Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.79
K. Perdikouri, F. Marini, D. Gennimata
Background and importance Although there is a direct relationship between rates of antibiotic use and emergence of antimicrobial resistance in the community and in hospital, measurement of antimicrobial consumption, without further analysis of any variations observed, is inadequate to support decision making. Aim and objectives The aim of the study was twofold: presenting variations in antimicrobial consumption in internal medicine wards and investigating potential variables in the choice of regimen. Material and methods Anonymous data on administration of parenteral antibiotics, during 2019, in two internal medicine wards of a general hospital and one semi-autonomous (independent) internal medicine clinic, located in the same healthcare region, were collected and compared. Antibiotic consumption was recorded as daily defined doses per 100 bed days (DDDs/100 bed days). All antibacterial antibiotics were included in the analyses. Furthermore, each substance’s contribution, as a percentage of the annual configuration of the total index, was calculated. Average length of stay (LOS) and regimen indications were also registered. Results In 2019, total antibiotic consumption in the general hospital internal medicine clinics ranged from 176.53 to 184.03 DDDs/100 bed days, exhibiting a 4.5-fold difference compared with the independent clinic. Administration of 33 and 35 different antibiotics, respectively, was recorded in the general hospital clinics versus 25 in the independent clinic. Ampicillin/sulbactam, meropenem and piperacillin/tazobactam (with minor differences observed) were more often used in the general hospital, while meropenem, piperacillin/tazobactam and clindamycin were used most in the independent one. Despite the differences, the relative contribution of different antibiotics to total consumption was comparable for piperacillin/tazobactam, meropenem and ceftriaxone in all cases. Variables in the choice of regimen were mainly patient age, LOS and antibiogram. Average LOS was 10 days versus 25 days between hospitals. More than 90% of admissions in the general hospital (vs 5%) were emergency admissions. Conclusion and relevance Only small differences in antimicrobial regimens were observed within each hospital, whereas between hospitals they varied significantly. Variables related to the general hospital environment, such as the increased probability of multiresistant pathogens (suggesting concomitant administration of two or more antibiotics) and the intensive care profile may adequately explain the observed variations. Such variables should always be considered in antibiotic stewardship programmes and/or other initiatives. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"4CPS-247 Variations in consumption of antimicrobials in internal medicine wards of hospitals","authors":"K. Perdikouri, F. Marini, D. Gennimata","doi":"10.1136/EJHPHARM-2021-EAHPCONF.79","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.79","url":null,"abstract":"Background and importance Although there is a direct relationship between rates of antibiotic use and emergence of antimicrobial resistance in the community and in hospital, measurement of antimicrobial consumption, without further analysis of any variations observed, is inadequate to support decision making. Aim and objectives The aim of the study was twofold: presenting variations in antimicrobial consumption in internal medicine wards and investigating potential variables in the choice of regimen. Material and methods Anonymous data on administration of parenteral antibiotics, during 2019, in two internal medicine wards of a general hospital and one semi-autonomous (independent) internal medicine clinic, located in the same healthcare region, were collected and compared. Antibiotic consumption was recorded as daily defined doses per 100 bed days (DDDs/100 bed days). All antibacterial antibiotics were included in the analyses. Furthermore, each substance’s contribution, as a percentage of the annual configuration of the total index, was calculated. Average length of stay (LOS) and regimen indications were also registered. Results In 2019, total antibiotic consumption in the general hospital internal medicine clinics ranged from 176.53 to 184.03 DDDs/100 bed days, exhibiting a 4.5-fold difference compared with the independent clinic. Administration of 33 and 35 different antibiotics, respectively, was recorded in the general hospital clinics versus 25 in the independent clinic. Ampicillin/sulbactam, meropenem and piperacillin/tazobactam (with minor differences observed) were more often used in the general hospital, while meropenem, piperacillin/tazobactam and clindamycin were used most in the independent one. Despite the differences, the relative contribution of different antibiotics to total consumption was comparable for piperacillin/tazobactam, meropenem and ceftriaxone in all cases. Variables in the choice of regimen were mainly patient age, LOS and antibiogram. Average LOS was 10 days versus 25 days between hospitals. More than 90% of admissions in the general hospital (vs 5%) were emergency admissions. Conclusion and relevance Only small differences in antimicrobial regimens were observed within each hospital, whereas between hospitals they varied significantly. Variables related to the general hospital environment, such as the increased probability of multiresistant pathogens (suggesting concomitant administration of two or more antibiotics) and the intensive care profile may adequately explain the observed variations. Such variables should always be considered in antibiotic stewardship programmes and/or other initiatives. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78825012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.121
V. Garau, SG Gheza, S. Colombo, S. Cadelano, M. Tulli, G. Marcias, P. Serra
Background and importance Handling of antiblastic agents poses major health risks to healthcare workers. Apart from pharmacists, nurses and physicians, staff involved in cleaning, transport and disposal of hazardous drugs or contaminated material are also involved. Monitoring via wipe samples can be used to investigate mechanisms of release and spread and thus help identify possible sources and routes of exposure. Aim and objectives Our aim was to evaluate the effectiveness of our decontamination procedure, to obtain objective data on contamination of operators in contact with antiblastic drugs. Material and methods The preparation rooms have closed laminar flow hoods where drugs are reconstituted and diluted using closed circuit devices. The exposure assessment involved nine nurses and two pharmacists. Biological monitoring was performed for cyclophosphamide (CP), gemcitabine and urinary metabolite 5-fluorouracil (5-FU), alpha-fluoro-beta-alanine (FBAL) in urine at the end of the shift. Analyses were performed using UHPLC-MS/MS liquid chromatography. In parallel, environmental monitoring was carried out for the determination of 5-FU and CP on the surfaces inside and adjacent to the set-up area and on the operators, using the WIPE test and PAD test techniques, respectively, at the beginning and end of the shift. Results Levels of urinary metabolites measured were all below their respective limits of determination (LOD). Drug contamination measured by the WIPE test was found to be slightly above the reference value of 0.1 ng/cm2 and high contamination in the external handle of the laminar flow hood was found. The analytical results collected by the PAD test showed levels of 5-FU lower than the LOD and the presence of a trace of CP on the preparer, while significant contamination by 5-FU was found on the chest and forearm of the off-field operator. Conclusion and relevance This study highlighted environmental contamination with a low exposure of operators limited to the preparation laboratory, but higher contamination levels were found on laboratory surfaces and on an off-field operator. Improper transport of a contaminated drug basket to a clean zone is critical. This assessment allowed us to review and update our decontamination procedure, confirmed by the subsequent environmental control. A monitoring schedule for the environment and health workers and specific training courses for the cleaning teams were proposed. References and/or acknowledgements Sottani, et al. 2017. Conflict of interest No conflict of interest
{"title":"4CPS-289 Analysis of antineoplastic drug contamination level in the hospital pharmacy: problem monitoring and solving","authors":"V. Garau, SG Gheza, S. Colombo, S. Cadelano, M. Tulli, G. Marcias, P. Serra","doi":"10.1136/EJHPHARM-2021-EAHPCONF.121","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.121","url":null,"abstract":"Background and importance Handling of antiblastic agents poses major health risks to healthcare workers. Apart from pharmacists, nurses and physicians, staff involved in cleaning, transport and disposal of hazardous drugs or contaminated material are also involved. Monitoring via wipe samples can be used to investigate mechanisms of release and spread and thus help identify possible sources and routes of exposure. Aim and objectives Our aim was to evaluate the effectiveness of our decontamination procedure, to obtain objective data on contamination of operators in contact with antiblastic drugs. Material and methods The preparation rooms have closed laminar flow hoods where drugs are reconstituted and diluted using closed circuit devices. The exposure assessment involved nine nurses and two pharmacists. Biological monitoring was performed for cyclophosphamide (CP), gemcitabine and urinary metabolite 5-fluorouracil (5-FU), alpha-fluoro-beta-alanine (FBAL) in urine at the end of the shift. Analyses were performed using UHPLC-MS/MS liquid chromatography. In parallel, environmental monitoring was carried out for the determination of 5-FU and CP on the surfaces inside and adjacent to the set-up area and on the operators, using the WIPE test and PAD test techniques, respectively, at the beginning and end of the shift. Results Levels of urinary metabolites measured were all below their respective limits of determination (LOD). Drug contamination measured by the WIPE test was found to be slightly above the reference value of 0.1 ng/cm2 and high contamination in the external handle of the laminar flow hood was found. The analytical results collected by the PAD test showed levels of 5-FU lower than the LOD and the presence of a trace of CP on the preparer, while significant contamination by 5-FU was found on the chest and forearm of the off-field operator. Conclusion and relevance This study highlighted environmental contamination with a low exposure of operators limited to the preparation laboratory, but higher contamination levels were found on laboratory surfaces and on an off-field operator. Improper transport of a contaminated drug basket to a clean zone is critical. This assessment allowed us to review and update our decontamination procedure, confirmed by the subsequent environmental control. A monitoring schedule for the environment and health workers and specific training courses for the cleaning teams were proposed. References and/or acknowledgements Sottani, et al. 2017. Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"1932 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87744090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.332
M. Rufo, L. Muñoz, A. Gago, E. D. Silveira, M. García, C. Fernandez, A. Díaz
Background and importance During the March and April, over 700 patients were discharged from the emergency department (ED) in a third level hospital to home with treatment for COVID-19. Their characteristics and final outcomes remain unknown. Aim and objectives To analyse the characteristics and clinical course of COVID-19 patients that were discharged from the ED with home treatment, having to be hospitalised afterwards due to clinical deterioration, and to record the most commonly prescribed drugs for COVID-19. Material and methods An observational retrospective study was conducted between 1 March and 10 April 2020. Hospitalised patients diagnosed with COVID-19 who had previously attended the ED and were discharged home were included. The following data were recorded: demographic, comorbidities, COVID-19 treatment, fever ≥38°C, tachypnoea, reason for consultation and admission, days between the first and second visit to the ED, days of hospitalisation, length of intensive care unit (ICU) stay if any and reason for discharge. Results 741 patients were discharged from the ED with home treatment for COVID-19, of whom 68 (9.2%) needed to be hospitalised. Median age was 55.5 years (IR 22–88) and 66.1% were men. 64.7% had comorbidities, mainly: hypertension 44.2%, dyslipidaemia 16.2% and asthma 8.8%. Patients were prescribed as home treatment hydroxychloroquine (100%), azithromycin (75%) and lopinavir/ritonavir (22.1%). Median number of days until patients went back to the ED was 4. The main reasons for consultations were dyspnoea (80.8%), fever (61.7%), coughing (42.6%) and anosmia/dysgeusia (10.3%). 32.4% had tachypnoea and 26.5% had fever. The main reasons for admission were clinical and radiological worsening (85.3%). Median inpatient stay was 7 days (IR 4–13), and 67.7% were hospitalised for less than 10 days. 8.8% needed critical care and stayed in the ICU for a median of 10.5 days (IR 6–16). The following drugs were prescribed as COVID-19 treatment during hospitalisation: lopinavir/ritonavir (86.8%), hydroxychloroquine (86.8%), corticosteroids (63.2%), ceftriaxone (58.8%), azithromycin (50%), tocilizumab (14.7%), remdesivir (4.4%) and anakinra (2.9%). One patient died and the rest were discharged to home. Conclusion and relevance Patients who needed hospitalisation due to clinical worsening after being discharged from the ED were mostly middle age men with hypertension. About 80% were admitted for presenting with dyspnoea and rapid radiological progression. Less than 10% needed intensive care, and only one died. Most showed clinical improvement in less than 10 days and were discharged home. Drugs most commonly prescribed for COVID-19 were hydroxychloroquine, azithromycin and lopinavir/ritonavir. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"5PSQ-213 Hospital admissions after discharge from the emergency department to home with COVID-19 treatment","authors":"M. Rufo, L. Muñoz, A. Gago, E. D. Silveira, M. García, C. Fernandez, A. Díaz","doi":"10.1136/EJHPHARM-2021-EAHPCONF.332","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.332","url":null,"abstract":"Background and importance During the March and April, over 700 patients were discharged from the emergency department (ED) in a third level hospital to home with treatment for COVID-19. Their characteristics and final outcomes remain unknown. Aim and objectives To analyse the characteristics and clinical course of COVID-19 patients that were discharged from the ED with home treatment, having to be hospitalised afterwards due to clinical deterioration, and to record the most commonly prescribed drugs for COVID-19. Material and methods An observational retrospective study was conducted between 1 March and 10 April 2020. Hospitalised patients diagnosed with COVID-19 who had previously attended the ED and were discharged home were included. The following data were recorded: demographic, comorbidities, COVID-19 treatment, fever ≥38°C, tachypnoea, reason for consultation and admission, days between the first and second visit to the ED, days of hospitalisation, length of intensive care unit (ICU) stay if any and reason for discharge. Results 741 patients were discharged from the ED with home treatment for COVID-19, of whom 68 (9.2%) needed to be hospitalised. Median age was 55.5 years (IR 22–88) and 66.1% were men. 64.7% had comorbidities, mainly: hypertension 44.2%, dyslipidaemia 16.2% and asthma 8.8%. Patients were prescribed as home treatment hydroxychloroquine (100%), azithromycin (75%) and lopinavir/ritonavir (22.1%). Median number of days until patients went back to the ED was 4. The main reasons for consultations were dyspnoea (80.8%), fever (61.7%), coughing (42.6%) and anosmia/dysgeusia (10.3%). 32.4% had tachypnoea and 26.5% had fever. The main reasons for admission were clinical and radiological worsening (85.3%). Median inpatient stay was 7 days (IR 4–13), and 67.7% were hospitalised for less than 10 days. 8.8% needed critical care and stayed in the ICU for a median of 10.5 days (IR 6–16). The following drugs were prescribed as COVID-19 treatment during hospitalisation: lopinavir/ritonavir (86.8%), hydroxychloroquine (86.8%), corticosteroids (63.2%), ceftriaxone (58.8%), azithromycin (50%), tocilizumab (14.7%), remdesivir (4.4%) and anakinra (2.9%). One patient died and the rest were discharged to home. Conclusion and relevance Patients who needed hospitalisation due to clinical worsening after being discharged from the ED were mostly middle age men with hypertension. About 80% were admitted for presenting with dyspnoea and rapid radiological progression. Less than 10% needed intensive care, and only one died. Most showed clinical improvement in less than 10 days and were discharged home. Drugs most commonly prescribed for COVID-19 were hydroxychloroquine, azithromycin and lopinavir/ritonavir. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90860758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.248
L. V. Torres, M. Padilla, J. D. Valencia
Background and importance Multifactorial anaemia is a common disease in elderly patients, usually treated with darbepoetin in different dosages. Aim and objectives To maintain normal haemoglobin (Hb) values (>12 g/dL in women and >13 g/dL in men according to the WHO) in multifactorial anaemic patients older than 75 years, using high doses of darbepoetin with initial monthly dosage, eliminating weekly/fortnightly induction, facilitating treatment. Material and methods A retrospective, multicentre, observational study was conducted in patients who started treatment with monthly doses of darbepoetin in the last 3 years (1 April 2017 to 1 April 2020), without previous induction doses. The first follow-up visit was made 1 month after the first dose was administered or just after the second dose, testing that Hb was maintained >12–13 g/dL. If the tests showed higher results, doses were lowered (20–25%); if the tests showed lower results, the dose was increased. The procedure was repeated the following month only in patients not in the range. In these cases, after two checks of stability, the test became quarterly. Variables measured were dosage, and initial, monthly and quarterly Hb values. Patients with insufficient information, or younger than 75 years, were excluded (because of different optimal values). Data were obtained from the hospital’s clinical information systems. Patients were informed if they required a different dosage than usual, giving their consent. Results 36 patients initiated darbepoetin monthly during the study (7 men, 29 women). Median age was 86 years. Six patients were excluded, one for age, and five for not having sufficient data. Dosage by prescribers was 1.5 µg/kg/month. Average Hb starting treatment was 9.76 g/dL (range 7.6–10.5) and in the first control (4–8 weeks) it was 11.11 g/dL (range 8.8–13.6). In 70% (21/30) of patients, it was not necessary to change the initial dose because therapeutic objectives were progressively achieved. This dose was maintained until the successive quarterly controls. In the other 30% (9/30), 4 had their dose increased and 5 had their dose decreased to keep within range. In successive quarterly controls, the average value was 12.62 g/dL (10.5–15.3), achieving the therapeutic goals in all but two patients. Two patients were transfused due to acute processes that could alter the results. Conclusion and relevance The monthly starting dosage in elderly patients appeared an effective and safe way to achieve therapeutic goals in multifactorial anaemia. The advantage over weekly/biweekly induction lies in better therapeutic adherence, reducing the number of doses needed in patients who also have many other medications. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"5PSQ-129 Management of multifactorial anaemia with subcutaneous darbepoetin with initial monthly dosage, omitting induction according to the technical data sheet, in elderly patients","authors":"L. V. Torres, M. Padilla, J. D. Valencia","doi":"10.1136/EJHPHARM-2021-EAHPCONF.248","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.248","url":null,"abstract":"Background and importance Multifactorial anaemia is a common disease in elderly patients, usually treated with darbepoetin in different dosages. Aim and objectives To maintain normal haemoglobin (Hb) values (>12 g/dL in women and >13 g/dL in men according to the WHO) in multifactorial anaemic patients older than 75 years, using high doses of darbepoetin with initial monthly dosage, eliminating weekly/fortnightly induction, facilitating treatment. Material and methods A retrospective, multicentre, observational study was conducted in patients who started treatment with monthly doses of darbepoetin in the last 3 years (1 April 2017 to 1 April 2020), without previous induction doses. The first follow-up visit was made 1 month after the first dose was administered or just after the second dose, testing that Hb was maintained >12–13 g/dL. If the tests showed higher results, doses were lowered (20–25%); if the tests showed lower results, the dose was increased. The procedure was repeated the following month only in patients not in the range. In these cases, after two checks of stability, the test became quarterly. Variables measured were dosage, and initial, monthly and quarterly Hb values. Patients with insufficient information, or younger than 75 years, were excluded (because of different optimal values). Data were obtained from the hospital’s clinical information systems. Patients were informed if they required a different dosage than usual, giving their consent. Results 36 patients initiated darbepoetin monthly during the study (7 men, 29 women). Median age was 86 years. Six patients were excluded, one for age, and five for not having sufficient data. Dosage by prescribers was 1.5 µg/kg/month. Average Hb starting treatment was 9.76 g/dL (range 7.6–10.5) and in the first control (4–8 weeks) it was 11.11 g/dL (range 8.8–13.6). In 70% (21/30) of patients, it was not necessary to change the initial dose because therapeutic objectives were progressively achieved. This dose was maintained until the successive quarterly controls. In the other 30% (9/30), 4 had their dose increased and 5 had their dose decreased to keep within range. In successive quarterly controls, the average value was 12.62 g/dL (10.5–15.3), achieving the therapeutic goals in all but two patients. Two patients were transfused due to acute processes that could alter the results. Conclusion and relevance The monthly starting dosage in elderly patients appeared an effective and safe way to achieve therapeutic goals in multifactorial anaemia. The advantage over weekly/biweekly induction lies in better therapeutic adherence, reducing the number of doses needed in patients who also have many other medications. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83078432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.158
C. P. Mondéjar, C. I. Navalón, I. Valverde, Amelia Soto, P. Fernández, M. Candel, L. R. Redondo, M. Candela, M. Coronel, Mdc Caballero Requejo, E. U. Sanz
Background and importance Adalimumab is a human monoclonal recombinant antibody whose mechanism of action is mediated by binding specifically to tumour necrosis factor (TNF), neutralising its function. Adalimumab is indicated for the treatment of progression of pathologies such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Aim and objectives To calculate the overall survival of adalimumab in patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis in our hospital. Material and methods A retrospective study was performed in which all patients diagnosed with these pathologies who initiated treatment with adalimumab from January 2007 to December 2016 were included. Data for start date, date of discontinuation of treatment if suspension occurred, sex and age of the patients were collected. Adalimumab’s persistence was calculated in months from the beginning of treatment to the last dispensation register. We collected dispensation data from January 2007 to May 2019 to calculate adalimumab’s persistence until this date. The drug’s survival was calculated using the Kaplan–Meier method and the log rank test to compare survival in each of the pathologies. A significant difference was considered with a p value Results 125 patients started treatment with adalimumab between January 2007 and December 2016; 48 patients (38.4%) were diagnosed with rheumatoid arthritis, 43 (34.4%) with ankylosing spondylitis and 34 (27.2%) with psoriasis arthritis. 52.1% of all patients were naive for biological drug treatments. 83.3%, 48.8% and 52.9% were women aged 57.6±43.8, 47.1±10.1 and 55.6 ±14.0 years in the rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis groups, respectively. After analysing the data using the Kaplan–Meier method, we obtained an overall survival of adalimumab in each pathology, which was greatest in psoriatic arthritis with 59.9 months (95% CI 39.6 to 80,2), followed by 46.8 months in rheumatoid arthritis (95% CI 31.5 to 62.0) and 38.8 months (95% CI 25.1 to 52.4) in ankylosing spondylitis. When we compared the different pathologies by the log rank test, adalimumab’ s persistence was statistically significant for rheumatoid arthritis and ankylosing spondylitis (p Conclusion and relevance Adalimumab is a biologic drug with proven therapeutic efficacy in the treatment of theses pathologies. According to our data, adalimumab showed considerable persistence, which was greatest in psoriatic arthritis. References and/or acknowledgements Conflict of interest No conflict of interest
背景和重要性阿达木单抗是一种人单克隆重组抗体，其作用机制是通过特异性结合肿瘤坏死因子(TNF)介导，中和其功能。阿达木单抗适用于治疗疾病进展，如类风湿关节炎、强直性脊柱炎和银屑病关节炎。目的和目的计算阿达木单抗在我院诊断为类风湿关节炎、强直性脊柱炎和银屑病关节炎患者的总生存率。材料和方法回顾性研究纳入了2007年1月至2016年12月间开始接受阿达木单抗治疗的所有诊断为上述病理的患者。收集患者的起始日期、停止治疗日期(如果停止治疗)、性别和年龄等数据。阿达木单抗的持续时间以月为单位计算，从开始治疗到最后一次配药登记。我们收集了2007年1月至2019年5月的配药数据，以计算阿达木单抗在此日期之前的持续时间。使用Kaplan-Meier法和log rank检验计算药物的生存期，以比较每种病理的生存期。结果:2007年1月至2016年12月，125例患者开始使用阿达木单抗治疗;其中类风湿关节炎48例(38.4%)，强直性脊柱炎43例(34.4%)，银屑病关节炎34例(27.2%)。52.1%的患者未接受生物药物治疗。类风湿关节炎组、强直性脊柱炎组和银屑病关节炎组女性患病率分别为57.6±43.8岁、47.1±10.1岁和55.6±14.0岁，占83.3%、48.8%和52.9%。在使用Kaplan-Meier方法分析数据后，我们获得了阿达木单抗在每种病理中的总生存期，其中银屑病关节炎的生存期最长，为59.9个月(95% CI 39.6至802,2)，其次是类风湿关节炎的46.8个月(95% CI 31.5至62.0)和强直性脊柱炎的38.8个月(95% CI 25.1至52.4)。当我们通过对数秩检验比较不同的病理时，阿达木单抗对类风湿关节炎和强直性脊柱炎的持续性具有统计学意义(p结论和相关性阿达木单抗是一种生物药物，在治疗这些病理方面已被证实有疗效。根据我们的数据，阿达木单抗显示出相当大的持久性，这在银屑病关节炎中表现最好。参考文献和/或致谢利益冲突无利益冲突
{"title":"4CPS-326 Adalimumab’s persistence in rheumatological diseases","authors":"C. P. Mondéjar, C. I. Navalón, I. Valverde, Amelia Soto, P. Fernández, M. Candel, L. R. Redondo, M. Candela, M. Coronel, Mdc Caballero Requejo, E. U. Sanz","doi":"10.1136/EJHPHARM-2021-EAHPCONF.158","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.158","url":null,"abstract":"Background and importance Adalimumab is a human monoclonal recombinant antibody whose mechanism of action is mediated by binding specifically to tumour necrosis factor (TNF), neutralising its function. Adalimumab is indicated for the treatment of progression of pathologies such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Aim and objectives To calculate the overall survival of adalimumab in patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis in our hospital. Material and methods A retrospective study was performed in which all patients diagnosed with these pathologies who initiated treatment with adalimumab from January 2007 to December 2016 were included. Data for start date, date of discontinuation of treatment if suspension occurred, sex and age of the patients were collected. Adalimumab’s persistence was calculated in months from the beginning of treatment to the last dispensation register. We collected dispensation data from January 2007 to May 2019 to calculate adalimumab’s persistence until this date. The drug’s survival was calculated using the Kaplan–Meier method and the log rank test to compare survival in each of the pathologies. A significant difference was considered with a p value Results 125 patients started treatment with adalimumab between January 2007 and December 2016; 48 patients (38.4%) were diagnosed with rheumatoid arthritis, 43 (34.4%) with ankylosing spondylitis and 34 (27.2%) with psoriasis arthritis. 52.1% of all patients were naive for biological drug treatments. 83.3%, 48.8% and 52.9% were women aged 57.6±43.8, 47.1±10.1 and 55.6 ±14.0 years in the rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis groups, respectively. After analysing the data using the Kaplan–Meier method, we obtained an overall survival of adalimumab in each pathology, which was greatest in psoriatic arthritis with 59.9 months (95% CI 39.6 to 80,2), followed by 46.8 months in rheumatoid arthritis (95% CI 31.5 to 62.0) and 38.8 months (95% CI 25.1 to 52.4) in ankylosing spondylitis. When we compared the different pathologies by the log rank test, adalimumab’ s persistence was statistically significant for rheumatoid arthritis and ankylosing spondylitis (p Conclusion and relevance Adalimumab is a biologic drug with proven therapeutic efficacy in the treatment of theses pathologies. According to our data, adalimumab showed considerable persistence, which was greatest in psoriatic arthritis. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84450043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.53
M. L. García, E. F. Liz, P. Broto, S. G. García, ME Barceló Colomer, P. Perez
Background and importance Direct oral anticoagulants (DOAC) were moderately used in the primary care (PC) setting due to their associated risks in elderly and their high cost. In contrast, acenocumarol was much more common in Catalonia, even though it requires intense monitoring. During the SARS-CoV-2 pandemic, the use of DOAC has been encouraged to reduce patient medical visits. Aim and objectives To analyse the change in DOAC use in our area and to evaluate prescription appropriateness. Material and methods This cross sectional study analysed the use of DOAC in a PC population in Barcelona in September 2020. The results were compared with historical data from December 2018. Demographic variables (age, gender), pharmacotherapeutic data (drugs, dose, frequency) and clinical data (glomerular filtration (GF), international normalised ratio (INR), CHA2DS2-VASc score) were obtained from the electronic medical record (September 2020). Prescription appropriateness was evaluated according to the drugs’ summary of product characteristics. Results The study included 351 732 patients in 2018 and 364 350 in 2020; 9194 (2.65%) and 10 017 (2.75%) of the patients were treated with oral anticoagulants (OA), respectively. Prevalence of OA use: 2018: acenocumarol 5734 (62.4%), warfarin 133 (2.3%), apixaban 1006 (10.9%), edoxaban 309 (3.4%), dabigatran 532 (5.8%) and rivaroxaban 1480 (16.1%). 2020: acenocumarol 3804 (38.0%), warfarin 157 (1.6%), apixaban 1875 (18.7%), edoxaban 959 (9.6%), dabigatran 712 (7.1%) and rivaroxaban 2510 (25.1%). Comparison of prevalence between 2018 and 2020: Decrease in acenocumarol (62.4% vs 38.0%, p No change in warfarin (1.45% vs 1.6%, p Increase in DOAC (36.2% vs 60.5%, p DOAC prescription appropriateness in 2020 (among 6056 patients): The main indication was atrial fibrillation (5881 patients, 97.1%). 373 men had CHA2DS2–VASc Frequency of contraindications: peptic ulcer (1603; 26.5%), valvulopathy (1060; 17.5%) and renal failure (76; 1.3%). 2433 (40.2%) patients had at least one contraindication. Dose was not appropriately reduced in 526 patients (8.7%). Conclusion and relevance DOAC use increased notably in our PC area during the SARS-CoV-2 pandemic. We found that 40.2% of patients treated with DOAC had at least one contraindication for the treatment. Interventions should be done to improve DOAC prescription and ensure patient safety. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"4CPS-221 Effect of SARS-CoV-2 pandemic on direct oral anticoagulant use in the primary care setting","authors":"M. L. García, E. F. Liz, P. Broto, S. G. García, ME Barceló Colomer, P. Perez","doi":"10.1136/EJHPHARM-2021-EAHPCONF.53","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.53","url":null,"abstract":"Background and importance Direct oral anticoagulants (DOAC) were moderately used in the primary care (PC) setting due to their associated risks in elderly and their high cost. In contrast, acenocumarol was much more common in Catalonia, even though it requires intense monitoring. During the SARS-CoV-2 pandemic, the use of DOAC has been encouraged to reduce patient medical visits. Aim and objectives To analyse the change in DOAC use in our area and to evaluate prescription appropriateness. Material and methods This cross sectional study analysed the use of DOAC in a PC population in Barcelona in September 2020. The results were compared with historical data from December 2018. Demographic variables (age, gender), pharmacotherapeutic data (drugs, dose, frequency) and clinical data (glomerular filtration (GF), international normalised ratio (INR), CHA2DS2-VASc score) were obtained from the electronic medical record (September 2020). Prescription appropriateness was evaluated according to the drugs’ summary of product characteristics. Results The study included 351 732 patients in 2018 and 364 350 in 2020; 9194 (2.65%) and 10 017 (2.75%) of the patients were treated with oral anticoagulants (OA), respectively. Prevalence of OA use: 2018: acenocumarol 5734 (62.4%), warfarin 133 (2.3%), apixaban 1006 (10.9%), edoxaban 309 (3.4%), dabigatran 532 (5.8%) and rivaroxaban 1480 (16.1%). 2020: acenocumarol 3804 (38.0%), warfarin 157 (1.6%), apixaban 1875 (18.7%), edoxaban 959 (9.6%), dabigatran 712 (7.1%) and rivaroxaban 2510 (25.1%). Comparison of prevalence between 2018 and 2020: Decrease in acenocumarol (62.4% vs 38.0%, p No change in warfarin (1.45% vs 1.6%, p Increase in DOAC (36.2% vs 60.5%, p DOAC prescription appropriateness in 2020 (among 6056 patients): The main indication was atrial fibrillation (5881 patients, 97.1%). 373 men had CHA2DS2–VASc Frequency of contraindications: peptic ulcer (1603; 26.5%), valvulopathy (1060; 17.5%) and renal failure (76; 1.3%). 2433 (40.2%) patients had at least one contraindication. Dose was not appropriately reduced in 526 patients (8.7%). Conclusion and relevance DOAC use increased notably in our PC area during the SARS-CoV-2 pandemic. We found that 40.2% of patients treated with DOAC had at least one contraindication for the treatment. Interventions should be done to improve DOAC prescription and ensure patient safety. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87342064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.228
L. V. Herpen-Meeuwissen, B. V. D. Bemt, B. Maat, H. V. Onzenoort
Background and importance Improving patient’s medication knowledge and consequently medication use is essential for optimal treatment outcomes. As patient knowledge about medication is currently suboptimal, interventions to optimise medication knowledge are necessary. We hypothesise that patient’s own medication (POM) use will improve patient’s medication knowledge. Aim and objectives To assess the impact of POM use on self-reported medication knowledge of hospitalised patients compared with standard care. Patient’s sense of medication safety, attitude to the provision of information and to inpatient medication use were studied in both standard care and during POM use. Material and methods In this nationwide intervention study, perceived medication knowledge was assessed with a questionnaire pre and post implementing POM use. The questionnaire assessed perceived medication knowledge (on how to and why to use medication) at admission and discharge, medication safety during hospitalisation, the provision of information during hospitalisation and at discharge, and inpatient medication use. Patients’ answers were categorised into positive and negative/neutral. The proportion of patients with adequate medication knowledge, in the standard care and POM use groups at hospital admission and discharge, were calculated and compared with correction of potential confounders. Results Among the 731 patients (80.2%) who completed the questionnaire, POM use seemed to be positively associated with self-reported knowledge on how to use medication at discharge (adjusted OR 3.22 (95% CI 2.01 to 5.16)). However, for the knowledge related statement on why medication was used, POM use was not associated. Medication knowledge at admission was the most important predictor of perceived medication knowledge at discharge. The majority perceived POM use safer (52.9% of standard care patients vs 74.0% of POM users; p Conclusion and relevance POM use has the ability to positively influence patient’s medication knowledge about how to use medication. Furthermore, it enhances the perception of medication safety, more patients have a positive attitude towards the provision of information and most patients prefer it. Therefore, POM use seems a valuable intervention and more research towards POM use (in combination with self-administration) is recommended. References and/or acknowledgements Conflict of interest Corporate sponsored research or other substantive relationships: Funding from the Dutch Ministry of Health, Welfare and Sport, the Hague.
背景和重要性提高患者的用药知识，从而提高用药对获得最佳治疗效果至关重要。由于患者对药物的了解目前是次优的，因此有必要采取干预措施来优化药物知识。我们假设患者使用自己的药物(POM)会提高患者的用药知识。目的与目的评价与标准护理相比，POM使用对住院患者自我报告的用药知识的影响。研究了患者在标准护理和使用POM期间的用药安全感、对信息提供的态度和住院用药的态度。材料与方法在这项全国性的干预研究中，采用问卷调查的方式对实施POM使用前后的认知用药知识进行评估。问卷评估了入院和出院时感知到的药物知识(如何和为什么使用药物)、住院期间的药物安全、住院和出院期间提供的信息以及住院患者的药物使用情况。患者的回答分为积极和消极/中性。计算住院和出院时标准护理组和POM使用组中具有充分用药知识的患者比例，并对潜在混杂因素进行校正。结果在完成问卷调查的731名患者(80.2%)中，POM的使用似乎与出院时自我报告的如何使用药物的知识呈正相关(调整OR为3.22 (95% CI 2.01至5.16))。然而，对于为什么使用药物的知识相关陈述，POM使用不相关。入院时的用药知识是出院时感知用药知识的最重要预测因子。大多数人认为使用POM更安全(52.9%的标准护理患者vs 74.0%的POM使用者;结论及相关性用药对患者用药知识有正向影响。此外，它增强了对用药安全的认知，更多的患者对提供信息持积极态度，大多数患者更愿意提供信息。因此，使用POM似乎是一种有价值的干预措施，建议对POM的使用(与自我给药相结合)进行更多的研究。参考文献和/或致谢利益冲突公司赞助的研究或其他实质性关系:荷兰卫生、福利和体育部资助，位于海牙。
{"title":"4CPS-396 Effect of the patient’s own medication use on patient self-reported medication knowledge during hospitalisation: a pre-post intervention study","authors":"L. V. Herpen-Meeuwissen, B. V. D. Bemt, B. Maat, H. V. Onzenoort","doi":"10.1136/EJHPHARM-2021-EAHPCONF.228","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.228","url":null,"abstract":"Background and importance Improving patient’s medication knowledge and consequently medication use is essential for optimal treatment outcomes. As patient knowledge about medication is currently suboptimal, interventions to optimise medication knowledge are necessary. We hypothesise that patient’s own medication (POM) use will improve patient’s medication knowledge. Aim and objectives To assess the impact of POM use on self-reported medication knowledge of hospitalised patients compared with standard care. Patient’s sense of medication safety, attitude to the provision of information and to inpatient medication use were studied in both standard care and during POM use. Material and methods In this nationwide intervention study, perceived medication knowledge was assessed with a questionnaire pre and post implementing POM use. The questionnaire assessed perceived medication knowledge (on how to and why to use medication) at admission and discharge, medication safety during hospitalisation, the provision of information during hospitalisation and at discharge, and inpatient medication use. Patients’ answers were categorised into positive and negative/neutral. The proportion of patients with adequate medication knowledge, in the standard care and POM use groups at hospital admission and discharge, were calculated and compared with correction of potential confounders. Results Among the 731 patients (80.2%) who completed the questionnaire, POM use seemed to be positively associated with self-reported knowledge on how to use medication at discharge (adjusted OR 3.22 (95% CI 2.01 to 5.16)). However, for the knowledge related statement on why medication was used, POM use was not associated. Medication knowledge at admission was the most important predictor of perceived medication knowledge at discharge. The majority perceived POM use safer (52.9% of standard care patients vs 74.0% of POM users; p Conclusion and relevance POM use has the ability to positively influence patient’s medication knowledge about how to use medication. Furthermore, it enhances the perception of medication safety, more patients have a positive attitude towards the provision of information and most patients prefer it. Therefore, POM use seems a valuable intervention and more research towards POM use (in combination with self-administration) is recommended. References and/or acknowledgements Conflict of interest Corporate sponsored research or other substantive relationships: Funding from the Dutch Ministry of Health, Welfare and Sport, the Hague.","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88511819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.278
FJ Salmeron Navas, E. Ríos-Sánchez, M. D. Cantero, EM Barreiro-Fernandez
Background and importance Loss of cell cycle regulation due to pathway alterations in cyclin D-CDK4/6-Rb is common in breast cancer. Palbociclib is a CDK4/6 inhibitor, indicated in metastatic breast cancer (mBC). Aim and objectives The aim of this study was to analyse the safety profile of patients with mBC positive hormone receptors receiving treatment with palbociclib. Material and methods A retrospective descriptive study was conducted in patients with mBC receiving treatment with palbociclib from July 2019 to July 2020. Electronic prescription programme for outpatient and medical records was consulted. Data collected for each patient were: sex, age, menopause status, performance status (PS), cancer stage, presence of visceral metastatic disease, therapeutic scheme and number of cycles received. The safety profile was assessed from the number of adverse events (AE), and the severity of AEs was graded on the basis of the common terminology criteria for adverse events, V.5.0. Number of patients and reasons for delays and dose reductions were also determined. Results 34 patients, 100% women, were included, with an average age of 60 (47–81) years, of whom 71% were postmenopausal. 29 patients presented at the beginning of treatment with PS ≤1. The percentage of patients with metastatic disease was 100%, of whom 76% had visceral metastases. The schemes, average numbers and range of cycles were: palbociclib 125 mg every 3 weeks, 7 (1–17) cycles. 105 AE occurred in 31 patients (91%): 54 haematological, 23 metabolic, 10 digestive, 7 asthenia, 2 cases of infections and 9 other causes. The degree of severity was: anaemia, anorexia asthenia, diarrhoea, dysgeusia, increased levels of GGT/AST/ALT/LDH, mucositis, nausea, neutropenia, itching, palmar–plantar erythrodysaesthesia syndrome, thrombopenia, urticaria and vomiting, grade 1 (59%); anaemia, anorexia, asthenia, headaches, GGT increased, infections, mucositis, nausea, neutropenia and vomiting, grade 2 (30%); and asthenia, neutropenia and GGT increased, grade 3 (12%). There were 13 patients who delayed treatment, and neutropenia was the reason in 85% of patients. 6% of patients had reduced doses of palbociclib because of neutropenia or mucositis. Conclusion and relevance There was a high incidence of AE, the most frequent being grade 1. The most common AE were haematological, with neutropenia being the highest degree. Our studies suggested a high percentage of delays and dose reductions. References and/or acknowledgements Conflict of interest No conflict of interest
{"title":"5PSQ-159 Palbociclib safety in metastatic breast cancer","authors":"FJ Salmeron Navas, E. Ríos-Sánchez, M. D. Cantero, EM Barreiro-Fernandez","doi":"10.1136/EJHPHARM-2021-EAHPCONF.278","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.278","url":null,"abstract":"Background and importance Loss of cell cycle regulation due to pathway alterations in cyclin D-CDK4/6-Rb is common in breast cancer. Palbociclib is a CDK4/6 inhibitor, indicated in metastatic breast cancer (mBC). Aim and objectives The aim of this study was to analyse the safety profile of patients with mBC positive hormone receptors receiving treatment with palbociclib. Material and methods A retrospective descriptive study was conducted in patients with mBC receiving treatment with palbociclib from July 2019 to July 2020. Electronic prescription programme for outpatient and medical records was consulted. Data collected for each patient were: sex, age, menopause status, performance status (PS), cancer stage, presence of visceral metastatic disease, therapeutic scheme and number of cycles received. The safety profile was assessed from the number of adverse events (AE), and the severity of AEs was graded on the basis of the common terminology criteria for adverse events, V.5.0. Number of patients and reasons for delays and dose reductions were also determined. Results 34 patients, 100% women, were included, with an average age of 60 (47–81) years, of whom 71% were postmenopausal. 29 patients presented at the beginning of treatment with PS ≤1. The percentage of patients with metastatic disease was 100%, of whom 76% had visceral metastases. The schemes, average numbers and range of cycles were: palbociclib 125 mg every 3 weeks, 7 (1–17) cycles. 105 AE occurred in 31 patients (91%): 54 haematological, 23 metabolic, 10 digestive, 7 asthenia, 2 cases of infections and 9 other causes. The degree of severity was: anaemia, anorexia asthenia, diarrhoea, dysgeusia, increased levels of GGT/AST/ALT/LDH, mucositis, nausea, neutropenia, itching, palmar–plantar erythrodysaesthesia syndrome, thrombopenia, urticaria and vomiting, grade 1 (59%); anaemia, anorexia, asthenia, headaches, GGT increased, infections, mucositis, nausea, neutropenia and vomiting, grade 2 (30%); and asthenia, neutropenia and GGT increased, grade 3 (12%). There were 13 patients who delayed treatment, and neutropenia was the reason in 85% of patients. 6% of patients had reduced doses of palbociclib because of neutropenia or mucositis. Conclusion and relevance There was a high incidence of AE, the most frequent being grade 1. The most common AE were haematological, with neutropenia being the highest degree. Our studies suggested a high percentage of delays and dose reductions. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83754411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.140
SM Oprea, S. Negreș
Background and importance Teriflunomide (TRF) is a once daily oral immunomodulatory drug approved in over 80 countries for multiple sclerosis (MS). It is indicated in young adults and contraindicated in pregnant women or women of reproductive age because of the potential for fetal harm. TRF became available as a unique option for oral MS treatment in our hospital in 2017. Aim and objectives To describe our experience with the use of TRF and assess its safety profile, as disease modifying therapies (DMTs) work differently and have different adverse reactions (AR). Material and methods An observational retrospective study was conducted from January 2017 to January 2020. Collected variables from medical records were: age, sex, expanded disability status scale score (EDSS), previous DMTs, safety profile (AR, suspension of TRF treatment) and results of blood tests. Sustained disability progression was defined as at least a 1 point increase from the baseline EDSS score ≤5.5 (or at least a 0.5 point increase for those with a baseline EDSS score >5.5) sustained for at least 12 weeks.1 Results 45 patients were analysed, 10 men and 35 women (mean age 35.7 years). TRF was the firstline drug for 10 patients, the rest had switched to TRF from parenteral therapies: 7 subcutaneous glatiramer acetate, 20 intramuscular or subcutaneous interferon beta and 2 intravenous natalizumab. The main reasons for change were: convenience of oral administration, poor tolerance and AR at the site of injection. The average duration for TRF was 2.5 years with no suspension recorded. In this period, for 30 patients EDSS score remained stable. The mean change in EDSS from baseline was 0.7; no increase in disability progression. 30 patients showed no AR and 15 patients presented gastrointestinal disorders (9), temporary alopecia (4) or headache (2). 9 patients experienced moderate elevation of liver enzymes. Conclusion and relevance TRF seemed to have a manageable safety profile, was well tolerated, and no new or unexpected AR were reported and there were no suspensions of treatment. Because our experience reflects only 3 years, increased monitoring is necessary to assess the long term safety. References and/or acknowledgements AUBAGIO (package insert). Cambridge, MA: Genzyme Corporation Conflict of interest No conflict of interest
{"title":"4CPS-308 Experience with teriflunomide treatment for multiple sclerosis in a university hospital","authors":"SM Oprea, S. Negreș","doi":"10.1136/EJHPHARM-2021-EAHPCONF.140","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.140","url":null,"abstract":"Background and importance Teriflunomide (TRF) is a once daily oral immunomodulatory drug approved in over 80 countries for multiple sclerosis (MS). It is indicated in young adults and contraindicated in pregnant women or women of reproductive age because of the potential for fetal harm. TRF became available as a unique option for oral MS treatment in our hospital in 2017. Aim and objectives To describe our experience with the use of TRF and assess its safety profile, as disease modifying therapies (DMTs) work differently and have different adverse reactions (AR). Material and methods An observational retrospective study was conducted from January 2017 to January 2020. Collected variables from medical records were: age, sex, expanded disability status scale score (EDSS), previous DMTs, safety profile (AR, suspension of TRF treatment) and results of blood tests. Sustained disability progression was defined as at least a 1 point increase from the baseline EDSS score ≤5.5 (or at least a 0.5 point increase for those with a baseline EDSS score >5.5) sustained for at least 12 weeks.1 Results 45 patients were analysed, 10 men and 35 women (mean age 35.7 years). TRF was the firstline drug for 10 patients, the rest had switched to TRF from parenteral therapies: 7 subcutaneous glatiramer acetate, 20 intramuscular or subcutaneous interferon beta and 2 intravenous natalizumab. The main reasons for change were: convenience of oral administration, poor tolerance and AR at the site of injection. The average duration for TRF was 2.5 years with no suspension recorded. In this period, for 30 patients EDSS score remained stable. The mean change in EDSS from baseline was 0.7; no increase in disability progression. 30 patients showed no AR and 15 patients presented gastrointestinal disorders (9), temporary alopecia (4) or headache (2). 9 patients experienced moderate elevation of liver enzymes. Conclusion and relevance TRF seemed to have a manageable safety profile, was well tolerated, and no new or unexpected AR were reported and there were no suspensions of treatment. Because our experience reflects only 3 years, increased monitoring is necessary to assess the long term safety. References and/or acknowledgements AUBAGIO (package insert). Cambridge, MA: Genzyme Corporation Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75286164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1136/EJHPHARM-2021-EAHPCONF.73
G. González Morcillo, B. Calderón Hernanz, M. Calderón Torres, ML Martín Fajardo, AC Mandilego García, L. Pérez de Amezaga Tomás, MM Parera Pascual, M. Vilanova Boltó
Background and importance Antibiotics are widely prescribed in the emergency department (ED). Around 30–60% of antibiotic prescriptions in the ED are inappropriate; this fact is associated with an increase in length of hospital stay and is a public health problem. In this context, the ED becomes a key point for antibiotic optimisation. Aim and objectives The objectives of the study were to determine the frequency and type of inappropriate prescriptions of antibiotic therapy (AT) in the ED and to assess the impact in terms of increase in hospital stay, readmissions and 30 day mortality after the event. Material and methods This was a descriptive, observational, retrospective, multidisciplinary study authorised by the hospital research commission. A cross sectional serial point prevalence study of all antibiotic prescriptions for patients under observation in the ED between January and March 2020 was conducted. The appropriateness of the prescription was evaluated by specialists from emergency medicine and clinical pharmacists, according to the centre’s infection guidelines (CIG). Demographic variables, comorbidity and site of infection were checked with the electronic medical record (HPHCIS V.3.8). SPSSV.23 software was used for data analysis with centralisation and frequency measurements for descriptive data and the χ2 test for inference. Results A total of 192 AT were administrated to a total of 168 patients (52% men), mean age 65 (SD 20) years and 68.5% had a Charlson index ≥2. The three main site of infection were respiratory (53%), urinary (19%) and intra-abdominal (12%). 39.6% of the antibiotic prescriptions were assessed as inappropriate. Inappropriateness was classified and distributed as: Unnecessary, no signs of infection: 3.3% of AT prescriptions Not active for the expected aetiology: 9.8% Appropriate, but wrongly dosed: 4% Appropriate, but not recommended according to the CIG: 22.8%. The indication with the highest degree of inappropriateness was urinary infections, with 19 of 31 AT prescriptions being inappropriate. Inappropriate prescription was not found to be a factor related to an increase in hospital stay (OR 1.39; 95% CI 0.77 to 2.50; p=0.269), readmissions (OR 0.751; 95% CI 0.35 to 1.59; p=0.455) or mortality (OR 1.40; 95% CI 0.87 to 22.86; p=0.809). Conclusion and relevance In general, CIG were followed because almost two-thirds of AT were appropriate. Furthermore, inappropriate AT prescriptions did not lead to an increase in hospital stays, or readmissions or mortality. The inappropriateness of the AT results may be considered for the development of antibiotic optimisation strategies. References and/or acknowledgements Conflict of interest No conflict of interest
背景和重要性抗生素在急诊科被广泛使用。急诊科约有30-60%的抗生素处方是不恰当的;这一事实与住院时间的增加有关，是一个公共卫生问题。在这种情况下，ED成为抗生素优化的关键点。目的和目的本研究的目的是确定急诊科抗生素治疗(AT)不当处方的频率和类型，并评估其对住院时间、再入院率和事件发生后30天死亡率增加的影响。材料和方法这是一项由医院研究委员会授权的描述性、观察性、回顾性、多学科研究。对2020年1月至3月在急诊科观察的所有抗生素处方患者进行横断面连续点流行研究。根据该中心的感染指南(CIG)，急诊医学专家和临床药剂师对处方的适当性进行了评估。用电子病历(HPHCIS V.3.8)检查人口统计学变量、合并症和感染部位。采用SPSSV.23软件进行数据分析，描述性数据采用集中和频率测量，推断采用χ2检验。结果168例患者共接受了192次AT治疗，其中男性占52%，平均年龄65岁(SD 20)， Charlson指数≥2的患者占68.5%。三个主要感染部位为呼吸道(53%)、泌尿(19%)和腹腔(12%)。39.6%的抗生素处方被评估为不合适。不适宜性分类和分布为:不必要，无感染迹象:3.3%的AT处方对预期病因无效:9.8%适当，但剂量错误:4%适当，但根据CIG不推荐:22.8%。不适宜程度最高的适应症为泌尿系感染，31张AT处方中有19张不适宜。不适当的处方未被发现是与住院时间增加相关的因素(OR 1.39;95% CI 0.77 ~ 2.50;p=0.269)，再入院率(OR 0.751;95% CI 0.35 ~ 1.59;p=0.455)或死亡率(or 1.40;95% CI 0.87 ~ 22.86;p = 0.809)。结论和相关性一般来说，CIG被遵循，因为几乎三分之二的AT是合适的。此外，不适当的AT处方不会导致住院时间、再入院率或死亡率的增加。AT结果的不适当性可以考虑抗生素优化策略的发展。参考文献和/或致谢利益冲突无利益冲突
{"title":"4CPS-241 Impact of antibiotic prescribing in an emergency department on hospital stays, readmission and mortality","authors":"G. González Morcillo, B. Calderón Hernanz, M. Calderón Torres, ML Martín Fajardo, AC Mandilego García, L. Pérez de Amezaga Tomás, MM Parera Pascual, M. Vilanova Boltó","doi":"10.1136/EJHPHARM-2021-EAHPCONF.73","DOIUrl":"https://doi.org/10.1136/EJHPHARM-2021-EAHPCONF.73","url":null,"abstract":"Background and importance Antibiotics are widely prescribed in the emergency department (ED). Around 30–60% of antibiotic prescriptions in the ED are inappropriate; this fact is associated with an increase in length of hospital stay and is a public health problem. In this context, the ED becomes a key point for antibiotic optimisation. Aim and objectives The objectives of the study were to determine the frequency and type of inappropriate prescriptions of antibiotic therapy (AT) in the ED and to assess the impact in terms of increase in hospital stay, readmissions and 30 day mortality after the event. Material and methods This was a descriptive, observational, retrospective, multidisciplinary study authorised by the hospital research commission. A cross sectional serial point prevalence study of all antibiotic prescriptions for patients under observation in the ED between January and March 2020 was conducted. The appropriateness of the prescription was evaluated by specialists from emergency medicine and clinical pharmacists, according to the centre’s infection guidelines (CIG). Demographic variables, comorbidity and site of infection were checked with the electronic medical record (HPHCIS V.3.8). SPSSV.23 software was used for data analysis with centralisation and frequency measurements for descriptive data and the χ2 test for inference. Results A total of 192 AT were administrated to a total of 168 patients (52% men), mean age 65 (SD 20) years and 68.5% had a Charlson index ≥2. The three main site of infection were respiratory (53%), urinary (19%) and intra-abdominal (12%). 39.6% of the antibiotic prescriptions were assessed as inappropriate. Inappropriateness was classified and distributed as: Unnecessary, no signs of infection: 3.3% of AT prescriptions Not active for the expected aetiology: 9.8% Appropriate, but wrongly dosed: 4% Appropriate, but not recommended according to the CIG: 22.8%. The indication with the highest degree of inappropriateness was urinary infections, with 19 of 31 AT prescriptions being inappropriate. Inappropriate prescription was not found to be a factor related to an increase in hospital stay (OR 1.39; 95% CI 0.77 to 2.50; p=0.269), readmissions (OR 0.751; 95% CI 0.35 to 1.59; p=0.455) or mortality (OR 1.40; 95% CI 0.87 to 22.86; p=0.809). Conclusion and relevance In general, CIG were followed because almost two-thirds of AT were appropriate. Furthermore, inappropriate AT prescriptions did not lead to an increase in hospital stays, or readmissions or mortality. The inappropriateness of the AT results may be considered for the development of antibiotic optimisation strategies. References and/or acknowledgements Conflict of interest No conflict of interest","PeriodicalId":11998,"journal":{"name":"European Journal of Hospital Pharmacy","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83244215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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