Introduction
Motor neuron diseases (MND) are a group of neurodegenerative disorders affecting motor neurons. Riluzole is a commonly used supportive therapy for MND patients. However, due to the rarity of MND cases, there is limited research exploring the effectiveness of riluzole use on survival outcomes for MND patients.

Aims
This study aimed to estimate the risk of all-cause mortality following riluzole use for MND patients.

Methods
The study used a multi-centre analysis from Hong Kong, Taiwan, and Korea. We applied a common data model-based approach to improve the reproducibility. Incident patients with MND as the primary diagnosis were selected. A multivariable Cox regression model was conducted to estimate hazard ratios (HRs) and 95% confidence intervals for all-cause mortality. The observation period was defined from the date of MND diagnosis to the death date, the study end date (December 31, 2018), whichever came first. The covariates included were sex, Charlson comorbidity index, and hypertension. The data cleaning and analysis were performed on each site using SAS 9.4 software. The results from each site were then integrated using a random-effects meta-analysis.

Results
The numbers of MND patients for time-to-event model from Hong Kong, Taiwan, and Korea are 1,939, 11,473, and 24,450. Although the meta-analysis with a random effect model revealed a significantly elevated risk of all-cause mortality among riluzole users [HR: 1.98 (95%CI: 1.17, 3.36)], a relatively large difference in baseline comorbidities was identified. The results are similar in Taiwan and Korea, while the results in Hong Kong were insignificant [1.16 (95%CI: 0.87, 1.54)].

Discussion
Our study found a higher mortality risk among MND patients following riluzole use. However, there is potential confounder by indication, time-varying confounding and heterogeneity of the population across different sites. A traditional conditional model may be inappropriate. Further analysis is needed to verify this conclusion.

- Introduction: Along with growing of a super-aging society, the number of patients with non-communicable diseases (NCDs) and its home medical care (Zaitaku) are rapidly increasing in Japan. At the same time, growing of medical expenses is big concern.
- Aims: In this study, We investigated the medical expenses of NCDs and its drug consumptions in home medical care using medical big data: the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).
- Methods: The databases of medical claims of outpatient and dispensing claims from the NDB Sampling Dataset (January, April, July, October of 2012-2019, and January of 2020) were linked based on patient IDs and the data analysis was performed. Patients who had the word "home (Zaitaku)" in the dispensing action code in the dispensing information record of the dispensing claims were considered to be patients receiving home medical care, and were counted based on medical expenses (insurance points). Patients who had the dispensing action code in the dispensing information record of the dispensing receipt receiving six or more kinds of medicines were extracted as patients receiving polypharmacy.
- Results: The total number of home medical care patients and the number of patients receiving polypharmacy increased year by year. The total medical expenses of home medical care patients also increased year by year, while the average medical expenses per patient with home medical care gradually decreased. It was also confirmed that the average medical expenses per home medical care patient were higher than those of home medical care patients.
- Discussion/Conclusion: In a super-aging society, the results suggested that patients with home medical care are increasing year by year, medical expenses for home medical care will increase rapidly.
- Acknowledgements: This work was supported by JSPS KAKENHI Grant Number JP22K10587.

Introduction: Perceived delays in drug approvals have been a major concern for policymakers in Indonesia. Access to a drug is not possible until the drug has received marketing authorization from the regulatory body. Comparison of biological product approvals in Indonesia and the United States (US) is crucial in improving access to innovative therapies.
Aims: To assess the differences between Indonesia and the US in the approvals of biological products between 2019 and 2023.
Methods: We searched publicly available data from the US Food and Drug Administration (USFDA) to identify biological products approved between 2019 and 2023. Indonesian marketing authorization data was taken from the Indonesian Food and Drug Authority (BPOM) website. Data from USFDA and BPOM were coded using the World Health Organization Anatomical Therapeutic Chemical (WHO ATC) classification system. We excluded allergens and antigens for diagnostic products. Differences in approvals of biological products between Indonesia and the US were described.
Results: Between 2019 and 2023, 162 biological products which consist of 47 diagnostic products, 58 therapeutic products, and 56 vaccines approved in the US were identified. Of those, we found 58 active ingredients (34 therapeutics and 24 vaccines) with 28 out of 58 (48%) being approved in Indonesia. Most of the approved therapeutics were blood products such as coagulation factor, immunoglobulin, fibrinogen, plasminogen, and prothrombin. On the other hand, cell and gene therapy is not yet available in Indonesia. Indonesia hasn’t approved vaccines for anthrax, chikungunya, Ebola, and tick-borne encephalitis. Vaccine for cholera was available but the marketing authorization expired in 2020.
Discussion/Conclusion: This study confirmed that fewer FDA-approved biological products were approved in Indonesia over the past five years. Due to limited data availability on the application submission date from the companies, we were unable to confirm the time difference between the application submission and the approval date.

Introduction:

Atherosclerotic cardiovascular disease (ASCVD) imposes a significant burden on the healthcare system in China. The analysis of lipid-lowering therapy in patients with ASCVD aims to provide evidence-based support for rational clinical drug use and relevant policy formulation.
Aims:

To analyze the characteristics, treatment patterns, and outcomes of ASCVD patients in China, focusing on the use of statins and PCSK9 inhibitors (PCSK9i).
Methods:

This retrospective study utilized electronic healthcare records from Jiangsu Province. Patients were included if they had ≥ 2 statin prescriptions or ≥ 1 PCSK9i prescription with an ASCVD diagnosis from July 31, 2018, to September 30, 2023, and were older than 18 years at first drug initiation. LDL-C follow-up trends and 95% confidence intervals (CI) were calculated. Patient demographic, clinical, and healthcare utilization characteristics were summarized using descriptive statistics.
Results:

The study included 86,789 patients (69,101 in the statin cohort and 17,688 in the PCSK9i cohort). The average age was 62.2 years (SD 11.44), with 38.3% of the statin cohort and 44.2% of the PCSK9i cohort being female. Patients in the PCSK9i cohort had higher outpatient visits (8.69 ± 12.99 vs. 7.10 ± 10.73) and inpatient admissions (1.42 ± 1.10 vs. 1.30 ± 1.10) compared to the statin cohort. Baseline LDL-C levels were 3.33 mmol/L (SD 1.12) in the PCSK9i cohort and 3.35 mmol/L (SD 1.10) in the statin cohort. Post-treatment, LDL-C levels in the PCSK9i cohort reduced to a median of 1.33 mmol/L (mean: 1.52 mmol/L), with a relative reduction of 56.3% (95% CI 49.7% to 56.3%), maintained over time.
Discussion:

Patients initiating PCSK9i treatment had more severe health conditions and higher healthcare utilization compared to those on statins. The effectiveness of PCSK9i underscores the importance of its use alongside other lipid-lowering therapies in ASCVD management.

Introduction. Adverse drug reactions (ADRs) are a significant concern in healthcare, often leading to increased morbidity and decreased quality of life among affected individuals. Understanding the impact of ADRs on QOL is crucial for effective patient management and improving healthcare outcomes.
Aims. To assess the quality of life (QOL) of patients post ADR using WHOQOL-BREF scale.
Methods. A prospective interventional study was conducted over a period of six months among patients admitted to the Departments of General Surgery, Intensive Care Units, General Medicine, and Medical Oncology in a tertiary care hospital who had an ADR-related admission or experienced at least one ADR during their hospital stay. The WHOQOL-BREF scale was used to assess the QOL of these patients post ADR. The questionnaire was administered 30-days after discharge. Pearson’s correlation coefficient was used to determine the level of agreement between the four domains of the WHOQOL-BREF. A paired t-test was used to compare the difference between the score means of different domains. A t-test was used to investigate the association between participants’ characteristics and QOL.

Results. A total of 218 ADRs were identified among 144 patients of whom 121 (89.5%) patients were administered with the questionnaire while the rest 23 (10.5%) were lost to follow-up due to deaths and unresponsive phone calls. Of the 121 participants, 69 (57%) males and 52 (43%) were females. The WHOQOL-BREF assessment revealed varying perceptions of health-related quality of life. Social Relationships score was the highest (61.46) and Environmental Health lowest (55.89), suggesting room for improvement. "Overall QOL" scored highest (4.05 ± 0.64), reflecting a positive outlook. A moderate positive correlation (0.428) between Q1 and Q2 indicated an alignment between overall quality of life and general health. Comparing WHOQOL-BREF scores with sex, age, medications, length of hospital stay, and comorbidities showed a significant correlation between sex and Social Relationship. Males showed slightly higher QOL scores in all domains compared to females in Physical Health [Males: 59.63, Females: 56.28], Psychological Health [Males: 60.86, Females: 58.38], Social Relationships [Males: 63.81, Females: 57.87], and Environmental Health [Males: 56.60, Females: 54.77].
Discussion. The study on ADRs' humanistic outcomes using the WHOQOL-BREF revealed that higher social and psychological QOL. Most patients reported moderate post-ADR QOL, underscoring the need for tailored interventions in post-ADR care, especially concerning gender-related QOL associations.
Keywords. Adverse drug reaction, QOL

Background: Oral chemotherapy has gained popularity due to its convenience and potential to improve cancer patients' quality of life (QoL). However, ensuring medication adherence remains a significant challenge.

Aims: This study aimed to implement clinical pharmacist services and evaluate their impact on medication adherence and QoL in patients receiving oral oncolytics.

Methods: A prospective interventional cohort study was conducted at a cancer speciality hospital for a period of nine months. The study included patients aged ≥18 years receiving oral chemotherapy. The intervention group received personalized medication counselling and educational materials, while the control group received standard care. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), and QoL was evaluated using the EQ-5D-5L and EORTC QLQ-C30 questionnaires.

Results: A total of 202 participants were randomly assigned to either the intervention or control group. The intervention group demonstrated a significantly higher change in medication adherence compared to the control group [mean difference (MD) 0.66±0.09, p<0.01)]. Furthermore, the intervention had a positive and significant effect on specific aspects of functioning and QoL. The intervention group showed improvements in overall role functioning (MD 0.06±0.02, p=0.03), cognitive functioning (MD 0.08±0.03, p=0.01), and social functioning (MD 0.12±0.03, p<0.01), along with a decrease in overall pain (MD -0.06±0.05, p=0.03) compared to the control group. The analysis of self-reported questionnaires revealed important findings regarding non-adherence factors in both the intervention and control groups. The primary factors contributing to non-adherence were consistently associated with feelings of depression or being overwhelmed (98%), perceiving the treatment as complex (94%), and facing challenges in reaching the hospital easily (51%).

Conclusion: Pharmacist-led interventions have demonstrated the potential to improve medication adherence and humanistic outcomes among oncology patients. The study also highlights the importance of personalized medication counselling in addressing adherence barriers and enhancing patient understanding.

Introduction
There is little consensus on initiating statins for primary prevention of cardiovascular diseases (CVDs) in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials.
Aims
To investigate the benefits and risks associated with statin use for primary prevention in old (aged 75-84 years) and very old (aged≥85 years) adults.
Methods
Using territory-wide electronic health records, we emulated a sequence of 96 nested target trials on the elderly who were aged over 75 years and met indications for statin initiation in each calendar month from January 2008 to December 2015 in Hong Kong. Propensity score matching was used to emulate the randomization of participants at baseline. Outcomes of interest included major CVDs (stroke, myocardial infarction, heart failure), all-cause mortality, and major adverse events. Pooled logistic regression models were adopted to estimate the risk differences in the intention-to-treat (ITT) analysis, as well as the per-protocol (PP) analysis with inverse probability weighting to adjust for time-varying confounders related to treatment adherence.
Results
Of 42 680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), risk reduction for overall CVD incidence was found for initiating statins in adults aged 75 to 84 years (5-year standardized risk reduction[95%CI] - ITT: 1.20%[0.57%,1.82%]; PP: 5.00%[1.11%, 8.89%]) and in those aged ≥ 85 years (ITT: 4.44%[1.40%, 7.48%]; PP: 12.50%[4.33%, 20.66%]). The risk reduction was consistently observed for all-cause mortality and CVD subtypes. No significantly increased risks for myopathies and liver dysfunction were found in either age group.
Conclusion
Reduction for CVDs after statin therapy was observed in patients aged 75 years or older without increasing risks for major adverse events. Notably, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older.

Aim/Objective: Efficacy/effectiveness and safety of the approved nirmatrelvir-ritonavir regimen (300mg of nirmatrelvir with 100mg of ritonavir administered twice daily over 5 days) for treatment of non-hospitalized adults with mild/moderately severe coronavirus disease 2019 (COVID-19) remains unclear.

Methods: We conducted a systematic evidence review of published peer-reviewed randomized controlled trials (RCTs) and real-world studies [RWS] (observational) of efficacy/effectiveness and/or safety of the approved nirmatrelvir-ritonavir regimen for treatment of non-hospitalized adults (≥18-year-olds) with mild/moderately severe laboratory-confirmed COVID-19. We pooled appropriate data (for RWS, the adjusted estimates) using an inverse variance, random-effects model, and calculated statistical heterogeneity using the I² statistic. Results are relative risk with associated 95% confidence intervals. Further, we assessed risk of bias/study quality of the included studies, and conducted trial sequential analysis (TSA) of the evidence from RCTs.

Results: From a retrieved total 1,104 literature citations, we included three RCTs (2,774 persons) and 16 RWS (1,925,047 persons). The RCTs were of unclear risk of bias while the RWS were of good quality. Nirmatrelvir-ritonavir significantly reduced worsening COVID-19 severity (0.19 [0.06 – 0.66], I² 54.8%, three RCTs, 2,774 persons) but increased adverse events (1.83 [1.35 – 2.48], I² 0%, three RCTs, 2,774 persons) compared with placebo/no treatment. There was no significant difference for clearance of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and all-cause mortality although TSA suggested more sample size for these outcomes before any conclusions. Further, compared with no treatment, nirmatrelvir-ritonavir appeared to significantly reduce hospitalization (0.48 [0.37 – 0.60], eleven RWS, 1,421,398 persons) and all-cause mortality (0.24 [0.14 – 0.34], seven RWS, 286,131 persons).

Conclusion: The approved nirmatrelvir-ritonavir treatment regimen appears promising against worsening severity and suggestively, against hospitalization and all-cause mortality in non-hospitalized adults with mild/moderately severe laboratory-confirmed COVID-19. However, the evidence is generally weak. More studies are necessary for a stronger evidence base.

Introduction Sodium-glucose cotransporter 2 (SGLT2) inhibitors may halt both neuro-inflammation and blood-brain barrier disturbance, indicating its antidepressant properties. However, no studies assessed suicide in patients receiving SGLT2 inhibitors with diabetes and depression.

Aims To evaluate the association between the use of SGLT2 inhibitors and suicide risk in patients with diabetes and depression.

Methods We emulated a target trial using data from the Taiwan National Health Insurance Research Database. Inclusion were adult patients with diabetes and depression newly receiving the SGLT-2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors treatments between 2016 and 2020. We assigned the patients to the SGLT-2 inhibitors or DPP-4 inhibitors group and defined the index date as the first day of receiving those medications. Excluded were patients with a history of attempted suicide, bipolar disorder, or schizophrenia. The outcomes were the successful suicide and attempted suicide. Inverse probability of treatment weighting (IPTW) was applied to mimic randomization between groups. We used the Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI).

Results A total of 26,775 patients with diabetes and depression newly received SGLT2 inhibitors (n=3,663) and DPP4 inhibitors (n=23,112). The mean age was 64.2 years, and 39.5% were male. We observed an increased risk of successful suicide in patients receiving SGLT2 inhibitors (crude HR 1.18 95% CI 0.64-2.18). After applying IPTW, patients receiving SGLT2 inhibitors were not associated with a reduced risk of successful suicide (HR 0.97 95% CI 0.50-1.92) or attempted suicide (HR 0.99 95% CI 0.82-1.20).

Discussion/Conclusion The Use of SGLT2 inhibitors was not associated with a reduced risk of suicide in patients with diabetes and depression. However, due to the observed increased risk of successful suicide, clinicians should continue to closely monitor their mental health.

Keywords: sodium-glucose cotransporter 2 inhibitors, diabetes, depression, suicide

- Introduction
In a health risk communication by Health Canada in March 2024 noted that ezetimibe may cause drug-induced liver injury (DILI). There is substantial evidence indicating a causal relationship between monotherapy with ezetimibe and the occurrence of DILI.
- Aims
This study aims to analyze the risk of DILI and other adverse effects associated with the use of ezetimibe at a regional hospital in Taiwan.
- Methods
This study retrospectively collected data from the hospital's medical system on patients who prescribed ezetimibe monotherapy from January 2022 to December 2023. The analysis included patients' basic demographic information. Liver function-related parameters, such as AST, ALT, alkaline phosphatase (ALP), gamma-glutamyl transferase (r-GT), and bilirubin levels, were evaluated to assess the occurrence of DILI.
- Results
A total of 380 patients were treated with ezetimibe monotherapy, with an average age of 62.3 years. 217 patients had abnormal ALT or AST levels, and 39 patients had abnormalities in both. One patient had ALT levels more than five times the upper limit of normal (ULN), and ten patients had more than three times ULN. One patient had ALP levels more than twice ULN combined with abnormal r-GT levels. None of the patients had diagnoses of drug-induced liver injury or related allergic reactions.
- Discussion/Conclusion
Based on the results, more than half of the patients had at least one abnormal liver function parameter. Two patients met the criteria for DILI, but their liver function abnormalities were more likely related to their comorbid conditions.
However, it is still recommended that liver function tests be considered when initiating ezetimibe therapy. Patients should also be instructed on the early symptoms of liver injury and advised to immediately inform healthcare providers if such symptoms occur. If liver injury is suspected, liver function should be tested and evaluated promptly.

Introduction
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) improve glycaemic control and cardio-renal outcomes for people with type 2 diabetes (T2D), and are preferentially recommended as add-on therapy. Despite evidence of significant clinical benefits, uptake of SGLT2i and GLP-1RA is low. Variation in this use is not well understood.

Aims
To explore geographic and socioeconomic variation in use of SGLT2i and GLP-1RA in New South Wales (NSW), Australia.

Methods
We identified 367,829 NSW residents aged ≥40 years dispensed metformin in 2020, as a proxy for T2D. We estimated the prevalence of use of other glucose-lowering medicines among people with T2D, and prevalence of SGLT2i and GLP-1RA use among people using concomitant T2D therapy (i.e. metformin + another glucose-lowering medicine). We measured prevalence by small-level geography, stratified by age group, and characterized by remoteness and socioeconomic status.

Results
The prevalence of SGLT2i (29.7%) and GLP-1RA (8.3%) use in people with T2D aged 40-64 increased with geographic remoteness and in areas of greater socioeconomic disadvantage, similar to other glucose-lowering medicines. The prevalence of SGLT2i (55.4%) and GLP-1RA (15.4%) among people using concomitant T2D therapy varied across geographic areas; with lower SGLT2i use in more disadvantaged areas, and localized areas of high GLP-1RA use. Compared to people aged 40-64 years, prevalence of SGLT2i and GLP1-RA use was lower in older age groups, but with similar patterns of variation across geographic areas.

Discussion/Conclusion
The prevalence of SGLT2i and GLP-1RA use varied by geography, likely reflecting a combination of system- and prescriber-level factors. Socioeconomic variation in GLP-1RA use was overshadowed by localised patterns of prescribing; geographic variation in medicine use cannot be interpreted without considering the potential impact of local policies and practice. Continued monitoring of variation can help shape interventions to optimise use among people who would benefit the most.

Introduction: Existing studies with different target populations found different diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) tool. Therefore, the actual utilisation of the FINDRISC to detect early metabolic syndrome in the Indonesian population requires further evaluation.
Aims: This study aims to evaluate the diagnostic accuracy of the FINDRISC tool for detecting individuals with metabolic syndrome in Indonesia.
Methods: A dataset from the Indonesian National Basic Health Survey 2018 was analysed, and instances of metabolic syndrome were identified in accordance with both National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) guidelines. Diagnostic accuracy of the FINDRISC tool was established using the Area Under the Curve of the Receiver Operating Characteristic (AUC ROC) curve, while optimal cut-off scores were determined by Youden’s Index.
Results: From 24,243 participants, the mean and standard deviation of the FINDRISC score was 5.5 (SD 4.1). The prevalence of metabolic syndrome was 32.6% and 25.0% based on NCEP-ATP III and IDF criteria respectively. Based on NCEP-ATP III criteria alone, the AUC of the FINDRISC was 81.3% (80.8%-81.9%) with 73.5% sensitivity and 76.6% specificity. Similarly, based on IDF criteria, AUC was 89.3% (88.9%-89.7%) with 89.6% sensitivity and 76.9% specificity. The optimal cut-off score was 6 for both criteria, with 39.8% of total participants above the cut-off who would require further confirmation tests.
Conclusion: Metabolic syndrome is prevalent in Indonesia, and the FINDRISC tool offers good diagnostic accuracy for detecting such cases. Utilising FINDRISC as a first-instance screening modality will reduce the number of people requiring further confirmation tests. As a result, FINDRISC has the potential for use in daily clinical practice, and the cost-effectiveness of FINDRISC should be further evaluated.

Introduction:
Western guidelines often recommend biguanides as the first-line treatment for diabetes. However, in Japan, dipeptidyl peptidase-4 (DPP-4) inhibitors alongside biguanides are increasingly used as the first-line therapy for type 2 diabetes (T2DM). There have been few studies comparing the effectiveness of biguanides and DPP-4 inhibitors concerning diabetes-related complications, cardio-cerebrovascular events, and associated costs.

Aims:
To compare the outcomes of patients with T2DM who initiate treatment with a biguanide versus a DPP-4 inhibitor, focusing on long-term complications, cardio-cerebrovascular events, and treatment costs.

Methods:
A cohort study was performed from 2012 to 2021 using the Shizuoka Kokuho Database. Patients diagnosed with T2DM were included. The primary outcome was the incidence of cardio-cerebrovascular events or mortality from the initial date of treatment. Secondary outcomes included incidences of diabetes-related complications (nephropathy, renal failure, retinopathy, and peripheral neuropathy) and the daily cost of the drugs used. The cost calculation in this study refers specifically to the medication costs of diabetes drugs. Propensity score matching was performed to compare the two groups.

Results:
The matched cohort comprised 529 patients treated with a biguanide and 2116 patients treated with a DPP-4 inhibitor. No significant differences were found in the incidence of cardio-cerebrovascular events or mortality (p=0.139) and T2DM-related complications (p=0.595) between the two groups. However, the biguanide group was significantly cheaper (mean daily cost of antidiabetes agent for biguanides group 61.1 JPY; for DPP-4 inhibitors group 122.7 JPY; p<0.001).

Discussion/Conclusion:
In patients with T2DM initiating pharmacotherapy, there were no differences in the long-term incidences of cardio-cerebrovascular events or complications between biguanide and DPP-4 inhibitor use, but biguanides were associated with lower costs.

Introduction: Clinical trials have shown that colchicine prevents secondary cardiovascular events, expanding its indications. Given the increased cardiovascular risk in patients with gout and type 2 diabetes (T2DM), evidence of colchicine's effectiveness in this population is needed.
Aims: To investigate the association between colchicine use and the risk of cardiovascular events in patients with T2DM and gout compared to nonsteroidal anti-inflammatory drugs (NSAIDs).
Methods: This population-based cohort study used the national claims database of South Korea (2010–2022). The study included patients diagnosed with T2DM who were newly prescribed colchicine or NSAIDs for gout. The outcome was major cardiovascular events (MACE), comprising stroke, myocardial infarction, and cardiovascular death. Patients were followed up using an as-treated definition of exposure from the date of first study drug prescription. We calculated propensity score (PS) incorporating over 50 demographic and clinical covariates and used 1:2 PS matching to balance the covariates between groups. Hazard ratios (HRs) were estimated using a Cox proportional hazard model. We performed subgroup analyses based on age, sex, antidiabetic treatment, and cardiovascular comorbidities. A duration-response analysis was performed with day 120 as a change point.
Results: We identified 13,019 colchicine (mean age 65.5; 35% female) and 117,156 NSAIDs (63.1; 35%) users with T2DM and gout. After PS matching, 12,908 colchicine and 25,816 NSAIDs users remained. The adjusted HR (aHR) for MACE was 1.04 (95% CI 0.73–1.49). Subgroup analyses were consistent except for patients with dyslipidemia (aHR 2.00, 1.06 – 3.79) compared to those without dyslipidemia (aHR 0.83, 0.52–1.33). The aHR was 1.67 (1.06–2.62) before day 120 and 0.82 (0.41–1.66) after day 120.
Discussion: This nationwide cohort study found that colchicine use does not significantly reduce MACE risk in a real-world population with comorbid T2DM and gout. Nevertheless, longer-term colchicine use may have a more favorable cardiovascular profile.

Introduction. Patient and caregiver perspectives provide crucial information in understanding disease burden, patient journey, and unmet medical needs. Patient voices were traditionally captured using classic patient-centered market research, however patient-centered clinical effectiveness research (CER) is increasingly used to provide advanced evidence for regulators and payers. The differences between these two approaches have not been thoroughly discussed.
Aims. This study assessed both patient-centered CER and market research approaches to assist researchers to make informed decisions on how to select the fit-for-purpose study design.
Methods. A comprehensive literature search on PubMed was performed using generative artificial intelligence to identify studies from 2014 to 2024. Online desk research was also performed as a supplement. Findings related to definitions, concepts, methods for patient-centered CER and market research were captured. Similarities and differences were synthesized with a narrative synthesis approach.
Results. A total of 726 studies were screened. Analysis concluded that CER aims to generate evidence in support of medical technologies value evaluation, drug effectiveness, and/or safety for regulators and payers, whereas market research is used to generate insights for commercial purposes without the same level of scientific rigor. Both approaches use standard instruments and customized questionnaires to collect data from patients, and researchers may apply quota sampling to achieve the comprehensiveness and representativeness of research. Major process differences are identified in which CER requires study protocol and ethics review. Furthermore, CER includes multiple rounds of instrument validation including cognitive debriefing to generate reliable results to meet requirements of advanced evidence. From a statistical analysis perspective, data derived from both approaches are suitable for descriptive analysis, however CER is more robust to enable comparative or multivariate analysis.
Discussion. There is an increasing trend of patient-centered studies in the APAC region. Researchers are recommended to select a study approach based on their objectives to enable generation of fit-for-purpose data to benefit stakeholders.

Introduction
There has been limited investigation in the combined, longitudinal cardiovascular consequences of patients with type 2 diabetes mellitus (DM) and obstructive sleep apnea (OSA).

Aim
To examine the major cardiovascular outcomes (MACE) of OSA in patients with DM (OSA-DM) compared to diabetic patients without OSA (non-OSA DM).

Methods
This retrospective population-based cohort study used data from Taiwan's National Health Insurance Research Database. Newly diagnosed DM patients from 2000–2017 were identified. Patients with and without OSA were matched by sex, age, year of DM diagnosis, duration of DM, and survival at one year post-DM. The primary outcome was major adverse cardiovascular events (MACE), analyzed using a Cox regression model. These events included nonfatal myocardial infarction, nonfatal stroke, death from cardiovascular disease (CVD), hospitalization due to unstable angina or coronary revascularization, and hospitalization due to heart failure. We controlled for age, sex, comorbidities, medications, medical utilization, and the Charlson Index.

Results
The study included 40,370 patients (71.48% male, mean age = 58.1). OSA-DM subjects had higher rates of cardiovascular comorbidities, antihyperglycemic and cardiovascular medication use, and health care utilization. Patients with both OSA and DM exhibited a decreased risk of MACE compared to those without OSA (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.88–0.98; p = 0.003). Additionally, OSA-DM patients had a lower risk of hospitalization for nonfatal myocardial infarction (HR, 0.67; 95% CI, 0.59–0.75; p < 0.001) and death within 30 days of hospitalization for CVD (HR, 0.69; 95% CI, 0.62–0.77; p < 0.001). The rates of hospitalization for heart failure, unstable angina, nonfatal stroke, and coronary revascularization did not differ significantly between the two groups.

Conclusion
Despite higher rates of comorbidities and healthcare utilization, patients with OSA and newly diagnosed DM have a lower risk of major adverse cardiovascular events than those with DM alone.

Introduction. Type 2 diabetes has affected 537 million adults aged 20 to 79 worldwide, which is expected to rise to 783 million by 2045. Individuals with evening chronotype [reduced physical activities and sleep, eating habits during late hours] have a higher risk of developing diabetes due to diminished glucose tolerance, increased inflammatory markers and increasing stress on the pancreas.
Aims. This study aims to explore the link between evening chronotype and diabetes, identify new approaches and target interventions to combat the rising trend in diabetes.
Methods. Using a comparative cross-sectional study design, 200 Indian subjects satisfying the study criteria were enrolled using a simple random sampling method within 6 months in a tertiary care hospital after the consenting process. Enrolled subjects were given a morningness-eveningness questionnaire by the American Thoracic Society [determines chronotype], glycated hemoglobin test, fasting blood glucose, and postprandial blood glucose tests were performed.
Results. The population's mean age and standard deviation were found to be [46.61±11.59 years]. 52.5 % of the population were males. Further, the population was segregated into morning chronotype (score: ≤41) [diabetics: 4(2%); nondiabetics: 93(46.50%)], intermediate type (score: 42-58) [diabetics: 6(3%); nondiabetics: 18(9%)]; evening type: (score: >59) [diabetics: 77(38.50%); nondiabetics: 2(1%)]. There was a statistically significant difference between the number of diabetics in morning and evening chronotypes [p value <0.001]. The clinical pharmacists played a crucial role by providing chronotherapy in evening type patients [79(39.5)] which helped in preventing the progression of diabetes, and lifestyle counselling for intermediate type patients [18(9%)] to avoid the ramifications.
Discussion. In a study done by Iwasai et al., middle-aged males were selected and a high rate of the evening chronotype (10.9%) was identified in those with type 2 diabetes, compared with just 2.2% evening type who were non-diabetics.
Conclusion. This study implies that there is an association between evening chronotype and diabetes, hence by chronotherapy and counselling altering the chronotypes we could control the ramifications of diabetes.

- Introduction:
Benzodiazepines (BZDs) are one of the secondary treatments for obstructive sleep apnea (OSA), and they should be used with caution because they have the potential to worsen airway obstruction. Patients with type 2 diabetes mellitus (DM) often present with OSA and obesity. However, there is limited research investigating BZDs use in this specific population.
- Aims:
To assess the utilization of BZDs among patients having DM with/without OSA (OSA-DM and non-OSA DM).
- Methods:
We conducted a retrospective nationwide longitudinal study using the data of Taiwan’s National Health Insurance for the period from 2001 to 2020. Patients with incident DM followed by a diagnosis of OSA were matched (1:1) with DM without OSA with factors of gender, age, DM diagnosis year, DM duration, and survival beyond one year after DM. We examined the use of hypnotic medications at DM diagnosis and one, two, three, or five years following diagnosis, including BZDs and non-benzodiazepines (non-BZDs).
- Results:
A total of 40,370 patients were included. At the time of DM diagnosis, 3,150 patients with OSA-DM (15.6%) were BZD users, and the trend of BZD use decreased after the first-year follow-up, with 16.4% in year one, 15.0% in year two, 15.0% in year three, and 13.2% in year five. Less than 10% of the non-OSA DM group used BZDs and stayed stable during the follow-up period. At baseline, 1,956 patients (9.69%) in the non-OSA DM group and 4,067 patients (20.15%) in the OSA-DM group used non-BZDs. Following the first-year follow-up, there was a decrease in non-BZDs use in both groups.
- Discussion:
In the OSA-DM group, BZD use was twice as common as in the non-OSA DM group, possibly due to comorbidities such as insomnia or psychiatric disorders. Non-BZDs, which have fewer respiratory depressant effects, may be preferred in OSA patients.

Introduction

Multimorbidity interval, referred to as the time interval from the first chronic condition diagnosis to the occurrence of multimorbidity. Multimorbidity is highly prevalent among people with diabetes and associated with a greater risk of mortality. However, there is little research quantifying the association of multimorbidity intervals with mortality risk among people with diabetes.

Aims

To examine whether, and to what extent, time interval between diabetes and a second chronic disease may be associated with the risk of mortality.

Methods

We conducted a territory-wide nested case-control study with data from Hong Kong. The underlying cohort included patients first diagnosed with diabetes from January 1, 2010 to December 31, 2012 and subsequently diagnosed with another chronic condition as of December 31, 2019. Patients with any chronic conditions 2 years before the diabetes diagnosis were excluded.
We extracted those who died after developing multimorbidity as case participants. We defined the time interval from the date of developing multimorbidity to the death date as survival period of case participants. We randomly selected 4 patients with the same age, sex, and second chronic condition who had not died after going through the same survival period of the case participants as the control participants.
Conditional logistic regression was used to estimate the adjusted odds ratio of death. Sub-group analysis was conducted in men, women, those aged 65 years or more, and those were younger than 65 years. Stratified analysis was conducted for each of the second chronic conditions.

Results

Overall, the risk of mortality reduces by 19% with the extension of multimorbidity interval by one year [95% CI 17%-21%]. Similar associations were estimated in sub-group analysis and stratified analysis.

Discussion

Our findings suggest that clinical management of diabetes should focus on mitigating and lowering the risk of developing multimorbidity to reduce further complications and mortality.

Introduction:
The prevalence of metabolic comorbidities is increasing as a function of increasing age, which is gaining a great concern in patients with chronic hepatitis B(CHB).
Aim:
We evaluated the impact of metabolic comorbidities (diabetes and hyperlipidemia) on cirrhosis and hepatocellular carcinoma (HCC) in Chinese adult patients with nucleos(t)ide analogue (NAs) treated CHB.
Method:
This is a retrospective, observational, cohort study used electronic medical records from first-tier hospital in China. Patients with CHB receiving NAs between Jan-1-2010 to Jun-01-2020 were enrolled and followed up from the first identified NAs prescription(the index date) until last visit or study end (Dec-31-2020). The baseline period is 1 year prior to the index date. Associations between the comorbidity burden and cirrhosis/HCC were explored using Cox regression models.
Results:
Among 19,987 patients enrolled, the median age was 45 years (range 18-97), 18.10% were older than 60 years, and 64.59% were male. 20.00% had at least one metabolic comorbidity including 19.18% with diabetes only, 64.53% with hyperlipidemia only and 16.28% with both. 1594 developed cirrhosis (3.525/100 person-years) and 300 patients developed HCC over the study period (0.559/100 person-years). Compared to no comorbidity, ≥1 comorbidity was significantly associated with cirrhosis (adjusted hazard ratio [aHR]1.63, 95% confidence interval [CI] [1.46-1.82]; p<0.001) and HCC (1.72 [1.35-2.19]; p<0.001). Results were consistent across ≤60 and >60-year age groups. When comes to detail comorbidity, diabetes alone was significantly associated with cirrhosis (2.34 [1.93-2.84]; p<0.001) and HCC (2.78 [2.01-3.84]; p<0.001), as was the combination of diabetes and hyperlipidemia (cirrhosis: 1.64 [1.30-2.07]; p<0.001, HCC: 1.79 [1.16-2.76]; p=0.009). Hyperlipidemia alone was associated with development of cirrhosis (1.45 [1.26-1.65]; p<0.001), but not HCC (p=0.254).
Conclusion:
Metabolic comorbidities increase the risk of cirrhosis and HCC in Chinese NA treated CHB patients. Patients with CHB warrant thorough screening and management of metabolic risk factors to reduce this risk.

Associated Factors of Cardiovascular Events in Diabetes Outpatients at Teaching Hospitals
Eka Kartika Untari1,5, Tri Murti Andayani2, Nanang Munif Yasin3, Rizka Humardewayanti Asdie4. Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada 1, Yogyakarta, ID; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada2, Yogyakarta, ID; Faculty of Pharmacy, Universitas Gadjah Mada3, Yogyakarta, ID; Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito General Hospital4, Yogyakarta, ID; Pharmacy Department, Medical Faculty of Tanjungpura University5, Pontianak, ID.
Introduction. Diabetes and cardiovascular disease are significant contributors of early mortality and significantly burden healthcare costs in Indonesia. Amounts of evidence indicate that hyperglycemia plays a crucial role in the elevated risk of cardiovascular events (CVEs).
Aims. Identifying the characteristics and clinical features as contributing factors to diabetes patients developing CVEs and their medication use.
Methods. This study examined the diabetes outpatient medical records of 250 patients, aged 18–60, from two hospitals in Yogyakarta, Indonesia. Descriptive and bivariate statistics to analyse the characteristics differences between patient with and without CVEs. The multivariable logistic models to predict the impact of variables on CVEs, along with the odds ratio (OR) and the 95% confidence interval (CI) for CVEs. CVEs involved the presence of any of these conditions: hypertension, coronary heart disease, ischemic stroke, or other atherosclerosis-related problems.
Results. Compared to diabetes patients without CVEs, those with CVEs had a higher age of 53.21 vs. 48.09 years (p < 0.001), a BMI of 26.48 vs. 25.60 (p = 0.101), a female gender of 28.4% (p = 0.139), a diabetes duration of >5 years (p < 0.001), hypertension 30% (p = 0.02), an uncontrolled glycemic 30% (p = 0.039), and dyslipidemia 34.8% (p = 0.053). The use of associated medications in diabetes with CVEs included insulin (61.71%), antihypertensives (66.67%), and antihypercholesterolemia (61.71%). Logistic multivariate analysis affirmed that amongst clinical features involved age (OR 1.069; CI 1.033-1.106; p < 0.001), hypertension (OR 1.923; CI 1.117-3.310; p 0.018), and dyslipidemia (OR 1.784; CI 1.032-3.084; p 0.038) had a meaningful effect on CVEs.
Discussion. The long history of diabetes and high glucose levels are still present in diabetes with CVEs. The number diabetics who received medication related CVEs were yet incomplete. Furthermore, the uncontrolled blood pressure and lipid level had 2 fold incidence of cardiovascular problems.

Introduction:
In the management of diabetes treatment satisfaction plays a crucial role in patient outcomes and adherence to medications. Research studies have shown that higher levels of treatment satisfaction is associated with better glycemic control, improved quality of life and lower healthcare costs.
Aim:
To assess diabetic treatment satisfaction and health-related quality of life in type 2 DM patients.
Methods:
Our study was conducted with meticulous care at KIMS Hospital, involving a prospective randomised interventional design. DTSQs, DTSQc, and DQOL questionnaires were administered to assess treatment satisfaction and health-related quality of life during 4 follow-ups with a month gap between each follow-up. Patients' HbA1C was monitored at baseline, and final follow-ups, whereas CBG levels were monitored at every follow-up. The results were then analysed for statistical significance at p<0.05 using the reliable SPSS version 29.0.2, ensuring the robustness of our findings.
Results:
A total of 400 patients were recruited and segregated into control (200) and test groups (200) using the block randomisation technique. Among the control group, 60% were males in the test group, and 55% were males. The mean age group of enrolled patients is 59.5 years. A significant improvement (p<0.05) in DTSQ scores in test group patients compared to Control group patients (p=0.02). DQOL scores were also observed, with a significant improvement (p<0.05) in Test group patients, demonstrating the influence of education and monitoring of the patients.
Discussion and Conclusion
Continuous monitoring of counselling has shown a significant improvement in clinical outcomes, which has a positive influence on treatment satisfaction and health-related quality of life.
Key Words
Diabetes Treatment Satisfaction, HRQoL, Pharmacist intervention

Introduction/Aim: Sodium-glucose transport protein 2 (SGLT2) inhibitors was associated with a lower anemia incidence in patients with diabetes and CKD. However, there was limited evidence on anemia and SGLT2 inhibitors in such patients across different CKD stages.
Methods: We emulated a pragmatic target trial of CREDENCE and DAPA-CKD using a multi-institutional cohort between 2016 and 2022. We included patients with diabetes and CKD stages 1-3 newly receiving SGLT2 inhibitors or GLP-1 RAs. Patients were stratified by baseline estimated Glomerular filtration rate: CKD stages 1-2 or CKD stage 3. Propensity score with fine stratification was employed to mimic similar probability of treatment assignment. The primary outcome were anemia event occurrence and anemia treatment initiation. HR and 95% CI were derived using Cox proportional hazards models to compare the risk of anemia for two treatment strategies. We assessed the effect modification using interaction terms of SGLT2 inhibitors and CKD stages.
Results: We identified a total of 12,121 and 1,474 patients with T2D and CKD stages 1-3 newly receiving SGLT2 inhibitors and GLP-1 RAs, respectively. Patients receiving SGLT2 inhibitors with CKD stage 3 experienced a lower risk of anemia event occurrence (HR 0.70, 95% CI 0.62 - 0.79) compared to those with CKD stage 1-2 (HR 0.81, 95% CI 0.69 - 0.95), with a p-value for interaction at 0.01. Additionally, patients with CKD stage 3 were associated with a reduced risk of anemia treatment initiation (HR: 0.73, 95% CI 0.60-0.89), while not for those with CKD stages 1-2 (HR: 1.37, 95% CI 0.99 - 1.90), with a p-value for interaction at 0.0001.
Conclusion: CKD stages was associated with different anemia risks for patients receiving SGLT2 inhibitors or GLP1-RAs. For patients with CKD stage 3, physicians may consider prescribe SGLT2 inhibitors to prevent anemia.

Keywords: Target trial emulation framework, SGLT2 inhibitors, anemia, CKD

Introduction: Type 2 diabetes increases the risk of complications such as retinopathy, nephropathy, and periodontal diseases. Regular medical examinations are essential for early detection and management of these complications to improve clinical outcomes. Prior research has primarily focused on medication adherence, leaving a gap in understanding adherence to routine examinations.
Aims: This study aimed to evaluate adherence rates to regular medical examinations among patients with type 2 diabetes and to identify associated factors. Additionally, it compared adherence across different examination types.
Methods: We analyzed data from the 2017 National Health Interview Survey in Taiwan, focusing on individuals diagnosed with diabetes after age 20. High adherence was defined as completing at least three of the following examinations in the past year: HbA1c test, eye screening, urinalysis, and dental check-up. Evaluated factors included current age, age at diagnosis, gender, marital status, educational level, living situation, employment status, income, self-rated health, daily activity limitations, and comorbidities. Adherence rates were calculated as weighted percentages, and influencing factors were assessed using Wald chi-square tests and logistic regression models.
Results: After applying weights, the study included 1,512,815 patients, of whom 47.2% achieved high adherence. The adherence rates were 77.5% for HbA1c test, 42.9% for eye screening, 59.6% for urinalysis, and 44.1% for dental check-up. Higher adherence was significantly associated with younger age at diagnosis, female gender, higher educational attainment, being married, retirement or unemployment, and higher income levels (p<0.05). Age at diagnosis emerged as the most consistent factor of adherence across all examination types.
Conclusion: Approximately half of type 2 diabetes patients adhere to recommended routine examinations, with significant disparities driven by demographic and socioeconomic factors. Targeted interventions tailored to address these factors are crucial to enhance adherence and improve patient outcomes.

Introduction

Previous research suggests that the clinical sequalae of Covid-19 are persistent long after the infection, which may be associated with an elevated risk of multimorbidity in people with a pre-existing chronic condition.

Aims

To examine the association of Covid-19 with multimorbidity incidence among people with one chronic condition and quantify the absolute and relative incidence rates of multimorbidity after COVID-19 with or without prior full vaccination.

Methods

We conducted a retrospective cohort study with territory-wide public healthcare records from Hong Kong. From patients with only one chronic disease before January 1, 2020, we selected patients infected with Covid-19 up to January 29, 2023 as the exposed group. We randomly selected 4 patients with the same age, sex, and first chronic condition of patients without Covid-19 at that point as the comparison group. Poisson regression was used to calculate the adjusted incidence rate ratio of multimorbidity between those with or without Covid-19, as well as those who were fully vaccinated (3 does or more) before the infection. Sub-group analysis was conducted in men, women, those who were younger than 65 years, older people, and those infected with Covid-19 before or after oral antiviral drugs were made available in Hong Kong. Stratified analysis was conducted for each of the first and the second chronic conditions respectively.

Results

Overall speaking, Covid-19 was associated with 26%-increased rates of multimorbidity [95% CI 23%-29%], and Covid-19 with prior full vaccination was associated with only 8%-increased rates. Similar associations were estimated in sub-group analyses and sensitivity analyses.

Discussion

Health services should be focused on the post-Covid-19 management of patients with pre-existing chronic diseases. An early roll-out of vaccines is essential in reducing the long-term burden among those living with a chronic condition.

The Psychological Impact of the COVID-19 Pandemic on the General Population in India: Insights from a Nationwide Survey
Amal Anand1, Juny Sebastian2, Rithika Vakkalaganti Rajesh3, Jisha Myalil Lucca4, Royes Joseph5
The Center for Pharmacoepidemiology and Treatment Sciences, Rutgers University1, New Brunswick, NJ, USA; Department of Pharmacy Practice, Gulf Medical University2, AJM, UAE; Department of Global Disease Epidemiology, Johns Hopkins University3, Baltimore, MD, USA; Department of Pharmacy Practice4,5, Imam Abdulrahman Bin Faisal University, DMM, Saudi Arabia

Introduction. A pandemic imposes restrictions in activities and changes to routine that are necessary to prevent the spread of an infectious disease, but these measures can have significant social and economic effects. Thus, this influences the mental health of the general population, as it may restrict activities, change normal routine, affect social and economic wellbeing of them.
Aims. This study aimed to assess the impact of COVID-19 pandemic on mental health of the public in India.
Methods. A cross-sectional web-based study was conducted for a period of 20 days among general population of India, through social media, emails, and online chat platforms, in the year 2020. The study used PHQ-4 and IES-6 scales to measure depression/anxiety and distress respectively. Multiple binary logistic regression was used to explore the relationship of the personal characteristics with the prevalence of self-reported psychiatric illness.
Results. The study enrolled a total of 1257 individuals with representation from all 29 states of India with a mean (SD) age of 29.3 (9.7). Based on the combined PHQ-4 scale, 13.9% (n=174) had reported a moderate-severe level of anxiety or depression. Regarding distress, nearly three-quarters (n=942) had exhibited clinical concern for distress, and more than a half (n=670) met the threshold for probable diagnosis of distress. The study found individuals who lived alone, lived in shared accommodation, or who did not have chronic illness were reported a higher prevalence of anxiety or depression, and accommodation type was associated with the distress level in comparison with their counterparts.
Discussion. Our findings can assist various healthcare professionals and government advisors in strategizing targeted interventions required for combating COVID-19 in India and across the globe. Given the higher risk of pandemic-related psychological illness and its ongoing impact on people, it is crucial for advisors and the population.

Introduction: Around the time COVID-19 was declared a global pandemic, various restrictions and measures were implemented at all levels to limit disease spread and preserve healthcare capacity. Data is lacking in many low and middle-income countries on how these measures impact healthcare utilization and outcomes.
Aims: This study aims to determine the impact of COVID-19 restrictions on volumes of the 3 emergency bellwether procedures in South and Southeast Asia.
Methods: This was a retrospective cohort study of patients who underwent any of the 3 emergency bellwether procedures (Caesarean section, laparotomy and open fracture fixation) from 1 January 2018 to 31 December 2021 at one of 8 institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different level of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index.
Results: Weekly volumes of emergency Caesarean section decreased significantly in Guwahati Neurological Research Centre (GNRC) (p = 5.76 x 10-6) and Ulin General Hospital (UGH) (p <2.2 x 10-16) but increased in Adam Malik Hospital (AMH) (p =1.45 x 10-5). For laparotomies, volume increased in Singapore General Hospital (p = 8.56 x 10-6) but decreased in Military Hospital 175 (p = 6.30 x 10-7). The volume of open fracture fixations decreased in GNRC (p = 1.33 x 10-5), AMH (p = 1.68 x 10-6) and UGH (p = 8.15 x 10-6).
Conclusion: COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the 3 bellwether procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and MH175 during periods of more stringent COVID-19 restrictions.

Keywords: acute care surgery; pandemic preparedness; health resources, LMIC 

Aims: To stratify the severity of patients with COVID-19 infection and evaluate the risk of COVID-19-related clinical sequelae and compared age-specific differences
Methods: A retrospective cohort study were conducted using the electronic health database of Hong Kong Hospital Authority between 01 Jan 2022 to 15 August 2022. The cohort was stratified by age (≤40, 41-64, and ≥65 years old) and patients in each age-group were divided into four groups: (1)critical-group (ICU admission, mechanical ventilation support, C-reactive protein (CRP)>80mg/L or D-dimmer>2g/mL); (2)severe-group (CRP 30-80mg/L , D-dimer 0.5-2g/mL or CT value<20), (3)mild-moderate-group (COVID-19 positive-tested but not meeting the aforementioned criteria), (4)individuals without COVID-19 infection. The propensity score weighting was used to adjust the covariates among four groups. The association between COVID-19 severity and the clinical sequelae and all-cause mortality in acute and post-acute phase was estimated by the Cox proportional regression model in each age group.
Results: In ≤40, 40-64, and ≥65 age group, there were 286,114, 320,304 and 194,227 patients with mild-moderate conditions, 18,419, 23,678 and 31,505 with severe conditions, and 1,168, 2,261 and 10,178 patients with critical conditions, respectively. A general increasing trend was observed between the risk of COVID-19 related clinical sequelae and the severity of COVID-19 with advancing age, both during the acute and post-acute phases. Notably, In the acute phase, insignificant risks were observed only in mild-moderate patients aged≤40 compared to the unexposed group [e.g. mortality-risk HR (95%CI) aged≤40: 1.0 (0.5,2.0); aged 41-64: 2.1 (1.8,2.6); aged>65: 4.8 (4.6, 5.1)]; while in the post-acute phase, only patients aged over 65 were observed with a significant higher risk of clinical sequelae [aged≤40: 0.8 (0.5,1.0); aged 41-64: 1.1 (1.0,1.2); aged>65: 1.5 (1.5,1.6)].
Conclusion: The risk of health consequences after COVID-19 infection increased with increasing severity of COVID-19 infection, specifically among the elderly in both acute and post-acute phase.

Introduction
Self-medication was highly common during the COVID-19 pandemic. In elderly, the risk of self-medication is higher. Pharmacists are well positioned to provide public health education and disease prevention.

Aims
This study aims to explore the self-medication patterns and intention to seek pharmacist guidance among elderly aged 65 years or above in Macao.

Methods
A face-to-face cross-sectional survey was performed in March-April 2023 among elderly in Macao. The questionnaire was designed based on the Theory of Planned Behavior (TPB) framework. Multiple regression analyses were conducted to predict factors influencing self-medication behavior and intention to seek pharmacist guidance.

Results
In total, 412 participants completed the questionnaire. The self-medication rate was 64.2%, with the age of 85 years old and higher education being significantly associated with such behavior. The most commonly used medications were over-the-counter products and traditional Chinese medicine products. These medications were mainly obtained from widely distributed anti-pandemic packages and pharmacies. The purposes of self-medication were mainly to treat COVID-19 symptoms or prevent COVID-19 infection. While friends and family were the primary sources of information about self-medication, some participants (20.8%) also consulted healthcare professionals for advice. Further investigation about the intention of seeking pharmacist guidance on medication use showed that only 42.7% of participants were willing to seek help from pharmacists and age was a significant predictor of intentions. Of the three variables of TPB, the average scores were 3.4/5 for Attitude, 2.7/5 for Subjective Norm, and 3.6/5 for Perceived Behavioral Control. All three TPB variables were all strong predictors of intention, explaining 53% of the variance.

Conclusion
Self-medication was common among the elderly in Macao during the COVID-19 pandemic, but their intention to consult pharmacists was moderate. Public education about pharmacist’s role in self-medication to manage major public health incidents should be reinforced.

Introduction:
Reports of narcolepsy following COVID-19 vaccination have raised concerns about potential risks. However, the association between the COVID-19 vaccine and narcolepsy remains uncertain.

Aims:
To assess the risk of narcolepsy following COVID-19 vaccination in the Korean population.

Methods:
We conducted a self-controlled case series study using a database linking nationwide COVID-19 registry data, including infection and vaccination information, with National Health Insurance Service claims data in Korea, covering January 1, 2002, to September 30, 2022. Patients who received at least one COVID-19 vaccine dose before September 30, 2021, were included. Narcolepsy patients were those diagnosed with rare incurable disease code indicating treatment for narcolepsy and cataplexy within 365 days of vaccination and prescribed stimulants within 6 months before or after diagnosis. Patients with prior stimulant prescriptions, COVID-19 infection before narcolepsy, or diagnosis of a rare incurable disease codes were excluded. We used conditional Poisson regression to estimate incidence rate ratios (IRRs), adjusted for calender time in monthly interval, and 95% confidence intervals (CI) comparing risk and control intervals. The risk window was 1-42 days after each dose. Sensitivity analyses were conducted using 14- and 21-day risk periods or ICD-10 codes for diagnoses. Subgroup analyses by sex, age, Charlson comorbidity index, and vaccine type were also performed.

Results:
Among 39,323,547 COVID-19 vaccine recipients, 412 cases of narcolepsy were identified. Of these, 239 were men (58.0%), and 240 were aged 18-29 (58.3%). The aIRR for narcolepsy risk within 1-42 days post-vaccination was 1.03 (95% CI: 0.90-1.38). Similar results were found in sensitivity and subgroup analyses.

Discussion/Conclusion:
There was no evidence of increased risk of narcolepsy following COVID-19 vaccination. Most cases occur in children and adolescents, and vaccinations for those under 18 began in Korea in October 2021. Extending the study period is necessary to gather more evidence.

Introduction: In the transition to the post-COVID-19 era, it is crucial to reassess the clinical severity of COVID-19 and influenza co-infection to update the currently available evidence and provide better guidance for medical practice.

Aims: To compare the risk of 30-day all-cause mortality between patients with co-infection of influenza and COVID-19 and those with single infection.

Methods: We retrieved data from the Hong Kong Clinical Data Analysis and Reporting System. We identified patients who received test for COVID-19 and influenza using reverse transcription polymerase chain reaction (RT-PCR) between 2023-01-01 – 2024-01-31. RT-PCR-confirmed COVID-19 and influenza within 7 days were considered as co-infection. Clone censor weight method was used to reduce immortal time bias. Sex, age group, prior morbidities, were included to compute an inverse probability of censoring weights. The risk of 30-day mortality was compared between patients with co-infection and (1) COVID-19 infection or (2) influenza only. Kaplan-Meier estimates and Cox proportional hazard models were used.

Results: Out of 64,436 patients tested for with both COVID-19 and influenza, 39,148 (61%) were RT-PCR-confirmed with COVID-19 positive only, while 24,873 (38%) were RT-PCR-confirmed with influenza positive only. 415 (0.64%) patients had co-infection. From the Kaplan-Meier estimate, the 30-day mortality rates for patients with COVID-19 or influenza infection alone, compared to those with co-infection, were not statistically significant (p = 0.83 and p = 0.15, respectively). The results from the Cox model were inconclusive as the proportional hazard assumption was not met in some of the analyses.

Discussion: Our data covered a period when pandemic restrictions started to relax and addressed the recent strains of COVID-19. The risk of 30-day mortality for patients with co-infection was found similar to those with single infection. These results contradict existing meta-analyses on this topic. Further investigation is needed, particularly in subgroups defined by age and co-morbidities.

Introduction: For more than a few decades, corticosteroids (CS) have been used to treat variety of inflammatory and allergy disorders. Though the effectiveness of CS is proven, safety concern prevails. The public is now more aware of CS because of the COVID-19 pandemic, but their information sources still need to be verified.

Aim: The study investigates the general public’s knowledge, experience, and fears about corticosteroids, examining their acceptance and validity, and their relationship with factors like gender, age, and education.

Methods: A cross-sectional study was conducted among the general public for a period of six months. An online questionnaire was utilized to collect the perception, knowledge, and phobia towards corticosteroids following COVID-19. People who could read and understand English were included in the study.  Each participant's knowledge and phobia concerning CS were scored and graded.

Results: A total of 472 participants were enrolled in the study; the majority were females (60%) and university students (92%). Less than 32% were previously infected with COVID-19, and 33% of the total participants had used CS. The majority of them reported using it for respiratory (47.5%) and dermatological disorders (44.3%). A quarter of the samples stated that they suffered from acne and mood changes because of CS. The overall knowledge score concerning CS of the population came out to be satisfactory, but the corticophobia score was high. Moreover, their corticophobia score was positively associated with their experience of side effects and knowledge score. However, participants' educational level was negatively associated with the development of corticophobia.

Conclusion: The study found that, despite having a satisfactory understanding of CS, participants displayed a high corticophobia. Addressing this issue requires awareness campaigns, awareness programs, and patient interaction, as well as educating healthcare workers.

Introduction: Corticosteroid therapy is extensively utilized for treating autoimmune diseases, allergies, and inflammatory disorders. Despite their effectiveness, corticosteroids can cause adverse effects that significantly impact patient quality of life and adherence to treatment.
Aims: This study aims to capture and analyse the adverse drug reactions (ADRs) associated with the use of corticosteroids.
Methods: This is a prospective observational study conducted in the Department of General Medicine, Nephrology and Respiratory Medicine. The ADRs observed are subjected to causality assessment, preventability and serverity. Clinical records and laboratory tests of patients were reviewed, and patient interviews were conducted to evaluate the occurrence and severity of short-term ADRs. Descriptive and inferential statistics were used to analyze the data and identify factors associated with adverse effects.
Results: In this study, we screened 360 patients and identified 102 patients receiving corticosteroid medication, with nearly equal gender distribution. A total of 55 ADRs were identified among the enrolled subjects with prevalence rate of 49.01%. The main adverse drug reactions observed were hyperglycemia (11.76%), hypokalemia (9.80%), and hypertension (3.92%). Also, rare ADRs such as epistaxis, steroid-induced leukocytosis, hypothalamic pituitary adrenal axis suppression, osteoporosis, and cushing's syndrome were also identified. These ADRs were categorized by organ system, revealing metabolic (11.76%), cardiovascular (3.92%), and electrolyte (9.80%) effects. ADRs assessed according to the Naranjo causality assessment scale were classified as probable (24.51%) and possible (75.49%), with a severity level predominantly at level 1 (56.8%) additionally, 80.39% of ADRs were identified as definitely preventable.
Discussion: The finding highlight the prevalence and variety of ADRs associated with corticosteroid therapy. One-fifth of ADRs were definitely preventable indicates opportunities for improving patient safety through enhanced monitoring and patient education. These insights can inform clinical practices and patient management strategies to mitigate the risks associated with corticosteroid use.

Introduction: With the globalization of the pharmaceutical industry, the need for incorporating post-marketing drug surveillance occurred in the overseas has been emphasized.

Aims: To investigate the trends in utilizing international safety information by regulatory authorities in Japan, Australia, and the European Union (EU) countries.

Methods: Japan, Australia, and the EU were selected for analysis due to their economic advancement and dominant pharmaceutical markets. Online research was conducted using keywords such as "overseas pharmacovigilance," "post-marketing surveillance," and "international drug regulation." Additionally, we sought to identify the rationales of selecting the referenced countries.

Results: Canada, the United States, and Switzerland were commonly referenced for safety information among the study countries. They share a similar economic status (relatively high per capita GDP) and continuously support the development of the pharmaceutical industry. Additionally, regulatory agencies such as the FDA in the US, Health Canada in Canada, and Swissmedic in Switzerland rigorously manage the safety and efficacy of drugs. They all operate various regulatory policies, including voluntary adverse event reporting systems, and collaborate with international organizations to adhere to global standards for drug surveillance. Besides these common countries, Japan specified the United Kingdom, France, and Germany as reference countries. Australia referred the UK and Singapore. The EU, apart from the common reference countries, also engages with Israel and New Zealand, with whom it has Mutual Recognition Agreements.

Conclusions: This study indicates that regulatory authorities are extensively monitoring and sharing safety information from overseas. The countries referenced for drug safety information are commonly characterized by their economic advancement, well-structured drug regulation systems, and large pharmaceutical markets. As regulatory authorities closely monitor overseas safety information, the quality of drug surveillance and the prompt response to adverse reactions is expected to improve further.

Objective
To evaluate the potential association between Drug-induced liver injury (DILI) and the use of Bruton Tyrosine Kinase (BTK)

Methods, Results
We searched the WHO global database (VigiBase) for all reported cases between 2013 and Feb 2024 using a signal detection tool (VigiLyze). The search terms included (Acute liver injury OR drug induced liver injury OR Hepatic enzyme increased OR elevated alkaline phosphatase OR hepatocellular injury OR ascites OR hepatocellular jaundice OR Hepatic failure OR liver failure OR ALT levels increased OR ALT levels elevated OR AST levels increased OR AST levels elevated) (Preferred Term (PT) (MedDRA)) AND (Ibrutinib OR Acalabrutinib OR Zanubrutinib (substance (WHO drug)). The WHO-UMC causality assessment system performed for cases for the top 30 completeness score for each medication. Microsoft Excel 2019 used to perform the descriptive analysis.

A total of 435 DILI cases reported with BTKIs use; Of these, 384 cases with Ibrutinib use, 40 cases of Acalabrutinib use, and 11 cases of Zanubrutinib use. Among these cases, 78.16% classified as “Serious”, and 42% involved individuals aged 65 years or older. The gender distribution showed 38.10% females, and 53.10% males. Causality assessment of the included cases for Ibrutinib (n=30) resulted in one certain, nine probable, four possible, nine unlikely, and seven un-assessable cases. Positive de-challenge was observed in 12 cases, while positive re-challenge occurred in two cases. Acalabrutinib (n=30), had two possible, two unlikely, and 26 un-assessable cases. positive de-challenge observed in one case. Zanubrutinib (n=11) had one possible, two unlikely, and eight cases were un-assessable.

Conclusion
Our finding suggests that there is a potential association between DILI and the use of Ibrutinib, Acalabrutinib, and Zanubrutinib. Further epidemiological studies are needed to assess the risk of DILI with the use of these medications.

Introduction: Healthcare providers use various drug information (DI) resources to select drug doses in patients with renal impairment. However, the differences among these resources in making dosage recommendations pose additional risks for drug use in this special population.

Aim: To assess the consistency of renal drug dosage recommendations among six DI resources.

Methods: We reviewed six DI resources namely; British National Formulary 85th edition (BNF-85), drugs.com (DDC), Medscape.com (MS), Micromedex (MM), Renal Drug Handbook 5th edition (RDH-5), and UpToDate® (UTD), to explore the recommendations on renal drug dosage adjustments for one-hundred drugs. The recommendations provided for each drug, in each DI resource, were carefully reviewed, documented, and then categorized as numerical, non-numerical, dosage adjustment not required, contraindicated, no advice mentioned, and not listed. Each DI resource was scored for scope by calculating the number of drugs for which the resource provided a recommendation. Fleiss' Kappa(k) score was estimated using SPSS v29.0 to measure the consistency in documented information among the DI resources.

Results: RDH-5 had the highest scope score (89%), followed by UTD (82%), whereas BNF-85 and MS had the least scope scores of 54% each. The intersource reliability test revealed Fleiss' kappa(k) score of 0.246 [CI: 0.216-0.276, p<0.001], indicating a fair agreement among the DI resources regarding information on drug use in impaired renal function. Further, the intersource reliability test according to the anatomical therapeutic chemical (ATC) classification of studied medications revealed that the DI resources had the highest consistency [k=0.289, CI:0.200-0.379, p<0.001] for the drugs acting on the nervous system, concerning information on their use in renal impairment.

Conclusion: Developing an evidence-based list of renal drug dosage adjustments based on a single scale of assessing renal impairment, will help guide rational drug use in this special population.

Keywords: Consistency, Drug information resources, Impaired renal function, Rational drug use.

Introduction

Good Pharmacovigilance practices are essential to minimising drug-related issues, such as adverse drug reactions, and their negative impact on clinical and economic outcomes.

Aims

To initiate and evaluate the adverse drug reaction reporting system at a tertiary care teaching hospital in South Telangana, India.

Methods
This prospective observational and interventional study conducted at the Department of Clinical Pharmacy at KIMS Hospital, Narketpalli, Telangana. All in-patients were monitored for drug safety issues. All unpleasant events were reported. Naranjo’s scale was used to assess causality, Hartwig’s scale was used for severity, and the modified Shumock and Thornton scale was used to assess preventability. All the reports were assessed based on drug and disease class.

Results
During the study period, 1330 Adverse events were detected. Among them, 446 were due to the coronavirus vaccine, and 884 were due to drugs. About 44.3% of males and 55.07% of females experienced adverse events. About 69% of ADRs were observed in patients with over 40 years of age. Alcohol (68%) and cigarette smoking (62%) showed an influence on precipitating ADRs. In the disease category, the majority of ADRs 397(29.84%) were seen in type 2 DM patients, followed by Hypertension (HTN) 206, and in Asthma (110). Causality scores reveal that, Definite (17%), Probable (54%) and Possible (28%). The majority of ADRs were mild (85.93%), Moderate (10.15%) and severe (3.9%) in severity, 17% of reported ADRs were preventable, and 75% of ADRs were probably preventable. The majority of ADRs reported were with Calcium Channel Blockers (5.09%) followed by Loop Diuretics (4.39%).

Discussion/Conclusion
ADRs negatively influence the clinical and economic outcomes. Properly initiated pharmacovigilance practices will prevent unwanted ADRs and help patients to get positive clinical outcomes.

Key Words
Adverse Drug Reaction, Pharmacovigilance, Causality, Severity and Preventability Assessment

Aim/Objective: For insights into the antiviral drug, molnupiravir for the coronavirus disease 2019 (COVID-19), we summarized published evidence on the approved regimen (800mg twice daily over 5 days) for non-hospitalized adults with mild/moderately severe COVID-19.

Methods: We systematically searched for randomized controlled trials (RCTs) of molnupiravir for COVID-19 and included only laboratory-confirmed infections. We conducted pooled analysis of appropriate data using an inverse variance, random-effects model, and presented results as relative risk with associated 95% confidence intervals. We assessed for statistical heterogeneity using the I² statistic. Further, we graded and conducted trial sequential analysis (TSA) of the evidence.

Results: We included nine RCTs (30,971 persons). There was a small but significant evidence to suggest more viral clearance (of the severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) for molnupiravir compared with no treatment/placebo (RR 1.08 [1.01 – 1.16], I² 40.8%, 5 RCTs, 1,785 persons; moderate quality evidence). However, molnupiravir did not reduce the risk of hospitalization (RR 0.73 [0.47 – 1.14], I² 58.3%, 5 RCTs, 28,626 persons; high quality evidence) and all-cause mortality (RR 0.51 [0.15 – 1.69], I² 36.8%, 4 RCTs, 27,445 persons; high quality evidence). Further, molnupiravir was not associated with significantly more adverse (RR 1.02 [0.90 – 1.14], I² 16.3%, 7 RCTs, 3,368 persons; moderate quality evidence) or serious adverse (RR 0.91 [0.71 – 1.16], I² 0%, 5 RCTs, 27,562 persons; high quality evidence) reactions. Nevertheless, TSA suggested that more RCTs are required before any conclusions regarding viral clearance, all-cause mortality, and adverse reactions, but that more RCTs on the risk of hospitalization, and serious adverse events may be futile as the efficacy of molnupiravir for these outcomes is unlikely.

Conclusion: Molnupiravir may be promising for clearance of SARS-CoV-2, but generally does not seem better than usual care. However, more RCTs are necessary for a stronger evidence base.

Objective: COVID-19 has been linked to an increase in the incidence of depression and anxious symptoms, according to population studies. The current study purpose was is to analyze the adherence to antidepressant drugs before and after the COVID-19 pandemic in the Asir region of Saudi Arabia.
Methods: Using anonymized data from the Saudi German private hospital in Asir region, the medication possession ratio (MPR) was calculated for all antidepressants users. The MPR was calculated one year before COVID-19 pandemic and one year after. After confounding variables were controlled for, logistic regression analysis was conducted to predict the factors influencing adherence to antidepressants and assess whether the COVID-19 pandemic had an impact on adherence.
Results: 281 antidepressants users were included in the study. The average medication possession ratio was 67.5%, before the pandemic and 51.2% after the pandemic. The logistic regression analysis indicated that factors such as being male and being younger were significant predictors of poor adherence.
Conclusion: Poor adherence to antidepressants in the Asir region can be a result of various factors such as the stigma associated with mental illness. The COVID pandemic has further highlighted the importance of mental health and has exposed vulnerabilities in mental health care services. This study highlights the need to improve the adherence to antidepressants among patients with depression in the Asir region. This research also highlights the impact of the COVID-19 pandemic on mental health care services, and the need to provide better resources and support to patients during these difficult times.

Keywords: Antidepressants, Adherence, Covid-19, Saudi Arabia

Corona-virus infection disease in 2019 (COVID-19) has become one of the deadliest infections during the 21st century. Clinical manifestations of the SARS-CoV-2 viral infection may vary depending on the age, sex, and immune response of infected individuals, with different disease severity. Furthermore, the mutations in this virus potentially change their characteristics and virulence. Therefore, we believe it is important to explore more about the characteristics and patterns of the virus and how these affect their virulence in humans.
This study is an exploratory descriptive with the initial stages of sample extraction using QIAamp viral RNA Mini Kit, qRT-PCR examination, and library preparation. Then, we continued with genome sequencing using the Miseq Illumina sequencing machine. The sequencing results were analyzed using the CLC Genomics Workbench app software so that the type of variance was obtained in each research sample. Data and clinical condition of patients obtained from the Center for Diagnostic and Research on Infectious Diseases, Faculty of Medicine, Universitas Andalas, Indonesia.
This study used 251 samples, with the results of variant analysis grouped into non-VOI-VOC variants (66.5%), delta variants (19.5%), and omicrons (13.9%). Sample characteristics showed that men were more infected with the delta variant (53.1%), while the non-VOI-VOC variant and the female omicron variant had a higher percentage (58.1% and 58.6%, respectively). Meanwhile, the highest infection rate was found in the age group of 20-59 years. Sample characteristics based on the degree of disease severity found the most moderate-severe category in the delta variant (16.3%).
Analysis of sample characteristics in patients infected with SARS-CoV-2 based on sex, age, and degree of disease severity influenced by the type of virus variant infecting.

- Introduction
During 2022, the COVID-19 prevalence rate soared from 0.73 per thousand person-years to 378.85, affecting over thirty percent of the population. During this time, residents avoided outside activities, and healthcare utilization decreased. However, several studies indicated that COVID-19 infection might increase the risk of herpes zoster (HZ) outbreaks.

- Aims
This study aims to understand whether there were changes in healthcare utilization and disease status for HZ before and after the pandemic.

- Methods
This study used the medical records database of a municipal hospital, collecting data on patients diagnosed with HZ from 2020 to 2023. The data were grouped by year of visit and age groups. Analyses were conducted on number of visits, department of visit, medical specialty, complication rates, and medication.

- Results
The study included a total of 1,522 HZ patients, with an average of 2.98±2.85 visits per patient. The average number of visits slightly increased since 2022 (2020-2023: 2.93±2.61, 2.84±2.50, 2.99±2.84, 3.15±3.37), with no significant difference. The prevalence rate increased after the pandemic (2020-2023: 2.9‰, 2.8‰, 3.0‰, 3.1‰). During 2022, 10 COVID-19 patients developed HZ (2.9% of HZ patients), with an average interval of 66.6±68.5 days. The next year, there were 9 (2.3%) patients with 157.2±88.1 days. Among HZ patients, the proportion of HZ with ocular complications increased during the pandemic (2020-2023: 13.9%, 17.6%, 18.2%, 17.5%), while HZ hospitalization and emergency visit rates decreased (2020-2023: 15.0%, 15.7%, 10.3%, 11.3%). The most commonly used medication was Vitamin B complex (43.3%), followed by antiviral drugs (35.8%). There was no significant correlation between medication usage trends and the year, age or COVID-19 history.

- Discussion/Conclusion
During the pandemic, the healthcare needs of HZ patients remained significant, with an increase in ocular complications. Further research may be needed to confirm whether COVID-19 contributes to this increased risk.

Introduction: The equitable allocation of COVID-19 therapeutics remains a concern, with previous studies showing inequity by race/ethnicity and access to healthcare.
Aims: To describe the population of COVID-19 patients who received monoclonal antibodies (mAbs) at a quaternary medical center in the United States.
Methods: Patients ≥18 years of age with a positive SARS-CoV-2 test and received a mAb at University of California San Francisco (December 3, 2020-October 3, 2021) for treatment of COVID-19 were included. Demographic information was collected and the cohort was stratified by race/ethnicity and geographic area. The California Healthy Places Index (HPI), Healthcare Access (HA) scores, and the Social Vulnerability Index (SVI) were used to assess health status and healthcare access by geography. Higher SVI and lower HPI/HA scores reflect poorer health status/access. Statistical significance was determined at p < 0.05. This study was approved by the UCSF Institutional Review Board.
Results: Of 529 patients who received mAbs, White/Caucasian, Hispanic/Latinx, Asian, Black/African American (B/AA), others/unknown were 46.1, 17.4, 14.4, 10.8, 11.3%, respectively. Compared to White/Caucasian, Hispanic/Latinx and B/AA were significantly younger, unvaccinated and more likely to receive mAbs due to pre-existing conditions or obesity. Hispanic/Latinx and B/AA patients were more likely to receive mAbs in the Emergency Department; White/Caucasian patients were more likely to be seen in a clinic which may reflect differences in access to healthcare. Hispanic/Latinx and B/AA recipients had higher SVI scores and lower HPI/HA scores compared to White/Caucasian [HPI score R²=0.21, p < 0.05].
Discussion/Conclusions: This study reflects an unbalance of COVID-19 patients who received mAbs in the early days of the pandemic. Ongoing auditing with active outreach to vulnerable populations may help decrease health inequities.

Introduction: Anemia is a common complication in patients with diabetes and impaired renal function. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), one of the second line glucose-lowering agents (GLA), have been shown to increase hemoglobin levels and reduce anemia-related outcomes in recent post-hoc studies of placebo-controlled trials. However, without an active comparator, the comparative effects of SGLT2i versus other GLA is unclear. Dipeptidyl peptidase-4 inhibitors (DPP4i), another commonly used second line GLA, have also been shown to reduce the decline in hemoglobin levels among diabetic kidney disease patients in recent studies. Therefore, comparisons of the potential anemia benefits of SGLT2i and DPP4i are warranted to better inform treatment decisions.

Aims: To investigate the association of SGLT2i versus DPP4i with the risk of incident anemia events using real-world clinical data in Hong Kong.

Methods: This was a population-based retrospective cohort study using electronic medical records from the public healthcare sector in Hong Kong (the CDARS database). Clinical data of type 2 diabetes patients using SGLT2i and DPP4i between 2015 and 2018 were collected. The “prevalent new-user” design was adopted to account for the previous exposure to the comparator drugs. Propensity score (PS) matching was used to balance baseline characteristics of the two exposure groups. Hazard ratio of incident anemia was evaluated using the Cox regression.

Results: The PS-matched cohort included 6,415 SGLT2i users and 25,660 DPP4i users, with a mean age of 61 and a median follow-up of 2.6 years. SGLT2i was significantly associated with a reduced risk of incident anemia compared to DPP4i (hazard ratio: 0.40; 95% CI: 0.31-0.52; p<0.001).

Discussion: The association of SGLT2i with reduced anemia among diabetes patients remained with an active comparator. Compared to DPP4i, SGLT2i conferred better protection against anemia, and therefore potentially a better treatment choice for diabetes patients with an elevated risk of anemia.

Introduction: Hematopoietic Cell Transplantation (HCT) is a complex procedure necessitating multiple medications to manage graft-versus-host disease. The concomitant use of multiple drugs raises concerns about drug-drug interactions (DDIs), which could compromise treatment efficacy or lead to adverse effects.
Aim: This study investigates the prevalence of potential drug-drug interactions (DDIs) in a HCT unit.
Methods: A prospective comprehensive analysis was conducted by examining the medical prescriptions/drug charts from the pre-infusion (day -8) to post infusion (day +12) day of 19 HCT patients. Potential DDIs were analyzed using Uptodate(®)/micromedex and categorized according to levels of severity, evidence, and onset (rapid and delayed). Only interactions of major or moderate severity were included in the potential DDI analysis.
Results: Data were analysed for 19 HCT patients. The median age was 32.5 years; 57.8% (11) of the patients were male, and 42.1% (8) were undergoing autologous HCT. The patients received a median of 8 drugs each. Up to 118 potential DDIs were detected, 63.1% (12) of patients had at least 1 potential DDI and 36.8% (7) were exposed to at least 1 major potential DDI. The most commonly involved drugs were voriconazole (9, 28.1%), furosemide (8, 25%) and fluconazole (5, 15.6%). Most potential DDIs had moderate severity (98, 83.0%), a pharmacokinetic mechanism (45, 38.1%), and were classified as delayed onset (91, 77.1%). Under the category of major interactions, voriconazole interacted with fosaprepitant, cyclosporine and tacrolimus, and fluconazole with levofloxacin frequently.
Conclusions: The therapeutic complexity of the treatment resulted in a significant prevalence of possible DDIs during the HCT conditioning period. The majority of possible DDIs found in the study have the potential to cause nephrotoxicity, and cardiotoxicity, among others that could be clinically significant. Adequate observation of clinical and laboratory parameters is necessary to guarantee a successful HCT.
Keywords: Hematopoietic cell transplant, Drug-drug interactions

Introduction: Medication errors were inevitable in patient care. Massive work burden on healthcare providers hinders medication safety assessment, especially during ambulatory care context.

Aim: To evaluate the medication safety program in ambulatory patients with chronic disease.

Methods: An interventional study was carried out in an ambulatory setting of a tertiary care hospital for 6 months. Patients above 18 years of age with chronic conditions were included. The medication safety assessment program was initiated by the ambulatory pharmacist in collaboration with the general medicine outpatient department. Under this program, patients’ prescriptions, and clinical findings were recorded. Obtained data screened with multiple medication safety assessment tools & drug databases. Descriptive & inferential statistics were used to analyze the data.

Results:
A total of 58 patients of age 50±11 years were enrolled, among them 45% were on (n=26) polypharmacy. The majority were diagnosed with hypertension (n=21, 36%), diabetes (n=12, 21%), and rheumatoid arthritis (n=15, 26%). During medication safety assessment, a total of 11 adverse reactions and 183 (77.5%) clinically important potential drug-drug interactions (pDDIs) were identified. Out of which 65.78% (n=155) of clinically important pDDIs & 36% (n=4) of adverse reactions were seen in patients with polypharmacy. Overall, 82% (n=150) of clinically important pDDIs and 55% (n=6) of adverse reactions were resolved with interventions led by ambulatory pharmacist under this program. A strong correlation exists between the number of medications prescribed to the patients and the number of clinically important pDDIs (r=0.65, p<0.001)*.

Conclusion:
Ambulatory pharmacist-led medication safety programs can significantly enhance the quality of care while reducing avertable healthcare costs in chronic disease patients.

Keywords: ambulatory care, drug interactions, medication safety, adverse reaction.

Introduction: Community pharmacy services play a crucial role in China's primary healthcare system. However, the COVID-19 pandemic has introduced unprecedented challenges, leading to compromised access and quality of pharmaceutical services. Understanding the impact of closure policies related to COVID-19 on patient satisfaction and identifying the underlying mechanisms is essential for enhancing the quality of pharmacy services.
Aims: To assess the impact of COVID-19 closure policies on patient satisfaction and evaluate the underlying mechanisms in community pharmacies in China.
Methods: Cross-sectional study conducted from April 2021 to September 2022, using an unannounced standardized patient approach in community pharmacies across China. Patient satisfaction measured using validated tools, with closure policies related to COVID-19 as the primary exposure variable.
Results: The study included 1,076 eligible visits sample of community pharmacies and patients. Results indicated that stricter closure policies had a significant negative impact on patient satisfaction (β = −0.18, p = 0.019). This negative effect may be attributed to worsened accessibility (β = -0.12, p = 0.019) and capability of pharmaceutical service providers (β = -0.17, p = 0.002). Subgroup analyses demonstrated a negative correlation between stricter closure policies and lower satisfaction levels with regard to accessibility, capability, and communication.
Discussion: COVID-19 closure policies in China have adverse consequences for the quality of pharmacy services. These findings highlight the urgency of addressing abrupt infectious diseases or public health emergencies. Enhancing access to pharmacy services and capability of providers are critical strategies to ensure an effective response to sudden public health crises.