Escitalopram Oxalate

*仅供医学专业人士阅读参考该说不说，致幻剂裸盖菇素算是我们的老熟人了。毕竟，这几年关于它的研究实在很多。裸盖菇素优点也很明显，比如它不仅可以在短期内快速且持续地改善抑郁症状，还无需像传统抗抑郁药物那样长期服用。正因如此，裸盖菇素常用来与传统抗抑郁药艾司西酞普兰做比较，不过既往研究多关注的是它们在抗抑郁方面的短期效果，至于这两种治疗方式在中重度抑郁症患者中的长期疗效还有待评估。近期，伦敦帝国理工学院的研究学者们就进行了一项2期临床双盲随机对照试验，主要对比了裸盖菇素和艾司西酞普兰在中重度抑郁症患者中的长期疗效。结果显示，在长达6个月的随访期间，裸盖菇素治疗组不仅在抗抑郁效果方面与艾司西酞普兰治疗组相当，而且在改善患者的社会功能、心理连结性和生命意义感方面更具优势。研究发表在eClinicalMedicine上[1]。论文首页截图这项随机双盲对照试验最终纳入了59例中重度抑郁症成人患者，并按照1:1的比例随机分到了裸盖菇素治疗组（裸盖菇素+心理治疗，PT组，n=30）和艾司西酞普兰治疗组（艾司西酞普兰+心理治疗，ET组，n=29），治疗时间持续6周。治疗期间，PT组患者将在第2次和第4次访视时在专业人员指导下分别口服两剂25 mg的裸盖菇素，在药物服用前后，患者均接受了心理辅导。ET组患者则在第2次访视时接受1 mg的裸盖菇素（作为安慰剂，为了不干扰双盲），并在随后的6周内每日服用艾司西酞普兰，前3周剂量为10 mg，后3周剂量增加到20 mg。在第4次访视时，参与者再次接受1 mg的裸盖菇素（还是作为安慰剂计量，只为双盲）。（注：为达到双盲，PT组也在与ET组服用艾司西酞普兰的对应时间节点上服用了安慰剂）研究的主要终点为，治疗后6个月时两组患者抑郁症状的改善情况（抑郁症状通过抑郁症状快速检查-自我报告评分16项[QIDS-SR-16]检测评分来评估，分数范围从0到27，分数越高表示抑郁程度越高，每月评估一次）；次要终点为治疗后6个月两组患者在改善社会功能、心理连结性和生命意义感方面的差异（分别通过社会适应量表[WSAS]、Watts心理连结性量表 [WCS]，以及生命意义问卷[MLQ]来评估，每三个月评估一次）。结果显示，在随访6个月时，与基线相比，PT组和ET组均可以显著改善中重度抑郁患者的抑郁症状，且两组之间在抗抑郁效果方面没有显著差异。主要终点结果，*代表两组存在显著差异此外，在社会功能、心理连结性和生命意义感方面，无论是在治疗结束时，还是治疗后6个月时，PT组改善的效果都要明显优于ET组。这也意味着，裸盖菇素治疗不仅能对患者的日常生活和工作能力有更持久的正面影响（对应社会功能），还可能帮助患者与他人建立更深的情感连结（对心理连结性），并加深对生活的意义感和目标感（对应生命意义感）。次要终点结果WSAS分数越低表示障碍越低；MLQ分数越高表示生命意义越高；WCS分数越高表示连结性越高总之，这项长达6个月随访的研究数据表明，无论是裸盖菇素，还是艾司西酞普兰均可以有效改善中重度抑郁症患者的抑郁症状。但相比艾司西酞普兰，裸盖菇素还有别的一些别的益处，尤其是在改善社会功能、心理连结性和生命意义感方面，裸盖菇素效果更好。当然，该研究还存在一些局限，比如没有做安全性分析，纳入人数较少等等，但不管怎样，该研究至少证实了裸盖菇素不仅具有长期改善抑郁症状的潜力，还能改善患者的生活质量。这正如研究团队说的那样：“这项研究结果很重要，因为改善心理连结性和生命意义感可以显著提高一个人的生活质量和长期心理健康。相比传统治疗药物，裸盖菇素可能更全面，因为它既能改善抑郁症的症状，又能提高患者整体健康状况。这可能会对抑郁症患者的整体幸福感和日常活动产生重大影响”。参考文献：[1]Erritzoe, David et al.Effect of psilocybin versus escitalopram on depression symptom severity in patients with moderate-to-severe major depressive disorder: observational 6-month follow-up of a phase 2, double-blind, randomised, controlled trial.eClinicalMedicine, Volume 0, Issue 0, 102799本文作者｜张金旭

If four full 737s were crashing daily resulting in total loss of life, there would be a public outcry and immediate governmental intervention. Yet, we lose an equivalent number of people daily — 275,000 American lives annually — to adverse drug events (ADEs). This public health crisis largely goes unnoticed because it happens to one mother, one son, one sister, and one friend at a time in homes, clinics, emergency rooms, nursing homes, and hospitals. Outdated surveillance and reporting systems mean many more ADEs go unrecorded. Most ADEs occur when medications are administered and taken correctly, contrary to the popular belief that this is most frequently due to non-adherence. The impact is worse for women, who are twice as likely to experience ADEs, and for non-White patients. This is because clinical trials for the generic drugs we primarily prescribe were conducted years ago and mostly included only White males of European ancestry. While some medication harm may be unavoidable, studies indicate that half or more can be prevented by prioritizing education, equitable healthcare access, and technology, which will require legislative action. The growing public health crisis Sponsored Post Get Ready for HLTH 2024: A Preview Guide HLTH 2024, scheduled for October 20-23 at the Venetian Expo Center in Las Vegas, will highlight new programming, a physicians roundtable, generative AI, the shifting landscapes of telemedicine, retail health, women's health, and lots more. By Stephanie Baum In 2016, the last time it was measured, we spent $528 billion on non-optimized medication, a staggering figure that exceeds the cost of the drugs themselves or any major chronic disease. The more medications a patient takes, the higher the risk of ADEs. Currently, over 40 million patients take five or more medications daily. With the “silver tsunami” of baby boomers aging into Medicare, this number is expected to double by 2040. The time to act is now. Despite investment in precision medicine, pharmacogenomics (PGx) testing is still underutilized as a tool for reducing avoidable medication harm. PGx testing helps determine which drugs and doses are likely to be safe and/or effective based on each patient’s genetic makeup. It is precision medicine for medications. Unlike other genetic variations that are usually uncommon, PGx variations occur in over 99% of patients. A single, comprehensive, multi-gene test can help maximize the safety and efficacy of many commonly prescribed medications used in mental health, pain management, cardiovascular care, cancer care, and more. Drug-gene interactions are very similar to drug-drug interactions – in fact, the FDA has stated in drug development guidance that they are similar in scope and should therefore receive similar attention. The key differentiator is unlike drugs, genetics cannot be altered. Consider the 1,300 patients that die each year, not from cancer, but from the fluorouracil or capecitabine treatment itself. For 5-7% of patients with DPYD PGx variants, standard doses of these medications can be toxic with a 25.6 times increased risk of treatment related death. Or, consider the 8% of patients with certain PGx variations impacting citalopram and escitalopram metabolism that are 34.3% more likely to become suicide victims because the drugs are processed out too quickly to provide treatment benefit or so slowly that they increase adverse effects leading to treatment discontinuation. Perhaps also consider the patients who continue to receive clopidogrel without PGx testing despite an FDA black box, first added in 2010, warning that patients with certain PGx variants are more likely to have another heart attack or stroke. The promise of PGx testing Biomarker testing, including PGx testing, can help turn this tide. Numerous studies have confirmed that optimizing prescribing with PGx testing reduces emergency room visits, hospitalizations, and healthcare costs. A large trial in several European countries across various specialties and care settings showed a 30% reduction in clinically significant adverse drug events in just 12 weeks. A recent meta-analysis in adult cancer patients showed a 53% reduction in significant adverse events with use of PGx testing. And despite the lack of widespread adoption, medical liability risks are increasing when evidence-based PGx testing is not discussed with and offered to patients. So why isn’t it standard of care? Numerous hurdles stand in the way of PGx testing becoming the standard of care, including: Inconsistent insurance coverage: A significant barrier to equitable access and adoption of biomarker testing, including PGx testing, is inconsistent insurance coverage that has not kept pace with professional guidelines and advances in the evidence. This has led to further socioeconomic, racial, and ethnic disparities in accessing quality care. Lack of education and clinical decision support: Both provider and patient education and prioritization of integrated clinical decision support are necessary to realize the benefits of genomic medicine, including PGx-guided medication management. Pharmacists’ lack of recognition as healthcare providers: Although many states recognize pharmacists as healthcare providers, they are not yet acknowledged as providers at the federal level. This lack of federal recognition hinders reimbursement for pharmacists, despite their provision of numerous and essential direct-care patient services that align with their training, including PGx-guided medication management. Support biomarker legislation and prioritize PGx educationTo address insurance coverage barriers, biomarker legislation has been enacted in sixteen states including Arizona, California, Georgia, Illinois, Maryland, Texas, and New York, and introduced in eleven others. The National College of Insurance Legislators (NCOIL) endorsed model biomarker legislation in the summer of 2023, setting the stage for expected nationwide adoption. Typically, this legislation requires state insurance providers, including Medicaid and commercial payers, to cover tests that guide treatment decisions based on medical and scientific evidence including testing covered by CMS NCDs, Medicare Administrative Contractor LCDS, or nationally recognized clinical practice guidelines and consensus statements. Medicare LCDs have covered certain evidence-based PGx testing since 2020.Clinicians must prioritize educating themselves about PGx testing and incorporate it into their practice to improve patient safety and care. Free resources can be found at NIH Inter-Society Coordinating Committee for Practitioner Education in Genomics (ISCC-PEG). Healthcare professionals in states that have not enacted biomarker legislation can learn how to support state efforts at ACS CAN. Other legislative actions and advocacy efforts to improve drug safety and reduce ADEs are also in the works. They include: Right Drug Dose Now Act of 2024 – You can urge your congressional representatives to support this act – learn more and sign support at Fourth Cause. Reintroduced by Swalwell and Crenshaw at the end of March, this bipartisan act would: Require an assessment and update of the National Action Plan for Adverse Drug Event Prevention; Create a healthcare provider educational campaign on preventing adverse drug events, in part by using evidence-based PGx information. Incentivize updates to electronic health record systems to ensure that healthcare providers are alerted to interactions between medications and genes when making prescribing decisions; Enhance reporting systems that would assist with the reporting of PGx-associated adverse drug events A second associated bill authorizes sustained funding for PGx implementation research and guideline development. Pharmacy and Medically Underserved Areas Enhancement Act – The bill would enable pharmacists to deliver Medicare Part B services that are already authorized by their respective state laws. Learn more at ASHP. Sponsored Post What Healthcare Can Learn from Costco The path forward is clear: employers must evaluate their health plan the same way they do their Saturday shopping excursion. By Jeff Bak, Imagine360 CEO and President The Hippocratic oath of “first do no harm” can’t stop with direct patient care; the healthcare industry and its key stakeholders must address persistent public health problems systematically. We have the tools to reduce medication harm by half or more; it is long past time to make this a public health priority. Common-sense legislation needs to be passed to ensure we move beyond an outdated system for medication management and safety that is no longer serving providers or the patients they care for. Editor’s note: The author on the PGx committee of the NIH Inter-Society Coordinating Committee for Practitioner Education in Genomics (ISCC-PEG), a member of the PGx workgroup for the American Cancer Society Cancer Action Network (ACS CAN) and serves on the steering committee for STRIPE, the FDA collaborative community for PGx.