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Rotea-Salvo S, Giménez-Arufe V, Martínez-Pradeda A, Fernández-Oliveira C, Mena-de-Cea Á, Margusino-Framiñán L, Martín-Herranz I, Cid-Silva P. Lipid profile changes associated with antiretroviral therapies in a real-world cohort. Farm Hosp 2023; 47:T210-T217. [PMID: 37673703 DOI: 10.1016/j.farma.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48 and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST- segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction) and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data was obtained from the medical history. The statistical analysis was performed with SPSS v.24 software. RESULTS A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favoring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1 ± 38.2 vs. 187.3 ± 29.4, p < 0.001) and LDL-C (126.1 ± 31.9 vs. 113.5 ± 28.5, p = 0.001) at week 48, and in total cholesterol (201.1 ± 33.4 vs. 188.7 ± 33.9, p = 0.013) and HDL-C (54.2 ± 15.6 vs. 48.3 ± 14.3, p = 0.01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
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Affiliation(s)
- Sandra Rotea-Salvo
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España
| | - Víctor Giménez-Arufe
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España
| | | | | | - Álvaro Mena-de-Cea
- Servicio de Infecciosos, Unidad de Medicina Interna, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España
| | - Luis Margusino-Framiñán
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España
| | | | - Purificación Cid-Silva
- Servicio de Farmacia, Hospital Universitario de A Coruña (CHUAC), A Coruña, España; División de Virología Clínica, Instituto de Investigación Biomédica A Coruña (INIBIC), Hospital Universitario de A Coruña (CHUAC), Universidad de A Coruña (UDC), A Coruña, España.
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Rotea-Salvo S, Giménez-Arufe V, Martínez-Pradeda A, Fernández-Oliveira C, Mena-de-Cea Á, Margusino-Framiñán L, Martín-Herranz I, Cid-Silva P. Lipid profile changes associated with antiretroviral therapies in a real-world cohort. Farm Hosp 2023; 47:210-217. [PMID: 37349200 DOI: 10.1016/j.farma.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To compare lipid profile changes and cardiovascular events among HIV naïve and experienced patients from a real-world cohort treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. METHOD A retrospective cohort study in HIV naïve and experienced people at a reference hospital in Spain was done. During the follow-up (March 2015-June 2019), patients were treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate or dolutegravir/abacavir/lamivudine. Epidemiological, clinical, and immunovirological variables were recorded. A statistical analysis of the lipid profile at baseline, 48, and 120 weeks after initiating the study therapy, cardiovascular events (myocardial infarction, heart failure, cerebrovascular accident, deep venous thrombosis, myocardiopathy, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction), and cardiovascular risks factors was performed. Data were analysed in naïve and experienced patients from each of the study treatments. The data were obtained from the medical history. The statistical analysis was performed with SPSS v. 24 software. RESULTS A total of 266 and 191 patients receiving treatment with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine were included in the study, respectively. After 120 weeks of treatment, a worsening of the lipid profile was found in the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group, both in naïve and experienced patients, whereas not so conspicuously observed in the dolutegravir/abacavir/lamivudine group. Statistically significant differences between both groups were found in experienced patients favouring dolutegravir/abacavir/lamivudine; in total cholesterol (204.1±38.2 vs. 187.3±29.4, P < .001) and LDL-C (126.1±31.9 vs. 113.5±28.5, P = .001) at week 48, and in total cholesterol (201.1±33.4 vs. 188.7±33.9, P = .013) and HDL-C (54.2±15.6 vs. 48.3±14.3, P = .01) at week 120. No significant differences in cardiovascular events were found, neither in naïve nor in experienced patients. CONCLUSIONS The lipid profile among elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate group worsened throughout the follow-up, both in naïve and experienced patients, not so remarkable in the dolutegravir/abacavir/lamivudine group. Both regimens were well tolerated, with similar rates of cardiovascular events.
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Affiliation(s)
- Sandra Rotea-Salvo
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - Víctor Giménez-Arufe
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | | | | | - Álvaro Mena-de-Cea
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain
| | - Isabel Martín-Herranz
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain
| | - Purificación Cid-Silva
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), Sergas, A Coruña, Spain; Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC)- Universitary Hospital of A Coruña (CHUAC), Sergas, University of A Coruña (UDC), Spain.
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Rotea-Salvo S, Martínez-Pradeda A, Fernández-Oliveira C, Giménez-Arufe V, Balboa-Barreiro V, Margusino-Framiñán L, Mena-De-Cea Á, Vázquez-Rodríguez P, Castro-Iglesias Á, López-Calvo S, Martín-Herranz I, Míguez-Rey E, Cid-Silva P. Renal profile of patients treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine: 120-week results from a real-world cohort. Eur J Hosp Pharm 2023; 30:221-226. [PMID: 34649965 PMCID: PMC10359784 DOI: 10.1136/ejhpharm-2021-002896] [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] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022] Open
Abstract
Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (EVG/c/FTC/TAF) and dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) are currently available for HIV patients. OBJECTIVES This study evaluated modifications in the renal safety profile in a large real-world cohort of patients who had received EVG/c/FTC/TAF or DTG/ABC/3TC. METHODS A retrospective observational study of HIV-infected patients who received EVG/c/FTC/TAF or DTG/ABC/3TC between March 2015 and June 2019 at a reference hospital in north-western Spain was conducted. Epidemiological, clinical, immunovirological data and information regarding antiretroviral therapy were recorded. The statistical differences between treatments were calculated. RESULTS A total of 457 patients were evaluated, 266 using EVG/c/FTC/TAF and 191 using DTG/ABC/3TC. Up to week 120, serum creatinine improved in both study groups among experienced patients (EVG/c/FTC/TAF 1.01±0.24 vs 0.91±0.19, p<0.001; DTG/ABC/3TC 1.08±0.24 vs 1.02±0.31, p<0.001), while in naïve patients serum creatinine remained stable compared with baseline. Statistically significant differences were found in serum creatinine when comparing both treatments at week 48 in experienced (0.94±0.21 vs 1.09±0.28, p<0.001) and naïve patients (0.89±0.16 vs 1.06±0.20, p=0.001), and among experienced patients at week 120 (0.91±0.19 vs 1.02±0.31, p=0.015) for the EVG/c/FTC/TAF and DTG/ABC/3TC groups, respectively. During the follow-up, 39 patients in EVG/c/FTC/TAF and 33 in DTG/ABC/3TC (p=0.449) discontinued treatment. The main reason for stopping treatment was adverse events, which were similar in both groups. CONCLUSIONS During the follow-up, patients experienced changes that were not clinically relevant in both treatment groups. Differences in renal events were not found.
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Affiliation(s)
- Sandra Rotea-Salvo
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | | | - Carla Fernández-Oliveira
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Victor Giménez-Arufe
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Álvaro Mena-De-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Pilar Vázquez-Rodríguez
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Soledad López-Calvo
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Isabel Martín-Herranz
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Enrique Míguez-Rey
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Purificación Cid-Silva
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
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Brandariz-Núñez D, Suanzes J, Gutiérrez-Urbón JM, Fernández-Oliveira C, Margusino L, Martín-Herranz I. Incidence and risk factors for mortality in patients treated with combined ceftaroline for Gram-positive infective endocarditis. Eur J Clin Microbiol Infect Dis 2022; 41:827-834. [PMID: 35435629 DOI: 10.1007/s10096-022-04443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ceftaroline is a fifth-generation cephalosporin and represents an alternative in the treatment of infective endocarditis (IE). The main objective of this study was to describe the incidence of in-hospital and 42-day mortality in patients with IE treated with ceftaroline. METHODS An observational retrospective study included adult patients with IE admitted during a 3.5-year period (January 2018-June 2021) and treated with ceftaroline in a single center. All cases were definite or possible IE according to the modified Duke criteria. RESULTS Seventy cases were analyzed. The mean age was 67.35 ± 16.62 (16-89) and 39 (55.7%) were males. The mean number of days of treatment with ceftaroline was 21.26 ± 16.17 (1-75). Overall mortality at 42 days was 30%, 20.7% in the first line, and 36.6% in rescue therapy. Predictors of 42 days-mortality were increased Charlson comorbidity index (CCI) (OR of 1.7 per 1 point increment, 95% CI 1.2-2.4, P 0.001), presence of methicillin-resistance (OR 6.8, 95% CI 1.3-36.8, P 0.026) and evidence of septic shock (OR 8.6 95% CI 1.7-44.2, P 0.01). Predictors of 42 days of therapeutic failure were the increase in the CCI (OR of 1.6 per 1 point increment, 95% CI 1.3-2.1, P 0.000) and septic shock (OR 4.5 95% CI 1.1-18 P 0.036). Adverse effects were described in 6/70 (8.6%) of the patients, precipitating in 4/70 (5.7%) the definitive withdrawal of the antibiotic. CONCLUSIONS The incidence of in-hospital and 42 day-mortality of IE patients treated with ceftaroline remains similar to literature data. Increased CCI, septic shock, and methicillin resistance are associated with poor prognosis.
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Affiliation(s)
- D Brandariz-Núñez
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain.
| | - J Suanzes
- Research Support Unit, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
- Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - J M Gutiérrez-Urbón
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - C Fernández-Oliveira
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - L Margusino
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - I Martín-Herranz
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
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Fernández-Oliveira C, Rotea-Salvo S, Fernández-Docampo M, González-Piñeiro S, Martín-Herranz I. Treatment of high-risk bleeding with susoctocog alfa in a patient with acquired haemophilia A and a nosocomial severe acute respiratory syndrome coronavirus 2 infection. Eur J Hosp Pharm 2021; 30:177-179. [PMID: 34011555 PMCID: PMC10176986 DOI: 10.1136/ejhpharm-2021-002805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/03/2022] Open
Abstract
We report the case of a man in his early 70s with idiopathic acquired haemophilia A and persistent high-titre type II inhibitors on immunosuppressive treatment to eradicate the inhibitor. As complications, he had a nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which caused severe pneumonia and an explosive inflammatory reaction that required tocilizumab and remdesivir treatment, and a high-risk retroperitoneal haematoma. Recombinant porcine factor VIII, susoctocog alfa, was requested from the Pharmacy Service in view of the extreme risk of thromboembolism resulting from the concomitant inflammatory storm caused by SARS-CoV-2. Improvement in the SARS-CoV-2 infection made it possible to complete the immunosuppressive treatment with rituximab. The patient was discharged with mycophenolate mofetil as immunosuppressive treatment after 89 days in hospital and 22 days of treatment with susoctocog alfa. His SARS-CoV-2 infection resolved and the haematoma evolved favourably.
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García-Queiruga M, Fernández-Oliveira C, Mauríz-Montero MJ, Porta-Sánchez Á, Margusino-Framiñán L, Martín-Herranz I. Development of the @Antidotos_bot chatbot tool for poisoning management. Farm Hosp 2021; 45:180-183. [PMID: 34218763 DOI: 10.7399/fh.11620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To describe the development of the Antidotos_bot chatbot tool, which is used to facilitate the search for information in the Antidote Administration Guide and to perform useful calculations in the use of antidotes. METHOD In January 2019, we proposed developing a freely accessible chatbot on Telegram® using Xenioo®. Software development defined the way it interacts with users and incorporated calculation functionalities. Internal validation was conducted and it was presented as Antidotos_bot in June 2019. RESULTS Antidotos_bot included information in Spanish on 49 antidotes and 57 poisonings. Three types of calculations were provided and two treatment algorithms could be consulted. Consultation was possible through 332 questions. Internal validation needed five sets of training over 2 months. By July 2020, it had 415 users. The most frequently consulted antidotes were glucagon, penicillin G, protamine, n- acetylcysteine and flumazenyl. Regarding monthly activity, there was an average of 29 calculations and an average of three new users and three queries per user. CONCLUSIONS Antidotos_bot is a poisoning management decisionmaking tool that provides up-to-date information in a user-friendly manner. It could contribute to improving the quality and safety of care in emergency situations.
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Affiliation(s)
- Marta García-Queiruga
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
| | - Carla Fernández-Oliveira
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
| | - María José Mauríz-Montero
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
| | - Ángeles Porta-Sánchez
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
| | - Luis Margusino-Framiñán
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
| | - Isabel Martín-Herranz
- Pharmacy Department, Complexo Hospitalario Universitario A Coruña. Área Sanitaria A Coruña e Cee. Spain..
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Fernández-Oliveira C, Martínez-Roca C, Ávila-Álvarez A, Balboa-Barreiro V, Giménez-Arufe V, Yáñez-Gómez P, Hermida-Bouzas MC, Martín-Herranz I. Impact of introducing assisted electronic prescription on paediatric patient safety. An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Margusino-Framiñán L, Cid-Silva P, Giménez-Arufe V, Mondelo-García C, Fernández-Oliveira C, Mena-de-Cea Á, Martín-Herranz I, Castro-Iglesias Á. Influence of drug-drug interactions on effectiveness and safety of direct-acting antivirals against hepatitis C virus. Eur J Hosp Pharm 2019; 28:16-21. [PMID: 33355279 DOI: 10.1136/ejhpharm-2019-001889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Direct-acting antivirals are the recommended treatment for hepatitis C-infected patients. Drug-drug interactions with concomitant treatments can cause lack of effectiveness and/or safety. The objective of this study is to characterise drug-drug interactions of direct-acting antivirals and to analyse their influence both on the effectiveness of antiviral treatment and on the overall safety of pharmacological treatment in hepatitis C-infected patients. METHODS Observational and prospective cohort study for 3 years in the pharmaceutical care outpatient consultation of a general hospital, undertaking detection, evaluation and management of drug-drug interactions by clinical pharmacists and physicians. The main outcome measures were sustained virologic response at week 12 for effectiveness and serious drug-related adverse events for safety. Multivariate statistical analysis applied to: (a) patient basal characteristics related to presence of drug-drug interactions; (b) previous antiviral treatments, viral genotype, cirrhosis, decompensations and presence of drug-drug interactions related to the effectiveness of direct-acting antivirals. RESULTS Of a total of 1092 patients, the majority of them were men, around 60 years old and HCV-genotype 1 mono-infected, with a high basal viral load, naive to antiviral treatment, treated with ledipasvir/sofosbuvir and without cirrhosis. 24.5% had drug-drug interactions. Proton pump inhibitors were the concomitant drugs that caused the most drug-drug interactions. Age ≥65 years and direct-acting antivirals based on protease inhibitors were independently related to the presence of drug-drug interactions (p≤0.012). All (100%) of the therapeutic recommendations based on detected drug-drug interactions were implemented; 97.7% of patients with interactions versus 99.0% without them reached sustained virologic failure (p=0.109). The serious adverse events rates were 1.5% and 1.3% in patients with and without drug-drug interactions, respectively (p=0.841). CONCLUSIONS Drug-drug interactions are frequent among hepatitis C-infected patients receiving treatment with direct-acting antivirals. However, the collaboration between physicians and clinical pharmacists makes it possible to detect, evaluate, avoid or clinically manage these drug-drug interactions, in order to maintain whole treatment therapeutic safety and the effectiveness of direct-acting antivirals.
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Affiliation(s)
- Luis Margusino-Framiñán
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain .,Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | - Purificación Cid-Silva
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain.,Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | | | | | | | - Álvaro Mena-de-Cea
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain.,Infectious Disease Unit. Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | - Ángeles Castro-Iglesias
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain.,Infectious Disease Unit. Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
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