Whitledge James D, Soto Pelayia, Glowacki Kieran M, Calello Diane P, Fox Erin R, Mazer-Amirshahi Maryann
Harvard Medical Toxicology Fellowship (JDW), Boston Children's Hospital, Boston, MA.
Department of Emergency Medicine (JDW), Beth Israel Deaconess Medical Center, Boston, MA.
J Pediatr Pharmacol Ther. 2024 Jun;29(3):306-315. doi: 10.5863/1551-6776-29.3.306. Epub 2024 Jun 10.
OBJECTIVE: The study aims to describe drug shortages affecting lead chelators in the United States from 2001 through 2022. METHODS: Drug shortage data were retrieved from the University of Utah Drug Information Service from January 1, 2001, through December 31, 2022. Shortages of first- and second-line lead chelators were analyzed. Drug class, formulation, administration route, shortage reason, shortage duration, generic status, single-source status, and presence of temporally overlapping shortages were examined. Total shortage months, percentages of study period on shortage, and median shortage durations were calculated. RESULTS: Thirteen lead chelator shortages were reported during the study period. Median duration was 7.4 months and the longest shortage (24.8 months) involved calcium disodium edetate. Calcium disodium edetate and dimercaprol had the greatest number of shortages, 4 each, and 61.5% of shortages involved parenteral medications. Median shortage duration was 14.2 months for parenteral agents and 2.2 months for non-parenteral agents. All shortages involved generic, single-source products. Supply/demand and manufacturing problems were the most common shortage reasons provided. Overlapping shortages occurred for 3.7% of the study period. Median shortage duration increased from 3 to 11 months in the second half of the study period, and 61.5% of shortages occurred in the second half of the study period. CONCLUSIONS: All chelators experienced multiple shortages, which became increasingly frequent and prolonged over time. Concurrent shortages occurred, potentially hampering substitution between different agents. Health care stakeholders must build supply chain resilience and develop guidelines regarding how to modify chelation therapy based on shortage conditions.
目的:本研究旨在描述2001年至2022年期间影响美国主要螯合剂的药品短缺情况。 方法:从犹他大学药品信息服务中心检索2001年1月1日至2022年12月31日期间的药品短缺数据。分析一线和二线铅螯合剂的短缺情况。检查药品类别、剂型、给药途径、短缺原因、短缺持续时间、通用状态、单源状态以及是否存在时间上重叠的短缺情况。计算短缺总月数、研究期间短缺的百分比以及短缺持续时间的中位数。 结果:研究期间报告了13起铅螯合剂短缺事件。中位数持续时间为7.4个月,最长短缺(24.8个月)涉及依地酸钙钠。依地酸钙钠和二巯丙醇的短缺次数最多,各有4次,61.5%的短缺涉及注射用药物。注射用药物的短缺持续时间中位数为14.2个月,非注射用药物为2.2个月。所有短缺均涉及通用的单源产品。供应/需求和生产问题是最常见的短缺原因。在3.7%的研究期间出现了短缺重叠情况。研究后半期短缺持续时间中位数从3个月增加到11个月,61.5%的短缺发生在研究后半期。 结论:所有螯合剂都经历了多次短缺,且随着时间的推移,短缺变得越来越频繁和持久。同时出现了短缺情况,这可能会阻碍不同药物之间的替代。医疗保健利益相关者必须增强供应链弹性,并制定有关如何根据短缺情况调整螯合疗法的指南。
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