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§132i-Verträge: Aktueller Stand. Stellungnahme von Priv.-Doz. Dr. med. Jürgen Koscielny, Ärztlicher Verhandlungsführers der §132i SGB V Verträge, Vorsitzender des BDDH Hintergrund und Auftrag Mit dem GSAV (Gesetz für mehr Sicherheit in der Arzneimittelversorgung) sollen eine bessere Zusammenarbeit von Bundes- und Länderbehörden sowie eine stärkere Kontrolle von Arzneimittelherstellern und Apotheken erreicht werden. Der Bund soll erweiterte Befugnisse zur Verbesserung der Arzneimittelsicherheit erhalten. Informationen über die Hersteller der Wirkstoffe in Arzneimitteln werden in Zukunft öffentlich zur Verfügung gestellt. Um Lieferengpässen bei Medikamenten entgegen zu wirken, werden Krankenkassen verpflichtet, bei Rabattverträgen künftig die Vielfalt der Anbieter zu berücksichtigen. Schließlich enthält das Gesetz einen Fahrplan zur schrittweisen Einführung des elektronischen Rezepts. Für Arzneimittel zur Versorgung von Patientinnen und Patienten mit hämophilen Gerinnungsstörungen, wird die bisherige Ausnahme vom Apothekenvertriebsweg (Direktvertrieb des Herstellers mit Ärzten und Krankenhäusern) zurückgenommen. Die Neuregelungen zum Vertriebsweg sowie die entsprechende Anpassung der Arzneimittelpreisverordnung und des Apothekengesetzes treten erst am 01.09.2020 in Kraft, auch infolge des vom BDDH initiierten und konzertierten Appells an den Bundesgesundheitsminister und die Gesundheitsbehörden der Bundesländer vom 24.03.2020 zur Verschiebung der Umsetzung des Vertriebsweges von Gerinnungsfaktorenzubereitungen.

We analyzed data for women who received fondaparinux for ≥7 days during pregnancy. The study retrospectively included women who received fondaparinux pre-, peri- and/or postpartum for ≥7 days for prophylaxis/venous thromboembolism (VTE) treatment at German specialist centers (2004-2010). Data on pregnancy, VTE risk factors, anticoagulant treatment, pregnancy outcome and adverse events were extracted from medical records. 120 women (mean age 31.5 years) were included. Among 84 women with prior pregnancies, 41.0% had ≥1 abortion. Anticoagulation was indicated for prophylaxis in 92.5% cases, including 82.5% women with an elevated VTE risk (82.8% thrombophilia, 34.2% VTE history). All women received low-molecular-weight heparin (LMWH) as first-line therapy; 3 also unfractionated heparin. Treatment changed to fondaparinux, due to heparin allergy (41.7%) or heparin-induced thrombocytopenia (10.0%). Fondaparinux was generally well tolerated. Adverse events included bleeding events (n = 5), abortion (n = 2), premature births (n = 2), stillbirth (n = 1), arrested labors (n = 2), injection site erythema (n = 4) and unspecified drug hypersensitivity (n = 6). No VTE events or increased liver enzymes occurred during treatment. In this retrospective study, fondaparinux was effective and well tolerated. Trial registration: ClinicalTrials.gov NCT01004939.

Background Inhalation of high concentrations of zinc oxide particles (ZnO) may cause metal fume fever. In an earlier human inhalation study, no effects were observed after exposure to ZnO concentrations of 0.5 mg/m3. Further data from experimental studies with pure ZnO in the concentration range between 0.5 and 2.5 mg/m3 are not available. It was the aim of this experimental study to establish the concentration-response relationship of pure nano-sized ZnO particles. Methods Sixteen healthy subjects were exposed to filtered air and ZnO particles (0.5, 1.0 and 2.0 mg/m3) for 4 h on 4 different days, including 2 h of cycling with a low workload. The effects were assessed before, immediately after, and about 24 h after each exposure. Effect parameters were symptoms, body temperature, inflammatory markers and clotting factors in blood, and lung function. Results Concentration-dependent increases in symptoms, body temperature, acute phase proteins and neutrophils in blood were detected after ZnO inhalation. Significant effects were detected with ZnO concentrations of 1.0 mg/m3 or higher, with the most sensitive parameters being inflammatory markers in blood. Conclusion A concentration-response relationship with nano-sized ZnO particles in a low concentration range was demonstrated. Systemic inflammatory effects of inhaled nano-sized ZnO particles were observed at concentrations well below the occpational exposure limit for ZnO in many countries. It is recommended to reassess the exposure limit for ZnO at workplaces.

Taurine is an abundant organic osmolyte with antioxidant and immunomodulatory properties. Its role in the pathogenesis of chronic liver disease is unknown. The liver phenotype was studied in taurine transporter knockout (taut-/-) mice. Hepatic taurine levels were ~21, 15 and 6 mumol/g liver wet weight in adult wild-type, heterozygous (taut+/-) and homozygous (taut-/-) mice, respectively. Immunoelectronmicroscopy revealed an almost complete depletion of taurine in Kupffer and sinusoidal endothelial cells, but not in parenchymal cells of (taut-/-) mice. Compared with wild-type mice, (taut-/-) and (taut+/-) mice developed moderate unspecific hepatitis and liver fibrosis with increased frequency of neoplastic lesions beyond 1 year of age. Liver disease in (taut-/-) mice was characterized by hepatocyte apoptosis, activation of the CD95 system, elevated plasma TNF-alpha levels, hepatic stellate cell and oval cell proliferation, and severe mitochondrial abnormalities in liver parenchymal cells. Mitochondrial dysfunction was suggested by a significantly lower respiratory control ratio in isolated mitochondria from (taut-/-) mice. Taut knockout had no effect on taurine-conjugated bile acids in bile; however, the relative amount of cholate-conjugates acid was decreased at the expense of 7-keto-cholate-conjugates. In conclusion, taurine deficiency due to defective taurine transport triggers chronic liver disease, which may involve mitochondrial dysfunction.

The impact of heterozygous HFE mutations on the course of chronic hepatitis C and iron indices was studied.Ferritin, transferrin saturation (TS), serum iron, C282Y and H63D mutations were determined in 401 patients with chronic hepatitis C virus (HCV) infection and 295 healthy controls. Liver histologies were available in 217 and HCV genotypes in 339 patients.Allele frequencies of the C282Y and H63D mutation did not differ between HCV patients and healthy controls (6.95 vs. 6.2%; 14.75 vs. 16.4%; n.s.). HFE heterozygous HCV patients had higher ferritin (349+/-37 vs. 193+/-15 microg/l; P0.0005), TS (38+/-2 vs. 32+/-1%; P0.0005), serum iron (144+/-6 vs. 121+/-3 microg/dl; P0.0005), semiquantitative liver iron staining (0.26+/-0.07 vs. 0.09+/-0.03; P0.006) and fibrosis scores (1.9+/-0.2 vs. 1.4+/-0.1; P0.003) compared to HFE wildtypes. By multivariate regression analysis odds ratios for liver cirrhosis were 5.9 (confidence interval (CI) 1.6-22.6; P0.009) for C282Y heterozygotes and 2.9 (CI 1.0-8.4; P0.05) for H63D heterozygotes compared to HFE wildtypes. Considering all HFE heterozygous HCV patients, odds ratios of 3.6 (CI 1.4-9.3; P0.009) for cirrhosis and 3.1 (CI 1.3-7.3; P0.009) for fibrosis were calculated.C282Y or H63D heterozygosity is an independent risk factor for liver fibrosis and cirrhosis in HCV infected individuals. Screening for HFE mutations should be considered in HCV infection.