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Clemente-Bautista S, Trocóniz IF, Segarra-Cantón Ó, Salvador-Marín S, Parramón-Teixidó CJ, Álvarez-Beltrán M, López-Fernández LA, Colom H, Cabañas-Poy MJ, Gorgas-Torner MQ, Miarons M. The Effect of Polymorphisms and Other Biomarkers on Infliximab Exposure in Paediatric Inflammatory Bowel Disease: Development of a Population Pharmacokinetic Model. Paediatr Drugs 2024; 26:331-346. [PMID: 38507036 DOI: 10.1007/s40272-024-00621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of infliximab has been shown to be a effective strategy for inflammatory bowel disease (IBD). Population pharmacokinetic (PopPK) modeling can predict trough concentrations for individualized dosing. OBJECTIVE The aim of this study was to develop a PopPK model of infliximab in a paediatric population with IBD, assessing the effect of single nucleotide polymorphisms (SNPs) and other biomarkers on infliximab clearance. METHODS This observational and ambispective single-centre study was conducted in paediatric patients with IBD treated with infliximab between July 2016 and July 2022 in the Paediatric Gastroenterology Service of the Hospital Universitari Vall d'Hebron (HUVH) (Spain). Demographic, clinical, and analytical variables were collected. Twenty SNPs potentially associated with variations in the response to infliximab plasma concentrations were analysed. infliximab serum concentrations and antibodies to infliximab (ATI) were determined by ELISA. PopPK modelling was performed using nonlinear mixed-effects analysis (NONMEM). RESULTS Thirty patients (21 males) were included. The median age (range) at the start of infliximab treatment was 13 years (16 months to 16 years). A total of 190 samples were obtained for model development (49 [25.8%] during the induction phase). The pharmacokinetics (PK) of infliximab were described using a two-compartment model. Weight, erythrocyte sedimentation rate (ESR), faecal calprotectin (FC), and the SNP rs1048610 (ADAM17) showed statistical significance for clearance (CL), and albumin for inter-compartmental clearance (Q). Estimates of CL1 (genotype 1-AA), CL2 (genotype 2-AG), CL3 (genotype 3-GG), Q, Vc, and Vp (central and peripheral distribution volumes) were 0.0066 L/h/46.4 kg, 0.0055 L/h/46.4 kg, 0.0081 L/h/46.4 kg, 0.0029 L/h/46.4 kg, 0.6750 L/46.4 kg, and 1.19 L/46.4 kg, respectively. The interindividual variability (IIV) estimates for clearance, Vc, and Vp were 19.33, 16.42, and 36.02%, respectively. CONCLUSIONS A popPK model utilising weight, albumin, FC, ESR, and the SNP rs1048610 accurately predicted infliximab trough concentrations in children with IBD.
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Affiliation(s)
- Susana Clemente-Bautista
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain.
| | - Iñaki F Trocóniz
- Department of Pharmaceutical Technology and Chemistry, Faculty of Pharmacy and Nutrition, University of Navarra, 31009, Navarra, Spain
| | - Óscar Segarra-Cantón
- Paediatric Gastroenterology and Clinical Nutrition Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health of the Universidad Autónoma de Barcelona, 08193, Bellaterra, Spain
| | - Sara Salvador-Marín
- Pharmacogenetics and Pharmacogenomics Laboratory, Pharmacy Department, Gregorio Marañón University Hospital, 28007, Madrid, Spain
| | - Carlos J Parramón-Teixidó
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
| | - Marina Álvarez-Beltrán
- Paediatric Gastroenterology and Clinical Nutrition Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
| | - Luís A López-Fernández
- Pharmacogenetics and Pharmacogenomics Laboratory, Pharmacy Department, Gregorio Marañón University Hospital, 28007, Madrid, Spain
| | - Helena Colom
- Pharmacy and Pharmaceutical Technology and Physical Chemistry Department, University of Barcelona, 08028, Barcelona, Spain
| | - Maria J Cabañas-Poy
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
| | - Maria Q Gorgas-Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, 08035, Barcelona, Spain
- Pharmacy Department, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
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Larrosa-García M, Garcia-Garcia S, Louro J, Sánchez-Montalvá A, Sampol Sirvent J, Augustín Recio S, Guillén Del Castillo A, Riera-Arnau J, Gorgas MQ, Miarons M. Use of chronic medications and risk of death due to COVID-19 in hospitalised patients. Eur J Hosp Pharm 2024; 31:247-252. [PMID: 36302612 DOI: 10.1136/ejhpharm-2021-003186] [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: 12/20/2021] [Accepted: 10/11/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate the potential association between chronic exposure to medication and death related to COVID-19. METHODS This is a retrospective cross-sectional study that included all patients hospitalised due to COVID-19 from 11 March to 4 June 2020 in our centre. Chronic patient medication was classified by the Anatomical Therapeutic Chemical (ATC) classification; demographic and clinical data were analysed. Multivariate logistic regression models were used to estimate the adjusted odds ratios (aOR) of death for each drug exposure; each aOR represents an independent model adjusted by clinical factors related to COVID-19 mortality. RESULTS The study included 978 patients with a mean (SD) age of 64.5 (17.7) years who were predominantly male (531, 54.3%). Of all 978 patients, 182 (18.61%) died during the follow-up of the study. The most common Charlson Comorbidity Index (CCI) was 0, 4.2% were smokers, 16.7% were obese, 47.4% had hypertension, and 19.4% were diabetic. Most patients (70.8%) were prescribed at least one treatment, 32.5% used >5 treatments, and 8.6% >10. Our data suggest that COVID-19 hospitalised patients taking trimethoprim and analogues, leukotriene receptor antagonists, calcineurin inhibitors, aldosterone antagonists, selective immunosuppressants, propulsives, insulins and analogues, and benzodiazepine derivatives have a higher risk of death. CONCLUSIONS This study investigated the association between chronic exposure to drugs and the risk of death in COVID-19 patients. Our results have shed some light on the impact of chronic drug exposure on the risk of severe COVID-19; however, further research is needed to increase the understanding about its relevance.
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Affiliation(s)
| | | | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM, Hospital del Mar INAD, Barcelona, Spain
| | | | | | | | | | - Judit Riera-Arnau
- Pharmacology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Marta Miarons
- Pharmacy Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Sánchez-Salinas MA, Miarons M, Troconiz IF, Navarro V, Varela J, Iacoboni G, Barba P. Is estimated exposure an accurate surrogate for measured fludarabine levels in CAR T-cell patients? Blood Adv 2024; 8:bloodadvances.2023011433. [PMID: 38231085 PMCID: PMC11059335 DOI: 10.1182/bloodadvances.2023011433] [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] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/18/2024] Open
Affiliation(s)
- Mario Andrés Sánchez-Salinas
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Pharmacy Department, Consorci Hospitalari de Vic, Barcelona, Spain
| | - Iñaki F. Troconiz
- Department of Pharmaceutical Sciences, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Víctor Navarro
- Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Javier Varela
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Biagetti B, Sánchez-Montalvá A, Puig-Perez A, Campos-Varela I, Pilia MF, Anderssen-Nordahl E, González-Sans D, Miarons M, Simó R. Hyponatremia after COVID-19 is frequent in the first year and increases re-admissions. Sci Rep 2024; 14:595. [PMID: 38182711 PMCID: PMC10770325 DOI: 10.1038/s41598-023-50970-z] [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: 07/25/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
Hyponatremia on admission has been related to worse outcomes in patients with COVID-19 infection. However, little is known about the frequency and the associated risk factors of hyponatremia after COVID-19 discharge. We performed an observational 24-month follow-up study of patients admitted during the first COVID-19 wave. Kaplan-Meier curves and Cox proportional hazard models were used to assess the main variables in predicting hyponatremia on follow-up (HYPO-FU). A total of 161 out of 683 (24.4%) developed HYPO-FU. The group with HYPO-FU comprised of more men [(62.3%) vs. (49.2%); p < 0.01], older [65.6 ± 18.2 vs. 60.3 ± 17.0; p < 0.01] and more frequently re-admitted [(16.2%) vs. (3.8%); p < 0.01). The rate of HYPO-FU was higher in the first year 23.6 per 100 individuals per year. After Cox regression analysis, the independent risk factors of HYPO-FU were diabetes [OR 2.12, IC 95% (1.48-3.04)], hypertension [OR 2.18, IC 95% (1.53-3.12)], heart failure [OR 3.34, IC 95% (1.72-6.48)] and invasive ventilation support requirement [OR: 2.38, IC 95% (1.63-3.50)]. To conclude, HYPO-FU was frequent in the first year after COVID-19 infection, and the risk was higher in older men with comorbidities, increasing rehospitalisation. Further studies aimed at evaluating the beneficial effects of correcting hyponatremia in these patients are warranted.
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Affiliation(s)
- Betina Biagetti
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Global Health Program from the Catalan Health Institute (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain
- Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
- Infectious Diseases Netword Biomedical Research Center (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Puig-Perez
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Florencia Pilia
- Pneumology Department, Vall d'Hebron University Hospital, Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Emilie Anderssen-Nordahl
- Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Didac González-Sans
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rafael Simó
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
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Parra AP, Ramos N, Perurena-Prieto J, Manrique-Rodríguez S, Climente M, Quintanilla LG, Escolano Á, Miarons M. [Translated article] Pharmacokinetics of eculizumab in adult and pediatric patients with atypical hemolytic uremic syndrome and C3 glomerulopathy. Farm Hosp 2024; 48:T16-T22. [PMID: 38057242 DOI: 10.1016/j.farma.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE The objective of the study was to analyze and describe the concentrations of eculizumab and the complement blockade in patients with atypical hemolytic uremic syndrome (aHUS) and C3 glomerulopathy, and to define a therapeutic margin where there is a high probability of achieving therapeutic efficacy. METHODS Observational, ambispective, and multicenter study that included adult and pediatric patients diagnosed with aHUS and C3 glomerulopathy from September 2020 to October 2022 in 5 hospitals in Spain. Eculizumab was administered at the doses recommended by the data sheet according to the European Medicines Agency (EMA). Pre- and post-dose concentrations of eculizumab were determined, as well as blockade of the classical complement pathway (CH50). Sociodemographic and clinical data were collected, and pharmacokinetic parameters were calculated. To establish the cut-off point for eculizumab concentrations that predicted complement blockade, Receiver Operating Characteristic (ROC) curve analysis was performed. Lastly, the Kruskal-Wallis test was used to contrast the differences in different parameters according to eculizumab concentrations. RESULTS Twenty-five patients were included, 19 adults (76.0%) and 6 pediatrics (24.0%), with median ages of 43.4 (interquartile range (IQR) 35.7-48.8) and 10.1 (IQR 9.6-11.3) years, respectively. Of these, 22 (88.0%) patients were diagnosed with aHUS and 3 (12.0%) with C3 glomerulopathy. A total of 111 eculizumab concentrations were determined. Mean pre- and post-dose concentration values detected during the maintenance phase were 243.8 (SD 240.6) μg/mL and 747.4 (standard deviation (SD) 444.3) μg/mL, respectively. Increased complement blockade was observed at higher pre-dose concentrations (P = .002) and decreased serum creatinine at both higher pre- and post-dose concentrations (P = .001 and P = .017, respectively). Using ROC curves, it was determined that a pre-dose concentration >149.0 μg/mL was optimal to achieve complement blockade, with an AUC of 0.87 (0.78-0.95). Finally, high inter-individual (48.9% variation coefficient (CV)) with low intra-individual variabilities (11.9% CV) in eculizumab clearance were observed. CONCLUSIONS The present study reports supratherapeutic concentrations of eculizumab in patients with aHUS, and defines higher concentrations than those described in the data sheet to achieve blockade, thus encouraging the personalization of treatment with eculizumab.
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Affiliation(s)
- Alba Pau Parra
- Servicio de Farmacia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Natalia Ramos
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Janire Perurena-Prieto
- Servicio de Inmunología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Monica Climente
- Servicio de Farmacia, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Laura García Quintanilla
- Servicio de Farmacia, Área Sanitaria de Santiago de Compostela e Barbanza (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Ángel Escolano
- Servicio de Farmacia, Hospital Universitario Miguel Servet, Aragón, Spain
| | - Marta Miarons
- Servicio de Farmacia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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Pau Parra A, Ramos N, Perurena-Prieto J, Manrique-Rodríguez S, Climente M, García Quintanilla L, Escolano Á, Miarons M. Pharmacokinetics of eculizumab in adult and pediatric patients with atypical hemolytic uremic syndrome and C3 glomerulopathy. Farm Hosp 2024; 48:16-22. [PMID: 37612186 DOI: 10.1016/j.farma.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE The objective of the study was to analyze and describe the concentrations of eculizumab and the complement blockade in patients with atypical hemolytic uremic syndrome (aHUS) and C3 glomerulopathy, and to define a therapeutic margin where there is a high probability of achieving therapeutic efficacy. METHODS Observational, ambispective and multicenter study that included adult and pediatric patients diagnosed with aHUS and C3 glomerulopathy from September 2020 to October 2022 in five hospitals in Spain. Eculizumab was administered at the doses recommended by the data sheet according to the European Medicines Agency (EMA). Pre-dose and post-dose concentrations of eculizumab were determined, as well as blockade of the classical complement pathway (CH50). Sociodemographic and clinical data were collected, and pharmacokinetic parameters were calculated. To establish the cut-off point for eculizumab concentrations that predicted complement blockade, Receiver Operating Characteristic (ROC) curve analysis was performed. Lastly, the Kruskal-Wallis test was used to contrast the differences in different parameters according to eculizumab concentrations. RESULTS Twenty-five patients were included, 19 adults (76.0%) and 6 pediatrics (24.0%), with median ages of 43.4 (IQR 35.7-48.8) and 10.1 (IQR 9.6-11.3) years, respectively. Of these, 22 (88.0%) patients were diagnosed with aHUS and 3 (12.0%) with C3 glomerulopathy. A total of 111 eculizumab concentrations were determined. Mean pre-dose and post-dose concentration values detected during the maintenance phase were 243.8 (SD 240.6) μg/mL and 747.4 (SD 444.3) μg/mL, respectively. Increased complement blockade was observed at higher pre-dose concentrations (p=0.002) and decreased serum creatinine at both higher pre- and post-dose concentrations (p=0.001 and p=0.017, respectively). Using ROC curves, it was determined that a pre-dose concentration >149.0 μg/mL was optimal to achieve complement blockade, with an AUC of 0.87 (0.78-0.95). Finally, high inter-individual (48.9% CV) with low intra-individual variabilities (11.9% CV) in eculizumab clearance were observed. CONCLUSIONS The present study reports supratherapeutic concentrations of eculizumab in patients with aHUS, and defines higher concentrations than those described in the data sheet to achieve blockade, thus encouraging the personalization of treatment with eculizumab.
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Affiliation(s)
- Alba Pau Parra
- Servicio de Farmacia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Natalia Ramos
- Servicio de Nefrología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Janire Perurena-Prieto
- Servicio de Inmunología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | | | - Monica Climente
- Servicio de Farmacia, Hospital Universitario Doctor Peset, Valencia, España
| | - Laura García Quintanilla
- Servicio de Farmacia, Área Sanitaria de Santiago de Compostela e Barbanza (SERGAS), Santiago de Compostela, Galicia, España
| | - Ángel Escolano
- Servicio de Farmacia, Hospital Universitario Miguel Servet, Aragón, España
| | - Marta Miarons
- Servicio de Farmacia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España.
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Lalagkas PN, Iliou J, Rigo R, Miarons M, Fernández-Alarcon B, Bestard O, Cruzado JM, Melilli E, Torras J, Grinyó JM, Lloberas N, Colom H. Comparison of Three Renal Function Formulas for Ganciclovir/Valganciclovir Dose Individualization in CMV-Infected Solid Organ Transplantation Patients Using a Population Approach. Clin Pharmacokinet 2023; 62:861-880. [PMID: 37140726 PMCID: PMC10256675 DOI: 10.1007/s40262-023-01237-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The gold standard treatment of established cytomegalovirus infection or prevention in solid organ transplantation is the intravenous administration of ganciclovir (GCV) or oral administration of valganciclovir (VGCV), both adjusted to the renal function. In both instances, there is a high interindividual pharmacokinetic variability, mainly owing to the wide range of variation of both the renal function and body weight. Therefore, accurate estimation of the renal function is crucial for GCV/VGCV dose optimization. This study aimed to compare three different formulas for estimating the renal function in solid organ transplantation patients with cytomegalovirus infection, for individualizing antiviral therapy with GCV/VGCV, using a population approach. METHODS A population pharmacokinetic analysis was performed using NONMEM 7.4. A total of 650 plasma concentrations obtained after intravenous GCV and oral VGCV administrations were analyzed, from intensive and sparse sampling designs. Three different population pharmacokinetic models were built with the renal function given by Cockcroft-Gault, Modification of Diet in Renal Disease, or Chronic Kidney Disease EPIdemiology Collaboration (CKD-EPI) formulas. Pharmacokinetic parameters were allometrically scaled to body weight. RESULTS The CKD-EPI formula was identified as the best predictor of between-patient variability in GCV clearance. Internal and external validation techniques showed that the CKD-EPI model had better stability and performed better compared with the others. CONCLUSIONS The model based on the more accurate estimation of the renal function with the CKD-EPI formula and body weight as a size metric most used in the clinical practice can refine initial dose recommendations and contribute to GCV and VGCV dose individualization when required in the prevention or treatment of cytomegalovirus infection in solid organ transplantation patients.
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Affiliation(s)
- Panagiotis Nikolaos Lalagkas
- Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, Avda. Joan XXIII, s/n, 08028, Barcelona, Spain
| | - Jorge Iliou
- Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, Avda. Joan XXIII, s/n, 08028, Barcelona, Spain
| | - Raul Rigo
- Biochemistry Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Service, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - Beatriz Fernández-Alarcon
- Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, Avda. Joan XXIII, s/n, 08028, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Service, Hospital Universitari de Bellvitge, IDIBELL, Lab Exp Nephrology 4122, Pav. Govern, 4a planta, UB, Feixa Llarga s/n, L'Hospitalet de Llobregat, Llobregat, 08907, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Service, Hospital Universitari de Bellvitge, IDIBELL, Lab Exp Nephrology 4122, Pav. Govern, 4a planta, UB, Feixa Llarga s/n, L'Hospitalet de Llobregat, Llobregat, 08907, Barcelona, Spain
| | - Edoardo Melilli
- Nephrology Service, Hospital Universitari de Bellvitge, IDIBELL, Lab Exp Nephrology 4122, Pav. Govern, 4a planta, UB, Feixa Llarga s/n, L'Hospitalet de Llobregat, Llobregat, 08907, Barcelona, Spain
| | - Joan Torras
- Nephrology Service, Hospital Universitari de Bellvitge, IDIBELL, Lab Exp Nephrology 4122, Pav. Govern, 4a planta, UB, Feixa Llarga s/n, L'Hospitalet de Llobregat, Llobregat, 08907, Barcelona, Spain
| | - Josep M Grinyó
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Nuria Lloberas
- Nephrology Service, Hospital Universitari de Bellvitge, IDIBELL, Lab Exp Nephrology 4122, Pav. Govern, 4a planta, UB, Feixa Llarga s/n, L'Hospitalet de Llobregat, Llobregat, 08907, Barcelona, Spain.
| | - Helena Colom
- Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology and Physical-Chemistry, School of Pharmacy and Food Sciences, University of Barcelona, Avda. Joan XXIII, s/n, 08028, Barcelona, Spain.
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Miarons M, Manzaneque Gordón A, Riera P, Gutiérrez Nicolás F. Allelic Frequency of DPYD Genetic Variants in Patients With Cancer in Spain: The PhotoDPYD Study. Oncologist 2023; 28:e304-e308. [PMID: 37014829 PMCID: PMC10166167 DOI: 10.1093/oncolo/oyad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Identifying polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) gene is gaining importance to be able to predict fluoropyrimidine-associated toxicity. The aim of this project was to describe the frequency of the DPYD variants DPYD*2A (rs3918290); c.1679T>G (rs55886062); c.2846A>T (rs67376798) and c.1129-5923C>G (rs75017182; HapB3) in the Spanish oncological patients. MATERIAL AND METHODS Cross-sectional and multicentric study (PhotoDPYD study) conducted in hospitals located in Spain designed to register the frequency of the most relevant DPYD genetic variants in oncological patients. All oncological patients with DPYD genotype were recruited in the participant hospitals. The measures determined where the presence or not of the 4 DPYD previously described variants. RESULTS Blood samples from 8054 patients with cancer from 40 different hospitals were used to determine the prevalence of the 4 variants located in the DPYD gene. The frequency of carriers of one defective DPYD variant was 4.9%. The most frequently identified variant was c.1129-5923C>G (rs75017182) (HapB3), in 2.9%, followed by c.2846A>T (rs67376798) in 1.4%, c.1905 + 1G>A (rs3918290, DPYD*2A) in 0.7% and c.1679T>G (rs55886062) in 0.2% of the patients. Only 7 patients (0.08%) were carrying the c.1129-5923C>G (rs75017182) (HapB3) variant, 3 (0.04%) the c.1905 + 1G>A (rs3918290, DPYD*2A) and one (0.01%) the DPYD c.2846A>T (rs67376798, p.D949V) variant in homozygosis. Moreover, 0.07% were compound heterozygous patients, 3 carrying the DPYD variants DPYD*2A + c.2846A>T, 2 the DPYD c.1129-5923C>G + c.2846A>T and one the DPYD*2A + c.1129-5923C>G variants. CONCLUSIONS Our results demonstrate the relatively high frequency of DPYD genetic variants in the Spanish patient with cancer population, which highlights the relevance of their determination before initiating a fluoropirimidine-containing regimen.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital, Campus, Barcelona, Spain
- ReDPyD group from the Spanish Society of Hospital Pharmacy (SEFH), Tenerife, Canarias, Spain
| | - Alba Manzaneque Gordón
- Pharmacy Department, Hospital Mutua de Terrassa, Terrassa, Barcelona, Spain
- ReDPyD group from the Spanish Society of Hospital Pharmacy (SEFH), Tenerife, Canarias, Spain
| | - Pau Riera
- Pharmacy Department, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Carrer Sant Quintí, Barcelona, Spain
- U705, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- ReDPyD group from the Spanish Society of Hospital Pharmacy (SEFH), Tenerife, Canarias, Spain
| | - Fernando Gutiérrez Nicolás
- Pharmacy Department, Research Unit Hospital Universitario de Canarias (CHUC), Tenerife, Canarias, Spain
- ReDPyD group from the Spanish Society of Hospital Pharmacy (SEFH), Tenerife, Canarias, Spain
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9
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Andrés C, González-Sánchez A, Jiménez M, Márquez-Algaba E, Piñana M, Fernández-Naval C, Esperalba J, Saubi N, Quer J, Rando-Segura A, Miarons M, Codina MG, Ruiz-Camps I, Pumarola T, Abrisqueta P, Antón A. Emergence of Delta and Omicron variants carrying resistance-associated mutations in immunocompromised patients undergoing sotrovimab treatment with long-term viral excretion. Clin Microbiol Infect 2023; 29:240-246. [PMID: 36067943 DOI: 10.1016/j.cmi.2022.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To monitor the early emergence of genetic mutations related to reduced susceptibility to monoclonal anti-body (mAb)-based treatment in immunocompromised patients with long-term viral excretion using whole-genome sequencing at a tertiary university hospital in Barcelona, Spain. METHODS Serial severe acute respiratory syndrome coronavirus 2-positive samples (mid-December 2021-mid-March 2022) from eight immunosuppressed, fully vaccinated patients (for solid-organ transplantation or haematologic malignancies) with long-term viral excretion despite undergoing mAb therapy (sotrovimab) for coronavirus disease 2019 were selected. Whole-genome sequencing was performed following the ARTIC, version 4.1, protocol on the MiSeq platform. Mutations in the coding sequence of the spike protein with a frequency of ≥5% were studied. RESULTS A total of 37 samples from the studied cases were analysed. All the cases, except one, were confirmed to have the Omicron variant BA.1; one had Delta (AY.100). Thirty-four different mutations were detected within the receptor-binding domain of the spike protein in 62.5% of patients, eight of which were not lineage related and located in the sotrovimab target epitope (P337L, E340D, E340R, E340K, E340V, E340Q, R346T and K356T). Except for P337L, all changes showed a significant increase in frequency or fixation after the administration of sotrovimab. Some of them have been associated with either reduced susceptibility to mAb therapy, such as those at position 340, or the acquisition of a new glycosylation site (346 and 356 positions). CONCLUSIONS This study highlights the importance of monitoring for early in vivo selection of mutations associated with reduced susceptibility to mAb therapy, especially in immunocompromised patients receiving anti-viral drugs, whose immune response is not able to control viral replication, resulting in long-term viral shedding, and those receiving selective evolution pressure. Virologic surveillance of genetically resistant viruses to available anti-viral therapies is considered a priority for both patients and the community.
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Affiliation(s)
- Cristina Andrés
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Alejandra González-Sánchez
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Ester Márquez-Algaba
- Department of Infectious Diseases. Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Piñana
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Candela Fernández-Naval
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Juliana Esperalba
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Narcís Saubi
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Josep Quer
- Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut of Research, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Av. Monforte de Lemos, Madrid, Spain; Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), UAB Campus, Plaça Cívica, Bellaterra, Spain
| | - Ariadna Rando-Segura
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Maria Gema Codina
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Isabel Ruiz-Camps
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Infectious Diseases. Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain.
| | - Pau Abrisqueta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
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10
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Villena-Ortiz Y, Castellote-Bellés L, Martinez-Sanchez L, Benítez-Carabante MI, Miarons M, Vima-Bofarull J, Barquin-DelPino R, Paciucci R, Rodríguez-Frías F, Ferrer-Costa R, Casis E, López-Hellín J. Rapid and accurate method for quantifying busulfan in plasma samples by isocratic liquid chromatography-tandem mass spectrometry (LC-MS/MS). Adv Lab Med 2022; 3:263-281. [PMID: 37362141 PMCID: PMC10197276 DOI: 10.1515/almed-2022-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 06/28/2023]
Abstract
Objectives Administration of busulfan is extending rapidly as a part of a conditioning regimen in patients undergoing hematopoietic stem cell transplantation (HSCT). Monitoring blood plasma levels of busulfan is recommended for identifying the optimal dose in patients and for minimizing toxicity. The aim of this research was to validate a simple, rapid, and cost-effective analytical tool for measuring busulfan in human plasma that would be suitable for routine clinical use. This novel tool was based on liquid chromatography coupled to mass spectrometry. Methods Human plasma samples were prepared using a one-step protein precipitation protocol. These samples were then resolved by isocratic elution in a C18 column. The mobile phase consisted 2 mM ammonium acetate and 0.1% formic acid dissolved in a 30:70 ratio of methanol/water. Busulfan-d8 was used as the internal standard. Results The run time was optimized at 1.6 min. Standard curves were linear from 0.03 to 5 mg/L. The coefficient of variation (%CV) was less than 8%. The accuracy of this method had an acceptable bias that fell within 85-115% range. No interference between busulfan and the interfering compound hemoglobin, lipemia, or bilirubin not even at the highest concentrations of compound was tested. Neither carryover nor matrix effects were observed using this method. The area under the plasma drug concentration-time curves obtained for 15 pediatric patients who received busulfan therapy prior to HSCT were analyzed and correlated properly with the administered doses. Conclusions This method was successfully validated and was found to be robust enough for therapeutic drug monitoring in a clinical setting.
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Affiliation(s)
- Yolanda Villena-Ortiz
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Bioquimica i Biologia Molecular, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Laura Castellote-Bellés
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Luisa Martinez-Sanchez
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Bioquimica i Biologia Molecular, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - María I. Benítez-Carabante
- Department of Pediatric Hematology and Oncology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Jaume Vima-Bofarull
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Raquel Barquin-DelPino
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Rosanna Paciucci
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francisco Rodríguez-Frías
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Bioquimica i Biologia Molecular, Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Roser Ferrer-Costa
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Ernesto Casis
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Joan López-Hellín
- Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain
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11
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Miarons M, Riera P, García-Gil S, Gutiérrez-Nicolás F. Efficacy and safety of high doses of irinotecan in patients with metastatic colorectal cancer treated with the FOLFIRI regimen based on the UGT1A1 genotype: A systematic review. Farm Hosp 2022; 46:224-233. [PMID: 36183220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review is to analyze the published data on the efficacy and safety of doses higher than 180 mg/m2 of irinotecan recommended in the drug's summary of product characteristics in metastatic colorectal cancer patients with genotypes UGT1A1*1/*1 or *1/*28 who are treated with the FOLFIRI regimen. METHOD A systematic review of the literature was carried out in Medline and Embase searching for articles published up to December 2021. The methods used were based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The criteria for the inclusion of studies were previously defined based on the two secondary goals addressed in this review: 1) To analyze the magnitude of the differences in clinical responses and 2) To study the magnitude of the differences in adverse effects of irinotecan at high doses, as compared to the doses described in the summary of product characteristics corresponding to the FOLFIRI regimen in patients with metastatic colorectal cancer with genotypes UGT1A1*1/* 1 or *1/*28. RESULTS The search yielded a total of 985 references, of which 13 were selected for analysis. Seven evaluated both efficacy and safety and six only safety. With regard to the studies that evaluated both efficacy and safety, six out of seven (85.7%) were in favor of increasing irinotecan dose according to the objective response rate and progression-free survival. Two of them even recommended dose increases based on overall survival. Irinotecan safety studies suggest that doses higher than 180 mg/m2 are tolerated by most UGT1A1*1/*1 and *1/*28 patients. CONCLUSIONS The present systematic review shows the advisability of considering adjusting the dose of irinotecan when used as part of the FOLFIRI regimen based on the polymorphisms of the UGT1A1 gene as this may increase the likelihood of an adequate clinical response.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. RedDPyD..
| | - Pau Riera
- Department of Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona. Spain. U705, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona. Spain..
| | - Sara García-Gil
- Department of Pharmacy, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna (Santa Cruz de Tenerife). Spain.
| | - Fernando Gutiérrez-Nicolás
- Department of Pharmacy, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna (Santa Cruz de Tenerife). Spain.
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Aguilera C, Danés I, Guillén E, Vimes A, Bosch M, Cereza G, Sánchez-Montalvá A, Campos-Varela I, Miarons M, Mestre-Torres J, Agustí A. Safety of Drugs Used during the First Wave of COVID-19: A Hospital-Registry-Based Study. Diagnostics (Basel) 2022; 12:diagnostics12071612. [PMID: 35885517 PMCID: PMC9316110 DOI: 10.3390/diagnostics12071612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 12/23/2022] Open
Abstract
The emergency of the coronavirus disease 2019 (COVID-19) pandemic led to the off-label use of drugs without data on their toxicity profiles in patients with COVID-19, or on their concomitant use. Patients included in the COVID-19 Patient Registry of a tertiary hospital during the first wave were analyzed to evaluate the adverse drug reactions (ADRs) with the selected treatments. Twenty-one percent of patients (197 out of 933) had at least one ADR, with a total of 240 ADRs. Patients with ADRs were more commonly treated with multiple drugs for COVID-19 infection than patients without ADRs (p < 0.001). They were younger (median 62 years vs. 70.1 years; p < 0.001) and took less medication regularly (69.5% vs. 75.7%; p = 0.031). The most frequent ADRs were gastrointestinal (67.1%), hepatobiliary (10.8%), and cardiac disorders (3.3%). Drugs more frequently involved included lopinavir/ritonavir (82.2%), hydroxychloroquine (72.1%), and azithromycin (66.5%). Although most ADRs recovered without sequelae, fatal cases were described, even though the role of the disease could not be completely ruled out. In similar situations, efforts should be made to use the drugs in the context of clinical trials, and to limit off-label use to those drugs with a better benefit/risk profile in specific situations and for patients at high risk of poor disease prognosis.
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Affiliation(s)
- Cristina Aguilera
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
- Immunomediated Diseases and Innovative Therapies Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
| | - Immaculada Danés
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
- Immunomediated Diseases and Innovative Therapies Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- Correspondence:
| | - Elena Guillén
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
| | - Alba Vimes
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
| | - Montserrat Bosch
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
- Immunomediated Diseases and Innovative Therapies Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
| | - Gloria Cereza
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
- Immunomediated Diseases and Innovative Therapies Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
- Catalan Institute of Pharmacology Foundation, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- International Health and Tuberculosis Unit, Infectious Diseases Department, National Referral Centre for Tropical Diseases, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Isabel Campos-Varela
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Jaume Mestre-Torres
- Internal Medicine Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Antònia Agustí
- Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain; (C.A.); (E.G.); (A.V.); (M.B.); (A.A.)
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
- Immunomediated Diseases and Innovative Therapies Group, Vall d’Hebron Research Institute, 08035 Barcelona, Spain
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Sánchez-Montalvá A, Sellarés-Nadal J, Espinosa-Pereiro J, Fernández-Hidalgo N, Pérez-Hoyos S, Salvador F, Durà X, Miarons M, Antón A, Eremiev-Eremiev S, Sempere-González A, Monforte-Pallarés A, Bosch-Nicolau P, Augustin S, Sampol J, Guillén-del-Castillo A, Almirante B. Early outcomes in adults hospitalized with severe SARS-CoV-2 infection receiving tocilizumab. Med Clin (Barc) 2022; 158:509-518. [PMID: 34544604 PMCID: PMC8448395 DOI: 10.1016/j.medcli.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Modulation of the immune system to prevent lung injury is being widely used against the new coronavirus disease (COVID-19). The primary endpoint was mortality at 7 days after tocilizumab administration. Secondary endpoints were admission to the intensive care unit, development of ARDS and respiratory insufficiency among others. METHODS We report the preliminary results from the Vall d'Hebron cohort study at Vall d'Hebron University Hospital, in Barcelona (Spain), including all consecutive patients who had a confirmed SARS-CoV-2 infection and who were treated with tocilizumab until March 25th. RESULTS 82 patients with COVID-19 received at least one dose of tocilizumab. The mean (± SD) age was 59.1 (19.8) years, 63% were male, 22% were of non-Spanish ancestry, and the median (IQR) age-adjusted Charlson index at baseline was 3 (1-4) points. Respiratory failure and ARDS developed in 62 (75.6%) and 45 (54.9%) patients, respectively. Median time from symptom onset to ARDS development was 8 (5-11) days. Mortality at 7 days was 26.8%. Hazard ratio for mortality was 3.3; 95% CI, 1.3-8.5 (age-adjusted hazard ratio for mortality 2.1; 95% CI, 0.8-5.8) if tocilizumab was administered after the onset of ARDS. CONCLUSION Early administration of tocilizumab in patients needing oxygen supplementation may be critical to patient recovery. Our preliminary data could inform bedside decisions until more data regarding the precise timing in of initiation of the treatment with tocilizumab.
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Affiliation(s)
- Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain,Tropical Medicine Spanish Research Network (RICET), Madrid, Spain,Corresponding author
| | - Júlia Sellarés-Nadal
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain
| | | | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain,Tropical Medicine Spanish Research Network (RICET), Madrid, Spain
| | - Xavier Durà
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Antón
- Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain,Microbiology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Simeón Eremiev-Eremiev
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Abiu Sempere-González
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Monforte-Pallarés
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Augustin
- Hepatology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Júlia Sampol
- Pneumology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alfredo Guillén-del-Castillo
- Internal Medicine Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain,Infectous Diseases Spanish Research Network (REIPI), Madrid, Spain
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Sánchez-Montalvá A, Sellarés-Nadal J, Espinosa-Pereiro J, Fernández-Hidalgo N, Pérez-Hoyos S, Salvador F, Durà X, Miarons M, Antón A, Eremiev-Eremiev S, Sempere-González A, Monforte-Pallarés A, Bosch-Nicolau P, Augustin S, Sampol J, Guillén-del-Castillo A, Almirante B. Early outcomes in adults hospitalized with severe SARS-CoV-2 infection receiving tocilizumab. Medicina Clínica (English Edition) 2022; 158:509-518. [PMID: 35755602 PMCID: PMC9213005 DOI: 10.1016/j.medcle.2021.06.023] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusion
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15
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Sánchez-Hernández JG, Rebollo N, Muñoz F, Padullés-Zamora N, Miarons M, Martín Gutiérrez N, Martín Gil M, Otero MJ. Relationship between vedolizumab serum concentrations in the induction phase and early and sustained response in the first year of treatment in patients with ulcerative colitis. Farm Hosp 2021; 45:38-44. [PMID: 35379109] [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: 06/14/2023] Open
Abstract
OBJECTIVE Evidence on the usefulness of proactive monitoring of vedolizumab serum concentrations during the induction phase of treatment is limited. The objective of our study was to evaluate the effectiveness of measuring such concentrations during this phase in predicting response to treatment in patients with ulcerative colitis with a view to determining whether patients would benefit from early monitoring of edolizumab serum concentrations. METHOD This was a prospective descriptive study carried out at three public general hospitals. It included adult patients with ulcerative colitis who were initiated on vedolizumab at the participating hospitals from June 2019 to June 2020. Vedolizumab serum concentrations were determined at weeks 6 and 14. Response to treatment was biologically, clinically, and endoscopically evaluated at weeks 6, 14, and 52. An analysis was made of the relationship between vedolizumab serum concentrations at week 6 and early response to treatment, and of the relationship between the vedolizumab serum concentrations at weeks 6 and 14 and persistent response at one year. RESULTS A total of 45 patients were included of whom 22 (49%) were considered non-responsive after one year and required intensification of treatment. The median (interquartile range) vedolizumab serum oncentrations obtained at 6 weeks was higher in patients who obtained an early response and in those who maintained the response at one year than in those who did not respond to vedolizumab [27.4 (19.0-40.8) μg/mL vs 15.6 (13.4-28.5) μg/mL; p = 0.018] and [29.9 (19.2-43.2) μg/mL vs 18.2 (15.4- 26.9) μg/mL; p = 0.022] respectively. Vedolizumab serum concentrations ≥ 17.3 μg/mL at week 6 were predictive of a good early response, and edolizumab serum concentrations ≥ 26.1 μg/mL at week 6 predicted a sustained response at one year. No relationship was found between edolizumab serum concentrations at week 14 and a sustained response. CONCLUSIONS We observed a relationship between vedolizumab serum concentrations determined at week 6, and early and maintained esponse to vedolizumab therapy in patients with ulcerative colitis, which supports early drug monitoring during the induction phase to individualize treatment and increase effectiveness.
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Affiliation(s)
| | - Noemí Rebollo
- Servicio de Farmacia, Hospital Universitario de Salamanca-IBSAL, Salamanca. Spain..
| | - Fernando Muñoz
- Servicio de Aparato Digestivo, Hospital Universitario de Salamanca-IBSAL, Salamanca. Spain..
| | - Nuria Padullés-Zamora
- Servicio de Farmacia, Hospital Universitario de Bellvitge-IDIBELL, Barcelona. Spain..
| | - Marta Miarons
- Servicio de Farmacia, Hospital Universitario de Vall'Hebron, Barcelona. Spain..
| | | | - Marcos Martín Gil
- Servicio de Farmacia, Hospital Universitario de Salamanca-IBSAL, Salamanca. Spain..
| | - María José Otero
- Servicio de Farmacia, Hospital Universitario de Salamanca-IBSAL, Salamanca. Spain..
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16
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Sempere A, Salvador F, Monforte A, Sampol J, Espinosa-Pereiro J, Miarons M, Bosch-Nicolau P, Guillén-del-Castillo A, Aznar ML, Campos-Varela I, Sánchez-Montalvá A, Leguízamo-Martínez LM, Oliveira I, Antón A, Almirante B. COVID-19 Clinical Profile in Latin American Migrants Living in Spain: Does the Geographical Origin Matter? J Clin Med 2021; 10:5213. [PMID: 34830495 PMCID: PMC8622310 DOI: 10.3390/jcm10225213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to describe and compare the clinical characteristics of hospitalized patients with COVID-19 pneumonia according to their geographical origin. This is a retrospective case-control study of hospitalized patients with confirmed COVID-19 pneumonia treated at Vall d'Hebron University Hospital (Barcelona) during the first wave of the pandemic. Cases were defined as patients born in Latin America and controls were randomly selected among Spanish patients matched by age and gender. Demographic and clinical variables were collected, including comorbidities, symptoms, vital signs and analytical parameters, intensive care unit admission and outcome at 28 days after admission. Overall, 1080 hospitalized patients were registered: 774 (71.6%) from Spain, 142 (13.1%) from Latin America and the rest from other countries. Patients from Latin America were considered as cases and 558 Spanish patients were randomly selected as controls. Latin American patients had a higher proportion of anosmia, rhinorrhea and odynophagia, as well as higher mean levels of platelets and lower mean levels of ferritin than Spanish patients. No differences were found in oxygen requirement and mortality at 28 days after admission, but there was a higher proportion of ICU admissions (28.2% vs. 20.2%, p = 0.0310). An increased proportion of ICU admissions were found in patients from Latin America compared with native Spanish patients when adjusted by age and gender, with no significant differences in in-hospital mortality.
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Affiliation(s)
- Abiu Sempere
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Arnau Monforte
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Júlia Sampol
- Department of Pneumology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Juan Espinosa-Pereiro
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Marta Miarons
- Department of Pharmacy, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | | | - Maria Luisa Aznar
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Isabel Campos-Varela
- Liver Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Lina María Leguízamo-Martínez
- Department of Pharmacovigilance and Pharmacoepidemiology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Inés Oliveira
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
| | - Andrés Antón
- Department of Microbiology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Benito Almirante
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain; (A.S.); (A.M.); (J.E.-P.); (P.B.-N.); (M.L.A.); (A.S.-M.); (I.O.); (B.A.)
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Larrosa-Garcia M, Garcia-Garcia S, Los-Arcos I, Moreso F, Berastegui C, Castells L, Gorgas Torner MQ, Miarons M. Long-term effects of COVID-19 in solid organ transplantation recipients. Transpl Infect Dis 2021; 23:e13677. [PMID: 34174006 PMCID: PMC8420400 DOI: 10.1111/tid.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Larrosa-Garcia
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sonia Garcia-Garcia
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Berastegui
- Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Q Gorgas Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Miarons M, Marín S, Amenós I, Campins L, Rovira M, Daza M. Pharmaceutical interventions in the emergency department: cost-effectiveness and cost-benefit analysis. Eur J Hosp Pharm 2021; 28:133-138. [DOI: 10.1136/ejhpharm-2019-002067] [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] [Received: 08/13/2019] [Revised: 01/13/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
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Jiménez-Lozano I, Caro-Teller JM, Fernández-Hidalgo N, Miarons M, Frick MA, Batllori Badia E, Serrano B, Parramon-Teixidó CJ, Camba-Longueira F, Moral-Pumarega MT, San Juan-Garrido R, Cabañas Poy MJ, Suy A, Gorgas Torner MQ. Safety of tocilizumab in COVID-19 pregnant women and their newborn: A retrospective study. J Clin Pharm Ther 2021; 46:1062-1070. [PMID: 33638257 PMCID: PMC8014796 DOI: 10.1111/jcpt.13394] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
What is known and objective Tocilizumab is an IL‐6 receptor inhibitor agent which has been proposed as a candidate to stop the inflammatory phase of infection by the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). However, safety data of tocilizumab in pregnant women and their newborn are scarce. We aimed to describe maternal and neonatal safety outcomes associated with tocilizumab treatment in pregnant women with severe COVID‐19. Methods This is a retrospective study of severe COVID‐19 pregnant women, treated with tocilizumab in two Spanish hospitals between 1 March and 31 April 2020. Demographics, medical history, clinical and radiologic findings, treatment information and laboratory data of mothers and their newborns were collected from electronic medical records. Results and discussion A total of 12 pregnant women were identified to have received tocilizumab during pregnancy in the two hospitals. Median gestational age at admission was 27.7 weeks (interquartile range, 18.0–36.4). Most of them received lopinavir/ritonavir, azithromycin and hydroxychloroquine, two patients received corticosteroids and one received interferon beta 1B. All 12 pregnancies resulted in live births. Somatometric values were normal for all newborns, and evolution at 14 and 28 days was favourable for all of them. Hepatotoxicity was observed in 2 patients, which improved or resolved at discharge. Cytomegalovirus reactivation was detected in another patient who had also received corticosteroids for 15 days, causing a congenital infection in her newborn. Both hepatotoxicity and viral reactivation adverse events were classified as possibly related to tocilizumab administration according to Naranjo's causality algorithm. What is new and conclusions It does not appear that tocilizumab has detrimental effects for the mother and newborn. Close monitoring of infections should be considered, especially if other immunosuppressive agents are used.
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Affiliation(s)
- Inés Jiménez-Lozano
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - José Manuel Caro-Teller
- Pharmacy Department. Hospital, Universitario "12 de Octubre", Research Institute 12 de Octubre (i+12, Madrid, Spain
| | - Nuria Fernández-Hidalgo
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Vall d´hebron Hospital, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Vall d´hebron Hospital, Barcelona, Spain
| | - Emma Batllori Badia
- Unit of perinatal medicine, Obstetric and Gynaecology Department, Hospital Universitario "12 de Octubre", Research Institute 12 de Octubre (i+12, Madrid, Spain
| | - Berta Serrano
- Department of Obstetrics and Gynecology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Fátima Camba-Longueira
- Department of Neonatology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Teresa Moral-Pumarega
- Unit of perinatal medicine, Obstetric and Gynaecology Department, Hospital Universitario "12 de Octubre", Research Institute 12 de Octubre (i+12, Madrid, Spain
| | - Rafael San Juan-Garrido
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Research Institute 12 de Octubre (i+12, Madrid, Spain
| | - Maria Josep Cabañas Poy
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anna Suy
- Department of Obstetrics and Gynecology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Queralt Gorgas Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Miarons M, Larrosa-García M, García-García S, Los-Arcos I, Moreso F, Berastegui C, Castells L, Pérez-Hoyos S, Varela J, Pau-Parra A, Varón-Galcera C, Parramon-Teixidó CJ, Martínez-Casanova J, Domènech L, García-Ortega P, Sánchez-Sancho P, Alonso-Martínez C, Gómez-Ganda L, Roch-Santed M, Gracia-Moya A, Del-Rio-Gutiérrez JM, Guillén-Del-Castillo A, Sans-Pola C, Antón A, Montoro B, Gorgas-Torner MQ. COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Evaluation of Immunosuppression Management. Transplantation 2021; 105:138-150. [PMID: 32941394 DOI: 10.1097/tp.0000000000003460] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. METHODS Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected. RESULTS Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. CONCLUSIONS In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María Larrosa-García
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sonia García-García
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Berastegui
- Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Pérez-Hoyos
- Statistic Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier Varela
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Pau-Parra
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carlota Varón-Galcera
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Javier Martínez-Casanova
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Domènech
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Patricia García-Ortega
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Sánchez-Sancho
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carla Alonso-Martínez
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Gómez-Ganda
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Roch-Santed
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ariadna Gracia-Moya
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Alfredo Guillén-Del-Castillo
- Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carla Sans-Pola
- Pharmacology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Microbiology Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Montoro
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria-Queralt Gorgas-Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Miarons M, Roca M, Salvà F. The role of pro-, pre- and symbiotics in cancer: A systematic review. J Clin Pharm Ther 2020; 46:50-65. [PMID: 33095928 DOI: 10.1111/jcpt.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/23/2020] [Revised: 09/14/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Cancer is one of the most important causes of morbidity and mortality worldwide. Pro-, pre- and symbiotics can modulate host metabolism and gut microbiota and potentially help prevent cancer and modulate the adverse effects (AEs) of treatments. Numerous studies on this role for pro-, pre- and symbiotics have reported inconsistent results. The purpose of this review was to examine current scientific evidence from randomized controlled trials (RCTs) on the effects of pro-, pre- and symbiotics on the incidence of complications and AEs, especially diarrhoea, in cancer management. METHODS A systematic literature search was implemented in MEDLINE using the MeSH terms "probiotics", "prebiotics", "symbiotics" and "neoplasms", according to PRISMA guidelines. Reference lists were also handsearched to identify additional eligible RCTs. Three reviewers independently assessed the eligibility of each RCT. Of 714 retrieved abstracts, 22 articles with 2287 participants were included in the analysis. RESULTS AND DISCUSSION The most studied bacteriotherapies were probiotics and symbiotics, in 10 and 7 studies, respectively. Both Lactobacillus and Bifidobacterium strains were used in 18 studies, while Lactobacillus and Bifidobacterium strains were individually used in 9 and 2 studies, respectively. Diarrhoea incidence rates were 3.2%-39.1% in intervention groups and 6.7%-60.9% in control groups, while infection incidence rates were 11.1%-22.7% in intervention groups and 17.3%-28.7% in control groups. WHAT IS NEW AND CONCLUSIONS Pro-, pre- and symbiotics may potentially be efficacious in reducing complications associated with chemotherapy, radiotherapy and surgery in patients with cancer.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital, Barcelona, Spain.,Pharmacy Department, Mataró Hospital, Barcelona, Spain
| | - Maria Roca
- Nutrition Department, Mataró Hospital, Barcelona, Spain
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Miarons M, Clavé P, Wijngaard R, Ortega O, Arreola V, Nascimento W, Rofes L. Pathophysiology of Oropharyngeal Dysphagia Assessed by Videofluoroscopy in Patients with Dementia Taking Antipsychotics. J Am Med Dir Assoc 2019; 19:812.e1-812.e10. [PMID: 30149844 DOI: 10.1016/j.jamda.2018.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/19/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The objective of this study was to assess the pathophysiology of oropharyngeal dysphagia (OD) in patients with dementia, specifically in those taking antipsychotics (APs). DESIGN A cross-sectional study was performed from January 2011 to May 2017 in a general hospital. SETTING AND PARTICIPANTS We included 114 patients with dementia, of which 39 (34.2%) were taking APs (82.5 ± 7.8 years, Barthel Index 52.28 ± 30.42) and 29 patients without dementia (82.4 ± 6.7 years, Barthel Index 77.71 ± 24.7) and OD confirmed by a videofluoroscopy. MEASURES Demographical and clinical factors as well as swallowing function of patients with dementia with OD were compared with older patients without dementia with OD. We also compared patients with dementia taking and not taking APs. Impaired efficacy during videofluoroscopy was defined as the presence of oral and/or pharyngeal residue, and impaired safety (unsafe swallow) was defined as aspiration or penetration. Receiver operating characteristic curves were drawn for laryngeal vestibule closure (LVC) time to predict unsafe swallow. RESULTS 87.7% of patients with dementia presented impaired efficacy of swallow and 74.6% impaired safety [penetration-aspiration scale (PAS) 3.94 ± 1.94]. 86.2% of patients without dementia presented impaired efficacy and 44.8% impaired safety (PAS 2.21 ± 1.92). Time to LVC was significantly delayed in patients with dementia taking APs in comparison with patients without dementia (LVC 0.377 ± 0.093 vs 0.305 ± 0.026, P = .003). In contrast, there were no differences in the PAS and LVC time in patients with dementia taking and not taking APs (PAS 3.96 ± 0.26 vs 3.88 ± 0.22, LVC 0.398 ± 0.117 vs 0.376 ± 0.115, NS). LVC time ≥0.340 seconds predicted unsafe swallow in patients with dementia with an accuracy of 0.71. CONCLUSIONS/IMPLICATIONS Patients with dementia presented high prevalence and severity of videofluoroscopy signs of impaired efficacy and safety of swallow and a more severe impairment in airway protection mechanisms (higher PAS and LVC delay). Clinical practice should implement specific protocols to prevent OD and its complications in these patients. AP treatment did not significantly worsen swallowing impairments.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Hospital de Mataró, Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Laia Rofes
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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Miarons M, Rofes L. Systematic review of case reports of oropharyngeal dysphagia following the use of antipsychotics. Gastroenterol Hepatol 2018; 42:209-227. [PMID: 30470564 DOI: 10.1016/j.gastrohep.2018.09.010] [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] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to examine the effect of antipsychotic medication on dysphagia based on clinical case reports. PATIENTS AND METHODS Literature searches were performed using the electronic databases PubMed and Embase. In PubMed, we used the MeSH terms "antipsychotic agents" OR "tranquilizing agents" combined with "deglutition disorders" OR "deglutition". In Embase, we used the Emtree terms "neuroleptic agents" combined with "swallowing" OR "dysphagia". Two reviewers assessed the eligibility of each case independently. RESULTS A total of 1043 abstracts were retrieved, of which 36 cases met the inclusion criteria; 14 cases were related to typical antipsychotics and 22 to atypical antipsychotics. Dysphagia occurred together with extrapyramidal symptoms in half of the cases and was the only prominent symptom in the other half. The most common strategy against dysphagia was changing to another antipsychotic (n=13, 36.1%). CONCLUSIONS The data from this review indicate that antipsychotics can increase the prevalence of dysphagia.
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Affiliation(s)
- Marta Miarons
- Pharmacy department, Mataró Hospital, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Marin S, Querol R, Campins L, Miarons M, Font A, Lianes P. Long‐term abiraterone withdrawal syndrome. J Clin Pharm Ther 2018; 43:714-716. [DOI: 10.1111/jcpt.12693] [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] [Received: 01/23/2018] [Accepted: 03/23/2018] [Indexed: 11/26/2022]
Affiliation(s)
- S. Marin
- PharmacyConsorci Sanitari del Maresme Mataro, Catalunya Spain
| | - R. Querol
- OncologyConsorci Sanitari del Maresme Mataro, Catalunya Spain
| | - L. Campins
- PharmacyConsorci Sanitari del Maresme Mataro, Catalunya Spain
| | - M. Miarons
- PharmacyConsorci Sanitari del Maresme Mataro, Catalunya Spain
| | - A. Font
- OncologyHospital Universitari Germans Trias i Pujol Badalona, Catalunya Spain
| | - P. Lianes
- OncologyConsorci Sanitari del Maresme Mataro, Catalunya Spain
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Miarons M, Tomsen N, Nascimento W, Espín À, López-Faixó D, Clavé P, Rofes L. Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia. Neurogastroenterol Motil 2018; 30:e13397. [PMID: 30043538 DOI: 10.1111/nmo.13397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/18/2018] [Accepted: 05/23/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND We have recently found a potential protective effect of beta-blockers on oropharyngeal dysphagia (OD). The action mechanism by which beta-blockers could wield this protective effect is unknown, but the neurotransmitter substance P (SP) could play a key role. The aim of this study was to analyze serum and saliva SP levels in patients taking beta-blockers (TBB), and to explore its relationship with OD. METHODS Adult (>50 year) patients TBB were randomly recruited from the primary care setting and 1:1 matched by age, sex, and Barthel Index (BI) with patients not taking beta-blockers (NTBB). Serum and saliva samples were taken and analyzed for their SP levels using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic and clinical variables were collected. Dysphagia was evaluated in all patients using the clinical volume-viscosity swallow test (V-VST). KEY RESULTS We studied 28 patients TBB (64.96 ± 7.31 years, 57.1% women, BI 99.6 ± 1.31, carvedilol-equivalent dose 24.11 ± 18.12 mg) and 28 patients NTBB (65.61 ± 6.43 years, 57.1% women, BI 99.6 ± 1.31). SP serum levels were significantly higher in patients TBB (260.68 ± 144.27 vs 175.46 ± 108.36 pg/mL, P = .009) as were SP saliva levels (170.34 ± 146.48 vs 102.73 ± 52.28 pg/mL, P < .001) compared with patients NTBB. The prevalence of OD was 32.1% in patients TBB and 67.9% in patients NTBB (P = .015). Moreover, patients with OD had significantly lower SP saliva levels in comparison with patients without clinical signs of OD (98.39 ± 43.25 vs 174.69 ± 147.21 pg/mL) P < .001. CONCLUSIONS & INFERENCES We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD.
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Affiliation(s)
- M Miarons
- Department of Pharmacy, Hospital de Mataró, Mataró, Spain
| | - N Tomsen
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - W Nascimento
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - À Espín
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - D López-Faixó
- Department of Pharmacy, Hospital de Mataró, Mataró, Spain
| | - P Clavé
- Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - L Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Marin S, Campins L, Miarons M, Pérez-Cordón L, Reina-Aguilar C, Solsona M. Successful desensitization to cloxacillin in a patient with sepsis, with infective endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report. J Clin Pharm Ther 2018; 43:921-924. [PMID: 30030968 DOI: 10.1111/jcpt.12751] [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: 03/12/2018] [Revised: 06/09/2018] [Accepted: 06/27/2018] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Beta-lactam antibiotic (BLA) therapy is frequently needed to treat infective endocarditis (IE). Hypersensitive reactions to BLA restrict BLA therapy in allergic patients. In the current case, we aim to describe the utility of desensitization (DS) in this context. Although the evidence is limited, DS is recommended. CASE DESCRIPTION This case report deals with a 79-year-old woman with a clinical suspicion of allergy to BLA and a methicillin-sensitive Staphylococcus aureus (MSSA) IE. A cloxacillin DS protocol was developed to enable treatment with cloxacillin. WHAT IS NEW AND CONCLUSION Alternative antibiotic treatments may be less effective or not available in MSSA IE. In this case report, DS allowed optimal cloxacillin treatment.
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Affiliation(s)
- S Marin
- Consorci Sanitari del Maresme, Pharmacy, Mataro, Spain
| | - L Campins
- Consorci Sanitari del Maresme, Pharmacy, Mataro, Spain
| | - M Miarons
- Consorci Sanitari del Maresme, Pharmacy, Mataro, Spain
| | | | - C Reina-Aguilar
- Consorci Sanitari del Maresme, Intensive Care Unit, Mataro, Spain
| | - M Solsona
- Consorci Sanitari del Maresme, Intensive Care Unit, Mataro, Spain
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Miarons M, Sánchez-Ulayar A, Sempere G, Marín S, Castellví JM. New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups. Eur J Hosp Pharm 2018; 26:135-139. [PMID: 31428320 DOI: 10.1136/ejhpharm-2017-001352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/12/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The new direct-acting antivirals (DAAs) have changed chronic hepatitis C virus (HCV) treatment perspectives by achieving success rates in all genotypes and by reducing the associated adverse effects in comparison to pegylated interferon α regimens. These adverse effects include depression, insomnia and suicidal intention, which make it difficult to treat psychiatric risk groups. The objectives of this study were to evaluate the neuropsychiatric symptoms during HCV treatment with DAAs in standard multidisciplinary clinical practice in psychiatric risk groups and to assess the risk factors associated with neuropsychiatric symptoms in this study population. Methods A prospective cross-sectional study was performed of all consecutive patients with psychiatric risk and HCV infection who completed treatment with the new DAAs at the ambulatory care pharmacy. We recorded demographic and clinical data, neuropsychiatric symptoms, emergency consultations, admissions to the psychiatric unit and interventions to manage neuropsychiatric symptoms. Statistical analysis was used to assess the association between neuropsychiatric symptoms and clinical data. Results We included 48 patients with psychiatric risk and detected 36 neuropsychiatric symptoms in 17 (35.4%) patients, with a mean of 0.75 neuropsychiatric symptoms per patient. However, no studied risk factors for developing neuropsychiatric symptoms were found in this population. Conclusions We found a moderate prevalence of neuropsychiatric symptoms in the psychiatric risk group. The neuropsychiatric symptoms more frequently reported were insomnia (17%), irritability (15%) and depression (13%). Neuropsychiatric symptoms in patients with psychiatric risk can occur during treatment with DAAs but less frequently than with pegylated interferon α regimens, and so is a safe treatment for these patients.
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Affiliation(s)
- Marta Miarons
- Department of Pharmacy, Mataró Hospital, Mataró, Spain
| | | | - Glòria Sempere
- Nursing Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - Sergio Marín
- Department of Pharmacy, Mataró Hospital, Mataró, Spain
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Miarons M, Velasco M, Campins L, Fernández S, Gurrera T, Lopez-Viaplana L. Gradual thrombocytopenia induced by long-term trastuzumab exposure. J Clin Pharm Ther 2016; 41:563-5. [DOI: 10.1111/jcpt.12416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. Miarons
- Department of Pharmacy; Mataro Hospital; Mataro Spain
| | - M. Velasco
- Department of Oncology; Mataro Hospital; Mataró Spain
| | - L. Campins
- Department of Pharmacy; Mataro Hospital; Mataro Spain
| | - S. Fernández
- Department of Oncology; Mataro Hospital; Mataró Spain
| | - T. Gurrera
- Department of Hematology; Mataro Hospital; Mataró Spain
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Moreno Q, Garcia V, Miarons M, Marin S, Camps M, Sanchez A, Campins L, Gurrera T, Lopez D, Agusti C. DI-075 Evaluation of the effectiveness and safety of pirfenidone and nintedanib in idiopathic pulmonary fibrosis. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.341] [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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Miarons M, García V, Moreno Q, Marín S, Camps M, Sánchez A, Agustí C, Gurrera T, Campins L. PS-011 Impact of pharmaceutical interventions on medication errors in preparation of chemotherapy regimens. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.496] [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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Miarons M, Martínez S, García V, Marin S, Camps ML, Agustí C, Gurrera T. CP-208 Pegylated liposomal doxorubicin and carboplatine combination in the treatment of recurrent ovarian carcinoma. Comparative long term effectiveness. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.208] [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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García V, Camps M, Moreno Q, Miarons M, Campins L, Sánchez A, Marín S, Gurrera T, Fábregas X, Agustí C. PS-002 New oral therapies in relapsing-remitting multiple sclerosis: Safety profile evaluation. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Camps M, Miarons M, García V, Moreno Q, Campins L, Agustí C, Lopez D, Sánchez A, Fabregas X, Lavado A. PS-090 Results of a medicines reconciliation program in complex chronic patients at hospital discharge. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.413] [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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