Efficacy of Statins on BMB or Fracture Risk in Postmenopausal Women

방준석,Bang, Joon-Seok Korean College Of Clinical Pharmacy 2006 한국임상약학회지 Vol.16 No.2

스타틴이 골형성을 자극하며 골밀도를 개선한다는 다수의 동물실험과 임상보고에 의해, 스타틴을 폐경기 이후 노령의 여성 고지혈증 환자에게 골다공증의 예방 혹은 치료적 용도로 사용할 수 있는가에 대한 관심이 고조되어 왔다. 하지만, 보고된 문헌들이 예방 혹은 치료효과를 제시하거나 해석됨에는 아직도 실험결과가 상이하거나 의견이 상충되고 있다. 본 연구는 폐경기 이후의 고지혈증을 지닌 골다공증 환자에게 처방된 스타틴이 실질적으로 골다공증 혹은 골절위험을 경감시키는 예방적 또는 치료적 효과를 지니는지 규명하고자, 1990년부터 2005년 사이에 MEDLINE에 등재된 데이터베이스 중에서 6개의 키워드를 사용하여 인체대상 연구보고서를 cross-sectional study, prospective cohort study 및 case-control study의 연구유형별로 수집, 분류하여 각각의 결과를 비교, 평가하였다. 각 연구결과들은 골다공증 평가에 이용하는 다수의 측정지표들에 대하여 공히 인정될 만한 수준의 유의성 여부를 제공하기에는 곤란했는데, 이는 연구디자인이 부적절했거나 실험대상 환자들이 보유한 각종 질병요소들과 치료상황이 복잡한 상호관계를 지녔기 때문이다. 따라서 대규모의 잘 계획된 이중맹검형 다국가 임상시험을 통해서 임상적 효과 유무가 입증되기 전에는 스타틴을 고지혈증을 보유한 폐경기 이후 노령 여성의 골다공증의 예방 혹은 치료적 용도로 사용하는 것은 아직 시기상조로 사료된다. There are 3 different hypotheses on how statins may affect bones, through promoting bone formation, inhibiting bone resorption or through anti-inflammatory effect. In the 3 cross-sectional studies above, one showed increase BMD at hip and spine, one showed increase BMD only at mid-forearm and one showed that the risk reduction in fractures is not explained by the changes in BMD however, all 3 studies showed a decrease in risk of fracture associated with statins. In the 2 prospective cohort studies, one showed the use of statins was not associated with BMD at any skeletal site or decreasing the risk of fracture, and the other showed statins except pravastatin decreased in risk of vertebrate fracture but not affecting lumbar spine BMD. All of case-control studies indicated reduction in fracture risk but did not provide any data regarding BMD. 2 of the randomized, controlled studies showed no significant reduction in fracture risk as well as statins' effects on BMD. Finally, one longitudinal study showed statin use reduced fracture risk and increased BMD. Among the conflicting results shown above, even when statin use was shown to increase BMD, it does not seem to account for the reduction in fracture risk. There may be different ways that statins affect bone other than those hypotheses proposed above. Many studies seem to agree that pravastatin does not have any effect on bone. Some studies suggested that the reason statins did not achieve clinically significant increases in BMD in some studies, is due to the low affinity of statins on bone; statins are designed to act in the liver therefore their effective concentration in extrahepatic tissue is low. The limitations to those studies discussed above. Many studies did not account for the change of lifestyle while subjects' were on statins. Increases in weight bearing exercise and changes in diet might affect BMD and thus reduce risk of fractures. Mental alertness and vision acuity might prevent falls from occurring; many statin-users in the studies were young so the risk of fractures from falls would be decreased. Almost all of the studies failed exclude patients with neurological problems. During study periods, many subjects may have been started on drugs for diseases that usually occur with aging which could cause drowsiness and lead to falls. The sample sizes used in some of the trials were small and the duration of treatment and follow up might not have been long enough to see clinically relevant results.

주상복합 제도개선을 위한 연구

방준석(Bang, Joon-Seok),조종수(Cho, jong-Soo) 대한건축학회 2015 대한건축학회 학술발표대회 논문집 Vol.2015 No.-

우리나라 건강보험의 위험분담제도가 재정 및 환자접근성에 미친 영향

이종혁,방준석,Lee, Jong Hyuk,Bang, Joon Seok 한국임상약학회 2018 한국임상약학회지 Vol.28 No.2

Objective: This study examined the Risk Sharing Agreement (RSA) on pharmaceutical pricing system in Korean national health insurance. Through RSA, the insurer was able to maintain the principles in the price listing process while managing the budget effectively and improving patient access to new drugs. Despite these positive effects, there are still issues raised by some stakeholders, such as lack of transparency in the listing process and doubts about its effectiveness. Therefore, we investigated the impacts of RSA on national health insurance financing and patient access to analyze the effects of RSA. Methods: The impact of RSA was investigated by analyzing the health insurance claims data for 2014~2016. The degree of improvement in patient access was determined by the decreased amount of patients' payment. Results: Results showed that the financial impact of RSA was not significant and patients' access to the new drug greatly improved. Conclusion: These results show that RSA is a good system for improving patient access to new drugs without additional expense on insurance.

외래 비만 클리닉에서 행해지는 비만 치료의 목적 및 타당성에 관한 평가

양정혜,이명구,임성진,이보름,권익혁,방준석,이종길,임성실,Yang, Jeong-Hye,Lee, Myung-Koo,Lim, Sung-Jin,Lee, Bo-Reum,Kwon, Ik-Hyun,Bang, Joon-Seok,Lee, Chong-Kil,Lim, Sung-Cil 대한약학회 2009 약학회지 Vol.53 No.1

Metabolic syndrome is increasing nowadays and one of causes is obesity. Therefore prevention and treatment of obesity is very important to decrease of Metabolic syndrome. However currently many pharmacotherapy for obesity are popular in Korea and it may be dangerous. The aim of this study is to evaluate the purpose and relevance of obese treatment in two areas (capital & local) of Korea and suggest to guide for the right directions of pharmacotherapy in obesity treatment. We selected and surveyed 90 patients (88 females, 2 males, age of $23{\sim}60$) at random who received a prescription after consulting with a doctor at several clinics of Cheongju-area and Seoul-area, from May thru June, 2007. And we evaluated their prescriptions. In results, only 26.7% were obese (13.3%, 23<BMI<25) or overweight (13.3%: BMI>25), most 73.3% patients were normal (65.6%, 18.5<BMI<23) or underweight (7.8%, BMI<18.5, p<0.01) by body mass index (BMI: Kg/$m^2$). The purpose of treatment was for appearance (38.9%), health (41.1%) or both (18.9%, p<0.01). 94% patients had the past history of obese treatment. Prescriptions were consisted of CNS stimulant, anticonvulsants, antidepressant, laxatives, diuretics, or antianxietics. Obese treatment is very important for health to prevent disease such as Metabolic Syndrome. However it should not be abused. In conclusion, some patients of obese treatment is not relevant to obesity and pharmacist role is important to guide them for the right directions in obesity treatment.

국내 제약기업의 연구개발비 및 마케팅 비용이 기업성과에 미치는 영향 연구

정재은(Jae Eun Jung),강민구(Minku Kang),방준석(Joon Seok Bang) 대한약학회 2019 약학회지 Vol.63 No.4

Abstract The purpose of this study was to investigate the effect of R&D investment and marketing expenses on the performance of the Korean pharmaceutical companies. The top-ranked forty companies in Korea were selected and the 6-year-long data were analyzed to obtain the correlations among R&D intensity, marketing expenses, growth rate, operating profitability. In addition, the differences between innovative and non-innovative pharmaceutical companies were also examined. Both the amount and the ratio of R&D investment over sales activities were significantly higher in the innovative pharmaceutical companies compared with the non-innovative pharmaceutical companies. In these competitive circumstances, R&D investment is indispensable for the sustainable growth in pharmaceutical companies. In conclusion, Korean pharmaceutical companies as well as government bodies should focus on more intensive and strategic R&D activities to increase the capabilities for developing innovative new products and future prosperity.

디지털 치료기기의 특성 및 사용 평가

정유림(Yu Rim Jeong),박은영(Eun-Young Park),백동재(Dong Jae Baek),방준석(Joon Seok Bang),김광준(Kwang Joon Kim) 대한약학회 2023 약학회지 Vol.67 No.5

Digital therapeutics (DTx) are defined as high-quality software designed to prevent, manage, and treat medical disorders or diseases by providing evidence-based therapeutic interventions. In this study, an investigation was conducted to examine the characteristics of DTx, including their methods, safety-related data, and user evaluations of reSET®, reSET-O®, and Somryst®. These DTx solutions have recently obtained the first FDA approval and the first insurance code registration by government. However, there are limitations in terms of the quantitative scale of patient feedback evaluations and concerns about accuracy, as indicated by research findings. Nevertheless, with the active global development of DTx and the increasing scale of investment, pharmacists need to pay attention to and prepare for this innovative treatment concept.

한병원의 외래를 이용한고혈압혹은 심장질환 환자대상 복약상담 실태조사

안성심,최고운,김순주,방준석,나현오 한국병원약사회 2009 병원약사회지 Vol.26 No.3

Abstract: The medication counseling to the patients with hypertension or cardiovascular dis-eases influences affirmative events for the treatment. In general, this kinds of education is pro-vided by the medical caregivers and is needed to evaluate the efficacy if fulfill the demands of the patients. The aims of this study are to analyze the actual condition and to present adequate methodological directions for developing effective counseling programs. The study subject was eighty-five out-patients who suffering with hypertension or cardiovascular diseases. The ques-tionnaire was developed and the face-to-face interviews were conducted by trained clinical pharmacists. About 74% of the patients recognized the dosage of their prescribed medications, 30% recognized the name, side effects, interaction, and precautions of the medications. Only 45.9% of patients(n=39) recognized their late blood pressure, 30%(n=18) recognized their thera-peutic target number of the blood pressure. Around 40% answered the medication counseling is necessary. Thirty-two percent of patients(31.8%) necessitated the knowledge of drug-drug inter-actions, or the adequate count-actions to manage the un-wanted side effects(29.4%, n=25). In conclusion, for the patients with hypertension or cardiovascular disease, well-designed medica-tion-counseling or education programs are essential to lessen the possibilities of the side effects and to increase the pharmacotherapeutic outcomes.