Gatton College of Pharmacy, Johnson City, TN, USA.
University of Louisville, Louisville, KY, USA.
J Oncol Pharm Pract. 2022 Jan;28(1):82-86. doi: 10.1177/1078155220984244. Epub 2021 Jan 12.
Drug-drug interactions (DDIs) with oral antineoplastics (OAs) are of increasing concern given the rapid increase in OA approvals and use in cancer patients. A small pilot study of 20 DDIs with OAs showed significant variability in commonly used DDI screening databases in sensitivity of detecting potentially clinically relevant DDIs. This study builds upon that work by expanding the number of potential DDIs analyzed and including a specificity analysis.
Newly approved OAs from 2016 to May 2019 (n = 22) were included in this analysis. Prescribing information for each drug was reviewed. A list of explicit and theoretical drug interactions was created for each OA by the two investigators. A board-certified oncology pharmacist adjudicated all DDI pairs for potential clinical significance. In total, 229 DDI pairs were used to analyze sensitivity of 5 DDI databases (Lexicomp®, Micromedex®, Medscape, Eporactes®, & Drugs.com). Additionally, 64 "dummy" or false DDI pairs were created to analyze specificity. Sensitivity and specific were analyzed using Cochran's Qtest, while accuracy was analyzed using chi-square test.
There was significant variability among the databases with regards to sensitivity (p < 0.0001), specificity (p < 0.0001), and accuracy (p < 0.0001). In terms of accuracy (max score = 400), Lexicomp®(355), Epocrates® (344), and Drugs.com (352) scored higher than MicroMedex® (270) and Medscape (280).
Considerable variability exists among DDI screening databases with regards to OAs and potential drug interactions. Clinicians should be vigilant in both screening for DDIs with OAs and describing DDIs encountered in clinical practice.
鉴于口服抗肿瘤药物（OAs）的批准和在癌症患者中的使用迅速增加，药物-药物相互作用（DDIs）引起了越来越多的关注。一项针对 20 种 OAs 药物相互作用的小型试点研究表明，在常用 DDI 筛选数据库中，检测潜在临床相关 DDI 的敏感性存在显著差异。本研究在此基础上，通过增加分析的潜在 DDI 数量并进行特异性分析，进一步扩展了工作。
本分析纳入了 2016 年至 2019 年 5 月期间新批准的 OAs。对每种药物的说明书进行了审查。由两位研究者为每种 OA 创建了一份明确和理论药物相互作用清单。由一名经董事会认证的肿瘤药师对所有 DDI 对的潜在临床意义进行裁决。总共使用了 229 对 DDI 对来分析 5 种 DDI 数据库（Lexicomp®、Micromedex®、Medscape、Eporactes®和 Drugs.com）的敏感性。此外，还创建了 64 对“虚拟”或虚假的 DDI 对来分析特异性。使用 Cochran 的 Q 检验分析敏感性和特异性，使用卡方检验分析准确性。
在敏感性（p<0.0001）、特异性（p<0.0001）和准确性（p<0.0001）方面，各数据库之间存在显著差异。在准确性方面（最高分 400 分），Lexicomp®（355 分）、Epocrates®（344 分）和 Drugs.com（352 分）得分高于 Micromedex®（270 分）和 Medscape（280 分）。
在 OAs 和潜在药物相互作用方面，DDI 筛选数据库之间存在相当大的差异。临床医生在筛选 OAs 药物相互作用和描述临床实践中遇到的 DDI 时应保持警惕。
