Background Current guidelines (GESIDA/PNS-2012) for antiretroviral therapy (ART) in adults recommend the combination of 3 drugs for the treatment of chronic HIV infection. Purpose To analyse the ART in adult HIV- infected patients monitored in our hospital. Materials and Methods A retrospective and descriptive analysis was conducted at the Outpatient Hospital Pharmacy studying the types of ART in HIV adult patients treated on 1 January 2012. Dates were obtained from the electronic outpatient database. Results 1226 patients were receiving ART. The type of therapy was: monotherapy in 40 patients (3.3%), dual therapy in 37 (3%), triple in 1107 (90.3%), quadruple in 32 (2.6%), quintuple in 7 (0.5%), sixfold in 2 (0.2%) and sevenfold in 1 (0.08%). 156 different treatments were observed with 22 drugs. The most common ART combinations were 2 nucleoside reverse transcriptase inhibitors (NRTI) plus a non-nucleoside reverse transcriptase inhibitor (NNRTI) in 585 patients (47.7%), followed by 2 NRTIs plus a protease inhibitor (PI) in 345 (28.1%) and 3 NRTIs in 75 (6.1%). 43.2% (530) received PI therapy and, mainly, boosted. The combinations tenofovir-emtricitabine or lamivudine-efavirenz were the most frequently prescribed in 358 patients (29.2%), followed by abacavir-lamivudine-efavirenz in 89 (7.3%), tenofovir-emtricitabine-lopinavir-ritonavir in 80 (6.6%), tenofovir-emtricitabine-darunavir-ritonavir in 74 (6%) and abacavir-lamivudine-zidovudine in 72 (5.9%). All patients received oral treatment and 3 of them subcutaneous treatment with the T-20 fusion inhibitor. 621 patients (50.7%) received once-daily treatment (49.3%), 604 twice-daily and one patient three doses daily. Regarding the number of dosage forms, 337 (27.5%) patients were taking one, 273 (22.3%) five, 238 (19.4%) three, 77 (14.4%) were taking two. Conclusions On January 2012, 76% of our hospital HIV patients treated with ART were taking triple combinations of 2 NRTIs + 1 NNRTI or 1 PI. All patients except one received once or twice daily treatment and 42% took 1 or 2 dosage forms/day. No conflict of interest.
Background Oral chemotherapy against metastatic or advanced renal-cell carcinoma (mRCC) is currently benefiting from a wide range of possibilities. Purpose To analyse the effectiveness of the actual therapy for the treatment of the mRCC in real conditions based on survival at one and two years and modifications in dosage or drug. Materials and methods Retrospective evaluation of clinical history from November 2011 to September 2013. In our hospital tyrosine kinase inhibitors were the first line treatment and mTOR inhibitors were the second line. Results 68 patients were treated for mRCC. Male/Female: 73/27. Average age: 64.6 years. After 1 year of treatment 81.4% patients survived (22/27) and 42.8% after two years (3/7). 44/68 patients (65%), needed a drug change due to progression. Average time to change was 6.4 months (59% CL: 4.6–8.1) (median: 5.1). 8/68 (11.7%) required a treatment change towards a third line. Of these 8 patients; 3 restarted treatment with sunitinib as fourth line. Out of 41 patients who initiated therapy with sunitinib 50 mg once daily on schedule 4–2; 19 patients (46.3%) needed a descending adjustment of the dose. The average time to dose adjustment was 4.2 months (59% CL: 2.6–5.7) Conclusions Oral treatment of advanced renal cancer has several therapeutic possibilities; which must be treated with rigorous criterion in favour of the clinical benefit applying the maximum efficiency. Even limited by the small sample size, the results are similar to those previously reported in this setting. First year survival rate: 81.4% vs. 75%1 Second year survival rate: 42.8% vs. 50%1 Of the 68 patients studied, 65% required a drug change during their treatment mostly due to loss of efficacy. Sunitinib 50 mg 4–2 schedule dose adjustment: 46.3% vs. 46%2 (33% + 13%) Time to dose adjustment: 4.2 months versus 7.5 months2 References RJ Motzer, B Escudier, R Bukowski, et al. Prognostic factors for survival in 1059 patients treated with sunitinib for metastatic renal cell carcinoma. British Journal of Cancer 2013;108:2470-2477 Martin E Gore, Cezary Szczlik, Camillo Porta, et al. Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol 2009;10:757-63 No conflict of interest.
Background Drug dosage modifications are a common clinical practise regarding Tumor Necrosis Factor (TNF) blockers, using posologies not specified on the authorised product information summary. This practise has a significant financial impact on the healthcare system. Purpose To revise and investigate actual drug dosages in our Hospital’s rheumatology service for conventional TNF blockers. Materials and Methods The Pharmacy Service analysed the internal data record for rheumatology patients treated during April 2012 and for at least one year with infliximab (IFX), etanercept (ETN) or adalimumab (ADA). Off-label indications were excluded. Therapeutic indication, initial and current posology were recorded. Results Number of patients by drug; IFX ETN ADA 128 152 121 Number of patients by indication: RA AS PA JIA 208 109 79 5 RA: Rheumatoid arthritis, AS Ankylosing spondylitis, PA psoriatic arthritis, JIA: Juvenile idiopathic arthritis Regarding posology, 261 patients (65%) were on a conventional dose (CD), 93 (23%) on a reduced dose (DR) and 47 (12%) on an increased dose (DI) Percentage of patients by drug on CD, DR or DI was; Treatment/posology CD DR DI IFX 33% 35% 32% ETN 79% 21% – ADA 82% 14% 4% Percentage of patients by indication was; Indication/posology CD DR DI RA 65% 19% 16% AS 59% 32% 9% PA 72% 24% 4% JIA 80% 20% – Conclusions Only 65% of patients using TNF blockers on rheumatology use a CD while a quarter of them have a reduced posology. Infliximab is the drug that requires more dosage modifications, on almost 2/3 of patients. AS and PA are the indications that allow more DR. Drug dosage revisions at the end of the first year of treatment allow an important number of patients to reduce their dose while controlling their disease and it is a relevant efficacy instrument. No conflict of interest.
Facilitate access to hepatitis C treatment in opiate dependant patients: an strategy between different assistance levels
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