Material and MethodsWe conducted a retrospective study carried out in a tertiary hospital. We included all AD patients treated with dupilumab with a minimum follow-up of 52 weeks.We collected the following data from electronic medical records: age, gender, previous treatments, eczema area and severity index (EASI) and dermatology life quality index (DLQI) at baseline and at 52 weeks of follow-up, adverse effects and treatment adherence (calculated by medication possession ratio [MPR]).Effectiveness was determined by the change in the EASI and DLQI values at 52 weeks compared to baseline. Safety endpoints were the number and type of adverse effects (AE) during the follow-up period. Results In total, 61 patients were included in the study. The mean age ( ± SD) was 40 ( ± 18) years. Thirty-five patients (57%) were men.As previous topical treatments, 100% of patients had received corticosteroids; whereas 49%, tacrolimus. Besides, 70% had underwent phototherapy. Regarding systemic treatment, 79% had received corticosteroids; 70%, cyclosporine; 25%, mycophenolate mofetil; 25%, azathioprine; and 28%, methotrexate.Mean ( ± SD) EASI and DLQI baseline values were 33 ± 11 and 19 ± 5, respectively. At 52 weeks follow-up, these indexes were 2 ± 3 and 4 ± 5, respectively. The reduction in EASI and DLQI was statistically significant (p<0.001). During this period, AE were reported in 22 patients (36%): conjunctivitis (20%), arthralgia (5%), herpes virus infection (5%) and paradoxical psoriasis (3%) were the most common ones. Three treatments were discontinued due to ineffectiveness, 4 due to AE and 2 because of clinical remission.The mean MPR ( ± SD) was 100 ± 14%, which demonstrates good rates of therapeutic adherence. No patient presented a MPR <75%, so we could not determine the impact of this variable on treatment effectiveness. Conclusion and RelevanceOur study shows that dupilumab is an effective and safe drug for moderate-to-severe DA. Our cohort experienced a statistically significant improvement in EASI and DLQI at 52 weeks of treatment. Additionally, therapeutic adherence was very high.
Conclusion and Relevance A PCP in patients undergoing cardiac surgery was successfully implemented, ensuring a correct preoperative drug management, with 0.8 severe medication errors avoided per patient that was interviewed and potential savings of 992.130C ¼ .
to the product information, an implant releases FAc for a maximum of 36 months, and an additional implant can be placed after 12 months if vision decreases or retinal thickness increases. Pivotal studies and the IRISS observational study concluded in the need to use 1.3 implants/eye and 1.13 implants/eye affected during the first 3 years respectively, this last value being the one considered by the ERG (Evidence Review Group). Taking this last reference, the cost of treatment/affected eye at C ¼ 1558.84/eye/year or C ¼ 4676.53/ eye/3 years.To estimate the target population, we used the criteria of the SMC evaluation report in which they considered a total of 179 patients with pseudophakic chronic DME eligible for treatment in the first year, increasing to 186 in the fifth year. Unlike the SMC, our NHS restricts its funding to third-line, after anti-angiogenic agents and in patients with a suboptimal response to various intravitreal dexamethasone implants or pseudophakic patients.Making a parallelism with the Scottish population, 33.5 patients/1st year-34.8 patients/5th year would be candidates to receive FAc in our region.NICE and the ERG found that in clinical practice 35% of patients would require bilateral treatment. Thus 12 patients/ year would need treatment in both eyes in our population. The economic impact in our region would range between C ¼ 5,3000.56/year if it were inserted in only one eye and C ¼ 71,706.64/year in both eyes. Conclusion and RelevanceThe financing conditions of our NHS position the drug in the third-line, which in a certain way contains the budget impact.Since SMC restricting the conditions of use more than our NHS, the budget impact could be underestimated.
and gamma), monitored drug and plasma level, pharmacokinetic reports and their degree of acceptance. Results A total of 202 pharmacokinetic reports were performed targeting 191 ambulatory patients. The mean age of the total was 42.33 ± 16.46 years (range: 6-106) and 51% were female. Only 5 patients had established renal insufficiency with renal clearance < 60 ml/min and 3 patients with hepatic insufficiency (liver enzymes greater than 3 times the upper limit of normal).The pharmacokinetic reports produced were valproic (43.56%), lithium (37.62%), carbamazepine (8.91%), digoxin (5.94%), phenytoin (2.47%) and phenobarbital (1.48%). Of the patients, 82.68% had plasma levels in therapeutic range, 14.85% were subtherapeutic and 2.47% were supratherapeutic. We highlight a degree of intervention in 17.32% of the pharmacokinetic reports made, and 10.93% of these reports required a change in the dosing regimen or dosing interval together with a new monitoring. The degree of acceptance by the physician was 67%. Conclusion and RelevanceIt is important to perform an adequate follow-up of patients with active treatment of drugs with a narrow therapeutic margin for a constant optimisation of the treatmentThe data reflect the importance of the hospital pharmacist as part of the multidisciplinary team and the need for direct communication with the primary care physician.The high degree of acceptance of pharmacokinetic reports shows that the circuit is well received.
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