FARMACIA HOSPITALARIA最新文献

Introduction: Obesity constitutes a global public health problem, and knowledge about drug dosing in obese patients is limited. Clinical trials in critically ill patients rarely include obese individuals, resulting in a lack of specific dosing information in product data sheets. The aim of this literature review is to provide clinicians with efficient and safe guidelines for this group of patients.

Methods: A multidisciplinary group composed of pharmacists specialised in hospital pharmacy and physicians specialised in intensive care medicine was formed. The therapeutic groups and, in depth, the most commonly used active ingredients in the intensive care unit were identified and reviewed. The bibliographic review was carried out using terms such as: "obese", "overweight", "critical illness", "drug dosification", and "therapeutic dose monitoring". All the information was evaluated by the working group, which reached a consensus on dosing recommendations for each drug in obese critically ill patients.

Results: Eighty three drugs belonging to the following therapeutic groups were identified: antivirals, antibacterials, antifungals, immunosuppressants, antiepileptics, vasopressors, anticoagulants, neuromuscular blocking agents, and sedatives. A table with the consensus dosing recommendation for each of these was produced after review.

Conclusions: Drug dosing in obese patients, both in critical and non-critical settings, remains an area with significant uncertainties. This review provides updated and exhaustive information on the dosing of the main therapeutic groups in obese critically ill patients, and is a useful tool for both physicians in critical care units and clinical pharmacists in their practice in this setting.

Introduction: Infections caused by multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients present a challenge for timely and appropriate antibiotic treatment. This is particularly important in patients undergoing extracorporeal life-support techniques such as renal replacement therapy and extracorporeal membrane oxygenation. These techniques can introduce additional pharmacokinetic alterations, potentially leading to suboptimal exposure to antibiotics. This study aims to outline dosing strategies and therapeutic drug monitoring protocols for new β-lactam antibiotics effective against MDR-GNB in critically ill patients undergoing extracorporeal life-support techniques at a national level. Additionally, the study seeks to develop a consensus document, based on available evidence.

Methods: The project will comprise two main phases: I) a national survey and II) the development of a consensus document. This consensus document, undertaken according to ACCORD guidelines, will encompass: a) establishment of a multidisciplinary panel of experts, b) prospective registration of the consensus, c) evidence synthesis, d) modified Delphi rounds. The antimicrobials to be included will be: meropenem, ceftazidime/avibactam, ceftolozane/tazobactam, cefiderocol, meropenem/vaborbactam, imipenem/relebactam, and aztreonam. Extracorporeal life-support techniques will include continuous renal replacement therapy, conventional intermittent hemodialysis, and extracorporeal membrane oxygenation.

Discussion: The availability of extracorporeal life-support techniques has expanded significantly in recent years, alongside a rise in the prevalence of infections caused by MDR-GNB. There is a need to develop evidence-based tools of high quality to standardize dosing and monitoring strategies for new β-lactam antibiotics.

Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease, its management and morbidity impose a great burden to healthcare systems. Development and rollout of biological disease modifying anti-rheumatic drugs has contributed to improvements for patients, however, high costs have prevented them to be widely used. This is being addressed with biosimilars, with equal benefit-risk profile and reduced costs. The objective is to analyze the cost-effectiveness of subcutaneous biosimilar tocilizumab (bsTCZ) for patients with moderate-severe RA in Spain from a healthcare system perspective.

Methods: A Markov model was developed with a lifetime horizon including 5 health states: remission of the disease; low, moderate, or high activity; and death. A PICO-S-T search retrieved efficacy of treatments in meta-analysis and network meta-analysis, and was further complemented with published clinical trials. Pharmacological costs were obtained from the BotPlus database, and medical resources costs from regional tariffs. Deterministic and probabilistic sensitivity analysis were performed to validate the robustness of results. Incremental cost-effectiveness ratio (ICER) for cost/percentage of remission and cost/quality-adjusted life year (QALY) gain were calculated.

Results: Lifetime cost of bsTCZ was 183 741€ (lowest) versus comparative costs ranging from 184 317€ for infliximab to 201 972€ (highest) for certolizumab. QALYs were 13.74 for upadacitinib and 13.73 for sarilumab and tocilizumab with values between 13.53 and 13.72 for the comparators. ICERs as €/remission and €/QALY showed that bsTCZ was either dominant in most of the comparisons or the most cost-effective alternative. The sensitivity analysis showed that bsTCZ long term cost, and transition from low to moderate disease activity health status were the most influential factors. Moreover, bsTCZ was either dominant or cost-effective in all the comparisons.

Conclusions: bsTCZ demonstrated to be a cost-effective and cost-saving alternative for the treatment of patients with RA in Spain when compared to all the available therapeutic alternatives.

Background: We assessed pain, acceptability, patient preference, and tolerability of patients with psoriasis and psoriatic arthritis after switching guselkumab from a prefilled syringe to One-Press autoinjector pen.

Methods: Patients with psoriasis and psoriatic arthritis treated for at least 6 months with guselkumab syringe were recruited from January 2019 to December 2022. Gender, age, diagnosis, self-administration and pain perception of guselkumab prefilled syringe were recorded. At the first visit patients completed a post-auto-injection syringe questionnaire before starting auto-injection pen administration. After 2 and 6 months of guselkumab self-injection using the One-Press autoinjector pen, patient experience, adherence, preference, pain and safety of each administration were assessed using post-guselkumab by One-Press autoinjector pen questionnaire.

Results: 40 patients (psoriasis n = 34, psoriatic arthritis n = 6) were included. All patients self-administered guselkumab by One-Press autoinjector pen. Pain at the injection site was significantly reduced with the use of the One-Press autoinjector pen. All patients considered that using One-Press autoinjector pen was easier than the syringe, 98% chose the pen as their preferred delivery system.

Conclusion: The One-Press autoinjector pen for guselkumab administration is presented as a preferred option, with a high satisfaction and less painful compared to the administration of guselkumab in a prefilled syringe.

Objective: Characterize the health-related quality of life among patients undergoing kidney replacement therapy and to explore associated factors.

Method: A descriptive observational study was conducted using the Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire to assess health-related quality of life. The Dader Method was employed to evaluate negative outcomes associated with medications. Face-to-face interviews and clinical records were utilized to collect sociodemographic and clinical data from patients undergoing kidney replacement therapy at the Nephrology Department of Virgen de las Nieves University Hospital (Granada, Spain). We explored the association between independent variables (clinical and demographic factors) and dependent variables (Mental Component Score and Physical Component Score) using the lineal regression method.

Results: Ninety-one participants were included, 47 (48.35%) were females. The mean age was 62 years, 52 patients (57.14%) were on hemodialysis, 13 patients (14.29%) on peritoneal dialysis, and 26 patients (28.57%) on other forms of kidney replacement therapy. The study revealed a mean Physical Component Score of 40.89 and a Mental Component Score of 47.19. Additionally, 98.90% of the patients experienced negative outcomes associated with medications. Influential factors include age, comorbid conditions, the number of medications, and clinical parameters such as vitamin D and calcium levels.

Conclusions: This study underscores significant findings in patients undergoing kidney replacement therapy, indicating low Mental Component Score and Physical Component Score, accompanied by negative outcomes associated with medications.