British Journal of Clinical Pharmacology, Год журнала: 2024, Номер unknown
Опубликована: Ноя. 5, 2024
Ageing of the population worldwide, with age-associated increase in multimorbidity, means that older people are now major users therapeutic drugs. Ensuring optimal drug development, evaluation and use by is an urgent priority for global clinical pharmacology community. This special edition builds on presentations discussions from a geriatric seminar deprescribing workshop led International Union Basic Clinical Pharmacology (IUPHAR) Geriatric Committee at World Congress Pharmacology, Glasgow, 2023. It includes reviews translational research some challenges proposed solutions to providing quality medicines people. Prescribing has relied evidence may not be generalizable them far too long. Pre-clinical been limited studies young, male rodents. The commentary Mitchell et al.1 highlights importance pre-clinical models representative who will drugs terms age, sex, frailty exposures (e.g., polypharmacy). Similarly, there international calls recruitment frail trials.2 review Nguyen al.3 identified have conducted subgroup analyses according frailty. measurement effect efficacy safety outcomes differed between studies. Prescribers rely adage, 'start low, go slow' select safe effective doses adults, aiming reduce risk adverse effects this vulnerable population. However, also disease need effective. Pharmacometrics, encompassing physiological pharmacokinetic pharmacodynamic modelling, can improve dose selection such patients optimize both efficacy. Population pharmacokinetics optimization levofloxacin were applied pneumonia study He al.4 highlighted patients, as obtaining accurate measures weight, well opportunities apply method using convenience sampling times. Pharmacometrics starting investigate pharmacokinetics. Another prescribing technique adults 'geriatrician's salute', known deprescribing.5 A barrier practice lack its effects, making it difficult 'informed shared decision-making'. In issue, three complementary systematic tackle issue. first focus, investigating heart failure pharmacotherapy people.6 second focus: diuretics,7 which most often prescribed either or hypertension. Both high-quality feasibility, tolerability deprescribing, no reporting status participants. third examines role technology enhance deprescribing. found existing applications focused education future including interactive elements artificial intelligence their utility care.8 Real-world data critically important understanding under-represented trials. Kalisch Ellett al.9 describes novel, innovative methods pharmacovigilance people, harnessing digital health technologies integration electronic records routine event systems wearables. Older residing aged care homes particularly trials extremely medication-related harms. Ea al.10 innovations gaps generating translating medication management through partnerships provider organizations leveraging knowledge sharing platforms. papers issue feature key applying patients. Some translatable cohort Multifactorial giants falls, cognitive impairment) other matter functional independence social connectedness) must addressed. These routinely captured baseline all phases research. Even if they captured, recognize events withdrawal when present non-specifically giants. Further each phase development pathway, bioinformatics consider complexity enable personalized medicine lifetime exposures, polypharmacy. Sarah N. Hilmer Chair IUPHAR Translational Section Committee. She chaired spoke symposium 'Translational approaches optimising people: Controversies pharmacology'. Danijela Gnjidic presented There associated editorial.
Язык: Английский
