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Use of two general-purpose scales to assess clinical pharmacy activities in a cell transplantation unit. 使用两种通用量表评估细胞移植单位的临床药学活动。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-25 DOI: 10.1177/10781552241297391
Florence Quinet, Sixtine Gilliot, David Beauvais, Michele Vasseur, Micha Srour, Léonardo Magro, Valérie Coiteux, Paul Chauvet, Ibrahim Yakoub-Agha, Pascal Odou, Bertrand Décaudin, Nicolas Simon

Introduction: The general-purpose rating scales used by clinical pharmacists to rate their activities have not been extensively studied in specialist care units. This study aims to describe drug-related problems (DRPs) and pharmacist interventions (PIs) in a French hematopoietic cell therapy (HCT) unit and to evaluate the PIs' likely clinical, economic, and organizational impacts.

Methods: We retrospectively assessed all DRPs reported and all PIs issued between December 2018 and December 2021. The Act-IP scale was used to rate DRPs and PIs, and the ClEO scale was used to rate each PI's clinical, economic and organizational impacts. Fisher's exact test was used to assess the relationships between PIs and DRPs and between the three dimensions of the ClEO scale.

Results: The DRPs were most frequently related to drug-drug interactions (16.5%), physicochemical incompatibilities (15.5%), and drug monitoring problems (14.9%). 62.8% of the PIs had at least a moderate clinical impact. PIs that recommended drug monitoring were most frequent (26.8%), and most of these (75%) were likely to have prevented incidents that would have required patient monitoring or treatment.

Conclusions: The results of this study showed that after a slight adaptation, the Act-IP scale can be used to map clinical pharmacy activity in an HCT unit. More than 60% of the DRPs/PIs were likely to have had a positive impact on the patient's clinical outcome. All the PIs were rated with a positive organizational impact and PIs likely to lead to cost savings were balanced by those likely to increase costs.

导言:临床药剂师用于评价其活动的通用评分量表尚未在专科护理单位中得到广泛研究。本研究旨在描述法国一家造血细胞治疗(HCT)单位的药物相关问题(DRPs)和药剂师干预措施(PIs),并评估 PIs 可能对临床、经济和组织产生的影响:我们对 2018 年 12 月至 2021 年 12 月期间报告的所有 DRP 和发布的所有 PI 进行了回顾性评估。采用 Act-IP 量表对 DRP 和 PI 进行评分,采用 ClEO 量表对每个 PI 的临床、经济和组织影响进行评分。费雪精确检验用于评估 PI 与 DRP 之间以及 ClEO 量表的三个维度之间的关系:结果:DRPs 最常与药物间相互作用(16.5%)、理化不相容性(15.5%)和药物监测问题(14.9%)有关。62.8%的临床研究项目至少有中等程度的临床影响。建议进行药物监测的 PIs 最多(26.8%),其中大多数(75%)可能避免了需要对患者进行监测或治疗的事件:这项研究的结果表明,Act-IP量表稍作调整后,可用于绘制造血干细胞移植病房的临床药学活动图。超过 60% 的 DRP/PI可能对患者的临床疗效产生了积极影响。所有 PI 均被评为对组织有积极影响,可能导致成本节约的 PI 与可能增加成本的 PI 相平衡。
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引用次数: 0
Efficacy and safety of daratumumab for the treatment of refractory/relapsed multiple myeloma. A systematic review of meta-analyses. 达拉单抗治疗难治性/复发性多发性骨髓瘤的疗效和安全性。荟萃分析系统综述。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-21 DOI: 10.1177/10781552241290452
Diala Alhaj Moustafa, Laila Shafei, Ruba Sulaiman, Mohamed A Yassin, Dina Abushanab, Yousef Algarabli, Daoud Al-Badriyeh

Introduction: Several meta-analyses (MAs) of the efficacy and safety of daratumumab in refractory/relapsed multiple myeloma (RRMM) exist. They include different types of populations, Daratumumab regimens, and outcomes. Moreover, there is a wide variation in methodological quality and risk of bias.

Objective: This study aimed to conduct a systematic review of MAs to summarize the literature on the efficacy and safety profile of daratumumab use in RRMM, and also provide an assessment of the quality and risk of bias of the MAs if sufficient data is available.

Methods: The literature databases Pubmed, Embase, Web of Science, and Cochrane were searched since inception. The quality of methodology was assessed by the AMSTAR-2 tool, and the risk of bias was assessed by the ROBIS tool.

Results: Eight MAs were included in the SR. Most studies reported ORR and CR improvement by adding daratumumab to the chemotherapy regimen. Five MAs reported improvement in PFS in daratumumab-based regimens compared to non- daratumumab-based regimens. Only two MAs reported molecular response, favoring daratumumab. Dara was associated with adverse drug events (ADEs), including pneumonia and diarrhea. Conflicting evidence regarding hematological ADEs association with daratumumab exists. The overall quality of the studies is poor, but the MAs had a low risk of bias overall.

Conclusion: Despite including low-quality MAs, this SR provides a summary that simplifies clinicians' access to efficacy and safety outcomes of daratumumab in RRMM patients. Future studies are required to reduce the uncertainty and produce higher-quality Mas, particularly regarding daratumumab's safety.

简介:关于达拉单抗治疗难治性/复发性多发性骨髓瘤(RRMM)的疗效和安全性的荟萃分析(MAs)已有多项。它们包括不同类型的人群、达拉单抗方案和结果。此外,在方法学质量和偏倚风险方面也存在很大差异:本研究旨在对MAs进行系统综述,总结达拉单抗用于RRMM的疗效和安全性方面的文献,并在有足够数据的情况下对MAs的质量和偏倚风险进行评估:方法:检索了Pubmed、Embase、Web of Science和Cochrane等文献数据库。采用 AMSTAR-2 工具评估研究方法的质量,采用 ROBIS 工具评估偏倚风险:结果:8项MA被纳入SR。大多数研究报告了在化疗方案中加入达拉单抗后ORR和CR的改善情况。5项MA报告了达拉单抗方案与非达拉单抗方案相比PFS的改善情况。只有两项MA报告了分子反应,达拉单抗更胜一筹。达拉与药物不良事件(ADE)有关,包括肺炎和腹泻。关于达拉土单抗的血液学不良反应,存在相互矛盾的证据。研究的总体质量较差,但MAs的总体偏倚风险较低:尽管包含了低质量的MAs,但本SR提供的摘要简化了临床医生获取达拉土单抗在RRMM患者中的疗效和安全性结果的途径。未来的研究需要减少不确定性并提供更高质量的Mas,尤其是有关达拉土单抗安全性的研究。
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引用次数: 0
Bilateral epithelial keratopathy and punctate keratitis due to ribociclib. 利波昔布导致双侧上皮性角膜炎和点状角膜炎。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-21 DOI: 10.1177/10781552241301406
Neslihan Bayraktar Bilen, Bilge Tarım, Mualla Hamurcu, Döndü Melek Ulusoy

Introduction: This report describes a rare occurrence of corneal epithelial keratopathy associated with ribociclib, a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor widely used in breast cancer treatment.

Case report: An 83-year-old female with a recent breast cancer diagnosis presented with blurred vision during the third cycle of ribociclib treatment. Ocular examination revealed corneal epitheliopathy and fluorescein staining findings. Detailed assessments and comparisons were made with existing literature, identifying a few reported cases of vortex keratopathy linked to ribociclib. To the best of our knowledge, this is the first reported case of epitheliopathy.

Management and outcome: Since it decreased visual acuity, ribociclib treatment was discontinued in consultation with oncology. There was no regression in epithelopathy findings and visual acuity did not improve during follow-up visits.

Discussion: This report underscores the uncommon association between ribociclib and corneal epithelial keratopathy, emphasizing the need for comprehensive monitoring and collaboration between oncologists and ophthalmologists.

导言:本报告描述了一种罕见的角膜上皮角膜病变,它与广泛用于乳腺癌治疗的细胞周期蛋白依赖性激酶 4/6(CDK4/6)抑制剂 ribociclib 有关:一位 83 岁的女性患者最近被诊断为乳腺癌,在接受第三周期的利波昔布治疗期间出现视力模糊。眼部检查发现角膜上皮病变和荧光素染色结果。我们进行了详细的评估,并与现有文献进行了比较,发现有几例报道的涡状角膜病与利福昔布有关。据我们所知,这是首例上皮细胞病变病例:由于视力下降,经与肿瘤科协商,停止了利福昔布治疗。随访期间,上皮细胞病的发现没有减少,视力也没有改善:本报告强调了利福昔布与角膜上皮角膜病之间的关联并不常见,强调了肿瘤学家和眼科医生之间进行全面监测和合作的必要性。
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引用次数: 0
Optimizing medication therapy in elderly patients: The impact of medication review using STOPP and START criteria version 2. 优化老年患者的药物治疗:使用 STOPP 和 START 标准 2 版进行药物审查的影响。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-18 DOI: 10.1177/10781552241296882
Silpa Murali, Aswin Damodaran, Namita Maria Jacob, Anjaly Venugopal, Joveena Johnson, Meenu Vijayan, K Pavithran, M Sonal Sekhar

Background: Higher prevalence of inappropriate medication use among cancer patients increases risk of drug-related problems(DRP) like drug-drug interactions, ADR, and non-adherence. Potentially inappropriate medication (PIM) and Potential Prescription Omission (PPO) were identified using Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to the Right Treatment (START) criteria. Objectives: The study objective was to optimize prescriptions for the elderly by analyzing the impact of medication review. Methods: An observational study in which PIM and/or PPO were identified and the prescriptions were optimized by a physician. Results: Out of 150 patients, a total of 35 drugs were stopped and 12 drugs were started. Medication omissions were identified in 12 patients (8%). There were no DRPs associated with medication adjustments. Conclusion: Based on a pharmacist-led comprehensive medication review of the elderly, the STOPP and START criteria allow the optimization of prescriptions.

背景:癌症患者用药不当的发生率较高,这增加了药物相关问题(DRP)的风险,如药物相互作用、药物不良反应和不依从性。我们使用老年人处方筛查工具(STOPP)和提醒医生正确治疗的筛查工具(START)标准来确定潜在的用药不当(PIM)和潜在的处方遗漏(PPO)。研究目标研究目的是通过分析药物审查的影响来优化老年人的处方。方法:一项观察性研究,其中确定了 PIM 和/或 PPO,并由一名医生对处方进行优化。结果在 150 名患者中,共有 35 种药物被停用,12 种药物被启用。发现有 12 名患者(8%)漏服药物。没有与药物调整相关的 DRP。结论基于药剂师主导的老年人综合用药检查,STOPP 和 START 标准可优化处方。
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引用次数: 0
Enteral tube administration of extemporaneously compounded suspensions of venetoclax according to an institutional medication use process. 根据机构用药流程,对临时配制的 venetoclax 悬浮液进行肠内管给药。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-18 DOI: 10.1177/10781552241299690
Sakib T Haque, Joseph S Bubalo

Introduction: Venetoclax is a potent oral oncology drug (OOD) frequently used to treat hematologic cancers due to its convenience and high efficacy. However, some patients cannot tolerate solid oral formulations, requiring a reformulated version of venetoclax for effective administration. Currently, there is limited information in the literature regarding the extemporaneous compounding of venetoclax.

Methods: We present our institution's medication use process (MUP) for preparing compounded suspensions of venetoclax for patients with dysphagia who cannot tolerate solid oral formulations. This report has two main aims: to review our MUP from design to implementation, illustrated with real patient cases, and to present it as a strategy for administering venetoclax-based therapies to patients with dysphagia or feeding tubes. From February 2020 to January 2024, 17 patients received venetoclax through the standard MUP, with four developing tumor lysis syndrome (TLS). This study describes their clinical courses and evaluates their responses to the compounded suspensions, considering the uncertain effects of venetoclax prepared through this method.

Results: The four patients received venetoclax suspensions during hospitalization due to swallowing difficulties or nutritional support needs. We prepared extemporaneous venetoclax suspensions to ensure continuous therapy, thus avoiding treatment interruptions. TLS was managed using rasburicase and prophylactic allopurinol.

Conclusions: The clinical outcomes indicate that the current MUP provides a practical approach to administering venetoclax for dysphagic patients. However, additional research is needed to determine if there are pharmacokinetic differences in the bioavailability of venetoclax between oral and enterally delivered formulations. Further studies will help inform best practices for patient care.

简介Venetoclax 是一种强效口服肿瘤药物(OOD),因其服用方便、疗效显著而常用于治疗血液肿瘤。然而,有些患者不能耐受固体口服制剂,因此需要重新配制 Venetoclax 才能有效给药。目前,有关 venetoclax 即用复方制剂的文献资料十分有限:我们介绍了本机构为无法耐受固体口服制剂的吞咽困难患者配制复方 venetoclax 悬浮液的用药流程 (MUP)。本报告有两个主要目的:回顾我们的 MUP 从设计到实施的整个过程,并以真实的患者病例加以说明;将其作为一种策略,用于为吞咽困难或插管喂养的患者提供基于 Venetoclax 的疗法。从2020年2月到2024年1月,17名患者通过标准MUP接受了venetoclax治疗,其中4人出现了肿瘤溶解综合征(TLS)。本研究描述了他们的临床过程,并评估了他们对复方混悬液的反应,同时考虑到通过这种方法制备的 venetoclax 的不确定性影响:四名患者因吞咽困难或营养支持需要而在住院期间接受了 Venetoclax 悬浮液治疗。我们临时配制了 Venetoclax 悬浮液,以确保持续治疗,从而避免治疗中断。使用拉布替卡酶和预防性别嘌呤醇治疗了TLS:临床结果表明,目前的 MUP 为呼吸困难患者提供了一种实用的 Venetoclax 施用方法。然而,还需要进行更多的研究,以确定口服制剂和肠道给药制剂的生物利用度是否存在药代动力学差异。进一步的研究将有助于为患者护理的最佳实践提供依据。
{"title":"Enteral tube administration of extemporaneously compounded suspensions of venetoclax according to an institutional medication use process.","authors":"Sakib T Haque, Joseph S Bubalo","doi":"10.1177/10781552241299690","DOIUrl":"10.1177/10781552241299690","url":null,"abstract":"<p><strong>Introduction: </strong>Venetoclax is a potent oral oncology drug (OOD) frequently used to treat hematologic cancers due to its convenience and high efficacy. However, some patients cannot tolerate solid oral formulations, requiring a reformulated version of venetoclax for effective administration. Currently, there is limited information in the literature regarding the extemporaneous compounding of venetoclax.</p><p><strong>Methods: </strong>We present our institution's medication use process (MUP) for preparing compounded suspensions of venetoclax for patients with dysphagia who cannot tolerate solid oral formulations. This report has two main aims: to review our MUP from design to implementation, illustrated with real patient cases, and to present it as a strategy for administering venetoclax-based therapies to patients with dysphagia or feeding tubes. From February 2020 to January 2024, 17 patients received venetoclax through the standard MUP, with four developing tumor lysis syndrome (TLS). This study describes their clinical courses and evaluates their responses to the compounded suspensions, considering the uncertain effects of venetoclax prepared through this method.</p><p><strong>Results: </strong>The four patients received venetoclax suspensions during hospitalization due to swallowing difficulties or nutritional support needs. We prepared extemporaneous venetoclax suspensions to ensure continuous therapy, thus avoiding treatment interruptions. TLS was managed using rasburicase and prophylactic allopurinol.</p><p><strong>Conclusions: </strong>The clinical outcomes indicate that the current MUP provides a practical approach to administering venetoclax for dysphagic patients. However, additional research is needed to determine if there are pharmacokinetic differences in the bioavailability of venetoclax between oral and enterally delivered formulations. Further studies will help inform best practices for patient care.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552241299690"},"PeriodicalIF":1.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Qualitative analysis of clinical pharmacy interventions in an inpatient leukemia service. 对白血病住院服务中临床药学干预措施的定性分析。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-11 DOI: 10.1177/10781552241296407
Rand Al-Hadaddin, Nour Mustafa, Ahmad Alyamani, Nour Faqeer

Introduction: Leukemia, a complex hematological malignancy, requires a multidisciplinary treatment approach, with clinical pharmacists playing a crucial role. However, their involvement in clinical practice is not well-documented in the literature. This study aimed to examine the characteristics of clinical pharmacy interventions (CPIs) reported by clinical pharmacists.

Method: This retrospective study involved extraction of CPIs entered into a pharmacy documentation database "Quantifi®" between January 2019 and June 2023. These CPIs included direct clinical pharmacist interventions (DCPIs), detected medication errors (MEs) and adverse drug reactions (ADRs).

Results: A total of 6286 CPIs were extracted, of which DCPIs, MEs and ADRs accounted for 5701 (90.7%), 357 (5.7%) and 228 (3.6%) reports, respectively. The most prevalent DCPIs were drug therapy discontinuation (n = 1080, 18.9%). Antimicrobials were the most common medications associated with DCPIs (n = 1991, 34.9%). Physicians accepted 99.4% of DCPIs and 64.1% (n = 3656) of direct interventions were considered significant. Among detected MEs, antimicrobials were the most reported medications (n = 158, 44.3%), with pharmacy internal errors being the most prevalent cause of the events (n = 172, 48.2%). Among the reported ADRs, hematological reactions were the most common (n = 81, 35.5%), and antineoplastic agents were the most frequently associated medications with ADRs (n = 164, 71.9%).

Conclusion: This study highlights the crucial role of clinical pharmacists in managing leukemia patients, emphasizing their key interventions and ability to identify MEs and ADRs. Further research is needed to explore the clinical outcomes and financial impact of their involvement.

简介:白血病是一种复杂的血液恶性肿瘤,需要采用多学科治疗方法,临床药剂师在其中发挥着至关重要的作用。然而,他们在临床实践中的参与并没有在文献中得到充分记录。本研究旨在探讨临床药师报告的临床药学干预(CPIs)的特点:这项回顾性研究涉及提取 2019 年 1 月至 2023 年 6 月期间输入药学文档数据库 "Quantifi®"的 CPI。这些 CPI 包括临床药师直接干预 (DCPI)、检测到的用药错误 (ME) 和药物不良反应 (ADR):共提取了 6286 份 CPI,其中 DCPI、ME 和 ADR 报告分别占 5701 份(90.7%)、357 份(5.7%)和 228 份(3.6%)。最常见的 DCPIs 是药物治疗中断(1080 例,18.9%)。抗菌药物是与 DCPIs 相关的最常见药物(n = 1991,34.9%)。医生接受了 99.4% 的 DCPIs,64.1%(n = 3656)的直接干预被认为是有意义的。在检测到的 MEs 中,抗菌药物是报告最多的药物(n = 158,44.3%),药房内部错误是最常见的事件原因(n = 172,48.2%)。在报告的不良反应中,血液学反应最为常见(n = 81,35.5%),抗肿瘤药物是最常发生不良反应的药物(n = 164,71.9%):本研究强调了临床药剂师在管理白血病患者中的关键作用,强调了他们的关键干预措施以及识别 ME 和 ADR 的能力。需要进一步开展研究,探讨药剂师参与的临床结果和经济影响。
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引用次数: 0
Barriers to opioid use in the Arab world. 阿拉伯世界使用阿片类药物的障碍。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-11 DOI: 10.1177/10781552241292497
Sewar Salmany, Suzan Hammoudeh, Asma Al-Khrabsheh, Saad Jaddoua, Omar Shamieh, Imad Treish

Background: The Arab world consists of 22 countries, representing 5.5% of the world's population. Morphine consumption accounts for less than 1% of the world's consumption. This is the first study to identify barriers to opioid use in the Arab world.

Aim: This study aimed to investigate the barriers to opioid use in pain management in the Arab world.

Method: Online survey was developed to investigate barriers to governance, prescribing, distributing, dispensing and administering, as well as educational barriers in the Arab world. The questionnaire was sent via email and a mobile app to one expert physician in pain management and one licensed pharmacist from each Arab country.

Results: With the exception of Tunisia, Djibouti and Comoros, 34(77%) participants from 19 Arab countries answered the survey. Most countries lack local opioid production, necessitate special licenses for physicians, and restrict opioid prescribing to medical specialists. Special prescription forms are mandated, and pharmacists lack the authority to correct prescription errors or accept refill or verbal orders on opioids. Storage requirements for empty ampoules and prescriptions are enforced. Nurses are not allowed to carry opioids during home visits, and only first degree relatives can collect opioids for patients. Furthermore, the integration of palliative care and pain management curricula into pharmacies and medical schools is lacking.

Conclusion: There is a wide range of regulatory and other barriers to opioid use in the Arab world. There is a substantial need for regulatory review and reform, as well as for educational initiatives, in most Arab countries.

背景:阿拉伯世界由 22 个国家组成,占世界人口的 5.5%:阿拉伯世界由 22 个国家组成,占世界人口的 5.5%。吗啡的消费量不到世界消费量的 1%。本研究旨在调查阿拉伯世界在疼痛治疗中使用阿片类药物的障碍:制定了在线调查问卷,以调查阿拉伯世界在治理、处方、分发、配药和用药方面的障碍以及教育障碍。调查问卷通过电子邮件和移动应用程序发送给每个阿拉伯国家的一名疼痛管理专家医师和一名执业药剂师:除突尼斯、吉布提和科摩罗外,来自 19 个阿拉伯国家的 34 名参与者(77%)回答了调查问卷。大多数国家缺乏阿片类药物的本地生产,医生必须持有特殊执照,阿片类药物的处方仅限于医疗专家。规定必须使用特殊的处方表格,药剂师无权纠正处方错误或接受阿片类药物的补货或口头订单。空安瓿和处方的储存要求得到强制执行。护士在家访时不得携带阿片类药物,只有一级亲属才能为病人领取阿片类药物。此外,药房和医学院缺乏姑息治疗和疼痛管理课程的整合:结论:在阿拉伯世界,阿片类药物的使用存在广泛的监管障碍和其他障碍。大多数阿拉伯国家亟需进行监管审查和改革,并采取教育措施。
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引用次数: 0
Carboplatin dosing in obese patients. 肥胖患者的卡铂剂量。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-11-04 DOI: 10.1177/10781552241292503
Cristina Ramírez-Roig, Alberto Espuny-Miró, Raquel Olmos-Jiménez, María Sacramento Díaz-Carrasco

Objectives: The study aimed to: 1) Describe the carboplatin dosing criteria in obese patients in routine clinical practicein a general university hospital. 2) Evaluate toxicity based on the dosing criterion used. 3) Assess effectiveness in major diagnoses according to the dosing criterion employed.

Methodology: An observational, retrospective, descriptive study, including all obese patients (BMI ≥ 30 kg/m2) who started carboplatin treatment between 1st January 2012 and 31st January 2015. Data on patient characteristics, disease and treatment were collected. As a result variables were collected: carboplatin dosing methods, dosage criteria, alternative dosing approaches, treatment delays, dose reductions, relative dose intensity, adverse reactions and severity (CTCAE v. 4.0) as well as overall survival and progressive free survival for major diagnoses.

Conclusions: 1) Carboplatin dosing at the centre used Calvert's formula for calculating AUC and Cockcroft-Gault's formula for estimating glomerular filtration rate. 2) Cockcroft-Gault's formula employed actual body weight and ideal adjusted body weight in similar proportions. 3) The ideal adjusted body weight was more commonly used in patients with higher obesity and diabetes. 4) In the general population, the developmental trend of toxicity during treatment was greater in the group dosed by actual body weight, reaching significant differences in thrombopenia, neutropenia, GOT elevation, hyporexia and myalgias. 5) Major diagnoses in the present study were ovarian cancer and non-small cell lung cancer. The effectiveness in terms of overall survival and progression-free survival, comparing the groups dosed by actual body weight and ideal adjusted body weight within each pathology did not show statistically significant differences.

目标:本研究旨在1) 描述一家综合性大学医院在常规临床实践中对肥胖患者使用卡铂的剂量标准。2)根据使用的剂量标准评估毒性。3)根据采用的剂量标准评估主要诊断的有效性:观察性、回顾性、描述性研究,包括2012年1月1日至2015年1月31日期间开始卡铂治疗的所有肥胖患者(体重指数≥30 kg/m2)。研究收集了有关患者特征、疾病和治疗的数据。收集的变量包括:卡铂给药方法、剂量标准、替代给药方法、治疗延迟、剂量减少、相对剂量强度、不良反应和严重程度(CTCAE v.4.0)以及主要诊断的总生存期和无进展生存期:1)该中心的卡铂剂量使用卡尔弗特公式计算AUC,使用Cockcroft-Gault公式估算肾小球滤过率。2)Cockcroft-Gault 公式中实际体重和理想调整体重的比例相似。3)理想调整体重更常用于肥胖和糖尿病患者。4)在普通人群中,按实际体重用药组在治疗期间的毒性发展趋势更大,在血栓性血小板减少症、中性粒细胞减少症、GOT 升高、厌食症和肌痛等方面差异显著。5)本研究的主要诊断为卵巢癌和非小细胞肺癌。在总生存期和无进展生存期方面,比较每种病理类型中按实际体重和理想调整体重用药的组别,其疗效未显示出统计学上的显著差异。
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引用次数: 0
Deprescribing in hospitalized patients with cancer: A clinical pharmacist-initiated multidisciplinary intervention. 住院癌症患者的去处方化:临床药剂师发起的多学科干预。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-10-29 DOI: 10.1177/10781552241294016
Razan Sakran, Michael Litvak, Nissim Haim, Daniel Kurnik

Purpose: To examine the feasibility and utility of a clinical pharmacist-led multidisciplinary deprescribing intervention in hospitalized cancer patients.

Methods: We performed a retrospective cohort study among cancer patients hospitalized in oncology department who underwent a medication review by a clinical pharmacist. The pharmacist's recommendations were evaluated by a multidisciplinary team. We collected demographic and clinical information, including information on medication burden before and after intervention and number and types of deprescribing recommendations and their acceptance, and compared them among patients with different estimated life expectancies.

Results: During a 2-year study period, 392 patients evaluated by the clinical pharmacist received 2808 prescriptions (median, 7 per patient). The clinical pharmacist recommended deprescribing of 559 medications (19.9%; 95 CI, 18.4-21.4%), at least 1 medication in 321 patients (82%). The multidisciplinary team accepted 89.6% of deprescribing recommendations, resulting in a reduction of the medication burden by 501 medications (P < 0.001). 12.8% of deprescriptions addressed clinically manifested adverse drug effects in 15.1% of patients. The estimation of life expectancy by the senior oncologist was reasonably accurate, but did not affect deprescribing rate.

Conclusions: A clinical pharmacist-led deprescribing intervention within a multidisciplinary team effectively reduces medication burden and addresses adverse drug effects in cancer patients. Deprescribing interventions should be incorporated in cancer patients at any stage of the disease.

目的:研究以临床药师为主导的多学科处方干预对住院癌症患者的可行性和实用性:我们对在肿瘤科住院的癌症患者进行了一项回顾性队列研究,这些患者接受了临床药剂师的用药审查。药剂师的建议由一个多学科团队进行评估。我们收集了人口统计学和临床信息,包括干预前后的用药负担、停药建议的数量和类型及其接受程度,并对不同预期寿命的患者进行了比较:在为期两年的研究期间,接受临床药剂师评估的 392 名患者共收到 2808 份处方(中位数为每名患者 7 份)。临床药剂师建议停用 559 种药物(19.9%;95 CI,18.4-21.4%),其中 321 名患者(82%)至少停用 1 种药物。多学科团队接受了 89.6% 的减药建议,从而减少了 501 种药物的用药负担(P 结论:临床药师主导的减药治疗可减少患者的用药负担:在多学科团队中由临床药师主导的去处方干预措施可有效减轻癌症患者的用药负担,并解决药物不良反应问题。在癌症患者的任何疾病阶段都应采取减药干预措施。
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引用次数: 0
Real world comparison of filgrastim to filgrastim-sndz in patients with chemotherapy-induced neutropenia. 在化疗引起的中性粒细胞减少症患者中,菲格列汀与菲格列汀-ndz的实际效果比较。
IF 1 4区 医学 Q4 ONCOLOGY Pub Date : 2024-10-23 DOI: 10.1177/10781552241290437
Manal Saad, Kelsey Shadick, Sapna Prasad, Kejal Amin, Randa Chaar, Osama Abdelghany

Introduction: There exists some apprehension by prescribers, healthcare providers, and other stakeholders regarding the real-world safety and effectiveness of biosimilars. While some of the apprehension is likely due to clinician knowledge gaps in the biosimilarity exercise, additional data (including those generated from the real-world) regarding safety and efficacy could reduce a clinician's perception of biosimilar uncertainty and can potentially increase biosimilar acceptance and uptake. The published literature is lacking regarding the real-world impact on healthcare costs and clinical outcomes when a single healthcare institution converts from filgrastim to filgrastim-sndz as its short-acting Granulocyte Colony Stimulating Factor (GCSF), especially within diverse populations and indications not explicitly studied through the registration trials. Specifically, both filgrastim and filgrastim-sndz possess FDA-approved indications within patients with hematologic malignancies receiving high-dose chemotherapy and in those undergoing bone marrow transplantation. As a biosimilar to filgrastim, the FDA did not require prospective, randomized controlled trials to obtain these indications for filgrastim-sndz. The purpose of this study is to describe real-world healthcare resource costs, utilization patterns, and clinical outcomes in patients with hematologic malignancies who received filgrastim-sndz or filgrastim to support neutrophil recovery following chemotherapy (i.e., induction or consolidation) or a bone marrow transplant (BMT) at Yale New Haven Hospital (YNHH).

Methods: A total of 148 patients were identified and met the following criteria: at least 18 years old, Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, absence of fever or infection, newly diagnosed acute myeloid leukemia or newly post-bone marrow transplant and received filgrastim-sndz (Zarxio®) or reference filgrastim (Neupogen®).

Results: Healthcare resource utilization outcomes were compared between biosimilar and reference filgrastim using descriptive statistics. There were no major differences between either cohort, including duration of hospitalization, the number of overall emergency room visits and additional hospital admissions with a primary diagnosis of febrile neutropenia or neutropenia within 30 days post-discharge from initial hospital admission, time to neutrophil recovery following GCSF support, and the incidence and duration of both fever and febrile neutropenia. The total cost based on treatment of all patients in each arm differed significantly with filgrastim-sndz being the most cost-effective choice.

Conclusion: filgrastim-sndz significantly reduced healthcare utilization costs compared to reference filgrastim with similar effect on absolute neutrophil count, incidence of fever, and febrile neutropenia.

导言:处方者、医疗服务提供者和其他利益相关者对生物类似药在真实世界中的安全性和有效性存在一些疑虑。虽然部分忧虑可能是由于临床医生对生物类似药的认识存在差距,但有关安全性和有效性的更多数据(包括从真实世界中获得的数据)可以减少临床医生对生物类似药不确定性的看法,并有可能提高生物类似药的接受度和吸收率。目前尚缺乏已发表的文献,说明当单一医疗机构从使用菲格司汀转为使用菲格司汀-ndz 作为其短效粒细胞集落刺激因子(GCSF)时,尤其是在注册试验未明确研究的不同人群和适应症中,对医疗成本和临床结果的实际影响。具体来说,filgrastim 和 filgrastim-sndz 都拥有 FDA 批准的适应症,适用于接受大剂量化疗的血液恶性肿瘤患者和接受骨髓移植的患者。作为 filgrastim 的生物仿制药,FDA 并不要求进行前瞻性随机对照试验来获得 filgrastim-sndz 的这些适应症。本研究旨在描述耶鲁大学纽黑文医院(YNHH)血液恶性肿瘤患者在化疗(即诱导或巩固治疗)或骨髓移植(BMT)后接受非格司亭-ndz或非格司亭治疗以支持中性粒细胞恢复的实际医疗资源成本、使用模式和临床结果:共有148名患者符合以下标准:至少18岁,东部合作肿瘤学组(ECOG)表现为0至2级,无发热或感染,新诊断为急性髓性白血病或新进行骨髓移植,并接受了filgrastim-ndz(Zarxio®)或参考filgrastim(Neupogen®)治疗:采用描述性统计方法比较了生物仿制药和参考药菲格拉司汀的医疗资源利用结果。两组患者的住院时间、急诊就诊总次数、以发热性中性粒细胞减少症或出院后30天内中性粒细胞减少症为主要诊断的额外住院次数、GCSF支持后中性粒细胞恢复时间、发热和发热性中性粒细胞减少症的发生率和持续时间等方面均无重大差异。结论:菲格拉司汀-桑德斯与参考菲格拉司汀相比显著降低了医疗费用,对绝对中性粒细胞计数、发热发生率和发热性中性粒细胞减少症的影响相似。
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引用次数: 0
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Journal of Oncology Pharmacy Practice
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