Prediabetes is a condition where blood glucose levels have deviated from the normal range but have not yet reached the diagnostic criteria for diabetes. It represents a transitional phase between health and diabetes. Currently, there are no global guidelines for managing prediabetes. However, the use of metformin in prediabetes is largely based on clinical experience, and there is a lack of high-quality evidence-based medicine. There are uncertainties regarding its dosage and unknown adverse reactions, and its exact efficacy and safety still require further study. This article systematically reviews the current state of metformin in the treatment of prediabetic, analyzing differences in efficacy across different dosages, the guideline recommendations, clinical application experiences, potential adverse effects and irrational drug use. We aim to provide scientific basis and clinical practice guidance for the rational use of metformin in the management of prediabetes.
Drug use disorders have become a major global public health challenge, threatening people's health, increasing the disease burden and hindering economic development and social progress. As the burden of disease varies among different drugs, preventing and controlling them has become a major concern for all sectors of society.
To analyse the trend in the disease burden of drug use disorders in China between 1990 and 2021. This includes calculating the age-standardised incidence and DALY rates of drug use disorders and their five subcategories, and making predictions about the incidence and DALY rates from 2022 to 2046. These findings will provide a scientific basis for policy formulation and intervention implementation.
Data from the Global Burden of Diseases 2021 (GBD 2021) database was extracted, including age-standardised incidence rates, disability-adjusted life years (DALY) rates for drug use disorders and five subcategories from 1990 to 2021 (Opioid use disorders, Cannabis use disorders, Cocaine use disorders, Amphetamine use disorders and Other drug use disorders). Joinpoint regression models were used to analyse the age-standardised incidence rates and the annual percent change(APC) and average annual percent change(AAPC) in DALY rates. Bayesian age-period-cohort prediction models were used to predict trends in age-standardised incidence and DALY rates from 2022 to 2046.
Joinpoint regression analysis revealed an overall downward trend in the age-standardised incidence and DALY rates of drug use disorders in the Chinese population from 1990 to 2021 (AAPC values of -0.76% and -2.75%, respectively, both P<0.05). The age-standardised incidence and DALY rates of drug use disorders showed an overall downward trend for both males and females (AAPC values of -0.69% and -2.50% for males, and -0.85% and -3.09% for females, respectively; both P<0.05). Among the five subcategories of drug use disorders nationwide, the age-standardised incidence and DALY rates of cannabis use disorders showed an overall increasing trend (AAPC=0.66%, 0.71%, respectively; both P<0.05). The age-standardised incidence and DALY rates of the remaining four subcategories showed an overall decreasing trend (Opioids: AAPC=-1.97%, -3.41%; Amphetamines: AAPC=-1.50%, -1.66%; Cocaine: AAPC=-0.66%, -2.12%; Other: AAPC=-0.64%, -3.83%; all P<0.05). The Bayesian age-period-cohort prediction models predicted that from 2022 to 2046, the incidence and DALY rates of drug use disorders in both male and female populations in China would increase. The projected increase in incidence was approximately 50.80% for males and 24.27% for females, with a higher increase in males than females. The projected increase in DALY rates was approximately 48.34% for males and 41.46% for females, with a higher increase in males than females.
From 1990 to 2021, the disease burden of drug use disorders in China decreased, with males bearing a higher burden than females. With the exception of Cannabis use disorders, the remaining four subcategories of drug use disorders showed an overall downward trend. The burden due to Opioid use disorders was the most severe. However, it is projected that, from 2022 to 2046, age-standardised incidence and DALY rates will increase.
Blinatumomab, as the first bispecific antibody targeting CD19, has shown significant efficacy in the treatment of acute lymphoblastic leukemia and has been widely used in clinical practice since its launch in 2014. However, the characteristics of adverse events, the differences in medication safety among different populations and the influencing factors of this drug in the real world are not very clear, requiring in-depth exploration.
To utilize the FDA Adverse Event Reporting System (FAERS) to obtain adverse drug event (ADE) reports for blinatumomab over the decade since its market launch and to analyze the influencing factors on the real-world safety of blinatumomab, thereby strengthening pharmacovigilance for high-risk populations.
Data in the FAERS database from the fourth quarter of 2014 to the third quarter of 2024 were searched. ADE positive signals were systematically classified. Conduct a statistical analysis on six types of adverse events with high incidence, strong characteristics and high relevance, including the nervous system disorders, cytokine release syndrome (CRS), immune system disorders, blood and lymphatic system disorders, infections and infestations, lineage switch leukaemia, categorized by various influencing factors such as age, gender, weight, interval time, and the continent where the patients were locate.
A total of 18 728 cases of ADE reports for blinatumomab were collected, along with 6 961 demographic data, identifying 371 valid signals involving 20 system organ classifications (SOC). Among these, the preferred term (PT) with the highest signal strength was lineage switch leukemia, which was not mentioned in the instructions, and the most frequent SOC was nervous system disorders. Statistical differences were observed in gender, body weight, interval time, and continent of residence among minors, young and middle-aged adults, and elderly individuals who experienced adverse events (P<0.05). Statistical differences were also found in interval time and continent of residence when comparing patients with nervous system disorders to other adverse events (P<0.05), as well as for cytokine release syndrome compared to other adverse events (P<0.05). For immune system adverse events, statistical differences were noted in age and continent of residence compared to other systemic adverse events (P<0.05). Additionally, statistical differences in interval time and continent of residence were found for blood and lymphatic system disorders compared to other adverse events (P<0.05), as well as for infections and infestations compared to other adverse events (P<0.05).
In clinical use of blinatumomab, there should be a high level of attention to the drug tolerance of the Asian population and vigilance against immediate and delayed adverse events. Blinatumomab has been on the market in China for a short time, and there is insufficient experience in medication use. In clinical applications, it is necessary to strengthen drug surveillance and risk protection for minors and the elderly in China.
