Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practices in patients with heart failure.
Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practices in patients with heart failure.
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DOI：
10.1002/phar.1480
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发表时间：
2014-11
期刊：
影响因子：
4.1
通讯作者：
Bauman, Jerry L.
中科院分区：
文献类型：
--
作者：
DiDomenico, Robert J.;Bress, Adam P.;Na-Thalang, Kwanta;Tsao, Yvonne Y.;Groo, Vicki L.;Deyo, Kelly L.;Patel, Shitalben R.;Bishop, Jeffrey R.;Bauman, Jerry L.
比较心衰患者地高辛治疗性血清浓度（SDC）（定义为0.5-0.9 ng/ml）的频率，通过使用简化的nomogram来个体化地高辛给药与标准给药实践，并表征ABCB1基因遗传多态性与SDC之间的关系。前瞻性研究与历史对照组。某城市学术医疗中心门诊部。地高辛治疗左心功能不全致心力衰竭131例。通过给药图（65例患者）或标准治疗（SC； 66例患者）确定地高辛剂量，通过使用从实验室记录中获得的sdc列表中随机选择的历史对照，并根据标准给药实践确定地高辛剂量。主要终点是达到稳态SDC 0.5-0.9 ng/ml的患者比例；次要终点为平均SDC和达到稳态SDC < 1.0 ng/ml的患者比例。在地高辛剂量调整或起始后2-4周测量分配后稳态sdc。两组治疗性sdc的实现频率相似（nomogram组为38.7%，SC组为34.5%,p=0.65）；然而，与SC组相比，nomogram组中sdc < 1.0 ng/ml的患者更多（85.0% vs. 44.9%, p<0.001）。图组的平均日地高辛剂量较低（149±67 mcg比177±74 mcg， p=0.02），导致平均sdc较SC组低（0.52±0.30 ng/ml比1.12±0.58 ng/ml, p<0.001）。药物遗传亚组研究的患者提供了血液样本，用于三种常见的ABCB1单核苷酸多态性的基因分型：C1236T （rs1128503）、G2677T/A （rs2032582）和C3435T （rs1045642）。sdc与ABCB1基因型无显著相关性。我们的简化地高辛给药图与标准给药做法相比导致了更低的sdc，但获得了相似频率的治疗性sdc。根据我们的nomogram给药，更大比例的患者sdc < 1.0 ng/ml，这与共识指南一致。ABCB1基因的遗传多态性与SDC无关。
To compare the frequency of achieving a therapeutic serum digoxin concentration (SDC), defined as 0.5–0.9 ng/ml, by using a simplified nomogram to individualize digoxin dosing with standard dosing practices in patients with heart failure, and to characterize the relationship between genetic polymorphisms of the ABCB1 gene and SDC. Prospective study with a historical control group. Outpatient care center of an urban academic medical center. One hundred thirty-one adults with heart failure due to left ventricular dysfunction who were treated with digoxin. Digoxin doses were determined either by the dosing nomogram (65 patients) or standard care (SC; 66 patients) by using a historical controls who were randomly selected from a list of SDCs obtained from laboratory records and who had their digoxin doses determined by standard dosing practices. The primary end point was the proportion of patients achieving a steady-state SDC of 0.5–0.9 ng/ml; secondary end points were mean SDC and proportion of patients achieving a steady-state SDC < 1.0 ng/ml. Postdistributive steady-state SDCs were measured 2–4 weeks after digoxin dosage adjustment or initiation. Therapeutic SDCs were achieved with similar frequency in both groups (38.7% in the nomogram group vs. 34.5% in the SC group, p=0.65); however, more patients in the nomogram group had SDCs < 1.0 ng/ml than in the SC group (85.0% vs. 44.9%, p<0.001). Mean daily digoxin doses were lower in nomogram group (149 ± 67 mcg vs. 177 ± 74 mcg, p=0.02), resulting in lower mean SDCs compared with those in the SC group (0.52 ± 0.30 ng/ml vs. 1.12 ± 0.58 ng/ml, p<0.001). Patients in the pharmacogenetic substudy provided blood samples for genotyping of three common ABCB1 single nucleotide polymorphisms: C1236T (rs1128503), G2677T/A (rs2032582), and C3435T (rs1045642). SDCs were not significantly associated with ABCB1 genotypes. Our simplified digoxin dosing nomogram resulted in lower SDCs compared with standard dosing practices but achieved therapeutic SDCs with similar frequency. A greater proportion of patients dosed according to our nomogram had SDCs < 1.0 ng/ml, consistent with consensus guidelines. Genetic polymorphisms of the ABCB1 gene were not associated with SDC.
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影响因子：
2.6
作者：
Aarnoudse, Albert-Jan L. H. J.;Dieleman, Jeanne P.;Stricker, Bruno H. Ch.
通讯作者：
Stricker, Bruno H. Ch.
影响因子：
3.4
作者：
Drescher, S;Schaeffeler, E;Fromm, MF
通讯作者：
Fromm, MF
影响因子：
2.9
作者：
Comets, Emmanuelle;Verstuyft, Celine;Mentre, France
通讯作者：
Mentre, France
DOI：
10.1046/j.1365-2710.2002.00418.x
发表时间：
2002-08-01
影响因子：
2
作者：
Konishi, H;Shimizu, S;Yamaji, A
通讯作者：
Yamaji, A
影响因子：
6
作者：
Heywood, J. Thomas;Fonarow, Gregg C.;Wynne, Janet
通讯作者：
Wynne, Janet