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Medicines, Volume 11, Issue 4 (April 2024) – 2 articles

Cover Story (view full-size image): Medicines (ISSN 2305-6320) is an international, peer-reviewed, and open access journal aimed at combining all areas of medical disciplines and subspecialties in one platform. It mainly publishes, but is not limited to, original research papers, case reports, reviews, systematic reviews, brief reports, concepts and opinions on all aspects of basic, clinical, and translational research in relation to human health. The journal will accept manuscripts on medical concepts that include evidence-based medicine and/or alternative medicine. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Full details must be provided when publishing an experiment so that the results can be reproduced.

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17 pages, 367 KiB

Open AccessReview

Human Leucocyte Antigen Genetics in Idiosyncratic Drug-Induced Liver Injury with Evidence Based on the Roussel Uclaf Causality Assessment Method

by Rolf Teschke and Gaby Danan

Medicines 2024, 11(4), 9; https://doi.org/10.3390/medicines11040009 - 11 Apr 2024

Viewed by 456

Abstract

The human leucocyte antigen (HLA) allele variability was studied in cohorts of patients with idiosyncratic drug-induced liver injury (iDILI). Some reports showed an association between HLA genetics and iDILI, proposing HLA alleles as a potential risk factor for the liver injury. However, the strength of such assumptions heavily depends on the quality of the iDILI diagnosis, calling for a thorough analysis. Using the PubMed database and Google Science, a total of 25 reports of case series or single cases were retrieved using the terms HLA genes and iDILI. It turned out that in 10/25 reports (40%), HLA genetics were determined in iDILI cases, for which no causality assessment method (CAM) was used or a non-validated tool was applied, meaning the findings were based on subjective opinion, providing disputable results and hence not scoring individual key elements. By contrast, in most iDILI reports (60%), the Roussel Uclaf Causality Assessment Method (RUCAM) was applied, which is the diagnostic algorithm preferred worldwide to assess causality in iDILI cases and represents a quantitative, objective tool that has been well validated by both internal and external DILI experts. The RUCAM provided evidence-based results concerning liver injury by 1 drug class (antituberculotics + antiretrovirals) and 19 different drugs, comprising 900 iDILI cases. Among the top-ranking drugs were amoxicillin–clavulanate (290 cases, HLA A*02:01 or HLA A*30:02), followed by flucloxacillin (255 cases, HLA B*57:01), trimethoprim–sulfamethoxazole (86 cases, HLA B*14:01 or HLA B*14:02), methimazole (40 cases, HLA C*03:02), carbamazepine (29 cases, HLA A*31:01), and nitrofurantoin (26 cases, HLA A*33:01). In conclusion, the HLA genetics in 900 idiosyncratic drug-induced liver injury cases with evidence based on the RUCAM are available for studying the mechanistic steps leading to the injury, including metabolic factors through cytochrome P450 isoforms and processes that activate the innate immune system to the adaptive immune system. Full article

(This article belongs to the Special Issue The 10th Anniversary of Medicines: Future Directions)

10 pages, 1251 KiB

Open AccessArticle

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

by Nathan T. Kolasinski, Eric A. Pasman, Cade M. Nylund, Patrick T. Reeves, Daniel I. Brooks, Katerina G. Lescouflair and Steve B. Min

Medicines 2024, 11(4), 8; https://doi.org/10.3390/medicines11040008 - 26 Mar 2024

Viewed by 547

Abstract

Eosinophilic esophagitis (EoE) disease activity can be caused by treatment non-adherence. Medication possession ratio (MPR) is an established metric of medication adherence. A higher MPR correlates with better outcomes in several chronic diseases, but MPR has not been investigated with respect to EoE. A retrospective cohort study was performed using an established EoE registry for the years 2005 to 2020. Treatment periods were identified, MPRs were calculated, and medical records were assessed for histologic remission (<15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period. In total, 275 treatment periods were included for analysis. The MPR in the histologic remission treatment period group was 0.91 (IQR 0.63–1) vs. 0.63 (IQR 0.31–0.95) for the non-remission treatment period group (p < 0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥ 0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% confidence interval 1.79–5.30) and significantly decreased odds of dysphagia (OR 0.27, 95% CI 0.15–0.45), food impaction (OR 0.26, 95% CI 0.11–0.55), stricture occurrence (OR 0.52 95% CI 0.29–0.92), and esophageal dilation (OR 0.29, 95% CI 0.15–0.54). Assessing MPR before repeating an esophagogastroduodenoscopy may decrease unnecessary procedures in the clinical management of eosinophilic esophagitis. Full article

(This article belongs to the Topic Drug Utilization and Medication Adherence: Strategies, Technologies and Practices)

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Medicines, Volume 11, Issue 4 (April 2024) – 2 articles

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