BackgroundBortezomib is an expensive drug with a very short stability. For subcutaneous administration each vial should be reconstituted with 1.4 mL of NaCl 0.9% (2.5 mg/mL). According to the manufacturer, reconstituted it is stable at 25°C for only 8 h. Considering the recommended dose of 1.3 mg/m2 and the amount of drug per vial (3.5 mg/1.4 mL), the loss of product during preparation may be significant. However, a study published by Walker et co-authors has shown that bortezomib is stable for up to 21 days, permitting an optimisation of costs.PurposeTo evaluate the impact of the extended stability limits of bortezomib on handling practices and the optimisation of costs.Material and methodsTwo periods were evaluated: before (January–September 2013) and after (January–September 2014) modification of the stability limits. From the individual preparation files, different parameters were recorded: number of patients and prescription lines, mean dose, theoretical residues, % of residues re-used, value of the residues re-used.ResultsSeventy patients were included, 34 in the first period and 36 in the second one. The number of prescription lines was 584 and 452 in the first and second period, respectively. The mean dose in both periods was 2.10 mg. In the first period the theoretical residues were 311.59 mL, the % of residue re-used 56.00 mL (17.9%) and the value of the re-used residues €24,137.57. For the second period, the theoretical residues were 248.39 mL, the % of residue re-used 232.4 mL (93.7%) and the value of the re-used residues €100,170.90. The cost per dose was €983 and €677 in the first and second period, respectively.ConclusionAn extended stability limit for bortezomib as compared to that recommended by the manufacturer should lead to an improvement of manufacturing processes and significant costs savings. The re-use of residues is a real strategy to contain costs.References and/or acknowledgementsNo conflict of interest
BackgroundThe pharmaceutical care model proposed in socio-health centres (SHC) aims to provide efficient and coordinated pharmaceutical services between different levels of care. The integration of the hospital pharmacist into the multidisciplinary team improves the socio-healthcare of institutionalised elderly patients.PurposeOptimise drug therapy of institutionalised patients (residents) in a SHC through pharmaceutical intervention (PI).Material and methodsProspective and quasi-experimental pilot study without control group, which includes the residents of a SHC Exclusion criteria: patients assigned to health centres (HC) and patients without drug treatment. Residents’ pharmacotherapy were reviewed with proposals for pharmaceutical treatment modification (PI), evaluation and multidisciplinary consensus. PI types: adequate adherence to the Pharmacotherapy Guide of SHC (PGSHC) in a Health Management Area with replacement for Specialties with Better Geriatric Profile (SBGP) and the implementation of the Therapeutic Equivalents Program; dose adjustment according to recommendations in geriatric patients (chronic kidney disease, psychoactive drugs); and deprescribing (duplicates, Non-Elevated Intrinsic Value Drugs (NEIVD) and Stopp criteria (safety issues or poor prognosis). Suggestions for improvement.ResultsNumber of residents, 104. Excluded: six (three assigned to HC, three without pharmacological treatment). Of the 97 patients included, 78.4%(n=76) were assisted and 21.6% (n=21) were valid residents. Mean age: 79.5 years (range 49–99, SD: 10.3); 54.6% (n=53) were males. Pharmacological profile: number prescription drugs/chronic patients: mean: 5.3 (range 1–12, SD: 2.93); prevalence of polypharmacy (≥5 drugs): 59.8%( n=58). Total PI performed: 61; average PI/resident: 0.6; therapeutic equivalent alternative: 40.9% (n=25). Adequacy to PGSHC: 36% (n=22) with adaptation to presentations included (24.5%, n=15) and SBGP (11.4%, n=7); dose adjustment: 8.1% (n=5); deprescribing: 14.75% (n=9) with five cases of duplicity, three safety issues and one NEIVD. Substitution of drugs prescribed by equivalent alternatives of the PGSHC supposes a significant cost saving. Improvement proposals: continuous re-evaluation of patients, so the design and implementation of a Pharmacotherapy Review Programme in institutionalised elderly patients is proposed, with a personalised action plan integrated into the Comprehensive Geriatric Assessment and quantification of the economic impact.ConclusionInstitutionalised patients are chronic patients with high complexity, so it is essential to review pharmacotherapeutic practices through an attention and care shared multidisciplinary team. The incorporation of the pharmacist into the multidisciplinary team allows optimisation of the treatments with a rational use of these.No conflict of interest
BackgroundTyrosine Kinase Inhibitors (TKIs) are drugs that cause significant adverse reactions and interactions in patients. Prescription and dispensing of TKIs both take place in Hospital Pharmacies. Primary Care physicians (GPs) do not have very much information about either these drugs or patients on TKI treatment.PurposeTo describe a model for giving advice with recommendations about interactions and adverse reactions of TKIs, to provide support and information for PC physicians.Material and methodsPatients on TKI treatment were identified by the APD-ATHOS Prisma and Oncofarm software. The databases were searched for adverse reactions and interactions due to TKIs, together with their management. We selected the most common adverse reactions and interactions, including those that could cause the patients to consult their general practitioner. Then, we made a document with all the information and PC pharmacists established a link between this document and the Electronic Clinical History of each patient to enable GPs to identify patients who were on TKI treatment and also recommendations about their management.Results44 patients were identified (37 with imatinib, 4 with dasatinib and 3 with nilotinib). 29 adverse reactions were found (9 common to all 3 TKIs, plus 8 with dasatinib, 8 with nilotinib and 4 with imatinib). Interactions were classified into: drugs that increase or reduce the effects of TKIs and drugs whose effects and toxicity are increased or decreased by TKIs. The most significant interactions were: imatinib-simvastatin, imatinib-acetaminophen, imatinib-ibuprofen; nilotinib/dasatinib-proton pump inhibitors, nilotinib/dasatinib-histamine-2 receptor antagonists, nilotinib/dasatinib-drugs that prolong the QT interval, nilotinib/dasatinib-oral anticoagulants and dasatinib-food.ConclusionThe way of giving advice should help GPs to identify and manage frequent adverse reactions and interactions of TKIs. This process will be repeated for other oral anti-cancer drugs. Further studies are necessary to confirm the usefulness of this tool.References and/or acknowledgementsNo conflict of interest.
BackgroundThere is only limited information about the sequential use of abiraterone acetate (AA) and enzalutamide (ENZ) in metastatic castration-resistant prostate cancer (mCRPC) patients. Patients who receive AA or ENZ as first-line therapy and subsequently become resistant have only a response rate of 15% to 30% to the alternative agent as second-line treatment. That finding clearly shows that cross-resistance occurs between ENZ and AA.PurposeTo evaluate the effectiveness of ENZ after failure of AA in patients with mCRPC.Material and methodsRetrospective study including all patients with mCRPC having sequential therapy with AA and ENZ from May 2012 to October 2017. Posttreatment changes in prostate-specific antigen (PSA) and differences in the median duration treatment (MDT) with AA and ENZ were used to determine the effectiveness of ENZ. A PSA reduction <30% and/or a MDT-ENZ/MDT-AA ratio <0.3 was considered as ineffective.ResultsThe study included 16 mCRPC patients treated sequentially with AA and ENZ. Only three patients had undergone prior docetaxel therapy. MDT-AA was 15 months (range: 3–38). During AA therapy 10 (67%) achieved a>50% decline in PSA, 12 (80%) a>30% and three (20%) did not achieve any decline in PSA. Subsequent MDT-ENZ was 4 months (range: 1–12), showing a MDT ratio of 0.27. Three patients did not have PSA levels after taking enzalutamide. None of the CRPC patients who were or not initially AA-sensitive showed a>30% PSA decline while taking ENZ. The medium PSA decline after abiraterone and enzalutamide were 37% and 17.8% respectively. Of the 15 patients, 7 (46.6%) were primarily ENZ-resistant and showed a rising PSA as the best response. Median time to progression was 7 months (range: 2–12) for five of 15 patients with at least one declining PSA value while taking enzalutamide (33.3%).ConclusionAlthough the number of patients included in this study is small, ENZ therapy after AA failure shows a low activity in terms of PSA response and/or medium duration of treatment. Results would be compatible with qualifying the use of ENZ after failure to AA as ineffective. Further properly designed studies to this aim are needed.Reference and/or Acknowledgements1. J Clin Oncol2014;32:125.No conflict of interest
BackgroundAlthough clinical trials show low virological failures rates (<10%) for initial combination regimens of antiretroviral therapy (ART), we have observed a considerable percentage of naïve patients switching to another combination regimen.PurposeTo evaluate the switch rate among naïve patients who begin ART and to determine the reasons that led to a change in the ART regimen.Material and methodsWe conducted a retrospective observational study that included naïve HIV positive persons who initiated ART between January 2015 and January 2016 and attended the pharmaceutical care office. The main variable was persistence with treatment. Secondary variables were: demographics (age, gender); virological response (viral load), pharmacotherapeutics (initial combination regimen, new combination regimen) and reason for switching to another combination (virological failure, documented toxicity, prevention of long term toxicity, avoiding serious drug–drug interactions, simplification). Persistence rates were obtained through dispensing records of the pharmacy programme. The remaining variables were obtained from microbiology reports and the medical history of each patient.Results31 patients with an average age of 40±11 years were included. Most patients were men (90.3%). Median viral load was 23.300 (elite controller 481.000) copies/mL. The proportion of patients coinfected with hepatitis C virus was 16.1%. In all cases patients received triple therapy. More than half of patients (67.7%) began treatment with a combination regimen based on two nucleos(t)ide analogues plus an integrase inhibitor and the preferred regimen was tenofovir, emtricitabine, elvitegravir and cobicistat (58.1%). Non-nucleoside rilpivirine was used as a third drug in 25.8% of cases. Almost half of the patients switched to another treatment (48.4%). No virological failure occurred in any patient. The most common reason for changing to another regimen was documented toxicity (6). Other reasons were prevention of long term toxicity (4), simplification (4) and avoidance of serious drug–drug interactions (1).ConclusionThis study showed that a high proportion of ART regimens in naïve HIV patients were changed, even though these regimens achieved undetectable viral load. The main reason for switching was based on safety, either documented or potential toxicity. These data might help in designing pharmacist intervention programmes to improve the efficacy and safety of ART.No conflict of interest
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