BackgroundCanakinumab is a IgG1 anti-interleukin-1β monoclonal antibody indicated in the treatment of Muckle–Wells syndrome (MWS). It is an autosomal dominant congenital disease that is considered a rare disease. Hives, joint pains, conjunctivitis, deafness, amyloidosis and fever are its symptoms. For years, the only available treatments were non-steroidal anti-inflammatory drugs (NSAIDs) and systemic corticoids.PurposeThe objective of this study was to determine the effectiveness of canakinumab in the treatment of MWS in patients who have failed treatment with NSAIDs and systemic corticoids.Material and methodsAn observational retrospective study was carried out in a tertiary care hospital from February 2011 to October 2016. Patients who were treated with canakinumab during this period were selected. The data was obtained from the electronic software used in the hospital (Landtools). Indication, posology, duration of treatment, previous therapy, adverse effects and C reactive protein (CRP) levels were collected from patients’ digital history. Suspension of treatment with canakinumab was also registered. Remission was defined as clinical improvement plus normal CRP (<6 mg/L). Available treatments were NSAIDs and systemic corticoids.Results6 patients were selected; median age 52 years (36–66 years). The indication for treatment with canakinumab was MWS. Patients received canakinumab 150 mg subcutaneously every 8 weeks (n=5) or 12 weeks (n=1) for a median of 47 months (range 24–70). All patients had received corticoids and NSAIDs with no suitable response. Other previous therapies were antihistamines, methotrexate, colchicine, infliximab, etanercept and hydroxychloroquine. Canakinumab was well tolerated; 1 patient experienced an injection site reaction.Treatment with canakinumab caused a significant reduction in clinical disease activity and CRP levels (average before treatment of 40.7 mg/L (3.7–81.2 mg/L) versus average after treatment of 19.27 mg/L (0.45–86.03 mg/L)). 50% (n=3) of canakinumab treated patients achieved remission. All patients are currently receiving treatment.ConclusionCanakinumab is an effective therapeutic alternative for the treatment of MKS if poor effects have been achieved on other therapies. The observed evolution was favourable, being safe and well tolerated.References and/or acknowledgementsOrphanet guide.No conflict of interest
BackgroundChemotherapy prescriptions validation by the oncology pharmacist often require interventions to optimise some aspects of the treatment, usually related to the safety and effectiveness of antineoplastic agents.PurposeOur pharmacy department has developed an initiative to register these interventions, in order to characterise possible areas of improvement in the prescription validation process.Material and methodsDuring a period of 2 months, we created a database collecting data from the interventions made, which included the following information: date of intervention, medical record number, drug involved, reason/type of intervention and result of the intervention (accepted/not accepted). Sociodemographic, clinical and laboratory data were obtained from medical records. Statistical analysis of the results was performed using Microsoft Excel.Results44 interventions (43 accepted) were recorded. The department in which more interventions were recorded was medical oncology (64%), followed by haematology (29%), paediatrics (4.8%) and radiotherapy oncology (2.4%). Median age of the patients included in the database was 58.5 years (2–87), and 72% of patients were women. The most common reasons for intervention were due to ‘prescribing errors’ (47.7%), ‘pharmacotherapeutic recommendations’ (22.7%), ‘consultations/requests for information’ (15.9%), ‘adverse events’ (6.8%) and some minor reasons grouped into the category ‘others’ (6.8%). The most common types of intervention were ‘dose modification due to an adverse event (AE)’ (34%) and ‘resolution of consultations regarding prescription/medication administration’ (18%). The next types of interventions by frequency were ‘treatment recommendations’ (9.1%) and dose adjustments based on renal function’ (6.81%). Less common intervention types (4.5%) were: ‘changes in prescription’, ‘dose adjustments based on an AE’, ‘dose adjustments based on pharmacotherapeutic recommendations’, ‘changes in route of administration’ and ‘changes in dosing schedule’. Finally, type of interventions such as ‘changes in the regimen of administration’, ‘treatment interruption’ or ‘pharmaceutical compounding’ were reported in 2.3% of cases.ConclusionOncology pharmacist participation in the patient care multidisciplinary team is essential, as is clear from the high rate of acceptance of our interventions. One of the most important aspects of pharmaceutical validation is to identify errors in the prescription and medication administration process, as well as participation in the individualisation of patient therapy through pharmacotherapeutic recommendations, ensuring the effectiveness and safety of the treatment.No conflict of interest.
BackgroundWe describe a 47-year-old women diagnosed with C3 category HIV infection in 1996. After other drug combinations, she started on LPV/r (a protease inhibitor (PI)) in 2007 and in 2013 she had a DDD pacemaker implanted.PurposeTo explore whether the cardiac event was related to PI treatment.Material and methodsThe medical history was obtained from the digital clinical history (DCH) and the refill records from the pharmacy department (Farmatools). A bibliographic research was conducted to find similar cases or if it was a common–uncommon adverse effect (AE). The LPV/r data sheet as well as other PI data sheets was revised. Naranjo’s algorithm (NA) was applied to assess the relationship between the atrioventricular block (AB) and PI. This algorithm establishes a positive or negative relation of the drug event based on a final assessment.ResultsThe patient was followed in 2010 as she was suffering from syncope whose cause was uncertain. As was recorded in her DCH, neither the neurologist nor the cardiologist was certain if the main cause was pharmacological or neurological, as the patient was also developing a progressive multifocal leukoencephalopathy. A pacemaker was implanted in 2013 to correct the cardiac dysfunction. She was started on LPV/r in 2007 but stopped when the pacemaker was implanted. After that, she was started on TDF/FTC. As described in the literature, PI can potentially provoke either second or third grade AB or Qt wave prolongation. This could unmask heart conditions that would not show up in other scenarios. According to NA, the final assessment was 4, giving a drug event relation as ‘possible’. Since the pacemaker was implanted, she has not returned to PI or had any more cardiac events.ConclusionAs we described in this case, there is a possibility that the AB was provoked by PI. This situation highlights the importance of being familiar with all AE to quickly modify a patient’s treatments to avoid future complications. Hospital pharmacists also play an important role in checking for possible drug interactions.References and/or acknowledgementsVillamañán E, Armada E, Ruano M. Prolongación del intervalo QT inducido por fármacos:?` conocemos sus riesgos? Med Clínica2015;144:269–74.No conflict of interest
BackgroundThe δ-9-tetrahydrocannabinol-cannabidiol (THC-CBD) oromucosal spray (Sativex) is a standardised cannabinoid based medicine for add on treatment of resistant multiple sclerosis (MS) induced spasticity.PurposeTo evaluate the use of oromucosal spray Sativex in terms of efficacy for symptoms and functional impairment associated with resistant MS induced spasticity and safety according to type of MS.Material and methodsA retrospective cohort study was conducted in a university hospital in South Spain in patients who commenced Sativex between March 2015 and November 2015. Data were retrieved from the electronic medical records (Diraya) and the dispensing programme for outpatient (Farmatools). Patients were classified by type of MS: relapsing remitting (RR), primary progressive (PP) and secondary progressive (SP). Evaluation was performed on day 0 and day 60 of treatment with Sativex. The Modified Ashworth Scale was used for grading spasticity where ‘improvement’ was defined as >20% deviation from baseline.Results14 patients were included. 4 (28.6%) were men with a median (IQR) age of 47.5 years (37–69). Types of MS were: 10 (71.4%) RR, 1 (7.1%) PP and 3 (21.4%) SP. The overall response, defined as ‘improvement’ to Sativex, was 9 (64.3%) and by type of MS: 6/10 (60%) RR, 1/1 (100%) PP and 2/3 (66.7%) SP. Only 1 patient (7.1%) discontinued treatment due to drug related adverse events. 2 additional patient were treated with Sativex but excluded from this analysis due to a diagnose different from MS.ConclusionIn our cohort, oromucosal spray Sativex was a well tolerated drug and an effective alternative for the management of resistant MS induced spasticity. As for MS type subgroup analysis, a greater sample size is needed for more robust conclusions.No conflict of interest
BackgroundOral chemotherapy is increasingly used in Oncology. It has important advantages, such as patient comfort, but it also brings new challenges which did not exist with the intravenous treatment. Some of these drugs have interactions with food, leading to changes in their bioavailability. As they are drugs with a narrow therapeutic margin, this can lead to alterations in their efficacy and/or toxicity.PurposeA. To assess the level of knowledge on the administration of oral cytostatics that present restrictions with meals (drugs that have to be taken with/without food) among the outpatients of a third level hospital. B. To minimise the incorrect administration and the risk of food-drug interactions, providing patients with information as to how and when drugs have to be administered.Material and methodsOnce the oral cytostatics with food restrictions were identified, we asked the patients in treatment about the information they had received from the doctor and the way they were taking the medicine. We provided those who were taking the drug incorrectly with the right information. In the following visit, it was confirmed if the patients who had previously been taking the cytostatic incorrectly, were now taking them correctly (intervention accepted/not accepted).Results97 patients were interviewed (54% men, 46% women). 40% of them were used to taking the drug incorrectly. Of this percentage, 77% correspond to patients treated with capecitabine, 8% with lapatinib, another 8% with temozolomide, and finally 3% with abiraterone, erlotinib and pazopanib, respectively. We detected a great diversity depending on the drug dispensed. 95% of the 39 interventions made were accepted.ConclusionThe data obtained suggest the need to reinforce the information that the patient receives. It is important to make sure that the patient understands how and when the oral cytostatic should be administered.ReferenceCharity D. Drug interactions in cancer therapy. Nature Rev Cancer 2006;6:546–58No conflict of interest.
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