Aim and objectives To analyse the profile of pharmacological interactions with RTV as an enhancer of PIs and their severity. Material and methods A retrospective observational study was conducted where patients undergoing treatment for HIV-1 infection with PI boosted with RTV before 2018 were reviewed. Patients who had been treated with RTV as an enhancer for at least 6 months were selected. Those that presented some interaction with PI/enhancer were reviewed. Data were collected on age, sex, drug interactions and their severity, and medical action/decision. The data were obtained from the drug dispensing register of the outpatient pharmaceutical care unit and the electronic clinical record. Interactions and their severity were reviewed using www.hivdruginteractions.org/checker. Results 210 patients were reviewed, of whom 5 patients (2.38%) had interactions that motivated treatment modification, reflected in the clinical history, with a mean age of 52 years (SD 5).. RTV-triazolam: avoid co-administration. RTV can increase triazolam concentrations resulting in prolonged sedation or respiratory depression. Decision: ART modification. . RTV-sildenafil: potential interaction. Co-administration of darunavir/RTV (400/100 mg twice daily) and a single dose of sildenafil resulted in fourfold greater exposure. Decision: use sildenafil single dose at a maximum 25 mg every 48 hours. . RTV-quetiapine: avoid co-administration. Concomitant administration of RTV and quetiapine is contraindicated because it can increase the toxicity related to quetiapine due to its metabolism mainly by CYP3A4, which RTV inhibits. Decision: reduce quetiapine dose to one-sixth if administered jointly. . RTV-atorvastatin: very low evidence interaction. Coadministration may increase atorvastatin concentrations and increase the risk of myopathy. Decision: exchange for pravastatin. . RTV-anti-VHC (ombitasvir+paritaprevir/RTV): avoid coadministration. Co-administration with additional ritonavir is not recommended. Optional decision: modification of ART until the end of anti-HCV treatment. Conclusion and relevanceInteractions related to ART based on PI/enhancer can be easily managed to avoid causing harm to the patient. It is necessary to review the complete treatment in ART patients whenever they start a new drug.
BackgroundSodium-glucose co-transporter 2 (SGLT2) inhibitors are used in patients with type-2 diabetes (T2DM), either alone or in combination with other anti-diabetic drugs, when these medicines together with exercise and diet do not provide adequate control of the diabetes. Dapagliflozin, empagliflozin and canagliflozin are the three SGLT2 inhibitors approved by the European Medicines Agency. SGLT2 inhibitors are associated with a significantly higher risk of recurrent genital and urinary tract infections (UTIs) than placebo and other active anti-diabetics, which may cause treatment discontinuations.PurposeTo evaluate SGLT2 inhibitors’ discontinuation due to recurrent UTIs, in patients with T2DM.Material and methodsA 1 year retrospective, observational study was performed. Patients with an active prescription of SGLT2 during the first 6 months of the study period were selected. Patients that interrupted SGLT2 treatment during the following 6 months were included in our study. The following data was collected: sex, age, cause of discontinuation, antibiotic and/or antifungal drugs prescribed for UTIs and duration of SGLT2 treatment.ResultsSix hundred and ninety-one patients with an SGLT2 inhibitor prescription were selected, of which 17 patients (2.5%) interrupted SGLT2 treatment due to recurrent UTIs during the study period, were included in our study. Median treatment duration was 8.8 (2.2–13) months. Ten patients (58.8%) received dapaglyfozin, five patients (29.4%) empaglyfozin and two patients(11.8%) canaglifozyn. Eighty-two per cent (14) of the patients were females: mean age 63. Thirty patients interrupted treatment: 17 (2.5%) because of recurrent UTIs, 13 (2%) because of other medication-related problems. Eight patients had urinary infections, seven patients genital infections and two patients had both genital and urinary infections. UTIs were not specifically monitored during clinical trials. The only available data showed a treatment interruption in 0.7% of the patients who had been treated with canaglifozine. In our study, canaglifozine was interrupted due to UTIs in 1.6% (2/123) of the patients, dapaglifozine in 2.8% (10/351) and empaglifozine in 2.3% (5/217). Only one patient had had previous UTIs. 76.47% (13) of the patients needed antibiotic/antifungal prescriptions: 38.5% (5) fosfomycin, 23.1% (3) ciprofloxacyn, 30.8% (4) clotrimazole, 7.7% (1) fluconazole and 7.7% (1) clindamycin.ConclusionPatients in treatment with SGLT2 inhibitors have an increased risk of UTIs. Recurrent UTIs significantly impair quality of life. Personal history of UTIs should be considered before initiating SGLT2 inhibitors.No conflict of interest
Both temporal modulation sensitivity and flicker fusion frequency (CFF) increase with increasing eccentricity. Based upon correlations between temporal sensitivity and cone outer segment diameter, it has been proposed that these temporal frequency changes may be due to differences in receptor morphology.1,2 Alternatively, CFF can be made independent of retinal eccentricity by M-scaling (scaling for the number of ganglion cells) and F-scaling (scaling for the luminous flux per ganglion cell). These findings suggested that changes in sensitivity may be correlated with post-receptoral factors such as the number of ganglion cells stimulated, their average receptive field size, and cortical magnification.3,4,5
BackgroundAlemtuzumab is a humanised monoclonal antibody that selectively targets CD52, resulting in depletion and subsequent distinct repopulation of circulating T and B lymphocytes.PurposeTo evaluate the effectiveness and security of alemtuzumab in patients diagnosed with relapsing-remitting multiple sclerosis (RRMS).Material and methodsRetrospective and observational study between December 2014 and November 2017 of patients diagnosed with RRMS after 1 year of treatment with alemtuzumab.Variables collected: age, sex, years with RRMS diagnosis, Extended Disability Status Scale (EDSS), percentage of patients without outbreaks and outbreaks/patient-year, previous treatments and adverse drug reactions (ADRs).The effectiveness of treatment was assessed by calculating annualised relapse rates(ARRs) and change in disability status by EDSS. Change in disability was defined according to criteria of Fernández et al. that defined improvement as any decrease ≥1 point, stabilisation as any change <1 point and aggravation as an increase ≥1 point in the EDSS scale.ResultsTwenty-five patients were included (72% females).Abstract 5PSQ-080 Table 1 Variables collected Results Mean age 39.6±9.7 years Mean disease duration 11±5.7 years Mean baseline EDSS 4.5±1.6 Mean previous treatment 2.4±1 Percentage of patients without outbreaks 80% AAR 0.24 outbreaks/patient-year Only one patient used alemtuzumab as first line.One-year follow-up showed EDSS improved by 0.08±0.27 point. Improved disability status was observed in two patient (one point decrease in EDDS) (8%), stabilisation in 23 patients (88%) and worsening in one patient (one point increase in EDSS) (4%).Abstract 5PSQ-080 Table 2 Registered ADRs % of patients Skin reactions (exanthems/pruritus) 44 Headache 12 Digestive/urinary tract infections 8 Fever/pseudopyroid syndrome 12 Tremor/tingling 4 Diplopia 4 Respiratory distress 4 Autoimmune hypothyroidism 4 One patient was diagnosed with Glioblastoma, so second cycle of treatment was discontinued.ConclusionAlemtuzumab is a moderately effective drug with acceptable toxicity in patients who have failed other treatments. In Phase III clinical trials, ADRs incidence was >90%, being mild to moderate in severity and generally included headache, rash, pyrexia, nausea, flushing, urticaria, insomnia and pruritus. Also,>10% of patients showed cardiac disorders, in particular tachycardia.References and/or Acknowledgements1. Fernández O, et al. Natalizumab treatment of multiple sclerosis in Spain: results of an extensive observational study. J Neurol2012;259:1814–23.2. Guarnera C, Bramanti P, Mazzon E. Alemtuzumab: a review of efficacy and risks in the treatment of relapsing remitting multiple sclerosis. Ther Clin Risk Manag2017;13:871–879.No conflict of interest
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