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Albanell-Fernández M, Salazar González F, Montero Pérez O, Aniyar V, Carrera Hueso FJ, Soriano A, García-Vidal C, Puerta-Alcalde P, Martínez JA, Vázquez Ferreiro P. Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis. Int J Infect Dis 2024; 143:107020. [PMID: 38548167 DOI: 10.1016/j.ijid.2024.107020] [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: 02/08/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30-day survival and compare it with continuing the treatment with echinocandins (non-DES). METHODS We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random-effects model. Heterogeneity was explored stratifying by subgroups and via meta-regression. This systematic review is registered with PROSPERO (CRD42023475486). RESULTS Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies stepped-down to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30-day survival 2.17 (95% CI: 1.09-4.32). The 30-day survival data into subgroups showed higher effect on critically ill patients and serious-risk bias studies. Meta-regression did not identify significant effect modifiers. CONCLUSIONS DES is a safe strategy; it showed no higher 30-day mortality and a trend towards greater clinical and microbiological cure.
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Affiliation(s)
- Marta Albanell-Fernández
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
| | | | - Olalla Montero Pérez
- Pharmacy Department, Institut Català d'Oncología, L'Hospitalet de Llobregat, Spain
| | - Victoria Aniyar
- Department of Pharmacology, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Albanell-Fernández M, Monge-Escartín I, Cid J. [Caplacizumab in acquired thrombotic thrombocytopenic purpura: Dose adjustment based on von Willebrand factor level]. Med Clin (Barc) 2023; 161:267-268. [PMID: 37385936 DOI: 10.1016/j.medcli.2023.04.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Marta Albanell-Fernández
- Servicio de Farmacia, Àrea del Medicament, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, España.
| | - Inés Monge-Escartín
- Servicio de Farmacia, Àrea del Medicament, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Joan Cid
- Aféresis y Unidad de Terapia Celular, Departamento de Hemoterapia y Hemostasia, ICMHO, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, España
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Albanell-Fernández M, Pérez Sánchez Á, Monge-Escartín I, Riu-Viladoms G, Rodríguez Mues MC, Corominas Bosch ML, Gaba García L, Rollán NB, Reguart N, Soy Muner D, Carcelero San Martín E. Assessment of the change of antiemetic prophylaxis from double to triple combination in patients with high dose carboplatin chemotherapy. J Oncol Pharm Pract 2023:10781552231194077. [PMID: 37563932 DOI: 10.1177/10781552231194077] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) is one of the adverse events that most affects oncologic patients' quality of life. Carboplatin AUC ≥ 4 belongs to agents with high emetic risk (moderate risk in ASCO guidelines). We aimed to compare the effectiveness of netupitant/palonosetron and dexamethasone triple combination (TC) therapy versus ondansetron and dexamethasone double combination (DC) therapy as antiemetic prophylaxis in patients with carboplatin AUC ≥ 4. As a secondary endpoint, in TC group we evaluated the effectiveness of changing NEPA administration timing from 1 h to 15 min before chemotherapy. METHODS Open-label prospective study conducted in a tertiary-care hospital in patients receiving carboplatin AUC ≥ 4. CINV was evaluated using MASCC antiemetic tool, in acute (<24 h) and delayed phase (24-120 h). Results were analyzed using χ2 test. RESULTS Two-hundred four completed questionnaires (CQ) were analyzed (76 in DC and 128 in TC). The proportion of patients who remained emesis-free was superior for TC-treated group compared to DC, either in acute (99.2% vs 92.1%, p = 0.0115) and delayed phase (97.6% vs 90.7%, p = 0.043). Likewise, a higher proportion of TC-treated patients compared to DC remained nausea-free for the first 24 h after treatment (90.6% vs 71%, p = 0.0004) and between 24 and 120 h (82.3% vs 62.7%, p = 0.0025). The change of NEPA administration time showed similar effectiveness in terms of CINV control (81.6% vs 74.5%, p = 0.70). CONCLUSIONS TC showed superiority in early and delayed CINV control in carboplatin AUC ≥ 4 regimens, with no significant differences among cancer types. Change in NEPA administration timing has beneficial implications; it allows NEPA to be administered at hospitals before chemotherapy session.
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Affiliation(s)
| | | | - Inés Monge-Escartín
- Pharmacy Department, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gisela Riu-Viladoms
- Pharmacy Department, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | | | - Lydia Gaba García
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Neus Basté Rollán
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Noemí Reguart
- Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Dolors Soy Muner
- Pharmacy Department, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, University of Barcelona, Barcelona, Spain
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Albanell-Fernández M, Monge-Escartín I, Carcelero-San Martín E, Riu Viladoms G, Ruiz-Boy S, Lozano M, Soy D, Moreno-Castaño AB, Diaz-Ricart M, Cid J. Real-world data of the use and experience of caplacizumab for the treatment of acquired thrombotic thrombocytopenic purpura: Case series. Transfus Apher Sci 2023:103722. [PMID: 37169697 DOI: 10.1016/j.transci.2023.103722] [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: 05/13/2023]
Abstract
PURPOSE Caplacizumab was licensed for acquired thrombotic thrombocytopenic purpura (aTTP) based on prospective controlled trials. Real-world evidence is crucial in rare diseases. We aim to describe a patient population with aTTP, receiving caplacizumab in a real-world setting, reporting their outcomes, including safety and tolerability, and contrasting them with a historical cohort from our center. METHODS We describe data collected retrospectively from 2012 to 2022 for 16 patients with aTTP (8 received caplacizumab and 8 the historical standard-of-care). Patients' characteristics and outcomes were compared between groups. RESULTS Patients' demographic and baseline characteristics were similar in both groups. Caplacizumab led to a rapid normalization of the platelet count of 3.5 (IQR, 2-6) versus 16 (IQR, 9.5-23.5) days in the historical cohort: (p = .002). The median number of plasma exchanges and the length of days requiring them, between the caplacizumab group versus the historical cohort, was 6 (IQR, 6-10) versus 19.5 (IQR, 12.5-29.5) plasma exchanges (p = .006); and 9 (IQR, 8.5-13.5) versus 22 (15-31) days (p = .049), respectively. There were no refractory cases in the caplacizumab group in comparison with 37.5 % in the historical cohort. None of patients treated with caplacizumab experienced a recurrence after 1081 (IQR, 511-3125) days of follow-up. Safety was in line with data reported in clinical trials, with mild adverse events (mostly grade≤2). CONCLUSION We provided real-world evidence in the treatment of aTTP, confirming the results obtained in clinical trials. Caplacizumab reduced the time to platelet count recovery and the number and length of plasma exchanges.
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Affiliation(s)
- Marta Albanell-Fernández
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Inés Monge-Escartín
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Esther Carcelero-San Martín
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Gisela Riu Viladoms
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Sonia Ruiz-Boy
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Dolors Soy
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Pharmacology, Toxicology and Therapeutic Chemistry. School of Pharmacy. University of Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hemostasis and Erythropathology Laboratory, Pathology Department. Biomedical Diagnosis Center (CDB), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Maribel Diaz-Ricart
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Hemostasis and Erythropathology Laboratory, Pathology Department. Biomedical Diagnosis Center (CDB), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
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Albanell-Fernández M, Bastida C, Marcos Fendian Á, Mercadal J, Castro-Rebollo P, Soy-Muner D. Predictive performance of glomerular filtration rate equations based on cystatin C, creatinine and their combination in critically ill patients. Eur J Hosp Pharm 2023:ejhpharm-2023-003738. [PMID: 37137686 DOI: 10.1136/ejhpharm-2023-003738] [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: 02/24/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE 24-hour urine creatinine clearance (ClCr 24 hours) remains the gold standard for estimating glomerular filtration rate (GFR) in critically ill patients; however, simpler methods are commonly used in clinical practice. Serum creatinine (SCr) is the most frequently used biomarker to estimate GFR; and cystatin C, another biomarker, has been shown to reflect GFR changes earlier than SCr. We assess the performance of equations based on SCr, cystatin C and their combination (SCr-Cyst C) for estimating GFR in critically ill patients. METHODS Observational unicentric study in a tertiary care hospital. Patients with cystatin C, SCr and ClCr 24 hours measurements in ±2 days admitted to an intensive care unit were included. ClCr 24 hours was considered the reference method. GFR was estimated using SCr-based equations: Chronic Kidney Disease Epidemiology Collaboration based on creatinine (CKD-EPI-Cr) and Cockcroft-Gault (CG); cystatin C-based equations: CKD-EPI-CystC and CAPA; and Cr-CystC-based equations: CKD-EPI-Cr-CystC. Performance of each equation was assessed by calculating bias and precision, and Bland-Altman plots were built. Further analysis was performed with stratified data into CrCl 24 hours <60, 60-130 and ≥130 mL/min/1.73 m2. RESULTS We included 275 measurements, corresponding to 186 patients. In the overall population, the CKD-EPI-Cr equation showed the lowest bias (2.6) and best precision (33.1). In patients with CrCl 24 hours <60 mL/min/1.73 m2, cystatin-C-based equations showed the lowest bias (<3.0) and CKD-EPI-Cr-CystC was the most accurate (13.6). In the subgroup of 60≤ CrCl 24 hours <130mL/min/1.73 m2, CKD-EPI-Cr-CystC was the most precise (20.9). However, in patients with CrCl 24 hours ≥130mL/min/1.73 m2, cystatin C-based equations underestimated GFR, while CG overestimated it (22.7). CONCLUSIONS Our study showed no evidence of superiority of any equation over the others for all evaluated parameters: bias, precision and Lin's concordance correlation coefficient. Cystatin C-based equations were less biased in individuals with impaired renal function (GFR <60 mL/min/1.73 m2). CKD-EPI-Cr-CystC performed properly in patients with GFR from 60-130 mL/min/1.73 m2 and none of them were accurate enough in patients ≥130 mL/min/1.73 m2.
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Affiliation(s)
- Marta Albanell-Fernández
- Pharmacy Service, Division of Medicines, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Carla Bastida
- Pharmacy Service, Division of Medicines, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Ángel Marcos Fendian
- Pharmacy Service, Division of Medicines, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Jordi Mercadal
- Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Pedro Castro-Rebollo
- Medical Intensive Care Unit, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Dolors Soy-Muner
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
- Pharmacy Service, Division of Medicines, Hospital Clinic de Barcelona, Barcelona, Spain
- Department of Pharmacology, Toxicology and Therapeutic Chemistry. School of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Catalunya, Spain
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Fendian ÁM, Albanell-Fernández M, Tuset M, Pitart C, Castro P, Soy D, Bodro M, Soriano A, Del Río A, Martínez JA. Real-Life Data on the Effectiveness and Safety of Cefiderocol in Severely Infected Patients: A Case Series. Infect Dis Ther 2023; 12:1205-1216. [PMID: 36943617 PMCID: PMC10029777 DOI: 10.1007/s40121-023-00776-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Real-life data about cefiderocol use to treat extensively drug-resistant bacteria are scarce. We aim to report our early experience in patients with difficult-to-treat infections and limited therapeutic options. METHODS Patients treated with cefiderocol from March 2018 to April 2022 in a tertiary-care hospital in Spain were included. Demographic, clinical, and microbiological data were collected up to 90 days after the end of treatment or until death. Survival status was recorded at 30 and 90 days. RESULTS Ten patients were included, seven of them critically ill. Ventilator-associated pneumonia (40%) and bacteremia (40%) were the main infections. Multidrug-resistant or extensively drug-resistant P. aeruginosa was the most frequently isolated pathogen (70%, of which six patients were infected with bacteria with difficult-to-treat resistance), followed by A. baumannii, E. coli, and A. xylosoxidans (10% each). Seven patients received combination therapy. Clinical and microbiological cures were achieved in 90% and 80% of patients, respectively. Two previously susceptible strains (20%) developed resistance to cefiderocol. Overall, 30-day and 90-day mortality rates were 10% and 50%, respectively, although two out of five patients died due to the infection. No serious adverse events were reported, except for one patient who developed thrombocytopenia. CONCLUSION Cefiderocol seems to be an effective and safe rescue therapy for patients infected with difficult-to-treat pathogens, although there is a definite risk of the emergence of resistance.
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Affiliation(s)
- Ángel Marcos Fendian
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain.
| | | | - Montse Tuset
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Dolors Soy
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana Del Río
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Albanell-Fernández M, Luque-Luna M, López-Cabezas C, Alamon-Reig F, Espinosa-Villaseñor N, Barboza-Guadagnini L, Mascaró JM. Treatment of Porokeratosis Ptychotropica With a Topical Combination of Cholesterol and Simvastatin. JAMA Dermatol 2023; 159:458-460. [PMID: 36811903 DOI: 10.1001/jamadermatol.2022.6591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This case report describes 2 patients with Ptychotropic porokeratosis who were treated with a combination of cholesterol and simvastatin.
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Affiliation(s)
| | - Mar Luque-Luna
- Department of Dermatology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen López-Cabezas
- Division of Medicines, Department of Pharmacy, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | | | - José M Mascaró
- Department of Dermatology, Hospital Clínic Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
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Albanell-Fernández M, Oltra SS, Orts-Arroyo M, Ibarrola-Villava M, Carrasco F, Jiménez-Martí E, Cervantes A, Castro I, Martínez-Lillo J, Ribas G. RUNAT-BI: A Ruthenium(III) Complex as a Selective Anti-Tumor Drug Candidate against Highly Aggressive Cancer Cell Lines. Cancers (Basel) 2022; 15:cancers15010069. [PMID: 36612065 PMCID: PMC9817854 DOI: 10.3390/cancers15010069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Ruthenium compounds have demonstrated promising activity in different cancer types, overcoming several limitations of platinum-based drugs, yet their global structure-activity is still under debate. We analyzed the activity of Runat-BI, a racemic Ru(III) compound, and of one of its isomers in eight tumor cell lines of breast, colon and gastric cancer as well as in a non-tumoral control. Runat-BI was prepared with 2,2'-biimidazole and dissolved in polyethylene glycol. We performed assays of time- and dose-dependent viability, migration, proliferation, and expression of pro- and antiapoptotic genes. Moreover, we studied the growth rate and cell doubling time to correlate it with the apoptotic effect of Runat-BI. As a racemic mixture, Runat-BI caused a significant reduction in the viability and migration of three cancer cell lines from colon, gastric and breast cancer, all of which displayed fast proliferation rates. This compound also demonstrated selectivity between tumor and non-tumor lines and increased proapoptotic gene expression. However, the isolated isomer did not show any effect. Racemic Runat-BI is a potential drug candidate for treatment of highly aggressive tumors. Further studies should be addressed at evaluating the role of the other isomer, for a more precise understanding of its antitumoral potential and mechanism of action.
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Affiliation(s)
- Marta Albanell-Fernández
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
| | - Sara S. Oltra
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
| | - Marta Orts-Arroyo
- Instituto de Ciencia Molecular (ICMol)/Departament de Química Inorgànica, University of Valencia, 46980 Valencia, Spain
| | - Maider Ibarrola-Villava
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
| | - Fany Carrasco
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
| | - Elena Jiménez-Martí
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Departament de Bioquímica i Biología Molecular, Facultat de Medicina, University of Valencia, 46010 Valencia, Spain
| | - Andrés Cervantes
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
| | - Isabel Castro
- Instituto de Ciencia Molecular (ICMol)/Departament de Química Inorgànica, University of Valencia, 46980 Valencia, Spain
| | - José Martínez-Lillo
- Instituto de Ciencia Molecular (ICMol)/Departament de Química Inorgànica, University of Valencia, 46980 Valencia, Spain
- Correspondence: (J.M.-L.); (G.R.); Tel.: +34-9635-44460 (J.M.-L.)
| | - Gloria Ribas
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, 46010 Valencia, Spain
- Center for Biomedical Network Research on Cancer (CIBERONC), 28029 Madrid, Spain
- Correspondence: (J.M.-L.); (G.R.); Tel.: +34-9635-44460 (J.M.-L.)
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González-García R, Albanell-Fernández M, Aranda L, Gelis S, Bartra J, Soy Muner D, López-Cabezas C. Evaluation of desensitization protocols to betalactam antibiotics. J Clin Pharm Ther 2021; 47:592-599. [PMID: 34820864 DOI: 10.1111/jcpt.13578] [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] [Received: 06/25/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Betalactam antibiotics are the most frequent cause of hypersensitivity reactions. Rapid drug desensitization (RDD) is a technique that induces temporary tolerance to a drug allowing a patient to receive the optimal agent. The increased use of RDD and the lack of standardization among available protocols in terms of formulation, starting dose, number of steps and dosing frequency make it essential to determine the safety and appropriate management of these protocols, especially regarding reconstitution, diluents, stability and drug administration in order to guarantee reproducibility. We reviewed betalactam desensitization protocols in a tertiary hospital, in accordance with currently published practices and evaluated its use on patients over a period of three years. METHODS (a) We performed a literature search in PubMed, MEDLINE and Google Scholar databases for case reports and/or systematic reviews describing desensitization protocols for betalactam antibiotics. Pharmacokinetic parameters and physicochemical stability were checked for each antibiotic. (b) We retrospectively reviewed inpatients undergoing our antibiotic desensitization protocols from February 2018 to January 2021. Data and outcomes of desensitization procedures were analysed. RESULTS We developed nine RDD protocols: meropenem, ceftriaxone, ceftazidime, ampicillin, ceftolozane/tazobactam, cloxacillin, piperacillin/tazobactam, amoxicillin/clavulanate and penicillin G sodium. Five antibiotics have RDD protocols for two different doses, adjusted to patients with impaired renal function. Detailed data (diluent, total dose, volume, concentrations, duration and stability) of the protocol of each antibiotic used are provided. 28 desensitizations were performed in 17 patients, three of them with confirmed allergies by skin test. 26 out of 28 (92.9%) of them were successfully completed, including those three with positive skin results. The pathogens most frequently involved were E. faecalis and P. aeruginosa; both frequently associated with bacterial resistance. Meropenem, ceftriaxone and ceftazidime were the antibiotics most desensitized. 25 out of 26 (96.1%) procedures were successful in resolving the infection. WHAT IS NEW AND CONCLUSIONS Detailed information about compounding, dilution and stability is crucial to ensure safe and successful desensitization processes, as well as good coordination between the Allergy and Pharmacy departments. The increase in bacterial resistance to many of the commercially available antibiotics limits the therapeutic options for treating multidrug-resistant infections; in those situations, antibiotic desensitization may be a key therapeutic option. Although there is a broad consensus in limiting the use of RDD to patients with confirmed allergy, in usual clinical practice its application in those strongly suspected of having type I hypersensitivity is still observed. Our betalactam desensitization protocols have shown themselves to be safe and effective, as evidenced by data from the 17 patients on whom they have been tested.
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Affiliation(s)
- Rubén González-García
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marta Albanell-Fernández
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Aranda
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sonia Gelis
- Allergology Section, Pneumology Service, ICR. ARADYAL, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan Bartra
- Allergology Section, Pneumology Service, ICR. ARADYAL, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Dolors Soy Muner
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carmen López-Cabezas
- Pharmacy Service, Division of Medicines, Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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