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Pereira-Céspedes A, Jiménez-Morales A, Polo-Moyano A, Palomares-Bayo M, Martínez-Martínez F, Calleja-Hernández MÁ. Factors Contributing to Negative Outcomes Associated with Medications and Drug-Related Problems in Kidney Replacement Therapy-A Hospital-Based Prospective Observational Study. J Clin Med 2024; 13:1048. [PMID: 38398360 PMCID: PMC10888631 DOI: 10.3390/jcm13041048] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Negative outcomes associated with medications (NOM) and drug-related problems (DRP) significantly impact individuals with kidney replacement therapy (KRT) given the complexities of managing kidney disease and associated comorbidities. The present study aims to assess the frequency of NOMs/DRPs among KRT patients and identify contributing factors. METHODS A cross-sectional study was conducted at Virgen de las Nieves University Hospital (Granada, Spain), involving 117 outpatient adults with KRT. Data were collected from February 2021 to July 2023 using electronic records, semi-structured interviews (Dáder Method), and discussions with nephrology specialists. NOMs/DRPs were identified following treatment guidelines. Binary logistic regression was used to determine associated factors (p-value < 0.05). RESULTS Across 117 patients, 2436 NOMs and 3303 DRPs were identified, averaging 20.82 NOMs and 28.23 DRPs per patient. Prevalent NOMs included untreated conditions (58.95%), quantitative ineffectiveness (35.43%), and non-quantitative safety problems (5.13%). Dominant DRPs were undertreated conditions (37.63%), wrong dose/posology/length (33.00%), risk of adverse drug reactions (ADR) (16.14%), and non-adherence (6.87%). Patients with ADR, undertreated conditions, and anemia were associated with quantitative ineffectiveness. Risk of ADR and vitamin D deficiency/insufficiency correlated with non-quantitative safety problems. CONCLUSIONS KRT patients exhibited a substantial prevalence of NOMs/DRPs. Further research is needed to deepen our understanding of these complexities for improved patient care.
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Affiliation(s)
- Alfonso Pereira-Céspedes
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Centro Nacional de Información de Medicamentos, Instituto de Investigaciones Farmacéuticas, Pharmacy Faculty, University of Costa Rica, San José 11501-2060, Costa Rica
- Nephrology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (A.P.-M.); (M.P.-B.)
| | - Alberto Jiménez-Morales
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Aurora Polo-Moyano
- Nephrology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (A.P.-M.); (M.P.-B.)
| | - Magdalena Palomares-Bayo
- Nephrology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain; (A.P.-M.); (M.P.-B.)
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
| | - Miguel Ángel Calleja-Hernández
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Amaro-Álvarez L, Cordero-Ramos J, Calleja-Hernández MÁ. Exploring the impact of pharmacogenetics on personalized medicine: A systematic review. Farm Hosp 2024:S1130-6343(24)00003-5. [PMID: 38341366 DOI: 10.1016/j.farma.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Pharmacogenetics evaluates how genetic variations influence drug responses. Nowadays, genetic tests have advanced, becoming more affordable, and its integration is supported by stronger clinical evidence. Guidelines such as those from CPIC (Clinical Pharmacogenetics Implementation Consortium) and resources like PharmGKB facilitate genotype-based prescribing; and organizations like the FDA promote genetic testing before initiating certain medications. Preventive pharmacogenetic panels seem promising, but further research on biomarkers and diverse populations is needed. The aim of this review is to analyze recent evidence on the genotype-drug response relationship to examine how the genetic profile of patients influences the clinical response to treatments, and analyze the areas of research that need further study to advance towards a genetic-based precision medicine. MATERIALS AND METHODS A systematic search was conducted on PubMed to identify articles investigating the genotype-drug response relationship. The search strategy included terms such as "pharmacogenetics", "personalized treatment", "precision medicine", "dose adjustment", "individualizing dosing", "clinical routine", and "clinical practice." Clinical trials, observational studies, and meta-analyses published in English or Spanish between 2013 and 2023 were included. The initial search resulted in a total of 136 articles for analysis. RESULTS 49 articles were included for the final analysis following review by 2 investigators. A relationship between genetic polymorphisms and drug response or toxicity was found for drugs such as opioids, GLP-1 agonists, tacrolimus, oral anticoagulants, antineoplastics, atypical antipsychotics, efavirenz, clopidogrel, lamotrigine, anti-TNFα agents, voriconazole, antidepressants, or statins. However, for drugs like metformin, quetiapine, irinotecan, bisoprolol, and anti-VEGF agents, no statistically significant association between genotype and response was found. CONCLUSION The studies analyzed in this review suggest a strong correlation between genetic variability and individual drug responses, supporting the use of pharmacogenetics for treatment optimization. However, for certain drugs like metformin or quetiapine, the influence of genotype on their response remains unclear. More studies with larger sample sizes, greater ethnic diversity, and consideration of non-genetic factors are needed. The lack of standardization in analysis methods and accessibility to genetic testing are significant challenges in this field. As a conclusion, pharmacogenetics shows immense potential in personalized medicine, but further research is required.
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Calleja-Hernández MÁ, Guerrero-Peral ÁL, Irimia-Sieira P, Martínez-López I, Santos-Lasaosa S, Sarobe-Carricas M, López-Matencio JMS, Láinez-Andrés JM. Consensus recommendations for the treatment of migraine prevention. Farm Hosp 2023; 47:246-253. [PMID: 37321919 DOI: 10.1016/j.farma.2023.03.011] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE The objectives are to know the opinion of neurologists and hospital pharmacists on those aspects still under debate regarding the role of anti-CGRP monoclonal antibodies in the preventive treatment of migraine. To identify those controversies that still exist. To propose agreed recommendations for improvement of care. And to promote access of clinicians and patients to these new treatments in the prevention of migraine with biological drugs, in order to improve patient care and follow-up. METHODOLOGY Recommendations for the use of biological drugs in the prevention of migraine were identified and evaluated through the Delphi consensus methodology, proposing 88 statements grouped into three themes: a clinical module that deals with the management of biological treatments in migraine; a patient module that discusses patient education and adherence improvement strategies; and a coordination module that includes statements related to strategies to improve joint work between the two groups. The 9-point Likert ordinal scale was used to score these recommendations and, subsequently, the data was statistically analyzed through different metrics. RESULTS After both rounds of voting, consensus was reached in agreement on 71 of the 88 statements (80.7%), leaving one statement (1.1%) with consensus in disagreement and 16 remaining as indeterminate (18.2%). CONCLUSIONS The high degree of consensus indicates that the opinion of neurologists and hospital pharmacists on the role of anti-CGRP monoclonal antibodies in the treatment of migraine is very similar and allows identifying those controversies that still exist, to improve the care and follow-up of patients with migraine.
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Affiliation(s)
| | - Ángel Luis Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Pablo Irimia-Sieira
- Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - Icíar Martínez-López
- Servicio de Farmacia Hospitalaria, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Sonia Santos-Lasaosa
- Servicio de Neurología, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España
| | - Maite Sarobe-Carricas
- Servicio de Farmacia Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, España
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Calleja-Hernández MÁ, Guerrero-Peral ÁL, Irimia-Sieira P, Martínez-López I, Santos-Lasaosa S, Sarobe-Carricas M, López-Matencio JMS, Láinez-Andrés JM. [Translated article] Consensus recommendations on the preventive treatment of migraine. Farm Hosp 2023; 47:T246-T253. [PMID: 37730507 DOI: 10.1016/j.farma.2023.07.002] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The objectives are to know the opinion of neurologists and hospital pharmacists on those aspects still under debate regarding the role of anti-Calcitonin Gene-related Peptide monoclonal antibodies in the preventive treatment of migraine. To identify those controversies that still exist. To propose agreed recommendations for improvement of care. And to promote access of clinicians and patients to these new treatments in the prevention of migraine with biological drugs, in order to improve patient care and follow-up. METHODOLOGY Recommendations for the use of biological drugs in the prevention of migraine were identified and evaluated through the Delphi consensus methodology, proposing 88 statements grouped into 3 themes: a clinical module that deals with the management of biological treatments in migraine; a patient module that discusses patient education and adherence improvement strategies; and a coordination module that includes statements related to strategies to improve joint work between the two groups. The 9-point Likert ordinal scale was used to score these recommendations and, subsequently, the data was statistically analysed through different metrics. RESULTS After both rounds of voting, consensus was reached in agreement on 71 of the 88 statements (80.7%), leaving 1 statement (1.1%) with consensus in disagreement and 16 remaining as indeterminate (18.2%). CONCLUSIONS The high degree of consensus indicates that the opinion of neurologists and hospital pharmacists on the role of anti-Calcitonin Gene-related Peptide monoclonal antibodies in the preventive treatment of migraine is very similar and allows identifying those controversies that still exist, to improve the care and follow-up of patients with migraine.
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Affiliation(s)
| | - Ángel Luis Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Irimia-Sieira
- Departamento de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Icíar Martínez-López
- Adjunta del Servicio de Farmacia Hospitalaria, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Sonia Santos-Lasaosa
- Servicio de Neurología, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Maite Sarobe-Carricas
- Jefe de Servicio de Farmacia Hospitalaria, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José María Serra López-Matencio
- Adjunto del Servicio de Farmacia Hospitalaria, responsable consulta monográfica de atención farmacéutica en migraña, Hospital Universitario de La Princesa, Madrid, Spain
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García-Fumero R, Fernández-López C, Calleja-Hernández MÁ, Expósito-Ruiz M, Espín J, Expósito-Hernández J. Clinical Outcomes of First-line Therapies for Advanced Non-Small Cell Lung Cancer: A Systematic Review of Trials Published Between 2010 and 2020. Am J Clin Oncol 2023; 46:433-438. [PMID: 37522643 DOI: 10.1097/coc.0000000000001031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To analyze the evolution of clinical outcomes derived from clinical trials on first-line therapies for advanced or metastatic non-small cell lung cancer (NSCLC) published between 2010 and 2020, focusing on how these outcomes impact survival rates and management of patients. METHODS A systematic review of phase III and pivotal phase II clinical trials was conducted by a structured search on Medline and Embase. A comprehensive set of variables was collected to assess their influence on survival rates. We also estimated the clinical benefit by applying the ESMO-MCBS v1.1 and extracted the authors' conclusions. RESULTS Sixty-six studies involving 34,951 patients were included. Best survival outcomes were found for nonsquamous non-small cell lung cancer (OS and progression-free survival medians: 19.4 and 10.2 mo) and for those expressing molecular targets (OS and progression-free survival medians: 23.8 and 11.0 mo). No significant influence on survival rates was observed for industry funding and disease stage (IIIB/IV vs. IV). ESMO-MCBS v1.1 was applied in 45 positive studies and resulted in a meaningful clinical benefit score in 37.8%. Quality of life (QoL) was reported in 57.6% of the original publications and showed statistical significance favoring the experimental arm in 33.3%. Positive authors' conclusions (75.7% of trials) were based on OS and/or QoL in 34% and on surrogate endpoints in 66%. CONCLUSIONS Extended survival times and a steady improvement in QoL have been observed. However, there were more than twice as many studies reporting positive authors' conclusions as studies meeting the ESMO threshold for meaningful clinical benefit.
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Affiliation(s)
| | | | | | | | - Jaime Espín
- Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Granada
- CIBER of Epidemiology and Public Health (CIBERESP), Spain
- Instituto de Investigación Biosanitaria ibs
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Pereira-Céspedes A, Jiménez-Morales A, Palomares-Bayo M, Martínez-Martínez F, Calleja-Hernández MÁ. Medication Review with Follow-Up for End-Stage Renal Disease: Drug-Related Problems and Negative Outcomes Associated with Medication-A Systematic Review. J Clin Med 2023; 12:5080. [PMID: 37568483 PMCID: PMC10419351 DOI: 10.3390/jcm12155080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This article reviews the available scientific literature on drug-related problems and negative outcomes associated with medications identified by medication review with follow-up for end-stage renal disease and discussed with the physicians. METHODS A systematic review was conducted of the scientific literature retrieved from the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Cochrane Library: The Cochrane Central Register and Control Trials (CENTRAL) and Literatura Latinoamericana y del Caribe (LILACS), Medicina en Español (MEDES), and the SciELO bibliographic database (a collection of scientific journals). The following terms were used as descriptors and searched in free text: "end-stage renal disease", "medication review", "drug-related problems", and "negative outcomes associated with medication". The following limits were applied: "humans" and "adults (more than 18 years)". RESULTS A total of 59 references were recovered and, after applying inclusion/exclusion criteria, 16 articles were selected. Of these selected articles, 15 provided information on drug-related problems and only 1 on negative outcomes associated with medications. CONCLUSIONS It can be concluded that drug-related problems and negative outcomes associated with medications affect patients with end-stage renal disease, mainly those receiving renal replacement therapy. More evidence is needed, especially on negative outcomes associated with medication.
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Affiliation(s)
- Alfonso Pereira-Céspedes
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Centro Nacional de Información de Medicamentos, Instituto de Investigaciones Farmacéuticas, Pharmacy Faculty, University of Costa Rica, San José 11501-2060, Costa Rica
- Nephrology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Alberto Jiménez-Morales
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | | | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
| | - Miguel Ángel Calleja-Hernández
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Cordero-Ramos J, Merino-Bohórquez V, Delgado-Valverde M, Barros-Tornay R, Cameán-Fenández M, Calleja-Hernández MÁ. Formulation, long-term physicochemical and microbiological stability of 15% topical resorcinol for hidradenitis suppurativa. Eur J Hosp Pharm 2022; 29:313-318. [PMID: 33328205 PMCID: PMC9614138 DOI: 10.1136/ejhpharm-2020-002534] [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] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Topical resorcinol 15% is a self-treatment for painful hidradenitis suppurativa nodules and abscesses with good results in reducing pain and lesion duration. The aim of this study is to establish a 15% topical resorcinol formula, to develop a physicochemical and microbiological stability study and to further determine the compounding shelf-life in different package conditions following the European Pharmacopoeia (Ph. Eur.) specifications. METHODS Physicochemical and microbiological stability studies of the formulation were conducted for 12 months at room temperature (25°C±2°C) in different package conditions: aluminium tubes (aluminium A7-99.7% varnish DF-6172), plastic tubes (low density polyethylene) and amber plastic containers (polyethylene terephthalate). High performance liquid chromatography (HPLC) was developed as a method of indicating the stability of the resorcinol formulation. A microbiological growth assay was also validated according to the Ph. Eur. Physical properties were inspected to determine parameters such as odour, colour, pH, emulsion phase and extensibility index and its evolution. RESULTS The HPLC method was validated according to the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines. At day 365, visual inspection remained unchanged only for preparations packaged in aluminium tubes. The pH did not vary by more than 0.3 units in all conditions. The extensibility index decreased in the preparations packaged in plastic and amber plastic containers. HPLC analysis conducted over 1 year did not show a degradation greater than 7% of resorcinol in the preparation in plastic and aluminium packages. The ability of ATCC strains to grow in resorcinol formulation was confirmed under the suitability test. Resorcinol packed in aluminium tubes achieved microbiological stability at day 365. CONCLUSIONS Only the formulation package in aluminium tubes showed physicochemical and microbiological stability of resorcinol for 12 months at room temperature (25°C±2°C).
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Affiliation(s)
- Jaime Cordero-Ramos
- Pharmacy Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| | - Vicente Merino-Bohórquez
- Pharmacy Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Department of Pharmacology, Faculty of Pharmacy, Universidad de Sevilla, Sevilla, Spain
| | - Mercedes Delgado-Valverde
- Infectious Diseases, Clinical Microbiology and Preventative Medicine Unit, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
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Calleja-Hernández MÁ, Martinez-Sesmero JM, Vallejo-Aparicio LA, Hernández-Novoa B, Badia X. Contribution of cabotegravir + rilpivirine long-acting for the treatment of HIV-1 infection. Farm Hosp 2022; 46:208-214. [PMID: 36183218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the value contribution of cabotegravir + rilpivirine, the first injectable every two months long-acting antiretroviral regimen, using multi-criteria decision analysis. METHOD The study was developed in two phases. After a small pilot, a field ork study with a larger number of multidisciplinary experts was carried out. Seven single-tablet regimens, currently recommended by the GeSIDA guidelines, were selected as comparators. EVIDEM methodology was followed, with a framework composed by 12 quantitative and 5 contextual criteria. Mean and standard deviations were calculated for quantitative criteria (1 to 5 scale; comparative criteria -5 to +5), whereas qualitative criteria were analyzed as percentages of experts that considered a positive, neutral or negative impact for the National Health System. RESULTS 35 experts participated in the study. Human immunodeficiency virus- 1 infection was considered severe (mean ± standard deviation: 3.0 ± 1.0), with moderate size of affected population (2.7 ± 1.2) and unmet needs (2.8 ± 1.0). Minimal differences were found in comparative efficacy/effectiveness (0.1 ± 0.5), safety/tolerability (-0.5 ± 0.7), and cost criteria: cost of the intervention (0.5 ± 2.0), other medical costs (0.2 ± 1.8) and non- medical/indirect costs (0.5 ± 1.6). Experts perceived an improvement with cabotegravir + rilpivirine long-acting, compared to current daily oral single-tablet regimens, in patient-reported outcomes (2.7 ± 1.4). Therapeutic benefit of the long-acting regimen was considered moderate-to-high (3.5 ± 1.2). Experts considered the evidence provided by cabotegravir + rilpivirine long- actingrobust (4.3 ± 0.8), with elevated consensus on its future recommendation in guidelines (3.2 ± 1.0). In contextual criteria, most experts considered positive the impact on population priorities and access (91%), common goal and specific interests (63%) and political, historical, and cultural context criteria (60%). Impact was neutral in system capacity and appropriate use (40%), and opportunity costs and affordability criteria (51%). Result of the weighted global value contribution of cabotegravir + rilpivirine long-acting was 0.34 (-1 to +1 scale), with Patient Reported Outcomes comparative criterion bringing the highest added value. CONCLUSIONS Cabotegravir + rilpivirine long-acting provides added value contribution to human immunodeficiency virus-1 management in Spain compared to daily oral single-tablet regimens. Patient Reported Outcomes and therapeutic benefit of cabotegravir + rilpivirine long-acting were highly valued by experts, as the expected benefit in adherence and stigma-related issues would improve overall quality of life for people living with human immunodeficiency virus-1.
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Cordero-Ramos J, Barros-Tornay R, Toledo-Pastrana T, Ferrándiz L, Calleja-Hernández MÁ, Moreno-Ramírez D. Effectiveness and safety of topical 15% resorcinol in the management of mild-to-moderate hidradenitis suppurativa: A cohort study. J Dermatol 2022; 49:459-462. [PMID: 34984726 DOI: 10.1111/1346-8138.16275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/26/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022]
Abstract
Antibiotics remain one of the main treatment alternatives in mild-to-moderate hidradenitis suppurativa. The use of topical 15% resorcinol reduces antibiotic pressure and the generation of resistance. However, knowledge on its efficacy and safety is limited. This single-center, prospective, follow-up cohort study evaluated topical 15% resorcinol every 12-h response at 16 weeks. Those individuals with mild-to-moderate hidradenitis suppurativa (Hurley I-II) who started treatment with topical resorcinol monotherapy between April 2019 and May 2020 were eligible for follow-up. The primary endpoint for effectiveness was the proportion of patients who achieved an overall clinical response (complete or partial response) at week 16, evaluated as intention-to-treat. Responses were measured according to the Hidradenitis Suppurativa Clinical Response index. Target lesion size was measured clinically and by ultrasonography. Quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire. Safety was measured by recording the adverse events reported during the follow-up period. A total of 32 patients were enrolled (mean age, 40.1 years [95% confidence interval, 35.7-44.4]; women, 20 [62.5%]; Hurley I, 17 [53.1%]). Under the intention-to-treat analysis, 68.8% (n = 22) of the patients achieved a clinical response. A ≥50% reduction in the size of the main lesion was observed in 56.3% of the patients (n = 18). Some 65.6% (n = 21) of the patients had a ≥50% reduction (improvement) in their baseline DLQI score. Fifty percent of patients who completed the follow-up period experienced adverse events, all of which were local, mild, and transient and did not lead to discontinuation of resorcinol. To conclude, in this cohort study, topical 15% resorcinol was shown to be effective for mild-to-moderate hidradenitis suppurativa and to have a positive impact on quality of life with an acceptable safety profile.
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Affiliation(s)
- Jaime Cordero-Ramos
- Hospital Pharmacy Unit, University Hospital Virgen Macarena, Seville, Spain.,Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Seville, Seville, Spain
| | | | | | - Lara Ferrándiz
- Dermatology Unit, University Hospital Virgen Macarena, Seville, Spain
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Calleja-Hernández MÁ, Ventayol-Bosch P, Martí-Ragué I, Casañas-Domingo M, Costa-Samarra J, Nieves-Calatrava D. Biologic treatments for psoriasis: the cost of alternative methods of dispensation of medication in Spain. Farm Hosp 2021; 45:323-328. [PMID: 34806572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Hospital pharmacy services have adapted to the COVID‑19 pandemic. The aim of the study is to determine the economic consequences of replacing hospital pharmacy dispensation with other dispensing methods in the context of biological treatments for psoriasis in Spain. METHOD Multiple dispensation scenarios were evaluated, combining different dispensation frequencies and sites, and telepharmacy followup intervals. Self- injectable biological medicines for psoriasis (interleukin and tumour necrosis factor alpha inhibitors) were included. All costs (in 2020 euros) were considered from the perspective of the National Health System. RESULTS The annual cost of hospital pharmacy-based dispensations every 4 weeks combined with telepharmacy monitoring at each administration ranged from €194.9 to €2,088.0 per patient. Across the different simulated scenarios, biological medicines associated with the lowest cost were those administered less frequently (every 12 weeks). CONCLUSIONS In the post-COVID-19 era, new models of hospital pharmaceutical care that include changes in drug dispensation and telepharmacy strategies will have economic consequences for the National Health System that merit consideration.
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Affiliation(s)
| | - Pere Ventayol-Bosch
- Hospital Pharmacy Department, Hospital Universitario Son Espases, Palma de Mallorca. Spain..
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García-Fumero R, Fernández-López C, Calleja-Hernández MÁ, Expósito-Hernández J. Analyzing the clinical benefit of newer therapies for advanced or metastatic non-small-cell lung cancer: application of the ESMO-magnitude of clinical benefit scale v1.1. Acta Oncol 2021; 60:1225-1232. [PMID: 34184595 DOI: 10.1080/0284186x.2021.1942546] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite newer therapies, advanced or metastatic non-small-cell lung cancer (NSCLC) continues to be the leading cause of cancer-related deaths worldwide. Deficits in the design and methods of randomized controlled trials (RCTs) may contribute to reducing the clinical benefit of therapies in oncology. To prioritize treatments based on efficacy results and toxicity data, the European Society for Medical Oncology (ESMO) has developed the Magnitude of Clinical Benefit Scale (MCBS). The objective of this study was to apply the ESMO-MCBS v1.1 to a cohort of RCTs on therapies for advanced or metastatic NSCLC. MATERIAL AND METHODS Phase III and pivotal phase II trials, published between 2013 and 2018, investigating drug therapies for advanced NSCLC were included. PubMed was specifically searched for efficacy/toxicity updates. Treatments were graded 5 to 1 on the ESMO-MCBS v1.1, using the lower limit of the 95% confidence interval of the hazard ratio (HR), where scores 5 and 4 represent a substantial clinical benefit. Additionally, scores using the point estimate HR were generated, for comparison. Discrepancies between our grade estimations and the ones published on the ESMO website, as scorecards, were identified. RESULTS ESMO-MCBS scores were calculated for 42 positive clinical trials. 54.8% met the ESMO-MCBS thresholds for clinically meaningful benefit (final grade of 4 or 5). That percentage decreased to 40.5% when considering the point estimate of the HR. 50.0% of the trials had no published scorecard on the ESMO website and discrepancies affected 11 (26.2%) studies. CONCLUSION Almost half of the RCTs showing a statistically significant result favoring the experimental arm, failed to demonstrate a substantial clinical benefit according to the ESMO framework.
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Affiliation(s)
| | - Cristina Fernández-López
- University of Granada, Granada, Spain
- Department of Pharmacy, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Expósito-Hernández
- University of Granada, Granada, Spain
- Department of Oncology, Virgen de las Nieves University Hospital, Granada, Spain
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Pérez-Encinas M, Lozano-Blázquez A, García-Pellicer J, Torre-Lloveras I, Poveda-Andrés JL, Calleja-Hernández MÁ. Erratum found in «Farmacia Hospitalaria. 2021;45(1):32-40». Farm Hosp 2021; 45:11740. [PMID: 34218770 DOI: 10.7399/fh.11740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Affiliation(s)
| | - Ana Lozano-Blázquez
- Pharmacy Department, Asturias Central University Hospital, Oviedo (Asturias). Spain..
| | | | - Inmaculada Torre-Lloveras
- Pharmacy Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramanet (Barcelona). Spain..
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Hernández-Guío A, Bernabéu-Martínez MªÁ, Corno-Caparrós A, Aznar-Saliente MªT, Bonete-Sánchez M, Calleja-Hernández MÁ. DPYD variant testing in candidates for fluoropyrimidine treatment: A study protocol. Farm Hosp 2021; 45:155-159. [PMID: 33941060 DOI: 10.7399/fh.11607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The main purpose of this study is to evaluate the potential clinical impact of pharmacogenetic testing on the reduction of the toxicity in patients treated with fluoropyrimidines. This will be achieved by comparing the frequency of adverse events and the incidence of toxicity of two groups of patients that will differ from each other only in that one will receive pharmacogenetic counseling. The hypothesis is that availability of a pharmacogenetic report prior to treatment initiation has a positive effect. One of the main secondary goals is to analyze allele frequencies and the association of polymorphisms rs895819 (miR27A) and rs1801160 (DPYD*6) with toxicity by conducting an observational study to determine their clinical relevance and standardize a dose adjustment recommendation. METHOD The study has an single-center ambispective, quasi-experimental design and is based on a multidisciplinary protocol involving implementation and standardization of DPYD*2A; DPYD*13; c.2846A>T; and HapB3 measurements. Following these measurements, pharmacogenetic counseling will be carried out and its clinical impact will be evaluated. The primary endpoint of the study is severe toxicity and/or mortality. The toxicity observed in two groups with similar epidemiological characteristics will be compared: the intervention group (candidates for treatment with fluoropyrimidines who will be subjected to the protocol) and the control group (retrospective cohort). Additionally, rs895819 (MIR27A) and rs1801160 (DPYD*6) will be determined. Testing for these variants is not part of the hospital's daily practice, nor are they included in clinical guidelines. However, according to recently published studies, the activity of dihydropyrimidine dehydrogenase might be affected by these variants, as they may be associated with toxicity. The results of the measurements of these two variants will not be incorporated to pharmacogenetics counseling until their association with toxicity is determined by means of the observational study to be conducted. The project, as well as the patient information sheet and the informed consent form, were approved by the Ethics Committee of the participating center (code 20/006).
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Affiliation(s)
- Ana Hernández-Guío
- Department of Pharmacy, San Juan de Alicante University Hospital, Alicante, Spain..
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Cancela Díez B, Pérez-Ramírez C, Maldonado-Montoro MDM, Carrasco-Campos MI, Sánchez Martín A, Pineda Lancheros LE, Martínez-Martínez F, Calleja-Hernández MÁ, Ramírez-Tortosa MC, Jiménez-Morales A. Association between polymorphisms in the vitamin D receptor and susceptibility to multiple sclerosis. Pharmacogenet Genomics 2021; 31:40-47. [PMID: 33044390 DOI: 10.1097/fpc.0000000000000420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a neurodegenerative chronic inflammatory. Mutations in the vitamin D receptor (VDR) gene can substantially affect serum vitamin D levels or alter its functionality, and can consequently increase susceptibility to developing MS. The objective of this study was to evaluate the association between polymorphisms in the VDR gene and risk of MS in a (Spanish) Caucasian population. PATIENTS AND METHODS We conducted a retrospective case-control study comprising 209 patients with relapsing-remitting multiple sclerosis (RRMS) and 836 controls of Caucasian origin from southern Spain. The ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms were determined by allelic discrimination real-time PCR using TaqMan probes. RESULTS The recessive logical regression model, adjusted for age and sex, revealed that the TT genotype for VDR FokI (rs2228570) polymorphism was associated with higher risk of MS (P = 0.0150; OR = 1.82; 95% CI = 1.12-2.94; TT vs. CT + CC). No association between the other polymorphisms and development of MS was found in any of the models analyzed. The haplotype analysis, adjusted for age, smoking, and sex, did not find any statistically significant association between the haplotypes analyzed and risk of MS. CONCLUSIONS The VDR FokI (rs2228570) polymorphism was significantly associated with developing MS. We found no influence of the ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms on the risk of developing MS in our patients.
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Affiliation(s)
- Bárbara Cancela Díez
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas
| | - Cristina Pérez-Ramírez
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen Macarena, Dr. Fedriani, Sevilla
| | | | - María Isabel Carrasco-Campos
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas
| | - Almudena Sánchez Martín
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas
| | - Laura Elena Pineda Lancheros
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas
| | - Fernando Martínez-Martínez
- Department of Pharmacy and Pharmaceutical Technology, Social and Legal Assistance Pharmacy Section, Faculty of Pharmacy
| | | | - María Carmen Ramírez-Tortosa
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
| | - Alberto Jiménez-Morales
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas
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Pérez-Encinas M, Lozano-Blázquez A, García-Pellicer J, Torre-Lloveras I, Poveda-Andrés JL, Calleja-Hernández MÁ. 2019 SEFH National Survey: service portfolio, care activities, education and research in Spain's hospital pharmacy departments. Farm Hosp 2021; 45:32-40. [PMID: 33443476 DOI: 10.7399/fh.11611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To report on the results obtained from the 2019 SEFH National Survey regarding the service portfolio, care activities, training programs and research work of Spanish hospital pharmacy departments. METHOD In March 2019, SEFH designed and distributed a questionnaire containing 77 questions grouped into 8 domains to its 368 affiliated hospital pharmacy departments. The questionnaire included an additional section on the activities carried out in 2017 and 2018. RESULTS The overall response rate was 54.3%. Sixty-nine percent of hospitals were public and 75% were general hospitals. A total of 88.6% of hospital pharmacy departments provided pharmaceutical care to inpatients, whereas 77.5% and 65% treated outpatients and ambulatory patients, respectively. Sterile formulations were prepared by 70.6% of pharmacy departments, while 12% measured drug levels in bodily fluids; 76.9% of hospitals with more than 1,000 beds prepared pharmacokinetic reports. In 2018, hospital pharmacies provided for a mean of 929 patients a month and 2,680 a year. The amount of formulations (sterile and non-sterile) prepared was 10,394,492, sterile formulations accounting for 62.6%. The average amount of clinical trials managed in hospitals with ≥ 500 and ≥ 1000 beds was of 186.2 and 421.8, respectively. The median of number of undergraduate tuition agreements between pharmacy departments and universities was 1 (IQR: 0-2); 21.5% of pharmacy departments had no agreements with any university. The mean number of undergraduate pharmacy students per hospital pharmacy was 4.12 (SD: 8,26). A total of 290 pharmacists were associate professors at some university. Fifteen percent of pharmacists held a certification from the Board of Pharmacy Specialties, 55.3% of them in the specialty of oncology. Hospital pharmacy departments employed a mean of 1.31(SD: 2,23) PhD holders. From those which reported the impact factor of their publications, 60% had an impact factor of zero while in 19.6% the impact factor was ≥ 10. CONCLUSIONS Care of out-patients and medication compounding are increasingly the main activities performed in Spanish hospital pharmacies, while there is still considerable room for improvement in the area of clinical pharmacokinetics. Pharmacy departments are generally committed to training as a key activity, while scientific output is still limited despite the increase in the number of PhD pharmacist.
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Affiliation(s)
| | - Ana Lozano-Blázquez
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo (Asturias). Spain..
| | | | - Inmaculada Torre-Lloveras
- Pharmacy Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramanet (Barcelona). Spain..
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Pérez-Encinas M, Lozano-Blázquez A, García-Pellicer J, Torre-Lloveras I, Poveda-Andrés JL, Calleja-Hernández MÁ. SEFH National Survey-2019: general characteristics, staffing, material resources and information systems in Spain's hospital pharmacy departments. Farm Hosp 2020; 44:288-296. [PMID: 33156747 DOI: 10.7399/fh.11565] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To publicize the results regarding the general characteristics, human resources, materials and information systems of Spanish hospital pharmacy departments arising from SEFH's 2019 Survey on the Situation of Spanish Hospital Pharmacy Departments. METHOD An online questionnaire was sent to the heads of the 368 hospital pharmacy departments affiliated to SEFH. The questionnaire included 77 questions grouped into 8 dimensions. The information was collected between March and September 2019. RESULTS The overall response rate was 54.3%. Sixty-nine percent of hospitals were public and the most commonly reported hospital size was 101-250 beds. Nine percent of responding hospitals remained open round the clock and 57.5% did not offer a continued care service. A total of 41.9% of hospitals dispensed medications to outpatients in the afternoon and 52.7% of hospital pharmacy departments were accredited to some quality standard. The mean number of specialist pharmacists per pharmacy Department was 5.34 (SD: 6.22); 47% of pharmacists spent at least half their working day in a clinical unit. Hospital pharmacy departments had a mean of 0.3 (SD: 0.7) or 0:9 (SD: 1.4) automated storage and dispensing carousels, depending on whether they were horizontal or vertical, respectively. A total of 16.1% of beds were assisted by automated dispensing systems, a figure that reached 33.5% in hospitals with more than 1,000 beds. Three percent of hospital pharmacy departments had a robotized system for compounding chemotherapy medications and 24.8% had a raceability and safety system. Smart infusion pumps were used by 21.4% of hospitals. Electronic prescriptions were implemented in 98.8% of hospitals for inpatients and in 62% for outpatients. CONCLUSIONS Spanish hospital pharmacy departments face a shortage of specialist pharmacists, although incorporation of such professionals to clinical units has doubled in the last few years. There has been an increase in the level of automation of the logistic processes involved in medication dispensing, but there is still significant room for improvement in the area of robotized dispensing and compounding traceability systems. This data could play an invaluable role in the design of future action plans.
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Affiliation(s)
| | - Ana Lozano-Blázquez
- Pharmacy Department, Hospital Universitario Central de Asturias. Oviedo (Asturias). Spain..
| | | | - Inmaculada Torre-Lloveras
- Pharmacy Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramanet (Barcelona). Spain..
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García-García R, Calleja-Hernández MÁ. Discontinuation of cholinesterase inhibitor treatment in institutionalised patients with advanced dementia. Eur J Hosp Pharm 2020; 29:145-150. [PMID: 32723787 PMCID: PMC9047926 DOI: 10.1136/ejhpharm-2019-002106] [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: 09/30/2019] [Revised: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the impact of discontinuation of treatment with cholinesterase inhibitors (ChEIs) on cognitive, behavioural and functional outcomes in patients with severe dementia. METHODS A prospective observational study in which the prescribing physician decides, depending on multidisciplinary assessment and following the recommendations of the clinical practice guidelines, whether to withdraw or continue ChEI treatment in institutionalised patients, with a follow-up of 3 months. Cognitive abilities were measured using the Mini-Mental State Examination (MMSE) and Reisberg's Global Deterioration Scale (GDS). Other measures were the behavioural and psychological symptoms of dementia (BPSD) according to the Neuropsychiatric Inventory (NPI), the activities of daily living using the Barthel index, the pharmacological and the non-pharmacological measures to treat the BPSD. RESULTS ChEI treatment was discontinued in 23 of 43 patients. After 3 months there were no differences in MMSE (p=0.441), GDS (p=0.976), NPI (p=0.882) or Barthel index (p=0.080) scores, or the establishing of new pharmacological measures (p=0.919) or non-pharmacological measures (p=0.832). CONCLUSIONS ChEI discontinuation in advanced stage dementia was not related to clinical deterioration in terms of cognitive function, BPSD, or functional status. Discontinuing ChEI treatment according to a multidisciplinary assessment and the recommendation of the guidelines appears to be a possible way of optimising pharmacotherapy without altering the main clinical evaluation scales.
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Affiliation(s)
- Ramón García-García
- Pharmacy, Hospital Universitario de Torrevieja, Torrevieja, Spain .,University of Granada, Granada, Spain
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Martínez-Aguilar L, Pérez-Ramírez C, Maldonado-Montoro MDM, Carrasco-Campos MI, Membrive-Jiménez C, Martínez-Martínez F, García-Collado C, Calleja-Hernández MÁ, Ramírez-Tortosa MC, Jiménez-Morales A. Effect of genetic polymorphisms on therapeutic response in multiple sclerosis relapsing-remitting patients treated with interferon-beta. Mutat Res Rev Mutat Res 2020; 785:108322. [PMID: 32800273 DOI: 10.1016/j.mrrev.2020.108322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
Treatment with interferon beta (IFNβ) is one of the first-line treatments for multiple sclerosis. In clinical practice, however, many patients present suboptimal response to IFNβ, with the proportion of non-responders ranging from 20 to 50%. This variable response can be affected by genetic factors, such as polymorphisms in the genes involved in the disease state, pharmacodynamics, metabolism or in the action mechanism of IFNβ, which can affect the efficacy of this drug. This review assesses the impact of pharmacogenetics studies on response to IFNβ treatment among patients diagnosed with relapsing-remitting multiple sclerosis (RRMS). The results suggest that the detection of polymorphisms in several genes (CD46, CD58, FHIT, IRF5, GAPVD1, GPC5, GRBRB3, MxA, PELI3 and ZNF697) could be used in the future as predictive markers of response to IFNβ treatment in patients diagnosed with RRMS. However, few studies have been carried out and they have been performed on small sample sizes, which makes it difficult to generalize the role of these genes in IFNβ treatment. Studies on large sample sizes with longer term follow-up are therefore required to confirm these results.
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Affiliation(s)
- Laura Martínez-Aguilar
- Department of Pharmacy and Pharmaceutical Technology. Social and Legal Assistance Pharmacy Section, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Cristina Pérez-Ramírez
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen Macarena, Dr. Fedriani, 3, 41009 Sevilla, Spain.
| | | | - María Isabel Carrasco-Campos
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas, 2, Spain.
| | - Cristina Membrive-Jiménez
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas, 2, Spain.
| | - Fernando Martínez-Martínez
- Department of Pharmacy and Pharmaceutical Technology. Social and Legal Assistance Pharmacy Section, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Carlos García-Collado
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas, 2, Spain.
| | | | - María Carmen Ramírez-Tortosa
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n 18071 Granada, Spain.
| | - Alberto Jiménez-Morales
- Pharmacy Service. Pharmacogenetics Unit, University Hospital Virgen de las Nieves, UGC Provincial de Farmacia de Granada, Avda. Fuerzas Armadas, 2, Spain.
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Morillo-Verdugo R, Calleja-Hernández MÁ, Robustillo-Cortés MDLA, Poveda-Andrés JL. A new definition and refocus of pharmaceutical care: the Barbate Document. Farm Hosp 2020; 44:158-162. [PMID: 32646347 DOI: 10.7399/fh.11389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To propose an updated definition of Pharmaceutical Care based on the Capacity-Motivation-Opportunity (CMO) model and on the key elements and optimal activities for its development that guarantee the highest levels of quality and excellence in this professional activity. METHOD The consensus was developed by a working group composed of members of the Spanish Society of Hospital Pharmacy and other pharmacists from different healthcare fields. A literature review of PubMed was conducted of the available scientific evidence on pharmaceutical healthcare models and activities with the greatest impact and ease of implementation. A working definition was developed and the initiatives chosen as key elements were collected and included in each pillar of the proposed model. After creating an initial list of activities and terms, the working group reviewed it and made corrections or proposed new activities. In addition, the definitions of the three key elements of the CMO model were agreed upon: Capacity-Motivation- Opportunity. In order to incorporate all appropriate suggestions and contributions before finalizing the consensus, the final draft was sent to the different scientific, pharmaceutical, and medical societies as well as patient associations with which the Spanish Society of Hospital Pharmacy has a collaboration agreement. RESULTS The definition of consensual Pharmaceutical Care was "Any professional activity by which the pharmacist is linked to the patient (and/or caregiver) and other healthcare professionals, to attend to the patient according to their needs, setting out strategies to align and achieve the shortand medium-/long-term objectives of pharmacotherapy and incorporating new technologies and the means available to continuously interact with ment was reached on the definitions of the three key elements of the CMO model. Finally, 27 key elements for the development of pharmaceutical activity were identified and included in the three pillars of the model. CONCLUSIONS A new definition of Pharmaceutical Care has been agreed upon that refocuses this professional activity, allowing us to advance within the multidisciplinary working approach toward a longitudinal and multidimensional approach to the patient.
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Affiliation(s)
- Ramón Morillo-Verdugo
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla. Spain.
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Calleja-Hernández MÁ, Martínez-Sesmero JM, Santiago-Josefat B. Biosimilars of monoclonal antibodies in inflammatory diseases and cancer: current situation, challenges, and opportunities. Farm Hosp 2020; 44:100-108. [PMID: 32452309 DOI: 10.7399/fh.11280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The approval pathway for biosimilars of monoclonal antibodies in the European Union is aimed at ruling out the presence of significant differences with the original biological in quality attributes, efficacy, immunogenicity and safety. It also provides the rationale for extrapolating the evidence obtained with a biosimilar in at least one indication to the rest of the approved indications of its original biological, thus simplifying the development programme of biosimilars. Biosimilars of monoclonal antibodies available in the European Union for the treatment of inflammatory diseases and cancer have fulfilled all the requirements for approval, and many of them have additional evidence available. Moreover, real world data confirms the safety and efficacy of these drugs in the indications they are being used for. In Spain, many scientific societies endorse the regulatory pathway of biosimilars and acknowledge their role in the efficiency of the healthcare system. Even so, some barriers remain that limit their use. The implementation of different measures at the patient, prescriber, institutional, and national levels might increase the penetration of biosimilars, freeing up resources that may be invested in other therapies and, potentially, boost innovation.
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Madrid-Paredes A, Casado-Combreras MÁ, Pérez-Ramírez C, Segura-Pérez AM, Chamorro-Santos C, Vergara-Alcalde E, Sánchez-Pozo A, Calleja-Hernández MÁ, Cañadas-Garre M. Association of ABCB1 and VEGFA gene polymorphisms with breast cancer susceptibility and prognosis. Pathol Res Pract 2020; 216:152860. [DOI: 10.1016/j.prp.2020.152860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
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Villanova-López MM, Núñez-Núñez M, Fernández-Prieto D, González-López C, García-Donaire J, Pérez-Pérez A, Sandoval Fernández Del Castillo S, Murillo-Izquierdo M, Camean-Fernández M, Gutiérrez-Pizarraya A, Navas-Iglesias N, Roca-Ruiz LJ, Calleja-Hernández MÁ, Ballester-Alfaro JJ. Randomized, double-blind, controlled trial, phase III, to evaluate the use of platelet-rich plasma versus hyaluronic acid in hip coxarthrosis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:134-142. [PMID: 31902736 DOI: 10.1016/j.recot.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/16/2019] [Revised: 08/04/2019] [Accepted: 09/14/2019] [Indexed: 01/11/2023] Open
Abstract
AIMS OF THE STUDY To compare efficacy and safety of a home-made platelet-rich plasma (PRP) solution versus hyaluronic acid in patients with hip osteoarthritis not responding to conservative treatment and to correlate cellular composition of PRP to clinical outcomes. MATERIAL AND METHODS This is a phase III clinical trial, double-blinded, controlled and randomised into two treatment groups (PRP and hyaluronic acid). Patients received one hip ultrasound-guided injection. Follow up was 12 months. Pain was assessed using VAS score, HHS and WOMAC were used as functional scores, analgesia, adverse events, cellular components (PRP group) in peripheral blood and in PRP were recorded. Clinical response was assessed using OARSI criteria. RESULTS Seventy-four patients were included. Both groups improved in VAS, WOMAC and HHS score and reduced the amount of analgesia (p<.05). Significant differences were seen at 1 year post-treatment in HHS score (PRP 70.9 [3.7-58], hyaluronic acid 60.2[43-74.2] p<.05). No adverse events were observed in none of the groups. Platelet concentration was different between responders and non-responders (at 1 month, non-responders 449[438-578] x103 platelets/μl versus responders 565 [481-666] x103 platelets/μl, p<.044). There was a correlation between leukocytes concentration and clinical scores (VAS at six months, r=0.748, p<.013, WOMAC at 6 months r=0.748, p <.013). Patients with early stage hip OA showed higher response rate to PRP compared with late stage (11.51 OR, 95%CI 2.34-50.65, p<.03). CONCLUSIONS Platelet-rich plasma injection improved hip function, reduced pain and the use of analgesia. It is important to bear in mind the cellular composition in order to achieve a better clinical response.
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Affiliation(s)
- M M Villanova-López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Hospiten, Estepona, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Núñez-Núñez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España; Servicio de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, España.
| | - D Fernández-Prieto
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C González-López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J García-Donaire
- Servicio de Cirugía Ortopédica y Traumatología, Hospital La Línea de la Concepción, Cádiz, España
| | - A Pérez-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - M Murillo-Izquierdo
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Camean-Fernández
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Gutiérrez-Pizarraya
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen Macarena, Sevilla, España
| | - N Navas-Iglesias
- Departamento de Química Analítica, Universidad de Granada, Granada, España
| | - L J Roca-Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Á Calleja-Hernández
- Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J J Ballester-Alfaro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Puerto Real, Cádiz, España
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Sadyrbaeva-Dolgova S, Aznarte-Padial P, Jimenez-Morales A, Expósito-Ruiz M, Calleja-Hernández MÁ, Hidalgo-Tenorio C. Pharmacist recommendations for carbapenem de-escalation in urinary tract infection within an antimicrobial stewardship program. J Infect Public Health 2019; 13:558-563. [PMID: 31685404 DOI: 10.1016/j.jiph.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 06/21/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Carbapenem antibiotics are considered the treatment of choice for serious extended-spectrum beta-lactamase-producing Gram-negative bacteria infections. Our objectives were to analyze the results of carbapenem de-escalation therapy in complicated urinary tract infections (UTIs) attended in a third-level Spanish hospital and to evaluate the impact of pharmacist recommendation in this practice, the outcomes obtained, and associated factors. METHODS This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third-level hospital between August 1 2013 and July 31, 2014. Data were gathered on carbapenem treatment duration, de-escalation, length of hospital stay, mortality rate, and associated re-admissions. RESULTS De-escalation, which was only ordered for patients with positive cultures, was conducted in 49.7% of the 163 patients with complicated UTI. More than half (69.1%) of pharmacist interventions were accepted. De-escalation reduced the median hospital stay by five days (p=0.030). Crude hospital mortality was lower in the de-escalation group (7.4% vs. 29.3%, p<0.001), although their exposure to carbapenems was lower (4 vs 6 days, p<0.001). Factors associated with de-escalation were ICU stay for at least 48h, pharmacist recommendation and ESBL or AmpC producing Enterobacteriaceae. Factors associated with in-hospital mortality were age, previous admission and duration of hospital stay, but not pharmacist recommendation. Otherwise, carbapenem de-escalation was associated as a protective factor against in-hospital mortality. CONCLUSIONS Carbapenem de-escalation in accordance with pharmacist recommendation proved to be a safe approach in complicated UTI, reducing the hospital stay of patients without affecting the re-admission rate.
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Affiliation(s)
| | - Pilar Aznarte-Padial
- Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Spain
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24
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Morillo-Verdugo R, Calleja-Hernández MÁ, de Las Aguas Robustillo-Cortés M. A New Pharmaceutical Care Concept: More Capable, Motivated, and Timely. Hosp Pharm 2019; 54:348-350. [PMID: 31762480 DOI: 10.1177/0018578719867657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Fernández-López C, Calleja-Hernández MÁ, Balbino JE, Cabeza-Barrera J, Expósito-Hernández J. Trends in endpoint selection and result interpretation in advanced non-small cell lung cancer clinical trials published between 2000 and 2012: A retrospective cohort study. Thorac Cancer 2019; 10:904-908. [PMID: 30868737 PMCID: PMC6449273 DOI: 10.1111/1759-7714.13024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/16/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this review was to investigate trends in clinical trial design, specifically, the primary outcomes used, interpretation of results, and the magnitude of the benefits described in phase III controlled clinical trials in the first‐line treatment of patients with advanced non‐small cell lung cancer (NSCLC). Methods Seventy‐six trials published between 2000 and 2012 were selected from a total of 122 identified in a structured search. Results Overall survival (OS) was evaluated as the primary study endpoint in 50 (65.8%) trials, followed by progression‐free survival (PFS) in 15 (19.7%), and other variables, such as toxicity, quality of life (QoL), and response rate in 11 (14.5%). Ten (66.7%) out of 15 clinical trials using PFS as the primary endpoint were published between 2010 and 2012. Median overall survival (mOS) was 9.90 months (interquartile range: 3.5) with an increase of 0.384 months per year of publication (P < 0.001). A statistically significant improvement in mOS was obtained in only 13 (18.8%) trials. A total of 41 (53.9%) studies concluded that the result was positive. Of these, only 16 (39.1%) showed a statistically significant benefit in OS. QoL was assessed in 46 trials (60.5%) and of these, 10 (21.7%) reported significant improvements. Conclusions These findings raise important questions about how clinical benefits are measured in clinical trials in advanced NSCLC. Appropriate clinically relevant outcome variables should be established and validated, and post‐marketing studies should be requested by regulatory authorities to ensure meaningful clinical benefits in OS and QoL.
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Affiliation(s)
| | | | - Jaime Espín Balbino
- Andalusian School of Public Health (EASP), Granada, Spain.,Health Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain
| | - José Cabeza-Barrera
- Department of Pharmacy, Biosanitary Research Institute of Granada, San Cecilio University Hospital, Granada, Spain
| | - José Expósito-Hernández
- Department of Oncology, University Hospitals of Granada, Health Research Institute of Granada (ibs.GRANADA), Spain
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26
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Pérez-Ramírez C, Cañadas-Garre M, Alnatsha A, Villar E, Valdivia-Bautista J, Faus-Dáder MJ, Calleja-Hernández MÁ. Pharmacogenetics of platinum-based chemotherapy: impact of DNA repair and folate metabolism gene polymorphisms on prognosis of non-small cell lung cancer patients. Pharmacogenomics J 2018; 19:164-177. [PMID: 29662106 DOI: 10.1038/s41397-018-0014-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/03/2017] [Accepted: 11/06/2017] [Indexed: 02/08/2023]
Abstract
Chemotherapy based on platinum compounds is the standard treatment for NSCLC patients with EGFR wild type, and is also used as second line in mutated EGFR patients. Nevertheless, this therapy presents poor clinical outcomes. ERCC1, ERCC2, XRCC1, MDM2, MTHFR, MTR, and SLC19A1 gene polymorphisms may contribute to individual variation in response and survival to platinum-based chemotherapy. The aim of this study was to investigate the influence of these polymorphisms on response and survival of NSCLC patients treated with platinum-based chemotherapy. A retrospective-prospective cohorts study was conducted, including 141 NSCLC patients. Polymorphisms were analyzed by PCR real-time with Taqman® probes. Patients with ERCC1 rs3212986-GG (p = 0.0268; OR = 2.50; CI95% = 1.12-5.69) and XRCC1 rs25487-GG (p = 0.0161; OR = 2.99; CI95% = 1.26-7.62) genotype showed significantly better ORR. Cox survival analysis revealed that patients carrying the MDM2 rs1690924-GG genotype (p = 0.0345; HR = 1.99; CI95% = 1.05-3.80) presented higher risk of death. Furthermore, carriers of MTR rs1805087-A alleles (p = 0.0060; HR = 8.91; CI95% = 1.87-42.42) and SLC19A1 rs1051266-AA genotype (p = 0.0130; HR = 1.74; CI95% = 1.12-2.68) showed greater risk of progression. No influence of ERCC1 rs11615, ERCC2 rs13181, ERCC2 rs1799793, XRCC1 rs1799782, MDM2 rs1470383, MTHFR rs1801131, and MTHFR rs1801133 on platinum-based chemotherapy clinical outcomes was found. In conclusion, our results suggest that ERCC1 rs3212986, XRCC1 rs25487, MDM2 rs1690924, MTR rs1805087, and SLC19A1 rs1051266 gene polymorphisms may significantly act as predictive factors in NSCLC patients treated with platinum-based chemotherapy.
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Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, Granada, Spain.,Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071, Granada, Spain
| | - Marisa Cañadas-Garre
- Centre for Public Health, Nephrology Research Group, Queen's University Belfast, c/o Regional Genetics Centre, Level A Tower Block Belfast City Hospital Lisburn Road, Belfast, BT9 7AB, UK.
| | - Ahmed Alnatsha
- Department of Molecular Medicine, Faculty of Medicine, University of Tübingen, Geissweg 5, 72076, Tübingen, Germany
| | - Eduardo Villar
- Pathology Service, UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014, Granada, Spain
| | - Javier Valdivia-Bautista
- Medical Oncology Service, UGC Oncología Médica Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014, Granada, Spain
| | - María José Faus-Dáder
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, Granada, Spain.,Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071, Granada, Spain
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27
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Pérez-Ramírez C, Cañadas-Garre M, Alnatsha A, Molina MÁ, Robles AI, Villar E, Delgado JR, Faus-Dáder MJ, Calleja-Hernández MÁ. Interleukins as new prognostic genetic biomarkers in non-small cell lung cancer. Surg Oncol 2017; 26:278-285. [PMID: 28807247 DOI: 10.1016/j.suronc.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/01/2017] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgery is the standard treatment for early-stage NSCLC, and platinum-based chemotherapy remains as the treatment of choice for advanced-stage NSCLC patients with naïve EGFR status. However, overall 5-years relative survival rates are low. Interleukins (ILs) are crucial for processes associated with tumor development. In NSCLC, IL1B, IL6, IL12A, IL13 and IL16 gene polymorphisms may contribute to individual variation in terms of patient survival. The purpose of this study was to evaluate the association between IL gene polymorphisms and survival in NSCLC patients. METHODS A prospective cohorts study was performed, including 170 NSCLC patients (114 Stage IIIB-IV, 56 Stage I-IIIA). IL1B (C > T; rs1143634), IL1B (C > T; rs12621220), IL1B (C > G; rs1143623), IL1B (A > G; rs16944), IL1B (C > T; rs1143627), IL6 (C > G; rs1800795), IL12A (C > T; rs662959), IL13 (A > C; rs1881457) and IL16 (G > T; rs7170924) gene polymorphisms were analyzed by PCR Real-Time. RESULTS Patients with IL16 rs7170924-GG genotype were in higher risk of death (p = 0.0139; HR = 1.82; CI95% = 1.13-2.94) Furthermore, carriers of the TT genotype for IL12A rs662959 presented higher risk of progression in the non-resected NSCLC patient subgroup (p = 0.0412; HR = 4.49; CI95% = 1.06-18.99). The rest of polymorphisms showed no effect of on outcomes. CONCLUSIONS Our results suggest that IL16 rs7170924-GG and IL12A rs662959-TT genotypes predict higher risk of death and progression, respectively, in NSCLC patients. No influence of IL1B rs12621220, IL1B rs1143623, IL1B rs16944, IL1B rs1143627, IL6 rs1800795, IL13 rs1881457 on NSCLC clinical outcomes was found in our patients.
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Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, Spain; Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Marisa Cañadas-Garre
- Centre for Public Health, Queen's University of Belfast c/o Regional Genetics Centre, Level A, Tower Block, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, United Kingdom.
| | - Ahmed Alnatsha
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, Spain; Department of Molecular Medicine, Faculty of Medicine, University of Tübingen, Geissweg 5, 72076 Tübingen, Germany.
| | - Miguel Ángel Molina
- Pangaea Biotech, S.L., Hospital Universitario Quirón Dexeus, C/ Sabino Arana, 5-19, 08028 Barcelona, Spain.
| | - Ana I Robles
- National Cancer Institute, 37 Convent Dr, 37/3060D, Bethesda, MD, United States.
| | - Eduardo Villar
- Pathology Service, UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - Juan Ramón Delgado
- Medical Oncology Service, UGC Oncología Médica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - María José Faus-Dáder
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Miguel Ángel Calleja-Hernández
- Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
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Domingues EAM, Ferrit-Martín M, Calleja-Hernández MÁ. Impact of pharmaceutical care on cardiovascular risk among older HIV patients on antiretroviral therapy. Int J Clin Pharm 2016; 39:52-60. [PMID: 27864732 DOI: 10.1007/s11096-016-0387-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/18/2016] [Accepted: 10/12/2016] [Indexed: 01/05/2023]
Abstract
Background Advances in the treatment of HIV infection have enabled better control of the disease, allowing patients to enjoy a longer life expectancy. However, the ageing of patients leads to an increased prevalence of cardiovascular disease. Various studies have found that pharmaceutical care results in better control of cardiovascular risk factors. Objective To measure the impact of pharmaceutical care on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy. Setting Outpatient pharmacy service of a tertiary hospital, Spain. Methods A pre/post-intervention quasi-experimental clinical study was conducted in which health education and pharmacist interventions to reduce cardiovascular risk factors were carried out in a single patient cohort using the Dader method of pharmacotherapy, with a 12-month follow-up period per patient. Patients included were older than 50 years, with moderate/elevated cardiovascular risk. Data were obtained from patient clinical histories, dispensing records and patient interviews, and were subjected to statistical analysis. Main outcome measure Cardiovascular risk estimated by SCORE and REGICOR equations. Results Forty-two patients completed the study. Of these, 93 % were men, with an average age of 57 years and 15 years since diagnosis of HIV. A reduction was observed in the mean values (baseline vs. 12 months) of the following cardiovascular risk factors: systolic blood pressure (P = 0.009), diastolic blood pressure (P = 0.010), total cholesterol (P = 0.006), low-density lipoprotein cholesterol (LDL-c; P = 0.039), triglycerides (P = 0.010) and total cholesterol/high-density lipoprotein cholesterol (HDL-c; P < 0.001). An increase in HDL-c (P = 0.037) was also observed. The average cardiovascular risk estimated by the SCORE instrument was reduced from 7.6 % at the beginning of the study to 6.4 % after 12 months (P = 0.039). The risk estimate according to REGICOR also decreased (P = 0.002). Over the 12-month period, 6.3 ± 3.4 interventions were carried out per patient. Quantitative ineffectiveness was the most prevalent negative outcome associated with medication throughout the study, and noncompliance was the most frequent cause. Interventions on health education were the most common, followed by interventions on improving adherence. Conclusion Pharmaceutical care, delivered as a combination of health education and pharmacotherapy follow-up to outpatients at a tertiary hospital, had a positive impact on cardiovascular risk in patients older than 50 years receiving combination antiretroviral therapy.
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Affiliation(s)
- Elza Aparecida Machado Domingues
- Federal University of Mato Grosso do Sul, Avenida Senador Filinto Muller, s/n, Campo Grande, MS, CEP 79080-190, Brazil. .,Doctoral Programme in Clinical Medicine and Public Health, Granada University, Granada, Spain.
| | - Mónica Ferrit-Martín
- Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacy Clinical Management Department, Virgen de las Nieves University Hospital, Granada University Hospital Complex, Granada, Spain
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29
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Pérez-Moreno MA, Cotrina-Luque J, Galván-Banqueri M, Flores-Moreno S, Bautista-Paloma FJ, Calleja-Hernández MÁ. Effectiveness and safety of pemetrexed for non-small cell lung cancer in the Andalusian Public Health System. Farm Hosp 2016; 40:477-485. [PMID: 27894221 DOI: 10.7399/fh.2016.40.6.10424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate effectiveness and safety profile of pemetrexed in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) when it´s used on real clinical practice in Andalusia (a Spanish region with 8.5 million inhabitants, 2014 census data). METHODS An observational multicentre retrospective study was conducted. Adult patients with locally advanced/metastatic NSCLC who received pemetrexed in any hospital in the Andalusian Public Health System during the last term of 2011 were included. We collected patients´ baseline characteristics, diagnostic and treatment data, effectiveness variables (response to treatment with pemetrexed and overallsurvival) and main adverse reactions detected. RESULTS 172 patients from 17 hospitals were included (77.33% were men), median age 63 years old (between 34 and 83). The predominant histology was adenocarcinoma (84.30%) and 85.20% were diagnosed of lung cancer with IV-stage. 78.49% had been smokers at some point in their lives. Median overall survival from the start of pemetrexed was 9 months (95%CI, 4.1-13.9). Progression of the disease was the most frequent response (33.14%), only one patient had complete response. Stable disease was associated with a higher probability of survival. Main adverse reactions detected were asthenia, haematological reactions, gastrointestinal reactions and dermal o mucous toxicity. No patients discontinued treatment for serious toxicity. CONCLUSIONS Pemetrexed resulted quite effective in NSCLC when it was used on real clinical practice, with higher survival in non-squamous histology and patients with the best score of Eastern Cooperative Oncology Group scale. The toxicity profile was well tolerated. Prospective studies would be needed to confirm the effect of prognostic factors observed.
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Affiliation(s)
| | - Jesús Cotrina-Luque
- Hospital Pharmacist. Pharmacy Department Hospital Universitario Virgen del Rocío, Seville..
| | | | - Sandra Flores-Moreno
- Hospital Pharmacist. Pharmacy Department Hospital Universitario Virgen del Rocío, Seville..
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30
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Pérez-Ramírez C, Cañadas-Garre M, Robles AI, Molina MÁ, Faus-Dáder MJ, Calleja-Hernández MÁ. Liquid biopsy in early stage lung cancer. Transl Lung Cancer Res 2016; 5:517-524. [PMID: 27826533 DOI: 10.21037/tlcr.2016.10.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 01/11/2023]
Abstract
Lung cancer is the leading cause of cancer-associated deaths worldwide. Surgery is the standard treatment for early-stage non-small cell lung cancer (NSCLC). However, 30% to 80% of these patients will die within 5 yearS of diagnosis. Circulating cell-free DNA (cfDNA) harbors pathologic characteristics of the original tumor, such as gene mutations or epigenetic alterations. Analysis of cfDNA has revolutionized the clinical care of advanced lung cancer patients undergoing targeted therapies. However, the low concentration of cfDNA in the blood of early-stage NSCLC patients has hampered its use for management of early disease. Continuing development of more specific and sensitive techniques for detection and analysis of cfDNA will soon enable its leverage in early stage and, perhaps, even screening settings. Therefore, cfDNA analysis may become a tool used for routine NSCLC diagnosis and for monitoring tumor burden, as well as for identifying hidden residual disease. In this review, we will focus on the current evidence of cfDNA in patients with early-stage NSCLC, new and upcoming approaches to identify circulating-tumor biomarkers, their clinical applications and future directions.
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Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain;; Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n 18071 Granada, Spain
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
| | - Ana I Robles
- Laboratory of Human Carcinogenesis, National Cancer Institute, 37 Convent Dr, Bethesda, MD 20892, USA
| | - Miguel Ángel Molina
- Pangaea Biotech, S.L., Hospital Universitario Quirón Dexeus, C/ Sabino Arana, 5-19. 08028 Barcelona, Spain
| | - María José Faus-Dáder
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n 18071 Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain;; Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
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Fernández-López C, Expósito-Hernández J, Arrebola-Moreno JP, Calleja-Hernández MÁ, Expósito-Ruíz M, Guerrero-Tejada R, Linares I, Cabeza-Barrera J. Trends in phase III randomized controlled clinical trials on the treatment of advanced non-small-cell lung cancer. Cancer Med 2016; 5:2190-7. [PMID: 27449070 PMCID: PMC5055155 DOI: 10.1002/cam4.782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 12/02/2022] Open
Abstract
The objective of this review was to analyze trends in outcomes and in the quality of phase III randomized controlled trials on advanced NSCLC published between 2000 and 2012, selecting 76 trials from a total of 122 retrieved in a structured search. Over the study period, the number of randomized patients per trial increased by 14 per year (P = 0.178). The sample size significantly increased between 2000 and 2012 in trials of targeted agents (460.1 vs. 740.8 patients, P = 0.009), trials of >1 drug (360.4 vs. 584.8, P = 0.014), and those including patients with good performance status (675.3 vs. 425.6; P = 0.003). Quality of life was assessed in 46 trials (60.5%), and significant improvements were reported in 10 of these (21.7%). Platinum-based regimens were the most frequently investigated (86.8% of trials). Molecular-targeted agents were studied in 25.0% of chemotherapy arms, and the percentage of trials including these agents increased each year. The median (interquartile range) overall survival (MOS) was 9.90 (3.5) months with an increase of 0.384 months per year of publication (P < 0.001). A statistically significant improvement in MOS was obtained in only 13 (18.8%) trials. The median progression-free survival was 4.9 (1.9) months, with a nonsignificant increase of 0.026 months per year (P > 0.05). There has been a continuous but modest improvement in the survival of patients with advanced NSCLC over the past 12 years. Nevertheless, the quality of clinical trials and the benefit in outcomes should be carefully considered before the incorporation of novel approaches into clinical practice.
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Affiliation(s)
- Cristina Fernández-López
- Department of Pharmacy, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain.
| | | | | | - Miguel Ángel Calleja-Hernández
- Department of Pharmacy, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain
| | - Manuela Expósito-Ruíz
- Unit Research Support, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain
| | - Rosa Guerrero-Tejada
- Department of Oncology, Virgen de las Nieves Universitary Hospital, Granada, Spain
| | - Isabel Linares
- Department of Oncology, Virgen de las Nieves Universitary Hospital, Granada, Spain
| | - José Cabeza-Barrera
- Department of Pharmacy, Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada/University of Granada, Granada, Spain
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Cañadas-Garre M, Becerra-Massare P, Moreno Casares A, Calleja-Hernández MÁ, Llamas-Elvira JM. Relevance of BRAF and NRAS mutations in the primary tumor and metastases of papillary thyroid carcinomas. Head Neck 2016; 38:1772-1779. [PMID: 27299298 DOI: 10.1002/hed.24517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multifocality of papillary thyroid carcinoma (PTC) is common. BRAF and NRAS mutations are the most frequent genetic alterations in PTC. The purpose of this study was to determine the distribution and relevance of BRAFT1799A and NRAS mutations in PTC. METHODS BRAFT1799A and NRAS mutations were evaluated in 195 intrathyroid or metastatic foci from 29 patients with multifocal PTC. RESULTS BRAFT1799A mutation was positive in 46.7% of the 59 intrathyroid and 136 metastatic foci (91/195 foci). Heterogeneous BRAF pattern was observed in 51.7% patients (15/29 patients). Irrespective of BRAF status at diagnosis (thyroid or nodes), all patients with recurrent PTC presented BRAF-mutated metastases during follow-up. All foci were negative for NRAS mutations. CONCLUSION BRAF but not NRAS mutations were heterogeneously distributed among primary tumor, nodal sites, and recurrent disease. The BRAF status of metastases generated during the follow-up can differ from the status of foci at diagnosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1772-1779, 2016.
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Affiliation(s)
- Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Patricia Becerra-Massare
- UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Antonia Moreno Casares
- Department of Clinical Analysis and Immunology, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - José Manuel Llamas-Elvira
- Nuclear Medicine Department, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
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Madrid-Paredes A, Cañadas-Garre M, Sánchez-Pozo A, Segura-Pérez AM, Chamorro-Santos C, Vergara-Alcaide E, Castillo-Portellano L, Calleja-Hernández MÁ. ABCB1 C3435T gene polymorphism as a potential biomarker of clinical outcomes in HER2-positive breast cancer patients. Pharmacol Res 2016; 108:111-118. [DOI: 10.1016/j.phrs.2016.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/19/2022]
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Pérez-Ramírez C, Cañadas-Garre M, Molina MÁ, Faus-Dáder MJ, Calleja-Hernández MÁ. PTEN and PI3K/AKT in non-small-cell lung cancer. Pharmacogenomics 2015; 16:1843-62. [DOI: 10.2217/pgs.15.122] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) is the leading cause of cancer deaths worldwide. In the last years, the identification of activating EGFR mutations, conferring increased sensitivity and disease response to tyrosine kinase inhibitors, has changed the prospect of NSCLC patients. The PTEN/PI3K/AKT pathway regulates multiple cellular functions, including cell growth, differentiation, proliferation, survival, motility, invasion and intracellular trafficking. Alterations in this pathway, mainly PTEN inactivation, have been associated with resistance to EGFR-tyrosine kinase inhibitor therapy and lower survival in NSCLC patients. In this review, we will briefly discuss the main PTEN/PI3K/AKT pathway alterations found in NSCLC, as well as the cell processes regulated by PTEN/PI3K/AKT leading to tumorigenesis.
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Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit. UGC Provincial de Farmacia de Granada. Instituto de Investigación Biosanitaria de Granada. Complejo Hospitalario Universitario de Granada. Avda. Fuerzas Armadas, 2. 18014 Granada, Spain
- Department of Biochemistry. Faculty of Pharmacy. University of Granada Campus Universitario de Cartuja, s/n. 18071 Granada, Spain
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit. UGC Provincial de Farmacia de Granada. Instituto de Investigación Biosanitaria de Granada. Complejo Hospitalario Universitario de Granada. Avda. Fuerzas Armadas, 2. 18014 Granada, Spain
| | - Miguel Ángel Molina
- PANGAEA BIOTECH, S.L. Hospital Universitario Quirón Dexeus. C/Sabino Arana, 5-19. 08028 Barcelona
| | - María José Faus-Dáder
- Department of Biochemistry. Faculty of Pharmacy. University of Granada Campus Universitario de Cartuja, s/n. 18071 Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit. UGC Provincial de Farmacia de Granada. Instituto de Investigación Biosanitaria de Granada. Complejo Hospitalario Universitario de Granada. Avda. Fuerzas Armadas, 2. 18014 Granada, Spain
- Department of Pharmacology. Faculty of Pharmacy. University of Granada. Campus Universitario de Cartuja, s/n. 18071 Granada, Spain
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Pérez-Ramírez C, Cañadas-Garre M, Molina MÁ, Faus-Dáder MJ, Calleja-Hernández MÁ. MET/HGF targeted drugs as potential therapeutic strategies in non-small cell lung cancer. Pharmacol Res 2015; 102:90-106. [PMID: 26413995 DOI: 10.1016/j.phrs.2015.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas 2, Granada, Spain; Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas 2, Granada, Spain.
| | - Miguel Ángel Molina
- Pangaea Biotech, S.L., Hospital Universitario Quirón Dexeus, C/Sabino Arana, 5-19, 08028 Barcelona, Spain.
| | - María José Faus-Dáder
- Department of Biochemistry, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas 2, Granada, Spain; Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain.
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Ríos-Tamayo R, Sánchez MJ, Puerta JM, Sáinz J, Chang DYL, Rodríguez T, López P, de Pablos JM, Navarro P, de Veas JLG, Romero A, Garrido P, Moratalla L, Alarcón-Payer C, López-Fernández E, González PA, Jiménez-Moleón JJ, Calleja-Hernández MÁ, Jurado M. Trends in survival of multiple myeloma: a thirty-year population-based study in a single institution. Cancer Epidemiol 2015; 39:693-9. [PMID: 26277330 DOI: 10.1016/j.canep.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/04/2015] [Revised: 08/02/2015] [Accepted: 08/06/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the progress made in recent years, multiple myeloma is still considered an incurable disease. Most survival data come from clinical trials. Little is known about the outcome in unselected real-life patients. METHODS Overall survival was analyzed in a cohort of newly diagnosed symptomatic multiple myeloma patients, over the last three decades, in a single institution population-based study. RESULTS 582 consecutive myeloma patients were included in the study. Survival increased over time in patients younger than 65 years but did not reach statistical significance in patients with 65 years or older. The prognostic factors associated with overall survival were the International Staging System, the serum lactate dehydrogenase level, the renal impairment, the realization of autologous stem cell transplantation, and the presence of concomitant amyloidosis. Overall survival shows a steady improvement over time. INTERPRETATION The survival of myeloma is improving progressively in real-life patients, particularly after the widespread use of the novel agents. A comprehensive assessment of comorbidity can help to explain the huge heterogeneity of myeloma outcome. The optimization of current therapeutic resources as well as the incorporation of new drugs will allow further improvement of survival in the coming years.
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Affiliation(s)
- Rafael Ríos-Tamayo
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
| | - María José Sánchez
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain; CIBER Epidemiology and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - José Manuel Puerta
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Juan Sáinz
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Daysi-Yoe-Ling Chang
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Teresa Rodríguez
- Department of Inmunology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar López
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - José María de Pablos
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar Navarro
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Antonio Romero
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar Garrido
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Lucía Moratalla
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | - José Juan Jiménez-Moleón
- CIBER Epidemiology and Public Health, Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Pharmacy Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - Manuel Jurado
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
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Madrid-Paredes A, Cañadas-Garre M, Sánchez-Pozo A, Calleja-Hernández MÁ. De novo resistance biomarkers to anti-HER2 therapies in HER2-positive breast cancer. Pharmacogenomics 2015; 16:1411-26. [PMID: 26257318 DOI: 10.2217/pgs.15.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/21/2022] Open
Abstract
Therapies targeting HER2 receptor, overexpressed in 20% breast cancer (BC), improved prognosis, however ~62% patients experiment progression during the first year. Molecular mechanisms proposed to be responsible for this de novo resistance include HER2 modifications, defects in the antibody dependent cellular cytotoxicity or in cell arrest and apoptosis or alterations in HER2 signaling components. This article will review the influence of genetic markers investigated to date as cause of de novo resistance to HER2-targeted drugs in HER2-positive BC patients. Biomarkers like p95HER2, CCND1 and CDC25A have demonstrated clinical relevance and prognostic value in HER2-positive BC patients. However, the prognostic value of most biomarkers investigated to date, such as PIK3CA or AKT1, cannot be fully established yet.
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Affiliation(s)
- Adela Madrid-Paredes
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.,Department of Biochemistry & Molecular Biology II, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
| | - Antonio Sánchez-Pozo
- Department of Biochemistry & Molecular Biology II, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n, 18071 Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.,Department of Pharmacology, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, s/n; 18071 Granada, Spain
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Abstract
Colorectal cancer is a tumor with increasing incidence which represents one of the first leading causes of death worldwide. Gene alterations described for colorectal cancer include genome instability (microsatellite and chromosomal instability), CpG islands methylator phenotype, microRNA, histone modification, protein biomarkers, gene mutations (RAS, BRAF, PI3K, TP53, PTEN) and polymorphisms (APC, CTNNB1, DCC). In this article, biomarkers with prognostic value commonly found in colorectal cancer will be reviewed.
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Affiliation(s)
- Elena Puerta-García
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain
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Jiménez-Varo E, Cañadas-Garre M, Garcés-Robles V, Gutiérrez-Pimentel MJ, Calleja-Hernández MÁ. Extrapolation of acenocoumarol pharmacogenetic algorithms. Vascul Pharmacol 2015; 74:151-157. [PMID: 26122664 DOI: 10.1016/j.vph.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/05/2015] [Revised: 06/01/2015] [Accepted: 06/23/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Acenocoumarol (ACN) has a narrow therapeutic range that is especially difficult to control at the start of its administration. Various dosing pharmacogenetic-guided dosing algorithms have been developed, but further work on their external validation is required. The aim of this study was to evaluate the extrapolation of pharmacogenetic algorithms for ACN as an alternative to the development of a specific algorithm for a given population. MATERIAL AND METHODS The predictive performance, deviation, accuracy, and clinical significance of five pharmacogenetic algorithms (EU-PACT, Borobia, Rathore, Markatos, Krishna Kumar) were compared in 189 stable ACN patients representing all indications for anticoagulant treatment. RESULTS The correlation between the dose predictions of the five pharmacogenetic models ranged from 7.7 to 70.6% and the percentage of patients with a correct prediction (deviation ≤20% from actual ACN dose) ranged from 5.9 to 40.7%. EU-PACT and Borobia pharmacogenetic dosing algorithms were the most accurate in our setting and evidenced the best clinical performance. CONCLUSIONS Among the five models studied, the EU-PACT and Borobia pharmacogenetic dosing algorithms demonstrated the best potential for extrapolation.
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Affiliation(s)
- Enrique Jiménez-Varo
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - Víctor Garcés-Robles
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - María José Gutiérrez-Pimentel
- Haematology Department, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain.
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Pérez-Moreno MA, Cotrina-Luque J, Galván-Banqueri M, Flores-Moreno S, Bautista-Paloma FJ, Calleja-Hernández MÁ. Use of pemetrexed for non-small cell lung cancer in the Andalusian public health system. J Chemother 2015; 27:371-7. [PMID: 25971603 DOI: 10.1179/1973947815y.0000000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/31/2022]
Abstract
The aim of this study is to determine the profile of the use of pemetrexed in metastatic or locally advanced NSCLC in Andalusia and its variation over 2 years (2010-2011). A prescription-indication observational retrospective multicenter study was conducted. Adult patients with locally advanced/metastatic NSCLC who received pemetrexed in any hospital in the Andalusian Public Health System during the first term of 2010 or the last term of 2011 were included. We collected patients' baseline characteristics, tumour histology and stage, pemetrexed indication and performance status at the start of treatment. In all, 107 and 170 patients (62 ± 11 years old) from 17 hospitals were included in 2010 and 2011, respectively. The predominant histology was adenocarcinoma (85%), 88% of patients had stage IV tumours and 52% Eastern Cooperative Oncology Group stage (ECOG) 1. Pemetrexed indications in 2010 and 2011 were: First line combined with platinum (28.97-37.64%); first line combined with platinum and maintenance with pemetrexed (24.30-28.82%); second line mono-therapy (12.15-7.65%) and maintenance (2.15-7.05%). Off-label use was detected in 22.43% (2010) and 18.84% (2011). In conclusion, pemetrexed combined with platinum is mainly used as first-line treatment in NSCLC patients with stage IV, adenocarcinoma histologic subtype and good performance status. Off-label use is high (especially in 2010). An adequate therapeutic positioning for pemetrexed based on effectiveness and safety analysis should be defined, so that NSCLC patients could be beneficiated with the most cost-effective chemotherapy treatment.
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Pérez-Ramírez C, Cañadas-Garre M, Jiménez-Varo E, Faus-Dáder MJ, Calleja-Hernández MÁ. MET: a new promising biomarker in non-small-cell lung carcinoma. Pharmacogenomics 2015; 16:631-47. [PMID: 25893986 DOI: 10.2217/pgs.15.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/25/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) leads cancer-related deaths worldwide. Mutations in the kinase domain of the EGFR gene provide sensitivity to tyrosine kinase inhibitors (TKI) drugs. TKI show initial response rates over 75% in mutant EGFR-NSCLC patients, although most of these patients acquire resistance to EGFR inhibitors after therapy. EGFR-TKI resistance mechanisms include amplification in MET and its ligand, and also MET mutations. MET signaling dysregulation has been involved in tumor cell growth, survival, migration and invasion, angiogenesis and activation of several pathways, therefore representing an attractive target for anticancer drug development. In this review, we will discuss MET-related mechanisms of EGFR-TKI resistance in NSCLC, as well as the main drugs targeted to inhibit MET pathway.
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Affiliation(s)
- Cristina Pérez-Ramírez
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Avda Fuerzas Armadas, 2, 18014 Granada, Spain
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Valencia Soto CM, López-Sepúlveda R, Alarcón-Payer C, Pérez-Morales J, Carrasco-Gomariz M, Calleja-Hernández MÁ. CP-044 Effectiveness and safety of imatinib in chronic myeloid leukaemia in a tertiary hospital. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.42] [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: 11/04/2022] Open
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Pérez-Morales J, Cañadas-Garre M, Valencia-Soto CM, Orantes-Casado-de-Amezua F, Calleja-Hernández MÁ. PKP-009 Genetic polymorphisms of efectiveness to interferon-B treatment in multiple sclerosis. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.325] [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: 11/04/2022] Open
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Lozano-Blázquez A, Calvo-Pita C, Carbajales-Álvarez M, Suárez-Gil P, Martínez-Martínez F, Calleja-Hernández MÁ. Drug assessment by a Pharmacy and Therapeutics committee: from drug selection criteria to use in clinical practice. Ther Clin Risk Manag 2014; 10:527-35. [PMID: 25031538 PMCID: PMC4096492 DOI: 10.2147/tcrm.s62572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/23/2022] Open
Abstract
Background In Spain, hospital medicines are assessed and selected by local Pharmacy and Therapeutics committees (PTCs). Of all the drugs assessed, cancer drugs are particularly important because of their budgetary impact and the sometimes arguable added value with respect to existing alternatives. This study analyzed the PTC drug selection process and the main objective was to evaluate the degree of compliance of prescriptions for oncology drugs with their criteria for use. Methods This was a retrospective observational study (May 2007 to April 2010) of PTC-assessed drugs. The variables measured to describe the committee’s activity were number of drugs assessed per year and number of drugs included in any of these settings: without restrictions, with criteria for use, and not included in formulary. These drugs were also analyzed by therapeutic group. To assess the degree of compliance of prescriptions, a score was calculated to determine whether prescriptions for bevacizumab, cetuximab, trastuzumab, and bortezomib were issued in accordance with PTC drug use criteria. Results The PTC received requests for inclusion of 40 drugs, of which 32 were included in the hospital formulary (80.0%). Criteria for use were established for 28 (87.5%) of the drugs included. In total, 293 patients were treated with the four cancer drugs in eight different therapeutic indications. The average prescription compliance scores were as follows: bevacizumab, 83% for metastatic colorectal cancer, 100% for metastatic breast cancer, and 82.3% for non-small-cell lung cancer; cetuximab, 62.0% for colorectal cancer and 50% for head and neck cancer; trastuzumab, 95.1% for early breast cancer and 82.4% for metastatic breast cancer; and bortezomib, 63.7% for multiple myeloma. Conclusion The degree of compliance with criteria for use of cancer drugs was reasonably high. PTC functions need to be changed so that they can carry out more innovative tasks, such as monitoring conditions for drug use.
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Affiliation(s)
| | - Cecilia Calvo-Pita
- Pharmacy Department, Primary Health Care, Servicio Madrileño de Salud, Dirección Asistencial Oeste, Madrid, Spain
| | | | | | | | - Miguel Ángel Calleja-Hernández
- UGC Provincial de Farmacia de Granada Instituto de Biomedicina de Granada, Hospital Virgen de las Nieves, Granada, Spain
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Jiménez-Varo E, Cañadas-Garre M, Henriques CI, Pinheiro AM, Gutiérrez-Pimentel MJ, Calleja-Hernández MÁ. Pharmacogenetics role in the safety of acenocoumarol therapy. Thromb Haemost 2014; 112:522-36. [PMID: 24919870 DOI: 10.1160/th13-11-0941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/18/2013] [Accepted: 04/23/2014] [Indexed: 11/05/2022]
Abstract
Vitamin K antagonists (VKAs) remain as the most prescribed drug for treatment and prevention of thrombotic disorders in many countries, despite the recent approval of the new oral anticoagulants (NOACs). Although effectiveness and safety of VKAs are tightly associated to maintaining the patient within the international normalised ratio (INR) therapeutic range (TWR), they have been likened to NOACs when patients are in good INR control (≥66% of TWR). Therefore, assessing the safety of patients should be a priority in the selection of the anticoagulation therapy. The aim of this study was to evaluate the association between CYP2C9*2, CYP2C9*3, VKORC1, CYP4F2*3, ABCB1 C3435T, APOE, CYP2C19*2 and CYP2C19*17 gene polymorphisms and treatment safety in 128 patients diagnosed with atrial fibrillation or venous thromboembolism during the initial first seven months of acenocoumarol therapy. After the first month, VKORC1-T-allele and APOE-E3/E3 genotype were independently associated to higher time above therapeutic range (TAR) and lower time below the therapeutic range (TBR). After seven months, VKORC1 T-allele predicted higher TAR, and was also associated to increased INR>4, particularly the TT-genotype (odds ratio [OR]: 32; 95% confidence interval [CI95%]: 6-175; p=810⁻⁵). C-alleles for CYP2C9*3 (OR: 5.5; CI95%: 1.8-17; p=0.003) and ABCB1 (OR: 8.9;CI95%: 1.1-70; p=0.039) independently influenced on INR>6 . Patients VKORC1-TT/ABCB1-C remained 26.8% [19.7-38.9] TAR, with associated relative risk (RR) for INR>4 1.8 higher (CI95%: 1.2-2.5; p=0.015). Patients VKORC1-TT also presented the highest risk of bleeding events (RR: 3.5;CI95%: 1.4-8.4; p=0,010). In conclusion, VKORC1, CYP2C9*3, APOE and ABCB1 genotypes should be considered in prevention of overanticoagulation and bleeding events in the initiation of acenocoumarol therapy.
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Affiliation(s)
| | - M Cañadas-Garre
- Marisa Cañadas-Garre, PhD, Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario de Granada, Avda. Fuerzas Armadas, 2, 18014 Granada, Spain, Tel.: +34 958020108, Fax: +34 958020004, E-mail:
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Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ, Martínez-Martínez F, Iglesias-Peinado I, Carrillo-Álvarez Á, Sanjurjo Sáez M, Fernández-Llamazares CM. Impact of implementing smart infusion pumps in a pediatric intensive care unit. Am J Health Syst Pharm 2014; 70:1897-906. [PMID: 24128965 DOI: 10.2146/ajhp120767] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of smart infusion pumps on the interception of errors in the programming of i.v. drug administrations on a pediatric intensive care unit (PICU) is investigated. METHODS A prospective observational intervention study was conducted in the PICU of a hospital in Madrid, Spain, to estimate the patient safety benefits resulting from the implementation of smart pump technology (Alaris System, CareFusion, San Diego, CA). A systematic analysis of data stored by the devices during the designated study period (January 2010-June 2011) was conducted using the system software (Guardrails CQI Event Reporter, CareFusion). The severity of intercepted errors was independently classified by a group of four clinical pharmacists and a group of four intensive care pediatricians; analyses of intragroup and intergroup agreement in perceptions of severity were performed. RESULTS During the 17-month study period, the overall rate of user compliance with the safety software was 78%. The use of smart pump technology resulted in the interception of 92 programming errors, 84% of which involved analgesics, antiinfectives, inotropes, and sedatives. About 97% of the errors resulted from user programming of doses or infusion rates above the hard limits defined in the smart pump drug library. The potential consequences of the intercepted errors were considered to be of moderate, serious, or catastrophic severity in 49% of cases. CONCLUSION The use of smart pumps in a PICU improved patient safety by enabling the interception of infusion programming errors that posed the potential for severe injury to pediatric patients.
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Affiliation(s)
- Silvia Manrique-Rodríguez
- Silvia Manrique-Rodríguez, Pharm.D., Ph.D., is Clinical Hospital Pharmacist; Amelia C. Sánchez-Galindo, M.D., is Intensive Care Pediatrician; and Jesús López-Herce, M.D., Ph.D., is Intensive Care Pediatrician, Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Miguel Ángel Calleja-Hernández, Pharm.D., Ph.D., is Director, Pharmacy Service, Hospital Universitario Virgen de las Nieves, Granada, Spain. Fernando Martínez-Martínez, Pharm.D., Ph.D., is University Professor, Faculty of Pharmacy, Campus de Cartuja, Granada. Irene Iglesias-Peinado, Pharm.D., Ph.D., is University Professor, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid. Ángel Carrillo-Álvarez, M.D., Ph.D., is Director, Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón. María Sanjurjo Sáez, Pharm.D., is Director; and Cecilia M. Fernández-Llamazares, Pharm.D., Ph.D., is Clinical Hospital Pharmacist, Pharmacy Service, Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón
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47
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Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J, Calleja-Hernández MÁ, Martínez-Martínez F, Iglesias-Peinado I, Carrillo-Álvarez A, Sanjurjo-Sáez M, Fernández-Llamazares CM. Implementing smart pump technology in a pediatric intensive care unit: a cost-effective approach. Int J Med Inform 2013; 83:99-105. [PMID: 24296271 DOI: 10.1016/j.ijmedinf.2013.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 02/20/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze the cost effectiveness of implementing smart infusion pump technology in a pediatric intensive care unit (PICU). MATERIAL AND METHODS An observational, prospective, intervention study with analytical components was carried out. A drug library was developed and integrated into the Carefusion Alaris Guardrails® infusion systems. A systematic analysis of all the data stored on the devices during use was performed by the data processing program Guardrails® CQI v4.1 Event Reporter. Intercepted errors were classified in terms of their potential severity and probability of causing an adverse effect (PAE) had they reached the patient. Knowing the estimated cost of a preventable adverse effect (AE), we analyzed costs saved and the profit/cost ratio resulting from the implementation process. RESULTS Compliance with the drug library was 92% and during the study period 92 infusion-related programming errors were intercepted, leading to a saving of 172,279 euros by preventing AEs. This means that 2.15 euros would be obtained for each euro invested in hiring a pharmacist to implement this technology. DISCUSSION The high percentage of use of safety software in our study compared to others allowed for the interception of 92 errors. The estimation of the potential impact of these errors is based on clinical judgment. The cost saved might be underestimated because the cost of an AE is usually higher in pediatrics, indirect and intangible costs were not considered and pharmacists involved do not spend the whole day on this task. CONCLUSIONS Smart pumps have shown to be profitable in a PICU because they have the ability to intercept potentially serious medication errors and reduce costs associated with such errors.
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Affiliation(s)
- Silvia Manrique-Rodríguez
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Amelia C Sánchez-Galindo
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, C/ Maiquez, 9, 28007 Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, C/ Maiquez, 9, 28007 Madrid, Spain
| | | | | | - Irene Iglesias-Peinado
- Faculty of Pharmacy, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, Ciudad Universitaria, 28040 Madrid, Spain
| | - Angel Carrillo-Álvarez
- Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, C/ Maiquez, 9, 28007 Madrid, Spain
| | - María Sanjurjo-Sáez
- Pharmacy Service, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
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Sánchez-Quiles I, Nájera-Pérez MD, Calleja-Hernández MÁ, Martinez-Martínez F, Belchí-Hernández J, Canteras M. [Improvement of the knowledge on allergic cross-reactions between two drug groups: beta-lactams and NSAIDS]. Farm Hosp 2013; 37:499-509. [PMID: 24256013 DOI: 10.7399/fh.2013.37.6.1005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To identify opportunities for improving the available knowledge of health care professionals (particularly, physicians, pharmacists, and nurses) on crossed allergic reactions (CAR) to penicillins and NSAIDs. METHOD Quasi-experimental prospective pre-exposure study at a 412-beds hospital. An assessment of the knowledge on CAR to penicillins and NSAIDs was performed by means of anonymous questionnaires before (1st questionnaire) and after (2d questionnaire) the implementation of a series of improvement measures: protocol of "patient allergic to drugs", pocket card, poster with summarized information, and informative talks. The questionnaires served as the CRF and the statistical analysis was done with the SPSS v18.0 software. RESULTS The mean number of errors in the first questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 20.53 and 27.62, respectively. The mean number of errors in the second questionnaire on CARs of penicillin allergic patient and on CARs of NSAIDs allergic patients was 2.27 and 7.26, respectively. All the results were significant for a p level < 0.005. CONCLUSIONS - There is insufficient knowledge on CARs to penicillins and NSAIDS, which justifies improvement measures. - After the implementation of improvement measures, there is an increased knowledge on CARs to penicillins and NSAIDs in the study groups.
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