Conclusion and relevance Because of the telematic consulting programme, we have innovated, with technological tools, continuity of pharmaceutical care, which does not require a visit to the hospital, facilitating delivery of the medication to the patient. Also, patient satisfaction was high.
BackgroundAfatinib is a second generation irreversible EGFR tyrosine kinase inhibitor (TKI), indicated as firstline therapy in non-small cell lung cancer (NSCLC). There are two other first generation EGFR TKIs indicated in NSCLC treatment, and no direct comparison of them.PurposeTo compare the efficacy of afatinib versus erlotinib or gefitinib in EGFR TKIs naïve patients with NSCLC.Material and methodsThis was an observational retrospective study carried out between January 2015 and April 2016. All patients with NSCLC undergoing firstline treatment with an EGFR TKI were included. Patient data were taken from clinical records. Efficacy endpoints were overall survival (OS), progression free survival (PFS) and response rate, assessed by RECIST criteria.Results46 patients were included. 76% were men, average age was 71 years. 71.8% had an ECOG performance status of 0–1 and 76% were current or past smokers. NSCLC stage was III/IV in 84.4% of patients and histologic type was adenocarcinoma in 37% of patients. 43.5% were treated with erlotinib, 39.9% with gefitinib and 17.4% with afatinib. EGFR status was determined in only 16 patients, being mutated in 7 (4 treated with erlotinib and the other 3 with afatinib). Median OS for afatinib, gefitinib and erlotinib was 5, 14 and 43 months, respectively (HR (95% CI) gefitinib vs afatinib: 0.25 (0.07–0.81); erlotinib vs afatinib: 0.16 (0.05–0.55)). Median PFS was 2 months for afatinib, 8 months for gefitinib and 16 months for erlotinib (HR (95% CI) gefitinib vs afatinib: 0.18 (0.06–0.59); erlotinib vs afatinib: 0.08 (0.02–0.29)). Response rate by group was 37.5%, 61.1% and 80% for afatinib, gefitinib and erlotinib, respectively.ConclusionAccording to the main clinical guidelines, EGFR mutation status should be known before the start of treatment, and EGFR TKIs should only be used in patients with a positive EGFR mutation test. Our study suggests that afatinib is less effective than erlotinib or gefitinib, but our population was small. Further studies with more patients are needed to compare afatinib with the other EGFR TKIs.References and/or acknowledgementsSequist LV, Yang JC-HC-H, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol2013;31:1–11.No conflict of interest
BackgroundDespite living in the high tech era, there is still a lack of software tools to help pharmacists to carry out their common tasks, pharmaceutical care being one of the most important.PurposeDesigning a friendly intuitive application to gather, assess and use patients’ demographic and clinical information to obtain better results in pharmaceutical care.Material and methodsWe created a Filemaker database compatible with computers and tablets. Its interface was designed with Adobe PhotoshopCC. Prior to this, a bibliographical review on pharmaceutical care was performed to decide which data would be useful for pharmacists to collect.ResultsAn iPadMini optimised (1024x669) ‘.fmp12’ file was obtained. The main page grants access to patient records. Each one allows demographic and clinical data, including history, current diagnosis and evolution to be collected. A button panel give access to the remaining areas. ‘Therapy’ section is set to collect pharmacotherapy data (drug, dose, interval, administration route, prescription date). To make follow-up easier, drugs can be flagged into five categories (restricted duration, possibility of intravenous to oral switching, common adverse reactions, potential contraindications and dose adjustment needs). A similar table records nutritional treatments. ‘Laboratory’ gathers the most relevant haematologic (cell counts, coagulation, haemoglobin, etc), biochemical (glucose, ion levels, etc) and microbiologic (culture findings, susceptibility testings) parameters related to pharmaceutical care. It calculates MDRD4 creatinine clearance, and warns the user if values are out of range. ‘PRIME zone’ allows recording of pharmaceutical problems, risk issues, drug Interactions, treatment mismatches and efficacy facts. Users can record how each problem is managed, and if they were able to influence clinicians (accepted, rejected or non-assessable interventions). The database is provided with a search engine, and can print a ‘.pdf’ case report.ConclusionOur database aims to make pharmacotherapy management easier, improving detection of medication related problems and allowing bedside work. In a pilot study in over 28 patients, our colleagues perceived an increase in the amount and quality of interventions to clinicians, but also regretted spending too much time when gathering data, due to the fact that the database cannot automatically collect data from official sources. Despite having enhanced our database functionality, Filemaker does not fulfil our needs, and professional software development would be desirable, which requires further funding.No conflict of interest
BackgroundDrugs interact when the effect of a drug is modified by another co-administered drug, food or herb. According to a number of studies, almost half the prescriptions are accompanied by interactions (8–43%, depending on the ward), but few (12–25%) are clinically relevant. Antibiotics are a wide group of drugs used a great deal in our environment (in 49.8% of inpatients), and are associated with important interactions. Pharmacists help doctors to manage them by writing an intervention on the patient history, after evaluating patient clinical status.PurposeTo describe quantitative and qualitative antibiotic-drug interactions among our patients, assessing their expected clinical impact and intervening if they are relevant; to see how doctors modify prescriptions.Material and methodsWe searched interactions involving antibiotics in all available prescriptions of every ward at the time of screening. We used Medscape app as screening tool, adopting their rating system (minor, significant, serious or contraindicated), considering intervention only in the relevant ones. SPSS20 was used for data coding and statistical processing. To improve intervention quality, additional data were reviewed in trusted sources like Stockley or Lex Interact.ResultsAntibiotics were found in 156 prescriptions, mostly penicillins (45 prescriptions), quinolones (35) and carbapenems (34). A total of 1,415 interactions were detected (average per patient 9.07 ± 9.39), only 271 (19.2%) involving antibiotics. Among those, 76 minor, 116 significant, 78 serious and one contraindicated interaction were found. We intervened in only 16 cases (mostly about nephro/ototoxicity, serotonergic syndrome involving linezolid and monoamine-oxidase inhibitors, and proarrhythmic combinations). Only four prescriptions were modified after the interaction had been reported.ConclusionAntibiotics play an important role in interactions; despite this few are dangerous, and must be filtered before choosing to intervene. Despite their relevance, doctors seem to underestimate the associated risks, ignoring the advice given. To improve their knowledge and respect for this topic, our Service will soon be teaching a course for healthcare professionals.References and/or Acknowledgements(NONE)No conflict of interest.
Background Treatment with bortezomib is frequently associated with haematological toxicity. In addition infrequent gastrointestinal disorders such as ischaemic colitis, irritable bowel syndrome and paralytic ileus are described, among others. Purpose To describe a case of ischemic colitis associated with treatment with bortezomib and to evaluate causality. Materials and methods The authors report on a woman, 77 years old, diagnosed with multiple myeloma, chronic renal insufficiency and echinococcosis, being treated with enalapril 20 mg/day, bisoprolol 2.5 mg/day, isosorbide 50 mg/day, calcium carbonate 1.25 g/8 h, furosemide 40 mg/day, darbepoetin α 40 mcg/15 days, omeprazole 20 mg/day. In June 2011, she was given fresh treatment with bortezomib 2.2 mg/72 h and dexamethasone 40 mg/week. After the fourth dose, the patient went to the emergency services with abdominal pain and constipation that had been coming on for several days. It was decided to interrupt treatment and she was admitted to the digestion ward. Naranjo's algorithm and Karch–Lasagna's algorithm were used to determine the reason. Results An urgent colonoscopy showed abundant red stained faecal residue in the descending colon, diffuse mucous with black plaques and surface ulcers which demonstrated severe ischaemic colitis. An abdominal axial CT scan reflected a remarkable oedematous thickening of the colon wall (7 cm) with adjacent frayed fatty tissue related to the colitis diagnosis. After 12 days the patient progressed satisfactorily on conservative treatment having interrupted her standard treatment. When the bortezomib treatment restarted the patient resumed the same medical regimen but very soon she experienced abdominal distension, nausea and vomited bile. Chronic mesenteric ischaemia was diagnosed. After a further 15 days the patient was discharged from hospital and is now trying oral lenalidomide as second line treatment of the multiple myeloma. After applying the causality algorithms, the adverse reaction came out in both cases as definitively due to bortezomib (10 points). Conclusions Ischaemic colitis is described in the bortezomib technical data sheet as an uncommon adverse event (<0.01%) as reported in postmarketing studies. In the Sistema Español de Farmacovigilancia (FEDRA) Spanish Pharmacovigilance System for Medicines for Human Use 239 bortezomib adverse events are recorded, 44 related to gastrointestinal disorders. Close monitoring of patients showing constipation during their bortezomib treatment is recommended together with notification of possible adverse events not described or listed as uncommon in their severity.
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