比较八种筛选工具，以检测草药补充剂与肿瘤药物之间的相互作用。

Comparison of eight screening tools to detect interactions between herbal supplements and oncology agents.

机构信息

Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA.

School of Public Health, University of Michigan, Ann Arbor, USA.

出版信息

J Oncol Pharm Pract. 2020 Dec;26(8):1843-1849. doi: 10.1177/1078155220905009. Epub 2020 Feb 19.

DOI:10.1177/1078155220905009

PMID:32075508

Abstract

INTRODUCTION

Patients with cancer are increasingly using herbal supplements, unaware that supplements can interact with oncology treatment. Herb-drug interaction management is critical to ensure optimal treatment outcomes. Several screening tools exist to detect drug-drug interactions, but their performance to detect herb-drug interactions is not known. This study compared the performance of eight drug-drug interaction screening tools to detect herb-drug interaction with anti-cancer agents.

METHODS

The herb-drug interaction detection performance of four subscription (Micromedex, Lexicomp, PEPID, Facts & Comparisons) and free (Drugs.com, Medscape, WebMD, RxList) drug-drug interaction tools was assessed. Clinical relevance of each herb-drug interaction was determined using Natural Medicine and each drug-drug interaction tool. Descriptive statistics were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Linear regression was used to compare performance between subscription and free tools.

RESULTS

All tools had poor sensitivity (<0.20) for detecting herb-drug interaction. Lexicomp had the highest positive predictive value (0.98) and best overall performance score (0.54), while Medscape was the best performing free tool (0.52). The worst subscription tools were as good as or better than the best free tools, and as a group subscription tools outperformed free tools on all metrics. Using an average subscription tool would detect one additional herb-drug interaction for every 10 herb-drug interactions screened by a free tool.

CONCLUSION

Lexicomp is the best available tool for screening herb-drug interaction, and Medscape is the best free alternative; however, the sensitivity and performance for detecting herb-drug interaction was far lower than for drug-drug interactions, and overall quite poor. Further research is needed to improve herb-drug interaction screening performance.

摘要

简介

越来越多的癌症患者正在使用草药补充剂，但他们并不知道这些补充剂可能会与肿瘤治疗药物发生相互作用。因此，管理草药-药物相互作用对于确保最佳治疗效果至关重要。目前已有多种筛选工具可用于检测药物相互作用，但这些工具检测草药-药物相互作用的性能尚不清楚。本研究比较了八种药物相互作用筛选工具检测与抗癌药物相互作用的草药的性能。

方法

评估了四种订阅（Micromedex、Lexicomp、PEPID、Facts & Comparisons）和四种免费（Drugs.com、Medscape、WebMD、RxList）药物相互作用工具检测草药-药物相互作用的性能。使用天然药物和每种药物相互作用工具来确定每种草药-药物相互作用的临床相关性。使用描述性统计来计算灵敏度、特异性、阳性预测值和阴性预测值。使用线性回归来比较订阅和免费工具之间的性能。

结果

所有工具检测草药-药物相互作用的灵敏度均较低（<0.20）。Lexicomp 具有最高的阳性预测值（0.98）和最佳的整体性能评分（0.54），而 Medscape 是表现最好的免费工具（0.52）。性能最差的订阅工具与表现最好的免费工具一样好，甚至更好，而且从整体来看，订阅工具的表现优于免费工具。使用平均订阅工具，每筛查 10 种草药-药物相互作用，就可额外检测到一种草药-药物相互作用。