1
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Bhat S, Click B, Regueiro M. Safety and Monitoring of Inflammatory Bowel Disease Advanced Therapies. Inflamm Bowel Dis 2024; 30:829-843. [PMID: 37450619 DOI: 10.1093/ibd/izad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Indexed: 07/18/2023]
Abstract
The recent approval of new medications with novel mechanisms of action and emergence of updated safety information for existing therapies has changed the treatment landscape of inflammatory bowel disease (IBD). These advances led to unique adverse effect profiles and identification of new safety signals, resulting in the evolution of the safety, monitoring, and positioning of IBD therapies. In this updated review, we (1) examine the existing and updated safety data of monoclonal antibodies and small molecules for IBD, with a focus on recently Food and Drug Administration (FDA)-approved therapies, and (2) propose risk stratification and assessment considerations prior to and during IBD treatment.
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Affiliation(s)
- Shubha Bhat
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Benjamin Click
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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2
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Syed H, Nadeem A, Gardinier D, Weekley K, Ribakow D, Lupe S, Bhat S, Holubar S, Cohen BL. Peri-Operative Optimization of Patients with Crohn's Disease. Curr Gastroenterol Rep 2024; 26:125-136. [PMID: 38421577 PMCID: PMC11081987 DOI: 10.1007/s11894-024-00925-9] [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] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW The management of patients with Crohn's disease (CD) undergoing surgery is complex and optimization of modifiable factors perioperatively can improve outcomes. This review focuses on the perioperative management of CD patients undergoing surgery, emphasizing the need for a multi-disciplinary approach. RECENT FINDINGS Research highlights the benefits of a comprehensive strategy, involving nutritional optimization, psychological assessment, and addressing septic complications before surgery. Despite many CD patients being on immune-suppressing medications, studies indicate that most of these medications are safe to use and should not delay surgery. However, a personalized approach for each case is needed. This review underscores the importance of multi-disciplinary team led peri-operative management of CD patients. We suggest that this can be done at a dedicated perioperative clinic for prehabilitation, with the potential to enhance outcomes for CD patients undergoing surgery.
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Affiliation(s)
- Hareem Syed
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ahmed Nadeem
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - David Gardinier
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Kendra Weekley
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Dovid Ribakow
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Stephen Lupe
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Shubha Bhat
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Stefan Holubar
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Benjamin L Cohen
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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3
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Angyal A, Bhat S. Biosimilars in IBD: What Every Clinician Needs to Know. Curr Gastroenterol Rep 2024; 26:77-85. [PMID: 38243154 DOI: 10.1007/s11894-023-00913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE OF REVIEW Biosimilars were introduced to decrease biologic-related expenditures, but their uptake in inflammatory bowel disease (IBD) remains suboptimal. Herein, we review biosimilar concepts, current products available for IBD treatment, and resources to support biosimilar utilization. RECENT FINDINGS Although a cornerstone of IBD treatment, biologics are costly due to their development. Biosimilars, which are biologic products highly similar to a reference product, aim to decrease these expenditures. Infliximab, adalimumab, and ustekinumab biosimilars are approved for IBD, but uptake remains low due to biosimilar efficacy and safety concerns and delayed market entry. Clinicians can effectively address some of these barriers and help patients and healthcare systems reap the benefits of decreased costs and increased treatment access. Data shows comparable efficacy and safety outcomes with biosimilars in IBD. Several biosimilar products are available and in the pipeline, but efforts are needed from various stakeholders to bolster utilization and generate benefits.
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Affiliation(s)
- Anthony Angyal
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shubha Bhat
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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4
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Karime C, Crosby S, Bhat S, Hashash JG, Farraye FA. Rapid Adoption of Pneumococcal 20-Valent Conjugate Vaccination in Adult Patients With Inflammatory Bowel Disease: An Analysis One Year After Availability. J Clin Gastroenterol 2024; 58:207-209. [PMID: 38047595 DOI: 10.1097/mcg.0000000000001954] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023]
Affiliation(s)
| | | | - Shubha Bhat
- Departments of Pharmacy and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Jana G Hashash
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, FL
| | - Francis A Farraye
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, FL
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5
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Choi D, Becker M, Ivanov M, Bhat S. Etrasimod: A Sphingosine-1-Phosphate Receptor Modulator for the Treatment of Ulcerative Colitis. Ann Pharmacother 2024:10600280231225770. [PMID: 38258760 DOI: 10.1177/10600280231225770] [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: 01/24/2024] Open
Abstract
OBJECTIVE To review the pharmacologic and clinical profile of etrasimod in the treatment of ulcerative colitis (UC). DATA SOURCES A PubMed search was conducted from inception to November 2023 using the keywords etrasimod, ulcerative colitis, and sphingosine-1-phosphate receptor modulator. Information was also obtained from published abstracts and package insert. STUDY SELECTION AND DATA EXTRACTION Phase 2 and 3 studies plus relevant literature on etrasimod pharmacologic and clinical profile were reviewed. DATA SYNTHESIS Per ELEVATE, 2 phase 3 studies, a higher proportion of patients with moderately to severely active UC achieved clinical remission in the induction and maintenance phase with etrasimod compared with placebo. In addition, a higher proportion of patients achieved secondary endpoints of clinical response, endoscopic improvement-histologic remission, corticosteroid-free remission, and endoscopic improvement with etrasimod vs placebo. Common adverse events include anemia and headache. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS Etrasimod is now the second orally administered sphingosine-1-phosphate modulator approved for UC, providing patients with additional treatment options. Efficacy rates of this treatment are in line with other UC medication options. Similar to other sphingosine-1-phosphate receptor modulators, various assessments are required at baseline and during treatment to ensure safe and appropriate use. CONCLUSION Etrasimod is another possibility in the armamentarium of UC treatment, providing patients with more oral medication options. Prior to treatment initiation, several assessments relating to safety, drug interactions, and pharmacogenomics factors are advised.
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Affiliation(s)
- David Choi
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Michelle Becker
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Marina Ivanov
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Shubha Bhat
- Department of Pharmacy and Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Bhat S, Xu W, Varghese C, Dubey N, Wells CI, Harmston C, O'Grady G, Bissett IP, Lin AY. Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis. Tech Coloproctol 2023; 27:827-845. [PMID: 37460830 PMCID: PMC10485107 DOI: 10.1007/s10151-023-02845-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Currently, the anal fistula treatment which optimises healing and preserves bowel continence remains unclear. The aim of our study was to compare the relative efficacy of different surgical treatments for AF through a network meta-analysis. METHODS Systematic searches of MEDLINE, EMBASE and CENTRAL databases up to October 2022 identified randomised controlled trials (RCTs) comparing surgical treatments for anal fistulae. Fistulae were classified as simple (inter-sphincteric or low trans-sphincteric fistulae crossing less than 30% of the external anal sphincter (EAS)) and complex (high trans-sphincteric fistulae involving more than 30% of the EAS). Treatments evaluated in only one trial were excluded from the primary analyses to minimise bias. The primary outcomes were rates of success in achieving AF healing and bowel incontinence. RESULTS Fifty-two RCTs were included. Of the 14 treatments considered, there were no significant differences regarding short-term (6 months or less postoperatively) and long-term (more than 6 months postoperatively) success rates between any of the treatments in patients with both simple and complex anal fistula. Ligation of the inter-sphincteric fistula tract (LIFT) ranked best for minimising bowel incontinence in simple (99.1% of comparisons; 3 trials, n = 70 patients) and complex anal fistula (86.2% of comparisons; 3 trials, n = 102 patients). CONCLUSIONS There is insufficient evidence in existing RCTs to recommend one treatment over another regarding their short and long-term efficacy in successfully facilitating healing of both simple and complex anal fistulae. However, LIFT appears to be associated with the least impairment of bowel continence, irrespective of AF classification.
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Affiliation(s)
- S Bhat
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Te Whatu Ora MidCentral, Palmerston North, New Zealand
| | - W Xu
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Te Whatu Ora Te Toka Tumai, Whangārei, New Zealand
| | - C Varghese
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - N Dubey
- Department of General Medicine, Tauranga Hospital, Te Whatu Ora, Tauranga, New Zealand
| | - C I Wells
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - C Harmston
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Te Whatu Ora Te Toka Tumai, Whangārei, New Zealand
| | - G O'Grady
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - I P Bissett
- Surgical and Translational Research Centre, Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - A Y Lin
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.
- Department of Surgery, Wellington Regional Hospital, Te Whatu Ora, Wellington, New Zealand.
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Cisek S, Choi D, Stubbings J, Bhat S. Preparing for the market entry of adalimumab biosimilars in the US in 2023: A primer for specialty pharmacists. Am J Health Syst Pharm 2023; 80:1223-1233. [PMID: 37257054 DOI: 10.1093/ajhp/zxad120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/29/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE The impact of the market entry of adalimumab biosimilars on clinical practices and specialty pharmacies is explained. A roadmap is also provided for how pharmacists can successfully navigate this landscape. SUMMARY Biosimilars have previously been introduced as a mechanism to help curb biologic expenditures, with biosimilars undergoing an abbreviated regulatory approval process that focuses on biosimilarity and generating product competition. Adalimumab is currently the leading product in the biologics market, generating approximately $20 to $30 billion in sales worldwide consecutively from 2019 to 2021. Many adalimumab biosimilars are slated to enter the market in 2023 and become available for patient use. However, compared to other biosimilars, adalimumab biosimilars have several unique considerations, such as interchangeability and concentration, that will impact pharmacy practices and workflows. Because pharmacists embedded in clinical practices and specialty pharmacies will be significantly involved in the processes relating to adalimumab biosimilar implementation, adoption, and use, a primer on understanding the various adalimumab biosimilar products available and considerations surrounding these products with regard to workflow and patient use is critical. Several resources are also provided to help pharmacists successfully navigate the adalimumab biosimilar landscape. CONCLUSION The biosimilar landscape continues to evolve, and 2023 will see the launch of several adalimumab biosimilar products, which vary with regard to formulation, concentration, and interchangeability status. Pharmacists are well positioned to educate providers and patients about this landscape and help implement an efficient workflow to support adalimumab biosimilar adoption and use.
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Affiliation(s)
- Stefanie Cisek
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - David Choi
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - JoAnn Stubbings
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Shubha Bhat
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
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8
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Bhat S, Lyu R, Agarwal M, Becker M, Bloomfeld R, Bruining DH, Cohen BL, Ivanov M, Leighton JA, Stewart AP, Trocke L, Tse SS, Ungaro RC, Vaughn BP, Regueiro M, Sokn E, Rieder F. Defining the Roles of Inflammatory Bowel Disease Clinical Pharmacists in the United States: A Systematic Review and National RAND/UCLA Consensus. Inflamm Bowel Dis 2023:izad143. [PMID: 37650888 DOI: 10.1093/ibd/izad143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Given the complexity of inflammatory bowel disease (IBD) care, utilization of multidisciplinary teams is recommended to optimize outcomes. There is a growing recognition that clinical pharmacists should be an integral part of this care model. We sought to define the roles of IBD clinical pharmacists in the United States. METHODS A national multidisciplinary expert panel of 12 gastroenterologists and clinical pharmacists practicing in IBD clinics was assembled. We used the RAND/University of California, Los Angeles appropriateness method, with a total of 281 statements generated based on a systematic literature review and expert opinion. Each statement was anonymously rated as appropriate, uncertain, or inappropriate in 2 rounds of voting. RESULTS The number of publications evaluating the clinical pharmacists' roles in IBD is limited, primarily focusing on thiopurine initiation and monitoring, medication adherence, and switching to biosimilars. Medication education; medication initiation and monitoring; therapeutic drug monitoring; biosimilar management; health maintenance review; and transitions of care were deemed by the panel to be appropriate roles for IBD clinical pharmacists. In considering real-world settings, IBD clinical pharmacists should practice clinically under a predefined scope and primarily focus on complex treatments (eg, immunomodulators, biologics, and small molecules). Clinical pharmacists should also be included in practice settings with IBD specialized physicians. Additionally, clinical pharmacists caring for patients with IBD should be residency trained and board certified. CONCLUSIONS This consensus defines IBD clinical pharmacists' roles and provides a framework for embedded clinical pharmacists in IBD care.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Ruishen Lyu
- Department of Quantitative Health Science, Cleveland Clinic Foundation, OH, USA
| | - Mitali Agarwal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | | | - Richard Bloomfeld
- Section of Gastroenterology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Marina Ivanov
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jonathan A Leighton
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Alyssa P Stewart
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lindsay Trocke
- Department of Gastroenterology, M Health Fairview, Minneapolis, MN, USA
| | - Stacy S Tse
- Susan and Leonard Feinstein IBD Clinical Center, Mount Sinai Hospital, New York, NY, USA
| | - Ryan C Ungaro
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Byron P Vaughn
- Department of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Erick Sokn
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
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9
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Bhat S. Optimizing Medication Access and Use in Inflammatory Bowel Disease: The Roles and Impact of Clinical Pharmacists and Pharmacy Technicians. Crohns Colitis 360 2023; 5:otad014. [PMID: 36937137 PMCID: PMC10022714 DOI: 10.1093/crocol/otad014] [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] [Indexed: 03/12/2023] Open
Affiliation(s)
- Shubha Bhat
- Address correspondence to: Shubha Bhat, PharmD, MS, FCCP, BCACP, 9500 Euclid Ave, Cleveland, OH 44195, USA ()
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10
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McFarland MS, Stover KR, Bhat S, Coon S, Cooper M, DiDomenico R, Herbert S, Kessler S, Lee M, Maddox MM, Quidley AM, Rhoney D, Wooten L, Zhou Y. Charting a new path forward for pharmacy residency expansion. J Am Coll Clin Pharm 2023. [DOI: 10.1002/jac5.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Shubha Bhat
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Scott Coon
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | - Sarah Kessler
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Michelle Lee
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Denise Rhoney
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Leslie Wooten
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Yi Zhou
- American College of Clinical Pharmacy Lenexa Kansas USA
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Abstract
Despite the significant advances in the medical armamentarium for inflammatory bowel diseases [IBD], current treatment options have notable limitations. Durable remission rates remain low, loss of response is common, administration routes are largely parenteral for novel biologics, and medication safety remains a concern. This explains an ongoing unmet need for safe medications with novel mechanisms of action that are administered orally. In line with these criteria, hypoxia-inducible factor [HIF]-1α stabilizers, acting via inhibition of prolyl hydroxylase enzymes, are emerging as an innovative therapeutic strategy. We herein review the mechanism of action and available clinical data for HIF-1α stabilizers and their potential place in the future IBD treatment algorithm.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.,Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease & Surgery Institute, Cleveland Clinic, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease & Surgery Institute, Cleveland Clinic, OH, USA
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12
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Patil SA, Bhat S, Limdi JK, Farraye FA, Cross RK. The Sincerest Form of Flattery? Biosimilars in Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1915-1923. [PMID: 35353189 DOI: 10.1093/ibd/izac048] [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: 10/19/2021] [Indexed: 12/13/2022]
Abstract
Lay Summary
Biosimilar medications have the potential to significantly reduce the cost of treatment in patients with inflammatory bowel disease. Observational studies have shown similar efficacy and safety of biosimilars to biologic reference products. Shared decision-making is crucial to the successful implementation of these agents.
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Affiliation(s)
- Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Shubha Bhat
- Departments of Pharmacy and Gastroenterology, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Jimmy K Limdi
- Division of Gastroenterology-Section of IBD, The Northern Care Alliance Hospitals NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, 2.41 Fairfield House, Manchester, BL9 7TD, UK
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
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13
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McNeal DM, Sahler OJZ, Noll RB, Fairclough DL, Voll ME, Bhat S, Morrato EH. Core functions and forms of Bright IDEAS: A multi-methods evaluation of the adoption of an evidence-based psychosocial training program through iterative adaptation. Front Health Serv 2022; 2:928580. [PMID: 36925829 PMCID: PMC10012676 DOI: 10.3389/frhs.2022.928580] [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] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Background Despite efforts to widely disseminate interventions designed to increase access to quality supportive care to pediatric cancer patients and their families, many of these interventions fail to meet expectations once deployed in real-life clinical settings. This study identifies the functions and forms of Bright IDEAS: Problem-Solving Skills Training, an evidence based psychosocial intervention for caregivers of children recently diagnosed with cancer, to identify pragmatic program adaptations in its real-world clinical implementation. We compare intervention adoption before and after adaptations to the Bright IDEAS training program as part of a national training program designed to disseminate the intervention. Methods 209 pediatric psychosocial oncology practitioners representing 134 unique institutions were trained during 10 in-person 8-hour workshops (2015-2019). Functions and forms of Bright IDEAS were identified, and adaptations made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Mixed method evaluation included longitudinal surveys at 6- and 12-months post training; and qualitative interviews among a subgroup of practitioners (N = 47) to understand and compare perspectives on intervention adoption and barriers to implementation before and after adaptations to the Bright IDEAS training program. The RE-AIM framework was used to guide dissemination evaluation. Results A total of four adaptations were tailored to the identified forms of the intervention: case studies; pre-training reading materials; training videos; and letters of institutional support from primary supervisor. Pre- and post-training adaptations to the Bright IDEAS training program were mapped to RE-AIM constructs. Quantitative findings demonstrate that adaptations appeared to improve adoption and usage overall. Conclusion This study provides insight into how contextual factors influence psychosocial practitioners' capacity to adopt, implement, and maintain Bright IDEAS in the clinical setting. This study demonstrates the use of real-time stakeholder feedback to guide intervention translation from research to practice settings.
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Affiliation(s)
- Demetria M. McNeal
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Olle Jane Z. Sahler
- Division of Pediatric Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, NY, United States
| | - Robert B. Noll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Diane L. Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan E. Voll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shubha Bhat
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H. Morrato
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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14
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Abstract
Objective: To review the pharmacologic and clinical profile of risankizumab-rzaa in the treatment of Crohn’s disease (CD). Data Sources: A PubMed search was performed from inception to August 2022 using keywords risankizumab, risankizumab-rzaa, interleukin-23 inhibitor, and Crohn’s disease. Information was obtained from package inserts as well as published abstracts. Study Selection and Data Extraction: Phase 2 and 3 studies plus relevant literature on risankizumab-rzaa pharmacologic and clinical profile were reviewed. Data Synthesis: Risankizumab-rzaa approval was based on ADVANCE, MOTIVATE, and FORTIFY. In these 3 phase 3 studies involving patients with moderate to severe CD, risankizumab-rzaa, when compared with placebo, resulted in clinical remission and endoscopic response in a significantly higher proportion of patients in both the induction and maintenance phase. In addition, risankizumab-rzaa met the secondary endpoints of clinical response, endoscopic improvement, corticosteroid-free remission, and mucosal healing. Common adverse events noted include nasopharyngitis, arthralgia, headache, abdominal pain, and nausea. Relevance to Patient Care and Clinical Practice: Risankizumab-rzaa is the first selective IL-23 inhibitor approved for CD and provides an additional therapeutic option for patients, particularly those who have been previously treated with other advanced inflammatory bowel disease therapies. Additional studies are required to determine how to best position risankizumab-rzaa in both bio-naïve and bio-experienced patients with CD. Conclusions: Risankizumab-rzaa is the most recent therapeutic advance for CD. It has a selective mechanism of action with a similar safety profile comparable with other currently approved advanced therapies.
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Affiliation(s)
- David Choi
- Department of Pharmacy and Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Hilary Sheridan
- Department of Pharmacy and Inflammatory Bowel Disease Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Shubha Bhat
- Department of Pharmacy and Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Kumar V, Nayak S, Rathore V, Bhat S, jindal A, Siddiqui S, Dola J, sahu A, Galhotra A, nagarkar N, Behera A. POS-027 COMPARISON OF CLINICAL OUTCOMES OF FIRST, SECOND, AND THIRD WAVES OF COVID19 AMONG CKD PATIENTS REQUIRING RRT IN A TERTIARY CARE HOSPITAL IN CENTRAL INDIA. Kidney Int Rep 2022. [PMCID: PMC9475100 DOI: 10.1016/j.ekir.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Matsunaga F, Bhat S, Amann N, Johnson S, Chen D. Abstract No. 21 Transcatheter arterial embolization outcomes in pediatric pelvic fractures: a National Trauma Data Bank analysis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.103] [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: 11/27/2022] Open
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17
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Bhat S, Laffin L, Kondoleon N, Van Iterson E. The effect of hemoglobin level on the prognostic value of peak exercise oxygen uptake differs between obese and non-obese patients with heart failure. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.201] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Obesity and low hemoglobin content (Hgb <13 and <12 g/dL, men/women, respectively) are commonly observed in patients with heart failure and reduced ejection fraction (HFrEF). This overlap typically yields reductions in peak exercise oxygen uptake (V̇O2peak) which exceed those observed in both non-obese and obese patients exhibiting normal Hgb levels. However, when matched for body size, non-obese patients exhibiting low Hgb levels also demonstrate worse V̇O2peak impairment than normal Hgb level counterparts. To date, it is unclear whether the effect of Hgb level on V̇O2peak also affects the association between V̇O2peak and mortality risk in both non-obese and obese patients.
Purpose
To assess whether V̇O2peak that is predictive of mortality risk is directly impacted by Hgb level regardless of whether a patient is non-obese or obese.
Methods
Adults with HFrEF (n=346; LVEF ≤40%; 76% men) completed cardiopulmonary exercise testing (CPET) as part of routine clinical management. The majority of patients performed Naughton or Modified Naughton CPET protocols. Patients with a BMI ≥30 kg/m2 were classified as obese (n=135; 81% men). Patients were followed up to one-year for the endpoint of all-cause mortality.
Results
Age (63±7 vs 61±8 yrs), total body weight (77±13 vs 107±15 kg), BMI (25.2±3.0 vs 34.5±4.0 kg/m2), and Hgb (12.6±1.8 vs 13.1±1.8 g/dL) differed between non-obese and obese patients (all P<0.01), respectively. There were no significant differences between non-obese and obese patients for % men (73 vs 81 %), % ischemic etiology (46 vs 42 %), and LVEF (23±8 vs 24±9 % (all P>0.05), respectively. Peak exercise RER (1.13±0.12 vs 1.10±0.11), V̇O2peak (13.0±3.8 vs 11.9±3.3 mL/kg/min), and absolute V̇O2peak (1.01±0.37 vs 1.28±0.40 L/min) differed between non-obese and obese patients (all P<0.02), respectively. Over the 1-year tracking period, 25 and 13 deaths were observed and crude survival was 85% and 88% in non-obese and obese patients (Log-rank, P=0.465), respectively. In obese patients, V̇O2peak and Hgb interacted (χ2=4.855, P=0.028), resulting in up to a 22% reduction in all-cause mortality risk per 1.0 mL/kg/min rise in V̇O2peak for Hgb levels ≤13.1 g/dL. In non-obese patients, V̇O2peak and Hgb did not interact (χ2=0.001, P=0.977), and when Hgb was removed from the Cox regression, this resulted in up to a 29% reduction in all-cause mortality risk per 1.0 mL/kg/min rise in V̇O2peak (χ2=23.618, P<0.001).
Conclusion
Demonstrating low Hgb and V̇O2peak levels yields comparable effects on all-cause mortality risk in non-obese and obese patients. However, at normal Hgb levels, V̇O2peak loses prognostic value in the obese, suggesting for these patients other CPET variables should be used to complement V̇O2peak when CPET is built into risk stratification models.
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Affiliation(s)
- S Bhat
- Cleveland Clinic, Cleveland, United States of America
| | - L Laffin
- Cleveland Clinic, Cleveland, United States of America
| | - N Kondoleon
- Cleveland Clinic, Cleveland, United States of America
| | - E Van Iterson
- Cleveland Clinic, Cleveland, United States of America
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18
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Abstract
OBJECTIVE The objective of the study was to review the pharmacologic and clinical profile of adalimumab-adbm (BI 695501), the first interchangeable biosimilar for treatment of inflammatory diseases. DATA SOURCES A PubMed search was conducted from inception to December 2021 using the keywords BI 695501 and adalimumab-adbm. Information was also obtained from published abstracts and package inserts. STUDY SELECTION AND DATA EXTRACTION Phase 1, 2 and 3 studies plus relevant literature on adalimumab-adbm pharmacologic and clinical profile were reviewed. DATA SYNTHESIS Adalimumab-adbm approval was based on a series of phase 3 VOLTAIRE trials, which evaluated the biosimilar's efficacy and safety in the treatment of moderate to severe Crohn's disease, rheumatoid arthritis, and psoriasis. Interchangeability status was granted based on data from the VOLTAIRE-X trial. The VOLTAIRE and VOLTAIRE-X studies demonstrated comparable efficacy and safety between adalimumab-adbm and reference adalimumab. Common adverse events included infections and injection site reactions. Similar to reference adalimumab, adalimumab-adbm contains black box warnings related to serious infections and malignancy. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Adalimumab-adbm is the first interchangeable biosimilar to be approved for inflammatory diseases and has the potential to improve patient access to treatment while decreasing medication-related costs. However, it will not be commercially available for patient use until 2023 and its adoption into clinical practice may face potential barriers seen with other biosimilars. CONCLUSION As an interchangeable biosimilar with comparable efficacy and safety to reference adalimumab, adalimumab-adbm is an important advance toward cost-effective management of inflammatory diseases.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy and Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Maitri Patel
- Department of Pharmacy and Dermatology, University of Chicago Medicine, Chicago, IL, USA
| | - Kristine Duly
- Department of Pharmacy and Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Choi
- Department of Pharmacy and Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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Covas Moschovas M, Rogers T, Noel J, Abdel J, Bhat S, Patel V. Anatomical robotic-assisted radical prostatectomy: Step-by-step nerve-sparing technique for different grades of preservation. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01293-3] [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: 11/24/2022]
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20
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Bhat S, Covas Moschovas M, Sandri M, Noel J, Rogers T, Pereira R, Reddy S, Roof S, Patel V. Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Covas Moschovas M, Noel J, Bhat S, Rogers T, Mottrie A, Patel V. SP approach to radical prostatectomy: Step-by-step technique comparing the Xi and SP consoles. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02281-3] [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: 11/28/2022] Open
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22
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Covas Moschovas M, Noel J, Bhat S, Sandri M, Kind S, Rogers T, Mottrie A, Patel V. Perioperative outcomes and long-term continence rates comparing the da Vinci SP and Xi consoles approaching radical prostatectomy: A propensity score matching analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Maten N, Kroehl ME, Loeb DF, Bhat S, Ota T, Billups SJ, Schilling LM, Heckman S, Reingardt C, Trinkley KE. An evaluation of clinical decision support tools for Patient Health Questionnaire-9 administration. Ment Health Clin 2021; 11:267-273. [PMID: 34621601 PMCID: PMC8463004 DOI: 10.9740/mhc.2021.09.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/11/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Many health care institutions are working to improve depression screening and management with the use of the Patient Health Questionnaire 9 (PHQ-9). Clinical decision support (CDS) within the EHR is one strategy, but little is known about effective approaches to design or implement such CDS. The purpose of this study is to compare implementation outcomes of two versions of a CDS tool to improve PHQ-9 administration for patients with depression. Methods This was a retrospective, observational study comparing two versions of a CDS. Version 1 interrupted clinician workflow, and version 2 did not interrupt workflow. Outcomes of interest included reach, adoption, and effectiveness. PHQ-9 administration was determined by chart review. Chi-square tests were used to evaluate associations between PHQ-9 administration with versions 1 and 2. Results Version 1 resulted in PHQ-9 administration 77 times (15.3% of 504 unique encounters) compared with 49 times (9.8% of 502 unique encounters) with version 2 (P = .011). Discussion An interruptive CDS tool may be more effective at increasing PHQ-9 administration, but a noninterruptive CDS tool may be preferred to minimize alert fatigue despite a decrease in effectiveness.
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Affiliation(s)
- Naweid Maten
- Student, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Miranda E Kroehl
- Statistician, Charter Communications Corporation, Greenwood Village, Colorado
| | - Danielle F Loeb
- Associate Professor, University of Colorado School of Medicine, Aurora, Colorado
| | - Shubha Bhat
- Clinical Pharmacy Specialist, Cleveland Clinic, Cleveland, Ohio
| | - Taylor Ota
- Student, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Sarah J Billups
- Associate Professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Lisa M Schilling
- Professor, University of Colorado School of Medicine, Aurora, Colorado; Medical Director, Office of Value Based Performance, University of Colorado Medicine, Aurora, Colorado
| | - Simeon Heckman
- Information Technology Supervisor, Department of Clinical Informatics, University of Colorado Health, Aurora, Colorado
| | - Crystal Reingardt
- Professional Research Assistant, University of Colorado School of Medicine, Aurora, Colorado; Project Manager, Office of Value Based Performance, University of Colorado Medicine, Aurora, Colorado
| | - Katy E Trinkley
- Student, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.,Statistician, Charter Communications Corporation, Greenwood Village, Colorado.,Associate Professor, University of Colorado School of Medicine, Aurora, Colorado.,Clinical Pharmacy Specialist, Cleveland Clinic, Cleveland, Ohio.,Student, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.,Associate Professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.,Professor, University of Colorado School of Medicine, Aurora, Colorado; Medical Director, Office of Value Based Performance, University of Colorado Medicine, Aurora, Colorado.,Information Technology Supervisor, Department of Clinical Informatics, University of Colorado Health, Aurora, Colorado.,Professional Research Assistant, University of Colorado School of Medicine, Aurora, Colorado; Project Manager, Office of Value Based Performance, University of Colorado Medicine, Aurora, Colorado
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24
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Bhat S, Caldera F, Farraye FA. Standardizing shared vaccination responsibilities among specialists to improve vaccination rates of immunosuppressed patients. Vaccine 2021; 39:6015-6016. [PMID: 34493411 PMCID: PMC8457760 DOI: 10.1016/j.vaccine.2021.08.073] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Shubha Bhat
- Departments of Pharmacy & Gastroenterology, Digestive Diseases Institute, Cleveland, OH, USA.
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI, USA.
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
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25
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Choi D, Patel S, Trivedi I, Rubin DT, Moss A, Bhat S. A survey of pharmacists' roles in gastroenterology and hepatology. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- David Choi
- Department of Medicine, Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago Illinois USA
| | - Shivani Patel
- University of Chicago Medicine Inflammatory Bowel Disease Center Chicago Illinois USA
| | - Itishree Trivedi
- Department of Medicine, Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago Illinois USA
| | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center Chicago Illinois USA
| | - Alan Moss
- Department of Medicine and Section of Gastroenterology, Boston Medical Center Boston University School of Medicine Boston Massachusetts USA
| | - Shubha Bhat
- Departments of Pharmacy and Gastroenterology Digestive Disease and Surgery Institute, Cleveland Clinic Cleveland Ohio USA
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26
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Jin JZ, Bhat S, Lee KT, Xia W, Hill AG. Interventional treatments for prolapsing haemorrhoids: network meta-analysis. BJS Open 2021; 5:6388197. [PMID: 34633439 PMCID: PMC8504447 DOI: 10.1093/bjsopen/zrab091] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background Multiple treatments for early–moderate grade symptomatic haemorrhoids currently exist, each associated with their respective efficacy, complications, and risks. The aim of this study was to compare the relative clinical outcomes and effectiveness of interventional treatments for grade II–III haemorrhoids. Methods A systematic review was conducted according to PRISMA criteria for all the RCTs published between 1980 and 2020; manuscripts were identified using the MEDLINE, Embase, and CENTRAL databases. Inclusion criteria were RCTs comparing procedural interventions for grade II–III haemorrhoids. Primary outcomes of interest were: symptom recurrence at a minimum follow-up of 6 weeks, postprocedural pain measured on a visual analogue scale (VAS) on day 1, and postprocedural complications (bleeding, urinary retention, and bowel incontinence). After bias assessment and heterogeneity analysis, a Bayesian network meta-analysis was performed. Results Seventy-nine RCTs were identified, including 9232 patients. Fourteen different treatments were analysed in the network meta-analysis. Overall, there were 59 RCTs (73 per cent) judged as being at high risk of bias, and the greatest risk was in the domain measurement of outcome. Variable amounts of heterogeneity were detected in direct treatment comparisons, in particular for symptom recurrence and postprocedural pain. Recurrence of haemorrhoidal symptoms was reported by 54 studies, involving 7026 patients and 14 treatments. Closed haemorrhoidectomy had the lowest recurrence risk, followed by open haemorrhoidectomy, suture ligation with mucopexy, stapled haemorrhoidopexy, and Doppler-guided haemorrhoid artery ligation (DG-HAL) with mucopexy. Pain was reported in 34 studies involving 3812 patients and 11 treatments. Direct current electrotherapy, DG-HAL with mucopexy, and infrared coagulation yielded the lowest pain scores. Postprocedural bleeding was recorded in 46 studies involving 5696 patients and 14 treatments. Open haemorrhoidectomy had the greatest risk of postprocedural bleeding, followed by stapled haemorrhoidopexy and closed haemorrhoidectomy. Urinary retention was reported in 30 studies comparing 10 treatments involving 3116 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had significantly higher odds of urinary retention than rubber band ligation and DG-HAL with mucopexy. Nine studies reported bowel incontinence comparing five treatments involving 1269 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had the highest probability of bowel incontinence. Conclusion Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence. The risks and benefits of each treatment should be discussed with patients before a decision is made.
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Affiliation(s)
- J Z Jin
- Correspondence to: South Auckland Clinical Campus, PO Box 93311 Otahuhu, Auckland 1640, New Zealand (e-mail: )
| | - S Bhat
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - K -T Lee
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - W Xia
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - A G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, Auckland, New Zealand
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Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE While COVID-19 vaccine emergency use authorization (EUA) deemed the vaccines to be effective and safe for public use, the phase 3 trials leading to EUA predominantly excluded patients with immunocompromising conditions. Immunocompromised patients make up a significant proportion of the population, and in light of recent mass vaccination efforts, we aim to review current evidence and recommendations of COVID-19 vaccines in 4 patient populations with immunocompromising disorders or conditions: human immunodeficiency virus (HIV) infection, solid organ transplantation, rheumatoid arthritis, and inflammatory bowel disease. SUMMARY Given the evolving data on safety and efficacy of the approved COVID-19 vaccines in the immunocompromised population, it is vital that pharmacists and other immunizing providers understand the current data and recommendations and provide the public with accurate information. To date, the only immunocompromised subgroup included in phase 3 COVID-19 vaccine trials have been those with HIV infection. However, recent retrospective trials have provided reassuring safety data of the COVID-19 vaccine in immunocompromised patients, and the interim analysis of the Moderna phase 3 trial produced promising efficacy data on HIV-infected patients. Presently, the US Centers for Disease Control and Prevention, British Society for Immunology, and various other governmental and professional societies and organizations endorse COVID-19 vaccination in the immunocompromised population. CONCLUSION While additional data is warranted to determine the effects of immunocompromising medical conditions and immunosuppressing medications on the efficacy of the vaccine, the benefits of the vaccine is anticipated to outweigh theoretical risks. Thus, the COVID-19 vaccine is recommended to be given to immunocompromised patients at this time, and providers should make efforts to decrease vaccine hesitancy in this population through education and reassurance.
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Affiliation(s)
- Kristine Duly
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Shubha Bhat
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Choi D, Stewart AP, Bhat S. Ozanimod: A First-in-Class Sphingosine 1-Phosphate Receptor Modulator for the Treatment of Ulcerative Colitis. Ann Pharmacother 2021; 56:592-599. [PMID: 34423657 DOI: 10.1177/10600280211041907] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/18/2022] Open
Abstract
OBJECTIVE To review the pharmacological and clinical profile of ozanimod in the treatment of ulcerative colitis (UC). DATA SOURCES A PubMed search was conducted from inception to July 2021 using the keywords ozanimod, ulcerative colitis, and sphingosine 1-phosphate receptor modulator. Information was also extracted from published abstracts and the package insert. STUDY SELECTION AND DATA EXTRACTION Phase 2 and 3 studies and relevant literature on ozanimod pharmacological and clinical profiles were reviewed. DATA SYNTHESIS Ozanimod approval was based on True North, a phase 3 trial evaluating ozanimod's efficacy and safety in the treatment of moderate to severe UC. Compared with placebo, ozanimod led to clinical remission in a significantly higher proportion of patients in both the induction and maintenance phase. Additionally, for secondary end points of clinical response, endoscopic improvement, corticosteroid-free remission, and mucosal healing, ozanimod performed significantly better than placebo. Common adverse events included infections, headaches, hypertension, bradycardia, and liver enzyme elevations. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Ozanimod is the first sphingosine 1-phosphate modulator to be approved for UC and is administered orally. Its efficacy profile is comparable with other UC medications. However, its safety profile is unique, requiring extensive assessments prior to initiation of and during treatment. Thus, it is unclear how ozanimod will be positioned in UC treatment. CONCLUSION Ozanimod is another option in the growing arsenal of UC treatment. Although it offers a novel mechanism of action and is administered orally, there are important safety, dosing, and pharmacokinetic factors to consider prior to initiation and use.
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Affiliation(s)
- David Choi
- University of Chicago Medicine, Chicago, IL, USA
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29
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Singh S, Acharya S, Bhat M, Bhat S, Chakravarthy PK, Kariya P. Health Locus of Control: A Determinant of Oral Health among Tobacco users in Rural India. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i38b32110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose: The concept of health locus of control is important because of its relation with health attitudes, behavior and coping styles. This study was done to compare the locus of control orientation and oral health status of tobacco users with that of non-tobacco users.
Method: This cross-sectional study was conducted on rural population in southern Indian state. All the participants were interviewed to gather data on their socio-demographic correlates, oral health related behavior and health locus of control with the help of a pre-tested questionnaire. Clinical examination was done using WHO oral health assessment form (1997).Main outcome measures were Locus of Control, Oral Health (dental caries status and periodontal status).
Results: Tobacco users were found to score lower on the dimension of Internality and higher on the Chance dimension compared to non-tobacco users. The prevalence and severity of periodontal disease was significantly higher in tobacco users than non-tobacco users irrespective of age and socioeconomic strata.
Conclusion: It was also concluded that non-tobacco users had internal orientation to health locus of control thereby being important behavioral factor controlling health in this group.Findings also demonstrated significant association between tobacco usage and adverse periodontal health.
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Vidya GB, Bhat S, Kavitha L. A study of second to fourth digit ratio in relation to verbal and numerical intelligence among medical students. Biomedicine (Taipei) 2021. [DOI: 10.51248/.v41i2.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Prenatal androgens are believed to be one of the probable etiological factors influencing intellectual development of an individual. In-utero testosterone exposure has been thought to affect the digit ratio which is the ratio of lengths of index finger and ring finger (2D:4D). In the present work we intended to study the correlation of 2D:4D with numerical and verbal intelligence believed to be variable among genders. The aim of our study was to find the association of 2D:4D with Verbal Intelligence and Numerical Intelligence in a sample of medical students.
Materials and Methods: This study was conducted in a sample of medical students. 44 female and 44 male students participated in the study. 2D:4D measurements were made using standard procedure after which the participants completed a questionnaire containing 20 questions each to test numerical and verbal intelligence.
Results: In this study, Males were found to have a lower 2D:4D when compared to females. Individuals with lower 2D:4D in their right-hand were seen to have lower verbal intelligence and higher numerical intelligence thus suggesting that males are born with better numerical intelligence and females with greater verbal intelligence.
Conclusion: Digit ratio can be considered as a valuable indicator of individual differences in terms of intelligence, although the exact role of testosterone on brain to cause variation in these cognitive domains is yet to be clearly understood.
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Abstract
BACKGROUND The biosimilar landscape for inflammatory bowel disease (IBD) continues to grow, with several biosimilar products for originator infliximab now available. The rapid infusion of originator infliximab and infliximab-dyyb has been shown to be well tolerated; however, the tolerability of rapid infusion in patients receiving infliximab-abda, another infliximab biosimilar, or in those who have switched among originator infliximab and biosimilars remains unknown. OBJECTIVE We aimed to evaluate the safety of rapid infusion in patients with IBD who received infliximab-abda or underwent switches with infliximab products. METHODS We conducted a retrospective observational study of all infliximab-related infusion encounters for patients ≥18 years with IBD who received their infusion over 30 to 90 minutes at our institution between March 1, 2020, and September 30, 2020. Patient, disease, and treatment characteristics were collected. The primary outcome was infusion reactions. RESULTS A total of 377 infusion encounters for 96 unique patients were evaluated. Within the study cohort, 16% of patients were treated with originator infliximab, 42% with infliximab-dyyb, and 2% with infliximab-abda. The remaining 41% of patients received at least 2 infliximab products during the study period, primarily infliximab-dyyb and infliximab-abda. Approximately 54% and 42% of infusions encounters included premedication and immunomodulator use. Within the 377 infusion encounters, no infusion reactions were noted. CONCLUSION AND RELEVANCE Rapid infusion of infliximab biosimilars (including infliximab-abda) and in patients who have switched among originator infliximab and biosimilars is well tolerated. Future studies should assess clinical impact and outcomes of rapid infusion with biosimilars.
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell’oglio P, Roof S, Reddy S, Chiara Sighinolfi M, Rocco B, Patel V. Association between Oncotype DX Genomic Prostate Score (GPS) and adverse tumor pathology after radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01393-2] [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: 11/25/2022]
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Noël J, Helman T, Moschovas M, Helman R, Bhat S, Reddy S, Rogers T, Patel V. Patient surgical satisfaction following da vinci single port and multi port robotic-assisted radical prostatectomy: A propensity score matched analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bhat S, Qazi T, Farraye FA. Managing infliximab infusions after a drug holiday. Am J Health Syst Pharm 2021; 78:1664-1665. [PMID: 34059875 DOI: 10.1093/ajhp/zxab234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Shubha Bhat
- Department of Pharmacy Cleveland Clinic Cleveland, OH.,Department of Gastroenterology, Hepatology & Nutrition Digestive Diseases Institutes Cleveland Clinic, Cleveland, OH, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition Digestive Diseases Institutes Cleveland Clinic Cleveland, OH, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center Division of Gastroenterology and Hepatology Mayo Clinic Jacksonville, FL, USA
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Covas Moschovas M, Bhat S, Rogers T, Reddy S, Noel J, Chew C, Mazzone E, Mottrie A, Patel V. Technical details comparing the da Vinci SP and da Vinci Xi approach to radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Covas Moschovas M, Bhat S, Sandri M, Rogers T, Mazzone E, Roof S, Mottrie A, Patel V. Comparing the approach to radical prostatectomy using the Da Vinci Xi and Da Vinci Single Port: A propensity score analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01485-8] [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: 11/27/2022]
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Bhat S, Nunes D. Pharmacist-Managed Helicobacter pylori Treatment Service Within a Gastroenterology Clinic: Workflow and Real-World Experiences. Ann Pharmacother 2021; 56:162-169. [PMID: 34049441 DOI: 10.1177/10600280211021501] [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 Treatment eradication rates of Helicobacter pylori, a gastrointestinal infection, are 70% to 90% in clinical studies but lower in real-world settings. Potential barriers include multidrug regimen complexity or prescribing/administration errors. A pharmacist-managed H pylori treatment service was implemented to address these barriers and optimize treatment outcomes. The clinical pharmacist provided 2 services: (1) treatment education and monitoring for treatment-naïve patients and (2) treatment initiation, education, and monitoring for treatment-experienced patients. OBJECTIVE We aimed to evaluate the impact of a pharmacist-managed H pylori treatment service within a gastroenterology clinic. METHODS We conducted a retrospective observational cohort study of all patients referred to and seen in the pharmacist-managed H pylori treatment service from July 10, 2019, to December 31, 2020. Patient demographics, prior treatment history, course(s) of treatment prescribed, frequency of follow-ups, and outcomes posttreatment were collected. RESULTS The clinical pharmacist managed 60 referrals for 55 unique patients over a mean of 5 ± 2 visits. Five patients failed H pylori treatment and were re-referred. Identified barriers included prescribing/dispensing and administration errors. Posttreatment, 38 referrals tested for H pylori eradication, of which 100% of treatment-naïve patients and 69% of treatment-experienced patients were cured, and 13 (22%) referrals were lost to follow-up. CONCLUSION AND RELEVANCE This study described and assessed the impact of a pharmacist-managed H pylori treatment service in a gastroenterology clinic, in which various barriers were effectively addressed to optimize treatment outcomes. Future studies should focus on long-term outcome, impact on health care costs, and patient satisfaction with this service.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
| | - David Nunes
- Department of Gastroenterology, Boston Medical Center, Boston, MA, USA
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Varghese C, Bhat S, Wang THH, O'Grady G, Pandanaboyana S. Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials. BJS Open 2021; 5:6275938. [PMID: 33989392 PMCID: PMC8121488 DOI: 10.1093/bjsopen/zrab035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/10/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear. Methods MEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons. Conclusion Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE. Preregistration PROSPERO submitted 23 December 2020. CRD42021227637
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Affiliation(s)
- C Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - T H-H Wang
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - G O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Singh V, Srinivas T, Bhat S, Goel S. Massive lateral neck mass: aberrant ectopic thyroid malignancy. BMJ Case Rep 2021; 14:14/5/e241451. [PMID: 33975840 PMCID: PMC8118039 DOI: 10.1136/bcr-2020-241451] [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: 11/04/2022] Open
Abstract
Lateral aberrant ectopic thyroid is very rare, comprising only 1%-3% of all the ectopic thyroid tissue. Clinically, these lesions are mistaken for lymph node swelling or metastatic tumour. Primary carcinoma in lateral aberrant ectopic thyroid with normal active native thyroid is very uncommon. We report a case of papillary carcinoma in lateral aberrant ectopic thyroid tissue, with a completely normal native thyroid gland in a 53-year-old man, who presented with a massive swelling in the lateral aspect of the neck clinically and radiologically diagnosed as a malignant soft tissue tumour with differential diagnosis of malignant lymphoma. Fine needle aspiration cytology revealed metastatic papillary carcinoma. In toto excision of the soft tissue mass along with subtotal thyroidectomy was performed. Histology of the mass revealed papillary carcinoma of lateral aberrant ectopic thyroid, while the thyroid gland did not show evidence of malignancy. The postsurgical period was uneventful, and the patient underwent radioiodine ablation.
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Affiliation(s)
- Vartika Singh
- Department of Pathology, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Teerthanath Srinivas
- Department of Pathology, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Shubha Bhat
- Department of Pathology, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Shreya Goel
- Department of Pathology, Nitte University K S Hegde Medical Academy, Mangalore, Karnataka, India
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Chittemsetti S, Baikunje N, Hosmane GB, Bhat S. Recurrent pleural effusion secondary to endometriosis: a rare malady. BMJ Case Rep 2021; 14:e240057. [PMID: 33849867 PMCID: PMC8051368 DOI: 10.1136/bcr-2020-240057] [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] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Abstract
Thoracic endometriosis is a rare entity, wherein thoracic endometrial tissue deposition occurs. Recurrent pleural effusion is one of its manifestations. Diagnosis and treatment are often challenging, owing to the rarity of the condition and recurrences. We present an interesting case of a young woman of childbearing age who presented with recurrent haemorrhagic pleural effusion. She was referred to our centre after her initial video-assisted thoracoscopic biopsy was inconclusive. She was re-evaluated, and video-assisted thoracoscopic biopsy confirmed thoracic endometriosis. She underwent pleurodesis two times and currently on hormonal treatment, maintaining well.
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Affiliation(s)
| | | | | | - Shubha Bhat
- Pathology, KS Hegde Medical Academy, Mangalore, Karnataka, India
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Affiliation(s)
- Shubha Bhat
- Crohn's and Colitis Program, Boston Medical Center, Boston, Massachusetts
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Alan Moss
- Crohn's and Colitis Program, Boston Medical Center, Boston, Massachusetts
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Affiliation(s)
- Shubha Bhat
- Departments of Pharmacy & Gastroenterology, Crohn’s and Colitis Program, Boston Medical Center, Boston, Massachussets, USA,Address correspondence to: Shubha Bhat, PharmD, MS, Boston Medical Center, 725 Albany Street, Suite 6B, Boston, MA, 02118, USA. E-mail:
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin—Madison, School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Bhat S, Qazi T. Switching from Infliximab to Biosimilar in Inflammatory Bowel Disease: A Review of Existing Literature and Best Practices. Crohns Colitis 360 2021; 3:otaa093. [PMID: 36777069 PMCID: PMC9802378 DOI: 10.1093/crocol/otaa093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
Biosimilars are highly similar but nonidentical biologic agents with no differences in clinical efficacy and safety when compared to bio-originator products. Considering the long-term costs of managing inflammatory bowel disease (IBD), biosimilars, through economic competition, provide an opportunity for cost savings to payors, may increase access to IBD medications, and could decrease health care spending in the long run. Studies investigating the use of biosimilars in IBD have shown a comparable clinical efficacy and safety profile compared to originator products. Moreover, studies have also suggested that solitary switches between bio-originators and biosimilars are acceptable and do not lead to worsening disease burden or increased immunogenicity or safety concerns. Despite available data and proposed benefits of biosimilars, skepticism about the widespread adoption of biosimilars throughout the United States continues to be present and creates many barriers. Herein, we detail the real-world, nonmedical switching experiences of 2 IBD centers in the United States and review best practices, which can be used as a potential roadmap for successful biosimilar adoption in other institutions.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy, Crohn’s and Colitis Program, Boston Medical Center, Boston, Massachusetts, USA,Department of Gastroenterology, Crohn’s and Colitis Program, Boston Medical Center, Boston, Massachusetts, USA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institutes, Cleveland Clinic, Cleveland, Ohio, USA,Address correspondence to: Taha Qazi, MD, A30, 9500 Euclid Avenue, Cleveland, OH 44195 ()
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Duart-Castells L, Nadal-Gratacós N, Muralter M, Puster B, Berzosa X, Estrada-Tejedor R, Niello M, Bhat S, Pubill D, Camarasa J, Sitte HH, Escubedo E, López-Arnau R. Role of amino terminal substitutions in the pharmacological, rewarding and psychostimulant profiles of novel synthetic cathinones. Neuropharmacology 2021; 186:108475. [PMID: 33529677 DOI: 10.1016/j.neuropharm.2021.108475] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/13/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 01/01/2023]
Abstract
The emergence of new synthetic cathinones continues to be a matter of public health concern. In fact, they are quickly replaced by new structurally related alternatives. The main goal of the present study was to characterize the pharmacological profile, the psychostimulant and rewarding properties of novel cathinones (pentedrone, N-ethyl-pentedrone, α-PVP, N,N-diethyl-pentedrone and α-PpVP) which only differs in their amino terminal substitution. Rat synaptosomes were used for [3H]dopamine uptake experiments. HEK293 transfected cells (hDAT, hSERT, hOCT; human dopamine, serotonin and organic cation transporter) were also used for [3H]monoamine uptake and transporter binding assays. Molecular docking was used to investigate the effect of the amino substitutions on the biological activity. Hyperlocomotion and conditioned place preference paradigm were used in order to study the psychostimulant and rewarding effects in mice. All compounds tested are potent inhibitors of DAT with very low affinity for SERT, hOCT-2 and -3, and their potency for inhibiting DAT increased when the amino-substituent expanded from a methyl to either an ethyl-, a pyrrolidine- or a piperidine-ring. Regarding the in vivo results, all the compounds induced an increase in locomotor activity and possess rewarding properties. Results also showed a significant correlation between predicted binding affinities by molecular docking and affinity constants (Ki) for hDAT as well as the cLogP of their amino-substituent with their hDAT/hSERT ratios. Our study demonstrates the role of the amino-substituent in the pharmacological profile of novel synthetic cathinones as well as their potency inhibiting DA uptake and ability to induce psychostimulant and rewarding effects in mice.
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Affiliation(s)
- L Duart-Castells
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - N Nadal-Gratacós
- Pharmaceutical Chemistry Group (GQF), IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
| | - M Muralter
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - B Puster
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - X Berzosa
- Pharmaceutical Chemistry Group (GQF), IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
| | - R Estrada-Tejedor
- Pharmaceutical Chemistry Group (GQF), IQS School of Engineering, Universitat Ramon Llull, Barcelona, Spain
| | - M Niello
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Vienna, Austria, A-1090
| | - S Bhat
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Vienna, Austria, A-1090
| | - D Pubill
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - J Camarasa
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - H H Sitte
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Vienna, Austria, A-1090; Center for Addiction Research and Science, Medical University Vienna, Waehringerstrasse 13 A, 1090, Vienna, Austria
| | - E Escubedo
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain.
| | - R López-Arnau
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, Pharmacology Section and Institute of Biomedicine (IBUB), Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
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Bhat S, Farraye FA, Hayney MS, Caldera F. How to Implement a Successful Vaccination Program in Outpatient Gastroenterology Practices: A Focus on Patients with Inflammatory Bowel Disease and Chronic Liver Disease. Gastroenterology 2021; 164:1047-1051. [PMID: 33460608 DOI: 10.1053/j.gastro.2021.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Shubha Bhat
- Departments of Pharmacy & Gastroenterology, Crohn's and Colitis Program, Boston Medical Center, Boston MA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, School of Medicine & Public Health
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine & Public Health, Madison, WI.
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Bhat S, Trieu K, Dai Z, Leander K, Gigante B, Qian F, Korat A, Sun Q, Pan X, Laguzzi F, Cederholm T, de Faire U, Hellénius M, Wu J, Risérus U, Marklund M. Biomarkers of Dairy Fat Intake, Incident Cardiovascular Disease, and All-Cause Mortality: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bhat S, deKemp R, Seto J, Green M, Birnie D, Beanlands R, Chow B, Dwivedi G. Does Left Ventricular Dyssynchrony by Positron Emission Tomography Predict Ventricular Tachyarrhythmia? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.028] [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: 11/29/2022]
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L. Prasad K, Piplani G, Sajitha K, Rajeev TP, Bhat S, Hegde S. Unusual presentation of mixed epithelial and stromal tumor of ureter posing diagnostic dilemma. Urol Sci 2021. [DOI: 10.4103/uros.uros_69_20] [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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Sajitha K, Kaur G, Bhat S. Breast cancer awareness among the female nursing staff in a tertiary care hospital. J Nurs Midwifery Sci 2021. [DOI: 10.4103/jnms.jnms_32_20] [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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Quinn AL, Bhat S, Lee JC. Effect of CYP2C9 *11/*11 genotype on initial and long-term warfarin dose requirement and therapeutic response. Pharmacogenomics 2020; 21:1271-1277. [PMID: 33350885 DOI: 10.2217/pgs-2020-0125] [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] [Indexed: 11/21/2022] Open
Abstract
The warfarin dose requirement and therapeutic response of a 42-year-old African-American male with genotype CYP2C9 *11/*11, VKORC1 -1639GG and CYP4F2 433Val/Val anticoagulated for ischemic stroke is described herein. Warfarin was dosed according to the institution's personalized medicine program recommendations of a 10 mg mini-load dose, followed by dose decreases to 4-6 mg/day through discharge. Stable international normalized ratio was achieved after eight doses, with good overall long-term maintenance of therapeutic international normalized ratio over several years with warfarin doses of 3.1-4.3 mg/day. This case report sheds further light on the clinical impact of CYP2C9 *11/*11 on warfarin dose requirements, short- and long-term treatment response and practical considerations for warfarin management in suspected carriers of rare variant CYP2C9 alleles.
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Affiliation(s)
| | - Shubha Bhat
- Department of Pharmacy Practice, Boston Medical Center, Boston, MA 02118, USA
| | - James C Lee
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL 60612, USA
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