Use of off-label nephrology-related drugs in hospitalized pediatric patients: a retrospective study
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Use of off-label nephrology-related drugs in hospitalized pediatric patients: a retrospective study Marchella Yasinta, Ruo-Chen Che, Cai-Yu Hu, Xiang-Hui Du, Gui-Xia Ding, Song-Ming Huang, Ying Chen, Ai-Hua Zhang Nanjing, China
Original article
Background: The information about the use of off-label drugs in pediatric nephrology is still lacking, which leads to increased adverse reactions and medical disputes. We retrospectively analyzed the use of off-label drugs in the in-patient ward of the nephrology department of Nanjing Children's Hospital, China in order to provide more complete information about the use of drugs for children. Methods: Proportional stratified random sampling was applied to select patients with renal diseases aged 1 month to 18 years, who were admitted to the hospital from October 1, 2012 to September 30, 2013. All nephrologyrelated drugs prescribed in the hospitalization period and take-home drugs prescribed on discharge were recorded and evaluated as off-label drugs or not from three different perspectives: person-time, prescription, and drug category. Results: From 385 person-times of patients with 1424 prescriptions, according to the ratio between off-label drugs and person-times, drug prescriptions, and drug products, the rates of off-label drugs were 40.78%, 16.64%, and 31.43%, respectively. Low-molecular-weight heparin, alfacalcidol and diltiazem were the most commonly used off-label drugs. Infants and younger children were the high-risk population of off-label drug use. The high rate off-label nephrology-related drug use in children was mainly related to lacking clinical research into drugs in children and the pace of drug label's revision, which cannot follow the development of medical science.
Author Affiliations: Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China (Yasinta M, Che RC, Hu CY, Du XH, Ding GX, Huang SM, Chen Y, Zhang AH); Jiangsu Key Laboratory of Pediatrics, Nanjing, China (Yasinta M, Che RC, Hu CY, Du XH, Ding GX, Huang SM, Chen Y, Zhang AH) Corresponding Author: Ying Chen, Department of Nephrology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, 72 Guangzhou Road, Nanjing 210029, China (Tel: +86-25-8311-7505; Fax: +86-25-8330-4239; Email: [email protected]) doi: 10.1007/s12519-015-0058-7 Online First December 2015 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2015. All rights reserved.
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Conclusions: Approximaely half of pediatric patients with renal diseases are usually prescribed with off-label nephrology-related drugs. Analyzing the off-label conditions from different perspectives may lead to various results. More clinical research into drugs for infants and younger children is needed so as to update drug descriptions. World J Pediatr 2016;12(2):236-242 Key words: in-patient; kidney; off-label drug; pediatrics
Introduction
T
he use of off-label drugs in children's hospitals is a common worldwide phenomenon and has
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