National Drug Research Articles

Improving Immunization Health Care Data Quality using Two-Dimensional Barcoding and Barcode Scanning Practices.

Manual data entry is time-consuming, inefficient, and error prone. In contrast, leveraging two-dimensional (2D) barcodes and barcode scanning tools is a rapid and effective practice for automatically entering vaccine data accurately and completely. CDC pilots documented clinical and public health impacts of 2D barcode scanning practices on data quality and completeness, time savings, workflow efficiencies, and staff experience. Data entry practices and entered records from routine and mass vaccination settings were analyzed. Data quality improvement opportunities were identified. A sample of 50 million emergency use authorization (EUA) coronavirus disease 2019 (COVID-19) vaccine records were analyzed for accuracy and completeness across three data fields: lot number, expiration date, and National Drug Code (NDC). The EUA COVID-19 vaccines lacked a 2D barcode containing these data fields, which necessitated manual data entry at administration. A CDC pilot at clinic compared scanned and manually entered data for routine vaccines across these same data fields. Analysis of 50 million manually entered EUA COVID-19 vaccine administration records indicated significant gaps in data accuracy and completeness across three data fields. Over half of the analyzed EUA vaccine NDCs (53%) and one-third of the expiration dates (35%) had missing or inaccurate data recorded. Pilot data also showed many errors when manually entered. However, when the pilot's routine vaccines were scanned (out of 71,969 records), nearly all entries were complete and accurate across all three data fields (ranging from 99.7% to 99.999% accurate). Vaccine 2D barcode scanning practices increased data accuracy and completeness (up to 99.999% accurate) across data fields assessed. When used consistently, vaccine 2D barcode scanning can resolve issues demonstrated in manually entered data. To realize these benefits, the immunization community should widely use scanning practices. To increase use, CDC developed a Vaccine 2D Barcode National Adoption Strategy and implementation resources.

Whole Genome Sequence-Based Analyses of Drug Resistance Characteristics, Genetic Diversity, and Transmission Dynamics of Drug-Resistant Mycobacterium tuberculosis in Urumqi City.

This study aims to analyze the drug resistance spectrum, genetic diversity, and transmission dynamics to provide a basis for the prevention and control of drug-resistant (DR) tuberculosis (TB) epidemics. This retrospective study is based on routine national drug resistance surveillance. The demographic, epidemiological, and clinical information on DR-TB patients from 2016 to 2021 was collected and used for phenotypic drug susceptibility testing and whole-genome sequencing. It was indicated that L2.2.1 was the dominant lineage in Urumqi. The drug resistance spectrum in Urumqi was narrow, which means more drug combinations can be used for clinical treatment. Furthermore, mutations identification of drug-resistance gene katG, rpoB, embA/B, rrs, rpsL, eis, gyrA/B, folC and tryA are important for clinical drug use. However, mutations in cross-resistance genes rrs have limited guidance for clinical selection of KM, CPM and AK. Moreover, there is an increased risk of cluster transmission of DR-TB, and the difference in clustering rate among L2, L3, and L4 was not statistically significant (χ2 = 2.6410, p = 0.2670). In the Urumqi, DR-TB has a complex prevalence state, a narrow drug resistance spectrum, and a high clustering rate and burden of drug resistance. To reduce the burden of DR-TB, related research should be strengthened, and the development of prevention, control, and treatment strategies should be accelerated.

Effect of China national centralized drug procurement policy on anticoagulation selection and hemorrhage events in patients with AF in Suining.

Background: Launched in March 2019, the National Centralized Drug Procurement (NCDP) initiative aimed to optimize the drug utilization framework in public healthcare facilities. Following the integration of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) into the procurement catalog, healthcare establishments in Suining swiftly transitioned to the widespread adoption of NOACs, beginning 1 March 2020. Objective: This study aims to comprehensively assess the impact of the NCDP policy on the efficacy of anticoagulation therapy, patient medication adherence, and the incidence of hemorrhagic events in individuals with non-valvular atrial fibrillation (NVAF) residing in Suining. The analysis seeks to elucidate the broader impacts of the NCDP policy on this patient demographic. Methods: This study analyzed patient hospitalization records from the Department of Cardiology at Suining County People's Hospital, spanning 1 January 2017, to 30 June 2022. The dataset included demographic details (age, sex), type of health insurance, year of admission, hospitalization expenses, and comprehensive information on anticoagulant therapy utilization. The CHA2DS2-VASc scoring system, an established risk assessment tool, was used to evaluate stroke risk in NVAF patients. Patients with a CHA2DS2-VASc score of 2 or higher were categorized as high-risk, while those with scores below 2 were considered medium or low-risk. Results: 1. Treatment Cost Analysis: The study included 3,986 patients diagnosed with NVAF. Following the implementation of the NCDP policy, a significant increase in the average treatment cost for hospitalized patients was observed, rising from 8,900.57 ± 9,023.02 CNY to 9,829.99 ± 10,886.87 CNY (p < 0.001). 2. Oral Anticoagulant Utilization: Overall, oral anticoagulant use increased from 40.02% to 61.33% post-NCDP (p < 0.001). Specifically, NOAC utilization among patients dramatically rose from 15.41% to 90.99% (p < 0.001). 3. Hemorrhagic Events: There was a significant decrease in hemorrhagic events following the NCDP policy, from 1.88% to 0.66% (p = 0.01). Hypertension [OR = 1.979, 95% CI (1.132, 3.462), p = 0.017], history of stroke [OR = 1.375, 95% CI (1.023, 1.847), p = 0.035], age ≥65years [OR = 0.339, 95% CI (0.188, 0.612), p < 0.001], combination therapy of anticoagulants and antiplatelets [OR = 3.620, 95% CI (1.752, 7.480), p < 0.001], hepatic and renal insufficiency [OR = 4.294, 95% CI (2.28, 8.084), p < 0.001], and the NCDP policy [OR = 0.295, 95% CI (0.115, 0.753), p = 0.011] are significant risk factors for bleeding in patients with atrial fibrillation. 4. Re-hospitalization and Anticoagulant Use: Among the 219 patients requiring re-hospitalization, there was a notable increase in anticoagulant usage post-NCDP, from 36.07% to 59.82% (p < 0.001). NOACs, in particular, saw a substantial rise in usage among these patients, from 11.39% to 80.92% (p < 0.001). 5. Anticoagulant Type Change: The NCDP policy [OR = 28.223, 95% CI (13.148, 60.585), p < 0.001] and bleeding events [OR = 27.772, 95% CI (3.213, 240.026), p = 0.003] were significant factors influencing the alteration of anticoagulant medications in patients. Conclusion: The NCDP policy has markedly improved anticoagulation management in patients with AF. This policy has played a crucial role in enhancing medication adherence and significantly reducing the incidence of hemorrhagic events among these patients. Additionally, the NCDP policy has proven to be a key factor in guiding the selection and modification of anticoagulant therapies in the AF patient population.

NIDA: Psilocybin mushroom seizures rose significantly

A National Institute on Drug Abuse (NIDA)‐funded study published in the journal Drug and Alcohol Dependence titled “National and Regional Trends in Seizures of Shrooms (Psilocybin) in the United States, 2017‐2022” reported a significant increase in law enforcement seizures of psilocybin mushrooms, also known as “magic mushrooms” or “shrooms,” in the United States from January 2017 to December 2022. The study is based on data from the White House Office of National Drug Control Policy's (ONDCP) High Intensity Drug Trafficking Areas (HIDTA) program, which tracks law enforcement seizures in hotspots across the country. Key findings include:

Strengthening and enhancing national antiretroviral drug resistance surveillance in Zimbabwe-A country that has reached UNAIDS 95-95-95 amongst adults.

Strengthening and enhancing national antiretroviral drug resistance surveillance in Zimbabwe-A country that has reached UNAIDS 95-95-95 amongst adults.

Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients.

Objectives: The study aimed to estimate the effects of National Volume-based Drug Procurement (NVBP) policy on drug utilization and medical expenditures of hypertension patients in public medical institutions in mainland China. Methods: This study used patient-level data based on electronic health records retrieved from the hospital information system of Nanjing Hospital of Chinese Medicine. Data on patients with hypertension who received care at this institution between 2016 and 2021 was used for analysis. Segmented linear regression models incorporating Interrupted Time Series (ITS) analysis were adopted to examine the effects of NVBP policy on drug utilization and health expenditures of eligible patients. Drug utilization volume and health expenditures were the primary outcomes used to assess the policy effects, and were measured using the prescription proportion of each drug class and the overall per-encounter treatment costs. Results: After the implementation of NVBP policy, the volume of non-winning drugs decreased from 54.42% to 36.25% for outpatient care and from 35.62% to 15.65% for inpatient care. The ITS analysis showed that the volume of bid-winning drugs in outpatient and inpatient settings increased by 9.55% (p < 0.001) and 6.31% (p < 0.001), respectively. The volume changes in non-volume based purchased (non-VBP) drugs differed between outpatients and inpatients. The proportion of non-VBP drugs immediately increased by 5.34% (p = 0.002) overall, and showed an upward trend in the outpatient setting specially (p < 0.001) during the post-intervention period. However, no significant differences were observed in the proportion of non-VBP drugs in inpatient setting (p > 0.05) in term of level change (p > 0.05) or trend change (p > 0.05). The average per-visit expenditures of outpatients across all drug groups exhibited an upward trend (p < 0.05) post policy intervention. In addition, a similar increase in the overall costs for chemical drugs were observed in inpatient settings (coefficient = 2,599.54, p = 0.036), with no statistically significant differences in the regression slope and level (p = 0.814). Conclusion: The usage proportion of bid-winning drugs increased significantly post policy intervention, indicating greater use of bid-winning drugs and the corresponding substitution of non-winning hypertensive drugs. Drug expenditures for outpatients and health expenditures per visit for inpatients also exhibited an upward trend, suggesting the importance of enhanced drug use management in Traditional Chinese Medicine hospital settings.

Validation of administrative claims to identify ultrasound enhancing agent use

BackgroundUltrasound enhancing agents (UEAs) are an invaluable adjunct to stress and transthoracic echocardiography (STE) to improve left ventricular visualization. Despite multiple single center studies evaluating UEA use, investigation into the rates, sources of variation, and outcomes of UEA use on a national level in the United States (US) has been limited by lack of validation of UEA codes for claims analyses.MethodsWe conducted a retrospective cross-sectional study, 2019–2022, using linked multicenter electronic medical record (EMR) data from > 30 health systems linked to all-payor claims data representing > 90% of the US population. Individuals receiving STE in both EMR and claims data on the same day during the study window were included. UEA receipt as identified by presence of a Current Procedural Terminology (CPT) or National Drug Code (NDC) for UEA use within 1-day of the index STE event. We evaluated the performance of claims to identify UEA use, using EMR data as the gold standard, stratified by inpatient and outpatient status.ResultsAmongst 54,525 individuals receiving STE in both EMR and claims data, 12,853 (23.6%) had a UEA claim in EMR, 10,461 (19.2%) had a UEA claim in claims, and 9140 (16.8%) had a UEA claim in both within the 1-day window. The sensitivity, specificity, accuracy, positive, and negative predictive values for UEA claims were 71.1%, 96.8%, 90.8%, 87.4%. and 91.6% respectively. However, amongst inpatients, the sensitivity of UEA claims was substantially lower (6.8%) compared to outpatients (79.7%).ConclusionsWhile the overall accuracy of claims to identify UEA use was high, there was substantial under-capture of UEA use by claims amongst inpatients. These results call into question published rates of UEA use amongst inpatients in studies using administrative claims, and highlight ongoing need to improve inpatient coding for UEA use.

Judicial Interpretations, Findings and Pronouncements of the Nigerian Apex Court: A Review of Mohammed Vs Frn

Purpose: The objective of this review was to challenge the apex court's decision, encompassing its findings, judicial interpretations, and pronouncements (DFIP). A notable issue arises from the discovery that the National Assembly (NA) mistakenly granted 'exclusive' criminal jurisdiction to the Federal High Court (FHC) regarding Indian hemp offenses. Consequently, this study critically examined the DFIP in depth.&#x0D; Methodology: This work adopts the doctrinal method of research, which involves the use of primary and secondary sources of law. This study relied on key primary sources, including the constitution of the Federal Republic of Nigeria, Acts of the National Assembly, case laws, and Decrees. Supplementary information was derived from secondary sources such as books and articles. This review extensively employed primary and secondary legal sources, focusing on statutory interpretation rules, the hierarchy of norms, particularly in relation to the principle of inconsistency, and the unalterable nature of jurisdiction prescribed by the Constitution of the Federal Republic of Nigeria (CFRN). These criteria were systematically applied to evaluate the Decision, Findings, Interpretations, and Pronouncements (DFIP) of the apex court.&#x0D; Findings: The apex court's determination that Section 8 of the Indian Hemp Act (IHA) was implicitly repealed by Section 26 of the National Drug Law Enforcement Agency (NDLEA) Act is inaccurate. Similarly, the assertion that the National Assembly (NA) granted 'exclusive' criminal jurisdiction to the Federal High Court (FHC) is flawed, as Section 251(3) of the Constitution of the Federal Republic of Nigeria (CFRN) actually confers concurrent criminal jurisdiction on the FHC. &#x0D; The finding of the apex court that Magistrate Courts (MC), being a creation of state legislation, cannot try Indian hemp offences is erroneous. The apex court's assertion that Indian hemp is both a 'drug' and a 'narcotic drug' is refuted as erroneous in the course of this review.&#x0D; Recommendations: Statutory intervention in the manner of amendment of Sections 251(1)(s) and 251(3) is required if the decision of the apex court is to represent the position of the law in Nigeria.

Breastfeeding decreases the risk of developing psoriasis through to early adulthood.

Psoriasis is a genetically determined systemic skin disease, although environmental trigger factors are required for disease manifestation. Some of these triggers, such as stress, infections and drug exposure, have been identified. To explore the role of early nutrition as a risk factor for the development of psoriasis. Parents in the All Babies in Southeast Sweden (ABIS) prospective birth cohort (n = 16 415) answered questionnaires at birth and when their children were aged 1 and 3 years. A diagnosis of psoriasis was determined from the Swedish National Patient Register and National Drug Prescription Register. Statistical analyses were conducted using custom-written R scripts. Individuals breastfed for < 4 months and who received infant formula before 4 months of age had a higher risk of psoriasis [odds ratio (OR) 1.84 (P = 0.02) and OR 1.88 (P = 0.02), respectively]. At the 3-year follow-up, the increased consumption of fish, especially from the Baltic Sea, increased the risk of psoriasis (OR 9.61; P = 0.003). In addition, the risk of psoriasis increased following the consumption of a large volume of milk (OR 2.53; P = 0.04). Our study underscores, for the first time, the impact of very early nutrition on the manifestation of psoriasis through early adulthood. Exclusive breastfeeding for 4 months appears to be protective.

Estimating rare disease prevalence and costs in the USA: a cohort study approach using the Healthcare Cost Institute claims data

ObjectiveThe study capitalised on national insurance claims data to gather information on patient characteristics and associated costs to better understand the diagnosis and treatment of rare diseases (RDs).Materials and methodsData...

Implementation of a tier system for IVIG indications to address IVIG shortage at a tertiary care pediatric medical center.

Drug shortages are a common issue that healthcare systems face and can result in adverse health outcomes for patients requiring inferior alternate treatment. The United States recently experienced a national drug shortage of intravenous immunoglobulin (IVIG). Several reported strategies to address the IVIG and other drug shortages have been proposed; however, there is a lack of evidence-based methods for protocol development and implementation. To evaluate the efficacy of introducing a multidisciplinary task force and tier system of indications and to minimize adverse effects during a shortage of IVIG. Faculty members across disciplines with expertise in IVIG use were invited to participate in a task force to address the shortage and ensure adequate supply for emergent indications. A tier system of IVIG indications was established according to the severity of diagnosis, urgency of indication, and quality of supporting evidence. Based on inventory, indications in selected tiers were auto-approved. Orders that could not be automatically approved were escalated for task force review. Overall, there were 342 distinct requests for IVIG during the study period (August 1, 2019 to December 31, 2019). All Tier 1 indications were approved. Of all requests, only 2.6% (9) of requests were denied, none of which resulted in adverse effects based on retrospective chart review. Seven patients who regularly receive IVIG had possible adverse effects due to dose reduction or spacing of treatment; however, each complication was multifactorial and not attributed to the shortage or tier system implementation alone. Implementation of a multidisciplinary task force and tier system to appropriately triage high-priority indications for limited pharmaceutical agents should be considered in health institutions faced with a drug shortage.

Comparison of methods to identify individuals prescribed opioid analgesics for pain

IntroductionWhile identifying opioid prescriptions in claims data has been instrumental in informing best practises, studies have not evaluated whether certain methods of identifying opioid prescriptions yield better results. We compared...

Prevalence of Substance Abuse Among University Undergraduates

The study investigated how many university students in private, state, and federal institutions abuse chemical substances. It also compared the three types of institution to know where abuse of substances is more prevalent. The population for the study were all university undergraduates from Ekiti State. The sample is made up of 450 respondents’ selected using simple randomization and purposive sampling technique with 115 participants from private institutions, 165 from state owned institutions and 170 participants from federal institutions. A Google Form questionnaire tagged Prevalence of Substance Abuse Scale (PSAS) was created, validated and used for data collection. Results; No significant difference could be determined in terms of gender on the prevalence of substance abuse among undergraduate students (F(1, 448) = 0.581, p &amp;lt;.05). A significant difference was detected in terms of age (F (3, 447) = 0.088, p &amp;lt; .05). It revealed a non-significant effect on the prevalence of substance abuse among undergraduates across different universities (private, state, and federal) (F(2, 447) = 0.084, p &amp;lt; 0.05). It was suggested that universities should have an active counselling centre with trained counsellors to help people who struggle with substance abuse. Counsellors should work with the National Drug Law Enforcement Agency (NDLEA) to hold events like awareness campaigns, seminars, and workshops to enlighten students about the negative effects of substance abuse.

Does China's national volume-based drug procurement policy promote or hinder pharmaceutical innovation?

The national volume-based drug procurement policy initiated in China since 2018 represents a significant reform in China's pharmaceutical distribution system. It has largely squeezed out the price bubble of low-end generic drugs, making competition in the pharmaceutical sales segment more intense and transparent. This policy intervenes in the distribution link of the pharmaceutical industry by intensifying market competition, thereby enhancing the innovation willingness and R&D capabilities of pharmaceutical companies. Taking the national volume-based drug procurement policy as the policy shock, we used the multi-period difference-in-difference method to study the impact of the policy on innovation input, innovation output quantity and innovation output quality of listed pharmaceutical companies and its impact mechanism. We found that the volume-based policy can significantly promote the pharmaceutical companies' innovation input and the innovation output quality, but significantly reduced the innovation output quantity. For innovative and generic drug companies, this policy has limited impact on innovative drug companies, but force generic drug companies to pay more attention to cost control and market positioning, and the quality and cost-effectiveness of R&D output to ensure competitiveness in the market. For bid-winning and non-winning companies, the policy has a greater innovation incentive for non-winning companies than winning companies, by imposing greater survival pressure on non-winning companies, forcing them to increase R&D investment intensity and adopt the innovation strategy of preferring quality to quantity. The results show that the national volume-based drug procurement policy should be expanded to lower drug prices and lighten the medical burden on patients, with enhanced quality and safety supervision. Additionally, it suggests cautious application of such policies to innovative and high-end generic drugs to encourage continued pharmaceutical innovation and industry advancement.

Epidemic trend, genetic characteristics, and transmission networks of HIV-1 among treatment-naive men who have sex with men in Hebei province, China.

Homosexual transmission has contributed greatly to the current HIV-1 epidemic in Hebei province, China. Dolutegravir (DTG) will be conditionally used as a component of free antiretroviral therapy (ART) according to manual for national free anti-AIDS treatment drugs (2023 edition) issued by China in June 2023. However, current genetic characteristics and pretreatment drug resistance (PDR) to proteinase inhibitors (PIs), reverse transcriptase inhibitors (RTs) and integrase strand transfer inhibitors (INSTIs) of HIV-1 in this population have remained unclear. Serial consecutive cross-sectional analyses for HIV- 1 infection trend, genetic characteristics, PDR and molecular transmission networks were conducted from 2018 to 2022. All of participants were HIV-1- infected MSM newly diagnosed at the HIV surveillance points (HSPs) in Hebei, China. Evidence of PDR was confirmed using the world health organization (WHO) list for surveillance of drug resistance mutations. In this study, a total of 14 HIV-1 subtypes were circulating in the HSPs of Hebei province, China. CRF01_ AE (51.9%, 350/675), CRF07_BC (30.4%, 205/675), B (6.2%, 42/675) and URFs (5.8%, 39/675) were the four most predominant subtypes among MSM. And, CRF07_BC (r > 0) and URFs (r > 0) indicated an increasing trend, respectively; however, CRF01_AE (r < 0) showed a decline trend. The overall prevalence of HIV-1 PDR showed a substantial increase from 6.3% in 2018 to 7.9% in 2022. The prevalence of NNRTI-PDR was the highest (5.8%, 39/675), followed by INSTIs (2.4%, 16/675), NRTIs (0.6%, 4/675) and PIs (0.3%, 2/675). Furthermore, extensive HIV-1 strains bearing PDR were circulating in the MSM population via molecular transmission networks for major HIV-1 subtypes, especially CRF01_AE and CRF07_BC. Our findings reflect that HIV-1 epidemic in the MSM population is complex and severe in Hebei, China. Therefore, it is urgent for us to implement more effective intervention measures to limit the further dissemination of HIV-1, especially the spread of HIV-1 INSTI-PDR strains.

Dynamics and trends of drug dealing: a local labour system perspective

This study provides a dynamic analysis of illegal drug trafficking in the Italian region of Sardinia, using the Local Labour Systems (LLS, ISTAT) framework. Data from major regional newspapers (January 2017 - De-cember 2022) were validated through institutional reports. A multivariate biplot analysis reveals an increase in drug seizures and the Island's role as a hub for national and international drug trade, facilitated by local and traditional mafia organizations. Related crimes are also infiltrating the le-gal economy, particularly in the coastal real estate market. This study high-lights the urgent need for targeted institutional and community strategies to protect younger people, who are increasingly involved in trafficking.

Drug Supply Chain Management in Public Secondary Health Facilities in Lagos State Nigeria

This study was conducted to analyze the drug supply chain at nineteen selected public secondary health centers (SHC) commonly referred to as General Hospitals, in Lagos State. Data was collected from both primary and secondary sources. The primary data were collected through a well-structured questionnaire while the secondary data were sourced from journals, Lagos State Ministry of Health, Lagos Bureau of Statistics (LBS), National Agency for Food and Drug Administration and Control (NAFDAC), etc. A descriptive statistical method was employed for data analysis using the statistical package for Social Science (SPSS) version 2.0 and ArcGIS 10.8 version. Maps, frequency counts, percentages, and analysis of variance (ANOVA) were also used to test the hypothesis The study contributed to the existing body of knowledge by establishing the Euclidean distance of SHC from Central Medical Store (CMS) Oshodi, the residences within and outside the buffer zone of 2km radius around the SHC in Lagos state and the distribution and accessibility of patients to essential drugs in the study area. Findings confirmed that 79.6% of Pharmacists have received training on supply chain practices. The respondents also said that SHC in Lagos gets about 75% of their drug supplies from Central Medical Store. The result also revealed there is a significant relationship between the number of dispensing outlet and the amount paid for drug by patients. Also, 57.5% of the patients preferred to have their drugs delivered at home and 49.5% were willing to pay extra cost for home delivery. The study suggests strong regulation and strict enforcement of National Drug Distribution Guidelines of 2012 (NDDG) by the regulator. The study concludes that effective supply chain will deliver safe, efficient, and quality drugs to meet the health need of the patients.

Comparative component analysis of registered Thai Ayuravej antidiarrheal regimen, yaleungpidsamuttara to classical Indian Ayurveda regimen

ABSTRACT Objective: Classical Indian Ayurveda is a very important traditional medicine system that is the rooted concept for several traditional medicine systems including Thai traditional medicine, Ayuravej. At present, there are many registered modern Ayuravej regimen products in the national drug list of Thailand including Yaleungpidsamuttara, which is an antidiarrheal regimen. Materials and Methods: The work is a clinical informatics analysis making use of data searching and systematic comparison. In this article, the authors analyze the registered components of the Yaleungpidsamuttara and compare them to the data on the classical Indian Ayurveda regimen. Results: Comparing to the classical Indian Ayurveda, there is no exact Indian Ayurveda with the same components. However, there are some antidiarrheal Indian Ayurveda regimens that have some common components. Conclusion: The studied Thai Ayuravej product has its rooted concept from classical Indian Ayurveda and the antidiarrheal activity is also confirmed by modern clinical evidence.

Bigdata of National Medicine Registers

Currently, various databases of approved drugs are widely used in the development and application of computer-aided drug design for training sets and validating predicted models. Most of the freely available databases contain information on a limited number of drugs. This leads to reduction in the space of pharmacotherapeutic chemistry studied and used by researchers. Information on drugs developed and used locally, in one or two countries, can be obtained from relevant national medicine registries. We have identified and analyzed registries from more than 70 countries around the world that are accessible through open web resources on the Internet. In addition to lists of approved therapeutics, many web resources offer the opportunity to review official documents published by medical authorities after the approval process. These documents contain a wide range of information about drugs, including data on structural formulations, pharmacodynamics and pharmacokinetics, toxicity, etc. The compounds represented in the registries, both in terms of quantity and structural diversity, exceed the known widely used databases of approved drugs. Combined data from national drug registries represent an example of “Big Data” in the biomedical field, taking into account all the difficulties involved in their processing. Its use in computer-aided drug design will not only expand the pharmacotherapeutic chemical space studied, but also improve the quality of the original data.

Medicare formulary restrictions for glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors used in type 2 diabetes mellitus: 2019-2023.

Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT2is) have proven benefits in patients with type 2 diabetes mellitus related to decreasing cardiovascular events and heart failure hospitalizations as well as preventing the progression of kidney disease. This led the American Diabetes Association (ADA) to update their guidelines in 2022 to recommend GLP1-RAs and SGLT2is as potential first-line options in patients with cardiorenal conditions. Formulary restrictions, such as step therapy and prior authorizations, can limit access to these beneficial medications. To evaluate trends in Medicare formulary restrictions of GLP1-RAs and SGLT2is following the recommendations by the ADA for first-line use. We conducted a retrospective cohort study of Quarter 1 Medicare formulary restrictions on GLP1-RAs and SGLT2is from 2019 to 2023. We analyzed changes in formulary restrictions by year, before and after the ADA first-line recommendations, single vs combination products, and products with and without other indications on a medication level (ie, each unique National Drug Code number on each unique formulary) and formulary level (ie, any prior authorization or step therapy requirements yield formulary restriction). We analyzed 12,212 unique Medicare formularies. GLP1-RAs were 12.5% less likely (relative risk [RR] = 0.87; 95% CI = 0.84-0.91; P < 0.001) and 33.2% less likely (RR = 0.67; 95% CI = 0.60-0.74; P < 0.001) to have restrictions after the ADA guideline changes on a medication and formulary level, respectively. SGLT2is were 87.8% less likely (RR = 0.12; 95% CI = 0.11-0.13; P < 0.001) and 53.0% less likely (RR = 0.47; 95% CI = 0.27-0.80; P = 0.005) to have restrictions after the ADA guideline changes on medication and formulary levels, respectively. Decreasing trends of medications and formularies with restrictions may indicate payers are recognizing GLP1-RAs and SGLT2is as potential first-line agents, aligning with ADA recommendations.