Langley Blake O, Rillamas-Sun Eileen, Huang Yuhan, Indorf Amy, Robles Michael, Feaster Rachel, D'Addario Lia, Ergas Isaac J, Roh Janise M, Kushi Lawrence H, Greenlee Heather
Fred Hutchinson Cancer Center, Public Health Sciences Division, Seattle, WA.
University of Washington, School of Public Health, Seattle, WA.
JCO Oncol Adv. 2024 Dec 6;1:e2400062. doi: 10.1200/OA-24-00062. eCollection 2024.
The increasing use of dietary supplements by patients with cancer and other chronic diseases requires the systematized review of potential interactions between prescription drugs and nutrients from supplements by health care and clinical research teams. Dietary supplement interaction databases are positioned to fill a gap in quantifying potential risks for patients, although none have been assessed for reliability in data interpretation. The NatMed database, a source for comprehensive reports on mechanistic and safety data for dietary supplement ingredients, was evaluated for use in future investigations.
Data from NatMed were retrieved using licensed end points for ingredient monographs with drug-nutrient interactions with doxorubicin across five pharmacokinetic and metabolic pathways, and for ingredient monographs with antioxidant activity. Interactions between dietary supplements and doxorubicin treatment and antioxidant monographs were independently reviewed and characterized by clinical pharmacists. Cohen's K was used to measure interrater reliability and the degree of agreement between pharmacists.
Three hundred fifteen potential interactions with doxorubicin (n = 115 monographs) and 455 other antioxidant ingredients were identified and reviewed by clinical pharmacists. There was substantial to near-perfect agreement for drug-nutrient interactions with doxorubicin (Cohen's K = 0.64-0.85) and for antioxidants (Cohen's K = 0.84). A small proportion of retrieved monographs were not validated by the clinical pharmacists for interactions with doxorubicin (n = 20 occurrences, 6.4%) or for antioxidant activity (n = 28, 6.2%).
A high degree of reliability in data on dietary supplement interactions with doxorubicin and mechanisms of action suggests NatMed may be a dependable source of data for future investigators. Additional procedures including independent data validation and use of multiple dietary supplement interaction databases will strengthen the quality of findings in future studies.
癌症及其他慢性病患者对膳食补充剂的使用日益增多，这就要求医疗保健和临床研究团队对处方药与补充剂中的营养素之间的潜在相互作用进行系统综述。膳食补充剂相互作用数据库旨在填补量化患者潜在风险方面的空白，不过尚无数据库在数据解读的可靠性方面得到评估。对天然药物数据库（NatMed）进行了评估，该数据库是膳食补充剂成分的作用机制和安全性数据综合报告的来源，以供未来研究使用。
使用许可的终点检索天然药物数据库中的数据，这些终点涉及与阿霉素在五条药代动力学和代谢途径上存在药物-营养素相互作用的成分专论，以及具有抗氧化活性的成分专论。膳食补充剂与阿霉素治疗之间的相互作用以及抗氧化剂专论由临床药剂师独立审查并进行特征描述。采用科恩Kappa系数（Cohen's K）来衡量评估者间的可靠性以及药剂师之间的一致程度。
临床药剂师识别并审查了与阿霉素的315种潜在相互作用（涉及115篇专论）以及455种其他抗氧化剂成分。对于与阿霉素的药物-营养素相互作用（科恩Kappa系数 = 0.64 - 0.85）以及抗氧化剂（科恩Kappa系数 = 0.84），存在实质性到近乎完美的一致性。一小部分检索到的专论未得到临床药剂师对与阿霉素相互作用（20例，6.4%）或抗氧化活性（28例，6.2%）的验证。
膳食补充剂与阿霉素相互作用及作用机制数据具有高度可靠性，这表明天然药物数据库可能是未来研究人员可靠的数据来源。包括独立数据验证和使用多个膳食补充剂相互作用数据库在内的其他程序将提高未来研究结果的质量。
