Incidence and relative reduction of preventable ADR for top 5 most frequently observed diagnoses.

<p>Incidence and relative reduction of preventable ADR for top 5 most frequently observed diagnoses.</p

Evaluation of preventable adverse drug reactions by implementation of the nationwide network of prospective drug utilization review program in Korea

<div><p>Background</p><p>A prospective Drug Utilization Review (DUR) program has been implemented in Korea to improve the quality and safety of medication use.</p><p>Objective</p><p>To evaluate the influence of the DUR program in reducing incidence of preventable adverse drug reactions (pADRs).</p><p>Methods</p><p>This study was performed using administrative data from the Health Insurance Review and Assessment Service (HIRA). The claims data for all adult patients with adverse drug events (ADE)-related diagnoses from 2009 to 2014 were obtained. Incidence rates of first-time and repeat pADRs prior to and after DUR program implementation were evaluated. Quarterly trends in incidence rates of overall ADE, allergic reactions, and ADRs were analyzed.</p><p>Results</p><p>Data extraction covering the period from 2009 to 2014 led to the identification of 3,927,662 records. First-time pADR rates decreased gradually after implementation of the DUR program (change in slope: -0.016, p = 0.02). The program had a similar influence on repeat pADR rates (change in slope: -0.006, p≤0.01). The program did not decrease rates of first-time or repeat allergic reactions (change in slope: 0.018, p = 0.07 and 0.003, p = 0.04, respectively). In the cohort aged ≤65 years, first-time pADR rate reduction was significant (28.2% [27.1–29.3] in ≤18 years, and 19.8% [18.1–21.5] in 19–64 years). In contrast, first-time pADR rate was increased by 0.6% [-0.7–1.9] in patients ≥65 years.</p><p>Conclusion</p><p>Implementation of the prospective DUR program effectively reduced the number of pADRs. In the future, to reduce non-preventable ADRs such as allergic reactions, provision of clinical information including allergy history should be added to the DUR program.</p></div

Incidence and relative reduction of preventable ADR by baseline characteristics.

<p>Incidence and relative reduction of preventable ADR by baseline characteristics.</p

Evaluation of preventable adverse drug reactions by implementation of the nationwide network of prospective drug utilization review program in Korea - Fig 1

<p>(a) Trends in incidence rates of first-time ADE, allergic reactions, and preventable ADR. (b) Trends in incidence rates of repeat ADE, allergic reactions, and preventable ADR.</p

Characteristics of study subjects who experienced adverse drug events in 2010–2014.

<p>Characteristics of study subjects who experienced adverse drug events in 2010–2014.</p

Antiplatelet Therapy of Cilostazol or Sarpogrelate with Aspirin and Clopidogrel after Percutaneous Coronary Intervention: A Retrospective Cohort Study Using the Korean National Health Insurance Claim Database

<div><p>Background/Objectives</p><p>Addition of cilostazol or sarpogrelate to the standard dual antiplatelet therapy of aspirin and clopidogrel has been implemented in patients that underwent percutaneous coronary intervention (PCI) with stents in Korea. This study aimed to evaluate the efficacy and safety of triple antiplatelet therapies.</p><p>Methods</p><p>This retrospective cohort study was performed using the Korean National Insurance Claim Data of the Health Insurance Review and Assessment Service from January 1, 2009 to December 31, 2014. The study cohort population consisted of patients with ischemic heart diseases and a history of PCI. They were treated with antiplatelet therapy of aspirin, clopidogrel (AC); aspirin, clopidogrel, cilostazol (ACCi); or aspirin, clopidogrel, sarpogrelate (ACSa) during the index period from January 1, 2010 to December 31, 2011. During the follow-up period up to December 31, 2014, the major adverse cardiac or cerebral events (MACCE) including death, myocardial infarction, target lesion revascularization, and ischemic stroke were assessed. Bleeding complications were also evaluated as adverse drug events.</p><p>Results</p><p>Out of 93,876 patients with PCI during the index period, 69,491 patients started dual (AC) or triple therapy (ACSa or ACCi). The clinical outcomes of comparing ACSa and ACCi therapy showed beneficial effects in the ACSa group in the prevention of subsequent cardiac or cerebral events. After Propensity score-matching between ACSa and ACCi groups, there were significant differences in MI and revascularization, with corresponding HR of 0.38 (95% CI, 0.20–0.73) and 0.66 (95% CI, 0.53–0.82) in ACSa vs. ACCi at 12 months, respectively. At the 24-month follow-up, the triple therapy groups (ACS or ACC) had a higher incidence of MACCE compared to the dual therapy (AC) group; ACSa vs. AC HR of 1.69 (95% CI, 1.62–1.77); ACC vs. AC HR of 1.22 (95% CI, 1.06–1.41). There was no significant difference in severe or life-threatening bleeding risk among three groups; ACSa vs. AC, HR of 0.68 (95% CI, 0.37–1.24), ACCi vs. AC, HR of 0.91 (95% CI, 0.77–1.09).</p><p>Conclusion</p><p>Sarpogrelate-containing triple antiplatelet therapy demonstrated comparable rates of MACCE prevention to the conventional dual antiplatelet therapy after PCI without significantly increasing bleeding risk during the two-year follow-up period.</p></div

Baseline characteristics of the study population.

<p>Baseline characteristics of the study population.</p

Clinical outcomes of incidence rates and relative risks of cardiac events between ACCi and ACSa.

<p>ACCi, aspirin+clopidogrel+cilostazol; ACSa, aspirin+clopidogrel+sarpogrelate; MACCE, major adverse cardiac cerebral events (composite events of death, myocardial infarction, ischemic stroke, revascularization).</p

Safety outcomes of incidence rates and relative risks of bleeding complications.

<p>Safety outcomes of incidence rates and relative risks of bleeding complications.</p

Clinical outcomes of Incidence rates and relative risks of cardiac or cerebral events.

<p>Clinical outcomes of Incidence rates and relative risks of cardiac or cerebral events.</p