Introduction: In modern clinical practice, various drug combinations are widely used, especially in cardiological patients. The existing clinical recommendations necessitate using organ protective agents, especially with a patient having a comorbid pathology and with an ineffective monotherapy. In some cases, drug interaction decreases the effectiveness of pharmacotherapy and increases the risk of developing adverse events (AE). The purpose of the study was to analyze the modern pharmacotherapy of patients with coronary heart disease (CHD), identify polypharmacy of treatment, evaluate its significance for the treatment process, and determine ways to solve the problem of using a multi-component system of pharmacotherapy risk management. Materials and methods: The study involved 156 patients with CHD, among whom 39 received more than 8 drugs at a time. Results and discussion: In these patients, the evaluation of drug interactions revealed 580 variants (48 were dangerous, 428 – significant, 104 – insignificant). The administration of a therapy to comorbid patients, taking into account possible changes in the activity of cytochrome P450 isoenzymes, is one of the promising ways to improve the safety of a combined pharmacotherapy. Conclusion: It was revealed that with a mutated cytochrome P450 most of processes of drug biotransformation occurs. And there is a greater risk of developing AE against the background of polypragmasia in polymorbid patients, which makes it possible to individually adjust the dose of beta-blockers, thus affecting the frequency of their development. The choice of management measures should be determined considering all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, pharmacoeconomic effectiveness, the development of adverse reactions, polypragmasia, and medical and social risk factors.

Coronary heart disease (CHD), being one of the most common cardiovascular diseases, has a negative impact on patients’ quality of life. The purpose of the work was to study the dynamics of quality of life indicators in patients with CHD during surgical revascularization of myocardium depending on the presence or absence of old myocardial infarction. 68 patients with CHD were examined, including 57 (83.8%) patients with old myocardial infarction (old MI) and 11 (16.2%) patients in the absence of old MI. There was a statistically significant improvement in quality of life, both in the physical and psychoemotional spheres, in patients with stable coronary heart disease including those with a history of myocardial infarction. No effect of old MI on quality of life in patients after myocardial revascularization surgery was observed.

Objectives The present study investigated the analysis of adverse drug reactions (ADRs) to Tamoxifen (TAM) in breast cancer patients in relation to the carriage of genetic polymorphisms of genes encoding enzymes of CYP system and transporters of P-glycoprotein (Pg) and predictive models based on it. Methods 120 women with breast cancer taking adjuvant TAM were examined for the gene polymorphisms such as CYP2D6*4, CYP3A5*3, CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*3 and ABCB1 (C3435T). Allelic variants were determined using the real-time polymerase chain reaction method. The research material was double sampling of buccal epithelium. Medical history data and extracts from case histories were used as sources of medical information, on the basis of which questionnaires specially created by us were filled out. Results An associative analysis showed association with the development of ADRs to tamoxifen indicating their clinical significance from different genetic polymorphisms of CYP2D6, CYP3A5, CYP2C9 and ABCB1. The complex associative analysis performed using mathematical modeling made it possible to build predictive risk models for the development of ADRs such as hot flashes, dyspepsia, bone pain, and asthenia. Conclusions Models that include both genetic and non-genetic determinants of ADRs of TAM may further improve the prediction of individual response to tamoxifen.

The article discusses the prevalence of osteoarthritis of the joints of the hands. The modern aspects of pathogenesis and the leading role of inflammation in it are highlighted. The article assesses the risk factors for osteoarthritis of the joints of the hands. According to recent studies, one of the important factors that increase the risk of developing osteoarthritis of the joints of the hands are gender (in premenopausal women, due to a decrease in estrogen levels, a higher risk of developing osteoarthritis of the joints of the hands is determined compared to men of the same age) and obesity as one of the causes of systemic inflammation. The article draws attention to studies studying a wide range of serum biomarkers with diagnostic and prognostic value, as well as the role of synovitis imaging as a factor contributing to the progression of the disease. The article also discusses the latest recommendations of the leading professional communities of EULAR and ARC on the treatment of patients with osteoarthritis of the joints of the hands. According to modern principles, the treatment of patients should include a combination of pharmacological and non-pharmacological methods and is aimed not only at reducing pain and improving the functional state of the joints, the quality of life of patients, but also at preventing / slowing the progression of the disease. Attention is also drawn to the main provisions on the rational use of NSAIDs by leading Russian associations and communities, which focus on possible adverse reactions of NSAIDs. The article pays great attention to the use of chondroitin sulfate as a substance recommended for the treatment of osteoarthritis of the joints of the hands by leading international communities. The authors present the results of a number of studies proving the safety and effectiveness of the use of chondroitin sulfate in osteoarthritis of the joints of the hands.

The article discusses the treatment of osteoarthritis (OA). In recent decades, ideas about the pathogenesis of OA have undergone significant changes. If at the dawn of the study OA was presented as a degenerative process associated with age, now that some immunological and genetic aspects of the disease have become known, the idea of the pathogenesis of OA has changed. Currently, there are clinical guidelines developed by professional communities that define approaches to the diagnosis and treatment of patients with OA. In Russia, the Association of Rheumatologists and Orthopedic Traumatologists in 2021 developed clinical guidelines for the management of patients with gonarthrosis and coxarthrosis, but currently no clear consensus has been developed in any of the treatment recommendations regarding the use of nutraceuticals and dietary supplements. While according to published studies of plant and botanical nutraceuticals developed from natural products, promising data on efficacy compared to placebo drugs and their potential for the treatment of patients with OA have been demonstrated. According to a study conducted by N.E. Lane et al., patients with OA regularly use supplements, as well as over-the-counter products in combination with prescription drugs, and the likelihood of using prescription products increases with increasing duration and severity of OA. And currently there is not enough knowledge and information about the possibilities of additional use of nutraceuticals in the treatment of patients. The article discusses the composition of the biologically active additive, which has anti-inflammatory, anti-catabolic and antiproliferative effects and can be considered as an addition to NSAIDs, chondroitin sulfate, glycosamine (sulfate or hydrochloride) and their combinations in OA. Type II collagen peptide, curcumin (curcuminoids 95%), black pepper extract (piperine) and Boswellia pilchata extract in clinical studies have demonstrated efficacy and safety in the treatment of patients with OA. A number of studies have also found a number of pleootropic effects. Effects such as anti-inflammatory, neuroprotective, immunomodulatory, cardioprotective and antitumor effects will be important in patients with comorbidity.