BackgroundSome of the most common adverse effects of protease inhibitors in treatment of HIV are dislypidaemia, diabetes and other metabolic disorders. These adverse effects should be recognised by health professionals so that they can perform an intervention to minimise the cardiovascular risk of the patient.PurposeTo analyse the impact of the metabolic adverse effects in HIV patients on darunavir/cobicistat monotherapy treatment.Material and methodsThis work is a descriptive observational study which took place in the outpatient consultation of a Hospital Pharmacy in a third-level hospital. We made a search of clinical variables as well as results of analytical tests. The variables included in this study were age, smoking habit, systolic blood pressure, presence of antihypertensive treatment, presence of diabetes mellitus, and HDL and total cholesterol serum concentrations at the beginning of treatment and at 6 and 12 months after. With these data, we calculated the Framingham Risk Score (FRS) at these months and we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males. They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. The median of FRS at the beginning of the treatment was 9.3 (3.9–22.7). At month 6 of treatment the median of FRS was 8.9 (4.2–20.8) and after 12 months was 8.9 (3.4–21.7). None of the patients had an increase of more than 4 points. A small group of patients (n=7) from this sample, who had an initial FRS over 25 were separately studied. Their mean FRS were 38.2 (28.4–39.4) at the beginning, 32.1 (28.9–36.4) at month 6 and 30.5 (25.2–37) at month 12. Five of these seven patients had a decrease in FRS of more than 4 points. Only one of them had an increase (2 points).ConclusionBased on these findings, we can affirm that there was no increase in the cardiovascular risk of the patients on treatment with darunavir/cobicistat, but there was also an improvement. Even patients at greater risk reduced their Framingham Risk Score. We want to show the importance of knowing the drugs deeply to prevent their adverse effects.No conflict of interest
BackgroundHIV therapies are usually based on the action of various antiretroviral drugs coadministered in order to achieve a good virologic (viral loads<50 copies/ml) and immune response (percentage of T CD4 lymphocytes between 32 and 60). In the past few years a single drug therapy based on a protease inhibitor has been used to control HIV infection.PurposeTo analyse the virologic and immune response in patients on darunavir/cobicistat monotherapy.Material and methodsThis work is a descriptive observational study. In it, we have made a search of clinical variables as well as the results of analytical tests. The variables included in this study were sex, age, viral loads at the beginning of the treatment and at months 6 and 12, and percentage of T CD4 lymphocytes in blood samples. After that, we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males.They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. At the beginning of treatment, 76% of patients had undetectable viral load, at month 6.83% and at month 12.73%. Patients with viral load over 50 copies/ml were 20% at the beginning of treatment, 13% at month 6, and 10% at month 12.Only 50% of patients who began the treatment without virological response could achieve it at month 12. Only 6% of patients with virological response failed it at month 12.In terms of immune response, patients without it at the beginning (percentage of T CD4 lymphocytes below 32%) represented 36.7% and they did not achieve it during 12 months. Every patient with immune response at the beginning of the treatment maintained this response. Only one patient had both virologic and immune failures. Thirty-three per cent of patients had no immune response with virologic response.ConclusionBased on these findings we can confirm that monotherapy is a great strategy in patients who already have a good control of the HIV infection. Immune and virologic response is difficult to achieve after 12 months in patients who began the treatment without them.No conflict of interest
BackgroundHormone treatment based on analogues of gonadotropin releasing hormone (GnRH) with antiandrogens is the first-line treatment for prostate cancer. This treatment produces a PSA reduction, improvement of symptoms and tumour regression. When PSA increases again it is considered to have developed resistance and other treatment lines such as abiraterone are used.Abiraterone is an androgen synthesis inhibitor in the testes, adrenals and prostate tumour tissue.PurposeTo analyse the response to, and safety of, abiraterone in the population of a tertiary level hospital.Material and methodsA retrospective observational study was carried out including all patients who started on abiraterone from 2011 to present. Demographical, diagnostic, therapeutic and clinical variables were gathered.The response was assessed by a 50% PSA reduction or more as compared to baseline values. To assess the safety, abiraterone-related adverse events were recorded.Outpatient dispensing application Farmatools and electronic medical records were used for patient identification and data collection.Results18 patients were included, 89% diagnosed with metastatic prostate cancer. 50% had poor tumour differentiation with high aggressiveness (Gleason 7–10).As a first-line of treatment, 83% received GnRH analogues plus an antiandrogen, 11% GnRH analogues alone and 6% ketoconazole. No patients orchiectomized. As a second-line treatment, 28% received docetaxel, 44% estramustine, 22% abiraterone and 6% ketoconazole. Abiraterone was started as third-line or later treatment and after tumour progression, except in 3 patients who received it as second-line treatment.44% were considered responders and 56% non-responders because of an increase or non-reduction of PSA.The median duration of treatment was 5 months (1–25). In all cases, the reason for suspension was disease progression.17% had fatigue as the only adverse effect.ConclusionAbiraterone is a well-tolerated drug that has shown low activity in previously-treated prostate cancer patients who had responded poorly to ketoconazole, docetaxel and estramustine.Best responding patients were those who received only GnRH analogues as pre-treatment.References and/or AcknowledgementsNo conflict of interest.
BackgroundStrongyloides stercoralis is one of the most common parasites in tropical areas. Nowadays, the treatment of such parasite is based on ivermectin. However, ivermectin is not marketed in Spain. Hospital pharmacists are responsible for permitting this treatment to patients, only after drawing up an exhaustive report. In this article, we have reviewed all the reports as well as classified the information in order to present our clinical practice.PurposeTo present our clinical experience regarding the treatment of strongyloidosis.Material and methodsDescriptive observational study. Patients’ data were obtained from their clinical history. Variables examined: age, sex, nationality, doses, diagnostic methods (ELISA and coproparasitological test), co-infections, eosinophilia and immunosuppressed patients.ResultsIvermectin was first used in February 2012.15 patients were analysed 8 men and 7 women. The average age was 36. Nationality: 12 patients from Bolivia, 1 from Guinea-Conakry, 1 from Cuba and 1 with unknown nationality. Posology: 1 oral dose of 200 mcg/kg/day of ivermectin for two days in 100% of patients. The ELISA test and the coproparasitological test were used in 100% and 86% of the patients respectively. The ELISA test result was positive in 93.3% of patients, whereas the coproparasitological test result was negative in 84.3%. Co-infections: Chaga’s disease, toxocariasis, tuberculosis, schistosomiasis, intestinal amoebiasis, uncinariasis (hookworm) and hymenolepis (tapeworm). Top of Form.Before [JM1] the treatment, the average eosinophilia was 15.99%. However, after the treatment, it decreased to 4.67%. No patients were diagnosed with HIV-1 or treated with corticosteroids.ConclusionThe decrease in eosinophilic cells reveals that ivermectin is effective for the treatment of strongyloidiasis. As our study shows, most of the patients also carry other coexisting parasitic diseases, likewise transmitted by the faecal-oral cycle. Therefore, pharmaceutics could play an important role in the prevention of this type of diseases. both by ensuring the appropriate use of this drug as well as by providing some useful advice on healthy practices.References and/or Acknowledgements[JM1]No conflict of interest.
BackgroundExtravasation of cytostatic agents is one of the major complications in cancer treatment with anthracyclines. There is a lot of information about the management of extravasations with ‘classical’ anthracyclines but liposomal anthracyclines have distinctive pharmacokinetics and a different toxic-effect profile. Currently, dexrazoxane is only licensed to treat extravasation with ‘classical’ anthracyclines. However, the efficacy of desrazoxane has been reported in some cases reports. This review collects all extravasation cases that have been published with liposomal and pegylated liposomal anthracyclines, with special emphasis on the use of dexrazoxane.PurposeTo review the scientific literature on the development and managenement of anthracycline extravasation injuries, including clinical evidence for desrazoxane.Material and methodsA bibliographic review was conducted using the Pubmed database with the following keywords: antracyclines, extravasations and chemotherapy. The period covered was from database inception to September 2015, inclusive. Articles about clinical cases and literature in English or Spanish were included. Practice guidelines and expert consensus were also analysed.ResultsPractice guidelines and expert consensus were not found. 7 articles fulfilled the inclusion criteria: 5 cases reports (including 6 patients) and 2 series of cases (each series treated in the same way).Extravasated drugs: 3 liposomal doxorubicin, 1 liposomal daunorubicin and 4 pegylated liposomal doxorubicin. General therapy: local cold packs, topical and subcutaneous corticosteroids, painkillers, subcutaneous lidocaine and low weight molecular heparin. Desrazoxane was administered in 3 cases but only 1 article reported the dosage. Symptoms: local oedema, pain, burning, erythema and haematoma. Outcome: only 1 patient treated with local cold packs and washing had necrotic areas and scars; the rest of the cases completely resolved in 2 or 3 months with no skin injury. Since 2006, the date of approval of desrazoxane, 3 of 4 reported cases have been treated with this medicine.ConclusionThere is a lack of consensus in the management of extravasations with liposomal anthracyclines, and desrazoxane could be used to treat severe extravasations of liposomal anthracyclines. Therefore, the introduction of this antidote for this medicine needs further study to ensure its efficacy and safety. Hence all oncology services should make a protocol including general interventions and the off-label use of this medicine.No conflict of interest.
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