Background Few data have been reported on the use and safety of denosumab in patients with solid tumors and bone metastasis in clinical practice. Objectives To describe the use of denosumab and to analyze its adverse effects (AE) in tertiary hospital cancer outpatients. Methods Retrospective study of patients who started denosumab between January 2013 and June 2015. We recorded demographic, clinical, and treatment-related variables, as well as the reasons for discontinuation and AE. Results The study population comprised 104 patients, of whom 86 (82.7%) were receiving concomitant outpatient cancer treatment and 39 (38%) had previously received zoledronate. At baseline, albumin-corrected calcium levels were available for 48 patients (46.2%), and 70 (67.3%) were receiving calcium/vitamin D supplements. The median number of denosumab doses was 7.5 (range, 1-29). The main reasons for treatment discontinuation were disease progression (20.2%) and AE (25%). Hypocalcaemia was recorded in 38.5% of patients and osteonecrosis of the jaw in 12.5%. Monitoring of calcium levels was poor at baseline and during follow-up. Conclusions We found a higher incidence of all-grade osteonecrosis of the jaw than reported in the literature. Adherence to published recommendations on calcium supplementation and guidelines on calcium monitoring was poor. In line with our findings, a protocol for use and monitoring of denosumab has been promoted in our hospital.
BackgroundAdherence to medication is a major problem in chronic diseases. Mobile health applications can be used as a support tool and could enhance the empowerment of patients with chronic illness.PurposeOur aim is to assess a medication self-management platform, Medplan, in order to improve adherence and health outcomes in chronic hepatitis B virus (HBV)-infected patients.Material and methodsA 6 month single-arm prospective pre-post intervention study was performed. Patients receiving treatment for chronic HBV infection were included. Participants were followed according to their usual care in the pre-intervention phase, and after 3 months, using Medplan (intervention phase). Medplan reminds patients to take their medications, provides drug information, is a patient-healthcare professionals communication channel and provides an adherence registration tool. Adherence and quality of life were determined using validated tools (simplified medication adherence questionnaire (SMAQ), proportion of days covered with medication (PDC) and EuroQol-5 Dimension (EQ-5D) questionnaire). HBV DNA pre- and post-intervention was collected. Medplan;s usefulness and patients’ self-registered adherence were analysed. The study was approved by the ethics committee. Informed consent was required.ResultsOf the 82 patients enrolled, 36 patients (43.9%) withdrew from the study, for the following reasons: difficulties installing and using Medplan (n=9), technical issues (application does not work/reminders did not trigger, n=7) and unwillingness to use the application (n=4). Nine patients are still in the study. Study population comprises 37 patients (73% males, 54±10 years, one naïve patient). The number of adherent patients increased during intervention: 20/37 to 26/36 by SMAQ (1one patient did not answer the final questionnaire) and 95.7±12.4 to 98.7%±5 by PDC. No changes were found in the mean quality of life during the study. The number of patients with undetectable HBV DNA increased using Medplan, from 17 at the beginning to 26 at the end of the study (three results are pending). Medplan application registered adherence was 91.6%±13%. Mean utility score was 8.4 out of 10 among patients.ConclusionMedplan platform could improve medication adherence and health outcomes for chronic HBV patients. Technical problems must be solved in order to include more patients. Further studies are required.Reference and/or Acknowledgements1. Anglada H, et al. J Med Syst2017;41(8):122.No conflict of interest
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