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Almutairy R, Khan MA, Shahbar A, Aseeri M, Alshamrani M, Almarhabi H, Naeem D. Posaconazole versus voriconazole as antifungal prophylaxis for invasive fungal diseases in patients with hematological malignancies. J Oncol Pharm Pract 2024:10781552241246119. [PMID: 38656201 DOI: 10.1177/10781552241246119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The incidence of invasive fungal diseases (IFDs) has risen in hematologic malignancy patients due to neutropenia. While posaconazole is recommended as the first-line antifungal prophylaxis in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients and voriconazole is an alternative, there is currently no direct comparison data available to assess their relative effectiveness. METHOD We retrospectively reviewed eligible patient charts from January 2017 to February 2019 to identify breakthrough IFD rates, drug adverse event frequency, and drug acquisition cost in AML/MDS patients. RESULTS Forty-eight patients received 130 chemo cycles, with 50 (38%) cycles prescribed posaconazole and 80 (62%) prescribed voriconazole as primary IFD prophylaxis. The incidence rates of IFD in the posaconazole group were 8% (4 out of 50), of which two were probable and two were possible infections, while 6.26% (5 out of 80) of patients in the voriconazole group developed IFD, with four possible infections and one probable infection (p = 0.73). A higher percentage of patients in the voriconazole group discontinued prophylaxis due to adverse events, with six patients compared to two patients in the posaconazole group (p = 0.15). The drug acquisition cost of posaconazole is 5.62 times more expensive than voriconazole. CONCLUSION The use of voriconazole instead of posaconazole for 130 chemo cycles would save $166,584.6. Posaconazole and voriconazole have comparable efficacy and safety in preventing IFD in AML and MDS patients receiving chemotherapy. However, posaconazole is more costly than voriconazole.
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Affiliation(s)
- Reem Almutairy
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Pharmaceutical Care Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Mansoor Ahmed Khan
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alaa Shahbar
- Faculty of Pharmacy, Pharmacy Practices Department, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohammed Aseeri
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
- King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Hassan Almarhabi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Infectious Diseases, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Internal Medicine, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Doaa Naeem
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
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Alnuhait M, Alshammari A, Alharbi M, Alotaibi L, Alharbi R, Khobrani A, Alkhudair N, Alshamrani M, Alrajhi AM. Correction: Comparative Assessment of Drug Lag for Approved Oncology Targeted Therapies Between Saudi Arabia, the United States, and the European Union. Ther Innov Regul Sci 2024:10.1007/s43441-024-00653-2. [PMID: 38625647 DOI: 10.1007/s43441-024-00653-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Mohammed Alnuhait
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Abdullah Alshammari
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Manar Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lina Alotaibi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Reem Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Attiah Khobrani
- Pharmaceutical Care Services, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Abdullah M Alrajhi
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
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Alnuhait M, Alshammari A, Alharbi M, AlOtaibi L, Alharbi R, Khobrani A, Alkhudair N, Alshamrani M, Alrajhi AM. Comparative Assessment of Drug Lag for Approved Oncology Targeted Therapies Between Saudi Arabia, the United States, and the European Union. Ther Innov Regul Sci 2024:10.1007/s43441-024-00642-5. [PMID: 38536660 DOI: 10.1007/s43441-024-00642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Pharmaceutical regulation on a global scale is a complex process, with regulatory bodies overseeing various aspects, including licensing, registration, manufacturing, marketing, and labeling. Among these, the USFDA plays a crucial role in upholding public health. The pharmaceutical industry contributes significantly to well-being by developing and distributing therapeutic agents. The journey of evaluating new pharmaceuticals involves meticulous examination through several phases, from safety and efficacy assessments to toxicity evaluation. Drug approval involves submitting New Drug Applications (NDAs) to regulatory agencies like the USFDA and EMA. However, disparities in durations contribute to the phenomenon known as "drug lag." This lag refers to delays in a pharmaceutical product's availability in one market compared to another. Addressing this issue is crucial, given its impact on patient access to treatments. METHOD This study aims to analyze the extent of drug lag, focusing on newly approved oncology targeted therapies in Saudi Arabia, the United States, and the European Union. Data for cancer treatments authorized by the USFDA, EMA, and SFDA from January 1, 1997, to December 31, 2022, were collected from regulatory agency websites. The data sources included authorization letters, prescription information, and evaluation documents. We conducted a comparative assessment of drug lag for approved oncology targeted therapies between Saudi Arabia, the US, and the EU. RESULT Our analysis identified 135 newly approved oncology-targeted drugs within the specified timeframe. Of these, 71 received approval in all three regions, while disparities were evident in others. The USFDA consistently had the highest number of approved drugs, with 98.5% of drugs initially approved there. In contrast, Saudi Arabia had the lowest number of approved drugs and a significantly longer median drug lag, indicating substantial delays in drug availability. CONCLUSION This study highlights the significance of mitigating drug lag to enhance global healthcare outcomes and patient access to innovative therapies. Further research and collaborative efforts are essential to bridging these disparities and promoting equitable healthcare worldwide.
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Affiliation(s)
- Mohammed Alnuhait
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Abdullah Alshammari
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Manar Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lina AlOtaibi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Reem Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Attiah Khobrani
- Pharmaceutical Care Services, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia
| | - Abdullah M Alrajhi
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
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Alkhudair N, Howaidi J, Alnuhait M, Alshamrani M, Khan M, Alharbi A, Alnajjar F, Bajnaid E, Almodaheem H, Alhowimel M, Alzahrani A, Khardaly A, Alnahedh M, Elsoudi H, Alabdulkareem H, Alrashidan A, Alzahrani M, Alrajhi A. Revitalizing oncology medications access in Saudi Arabia: Current challenges and recommendations by the Saudi Oncology Pharmacy Assembly. J Oncol Pharm Pract 2024:10781552241232697. [PMID: 38377985 DOI: 10.1177/10781552241232697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cancer care is posing immense challenges to healthcare systems globally. Advances in screening, monitoring, and treating cancer improved patient outcomes and survival rates yet amplified the disease burden. Multiple barriers might impede early access to innovative therapies. We thoroughly examined the current challenges in oncology medication access in Saudi Arabia and provided consensus recommendations to revitalize the process. METHODS A focus group discussion was conducted. Expert healthcare providers (pharmacists and physicians) were invited to participate based on prespecified criteria. The research team conducted a qualitative analysis of the discussion to identify themes and formulate recommendations. RESULTS Fourteen experts were equally distributed into two groups, limiting the number in each group to 7. Pharmacists were 12 (∼86%), and physicians were 2 (∼14%). Ten were practicing in governmental hospitals, four representing different sectors; regulatory bodies, including Ministry of Health, National Unified Procurement Company, and Saudi Food and Drug Authority. Five themes were identified: national cancer burden, local data availability, pharmacoeconomic evaluation, patients reported outcomes, administration, and procurement. Consensus recommendations were formulated to optimize the formulary management process, enabling informed decision-making and facilitating early medication access for cancer patients. CONCLUSIONS The formulary management process can be enhanced by addressing the national cancer burden, promoting local data availability, conducting pharmacoeconomic evaluations, focusing on patient outcomes, and improving administration and procurement procedures. Implementing these recommendations can improve access to oncology medications and improve patient care outcomes in Saudi Arabia.
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Affiliation(s)
- Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jude Howaidi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alnuhait
- Department of Clinical Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mansour Khan
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Atika Alharbi
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Fouad Alnajjar
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Eshtyag Bajnaid
- Pharmaceutical Care Services Administration, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hajer Almodaheem
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Mansour Alhowimel
- Unified Procurement, National Unified Procurement Company, Riyadh, Saudi Arabia
| | - Ali Alzahrani
- Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amr Khardaly
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed Alnahedh
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hamdi Elsoudi
- Clinical Pharmacy Department, Pharmaceutical Care Services Administration, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hana Alabdulkareem
- Drug Policy and Economic Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Ahmed Alrashidan
- Corporate pharmaceutical planning, logistic & contracts management, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alrajhi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlFaisal University, Riyadh, Saudi Arabia
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Khan M, Alharbi S, Aljuhani S, Tunkar M, Morya A, Alnatsheh A, Alshamrani M, Felemban R. The Incidence of Hematological Toxicities in Colorectal Cancer Patients Treated With Fluoropyrimidine-Based Regimens at Princess Noorah Oncology Center. Cureus 2023; 15:e44267. [PMID: 37772227 PMCID: PMC10529469 DOI: 10.7759/cureus.44267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Fluoropyrimidine-based regimens are used for the management of colorectal cancer, which is the second most common cancer in Saudi Arabia. We aimed to study the incidence of hematological toxicities in colorectal cancer patients treated with fluoropyrimidine and fluoropyrimidine-based regimens at Princess Noorah Oncology Center, King Abdulaziz Medical City- Jeddah, Saudi Arabia. Methods A retrospective cohort study that included adult colorectal cancer patients who were treated with fluoropyrimidine-based regimens from January 1, 2018 to December 31, 2018 at Princess Noorah Oncology Center, Jeddah, Saudi Arabia was performed. Our primary objective was to determine the incidence of anemia, neutropenia, and thrombocytopenia in colorectal cancer patients treated with fluoropyrimidines and fluoropyrimidine-based regimens. Secondary objectives were to assess the grade of hematological toxicities associated with 5-fluorouracil (5-FU) use and to determine the frequency of unplanned hospital admissions or emergency department (ED) visits after receiving fluoropyrimidine-based regimens. The collected data contained patients' characteristics (weight, height, age, gender, and diagnosis), chemotherapy agents, and hematological toxicity-related findings such as absolute neutrophil count, hemoglobin, platelet count, and number of ED visits or hospital admissions during fluoropyrimidine-based chemotherapy regimens. Results Of the 570 cycles of the fluoropyrimidine-based regimen received by 68 patients, hematological toxicities were observed in 508 (89.1%) cycles, and grade ≥ 3 grade toxicities were found in 46 (8.1%) cycles. The results demonstrated a statistically significant difference in the incidence of grade 3-4 neutropenia between patients who received bolus administration of 5-FU and those who did not (8.5% vs. 2.3% respectively, p=0.025). The incidence of grade 3-4 anemia was higher in the bolus group (11.3%) compared to the group where bolus was omitted (4.6%); however, the difference was not statistically significant (p=0.059). Furthermore, there was no significant difference among the two groups for grade 3 and grade 4 thrombocytopenia (0.0% with bolus given and 0.7% with bolus omission p=1.00). Conclusion Our retrospective study showed that there have been significantly higher grade 3-4 hematological toxicities observed with bolus administration of 5-FU, which confirms the previous reports.
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Affiliation(s)
- Mansoor Khan
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sara Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Shahad Aljuhani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mariam Tunkar
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amjaad Morya
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Razaz Felemban
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Alnuhait M, Alharbi A, Alanizi A, Alkhudair N, Alshamrani M, Bajnaid E, Alrajhi A, Alnajjar F, Khardaly A. Implementing Oncology Pharmacy Boot Camp for Advanced Pharmacy Practice Experience Students at a Regional Conference in Saudi Arabia. Cureus 2023; 15:e34780. [PMID: 36909037 PMCID: PMC10005846 DOI: 10.7759/cureus.34780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/10/2023] Open
Abstract
Background Upon graduation, pharmacy students are expected to possess a diverse array of knowledge, skills, and attitudes. A subject-specific boot camp may support bridging the gap between the information and skills gained during clerkships, courses required for pharmacy school after graduation, and skills needed for the job market, as well as the gap between pharmacy school and residency. This research aimed to determine whether an integrated boot camp increased Advanced Pharmacy Practice Experience (APPE) student self-confidence and enhanced students' knowledge in oncology pharmacy. Method APPE students who attended the annual meeting of the Saudi Oncology Pharmacy Assembly (SOPA)/International Society of Oncology Pharmacy Practitioners (ISOPP) Regional Conference 2021 were voluntarily enrolled in a three-hour oncology-focused boot camp consisting of interactive lectures. Pre- and post-intervention examinations were used to evaluate student learning outcomes and their experience feedback. Result Of 118 students who attended the boot camp, 80 students who met the criteria were included in the study. The pre- and post-intervention examinations were completed by the 80 APPE students. The pre-intervention test results (mean: 66%, standard deviation (SD): 16%) increased by 21.5% after the boot camp (mean: 87.5%, SD: 12%, p = 0.001). Students scored better on each of the 10 test questions, with nine questions demonstrating a statistically significant result. Conclusion The results of this research showed that interns who participated in an oncology boot camp had a higher level of knowledge and confidence in applying key oncology concepts. Interns were satisfied with the chance to engage in the activity, and they agreed to adding boot camps to future conferences would be valuable. This research shows that it is possible to hold a transitional boot camp during conferences to better prepare students for their fields of study and increase their participation in oncology conferences.
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Affiliation(s)
- Mohammed Alnuhait
- Department of Clinical Pharmacy, Umm Al-Qura University, Makkah, SAU
| | - Atika Alharbi
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, SAU
| | - Abdalrhman Alanizi
- Department of Pharmaceutical Care, King Abdullah bin Abdulaziz University Hospital, Riyadh, SAU
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, SAU
| | - Majed Alshamrani
- Department of Pharmaceutical Care Services, King Abdulaziz Medical City (KAMC), Jeddah, SAU
| | - Eshtyag Bajnaid
- Department of Pharmaceutical Care Services, King Abdullah Medical City, Makkah, SAU
| | - Abdullah Alrajhi
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, SAU.,College of Pharmacy, Alfaisal University, Riyadh, SAU
| | - Fouad Alnajjar
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, SAU
| | - Amr Khardaly
- Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, SAU
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Yousef CC, Khan MA, Almodaimegh H, Alshamrani M, Al-Foheidi M, AlAbdalkarim H, AlJedai A, Naeem A, Abraham I. Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study. J Med Econ 2023; 26:394-402. [PMID: 36815700 DOI: 10.1080/13696998.2023.2183680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
AIMS This study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient. MATERIALS AND METHODS Replicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment. RESULTS Savings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio). CONCLUSION This simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard - Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mansoor Ahmed Khan
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hana AlAbdalkarim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Drug Policy and Economic Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Obuda University, Budapest, Hungary
| | - Ahmed AlJedai
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anjum Naeem
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
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Almouaalamy NA, Alshamrani M, Alnejadi WK, Alharbi ZM, Aldosari FM, Alsulimani EF, Saif SA, Aldawsari MK. Opioid-induced respiratory depression and risk factors in a tertiary hospital: A retrospective study. Saudi Pharm J 2022; 30:1095-1100. [PMID: 36164577 PMCID: PMC9508628 DOI: 10.1016/j.jsps.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Opioids are potent analgesics used for the treatment of moderate to severe acute and chronic cancer and non-cancer pain. However, opioid usage may be limited by negative side effects, such as potentially life-threatening respiratory depression. Objectives The aim of our study is to investigate the prevalence of opioid-induced respiratory depression (OIRD) and its predictors at King Abdulaziz Medical City in Jeddah (KAMC-JD). Method This is a retrospective cross-sectional (chart review) study conducted from January 1, 2016, to December 31, 2020. Results A total of 15,753 patients received opioids during admission to KAMC-JD, and only 144 (0.915%) of them received naloxone from January 1, 2016 to December 31, 2020. Only 91 patients (0.57%) developed opioid-induced respiratory depression (OIRD), which was more frequently reported among young and middle-aged adults. OIRD was significantly associated with receiving a daily morphine milligram equivalent (MME) dose of ≥150 MME and with having a low urea concentration at the baseline and at admission under surgery. Also, fentanyl use remained a significant risk factor for OIRD. Conclusion In conclusion, monitoring patient receiving opioids with a daily MME dose of ≥150 MME, prescribed Fentanyl, low urea concentration at the baseline, and patients’ admissions to the surgery department may mitigate the risk of developing OIRD.
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Affiliation(s)
- Nabil A. Almouaalamy
- Oncology Department, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Corresponding author at: Consultant Geriatric & Palliative Medicine, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Makkah/Jeddah Highway, Jeddah 21423, Saudi Arabia.
| | - Majed Alshamrani
- Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Waleed K. Alnejadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ziyad M. Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Faisal M. Aldosari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Enad F. Alsulimani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Saif A. Saif
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed K. Aldawsari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Ogbaghebriel A, Alshamrani M, Ibrahim A, Al-Masaary W, Hakami S, Alrasheed S, Al-Sayed N. Pharmacy practitioners' adherence to safe-handling practices of chemotherapeutic drugs: A cross-sectional study in Saudi Arabia. J Oncol Pharm Pract 2022:10781552221105584. [PMID: 35642271 DOI: 10.1177/10781552221105584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy drug handling and occupational exposure are topics of concern for a variety of oncology health care professionals. Inappropriate handling can pose health risks to practitioners particularly, those who handle them on a daily basis. Therefore, this study aimed to assess chemotherapy handling practices among oncology pharmacists and pharmacy technicians in Saudi Arabia. METHODS A cross-sectional study was conducted using an online survey with a structured pre-validated questionnaire. Data was collected from pharmacists and pharmacy technicians who handle chemotherapeutic agents in Saudi Arabia, and analyzed using descriptive and inferential statistics. RESULTS A total of 79 oncology pharmacy practitioners responded to the survey. The majority (92.4%) had written chemotherapy guidelines at their workplaces. Almost all participants (98.7%) reported the availability of protective gloves and gowns, however, the availability of eye protection was only 57%. Most used chemotherapy-designated gloves (83.6%), and gowns (86.1%). However, 54.4% have reused disposable gowns. The extent of utilization of most protective equipment ranged from 70% (always using closed system transfer device) to 98% (always using shoe cover); while the practice of always using eye protection and face shield was only 30.4% and 38%, respectively. With regard to cleaning practice, the work area was cleaned at least once a day by 35%; monthly decontamination (77%); certification by the biomedical department every 6 months (67%) and at least yearly (95%). Accidental exposure was reported by 28%, and the most common adverse effect was skin irritation (82%). There was no workplace medical surveillance available for 50%. The majority (88.6%) received relevant training, but not periodic updates on their training (38%). The main barriers against the use of personal protective equipment were: that some personal protective equipments were not always available (38%), and personal protective equipments were too uncomfortable to use (30.4%). The demographic variables did not have a statistically significant effect (p > 0.05) on the responses except for type of institution (workplace) on some of the cleaning practices that showed significant differences namely, the monthly decontamination and certification by the biomedical department. CONCLUSIONS Most protective equipment and chemotherapy guidelines were available, and the majority of pharmacy practitioners adhered to many aspects of chemotherapy safe-handling practices. Nevertheless, some areas such as medical surveillance programs, use of eye protection and face shields, the practice of re-using disposable gowns, some of the barriers against personal protective equipment use, and the provision of periodic training need improvement for better protection of the health care professionals.
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Affiliation(s)
- Azieb Ogbaghebriel
- Department of Pharmaceutical Sciences, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alnada Ibrahim
- Department of Pharmacy Practice, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Wed Al-Masaary
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Sarah Hakami
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Shahad Alrasheed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Nada Al-Sayed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
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10
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Chazan G, Jupp J, Bauters T, Duncan N, Weddle KJ, Nomura H, O'Connor S, Chan A, Alkhudair N, Alshamrani M, Buie LW, Chambers P, Chieh TW, DeRemer DL, Duvivier F, Katabalo D, McFarlane T, Mckavanagh D, Mensah K, Martinez EM, Rowan G, Sae-Teaw M, Tadesse TA, Weru I, Alexander M. Impact of coronavirus of 2019 on the delivery of pharmacy services to patients with cancer: An international survey of oncology pharmacy practitioners. J Oncol Pharm Pract 2021; 28:1832-1847. [PMID: 34693814 DOI: 10.1177/10781552211048892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. METHODS/AIMS An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. RESULTS The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists (n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. CONCLUSION The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable.
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Affiliation(s)
- Grace Chazan
- Sir Peter MacCallum Department of Oncology, 60078University of Melbourne, Australia.,Department of Medical Oncology, 3085Peter MacCallum Cancer Centre, Australia
| | - Jennifer Jupp
- Pharmacy Services, 3146Alberta Health Services, Canada
| | - Tiene Bauters
- Pharmacy Department, 60200Ghent University Hospital, Belgium
| | - Nick Duncan
- Pharmacy Department, 156807Queen Elizabeth Hospital, UK
| | | | - Hisanaga Nomura
- Department of Data Science/Pharmacy, 444492National Cancer Center Hospital East, Japan
| | - Shaun O'Connor
- Pharmacy Department, St Vincent's Hospital, Australia.,Commissioning and System Improvement Division, 1457Department of Health Victoria, Australia
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, 8788University of California, USA
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, 37850King Saud University, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, 47798Ministry of National Guard Health Affairs, Saudi Arabia
| | - Larry W Buie
- Pharmacy Department, 5803Memorial Sloan Kettering Cancer Center, USA
| | - Pinkie Chambers
- 4919University College London Hospital NHS Trust & University College London School of Pharmacy, UK
| | - Tan Wen Chieh
- Pharmacy Department, 69844University Malaya Medical Centre, Malaysia
| | - David L DeRemer
- Department of Pharmacotherapy and Translational Research, 15505University of Florida College of Pharmacy, USA
| | | | - Deogratias Katabalo
- 227206Bugando Medical Center, Tanzania.,150778Catholic University of Health and Allied Sciences, School of pharmacy, Department of Pharmacy Practice and Therapeutics, Tanzania
| | | | - Daniel Mckavanagh
- Office of the Chief Clinical Information Officer, Clinical Excellence Queensland, 1288Queensland Health, Australia
| | - Kofi Mensah
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, 98763Kwame Nkrumah University of Science and Technology, Ghana.,Discipline of Pharmaceutical Sciences, College of Health Sciences, 56394University of KwaZulu-Natal, South Africa.,Pharmacy Practice Department, Faculty of Pharmacy and Pharmaceutical Sciences, 98763Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Gail Rowan
- Pharmacy Department, 3085Peter MacCallum Cancer Centre, Australia
| | - Manit Sae-Teaw
- Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Thailand
| | - Tamrat Assefa Tadesse
- School of Pharmacy, College of Health Sciences, 37602Addis Ababa University, Ethiopia
| | - Irene Weru
- Pharmacy Division, 285569Kenyatta National Hospital, Kenya
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, 60078University of Melbourne, Australia.,Pharmacy Department, 3085Peter MacCallum Cancer Centre, Australia
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11
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Shahbar A, Alshamrani M, Aseeri M, Alfayea T, Alnatsheh A. Safety and discontinuation rate of immune checkpoint inhibitors used in patients with solid and hematological malignancies. A population based retrospective analysis. J Oncol Pharm Pract 2021; 28:771-776. [PMID: 34034557 DOI: 10.1177/10781552211017634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The discovery of immune checkpoint inhibitors caused a paradigm shift in cancer treatment and led to a major improvement in clinical outcomes. However, they may induce inflammatory side effects that are known as immune-related adverse effect (iRAE). This study aimed to assess the safety profile and discontinuation rate of immune checkpoint inhibitors in cancer patients. METHODS Adult cancer patients ≥18 years who received at least one dose of immune-checkpoint inhibitor (ICI) were included. The primary endpoint was the rate of permanent discontinuation of immune checkpoint inhibitors due to immune-related adverse effects. The secondary endpoints were rate and type of specific organ iRAEs, interventions used to treat specific organ iRAEs, and discontinuation rate of immune checkpoint inhibitors due to disease progression. RESULTS A total of 75 patients were included in the study with a median age of 60 years [IQR: 46-72 years]. Of 75 patients, 7 patients (9.33%) have permanently discontinued ICIs due to immune-related adverse effects. Seven iRAEs occurred in the 7 patients who have permanently discontinued ICIs. Steroids were the main treatment used for 8 patients, followed by levothyroxine for 2 patients and one patient did not receive any medication. The discontinuation rate due to disease progression was reported in 32 patients (42.66%). CONCLUSION Immune checkpoint inhibitors were well tolerated in the majority of our patient population with a comparable rate of immunerelated adverse effects in comparison to the published data. Corticosteroids were fundamentally used to treat immune-related adverse effects.
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Affiliation(s)
- Alaa Shahbar
- Umm Alqura University, College of Pharmacy, Clinical Pharmacy Department, Makkah, Saudi Arabia.,Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
| | - Mohammed Aseeri
- Pharmaceutical Care, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.,King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Turki Alfayea
- Medical Oncology Department, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
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12
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Alkhudair N, Alshamrani M, Samarkandi H, Almodaheem H, Alabdulkarim H, Alsaqaaby M, Alnajjar F, Alhashem H, Bakkar M, Bazarbashi S, Alnahedh M, Alfraih F, Alawagi M, Al-jedai A. Cancer Management in Saudi Arabia: Recommendations by the Saudi Oncology HeAlth Economics ExpeRt GrouP (SHARP). Saudi Pharm J 2021; 29:115-120. [PMID: 33679175 PMCID: PMC7910134 DOI: 10.1016/j.jsps.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
Cancer is widely recognized as a major global health problem and is estimated to rank as one of the leading causes of death worldwide. Saudi Arabia has undergone remarkable socioeconomic development in the past 40 years which has contributed to the increase in cancer incidence. The high costs of new oncology medications in combination with uncertainty of long-term effectiveness and safety outcomes highlight the importance of considering value, in terms of clinical outcomes, relative to cost. We convened a group of experts to discuss key factors impacting the current state of cancer management in Saudi Arabia and to agree on a list of recommendations, with a focus on value-based care, considering evidence, patients, and costs.
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Affiliation(s)
- Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hadeel Samarkandi
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Alfaisal University, College of Pharmacy, Riyadh, Saudi Arabia
| | - Hajer Almodaheem
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hana Alabdulkarim
- Drug Policy and Economic Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mai Alsaqaaby
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Fouad Alnajjar
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hashem Alhashem
- Department of Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Shouki Bazarbashi
- King Abdullah Center of Oncology and Liver Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alnahedh
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Abdullah Center of Oncology and Liver Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammad Alawagi
- Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ahmed Al-jedai
- Alfaisal University, College of Pharmacy, Riyadh, Saudi Arabia
- Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Corresponding author at: Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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13
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Almutairy RF, Khan M, Alshamrani M, Marhabi H, Naeem D. 755. Posaconazole versus voriconazole as antifungal prophylaxis for invasive fungal diseases in patients with hematological malignancies. Open Forum Infect Dis 2020. [PMCID: PMC7776908 DOI: 10.1093/ofid/ofaa439.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The incidence of Invasive Fungal Diseases (IFDs) has dramatically increased in patients with hematologic malignancies due to prolonged neutropenia. IFDs are associated with significant morbidity and mortality. Due to these risks, international guidelines have recommended antifungal prophylaxis for Acute Myeloid Leukemia (AML) and Myelodysplastic syndromes (MDS) patients. Posaconazole has been recommended as the prophylactic agent of choice. Also, voriconazole has been recommended by guidelines with different levels of recommendations. Data on a direct comparison between Posaconazole delayed-release tablets (DR) and Voriconazole for IFD prophylaxis are lacking. Therefore, we aim to compare the efficacy and safety of the fungal prophylaxis; voriconazole versus posaconazole in AML/MDS patients at Princess Nourah Oncology Center, Jeddah Methods Retrospective chart review study for eligible patients from January 2017 to February 2019 to identify the breakthrough IFD rates and assess the frequency of adverse events within AML/MDS patients at PNOC, Saudi Arabia Results A total of 48 patients (130 chemo cycles) were included in the study: 50 using posaconazole (DR) and 80 using oral voriconazole as antifungal prophylaxis. The incidence rates of IFD in the posaconazole group was 8 % (4/50) of those 2 were probable, and 2 were possible infections while 6.26 % (5/80) of patients in the voriconazole group have developed IFD of them 4 had a possible infection, and one had a probable infection (p=0.7325). A higher percentage of patients in the voriconazole group discontinued prophylaxis due to adverse events (5 patients vs. 2 patients). Use of voriconazole as antifungal prophylaxis for 15 days in 130 cycles in 48 AML/MDS patients would cost 175,500 SR in comparison to the cost of the posaconazole for the same duration of 1,350,130 SR. So, use of voriconazole would save 1.13 million SR and is more cost effective when used as antifungal prophylaxis in AML/MDS patients in comparison to posaconazole although later is category 1 recommended antifungal prophylaxis in international guidelines Conclusion Our study has shown that both posaconazole and voriconazole have comparable efficacy and safety in the prevention of IFD in AML and MDS receiving chemotherapy but voriconazole is more cost effective Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Reem F Almutairy
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, jeddah, Makkah, Saudi Arabia
| | - Mansoor Khan
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, jeddah, Makkah, Saudi Arabia
| | - Majed Alshamrani
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, jeddah, Makkah, Saudi Arabia
| | - Hassan Marhabi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, jeddah, Makkah, Saudi Arabia
| | - Doaa Naeem
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, jeddah, Makkah, Saudi Arabia
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14
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Alshamrani M, AlHarbi A, Alkhudair N, AlNajjar F, Khan M, Obaid AB, Khardaly A, Bajnaid E, Samarkandi H, AlAzmi A, Alabdali S, AlNahedh M. Practical strategies to manage cancer patients during the COVID-19 pandemic: Saudi Oncology Pharmacy Assembly Experts recommendations. J Oncol Pharm Pract 2020; 26:1429-1440. [PMID: 32580641 PMCID: PMC7448793 DOI: 10.1177/1078155220935564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose During COVID-19 pandemic, cancer patients are considered one of the most vulnerable to infection since they tend to have advanced age, multiple comorbidities, and are often immunosuppressed by their cancer or therapy. Hence, the Saudi Oncology Pharmacy Assembly has issued recommendations to reduce the frequency of cancer patients’ visits to oncology centers during the pandemic while maintaining the access to cancer therapy and minimize the risk of exposure to coronavirus disease. Materials and methods A qualitative methodological approach was conducted in April 2020 using a virtual panel discussion for collection of recommendations. Results A total of 12 expert oncology pharmacy practitioners shared their knowledge and experiences in managing oncology patients during the COVID-19 pandemic. The participants recognized many fundamental recommendations that were already applied in many cancer centers since the start of the COVID-19 outbreak. On that basis, the panelists developed eight practice-related recommendations for action, with a main focus on cancer treatment modification. Conclusions In conclusion, delivering cancer care during the COVID-19 pandemic carries significant challenges. This paper addressed suggestions to properly manage cancer patients during difficult times. Implementing changes in practice mandates a national collaborative effort from different sectors to guarantee the quality and continuity of care. The SOPA expert panel developed these recommendations, to ultimately contribute in maintaining access to cancer therapy while minimizing the risk of COVID-19 exposure.
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Affiliation(s)
| | - Atika AlHarbi
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | | | - Mansoor Khan
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | - Amr Khardaly
- Saudi Oncology Pharmacy Assembly, Riyadh, Saudi Arabia
| | - Eshtyag Bajnaid
- Clinical Pharmacy Department, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Hadeel Samarkandi
- Department of Pharmaceutical Care, Oncology Pharmacy Services, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Aeshah AlAzmi
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Salman Alabdali
- King Fahad Hospital, Ministry of Health, Almadina, Saudi Arabia
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15
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Bosaeed M, Ahmad A, Alali A, Mahmoud E, Alswidan L, Alsaedy A, Aljuhani S, Alalwan B, Alshamrani M, Alothman A. Experience With Ceftolozane-Tazobactam for the Treatment of Serious Pseudomonas aeruginosa Infections in Saudi Tertiary Care Center. Infect Dis (Lond) 2020; 13:1178633720905977. [PMID: 32110036 PMCID: PMC7016308 DOI: 10.1177/1178633720905977] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction: Multidrug-resistant Pseudomonas aeruginosa isolates have multiple resistance mechanisms, and there are insufficient therapeutic options to target them. Ceftolozane-tazobactam is a novel antipseudomonal agent that contains a combination of an oxyimino-aminothiazolyl cephalosporin (ceftolozane) and a β-lactamase inhibitor (tazobactam). Methods: A single-center retrospective observational study between January 2017 and December 2018 for patients who had been diagnosed with carbapenem-resistant P aeruginosa infections and treated with ceftolozane-tazobactam for more than 72 hours. We assessed clinical success based on microbiological clearance as well as the clinical resolution of signs and symptoms of infection. Results: A total of 19 patients fit the inclusion criteria, with a median age was 57 years, and 53% were female. The types of infections were nosocomial pneumonia, acute bacterial skin, and skin structure infections; complicated intra-abdominal infections; and central line–associated bloodstream infections. All of the isolates were resistant to both meropenem and imipenem. The duration of therapy was variable (average of 14 days). At day 14 of starting ceftolozane-tazobactam, 18 of 19 patients had a resolution of signs and symptoms of the infection. Only 14 of 19 patients (74%) had proven microbiological eradication observed at the end of therapy. During therapy, there was no adverse event secondary to ceftolozane-tazobactam, and no Clostridium difficile infection was identified. The 30-day mortality rate was 21% (4/19). Conclusions: Multidrug-resistant P aeruginosa infection is associated with high mortality, which would potentially be improved using a new antibiotic such as ceftolozane-tazobactam. Studies are required to explain the role of combination therapy, define adequate dosing, and identify the proper duration of treatment.
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Affiliation(s)
- M Bosaeed
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - A Ahmad
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - A Alali
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - E Mahmoud
- Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - L Alswidan
- Pharmaceutical Care Department, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - A Alsaedy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - S Aljuhani
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - B Alalwan
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia
| | - M Alshamrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - A Alothman
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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16
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Almunif S, Alshamrani M, El-Saeed A, AlMazroa E. Achieving the United Nations AIDS (UNAIDS) 90-90-90 Target; A Single Center Experience. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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17
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Balkhy H, Alshamrani M, Baffoe-Bonnie H, El-Saed A, Mohammed A, Slim O, Arabi Y. Direct Physician Engagement as a Stewardship Modality to Curtail the Overuse of Antimicrobials in the Intensive Care Units at a Tertiary Care Hospital in Saudi Arabia. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Alshamrani M, Almalki A, Qureshi M, Yusuf O, Ismail S. Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing. Pharmacy (Basel) 2018; 6:E76. [PMID: 30046021 PMCID: PMC6163628 DOI: 10.3390/pharmacy6030076] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 12/02/2022] Open
Abstract
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%⁻99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients.
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Affiliation(s)
- Majed Alshamrani
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Pharmaceutical Care Department, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Abdullah Almalki
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Nephrology Section, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Mohamed Qureshi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Nephrology Section, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Oyindamola Yusuf
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Sherine Ismail
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Pharmaceutical Care Department, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
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Bukhari E, Alaklobi F, Bakheet H, Alrabiaah A, Alotibi F, Aljobair F, Alshamrani M, Alaki E, Alnahdi F, Alodyani A, Alzamil F. Disseminated bacille Calmette-Guérin disease in Saudi children: clinical profile, microbiology, immunology evaluation and outcome. Eur Rev Med Pharmacol Sci 2016; 20:3696-3702. [PMID: 27649674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The bacille Calmette Guérin (BCG) vaccine is administered worldwide to prevent tuberculosis. Although, Post BCG vaccination complications like disseminated BCG infections are rare and immunocompromised children are at high risk of developing BCG-related complications including BCG-lymphadenitis and other disseminated diseases. PATIENTS AND METHODS This was a prospective study of children who developed disseminated BCG after vaccination who were admitted in three tertiary care hospital in Riyadh, Saudi Arabia, in the year 2015. The clinical presentation, microbiological/immunological evaluation and outcome will be discussed. RESULTS 12 cases (7 males and 5 females) of disseminated BCG infections after vaccination were documented with age ranges 3 and 32 months. Eight (66%) patients had interleukin IL-12 deficiency and 3 (25%) had severe combined immune deficiency (SCID) and 1 (8%) had Interferon gamma receptor II deficiency. 9 (75%) patients presented with generalized lymphadenopathy. Hepatosplenomegaly was present in 6 (50%) patients. 2 (16%) patients presented with a recurrent skin infection and persistent oral candidiasis in one patient and pneumonia in the other. Five (41%) families were from 1st degree consanguineous marriage. Tuberculosis (TB) culture and sensitivity were positive for Mycobacterium bovis from gastric aspirate (GA) in 4 patients and the lymph node in 9 patients and 1 patient had culture positive from both skin lesion and lymph nodes. Mycobacterium bovis PCR was positive in 4 patients. All patients received anti-tuberculosis therapy; all patients survived except one who died due to multi-organ failure. CONCLUSIONS These results indicate that the prevalence of disseminated BCG vaccine in immunocompromised Saudi children is significantly high. Since in our region we have a high consanguinity rate and a high number of primary immune deficiency disorder (PID), we believe that BCG vaccination should be postponed till a child reaches one-year-old and appropriate tests exclude the diagnosis of primary immunodeficiency diseases.
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Affiliation(s)
- E Bukhari
- Prince Abdullah Ben Khalid Celiac Disease Research Chair, Department of Pediatric, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Alaklobi F, Aljobair F, Alrashod A, Alhababi R, Alshamrani M, Alamin W, Lytvyn L, Alrouki F, Mertz D. The prevalence of community-associated methicillin-resistant Staphylococcus aureus among outpatient children in a tertiary hospital: A prospective observational study in Riyadh, Saudi Arabia. Int J Pediatr Adolesc Med 2015; 2:136-140. [PMID: 30805452 PMCID: PMC6372392 DOI: 10.1016/j.ijpam.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/28/2022]
Abstract
Background and objectives The emergence of methicillin-resistant Staphylococcus aureus (MRSA) infections among previously healthy persons in community settings, without exposure to health care facilities, has been noted recently. Colonization rates of community-associated MRSA (CA-MRSA) have been reported to range from 0 to 9.2 percent. The nose and open skin areas are considered the most important sites for colonization. The aim of our study was to assess the prevalence and to describe the antibiotic susceptibility pattern of CA-MRSA among outpatient children. Patients and methods We prospectively screened every third consecutive child presenting to our pediatric emergency department of King Saud Medical City, a 275 bed tertiary care teaching hospital in Riyadh, Saudi Arabia, from March through July 2015. Results We analyzed a total of 830 screening results (n = 478 males, 57.6%). Most of the screened patients were from Riyadh (n = 824, 99.3%). A total of 164 (19.8%) were found to be colonized with S. aureus, and of these 38 (4.6%) with MRSA. Thus, the MRSA rate amongst all S. aureus carriers was 23.2%. All MRSA were susceptible to vancomycin, (94.7%) were susceptible to linezolid, (65.8%) to clindamycin, and (89.5%) to trimethoprim/sulfamethoxazole. Conclusion The rate of MRSA carriage among children in Riyadh province was within the range reported internationally. As the MRSA rate among S. aureus infected children was 23.2%, empirical MRSA coverage should be considered in children with suspected S. aureus infections.
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Affiliation(s)
- F Alaklobi
- Pediatric Infectious Disease, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - F Aljobair
- Pediatric Infectious Disease, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - A Alrashod
- Pediatric Emergency, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - R Alhababi
- Riyadh Regional Laboratory, King Saud Medical City, Riyadh, Saudi Arabia
| | - M Alshamrani
- Pediatric Infectious Disease, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - W Alamin
- Pediatric Emergency, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lyubov Lytvyn
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Deparment of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - F Alrouki
- Pediatric Emergency, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - D Mertz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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