新药研发中的me-too, me-better, me-new

文中根据作者对我国新药研发的认识和理解,提出了新药研发过程中me-too,me-better和me-new类新药的概念,并对新药研发过程中的这3类创新活动之间的关系、新药研发的创新程度与经济效益的关系,以及目前我国新药研发的途径选择做了简要的论述。     

谈原研药与仿制药的不同

本文主要从新药法规、药价、质量和疗效等方面介绍原研药与仿制药的区别,并使公众对两者有更深入的了解。     

Clinical perspectives in drug safety and adverse drug reactions

Adverse drug reactions (ADRs) remain a common clinical problem since they can mimic many diseases and cause significant morbidity and mortality. Judicious prescribing is important to minimize their occurrence. Apart from the recent identification of a few pharmacogenomic biomarkers for serious reactions, many remain unpredictable. Spontaneous reporting continues to play an important role in pharmacovigilance and the value of astute clinical observation and well-documented reports of suspicions of a causal link cannot be underestimated. Many national reporting schemes have developed considerable experience and expertise over many years and have large ADR databases, which are national assets. Despite advances in pharmacovigilance, numerous deficiencies have been identified; postmarketing surveillance remains the weakest link in the regulatory process. Regulatory authorities have tended to act later rather than sooner in response to safety signals, and this, when combined with under-reporting, may have led to exposure of a large number of patients to drug-related harm before restriction or withdrawal. In an attempt to improve vigilance, international surveillance may benefit by moving from its current passive/reactive mode toward active surveillance systems with a prospective, comprehensive and systematic approach to monitoring, collecting, analyzing and reporting data on ADRs. This will include increased pressure on pharmaceutical companies to conduct postmarketing studies. Such an active/proactive approach, while maintaining focus on ADR detection, could also aim to extend knowledge of safety, such that emerging changes in risk–benefit during a drug’s marketed life are effectively communicated to clinicians and patients. Drug safety monitoring and its regulation are now undergoing an overhaul and it is hoped that vigilance, public safety and trust will improve as a result.     

护士专科药物学知识的继续教育与用药安全

目的加强护士专科药物学知识的继续教育，保障用药安全。方法有目标、有计划、系统地、适时地进行专科药物学知识的继续教育，保障给药安全，加强用药监护，及时发现药品不良反应。结果护士从被动盲从医嘱变为主动正确执行医嘱，安全给药的同时积极主动进行用药监护，最大限度地保障了用药安全。结论护士通过专科药物学知识的继续教育，避免药品不良事件的发生，及时发现药品不良反应，承担起用药安全的护理职责，展示护理专业的价值。     

药物分子设计的策略：双靶标药物设计

新药研究可分两种模式：以生理学和表型为基础的研究和以生物靶标为核心的药物研究,这两种模式相互补充和印证。当今以靶标为切入点的模式占主导地位,研发出不少新药。许多疾病如肿瘤、代谢性和中枢神经系统疾病的药物治疗非单一靶标可治愈,同时干预与疾病相关的双（多）靶标药物可提高药物的效力,因而成为创制新药的活跃领域。双靶标药物可以是两个受体的调节剂、两个酶的抑制剂或同时作用于酶和受体或作用于受体和通道或转运蛋白的双功能性分子等。从药物分子设计的视角,构建双靶标药物分子可将两个活性分子或其药效团用连接基连接在一起,构成连接型分子;两个活性分子的部分结构或药效团特征相同,可将共同部分融合或并合,形成融合型或并合型分子,可以控制分子的大小和相对分子质量,使得分子结构的药效空间与药代动力学空间有较大的重叠,提高成药的几率。     

映射法分析药物联合治疗的相互作用(英文)

目的:在联合药物治疗中,建立一种分析药物相互作用的新方法。方法:基于联合用药的量效关系曲线和等效性检验的原理,建立一种新的数学模型:Q=(E_o-E_t》/L(-1相似文献   

抗心律失常药物不良反应分析

目的：探讨抗心律失常药物所致不良反应(ADR)的发生情况,为临床安全、合理用药提供参考。方法130例抗心律失常药物所致不良反应报告,对患者的年龄、性别、基础疾病、用药途径、用药剂量、不良反应史、所用药物、不良反应的临床表现等进行统计分析。结果上报的抗心律失常药物所致不良反应发生在21~97岁;不良反应主要包括致心律失常作用及其他系统损害。结论医疗机构应重视抗心律失常药物引起的不良反应,加强抗心律失常药物的合理应用。     

FDA对药品说明书的药物滥用和依赖项目的撰写要求

美国食品药品管理局（FDA）于2019年07月发布了"人用处方药和生物制品说明书的药物滥用和依赖项目——内容和格式供企业用指导原则"（草案）。该指导原则介绍了撰写药物滥用和药物依赖项=目的一般原则以及对其中管制物质、滥用和依赖性3个小项的撰写要求。而我国目前尚无类似指导原则，详细介绍该指导原则，期望对我国说明书这部分内容的撰写和监管有帮助。     

联合用药的药物相互作用及研究方法

随着人们对于疾病的认识越来越深入,联合用药得到越来越普遍的使用,同时所产生的药物间的相互作用也越来越受到关注。联合用药可能通过影响与药物吸收、分布、代谢、排泄等相关的酶、转运体等,以改变药物的药代属性（生物利用度、分布特性等）,调节体内动态药效物质组的构成,改变药物的药效（协同作用、拮抗作用、毒副作用等）,从而对药物的有效性、安全性产生影响。从联合用药对药物吸收与代谢的影响这两方面来阐述联合用药的研究近况,为联合用药的基础研究以及临床应用的安全有效提供参考。     

DNA甲基化在药物效应和新药研发中的研究进展

DNA甲基化对药物作用的影响日渐受到关注。许多编码药物代谢酶、药物转运体、核受体及药物靶点的基因受DNA甲基化调控。DNA甲基化在影响细胞色素P450酶(CYP450)的表达水平上起着重要的作用,而CYP450酶系催化多种药物代谢反应,能显著影响药物疗效。目前的研究也发现DNA甲基化水平在个体间的差异与药物疗效和不良反应在个体间的差异是紧密相关的。DNA甲基化状态会受药物作用影响,进而引起不同程度的药物不良反应。近年来,以DNA甲基化为靶向的药物研发呈增长态势,DNA甲基转移酶抑制剂对肿瘤等重大疾病治疗具决定性作用。临床试验结果显示,DNA甲基化药物治疗已在改善药物疗效、稳定药理作用及减少药物不良反应上初见成效。DNA甲基化可能成为早期预测药物效应的潜在生物标记,将成为实现临床个体化用药的有力工具。     

Inter-ethnic differences in drug response: Implications for drug development and complying with drug regulation

Abstract

The two key components of the pharmacology of a drug—dose–concentration (pharmacokinetic) and/or concentration–response (pharmacodynamic) relationships—are often influenced by genetic variations. These account for a substantial fraction of variability in dose–response or drug response, not only between individuals, but also between different ethnic groups. The approval of ‘BiDil’ for the treatment of cardiac failure in self-identified black patients is a spectacular example of inter-ethnic differences in drug response and regulatory awareness of ethnicity of the study population. Drug development programs are increasingly undertaken globally to reduce costs, shorten timeframes, and address issues concerning global prescribing. Regulatory authorities have responded to this globalization of drug development by promulgating guidelines that recommend sponsors of new drugs to explore the role of genetic variations, and potential differences in drug response, between different ethnic populations. They may refuse to accept an application, or require bridging studies, when such differences are anticipated but not adequately addressed. These bridging studies may include (i) pharmacokinetic studies, (ii) pharmacodynamic studies, (iii) dose–response studies, and/or (iv) in extreme cases, pivotal phase III studies in order to extrapolate efficacy and/or safety data from one population to another.     

我院门诊处方点评及用药分析

目的：根据《医院处方点评管理规范》的基本指标要求,研究我院门诊处方特点,并采取干预措施减少不合理用药,促进临床合理用药。方法：随机抽取我院2013年1～12月每月门诊处方300张,总计3600张进行统计点评,对不合理处方及用药进行分析整理。结果：在随机抽取的处方中抗菌药物使用率为15．09％,基本药物使用率47．3％,平均用药2．60种,合格处方率92．17％。经过一年的持续点评干预,不合格处方率下降到7．83％。结论：处方点评和干预措施改善了我院处方质量。加强门诊审核药师药学知识学习会对降低不合格处方率具有很好的作用。     

抗体偶联药物的临床应用及其耐药性优化对策的研究进展

抗体–药物偶联(ADC)是现代“精准医疗”需求下药学发展的必然趋势。从2000年第一款ADC药物的上市成功到2020年ADC药物的研发层出不穷。肿瘤靶向治疗的发展带动了ADC药物研发领域的快速兴起。ADC药物是使用具有特异性的单克隆抗体与具有生物活性的细胞毒素结合,将药物特异性递送至肿瘤表面位点,避免对正常细胞的杀伤,减少毒副作用。ADC为细胞毒性有效载荷提供了一种较为理想的递送方法。但是也必须清楚的认识到,由于肿瘤异质性、肿瘤代谢、肿瘤血供等多种因素导致的肿瘤耐药是ADC药物发展中所面临的一大挑战。从ADC药物的发展进程、临床应用及其所面临的耐药问题进行综述,探讨抗体偶联药物的临床应用及其所面临的挑战和策略。     

药物临床试验辅助药品管理系统的建设与应用

目的:建立药物临床试验辅助药品管理体系,保证该部分药品的合理使用。方法:建立药物临床试验辅助药品管理流程,设计相应软件,与药物临床试验项目管理系统和医院信息管理系统建立数据接口,实施上述管理流程。结果:郑州大学第一附属医院运行药物临床试验项目的30%需要辅助药品,药品种类繁多。通过抽样数据对比发现,辅助药品管理系统上线初期至中期受试者人数和处方药品数量大幅增加,上线中后期受试者人数和药品数量趋于稳定,提示系统上线成功。与上线前数据比较,系统上线后授权药师审核处方的比例显著增加,处方药物为方案指定辅助药品的比例显著上升。结论:建立药物临床试验辅助药品管理系统,在有效保障辅助药品的院内供应的前提下,满足了辅助药品费用支付流程的伦理性、合规性,实现了该类处方前置审核,是药物临床试验数字化进程中的重要创新。     

A drug survey — Precepts and practices

Summary An attempt has been made to quantitate drug consumption in a conurbation. The prescribing habits of physicians, self medication rate and therapeutic classes of drugs purchased have been evaluated. The study indicates that some of the prevailing practices in the area are unhealthy. The high self medication rate, faulty prescribing habits of physicians and liberal dispensing methods of pharmacist need to be viewed with concern. The wide gap between the precepts and practices prevailing among practitioners, the use of potent medicines without proper medical advice and the uninhibited sale of scheduled drugs over the pharmacy counter require careful consideration. If such unhealthy trends persist iatrogenic problems may surface in the near future. The physician, pharmacist and the public need to cooperate to create the proper pattern of drug usage.     

我国基本药物的地位与合理用药

阐述了中国基本药物的法律地位、可获得性,规范合理用药。探索推行国家基本药物政策的方法和途径,提出中国今后全面推行该政策的措施与对策。为国家建立与完善基本药物政策提供建议。     

药品流通与结算信息系统的研究与实现

目的：建立符合我国国情的、具有实际应用价值的、实现药品流通和结算信息化的解决方案.方法：以华西医院为模型,明确医院在药品流通和结算过程中实现数据交换和信息共享的需求,建立新的药品采购供应和药款支付的业务流程.确定以医院为核心,通过第三方中介,搭建信息交换平台的实现模式.结果：建立了包含医院HIS系统、数字药库系统、在线交易系统等模块在内的一套完整的信息管理系统,实现了药品采购、供应和结算信息化,并通过商业银行完成对供应商的药品价款的网上结算与支付.结论：药品流通和结算信息系统的建立,具有明显的管理效益、经济效益和重要的社会意义.     

Treatment and services for drug users in Britain

The pattern of British drug service provision was transformed during the late 1980s. Policy makers and service providers recognised the need for a more flexible response to changing drug trends and client needs; consequently community-based services proliferated. HIV has had considerable impact on the working approach of many agencies, where harm minimisation is now the immediate goal. This article provides an overview of patterns of drug use and drug service provision in Britain.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.