Secukinumab is an anti-IL 17A monoclonal antibody currently licensed for the treatment of plaque psoriasis, psoriatic arthritis and ankylosing spondylitis. However, although inflammatory bowel disease is a disorder with related immune characteristics, secukinumab has not proved to be effective in these diseases. In fact, negative results in a clinical trial designed to assess its efficacy in patients with Crohn disease have been published. On the other hand, the drug fact sheet states that secukinumab should be used with caution in patients with inflammatoy bowel disease. Although the drug has shown to worsen these pathologies, there are no published data of cases in which the patient is first diagnosed with inflammatory bowel disease during secukinumab treatment. We present two cases of emergence of inflammatory bowel disease in patients with plaque psoriasis and ankylosing spondylitis treated with secukinumab.
Objectives. We assessed the prevalence of potentially inappropriate prescriptions (PIP) among older (≥ 65 years) people living with HIV (PLWHIV). Additionally, the secondary objective was to analyse the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers criteria associated with Top-10 drugs classes to avoid (TOP-10-A) of European AIDS Clinical Society (EACS) guidelines. Methods. This was a cross-sectional observational single-centre study. PLWHIV aged 65 years-old or over on ART attending at hospital pharmacy outpatient service from December-2019 to March-2020 were included. Patients were classified by age group: 65-69, 70-75 and more than 75 years. Moreover, was analysed the relationship between pharmacotherapeutic complexity and compliance with STOPP-Beers Criteria associated with Top-10-A drugs. Results. A total of 19 individuals were included. Overall polypharmacy was observed in 16 PLWHIV (84.2%). A PIP included Top-10-A was identified in 9 (47.4%) PLWHIV. Benzodiazepines were the most prevalent group of prescribed drugs in 6 patients (30.0%). Complex patients were observed in 57.9% (MRCI index value greater than 11.25). Similarly, the sum of criteria STOPP-Beers was higher in older patients. Student’s t test showed the existence of a statistically significant relationship between pharmacotherapeutic complexity and sum of STOPP-Beers Criteria (p <0.05) in elderly PLWHIV. Conclusions. Prescription of PIPs is highly prevalent in older PLWHIV. Consistent with data, presence of PIPs were associated a presence of higher pharmacotherapeutic complexity and sum of STOPP-Beers Criteria. The basis for a new revised care plan for PLWHIV focussed on optimising overall patient care pharmacotherapeutic complexity and its possible consequences.
Available evidence indicates that a therapeutic drug monitoring strategy leads to major cost savings related to the anti‐tumour necrosis factor‐α therapy in both inflammatory bowel disease and rheumatoid arthritis (RA) patients, with no negative impact on efficacy. However, although the systematic use of therapeutic drug monitoring could potentially be beneficial and economically acceptable to drug dose optimization, it is not justifiable for all drugs. Infliximab (IFX) is a chimeric monoclonal immunoglobulin G1 targeting tumour necrosis factor. It has been approved for the treatment of immuno‐inflammatory diseases, including RA, ankylosing spondylitis, psoriatic arthritis, Crohn's disease and ulcerative colitis. IFX's pharmacokinetics is highly variable and influences clinical response in chronic inflammatory diseases. Clinical response increases with IFX trough concentrations in RA, ankylosing spondylitis, inflammatory bowel disease and psoriatic patients. Target concentrations predictive of good clinical response were proposed in RA, Crohn's disease and ulcerative colitis. The purpose of this article is to review the current literature surrounding IFX serum concentrations and their related parameters with disease activity in patients with spondyloarthritis. Gathering information about the efficacy of IFX in patients with spondyloarthritis and relating IFX serum concentrations to disease activity were the main goals of this study.
Objectives. HIV population is aging at an earlier age than those uninfected, requiring more non-HIV medications to treat noncommunicable diseases. In the context of chronic HIV infection, the next therapeutic change would be the polymedication control. This paper has the purpose of explore the attitudes of older people living with HIV toward deprescribing. Material and methods. This was an observational, prospective and multicenter study conducted from March-April, 2018. People living with HIV (PLWH) on highly active antiretroviral therapy and older than 65 years were included. In addition to demographic and pharmacotherapeutic data, attitudes regarding deprescribing were collected through the “Revised Patients’ Attitudes Towards Deprescribing Questionnaire”. Results. A total of 42 patients were included in this study. Regarding their attitudes in relation to deprescription, there were three statements with the most consensuses. The first (“I have a good understanding of the reasons I was prescribed each of my medicines”) had 91.9% consensus. The second and third questions showed 89.2% consensus in both cases; “Overall, I am satisfied with my current medicines” and “I like to be involved in making decisions about my medicines with my doctors”. Conclusions. This study is the first to explore the beliefs and attitudes of older PLWH in relation to deprescription process. There are positive attitudes regarding medication knowledge but there also is a percentage of patients who had a negative opinion regarding deprescription. We must study and go deeper in our knowledge of techniques that could help us to better understand their preferences, in order to establish effective and successful deprescription strategies.
Variables collected were age, sex, risk factors included in the health alert and continuation or discontinuation of treatment. Results A total of 71 patients receiving tofacitinib treatment were included (mean age: 41 ± 16; sex: 74.6% women). The treatment was discontinued in 25.4% (18/71) of the patients due to inefficacy, adverse reactions or presenting at least one risk factor. However, 74.6% (53/71) of the patients continued treatment, with 43.4% (23/53) having at least one risk factor. Results were shown to the Pharmacy Commission, where the pharmacist developed a protocol regarding tofacitinib safety issues.Conclusion and Relevance This is the first experience in our hospital regarding the global monitoring of safety notes released by the AEMPS, endorsed by autonomic regulation. Despite the presence of risk factors, tofacitinib was not withdrawn nor justified in a high percentage of patients. This finding underlines the relevance of systematic patients follow-up and the need to develop protocols agreed by the pharmacists and involved physicians.
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