Drug-drug interactions in patients receiving hematopoietic stem cell transplantation

INTRODUCTION

Recipients of hematopoietic stem cell transplantation (HSCT) are exposed to numerous drugs in both pre- and post-transplantation period, which creates an opportunity for drug-drug interactions (DDIs); if clinically relevant DDIs happen, the risk of adverse treatment outcomes is increased. Areas covered: This review is focused on DDIs in recipients of HSCT that were observed and published as clinical trials, case series or case reports. Relevant publications were found by the systematic search of the following online databases: MEDLINE, SCOPUS, EBSCO, and SCINDEX. Expert opinion: The most important DDIs involve cytostatic or immunosuppressant drug on one side, and antimicrobial drugs on the other. The majority of clinically relevant interactions have pharmacokinetic character, involving drug metabolizing enzymes in the liver. Antifungal azoles inhibit metabolism of many cytostatic and immunosuppressant drugs at cytochromes and increase their plasma concentrations. Macrolide antibiotics and fluoroqunolones should be avoided in HSCT recipients, as they have much larger potential for DDIs than other antibiotic groups. HSCT recipients increasingly receive new immunomodulating drugs, and further observational studies are needed to reveal unsuspected DDIs with clinical relevance.

Evaluation of brivaracetam: a new drug to treat epilepsy

INTRODUCTION

High prevalence of therapy-resistant epilepsy demands development of anticonvulsants with new mechanisms of action. Brivaracetam is an analogue of levetiracetam which binds to the synaptic vesicle protein 2A (SV2A) and decreases release of excitatory neurotransmitters. Areas covered: Relevant published studies were searched for by predefined strategy in MEDLINE, EBSCO and SCINDEKS electronic databases. Brivaracetam is effective as adjunctive therapy for uncontrolled partial-onset seizures with or without secondary generalization in patients 16 years and older with epilepsy. It reduces baseline-adjusted focal seizure frequency per week from 7.3 to 12.8% over placebo. Adverse events rate in patients with brivaracetam is not higher than in patients with placebo. Expert opinion: Brivaracetam is an important step forward in the treatment of therapy-resistant partial-onset seizures with or without secondary generalization. Its development was systematic and targeted. Due to its efficacy and excellent safety profile, it is likely that brivaracetam will be often prescribed. In future, efficacy and safety of brivaracetam should be tested in monotherapy settings and also in the first-line therapy of partial-onset seizures.

Developmentand Validation of a Questionnaire about Patient Knowledge of Adverse Effects of Statins

Statins are drugs that are well tolerated, but considering their extensive use, there are still concerns regarding their safety. Knowledge of patients about the side effects of statins has not been adequately studied, although timely recognition of the AES is of vital importance for improving the quality of patient care and reducing morbidity and suffering. The aim of this study was to develop and test a questionnaire for measuring the knowledge of patients about statin therapy about adverse effects of statins (AES).

This two-center cross-sectional study was conducted during the period from March 1, 2015 to April 1, 2016, taking place in pharmacies from the city of Belgrade and at the Department of Internal Medicine, Clinical Center in Kragujevac, Serbia. The study included 300 patients and 20 pharmacists.

The questionnaire showed satisfactory internal consistency, with Cronbach’s alpha of 0.898, good construction and homogeneity of questions. After splitting the questionnaire to two parts at random, Cronbach’s alphas were 0.834 and 0.842 for the both parts, respectively. Exploratory factorial analysis revealed two domains. The patients rated their knowledge of the side effects of statins 52.7±19.9 on the visual analogue scale.

Based on the results of this study, we believe that this questionnaire could be a useful tool for testing the knowledge of patients about adverse effects of statins and help physicians to identify patients with insufficient knowledge who should be additionally informed about it.