To develop a machine learning model for predicting rapid kidney function decline in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) and to pinpoint key modifiable risk factors for targeted interventions. We conducted a retrospective cohort study on 6,924 individuals with T2D and CKD at Seoul National University Hospital. Kidney function decline was assessed using estimated glomerular filtration rate slopes. The performance of the eXtreme Gradient Boosting (XGBoost) model was evaluated through model diagnosis and time-to-event analyses. Copula simulation was conducted to stratify risk subgroups using modifiable risk factors. A total of 906 (13.1 %) individuals experienced rapid kidney function decline. The XGBoost model demonstrated optimal performance (area under the receiver operating characteristic curve: 0.826). The hazard of end-stage kidney disease within eight years increased across risk quartiles, with statistically significant hazard ratios in Q3 (2.06; 95 % confidence interval [CI]: 1.29-3.29) and Q4 (10.9; 95 % CI: 7.36-16.2). Simulation analysis identified high-risk subgroups by stage A3 albuminuria and at least two of the following: haematocrit < 39.0 %, systolic blood pressure > 120 mmHg, and glycated hemoglobin A1c > 6.5 %. The XGBoost model, augmented by copula simulation, successfully stratified kidney prognosis in individuals with T2D and CKD.

(1) Background: A pharmacist-led deprescribing service previously developed within the Consultation-Based Palliative Care Team (CB-PCT) was implemented for terminal cancer patients. (2) Objective: To evaluate the clinical outcomes of the developed deprescribing service for terminal cancer patients in CB-PCT. (3) Methods: A retrospective analysis compared the active care (AC) group to the historical usual care (UC) group. The clinical outcomes included the deprescribing rate of preventive medications, the proportion of patients with one or more medication-related problems (MRPs) resolved upon discharge, and the clinical significance. The implementability of the service was also gauged by the acceptance rates of pharmacists’ interventions. (4) Results: Preventive medications included lipid-lowering agents, gastroprotective agents, vitamins, antihypertensives, and antidiabetic agents. The AC group revealed a higher deprescribing rate (10.4% in the UC group vs. 29.6% in the AC group, p < 0.001). At discharge, more AC patients had one or more MRPs deprescribed (39.7% vs. 2.97% in UC, p < 0.001). The clinical significance consistently had a very significant rating (mean score of 2.96 out of 4). Acceptance rates were notably higher in the AC group (30.0% vs. 78.0%. p = 0.003). (5) Conclusions: The collaborative deprescribing service in CB-PCT effectively identified and deprescribed MRPs that are clinically significant and implementable in practice.

Background/Objectives: Taxanes, including paclitaxel and docetaxel, are widely used in cancer treatment but frequently cause hypersensitivity reactions (HSRs), disrupting treatment continuity. This meta-analysis aimed to identify consistent risk factors for taxane-induced HSRs to support personalized risk assessments and optimize therapeutic outcomes. Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was registered with PROSPERO (CRD42023476738). Comprehensive literature searches were conducted up to 30 June 2024. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Data were synthesized to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs), using fixed or random effects models. Results: A total of 18 studies of moderate or higher quality were included, involving 8333 patients. The incidence of HSRs ranged from 3.0% to 33.1%. Risk factors assessed included history of allergy, obesity, postmenopausal state, ovarian cancer, and H2 receptor antagonist (H2RA) premedication. A history of allergy was identified as a potential risk factor with marginal significance (OR 1.85, 95% CI 0.97–3.54, p = 0.06), while H2RA premedication, ovarian cancer, and female sex were not significantly associated with HSR risk. Substantial heterogeneity was observed for obesity (I² = 57.71%, p = 0.069) and postmenopausal status (I² = 78.98%). Conclusions: This study highlights the complex nature of taxane-induced HSRs and emphasizes the need for personalized risk assessments. While a history of allergy is a potential risk factor, heterogeneity across other factors underscores the importance of individualized approaches. Clinicians should tailor strategies to balance the benefits of taxane therapy with patient-specific risks to improve clinical outcomes.

Minoh Ko, PharmD, MS, BCOP, Jieun Choi, PharmD, Sujin Kim, PharmD, Sung Hwan Kim, MS, Eun Jung Cho, BPharm, Yoon Sook Cho, PhD, Young Il Koh, MD, PhD and Jung Mi Oh, PharmD. Journal of Pharmacoepidemiology and Risk Management 2022;14:149-57. https://doi.org/10.56142/jperm.22.0014

This study aimed to compare social issues influencing the use of mifepristone for medical abortion between South Korea and the United States by analyzing media coverage through text mining techniques. News articles published between 2006 and 2022 related to mifepristone were collected using web scraping from representative news platforms in both countries. The collected data underwent preprocessing, followed by text analysis using the bag-of-words model. Topic modeling was conducted through Latent Dirichlet Allocation, and sentiment analysis involved using the lexicon-based methods specific to Korean and English texts. Analysis of 7,938 Korean and 650 United States articles revealed distinct patterns in media discourse on mifepristone and medical abortion. The United States coverage was polarized, encompassing clinical, legal, and access-related debates, whereas Korean articles prioritized access barriers, safety concerns, and the urgency for domestic approval, reflecting predominantly negative sentiments related to cultural stigma. This study highlights differences in the media portrayals and public perceptions of mifepristone between South Korea and the United States, underscoring the influence of regulatory contexts, public concerns and cultural attitudes on medical abortion discourse.

Despite the immunomodulatory mechanism of immune checkpoint inhibitors (ICIs), systemic glucocorticoids are commonly used in advanced non–small cell lung cancer (NSCLC). Evidence regarding their effects on ICI outcomes is inconsistent, in part due to confounding by indication and immortal time bias. We conducted a multicenter target trial emulation to assess the association of glucocorticoid timing and dose with survival outcomes while addressing these biases. Patients with advanced NSCLC who initiated ICI therapy between 2015 and 2021 at four Korean tertiary hospitals were included. The primary endpoint was 2‐year overall survival (OS), with disease progression as a secondary endpoint. To minimize biases, outcomes were compared between concomitant glucocorticoid users and non‐users using time‐dependent propensity score matching. Among 1,815 eligible patients, 1,128 were matched. Hazard ratios (HRs) from the four institutions were pooled using a random‐effects meta‐analysis. Concomitant glucocorticoid use was associated with an increased risk of mortality (pooled aHR 1.36; 95% CI, 1.06–1.75). Early exposure within 90 days of ICI initiation was associated with poorer OS (aHR 1.49; 95% CI, 1.18–1.87), whereas later initiation showed no association. Dose‐stratified analyses showed that high‐dose exposure (> 1 mg/kg/day) was associated with reduced survival (aHR 1.61; 95% CI, 1.31–1.99), whereas low‐dose exposure was not associated with adverse outcomes. After accounting for confounding by indication and time‐related biases, concomitant systemic glucocorticoid use during ICI therapy was associated with less favorable survival outcomes. This association was more pronounced with early and high‐dose exposure, underscoring the clinical importance of glucocorticoid timing and dose.