Vol 8, No 5 (2020)

The aim. The article highlights the current state of the problem of mumps in the world and the Russian Federation.

Materials and methods. The materials of the study were electronic resources WHO infection control, Cohrane, Elsevier, ScienceDirect, CDC infection diseases database, PubMed, eLibrary, CyberLeninka. The research methods were the analysis and generalization of scientific literature. The assessment is presented by the immunological structure of the population in different age groups to mumps (n = 593) in the study area (2018) according to the data of the Center for Hygiene and Epidemiology in the Perm Territory.

Results. The spread of mumps is found to be widespread and uneven in different regions of the world in the form of sporadic cases and large epidemic outbreaks, despite the world practice of vaccine prevention of mumps. Analysis of the immunological structure to mumps in different age groups revealed a fairly high number of seronegative individuals (the largest number was found among adults aged 20–39 years) in the study area (2018). A decrease in the tension of post-vaccination immunity is the main cause for the emergence of an outbreak among the adult population, in addition to vaccination failures among vaccinated children. The immune defenses created by the vaccine strain do not have the same intensity and duration as with natural infection, and some genotypes of “wild” variants of the mumps virus can break through the immune barrier and cause disease. Antigenic differences between vaccine and circulating strains, low inoculation dose can weaken immunity and reduce the effectiveness of mass vaccine prevention.

Conclusion. Ways of solving the problem were proposed to forestall an unfavorable epidemic situation with mumps.

Severe and critical forms of COVID-19 are beset by the development of a “cytokine storm”, which is characterized by increased secretion of proinflammatory cytokines. Therefore, one of leading strategies for treating patients with severe forms of COVID-19, is the reduction of concentration of proinflammatory cytokines and leveling out their effect on the patient. Among the drugs aimed at reducing the concentration of proinflammatory cytokines, IL-6 inhibitors, IL-1 inhibitors, JAK inhibitors and systemic glucocorticosteroids have been found useful in COVID-19. All of these drugs are currently prescribed off-label.

The aim of the work is a comparative analysis of the data from the literature sources in the PubMed system, devoted to the clinical efficacy and safety of IL-6, IL-1, JAK inhibitors and systemic glucocorticosteroids in the treatment for severe forms of COVID-19.

Materials and Methods. In the treatment for severe forms of COVID-19, materials for the comparative analysis were the data from the literature sources in the PubMed system, on the studies devoted to the use of the systemic glucocorticosteroid dexamethasone, IL-6 inhibitor tocilizumab, IL-1 inhibitor anakinra, and JAK inhibitor ruxoliniteb. The analysis was performed by statistical evaluation of the effect of the drugs on the 28^th-day survival rate among the patients with severe COVID-19. Attribute-based statistics was used as a statistical tool. The safety of the drug use was assessed by analyzing potential drug interactions. The information about potential drug interactions, was obtained from a specialized website – Drugs.com. Knowmore. Besure (https://www.drugs.com/interaction/list/).

Results. As a result of the analysis, it has been established that tocilizumab has the highest efficacy rates. In this respect, it is followed by dexamethasone. The attributive efficacy rates and 95% confidence interval values for the both drugs, were statistically significant. The indices of relative and population attributive kinds of efficacy, were also higher for tocilizumab, but a 95% confidence interval of these indices, get into the range of statistically insignificant values, requiring additional evidence of their efficacy. According to the data obtained, tocilizumab efficacy is higher than that of the other drugs compared: NNT (dexamethasone) – 32; NNT (tocilizumab) – 4, NNT (ruxolitinib) – 7; NNT (anakinra) – 35.

Conclusion. The choice of a drug should be based on the patient’s condition, comorbidities, and medications used in therapy to minimize the risk of undesirable drug interactions.

Against the background of the lowest efficacy among the compared drugs, a high efficacy for the patients with concomitant hepatobiliary disorders and DIC syndrome, has been established for the inhibitor IL-1 anakinra, which makes it the drug of choice among the patients with these diseases and under these conditions in the development of a “cytokine storm”.

The aim of the review article was to highlight the methodologies for assessing the financial costs of adverse drug reactions exemplified by the Russian Federation and Brazil.

Materials and methods: for a comparative analysis, materials from open sources were used. The study of the experience of methods used for assessing the burden of adverse drug reactions, was carried out using the system for calculating payments for medical care by clinical-statistical and clinical-profile groups, the methodology for assessing the severity of adverse events of the US National Cancer Institute, drug-associated problems, and “the decision tree” model.

Results. When comparing the costs of ADR management in the Russian Federation and Brazil, the following results have been obtained: in the Russian Federation, the “cost” of reaction can be estimated only for a limited number of nosological groups that are regulated by the classification of diseases by clinical and statistical groups; in Brazil, when predicting the costs of adverse reactions management, the combination of “the decision tree” method and the Delphi method is used. In the Russian Federation, the cost of the 3^rd and above severity adverse event (according to CTCAE v. 4.03), varies from 26,849.22 up to 26,196.37 RUB in the North-West region (St. Petersburg). In Brazil, the cost of ADR ranges from 13 USD (the best scenario for the patient) to 574 USD (the worst scenario for the patient), which is about 975 and 43,000 RUB, respectively. The introduction of methods that make it possible to predict the development and potential outcomes of adverse drug reactions, as well as taking into account the experiences of foreign colleagues in their modeling, will reduce economic costs in the Russian Federation at the federal level.

Conclusion: for the economic value analysis and further forecasting, an improvement of existing methodologies is required. The models used in the Russian Federation (“the decision tree”, classification of diseases by clinical groups, Markov model) do not take into account the time factor, therefore, when planning the analysis of potential costs for adverse reactions, it is necessary to reinforce the methods with such tools as QALY, YLL, and YLD.

Cure of allergy symptoms reported by a patient with the help of non-prescription antiallergic drugs, is one of the important aspects of a responsible self-medication.

The aim of the study is to assess the peculiarities of consumers’ behavior as pharmacy visitors, when choosing non-prescription antiallergic drugs, and to identify potential problems of pharmaceutical counseling for allergy symptoms regarding the responsible self-medication.

Materials and methods. Sociological survey in the form of a questionnaire; graphoanalytical and comparative analyses.

Results. The profile of an over-the-counter antiallergic drugs buyer in the pharmacies of Kazan was assessed in the following way: it is a woman aged 18–44 of a middle level of income, having a family of 3–4 people, ready to spend from 101 to 500 rubles on the purchase of antiallergic drugs, buying anti-allergic drugs not for the first time. The main reasons to seek for treatment were skin rash, redness and itching, which had also been observed in the past. The allergic nature of the disease had already been confirmed by the doctor. For the average consumer of over-the-counter antiallergic drugs, the most important criteria for choosing a medicine were: efficiency, safety, the doctor’s recommendations and price. The medicines were purchased for the visitors themselves or their children. The customers were satisfied with the choice of non-prescription antiallergic medicines available in the pharmacy. The visitors generally trusted the pharmacists’ advice and recognized them as health professionals, but considered that the main goal was not only to provide a pharmaceutical care, but also to profit from the sale of the drugs. The following flaws of pharmaceutical counseling when dispensing non-prescription antiallergic drugs, were identified: an improper diagnosis by a pharmaceutical specialist, the lack of recommendations to consult a doctor, incomplete provision of information on the use, storage, and the possibility of interaction with other drugs and food.

Conclusion. Misdiagnosis and incomplete provision of information by pharmaceutical specialists on antiallergic the drugs that are approved for the over-the-counter dispensing, require the implementation of a pharmaceutical consultation algorithm for the visitors contacting a pharmacy with allergy symptoms.