药学管理对抗病毒治疗中禁忌性药物相互作用的研究探讨

Study on Contraindicated Drug-Drug Interactions in PharmaceuticalManagement of Antiviral Therapy

目的:探讨药物管理计划对直接作用抗病毒药物(DAA)治疗中禁忌性药物相互作用(DDIS)的影响,旨在为临床药学提供参考。方法:选择我院2020年1月至2023年1月期间于我院接受DAA治疗的200例慢性丙型肝炎患者作为研究对象,药师在DAA治疗前为所有患者筛查DDIS,分析禁忌性DDIS的频率、接受率和药物管理计划的成本节约。结果:纳入的200例患者平均年龄为(67.1±11.9)岁,其中DDI合并DAA最常见的治疗药物是质子泵抑制剂/组胺2受体拮抗剂(27%)、钙通道阻滞剂(19%)和他汀类药物(16%)。禁忌性DDIS的发生率为2%(n=4),潜在的具有临床意义的相互作用发生率为22%(n=44),两者合计共48例。瑞舒伐他汀(38%;18/48)、阿托伐他汀(18%;8/48)和胺碘酮(9%;4/48)是使用频率最高的药物。对于有禁忌证及具有潜在临床意义的相互作用的DDIS,“更换药物”(93%,45/48),临床医生总体接受率为70%(33/48),临床常见方案是选择另一个没有禁忌证的DAA。两名临床药师和两名肝病专家独立审查了4例禁忌性DDIS和44例潜在的具有临床意义的相互作用。通过药学管理,药物不良事件(ADE)的预计入院天数减少了84.2 d,可预防的ADE可节约成本为14 033元。结论:在DAA治疗中实施药物管理计划提供了良好的结果和实质性的成本节约。

Objective:To evaluate and explore the impact of pharmaceutical management projects on the contraindicated drug-drug interactions(DDIS)in the treatment of direct-acting antiviral drugs(DAAs),with a view to providing reference for clinical pharmacy.Methods:A total of 200 patients with hepatitisc who received DAA treatment in our hospital from January 2020 to January 2023 were selected as the research subjects.Pharmacists screen all these C patients for DDIS before DAA treatment.The research results include the frequency,acceptance rate,and cost savings of contraindicated DDIS in drug management plans.Result:The mean age of the 200 patients included was(67.1±11.9)years old,and the most common treatments for DDI and DAA were proton pump inhibitors/histamine-2 receptor antagonists(27%),calcium channel blockers(19%),and statins(16%).The incidence of contraindicated DDIS was 2%(n=4)and the incidence of potentially clinically significant interactions was 22%(n=44),for a total of 48 cases.Rosuvastatin(38%,18/48),atorvastatin(18%,8/48)and amiodarone(9%,4/48)is the most frequently used drug.For DDIS with contraindications and poten‐tially clinically significant interactions,the most common pharmacist recommendation was to"change the drug"(93%,45/48),with an overall clinician acceptance rate of 70%(33/48),and the choice of another DAA without contraindications was a common clinical option.Two clinical pharmacists and two hepatologists independently reviewed four cases of contraindicated DDIS and 44 cases of DDIS with potential clinically meaningful interactions.Through pharmacentical management,the estimated number of days admitted to hospital for ADE was reduced by 84.2 d,and the estimated avoided cost of preventable ADE was 14033 yuan.Conclusion:The implementation of drug management plan in DAA treatment provides good results and substantial cost savings,which is worth promoting in clinical pharmacy.