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      Influence of Malnutrition on the Pharmacokinetics of Drugs Used in the Treatment of Poverty-Related Diseases: A Systematic Review

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          Abstract

          Background

          Patients affected by poverty-related infectious diseases (PRDs) are disproportionally affected by malnutrition. To optimize treatment of patients affected by PRDs, we aimed to assess the influence of malnutrition associated with PRDs on drug pharmacokinetics, by way of a systematic review.

          Methods

          A systematic review was performed on the effects of malnourishment on the pharmacokinetics of drugs to treat PRDs, including HIV, tuberculosis, malaria, and neglected tropical diseases.

          Results

          In 21/29 PRD drugs included in this review, pharmacokinetics were affected by malnutrition. Effects were heterogeneous, but trends were observed for specific classes of drugs and different types and degrees of malnutrition. Bioavailability of lumefantrine, sulfadoxine, pyrimethamine, lopinavir, and efavirenz was decreased in severely malnourished patients, but increased for the P-glycoprotein substrates abacavir, saquinavir, nevirapine, and ivermectin. Distribution volume was decreased for the lipophilic drugs isoniazid, chloroquine, and nevirapine, and the α1-acid glycoprotein-bound drugs quinine, rifabutin, and saquinavir. Distribution volume was increased for the hydrophilic drug streptomycin and the albumin-bound drugs rifampicin, lopinavir, and efavirenz. Drug elimination was decreased for isoniazid, chloroquine, quinine, zidovudine, saquinavir, and streptomycin, but increased for the albumin-bound drugs quinine, chloroquine, rifampicin, lopinavir, efavirenz, and ethambutol. Clinically relevant effects were mainly observed in severely malnourished and kwashiorkor patients.

          Conclusions

          Malnutrition-related effects on pharmacokinetics potentially affect treatment response, particularly for severe malnutrition or kwashiorkor. However, pharmacokinetic knowledge is lacking for specific populations, especially patients with neglected tropical diseases and severe malnutrition. To optimize treatment in these neglected subpopulations, adequate pharmacokinetic studies are needed, including severely malnourished or kwashiorkor patients.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40262-021-01031-z.

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          Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

          David Moher, Larissa Shamseer, Mike Clarke … (2017)
          Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
          Article 0 comments Cited 6152 times – based on 0 reviews     Review now
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            Rayyan—a web and mobile app for systematic reviews

            Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz … (2017)
            Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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              Maternal and child undernutrition and overweight in low-income and middle-income countries

              Robert E Black, Cesar G Victora, Susan P. Walker … (2013)
              The Lancet, 382(9890), 427-451
              Article 0 comments Cited 2846 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Thomas P. C. Dorlo: t.dorlo@nki.nl
                Journal
                Journal ID (nlm-ta): Clin Pharmacokinet
                Journal ID (iso-abbrev): Clin Pharmacokinet
                Title: Clinical Pharmacokinetics
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0312-5963
                ISSN (Electronic): 1179-1926
                Publication date (Electronic): 1 June 2021
                Publication date PMC-release: 1 June 2021
                Publication date (Print): 2021
                Volume: 60
                Issue: 9
                Pages: 1149-1169
                Affiliations
                [1 ]GRID grid.430814.a, ISNI 0000 0001 0674 1393, Department of Pharmacy and Pharmacology, , Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, ; PO Box 90440, 1006 BK Amsterdam, The Netherlands
                [2 ]GRID grid.430814.a, ISNI 0000 0001 0674 1393, Scientific Information Service, , Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, ; Amsterdam, The Netherlands
                [3 ]GRID grid.5477.1, ISNI 0000000120346234, Department of Clinical Pharmacy, University Medical Center Utrecht, , Utrecht University, ; Utrecht, The Netherlands
                [4 ]GRID grid.487647.e, Department of Pharmacology, , Princess Máxima Center for Pediatric Oncology, ; Utrecht, The Netherlands
                Article
                Publisher ID: 1031
                DOI: 10.1007/s40262-021-01031-z
                PMC ID: 8545752
                PubMed ID: 34060020
                SO-VID: bfaa4329-7c9e-4692-b6ac-f058cb3420b0
                Copyright © © The Author(s) 2021, corrected publication 2021
                License:

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 23 April 2021
                Funding
                Funded by: Second European and Developing Countries Clinical Trials Partnership Programme (EDCTP2)
                Award ID: RIA2016S1635
                Award Recipient :
                Funded by: ZonMw / Dutch Research Council (NWO) Veni grant
                Award ID: 91617140
                Award Recipient :
                Categories
                Subject: Systematic Review
                Custom metadata
                issue-copyright-statement © Springer Nature Switzerland AG 2021

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