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All Journal INDONESIAN JOURNAL OF PHARMACY JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Journal of Tropical Pharmacy and Chemistry
Yolanda Dyah Kartika
Department Of Pharmacology And Therapy, Faculty Of Medicine, Public Health And Nursing, Gadjah Mada University, Yogyakarta, 55281, Indonesia
Biochemistry, Genetics & Molecular Biology Chemistry Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting Dwiprahasto, Iwan; Kristin, Erna; Endarti, Dwi; Pinzon, Rizaldy Taslim; Yasmina, Alfi; Thobari, Jarir At; Pratiwi, Woro Rukmi; Kartika, Yolanda Dyah; Trijayanti, Christiana
Indonesian Journal of Pharmacy Vol 30 No 1, 2019
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1127.563 KB) | DOI: 10.14499/indonesianjpharm30iss1pp74

Abstract

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin.
The expression of multidrug resistance protein 5 and thymydilate synthase on fluorouracil resistance WiDr colon cancer cell line Yolanda Dyah Kartika; Indwiani Astuti; Woro Rukmi Pratiwi
JKKI : Jurnal Kedokteran dan Kesehatan Indonesia JKKI, Vol 7, No 2, (2015)
Publisher : Faculty of Medicine, Universitas Islam Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20885/JKKI.Vol7.Iss2.art5

Abstract

Background: Colorectal cancer becomes one of the most common cancer in Indonesia. Fluorouracil is an essential drug in colorectal cancer therapy as it has been supplemented in about 69% of current regiments of chemotherapy. However, drug resistance has reduced its clinical applications. Many factors that contribute to fluorouracil resistance have been investigated including overexpression of Multidrug Resistance Protein 5 (MRP 5) and high level expression of Thymidylate Synthase (TS). Therefore, the expression of those proteins may become key indicators to predict the presence of resistance in the model of fluorouracil-resistance-WiDr colon cancer cell line. Objective: The aim of this study is to characterize a 5-FU acquired resistance WiDr colon cancer cell line, focus on the expression of MRP5 and TS. Methods: This study was a post test controlled group design. The expression of MRP5 and TS were analyzed using immunocytochemistry method. Before protein expression analysis, 4 groups of WiDr colon cancer cell line, group 1, 2, 3, and 4 (control) were treated with 4 different concentration of fluorouracil 12.3 μM, 6.15 μM, 3.08 μM, and 0 μM respectively. Previous study showed that a significant increased level of IC50 value is observed in group induced with fluorouracil 3.08 μM (group 3). Statistical tests for protein expression performed with SPSS version 19 using Kruskall Wallis with 95% confidence level (p<0.05). Results: The expression of MRP5 and TS in the group developed fluorouracil resistance (group 3) were significantly increased compared to control group (p<0.05). In contrast, the other group exposed with higher dose of fluorouracil did not show both significant increased level of IC50 nor significant different of MRP5 and TS expression compared with the control group. Conclusion: The model of fluorouracil-acquired resistant WiDr cell line expresses Thymidilate Synthase and Multidrug Resistance Protein 5. The expressions of these proteins are in accordance with the profile of fluorouracil resistancy.
Immunosupressant Effect of the Extract of Tridax procumbens on Lymphocyte Cells Line from Patients with Systemic Lupus Erythematous: Immunoglobulin Gbiomarker Abdul Khairul Rizki Purba; Endang Mahati; Yolanda Dyah Kartika; Indwiani Astuti; Nyoman Kertia
Journal of Tropical Pharmacy and Chemistry Vol. 2 No. 2 (2013): J. Trop. Pharm. Chem.
Publisher : Faculty of Pharmacy, Universitas Mulawarman, Samarinda, Indonesia, 75117, Gedung Administrasi Fakultas Farmasi Jl. Penajam, Kampus UNMUL Gunung Kelua, Samarinda, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25026/jtpc.v2i2.50

Abstract

Systemic Lupus Erythematous (SLE) is one of the major autoimmune diseases that can cause severe damage to the tissues and organs in the body and lead to high mortality rates. The clinical manifestations are characterized by the production of autoantibody immunoglobulin G (Ig G) that fights component of the nucleus. The present scientific information issues about peculiar property of Tridax procumbens as immunosuppressant by inhibiting enzyme of cyclooxygenase-2 (COX-2) on surface of B cells. This study approved effect of the extract of Tridax procumbens on human lymphocytes cells line with SLE disease. The aim of this study was to approve effect of extract of Tridax procumbens in suppressing Ig G concentration from patient with stable SLE and patient with active SLE in vitro. This study was an in vitro experimental design on lymphocytes cell line that was isolated from whole blood patient with stable SLE and active SLE. Lymphocyte cells from healthy volunteer were also collected as control. American Rheumatism Association Diagnostic was used for inclusion criteria.Tridax procumbens was extracted with maceration method in solution of ethyl acetate. The extract was divided in several doses as immunosuppressant i.e.1000; 250; 62.5; 31.25; 15.13; and 3.91 µg/mL. Supernatant of the cultured cells was collected and examined for measuring Ig G concentration as secretion from activated B cells by ELISA. Ethical clearance had been completed before this study started. The extract of Tridax procumbens significantly suppressed Ig G secretion in patient with stable SLE at dose over 62.5 µg/mL, but Ig G concentration in patient with active SLE was significantly increased when compared with control. Furthermore from the analysis, effect of the Tridax procumbens extract on Ig G concentration followed dose dependent response. In in-vitro study, the extract of Tridax procumbens could significantly suppress Ig G secretion in healthy volunteer and patient with stable SLE. Otherwise, the extract does not suggest for patient with active SLE and it needs caution in use and investigation in-depth. Keywords: SLE, Tridax procumbens, immunoglobulin G ABSTRAK Penyakit Systemic Lupus Erythematous (SLE) merupakan salah satu penyakit autoimun yang sering menyebabkan kerusakan jaringan dan organ sehingga angka kematiannya tinggi. Karakteristik patognomonik penyakit SLE ditandai ada produksi auto antibody immunoglobulin G (Ig G) yang melawan komponen nukleosom tubuh sendiri. Penelitian ilmiah terbaru menunjukkan bahwa ekstrak Tridax procumbens memiliki efek imunosupresan melalui hambatan enzim cyclooxygenase-2 (COX-2) pada permukaan sel B. Pada studi ini menguji efek ekstrak Tridax procumbens pada cells line limfosit dari pasien SLE. Tujuan penelitian ini adalah mengetahui efek ekstrak Tridax procumbens dalam menekan konsentrasi Ig G pasien dengan SLE stabil dan pasien dengan SLE aktif secara in vitro. Penelitian ini merupakan penelitian eksperimen pada cell line limfosit yang diisolasi dari whole blood pasien dengan SLE stabil dan SLE aktif. Kelompok kontrol limfosit diambil dari sukarelawan sehat. Kriteria inklusi pasien yang mengikuti penelitian ini berdasarkan kriteria diagnostik American Rheumatism Association. Tridax procumbens diekstraksi dengan metode maserasi larutan etil asetat. Ekstrak dibagi menjadi beberapa dosis sebagai imunosupresan yaitu 1000; 250; 62,5; 31,25; 15,13; dan 3,91 µg/mL. Supernatan dari sel kultur dikoleksi dan diukur konsentrasi Ig G yang merupakan sekresi sel B dengan menggunakan metode ELISA. Persetujuan etik dilakukan sebelum penelitian dilakukan. Ekstrak Tridax procumbens menekan sekresi Ig G pasien dengan SLE stabil pada dosis diatas 62,5 µg/mL, namun konsentrasi Ig G dari pasien dengan SLE aktif meningkat secara signifikan dibandingkan dengan kontrol. Efek ekstrak Tridax procumbens pada konsentrasi Ig G mengikuti dose dependent response. Pada penelitian ini, ekstrak Tridax procumbens dapat menekan sekresi Ig G dari pasien dengan SLE stabil dan sukarelawan sehat. Pemberian ekstrak Tridax procumbens tidak dianjurkan pada pasien dengan SLE aktif, namun hal ini masih membutuhkan penelitian lebih mendalam. Keywords: SLE, Tridax procumbens, imunoglobulin G
Co-Authors Abdul Khairul Rizki Purba Mustofa Indwiani Astuti Alfi Yasmina Endang Mahati Erna Kristin Indwiani Astuti Indwiani Astuti Iwan Dwiprahasto Jarir At Thobari Nyoman Kertia Pratiwi, Woro Rukmi Pratiwi, Woro Rukmi Rizaldy Pinzon Trijayanti, Christiana