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Original

Risk factors for renal impairment in patients with solid tumors or multiple myeloma treated with zoledronic acid

You Jin Cha and Yu Jeung Lee

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Volume 51 p. 274 - 282

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 51 – No. 4/2013 (274-282)

Risk factors for renal impairment in patients with solid tumors or multiple myeloma treated with zoledronic acid

You Jin Cha¹ and Yu Jeung Lee²

¹Graduate School of Clinical Pharmacy, Sookmyung Women’s University, Seoul, Korea and ²College of Pharmacy, Kangwon National University, Gangwon-do, Korea
Objective: Using retrospective prescription analysis, this study aimed to investigate the risk factors for renal impairment among adult solid tumor and multiple myeloma patients who have received zoledronic acid injections in a teaching hospital over the last 4 years. Methods: We examined solid tumor and multiple myeloma patients who had received at least 1 zoledronic acid injection in a teaching hospital in Seoul with at least 2,000 beds over the 4 years between January 2008 and December 2011. The injection histories and serum creatinine levels of these patients were included in the analysis. Patients who developed renal impairment subsequent to zoledronic acid injection were identified, and the risk factors were statistically analyzed. Results: In only 1 case was zoledronic acid injection reduced as directed by the creatinine clearance guidelines. Four patients whose creatinine clearance was less than 30 ml/min were injected with zoledronic acid even though its use is contraindicated in this situation. Of the 338 research subjects, 26 developed renal impairment. The following were confirmed to be statistically significant (p < 0.05) risk factors for the development of renal impairment: serum creatinine (at first injection) of greater than 1.4 mg/dl, diabetes, hypertension, thalidomide prescription, multiple myeloma, and previous pamidronate usage. Conclusions: Based on the results of this study, renal monitoring is necessary following zoledronic acid injection. In addition, for patients with renal impairment risk factors, a risk-benefit analysis must be performed before zoledronic acid is administered, and it must be administered at an appropriate dose according to the level of renal function.Correspondence to:
Yu Jeung Lee, PharmD, PhD
College of Pharmacy, Kangwon National University
Kangwondaehak-gil 1, Chungcheon-si,
Gangwon-do, 200-701 Korea
Email: [email protected]

Original

Correlation of skin toxicity and hypertension with clinical benefit in advanced hepatocellular carcinoma patients treated with sorafenib

Sun Young Shin and Yu Jeung Lee

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Volume 51 p. 837 - 846

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 51 – No. 11/2013 (837-846)

Correlation of skin toxicity and hypertension with clinical benefit in advanced hepatocellular carcinoma patients treated with sorafenib

Sun Young Shin¹ and Yu Jeung Lee²

¹Department of Pharmacy, Asan Medical Center, Seoul, and ²Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University, Gangwon-do, Korea
Objective: The purpose of this study was to identify the correlation of skin toxicity and hypertension with clinical benefit in advanced hepatocellular carcinoma (HCC) patients treated with sorafenib by analyzing medical records retrospectively. Methods: Data from medical records was statistically analyzed to identify a correlation of skin toxicity and hypertension with treatment response and prognosis in advanced HCC patients who had received sorafenib at the Asan Medical Center from July 2010 to June 2012. This study investigated prognostic factors for overall survival and the correlation between the development of skin toxicities and hypertension. Results: A total of 99 patients receiving sorafenib were included in this study. 29 patients who developed skin toxicities Grade 2 or higher showed significantly longer survival than the 70 patients who developed skin toxicities less than Grade 2 or those without skin toxicity (p = 0.024). However, development of hypertension was not related to survival (p = 0.262). In a multivariate analysis, skin toxicities were found to be good prognostic factors for overall survival (hazard ratio, 0.320; 95% CI, 0.119 – 0.861; p = 0.024) as well as low α-fetoprotein level (hazard ratio, 0.195; 95% CI, 0.076 – 0.500; p = 0.001). On the other hand, no correlation was found between the development of skin toxicities and hypertension (p = 0.109). Conclusions: Skin toxicities that are common adverse reactions in advanced HCC patients treated with sorafenib may be used as surrogate markers for clinical benefit. Therefore, early detection and proper management of these toxicities is crucial for continuing treatment with sorafenib.Correspondence to:
Yu Jeung Lee, PharmD, PhD Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University, Kangwon daehak-gil 1, Chuncheon-si, Gangwon-do, 200-701 Korea
Email: [email protected]

Original

Factors affecting voriconazole plasma concentrations in patients with invasive fungal infections

Do-Young Kim, Hyo Jung Park, and Yu Jeung Lee

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Volume 52 p. 209 - 216

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 52 – No. 3/2014 (209-216)

Factors affecting voriconazole plasma concentrations in patients with invasive fungal infections

Do-Young Kim¹, Hyo Jung Park¹, and Yu Jeung Lee²

¹Department of Pharmacy, Samsung Medical Center, Seoul, and ²Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University, Gangwon-do, Korea
Objective: This study retrospectively analyzed the medical records of patients with invasive fungal infections treated with voriconazole in a teaching hospital in order to identify the factors affecting plasma concentrations of voriconazole. Methods: Patients treated with voriconazole for invasive fungal infection at the oncology department of the Samsung Medical Center, which is a tertiary teaching hospital located in Seoul, Korea, between January 2010 and May 2012 were statistically analyzed for the identification of factors affecting plasma concentrations of voriconazole. Results: Of the 64 patients analyzed, 3 patients who were also treated with cytochrome P450 (CYP) 2C19 inducers showed a statistically lower plasma concentration of voriconazole compared to the other 61 patients (p = 0.034). Factors such as sex, underlying disease, age, and voriconazole dosage were not significantly associated with the median plasma concentrations of voriconazole. The different administration routes of voriconazole were also not significantly associated with the median plasma concentration, but there was a tendency for higher plasma concentrations in 28 patients receiving the drug intravenously compared to 36 patients who received it orally. Conclusions: We found that patients with invasive fungal infections receiving voriconazole and CYP2C19 inducers concomitantly had significantly lower plasma concentrations of voriconazole compared to the other patients. In addition, there was a tendency for patients to have a higher plasma concentration of voriconazole when it was administered intravenously. However, additional prospective studies are needed to confirm these results and apply them to routine clinical practice. In the future it will be important to monitor plasma concentrations of voriconazole while considering the influence of various factors that could affect the concentrations.Correspondence to:
Yu Jeung Lee, PharmD, PhD
Department of Clinical Pharmacy
College of Pharmacy, Kangwon National University
Kangwondaehak-gil 1, Chuncheon-si,
Gangwon-do, 200-701 Korea
Email: [email protected]

Original

Effects of vitamin D on blood pressure in patients with type 2 diabetes mellitus

Kyeong Ju Lee and Yu Jeung Lee

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Volume 54 p. 233 - 242

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 54 – No. 4/2016 (233-242)

Effects of vitamin D on blood pressure in patients with type 2 diabetes mellitus

Kyeong Ju Lee and Yu Jeung Lee

Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University, Gangwon-do, Korea
Purpose: Previous studies have suggested that vitamin D supplementation may decrease blood pressure in patients with type 2 diabetes, although conflicting results have been reported. The purpose of this meta-analysis was to evaluate the effects of the vitamin D supplementation on blood pressure in patients with type 2 diabetes. Methods: A meta-analysis of published randomized controlled trials was conducted. Eligible studies were identified via a literature search of the MEDLINE (PubMed), EMBASE, and Cochrane Library databases through to May 25, 2015. The endpoint of the analysis was the change in blood pressure due to vitamin D treatment in patients with type 2 diabetes. These changes were calculated as the difference between the baseline and final measurements performed in each study. A fixed-effects model was used to calculate the combined effect estimates; in the presence of heterogeneity, a random-effects model was used. Results: A total of 15 articles were included in the meta-analysis. All 15 articles, including 1,134 patients with type 2 diabetes, were analyzed for systolic blood pressure (SBP), and 13 articles, including 793 patients, were analyzed for diastolic blood pressure (DBP). The combined-effect estimate of vitamin D intervention on SBP was –0.121 mmHg (95% confidence interval (CI) –0.355 to 0.113, p = 0.311), and considerable heterogeneity was observed between studies (p < 0.001, I² = 74.2%). For DBP, the combined effect estimate was –0.160 mmHg (95% CI –0.298 to –0.022, p = 0.023), and no heterigenieity was observed (p = 0.673, I2 = 0.0%). Conclusions: This study is the first meta-analysis of the effect of vitamin D supplementation on blood pressure in patients with type 2 diabetes. This meta-analysis demonstrated that vitamin D supplementation may result in a reduction in DBP in patients with type 2 diabetes. However, additional studies with large sample sizes and longer durations are needed to establish a relationship between vitamin D and blood pressure in patients with type 2 diabetes.Correspondence to:
Yu Jeung Lee, PharmD, PhD
Department of Clinical Pharmacy
College of Pharmacy, Kangwon National University
Kangwondaehak-gil 1, Chuncheon-si
Gangwon-do, Korea 200-701
Email: [email protected]

Original Research

Evaluation of medication dosing errors in elderly patients with renal impairment 

Hyo-Joong Won, Gokyung Chung, Kyeong Ju Lee, Eunkyung Lee, Soonjoo Son, Soyoung Choi, Seon Cheol Park, and Yu Jeung Lee

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Volume 56 (2018) p. 358 - 365

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 56 – No. 8/2018 (359-366)

Evaluation of medication dosing errors in elderly patients with renal impairment 

Hyo-Joong Won¹*, Gokyung Chung¹*, Kyeong Ju Lee¹, Eunkyung Lee², Soonjoo Son², Soyoung Choi¹#², Seon Cheol Park³, and Yu Jeung Lee¹

¹College of Pharmacy, Kangwon National University, ²Department of Pharmacy, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, and ³Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea
Objective: The administration of the usual dosage of medication in elderly patients with renal impairment can cause adverse drug reactions due to patients’ decreased renal function. Using retrospective prescription analysis, in a teaching hospital, this study aimed to evaluate medication dosing errors in elderly patients with renal impairment and the risk factors for these dosing errors. Materials and methods: This retrospective study included elderly patients with a creatinine clearance of 59 mL/min or less who were hospitalized in a teaching hospital between July 1, 2015, and September 30, 2015. Data including the patients’ age, gender, weight, serum creatinine, duration of hospital stay, and discharge prescriptions were obtained from electronic medical records. Patients with dosing errors were identified, and the risk factors for the dosing errors were statistically analyzed. Results: Out of 497 patients, 164 (33%) had evidence of dosing errors. All metformin prescriptions (n = 38) were associated with dosing errors (100%), and trimetazidine was prescribed 11 times in cases where it was contraindicated (31%). The following were confirmed to be statistically significant risk factors that increased the likelihood of the dosing errors: the patient’s age (odds ratio (OR): 1.050, 95% confidence interval (CI): 1.011 – 1.092), the number of drugs prescribed per patient (OR: 1.106; 95% CI: 1.012 – 1.210), and the number of drugs requiring dosing adjustments in patients with renal impairment (OR: 1.996; 95% CI: 1.614 – 2.468). Conclusion: There was a considerable rate of dosing errors in hospitalized elderly patients with renal impairment. It is necessary for healthcare professionals to make appropriate dosage adjustments in elderly patients with renal impairment to improve the outcomes of pharmacotherapy and patients’ quality of life. Correspondence to:
Yu Jeung Lee, PharmD, PhD 
College of Pharmacy, Kangwon National University
Kangwondaehak-gil 1, Chuncheon-si, Gangwon-do, 24341, Korea 
Email: [email protected]

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