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Effect of Hangeshashin-To (Japanese Herbal Medicine Tj-14) on Tolerability of Irinotecan: Propensity Score and Instrumental Variable Analyses

1
Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
2
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
3
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
4
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(9), 246; https://doi.org/10.3390/jcm7090246
Received: 8 August 2018 / Revised: 22 August 2018 / Accepted: 24 August 2018 / Published: 28 August 2018
(This article belongs to the Section Pharmacology)
Irinotecan hydrochloride (CPT-11) is used to treat a wide spectrum of malignant tumors. Hangeshashin-to (Japanese herbal medicine TJ-14) is reportedly effective in preventing and controlling diarrhea associated with CPT-11. However, the effect of TJ-14 on tolerability of chemotherapy with CPT-11 has not been fully investigated. We used the Japanese Diagnosis Procedure Combination inpatient database to retrospectively identify patients who had received CPT-11 on their first admission with and without TJ-14. Patients who did receive TJ-14 (N = 7092) received CPT-11 more often and in larger doses than those who did not receive TJ-14 (N = 82,019). The incidence rate ratio of CPT-11 administration was 1.34 for frequency (95% confidence interval [CI], 1.31–1.38; p < 0.001), and 1.16 for total dose (95% CI, 1.14–1.19; p < 0.001) according to stabilized inverse probability treatment weighting using propensity scores. Instrumental variable analysis showed similar trends. In-hospital mortality was significantly lower in patients who received TJ-14 than in those who did not. Odds ratios of in-hospital death in patients receiving TJ-14 was 0.81 (95% CI, 0.71–0.93; p = 0.002) according to stabilized inverse probability treatment weighting using propensity scores and 0.42 (95% CI, 0.22–0.81; p = 0.009) according to instrumental variable analysis. Our findings indicate that TJ-14 improve the tolerability of CPT-11. View Full-Text
Keywords: Hangeshashin-to (TJ-14); irinotecan; cancer chemotherapy; drug intolerance; supportive therapy; cohort study; clinical epidemiology; propensity score; inverse probability treatment weighting; instrumental variable Hangeshashin-to (TJ-14); irinotecan; cancer chemotherapy; drug intolerance; supportive therapy; cohort study; clinical epidemiology; propensity score; inverse probability treatment weighting; instrumental variable
MDPI and ACS Style

Urushiyama, H.; Jo, T.; Yasunaga, H.; Michihata, N.; Yamana, H.; Matsui, H.; Hasegawa, W.; Hiraishi, Y.; Mitani, A.; Fushimi, K.; Nagase, T.; Yamauchi, Y. Effect of Hangeshashin-To (Japanese Herbal Medicine Tj-14) on Tolerability of Irinotecan: Propensity Score and Instrumental Variable Analyses. J. Clin. Med. 2018, 7, 246.

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