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Gómez Á, Benéitez García MC, Barrueco N, Lucena-Campillo MA, López-Lunar E, García-Díaz B, Vicario-de-la-Torre M, Escobar-Rodríguez I, Gil-Alegre ME. Physicochemical stability of bortezomib solutions for subcutaneous administration. Sci Rep 2024; 14:8975. [PMID: 38637597 PMCID: PMC11026495 DOI: 10.1038/s41598-024-58473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
For the majority of cytotoxic drug preparations, such as bortezomib, the unit dose information is not available. In addition, there is a lack of information on the physicochemical stability of the pharmaceutical preparation after opening; this information is crucial for its administration to patients in successive visits, and the per-patient cost can be affected. The purpose of our proposed physicochemical stability study is to determine the shelf life of the reconstituted liquid product under refrigeration and clinical practice conditions. This evaluation was extended to both vials and ready-to-use syringes prefilled with the contents of the open vial. The stability test design includes the specified storage conditions and the critical physicochemical parameters of reconstituted injectable bortezomib. Furthermore, this approach includes the determination of impurities, the monitoring of the purity of the mean peak using a photodiode array, the control of the mass balance, the monitoring of subvisible particles using a laser diffraction analyser, and the setting of stability specifications. For the chemical stability study, the amount of bortezomib and its degradation products were determined using a stability-indicating HPLC method. The physical inspection of the samples was performed throughout the stability study, and their pH values were also monitored. Bortezomib (2.5 mg/mL) in 0.9% sodium chloride remained stable for 7 days when stored in both polypropylene syringes and vials at 5 ± 3 °C (refrigeration) and shielded from light. Additionally, it exhibits stability for 24 h under storage conditions simulating clinical use (20-30 °C and protected from light). The proposed protocol provides the stability in the vials once reconstituted and in prefilled refrigerated syringes; this protocol can be used to reduce waste and increase cost savings.
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Affiliation(s)
- Ángela Gómez
- Department of Pharmaceutical and Food Technology, Complutense University of Madrid, 28040, Madrid, Spain
| | - Mª Cristina Benéitez García
- Department of Basic Health Sciences, Area of Pharmacy and Pharmaceutical Technology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | | | | | - Elena López-Lunar
- Department of Pharmacy Jose Germain Psychiatric Institute. Department of Pharmacy and Pharmaceutical Technology, Complutense University of Madrid, Madrid, Spain
| | | | - Marta Vicario-de-la-Torre
- Department of Pharmaceutical and Food Technology, Complutense University of Madrid, 28040, Madrid, Spain
| | | | - María Esther Gil-Alegre
- Department of Pharmaceutical and Food Technology, Complutense University of Madrid, 28040, Madrid, Spain.
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Vieillard V, Le Guyader G, Jallades A, Astier A. Extended physicochemical stability of cetuximab in opened vials and infusion bags when stored at 4°C and 25°C. J Oncol Pharm Pract 2024; 30:142-150. [PMID: 37078110 PMCID: PMC10804814 DOI: 10.1177/10781552231170583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study aimed to determine the stability of cetuximab: (1) under "in-use" conditions after dilution to 1 mg/mL in 0.9% sodium chloride in polyolefin bags and (2) as an undiluted solution (5 mg/mL) repackaged in polypropylene bags or kept in the vial after opening. METHODS Ready-to-use 500 mg/100 mL vials of cetuximab solution were diluted to 1 mg/mL in 100 mL bags of 0.9% sodium chloride or repackaged as a 5 mg/mL solution into empty 100 mL bags. Bags and vials were stored at 4°C for 90 days and 25°C for 3 days. A syringe sample of 7 mL was taken from each bag for the initial determinations. The sampled bags were weighed to determine their initial weight and placed under the planned storage conditions. The physicochemical stability of cetuximab was estimated using validated methods. RESULTS No changes in turbidity, no protein loss, and no changes in cetuximab tertiary structure were observed after 30 days of storage or when subjected to a temperature excursion of 3 days at 25°C and when stored at 4°C for up to 90 days, regardless of the concentrations and batches. The colligative parameters did not change under any of the tested conditions. No evidence of microbial growth was found in bags after 90 days of storage at 4°C. CONCLUSION These results support the extended in-use shelf-life of cetuximab vials and bags, which can be cost-effective for healthcare providers.
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Affiliation(s)
- Victoire Vieillard
- Department of Pharmacy, AP-HP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Guillaume Le Guyader
- Department of Pharmacy, AP-HP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Alice Jallades
- Merck Santé S.A.S., Lyon, France, an affiliate of Merck KGaA
| | - Alain Astier
- Department of Pharmacy, AP-HP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
- Academie Nationale de Pharmacie, Paris, France
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Donnette M, Osanno L, Giocanti M, Venton G, Farnault L, Berda-Haddad Y, Costello R, Caroline S, Ouafik L'H, Ciccolini J, Fanciullino R. Determination of 5-azacitidine in human plasma by LC-MS/MS: application to pharmacokinetics pilot study in MDS/AML patients. Cancer Chemother Pharmacol 2023; 91:231-238. [PMID: 36859512 DOI: 10.1007/s00280-023-04505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/17/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Azacitidine (Vidaza®, AZA) is a mainstay for treating acute myeloid leukemia (AML) in patients unfit for standard induction and other myelodysplastic syndromes (MDS). However, only half of the patients usually respond to this drug and almost all patients will eventually relapse. Predictive markers for response to AZA are yet to be identified. AZA is metabolized in the liver by a single enzyme, cytidine deaminase (CDA). CDA is a ubiquitous enzyme coded by a highly polymorphic gene, with subsequent great variability in resulting activities in the liver. The quantitative determination of AZA in plasma is challenging due the required sensitivity and because of the instability in the biological matrix upon sampling, possibly resulting in erratic values. METHODS We have developed and validated following EMA standards a simple, rapid, and cost-effective liquid chromatography-tandem mass spectrometry method for the determination of azacitidine in human plasma. RESULTS After a simple and rapid precipitation step, analytes were successfully separated and quantitated over a 5-500 ng/mL range. The performance and reliability of this method were tested as part of an investigational study in MDS/AML patients treated with standard azacitidine (75 mg/m2 for 7 days a week every 28 days). CONCLUSION Overall, this new method meets the requirements of current bioanalytical guidelines and could be used to monitor drug levels in MDS/AML patients.
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Affiliation(s)
- Melanie Donnette
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie de Marseille, SMARTc, Simulation and Modeling Adaptative Response for Therapeutics in Cancer, 27 Bd Jean Moulin, 13385, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068 & INRIA Sophia Antipolis, 27 Boulevard Jean-Moulin, 13385, Marseille, France
| | - Loic Osanno
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie de Marseille, SMARTc, Simulation and Modeling Adaptative Response for Therapeutics in Cancer, 27 Bd Jean Moulin, 13385, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068 & INRIA Sophia Antipolis, 27 Boulevard Jean-Moulin, 13385, Marseille, France
| | - Madeleine Giocanti
- Laboratoire de Pharmacocinétique et Toxicologie, La Timone University Hospital of Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Geoffroy Venton
- Department of Hematology and Cellular Therapy, La Conception University Hospital of Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Laure Farnault
- Department of Hematology and Cellular Therapy, La Conception University Hospital of Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Yael Berda-Haddad
- Laboratoire de Biologie Medicale, La Conception University Hospital of Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Régis Costello
- Department of Hematology and Cellular Therapy, La Conception University Hospital of Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Solas Caroline
- Laboratoire de Pharmacocinétique et Toxicologie, La Timone University Hospital of Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - L 'Houcine Ouafik
- Laboratoire de Transfert en Oncologie Biologie, Nord University Hispoital of Marseille, Chemin des Bourrely, 13915, Marseille cedex 20, France
| | - Joseph Ciccolini
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie de Marseille, SMARTc, Simulation and Modeling Adaptative Response for Therapeutics in Cancer, 27 Bd Jean Moulin, 13385, Marseille, France
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068 & INRIA Sophia Antipolis, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Laboratoire de Pharmacocinétique et Toxicologie, La Timone University Hospital of Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - Raphaëlle Fanciullino
- Laboratoire de Pharmacocinétique, Faculté de Pharmacie de Marseille, SMARTc, Simulation and Modeling Adaptative Response for Therapeutics in Cancer, 27 Bd Jean Moulin, 13385, Marseille, France.
- Faculté de Pharmacie de Marseille, COMPO, CRCM Inserm UMR 1068 & INRIA Sophia Antipolis, 27 Boulevard Jean-Moulin, 13385, Marseille, France.
- Unit Pharmacy Hospital of Conception, University Hospital of Marseille, 147 Boulevard Baille, 13005, Marseille, France.
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Vieillard V, Paul M. Physicochemical stability study of a biosimilar of Bevacizumab in vials and after dilution in 0.9% NaCl in polyolefin intravenous bags. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2023. [DOI: 10.1515/pthp-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Objectives
Bevacizumab was first marketed in 2005. Since then, its stability has been extensively studied. The arrival of numerous biosimilars on the market has called into question these stabilities and organisation within reconstitution units. To study the stability of the Bevacizumab biosimilar Alymsys® marketed by Zentiva laboratory in ready-to-use vials at a concentration of 25 mg/mL and following dilution to obtain final concentrations of 1.4 and 16.5 mg/mL and storage in polyolefin IV bags at 4 °C. In parallel, the impact of a storage temperature excursion at 25 °C for three days and storage of the vial before opening at room temperature (25 ± 2 °C) and after opening at 4 °C was studied.
Methods
The vials were supplied by Zentiva laboratory. The vials (three batches) were diluted to the final concentrations of 1.4 or 16.5 mg/mL in 100 mL IV bags of NaCl. The IV bags and vials were stored at 4 °C and at room temperature throughout the duration of the study. The physico-chemical stability was tested using the following methods: turbidimetry, UV spectrometry and fluorescence, dynamic light scattering, ion exchange and steric exclusion chromatography, pH, osmolality and density.
Results
Out of all the parameters studied, for the two concentrations and standard storage conditions (90 days at +4 °C) or after a three-day temperature excursion at +25 °C, no modification was detected for the three batches tested with respect to physical and chemical stability. Hence, no signs of physical instability were observed, with, in particular, the absence of formation of submicron or micron sized aggregates and particles. The steric exclusion chromatography profiles did not demonstrate any oligomer formation or molecular structure rupture. Ion exchange chromatography did not demonstrate any significant modification in the distribution of charge variants. Derivative UV and fluorescence spectral analysis did not demonstrate any modification. The thermal denaturation curves were identical, suggesting the absence of thermodynamic destabilisation. Identical results were observed for the vials stored for 60 days at 4 °C after opening. Finally, only ion exchange chromatography demonstrated a slight change after 45 days of storage at 25 °C for vials before opening.
Conclusions
After dilution in sterile conditions with 0.9% NaCl in polyolefin IV bags, at the usual concentrations of 1.4 and 16.5 mg/mL, the Bevacizumab biosimilar Alymsys® is stable for at least three months at 4 °C protected from light and after a three-day temperature excursion at +25 °C. The same conclusions can be reached for the 25 mg/mL vials stored for 60 days at +4 °C after opening. However, the stability of vials stored at 25 °C before opening is no longer guaranteed beyond 15 days.
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Affiliation(s)
| | - Muriel Paul
- Service Pharmacie , CHU Henri Mondor , Créteil , France
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Sorrieul J, Robert J, Vincent L, Andre M, Bourcier B, Bienfait F, Hamon SJ, Dupoiron D, Devys C. Stability of Morphine Sulfate-Clonidine and Sufentanil-Clonidine Mixtures. Neuromodulation 2022:S1094-7159(22)00769-3. [PMID: 36038481 DOI: 10.1016/j.neurom.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Spinal analgesia is recommended for intractable cancer pain. Morphine-clonidine and sufentanil-clonidine are often used in association in intrathecal drug delivery systems, injected by intraabdominal pumps. To refill these pumps and to limit patient transport, it may be necessary to ship the mixtures in polypropylene syringes to peripheral establishments located near patient homes. The purpose of this study is to determine the stability of morphine-clonidine and sufentanil-clonidine mixtures in polypropylene syringes to ensure the best and safest transport conditions and in implantable pumps for intrathecal use. MATERIALS AND METHODS The stability study method was conceived according to the International Council for Harmonization guidelines. For polypropylene syringes, four different mixtures of morphine-clonidine and sufentanil-clonidine were assessed over seven days. Two storage temperatures were tested (5 ± 3 °C and 25 ± 2 °C). For implantable pumps, two different mixtures of morphine-clonidine and sufentanil-clonidine were assessed over 28 days and stored at 37 °C. RESULTS For the morphine-clonidine mixtures in polypropylene syringes, all mixtures remained stable for five days in both storage conditions (5 ± 3 °C and 25 ± 2 °C) because of relative concentrations systematically positioned between 90% and 110% (95% CIs of the mean of three samples). The two mixtures in implantable pumps remained stable for 28 days. For the sufentanil-clonidine mixtures in polypropylene syringes, cold conservation kept all the preparations stable for seven days, whereas a quick degradation was observed after only two days for ambient storage conditions. This result is similar to that with an implantable pump, in which the concentration is <90% on day 7 for low concentration mixtures. No visual modification, no significant pH modification, and no changes in turbidity assays were observed in either study. CONCLUSION This study shows the stability of the morphine-clonidine mixtures in syringes stored at 5 °C for five days and in implantable pumps stored at 37 °C for 28 days. For the sufentanil-clonidine mixtures, the results show stability in syringes for seven days at 5 °C. Pump results show stability of seven days for low concentrations and 28 days for high concentrations.
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Iudicello A, Genovese F, Strusi V, Dominici M, Ruozi B. Development and Validation of a New Storage Procedure to Extend the In-Use Stability of Azacitidine in Pharmaceutical Formulations. Pharmaceuticals (Basel) 2021; 14:ph14090943. [PMID: 34577643 PMCID: PMC8470010 DOI: 10.3390/ph14090943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
Stability studies performed by the pharmaceutical industry are principally designed to fulfill licensing requirements. Thus, post-dilution or post-reconstitution stability data are frequently limited to 24 h only for bacteriological reasons, regardless of the true physicochemical stability which could, in many cases, be longer. In practice, the pharmacy-based centralized preparation may require preparation in advance for administration, for example, on weekends, holidays, or in general when pharmacies may be closed. We report an innovative strategy for storing resuspended solutions of azacitidine, a well-known chemotherapic agent, for which the manufacturer lists maximum stability of 22 h. By placing the syringe with the azacitidine reconstituted suspension between two refrigerant gel packs and storing it at 4 °C, we found that the concentration of azacitidine remained above 98% of the initial concentration for 48 h, and no change in color nor the physicochemical properties of the suspension were observed throughout the study period. The physicochemical and microbiological properties were evaluated by HPLC–UV and UHPLC-HRMS analysis, FTIR spectroscopy, pH determination, visual and subvisual examination, and sterility assay. The HPLC-UV method used for evaluating the chemical stability of azacitidine was validated according to ICH. Precise control of storage temperature was obtained by a digital data logger. Our study indicates that by changing the storage procedure of azacitidine reconstituted suspension, the usage window of the drug can be significantly extended to a time frame that better copes with its use in the clinical environment.
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Affiliation(s)
- Antonella Iudicello
- Pharmaceutical Department, Azienda USL of Modena, Largo del Pozzo 71, 41121 Modena, Italy
- Nuclear Medicine Unit, Oncology and Hematology Department, Azienda Ospedaliero-Universitaria of Modena, Largo del Pozzo 71, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-0594225167
| | - Filippo Genovese
- Centro Interdipartimentale Grandi Strumenti, University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy;
| | - Valentina Strusi
- Scientific and Technological Park of Medicine “Mario Veronesi”, Via 29 Maggio 6, 41037 Mirandola, Italy; (V.S.); (M.D.)
| | - Massimo Dominici
- Scientific and Technological Park of Medicine “Mario Veronesi”, Via 29 Maggio 6, 41037 Mirandola, Italy; (V.S.); (M.D.)
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Hospital of Modena, Largo del Pozzo 71, 44125 Modena, Italy
| | - Barbara Ruozi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy;
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Adade CA, Diop BB, Attjioui H, Cheikh A, Mefetah H, Bouatia M. Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding. J Oncol Pharm Pract 2021; 28:605-612. [PMID: 33847197 DOI: 10.1177/10781552211008527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. OBJECTIVE The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. MATERIALS AND METHODS This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. RESULTS In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. CONCLUSION The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.
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Affiliation(s)
- Casimir Adade Adade
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Boubacar Bf Diop
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Houda Attjioui
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Amine Cheikh
- Department of Pharmacy, Faculty of Pharmacy, Abulcasis University, Rabat, Morocco
| | - Hafid Mefetah
- Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
| | - Mustapha Bouatia
- Faculty of Medicine and Pharmacy of Rabat, Mohamed V University, Rabat, Morocco.,Department of Pharmacy, Pediatric Hospital, Rabat, Morocco
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Adade CA, Benabbes M, Belahcen MJ, Rahali Y. Centralization impact and cost-saving study in a Moroccan hospital’s centralized unit of chemotherapy preparation. J Oncol Pharm Pract 2020; 26:1630-1636. [DOI: 10.1177/1078155220901336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose The purpose of this study was to assess the cost saved and the amount of drug wasted when compounding anticancer drugs in the centralized unit for chemotherapy preparation. A secondary objective was to estimate the centralization impact of activities related to the preparation of chemotherapies. Methods This was a two-month, single-centre, prospective study conducted at the National Oncology Institute in Rabat. The cost saved and the amount of drug wasted were calculated using a standardized data collection sheet (the prescribed dose, the amount of drug deployed, the amount remaining after compounding, the amount of drug saved and the drug wastage). The centralization impact was calculated using the amount of drug wasted in the centralized unit for chemotherapy preparation and a theoretical amount of drug wasted without centralization of preparation. Results During the study period, the total amount of drug saved was 249,959.5 mg (7.2% of drug used), which represented 96,657 USD. The amount of drug wasted was 89,290.5 mg or 42275.5 USD. The drug waste per dilution and per drug was 6.4 mg [1.6-16.1]. While the potential savings over one year (580,000 USD) reached 13.9% of the cytostatic drugs budget for 2018, the potential drug waste cost reached 6.1%. The centralization impact is estimated at an average of 79.5% ± 13.7% waste reduction. Conclusion The outcome of our study showed that the grouping of prescriptions in centralized unit for chemotherapy preparation could result in significant savings on the amount of drugs deployed. The centralization of cytostatic preparations is of economic interest.
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Affiliation(s)
- Casimir A Adade
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Majda Benabbes
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Mohammed J Belahcen
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Younes Rahali
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Team of Formulation and Quality Control of Health Products, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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9
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Tokhadzé N, Chennell P, Cueff R, Sautou V. Do bevacizumab solutions interact with silicone or polyurethane catheters during an infusion through implantable venous access ports? J R Soc Interface 2019; 16:20180721. [PMID: 31551048 DOI: 10.1098/rsif.2018.0721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This work aims to evaluate the possible impact of interactions between bevacizumab solutions and an implantable port equipped with a silicone or a polyurethane catheter after infusion through a complete infusion set-up in simulated use conditions. Physico-chemical and structural stability of bevacizumab solution was assessed by visual examination, subvisible particles counting, dynamic light scattering, size exclusion chromatography and ion exchange chromatography. Mechanical properties of the catheters were evaluated by measuring Shore A hardness, strain at break, strain at stress and Young's modulus. The physico-chemical surface state of the catheters was assessed by FTIR-ATR spectroscopy, scanning electron microscopy (SEM) and by water contact angle measurement. The analysis of the bevacizumab solution did not highlight any signs of instability or loss of active substance. Mechanical properties of both materials remained unchanged after the infusion. During material analysis, a decrease in water contact angle observed after infusion and was more pronounced for polyurethane catheters than for silicone, possibly due to bevacizumab adsorption or possible leachable extraction from the materials. Surface modifications were also noted at SEM. This study did not highlight any modifications that could alter the quality of the bevacizumab infusion, nor of the infusion catheter in polyurethane or silicone, despite a modification of surface hydrophilicity. Even if after a single infusion, implantable ports remained safe to use, they aim to be used for several infusion of various drugs during their lifetime, and further studies are needed to assess the impact of repeated infusions.
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Affiliation(s)
- Nicolas Tokhadzé
- Universite Clermont Auvergne, CHU Clermont Ferrand, CNRS, Sigma Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Philip Chennell
- Universite Clermont Auvergne, CHU Clermont Ferrand, CNRS, Sigma Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Régis Cueff
- Universite Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Valérie Sautou
- Universite Clermont Auvergne, CHU Clermont Ferrand, CNRS, Sigma Clermont, ICCF, 63000 Clermont-Ferrand, France
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10
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Claus B, Pourcq KD, Clottens N, Kruse V, Gemmel P, Vandenbroucke J. The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital. Eur J Hosp Pharm 2019; 25:334-336. [PMID: 31157053 DOI: 10.1136/ejhpharm-2016-001093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/10/2017] [Accepted: 01/23/2017] [Indexed: 11/04/2022] Open
Abstract
Background Dose banding (DB) (dose rounding with predetermined variation with prescription) enables in-advance preparation of high-turnover anticancer drugs with potential benefit for pharmacy compounding work flow. Objectives To analyse the impact of potential situations on the efficiency of DB in the pharmacy (safe and maximum storage), calculate preparation lead times and the potential full-time equivalent (FTE) benefit. Methods Candidate intravenous anticancer drugs were selected for logarithmic DB according to prescribing frequency, infusion volume and stability (usage data 2015 of the tertiary Ghent University Hospital, Belgium). With a selected DB set already stored, a 2-week time study (April/November 2015) provided lead times (between prescription and transfer) for just-in-time and DB preparations. A 'maximal' storage (using all drugs with a relative incidence of ≥2% recurrent monthly prescription) and a 'safe' storage scenario (lowest monthly prescribing pattern) were used to calculate the potential future FTE change. Results Mean lead times for DB storage and just-in-time preparation were 17.1 min (95% CI 13.5 to 21.0) and 26.5 min (23.3 to 29.8). For 21 164 yearly preparations with already 5292 in DB (25%), 11 157 and 6 862 could be batch-produced in advance in a maximum storage and safe storage scenario, respectively. The existing FTE in 2015 of 5.41 could then be reduced to 4.91 and 5.27. Conclusion Further development of DB could contribute to pharmacy compounding efficiency.
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Affiliation(s)
- Barbara Claus
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium.,Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Kaat De Pourcq
- Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Nele Clottens
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
| | - Vibeke Kruse
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Paul Gemmel
- Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
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11
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Albert-Marí A, Valero-García S, Fornés-Ferrer V, Poveda-Andrés JL. Exploratory analysis for the implementation of antineoplastic logarithmic dose banding. Int J Clin Pharm 2018; 40:1281-1291. [DOI: 10.1007/s11096-018-0714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
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12
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Vázquez-Sánchez R, Sánchez-Rubio-Ferrández J, Córdoba-Díaz D, Córdoba-Díaz M, Molina-Garcia T. Stability of carboplatin infusion solutions used in desensitization protocol. J Oncol Pharm Pract 2018; 25:1076-1081. [DOI: 10.1177/1078155218772885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - D Córdoba-Díaz
- Complutense University of Madrid. Faculty of Pharmacy, Spain
| | - M Córdoba-Díaz
- Complutense University of Madrid. Faculty of Pharmacy, Spain
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13
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Tokhadze N, Chennell P, Le Basle Y, Sautou V. Stability of infliximab solutions in different temperature and dilution conditions. J Pharm Biomed Anal 2018; 150:386-395. [DOI: 10.1016/j.jpba.2017.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 01/09/2023]
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14
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Karakoç MD. A Cost Saving and Waste Minimization Study About Handling of the Antineoplastic Agents. Turk J Pharm Sci 2017; 14:304-310. [PMID: 32454629 DOI: 10.4274/tjps.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/09/2017] [Indexed: 12/01/2022]
Abstract
Objectives As a cancer treatment option, chemotherapy costs make up a large part of the budgets of social insurance foundations and related expenditures are increasing continuously annually. Cost saving and waste minimizing strategies are required to reduce the expenditures in the field of oncology. The study aimed to reduce the amount of wasted antineoplastic drugs and medical supply consumption. Materials and Methods The study explains why vials with a larger size and drugs in liquid form should be preferred over various smaller sizes and powder forms of antineoplastic preparations. Results Amounts of drug wastage, vial adaptor, and transfer set consumption data were recorded regularly for a period of seven months. The average vial adaptor consumption per patient in the last three months decreased from 5 to 3.3. The preference of liquid forms as much as possible instead of powder forms, which has a shorter stability time after dilution, and the choice of larger package sizes of frequently used drugs decreased vial adaptor consumption. Potential savings were calculated as around 31.660 USD annually. Costs of total wasted doses were 8.699.87 USD, and the whole antineoplastic drug consumption was 515.500 USD during the study. A decrease of 0.58 USD was observed per capita when the first and last three-month periods were compared in terms of waste costs. Conclusion These values indicate that the reduction of wasted drugs have potential annual savings of 3.375 USD. It is shown that total potential savings of 35.000 USD could be made per year. By implementing the same principles in all hospitals in Turkey, approximately 2.8 million USD could be made annually. The pharmaceutical industry and hospital pharmacists have important responsibilities in this issue.
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15
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Nissen KB, Jorgensen LB, Berg DL, Andersen G. Stability study of methotrexate in 0.9% sodium chloride injection and 5% dextrose injection with limit tests for impurities. Am J Health Syst Pharm 2017; 74:e211-e223. [PMID: 28438826 DOI: 10.2146/ajhp150818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of an evaluation of the stability of methotrexate in 0.9% sodium chloride injection and 5% dextrose injection are presented. METHODS Methotrexate concentrated solution (100 mg/mL) was diluted to nominal concentrations of 0.2 and 20 mg/mL in infusion bags containing 0.9% sodium chloride injection or 5% dextrose injection. The filled bags were stored for 28 days at 25 °C and 60% relative humidity and protected from light. Samples were withdrawn for analysis on the day of preparation and after 3, 7, 14, 21, and 28 days. The test program included visual inspections, measurements of pH and infusion bag weight loss, and high-performance liquid chromatography assays to determine methotrexate content and characterize degradation products. RESULTS At both evaluated concentrations, methotrexate in 0.9% sodium chloride injection was stable for 28 days; only minor (<0.05%) increases in amounts of known and unknown degradation products were detected. In 5% dextrose injection, methotrexate at the higher concentration was stable for 28 days, with minor formation of degradation products; in the 0.2-mg/mL solution, however, methotrexate was stable for only 3 days. At later time points, an unknown impurity present at a concentration higher than 0.1% was observed. CONCLUSION At concentrations of 0.2 and 20 mg/mL, methotrexate in 0.9% sodium chloride injection was found to be stable for 28 days when stored at 25 °C and protected from light. Under the same storage conditions, methotrexate in a 20-mg/mL solution prepared with 5% dextrose injection was stable for 28 days, whereas a 0.2-mg/mL solution in the same diluent was stable for only 3 days.
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Affiliation(s)
| | | | | | - Gitte Andersen
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
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16
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Vieillard V, Astier A, Sauzay C, Paul M. One-month stability study of a biosimilar of infliximab (Remsima®) after dilution and storage at 4°C and 25°C. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:17-29. [DOI: 10.1016/j.pharma.2016.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
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17
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Maraiki F, Farooq F, Ahmed M. Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:271-82. [PMID: 26857236 DOI: 10.1111/ijpp.12245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify the intravenous (IV) medications that are prepared in glass bottles at the institution and establish which of these medications can be prepared in flexible IV bags such as polyvinyl chloride (PVC) or non-PVC instead of glass bottles. The cost implication of switching from glass bottles to flexible IV bags was calculated. METHODS A study using FOCUS-PDCA model to identify IV medications prepared in glass bottles and establish which of these medications could be prepared in IV bags (PVC or non-PVC). The cost impact of switching from glass bottles to IV plastic bags (including PVC or non-PVC) was calculated. The stability data obtained were used as a reference for updating pharmacy internal IV preparation charts. KEY FINDINGS A total of 17 IV medications were found to be prepared in IV glass bottles. Of these 17 medications, only 8 (47%) were prepared in IV glass bottles due to incompatibility with PVC bags. For 7 (41%) of the medications, of which 6 were monoclonal antibodies (MABs), the reason for preparation in glass bottles was unclear as these medications are compatible with either PVC or non-PVC or both. The potential cost savings associated with switching all of the identified medications to IV plastic bags (either non-PVC or PVC) exceeded $200 000. CONCLUSIONS The elimination of glass bottles within the institution resulted in a significant cost saving. The use of FOCUS-PDCA model can help healthcare institution achieve significant improvements in process and realize significant cost savings.
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Affiliation(s)
- Fatma Maraiki
- King Faisal Specialist Hospital & Research Centre, Pharmacy Department, Riyadh, Saudi Arabia
| | - Faiyaz Farooq
- King Faisal Specialist Hospital & Research Centre, Pharmacy Department, Riyadh, Saudi Arabia
| | - Mohamed Ahmed
- King Faisal Specialist Hospital & Research Centre, Pharmacy Department, Riyadh, Saudi Arabia
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Bennis Y, Savry A, Correard F, Montana M, Sauzet C, Gauthier-Villano L, Pisano P, Pourroy B. Stability of a highly concentrated solution of epirubicin for conventional transcatheter arterial chemoembolization. Int J Pharm 2015; 495:956-62. [DOI: 10.1016/j.ijpharm.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/25/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
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The physical and chemical stability of cisplatin (Teva) in concentrate and diluted in sodium chloride 0.9%. Contemp Oncol (Pozn) 2012; 16:435-9. [PMID: 23788924 PMCID: PMC3687456 DOI: 10.5114/wo.2012.31775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/11/2012] [Accepted: 06/21/2012] [Indexed: 11/17/2022] Open
Abstract
Aim of the study The subject of study was the stability of cisplatin in concentrate in glass vials and diluted in polyethylene (PE) bags stored at 15–25°C for up to 30 days. Material and methods Original vials of cisplatin injection (1 mg/ml, Teva) were stored at room temperature and subjected to re-piercing after 1, 2, 3, 7, 14, 21, 28 and 30 days following the initial piercing. Cisplatin infusions at nominal concentrations of 0.1 mg/ml were prepared in 0.9% sodium chloride (1000 ml) in PE bags. Chemical stability was measured by means of a stability-indicating high-performance liquid chromatography (HPLC) assay. Physical stability was assessed by visual inspection in normal light. Results The concentration of cisplatin at each sampling time in the analysed solutions remained within 92.0–100.7% of initial concentration, regardless of the container. No changes in colour or turbidity were observed in any of the vials or prepared solutions. Conclusions Cisplatin, both undiluted in glass containers and diluted with NaCl 0.9% in PE bags, remains stable (< 10% degradation) for at least 30 days at room temperature when protected from light.
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