社團法人臺灣臨床藥學會

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【原著】Filgrastim於中山醫學大學附設醫院之回溯性使用評估
Retrospective Drug Utilization Evaluation of Filgrastim at Chung-Shan Medical University Hospital
Filgrastim、G-CSF、藥物使用評估(DUE)、 G-CSF, Filgrastim, DUE
賴永昌Yung-Chang Lai 、賴婕瑄Jie-Shiuan Lai 、陳玉蘭Yu-Lan Chen 、李建瑩Chien-Ying Lee 、尤靜儀Ching-I Yu
1中山醫學大學附設醫院 藥劑科
Filgrastim(G-CSF)是一種嗜中性白血球刺激因子,可促進嗜中性白血球前驅細胞分化與增殖。為實際了解filgrastim在臨床上的使用狀況,本研究採電腦資料庫取樣民國91年1月至12月間使用filgrastim之患者,以人工審閱病歷記載之方式進行藥物使用評估(DUE),希望提供日後更合理、有效的用藥參考。評估項目包括健保使用規範(適應症、治療監測)、藥物交互作用及副作用之考量。
本研究報告共含110位病患資料,51位男性及59位女性。病患平均年齡為56.1  16.8歲。申請健保給付者佔60.0%,自費負擔者佔40.0%。適應症合乎健保使用規範者佔80.3%,不符合健保規範者佔19.7%。合乎治療監測原則者佔86.4%,未按時檢測或從未檢測白血球變化者佔13.6%。有4位患者血液及生化檢測值均正常,且病歷中無任何記錄提及應接受治療,但仍投予filgrastim。
在藥品交互作用方面:filgrastim併用lithium者共3人,其中33.3%(1/3)未嚴密監控白血球數量變化。併用抗癌藥vincristine(Oncovin®)者共2人,併用時並無調整vincristine劑量及採取適當監測措施,記錄是否有嚴重周邊神經炎的發生。於副作用方面:filgrastim治療期間86.3%的患者曾發生貧血之副作用;38.9%的患者曾發生白血球增多症;36.8%的患者曾出現血小板低下(platelets <50000/mm3)。
由以上研究結果顯示filgrastim的用藥追蹤應再加強。建議醫師們應常規性的監測患者血球變化值,作為劑量調整的依據;在藥品交互作用及併發症方面亦應有所考量。而藥師們在給藥方面也應再嚴格要求,務必讓相關醫護人員了解正確藥物的投予方式及告知病患可能會發生的副作用與何時應和醫師主動連絡。

Filgrastim, a granulocyte colony-stimulating factor (G-CSF), has been indicated to lessen neutropenia associated with myelosuppressive chemotherapy (including those with acute myeloid leukemia), bone marrow transplantation, and severe chronic neutropenia including those with congenital, idiopathic, and cyclic neutropenia. Filgrastim has also been indicated for the mobilization of peripheral blood progenitor cells (PBPC) prior to PBPC collection.
In order to develop more effective and safe clinical guidelines for prescribing filgrastim, we performed a retrospective drug use evaluation (DUE) of patients who were listed on a computer database as having visited Chung-Shan Medical University Hospital. Patients who had received filgrastim between January 2002 and December 2002 were randomly selected and categorized based on National Health Insurance (NHI) guidelines, drug interactions and side effects.
According to our research, there were 110 patients enrolled totally, including 51 males and 59 females. The average age was 56.1  16.8 years old. Sixty percent of patients were claimers for the NHI payment clause, meanwhile, 40.0% patients were at their own expense. Filgrastim prescription rate following NHI guidelines was 80.3%. Prescriptions to 13.6% of total patients did not strictly adhere to monitor parameters of laboratory examinations in compliance with the therapeutic guidelines. Four patients whose white blood cells were at normal ranges (4500 – 10000/mm3) were receiving filgrastim without specific reasons recorded.
There were three patients who received filgrastim combined with lithium, and 33.3% of these patients were not monitored closely for whole blood cell changes. Two patients on filgrastim were treated with vincristine (Oncovin®), but severe side effects secondary to co-administration of these two drugs were not recorded in these patients. In respect of adverse effects regarding the treatment of filgrastim, 86.3% of patients receiving filgrastim have experienced anemia; 38.9% of patients have reported leukocytosis (>10000 cells/mm3); and 36.8% of patients have recorded thrombocytopenia (<50000 cells/mm3).
Our results indicate that the use of filgrastim needs stricter enforcement. This is especially applicable with respect to monitoring drug efficacy, adverse drug reactions and co-administration of other drugs.
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