Clinical Research

Medication outcomes and comparative effectiveness

the assessment of relative drug effectiveness in the treatment of various disease states

The department-based UCSF Medication Outcomes Center (MOC) performs research and conducts evidence-based analyses to assess the safety, efficacy, and cost-effectiveness of medications at UCSF Health and affiliated institutions.

Examples of our research include:

• Reviewing World Health Organization, U.S. Food and Drug Administration, and medical literature databases to determine whether the antipsychotic haloperidol, when administered intravenously to treat acute delirium, was associated with dangerous arrhythmias and thus required continuous electrocardiogram monitoring
• Analyzing the safety and coordination of drug monitoring and information resources (such as black box safety warning information about potential adverse drug reactions) to warn dispensing pharmacists of duplications of drug classes, in particular cumulative excessive doses of acetaminophen

Pharmacoepidemiology

observational studies of drug effectiveness and harm in broad populations

The department is home to the California Poison Control System (CPCS), which provides round-the-clock telephone consultations to the public, as well as to health care and emergency medical providers, on more than 300,000 poisoning cases each year. While a public service, the CPCS also has a research agenda that includes retrospective reviews of poisoning and overdose trends, risk factors for complications, comparable toxicities, and best treatment practices.

Examples of our research include:

• Evaluating the association between pharmacological clearance and severe rash and hepatotoxicity for the antiretroviral nevirapine in HIV-infected sub-Saharan African women
• Evaluating risk factors for complications of drug-induced seizures, and determining which newer medications have emerged as common causes of seizures
• Comparing the acute toxicity of first- versus second-generation antipsychotic drugs, via chart review of nearly 2,000 overdose cases in the CPCS database
• Evaluating the impact of a hospital-wide increase in initial dosing of the antibiotic vancomycin in children suspected of having methicillin-resistant Staphylococcus aureus (MRSA) infection, based on predictive models of pediatric drug clearance
• Comparing the cost-effectiveness of using a more expensive antifungal medication with a reduced rate of nephrotoxicity for the prophylactic treatment of chemotherapy-associated neutropenia

Pharmacokinetics and pharmacodynamics

the absorption, distribution, metabolism, and excretion of drugs by the body, and the effects of drugs on pathogens and diseases

Examples of our research include:

• Developing new drug regimens to more effectively kill bacteria when they aggregate into antibiotic-resistant biofilms, specifically P. aeruginosa infections in the lungs of patients with cystic fibrosis
• Evaluating the most widely-used treatments for malaria to determine if standard dosing derived from adult studies is safe and effective for young children or pregnant women, including when it is given in combination with antiretrovirals for HIV
• Studying how variables (age, kidney function, or genetics) affect the pharmacokinetics of drugs used to treat patients undergoing stem cell transplants for blood and bone marrow cancers, such as leukemia
• Developing a low-cost, non-invasive, and field-friendly test for patient adherence to and pharmacokinetics of antiretrovirals—thus predicting HIV treatment outcomes—by analyzing drug levels in hair samples