BackgroundTreatment with rituximab may cause reactivation of hepatitis B virus (HBV).PurposeTo find out if HBV serology for patients with haematological diseases treated with rituximab is routinely performed in accordance with the HBV reactivation prophylaxis protocol. According to the results, to develop a strategy to ensure compliance with the protocol.Material and methodsObservational, retrospective study of haematological patients who started treatment with rituximab between December 2012 and April 2014. The HBV reactivation prophylaxis protocol requires patients to be screened before starting treatment with rituximab and, depending on the serological results, the recommendations of the European Association for Study of the Liver and Asociación Española para Estudio del Hígado are to be followed. The following data were collected: date of initiation of treatment with rituximab, date and results of serology (HBsAg, anti-HBc, viral DNA).Results96 patients were included. The protocol was not followed in 24 patients (25%). Non-compliance was due to no screening for HBV in 21 patients (22%). The remaining 3 patients (3%) were anti-HBc positive and in one of them the viral load was not determined. Furthermore, none of the 3 received the recommended prophylactic treatment required because they were anti-HBc positive. We therefore propose making the proper HBV screening and monitoring of all patients treated with rituximab an essential requisite prior to the pharmaceutical validation. This is to ensure that the serological profile of HBV is available and that preventive actions and treatments have been carried according to the serology results.ConclusionThe risk of reactivation of HBV is due to: absence of HBV serology and absence of viral DNA levels and/or recommended prophylactic treatment according to the protocol. The proposed strategy to prevent HBV reactivation is to include serological profiling as a requirement for pharmaceutical validation of those patients treated with rituximab.ReferenceHoofnagle JH. Reactivation of hepatitis B. Hepatology 2009;49:S156–65No conflict of interest.
The frequency of early changes during inpatient hospitalisation to antimicrobial regimens which were initially prescribed in the Emergency Department is high. Microbiological results were rarely used to guide these changes.
BackgroundImatinib has a high likelihood of drug interactions due to hepatic oxidative metabolism.PurposeTo evaluate the incidence and severity of interactions between imatinib and home treatment of oncohaematology patients.Material and methodsRetrospective observational study of oncohaematology patients treated with imatinib between January and March 2014. The following data were collected: age, sex, diagnosis, date of start and end of treatment with Imatinib and concomitant prescribed medicines. Imatinib interactions with other drugs were assessed by the software tool Micromedex 2.0. These were classified as: contraindicated, severe, moderate and mild.Results24 patients were included. 58% were men (n = 14) with a mean age of 61 years. The main indication for imatinib was chronic myeloid leukaemia (54%). 164 prescriptions were analysed. The most prescribed therapeutic groups were: analgesics (19%), antidepressants and anxiolytics (16%), antihypertensives (11%) and gastric protectors (10%). 16 interactions between imatinib and concomitant treatment were detected, affecting 50% of patients. 69% were severe interactions and 31% moderate interactions. 6 patients had one severe interaction, 2 had two severe interactions, 1 patient suffered a severe and a moderate interaction and 2 patients each had two moderate interactions. Severe interactions were due to paracetamol (n = 8), acenocoumarol (n = 2) and amiodarone (n = 1). Moderate interactions were for itraconazole (n = 2), tamsulosin (n = 1), ketoconazole (n = 1) and levothyroxine (n = 1). The effect of severe interactions was reviewed and no clinical relevance was detected to date. These patients were selected for special monitoring by the pharmacist.ConclusionLike other studies on the subject, our study shows that there are numerous interactions between imatinib and other drugs. The interactions detected are severe or moderate. It is important to keep track of patients treated with imatinib who take paracetamol due to the very frequent use of this drug.ReferenceFarm Hosp 2014;38(4):338–363No conflict of interest.
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