Background We aimed to describe the frequency of use and effectiveness of bezlotoxumab (BZX) and fecal microbiota transplantation (FMT) in patients with Clostridioides difficile infection (CDI) in real-world practice. Methods Retrospective study conducted in a university hospital in which adult patients treated with BZX or FMT from January-2018 to April-2021 were included. The primary objective was to evaluate the effectiveness of BZX and FMT in preventing early (within 8 weeks) and late (within one year) CDI recurrences (rCDI). A multivariate analysis of risk factors for early recurrence was performed. Results Of 1,377 consecutive CDI episodes, 117 (8.5%) received BZX or FMT, with full information available for 100 of the episodes: 51 received BZX and 49 received FMT. BZX was used mostly in immunosuppressed patients (66.7%) and in first episodes or first recurrences in 70.6% of the cases. FMT was prescribed only in CDI recurrences. Despite the different conditions of the patients, there were no significant differences between BZX and FMT in preventing early rCDI (19.6% vs. 24.5%, p = 0.55) or late rCDI (9.8% vs. 18.4%, p = 0.31). In the multivariate analysis, risk factors for recurrence were presence of ≥ 2 previous rCDI episodes (OR 2.90, 95%CI 1.03-8.63) and use of non-CDI antibiotics (OR 3.45, 95%CI 1.24-9.57). Conclusions BZX and FMT were infrequently used in a real-world practice. Both treatments had similar effectiveness in preventing CDI recurrence despite its application to different populations.
BackgroundThe new direct acting antiviral (DAA) agents mean a breakthrough in the treatment of hepatitis C virus. However, these DAA agents are not free of drug-drug interactions (DDI), which can significantly reduce their effectiveness or produce adverse events.PurposeThe aim of this study was to describe the type and severity of DDI between DAA and concurrent patient medication, and resolve them through pharmacist interventions.Material and methodsAn observational, descriptive, prospective study was carried out in the outpatients pharmacy consults of a university hospital. Every patient starting treatment from April to September 2015 was included.The patients’ concurrent medications were screened by the pharmacist during the interviews carried out on a monthly basis, as part of an intensive pharmaceutical care programme. Potential interactions between DAA and concurrent medications were checked through the Lexi-comp application and the website of the University of Liverpool. Those interactions were classified according to severity, defined by FDA (B, C, D, X).Recommendations were made by pharmacists to avoid clinically significant DDI.Results694 patients were included (63.4% men); mean age 56.7 (SD 12.9) years. 54.5% of patients were treated with ombitasvir/paritaprevir/ritonavir±dasabuvir, 40.6% with sofosbuvir/ledipasvir and 4.9% with others. The mean number of concurrent medication per patient was 4.7(SD 3.3).471 DDI were recorded: 52.3% with ombitasvir/paritaprevir/ritonavir±dasabuvir, 46.1% with sofosbuvir/ledipasvir and 1.6% with others. At least one DDI was identified in 310 patients (44.7%). According to FDA severity, DDI were classified as follows: type B (2.3%), type C (43.1%), type D (47.6%) and type X (7%).The most frequent DDI were as follows: cardiovascular agents (35.9%), proton pump inhibitors (11.9%) and antidepressants (7.4%). In most cases the drug interacting with ombitasvir/paritaprevir/ritonavir±dasabuvir was amlodipino, and with sofosbuvir/ledipasvir was omeprazole.In 141 (29.9%) interactions, pharmaceutical intervention was required: 69 (48.9%) interventions were necessary to correct the technique of administration, 31 (22%) interventions to improve safety or effectiveness monitoring and 25 (17.7%) to withhold any of the treatments for contraindication.ConclusionPatients treated with DDA are polymedicated and almost half of them suffered at least one moderate/severe drug interaction. The most relevant DDI were cardiovascular agents, proton pump inhibitors and antidepressants. The intensive pharmaceutical care programme has proved to be important to detect DDI and improve safety and effectiveness of clinically significant DDI.References and/or AcknowledgementsLexi-Comp. Available from: Drug interactions charts. Available from: No conflict of interest.
What Is Known and Objective: Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and highly disabling diseases. The objective is to evaluate the satisfaction with the health care received by patients with the most prevalent IMIDs in Spain: inflammatory bowel disease (IBD), psoriasis (Ps) psoriatic arthritis (PsA), rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and to determine the factors that influence patient satisfaction.Methods: This was an observational, cross-sectional, multicentre study in a real-world evidence context conducted in the Pharmacy Service in four hospital centres of the Community of Madrid that belong to the National Health System. The study included adult patients diagnosed with an IMID who had attended the Pharmacy Service at least three times. The patients were grouped according to the main IMID. Health care satisfaction was evaluated using the chronic patient experience assessment (IEXPAC) questionnaire. The responses to IEXPAC are grouped into three factors: productive interactions, new relational model and patient self-management, with a total score from 0 (worst) to 10 (best experience). Health-related quality of life (HRQoL) was also evaluated using the EQ-5D-5L questionnaire, and pharmacological adherence was evaluated through the Morisky-Green test.Results and Discussion: A total of 578 patients were analysed (IBD = 25.3%; Ps = 19.7%; SpAs = 18.7%; RA = 18.5%; PsA = 17.8%). The mean age (SD) was 49.8 (12.3) years and 50.7% were male. The average score (SD) for the total IEXPAC sample was 6.6 (1.9). RA was the IMID with the lowest score, at 5.83 (2.0), significantly lower than the scores of Ps (SD) [7.01 (1.7); p = 0.003], IBD [6.83 (1,9); p = 0.012] and SpAs [6.80 (1.6); p = 0.001]. Productive interactions (SD) [8.5 (1.8)] and patient self-management (SD) [7.3 (2.3)] were the factors with the highest scores, and the new relational model had the lowest score (SD) [3.2 (2.7)]. Male gender, a longer time
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