Department of Digital Health, Rouen University Hospital, 1, rue de Germont, Cour Leschevin, Gate 21, 3rd floor, Rouen, 76031, France, 33 659775063.
Department of Pharmacy, Rouen University Hospital, Rouen, France.
JMIR Med Inform. 2024 Nov 28;12:e57705. doi: 10.2196/57705.
The enzymatic system of cytochrome P450 (CYP450) is a group of enzymes involved in the metabolism of drugs present in the liver. Literature records instances of underdosing of drugs due to the concurrent administration of another drug that strongly induces the same cytochrome for which the first drug is a substrate and overdosing due to strong inhibition. IT solutions have been proposed to raise awareness among prescribers to mitigate these interactions.
This study aimed to develop a drug interaction dashboard for Cytochrome-mediated drug interactions (DIDC) using a health care data warehouse to display results that are easily readable and interpretable by clinical experts.
The initial step involved defining requirements with expert pharmacologists. An existing model of interactions involving the (CYP450) was used. A program for the automatic detection of cytochrome-mediated drug interactions (DI) was developed. Finally, the development and visualization of the DIDC were carried out by an IT engineer. An evaluation of the tool was carried out.
The development of the DIDC was successfully completed. It automatically compiled cytochrome-mediated DIs in a comprehensive table and provided a dedicated dashboard for each potential DI. The most frequent interaction involved paracetamol and carbamazepine with CYP450 3A4 (n=50 patients). The prescription of tacrolimus with CYP3A5 genotyping pertained to 675 patients. Two experts qualitatively evaluated the tool, resulting in overall satisfaction scores of 6 and 5 out of 7, respectively.
At our hospital, measurements of molecules that could have altered concentrations due to cytochrome-mediated DIs are not systematic. These DIs can lead to serious clinical consequences. The purpose of this DIDC is to provide an overall view and raise awareness among prescribers about the importance of measuring concentrations of specific drugs and metabolites. Ultimately, the tool could lead to an individualized approach and become a prescription support tool if integrated into prescription assistance software.
细胞色素 P450（CYP450）的酶系统是一组参与肝脏中药物代谢的酶。文献中有因同时服用另一种强烈诱导首种药物代谢的同一细胞色素的药物而导致药物剂量不足，以及因强烈抑制而导致药物剂量过量的情况。已经提出了 IT 解决方案来提高开处方者的认识，以减轻这些相互作用。
本研究旨在使用医疗保健数据仓库为细胞色素介导的药物相互作用（DIDC）开发药物相互作用仪表板，以便临床专家轻松阅读和解释结果。
最初的步骤涉及与专家药理学家一起定义需求。使用了涉及（CYP450）的现有相互作用模型。开发了一种用于自动检测细胞色素介导的药物相互作用（DI）的程序。最后，由 IT 工程师开发和可视化 DIDC。对工具进行了评估。
成功完成了 DIDC 的开发。它自动在综合表中编译细胞色素介导的 DIs，并为每个潜在的 DI 提供专用仪表板。最常见的相互作用涉及对乙酰氨基酚和卡马西平与 CYP450 3A4（n=50 名患者）。CYP3A5 基因分型的他克莫司处方涉及 675 名患者。两位专家对工具进行了定性评估，分别得到 6 分和 5 分的总体满意度评分。
在我们医院，由于细胞色素介导的 DIs 而可能改变浓度的分子的测量不是系统的。这些 DIs 可能导致严重的临床后果。该 DIDC 的目的是提供整体视图，并提高开处方者对测量特定药物和代谢物浓度的重要性的认识。最终，如果将其集成到处方辅助软件中，该工具可以实现个性化方法并成为处方支持工具。
