Conclusions: Hypercholesteraemic Met Synd individuals (compared to metabolically healthy controls) are resistant to the effects of exercise on reducing PPTG. However, chronic statin medication blunts the elevations in TG after a fat meal (i.e., iAUC of PPTG) reducing their cardiovascular risk associated to their atherogenic dyslipidemia. Statin decreases PPTG by reducing the secretion or accelerating the catabolism of intestinal Apo B48.

Personalization of oral small molecule anticancer drug doses based on individual patient blood drug levels, also known as therapeutic drug monitoring or TDM, has the potential to significantly improve the effectiveness of treatment by maximizing drug efficacy and minimize toxicity. However, this option has not yet been widely embraced by the oncology community. Some reasons for this include increased logistical complexity of dose individualization, the lack of clinical laboratories that measure small molecule drug concentrations in support of patient care, and the lack of reimbursement of costs. However, the main obstacle may be the lack of studies clearly demonstrating that monitoring of oral small molecule anticancer drug levels actually improves clinical outcomes. Without unequivocal evidence in support of TDM-guided dose individualization, especially demonstration of improved survival with TDM in randomized controlled trials, wide acceptance of this approach by oncologists and reimbursement by insurance companies is unlikely, and patients may continue to suffer as a result of receiving incorrect drug doses. This article reviews the current status of therapeutic drug monitoring of oral small molecule drugs in oncology and intends to provide strategic insights into the design of studies for evaluating the utility of TDM in this clinical context.

The deployment of artesunate for severe malaria and the artemisinin combination therapies (ACTs) for uncomplicated malaria has been a major advance in antimalarial therapeutics. These drugs have reduced treated mortality, accelerated recovery, and reduced treatment failure rates and transmission from the treated infection. These drugs remain highly effective against falciparum malaria in most malaria endemic areas but significant resistance has emerged in the Greater Mekong subregion of Southeast Asia. Resistance to artemisinin was followed by resistance in the ACT partner drugs, and fit multidrug resistant parasite lineages have now spread widely across the region. ACTs are highly effective against P. vivax and the other malaria species. Recent studies show that radical curative regimens of primaquine (to prevent relapse) can be shortened to seven days, and that the newly introduced single dose tafenoquine is an alternative, although the currently recommended dose is insufficient in Southeast Asia and Oceania. Targeted malaria elimination using focal mass treatments with dihydroartemisinin-piperaquine have proved safe and effective malaria elimination accelerators, but progress overall towards malaria elimination is very slow. Indeed since 2015 overall malaria case numbers globally have risen.

There is an urgent need for targeted and effective COVID-19 treatment. A number of medications, including hydroxychloroquine, remdesivir, lopinavir-ritonavir, fapiravir, and tocilizumab, have been identified as potential treatments for COVID-19. Bringing these repurposed medications to the public for COVID-19 will require robust and high-quality clinical trials. This article reviews translational science principles and strategies for conducting clinical trials in a pandemic and evaluates recent trials for each drug candidate. We hope that this knowledge will help focus efforts during this crisis and lead to the expedited development and approval of COVID-19 therapy.

Initiation of statin treatment is suggested to increase the international normalised ratio (INR) among warfarin users. However, available data is limited and conflicting. We conducted a register-based cohort study to evaluate the drug-drug interaction between warfarin and statins. By linking data on INR measurements and filled prescriptions, we identified warfarin users 2000-2015 initiating simvastatin (n=1,363), atorvastatin (n=165), or rosuvastatin (n=23). Simvastatin initiation led to an increase in mean INR from 2.40 to 2.71, with INRs peaking after 4 weeks, corresponding to a mean change of 0.32 (95%CI 0.25-0.38). High-dose and low-dose simvastatin led to comparable changes (mean change 0.33 vs 0.29). Initiation of atorvastatin and rosuvastatin lead to INR increases of 0.27 (95%CI 0.12-0.42) and 0.30 (95%CI -0.09-0.69). In conclusion, initiation of simvastatin, atorvastatin, or rosuvastatin among warfarin users led to a minor increase in INR. The magnitude of this change is for most patients likely of limited clinical relevance.

Tyrosine kinase inhibitors (TKIs) have revolutionized the management of chronic myeloid leukemia (CML), and currently in patients with CML in chronic phase (CML-CP) the first-line treatment is based on BCR-ABL targeted therapy with TKIs [1]. Although generally well tolerated, all BCR-ABL TKIs can be associated with hematologic and non-hematologic toxicities [2]. Most of the patients with CML-CP continue receiving TKIs, unless there is lack of optimal response and/or serious toxicities.