Objectives The objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs). Methods A multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome. Results A total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC. Conclusions PIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription. Trial registration number NCT02830425

Azole antifungals have frequently been linked to the presence of hepatotoxicity, but there is scarce information on cross-toxicity between these drugs or on the possibility of using some of them when this type of toxicity occurs. We report the case of a 64-year-old man with invasive aspergillosis (IA) leading to spondylodiscitis with neurological involvement. Early management included intravenous (iv) voriconazole, which had to be interrupted after 1 week due to liver damage. Therapeutic drug monitoring (TDM) of voriconazole showed that the plasma concentration was within the therapeutic range. However, it was replaced by a combination therapy of oral posaconazole plus iv caspofungin. Posaconazole allowed normalization of liver enzymes. After finishing posaconazole monotherapy on an outpatient basis, the patient made a full recovery. This case report provides further evidence that oral posaconazole is safe and effective as rescue therapy after the appearance of voriconazole-induced liver toxicity.

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administration route (oral/injectable/intravenous), treatment satisfaction and treatment decision-making. This questionnaire was elaborated and validated by an MS expert committee (hospital pharmacists, neurologist, patients' associations: Fundación Esclerosis Múltiple Madrid (nurses) and Esclerosis Múltiple España (clinical psychologists). Results One-hundred and fifty-seven MS patients (44 males/ 113 females) were included. The adherence rate was 71% (Morisky-Green scale), and was associated with: older age (mean: 45.2 years compliance; 40.4 years non-compliance), better cognitive status, being married/in-union, more lines of prior treatments, time to diagnosis of 5-10 years, exacerbations absence, clear information about the disease and high treatment satisfaction (table ). There were no differences in the adherence rate between oral (63%) and injectable (77%) treatments. Analysing the injectable administration, there was greater adherence in patients with IV (100%) vs SC (68%). There was also a significant difference between IV (100%) vs oral (63%) (p=0.001). The main cause for non-compliance was forgetfulness (27%). Conclusion Adherence rate for the MS treatment is acceptable (71%). It is negatively affected by forgetfulness, lower cognitive status and lack of family support. The injectable route shows higher adherence than the oral route, although the latter show the highest patient satisfaction. REFERENCES AND/OR ACKNOWLEDGEMENTSStudy supported by Roche, Spain. We gratefully acknowledge AMBER for its contribution (data collection/statistical analysis).No conflict of interest.