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Cantarelli L, Gutiérrez Nicolás F, García Gil S, Morales Barrios JA, Oramas Rodriguez J, Nazco Casariego GJ. Effect of Concomitant Use of Proton Pump Inhibitors on Immunotherapy Clinical Response in Advanced Cancer Patients: Real-Life Setting. J Immunother 2023:00002371-990000000-00074. [PMID: 37937583 DOI: 10.1097/cji.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/27/2023] [Indexed: 11/09/2023]
Abstract
The alteration of the gut microbiota mediated by proton pump inhibitor (PPI) drugs could be involved in the clinical response associated with immunotherapy [immunocheckpoint inhibitors (ICIs)] in cancer patients. Due to the current controversy in the scientific evidence, it has been proposed to evaluate the correlation between the concomitant use of PPIs and the effectiveness of immunotherapy in a real clinical practice setting. Single-center retrospective cohort study that included patients treated with anti-PD-1 or anti-CTLA4, including nivolumab, pembrolizumab, atezolizumab, or the combination ipilimumab-nivolumab in metastatic neoplastic disease. The clinical effectiveness of ICI, measured in progression-free survival (PFS) and overall survival (OS), was compared between the PPI-use versus PPI-no-use group. PPI-use group was associated with lower PFS [hazard ratio (HR):1.89 (1.38-2.59), P<0.001] and OS [HR: 2.02 (1.45-2.82), P<0.001] versus PPI-no-use group. However, this difference was not observed for pembrolizumab PFS [HR: 1.38 (0.93-2.39), P=0.160] and OS [HR: 1.41 (0.81-2.44), P=0.187]. The study showed significantly lower PFS and OS in the chronic PPI-use group (P<0.001), recent PPI-use group (P<0.001) and concomitant PPI-use group (P=0.001, 0.007) versus PPI-no-use group. However, late PPI use >30 days after the onset of ICI has no significant effect on the efficacy of treatment [HR: 0.92 (0.49-1.70), P=0.791; HR: 1.10 (0.59-2.05), P=0.756]. The concomitant use of PPIs in immunotherapy is associated with worse clinical outcomes compared with the group without PPI use. In addition, the study shows how the late use of PPIs does not have a significant effect on clinical benefit.
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Affiliation(s)
- Lorenzo Cantarelli
- Servicio de Farmacia, Hospital Nuestra Señora de Guadalupe, La Gomera, Spain
| | | | - Sara García Gil
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | | | - Juana Oramas Rodriguez
- Servicio de Oncología médica, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Letter: Albumin-Does formulation matter? Authors' reply. Aliment Pharmacol Ther 2023; 57:1484-1485. [PMID: 37243460 DOI: 10.1111/apt.17546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Cantarelli L, Pestana Grafiña D, Gonzalez Perez A, García Gil S, Gutiérrez Nicolás F, Ramos Santana E, Navarro Dávila MA, Otazo Pérez SM, Calzado Gómez G, Perez Reyes S, Nazco Casariego GJ. Efficacy and Safety of Erenumab, Galcanezumab, and Fremanezumab in the Treatment of Drug-Resistant Chronic Migraine: Experience in Real Clinical Practice. Ann Pharmacother 2023; 57:416-424. [PMID: 35979920 DOI: 10.1177/10600280221118402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Due to the recent introduction of new biologic drugs for chronic migraine, a global evaluation in real clinical practice is necessary. OBJECTIVE The objective was to evaluate the effectiveness and safety in real clinical practice of drugs targeting the calcitonin gene-related peptide receptor (CGRPr) in patients with chronic migraine. METHODS Single-center, restrospective study (2019-2022), including patients with chronic migraine treated with erenumab, galcanezumab, or fremanezumab. Effectiveness variables were recorded, namely, number of migraine headache days per month (MHD), Migraine Disability Assessment Scale (MIDAS) score, and Headache Impact Test-6 (HIT-6) score, assessing changes at week 12, 24 from baseline. Toxicity was recorded following the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. RESULTS In all, 104 patients were included (46.2% erenumab, 41.3% galcanezumab, 12.5% fremanezumab). A reduction in MHD, MIDAS, and HIT-6 was achieved at weeks 12 and 24 with erenumab (p75% at week 24 than those intensified; P = 0.041). There was no difference in efficacy (P = 0.154) or improvement in quality of life (P = 0.783, P = 0.150), but there was greater toxicity (P < 0.001) among nonresponders with erenumab 70 mg versus erenumab 140 mg. CONCLUSIONS The results confirm the effectiveness and safety of anticalcitonin gene-related peptide (CGRP) drugs in real clinical practice. However, the study shows little benefit from erenumab intensification, with similar effectiveness and worse tolerability than the standard dose.
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Affiliation(s)
- Lorenzo Cantarelli
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Diana Pestana Grafiña
- Servicio de Neurología, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Amanda Gonzalez Perez
- Servicio de Neurología, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Sara García Gil
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | | | - Emma Ramos Santana
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | | | | | - Gloria Calzado Gómez
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Sergio Perez Reyes
- Servicio de Farmacia, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
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Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis. Aliment Pharmacol Ther 2023; 57:620-634. [PMID: 36524316 DOI: 10.1111/apt.17344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. MATERIALS AND METHODS We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed. RESULTS Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL. CONCLUSION Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
| | - Juan Uriz
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - Federico Bolado
- Department of Gastroenterology and Hepatology, University Hospital of Navarre, Pamplona, Spain
| | - José Antonio García-Erce
- Navarra's Blood and Tissue Bank, Navarre Health Service, Pamplona, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Aragon Health Science Institute, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Lorenzo Cantarelli
- Department of Hospital Pharmacy, University Hospital of Canary Islands (CHUC), Santa Cruz de Tenerife, Spain
| | - Juan Erviti
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Navarre, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain
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Cantarelli L, Carrillo Palau M, Hernandez Guerra M, Nazco Casariego GJ, Gutierrez Nicolás F. Definition of a therapeutic range for predicting long-term infliximab response in patients with inflammatory bowel disease. Med Clin (Barc) 2023; 160:107-112. [PMID: 35931568 DOI: 10.1016/j.medcli.2022.05.008] [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: 01/11/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Monitoring plasma levels of Infliximab plays an important role in optimising treatment in patients with inflammatory bowel disease (IBD). The aim of the following study has been to determine the predictive potential of monitoring infliximab plasma levels for sustained clinical response and evaluate its usefulness to improve treatment efficacy and symptom control, in patients with IBD. METHODS This single-centre retrospective study (2017-2019) included patients diagnosed with IBD treated with infliximab. Serum levels and the occurrence of drug-associated immunogenicity were analysed at Week 8 post-induction and 6, 12 and 24 months. Clinical parameters and inflammatory markers were recorded such as subjective global assessment (SGA), C-reactive protein (CRP) and faecal calprotectin (FC). Factors associated with early discontinuation and dose intensification of infliximab were determined. RESULTS Multivariate analysis determined that IFX concentrations>7μg/mL at week 8, and at 6 months, are associated with inflammatory remission (p=0.046, 0.045). IFX>7μg/mL at 12 months predicted remission at 18 months of treatment (p=0.006). IFX values>3μg/mL at 12 months are associated with stable SGA at 18 months (p=0.001). Such values at 18 months are associated with stable SGA at 24 months (p=0.044). CONCLUSIONS AND RELEVANCE The predictive potential of monitoring IFX plasma levels as a strategy to evaluate sustained long-term clinical response was confirmed. Our results highlight the importance of its introduction into routine clinical practice to enable early identification of non-responders, treatment optimisation, relapse prevention and improve long-term therapy maintenance.
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Affiliation(s)
- Lorenzo Cantarelli
- Servicio de Farmacia. Complejo Hospitalario Universitario de Canarias, Tenerife, Spain.
| | - Marta Carrillo Palau
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Manuel Hernandez Guerra
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
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Cantarelli L, Gutiérrez Nicolás F, Nazco Casariego GJ, García Gil S. Adequacy to diagnostic recommendations in patients with Pneumocystis jirovecii pneumonia treated with intravenous pentamidine. Rev Esp Quimioter 2022; 35:30-34. [PMID: 34854660 PMCID: PMC8790643 DOI: 10.37201/req/064.2021] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objetivos Determinar la tasa de confirmación microbiológica en el diagnóstico de la neumonía por Pneumocystis jirovecii en pacientes tratados con pentamidina intravenosa y la potencial correlación con la efectividad y seguridad del tratamiento. Material y métodos Estudio retrospectivo unicéntrico (2010-2020), que incluyó aquellos pacientes que recibieron tratamiento con pentamidina intravenosa durante al menos 48 horas. Se registró el procedimiento de recogida de la muestra y el análisis microbiológico realizado. Se determinó la eficacia según la tasa de mortalidad a los 14 días e ingreso en Unidad de Vigilancia Intensiva (UVI), y el control de la enfermedad, mediante la duración de estancia hospitalaria y tiempo desde la finalización del tratamiento hasta el alta. El perfil de seguridad se evaluó según la Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Resultados Un total de 17 pacientes con neumonía por P. jirovecii fueron tratados con pentamidina (76,5% hombres (n=13); edad media [desviación estándar]: 58,6 [15,5]). En el 47,1% (n=8) de los casos se estableció una confirmación microbiológica del patógeno. El empleo dirigido con pentamidina redujo de forma significativa el tiempo desde la finalización del tratamiento hasta el alta hospitalaria (p=0,019). El perfil de seguridad fue aceptable, apareciendo toxicidad grado I en un paciente. Conclusiones El estudio muestra como más del 50% de los pacientes reciben tratamiento a partir de un diagnóstico presuntivo y sin ajustarse a las recomendaciones establecidas, repercutiendo en la duración de ingreso y recuperación del pa-ciente. Serán necesarios futuros estudios con un mayor tamaño muestral para consolidar los resultados obtenidos.
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Affiliation(s)
- L Cantarelli
- Lorenzo Cantarelli, Servicio de Farmacia. Complejo Hospitalario Universitario de Canarias, Tenerife (España). Carretera Ofra s/n, La Laguna (Tenerife); Spain.
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Bonaiuti D, Gatti R, Raschi A, Cantarelli L, Sirtori V. Manual autotraction: preliminary study on the effectiveness of a new device for back pain treatment. Eura Medicophys 2004; 40:75-81. [PMID: 16046930] [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: 05/03/2023]
Abstract
AIM The aim of this study is to assess the efficacy of a new, simple and cheap device of manual autotraction (MAT), in comparison with Natchev's autotraction system. METHODS Fifty-four patients, with lumbalgia or sciatalgia for more than 4 months and disc herniation or protrusion at computed tomography (CT) or nuclear magnetic resonance (NRM), have been selected, at random, in a randomized control trial. Patients have been treated by MAT or by Natchev's autotraction. Treatments' efficacy has been assessed through the differences in visual analogic scale (VAS) for pain, and Backill scale for disability, before and after therapy (diffVAS and diffBi). The results of the 2 autotraction's devices have been compared in order to distinguish their differences. The results have been considered significant if p<0.05. RESULTS Both treatments proved to be effective (MAT: diffVAS p<0.0001, diffBackill p<0.001; Natchev's group: diffVAS p<0.0001, diffBackill p<0.001). No significant difference of efficacy emerges between the treatments in diffVAS (p=0.199) and diffBi (p=0.906), and a greater efficacy of both in case of pain with nocturnal aggravation (MAT group: diffVAS: p=0.001; Natchev's group: p=0.001). CONCLUSIONS The results of this study show an equal efficacy of MAT compared to the known Natchev's system, so it could be equally proposed like a simple conservative treatment in disc protrusion or herniation without surgery indication.
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Affiliation(s)
- D Bonaiuti
- Physical Medicine and Rehabilitation Department, San Gerardo Hospital, Milan, Italy.
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Cantarelli L, Passega-Sidler E, Taddei L, Balestra B. [A case of pseudophlebitis of the great saphenous vein: focal nodular myositis of the gracilis muscle]. Schweiz Med Wochenschr 2000; 130:1692-4. [PMID: 11103443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A case of focal myositis in a healthy 68-year-old woman is described. The patient was admitted for evaluation of a painful soft-tissue mass localised on the medial side of the left thigh, initially misdiagnosed as thrombophlebitis of the v. saphena magna. Laboratory data were normal, in particular sedimentation rate and muscle enzyme levels. After exclusion of venous thrombosis, the mass localised in the left m. gracilis was surgically removed. Histologic examination of the biopsy specimen showed muscle cell necrosis and severe inflammation, with lymphocytic infiltration leading to the diagnosis of focal myositis. This is a rare benign inflammatory pseudotumour of skeletal muscle. The aetiology and pathogenesis of the disease remain unclear. It is most commonly seen in the lower extremities and may mimic thrombophlebitis or soft-tissue neoplasm. Ultrasound and magnetic-resonance scans are helpful, but definitive diagnosis is obtained only by histology. Because recurrent lesions in other skeletal muscles are possible, and a third of patients develop polymyositis, a follow-up of several years is recommended.
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Affiliation(s)
- L Cantarelli
- Service de médecine interne, Ospedale Regionale della Beata Vergine, Mendrisio
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