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Monoclonal antibodies targeting the calcitonin gene-related peptide have been introduced into the therapeutic arsenal of migraine prophylaxis. Clinical trials report similar efficacy between them, and there is no evidence of switching to another one after failure. We aim to describe our experience in switching from erenumab to galcanezumab after therapeutic failure. We retrospectively reviewed 30 migraine patients who received monoclonal antibodies, with 15 of them switched after failure to achieve reduction in migraine days per month ≥30%. A ≥30% reduction in migraine days per month compared to baseline was observed in 8/15 (4/15 ≥ 50%) patients after switch. Some nonresponsive patients may benefit from switching between monoclonal antibodies with different therapeutic targets.
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Anticuerpos Monoclonales , Trastornos Migrañosos , Anticuerpos Monoclonales/uso terapéutico , Péptido Relacionado con Gen de Calcitonina/uso terapéutico , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Estudios Retrospectivos , España , Resultado del TratamientoRESUMEN
Purpose Ethanol as an excipient is used to enhance the solubility of gemcitabine, but, sometimes, the dose of ethanol a patient may be given is much higher than the dose considered to be toxic. We aimed to assess ethanol-related symptoms and signs in patients receiving two formulations of gemcitabine, with and without ethanol. Methods A randomized double blind cross-over study was conducted. All patients being treated with gemcitabine received two consecutive doses of the drug, one diluted from a concentrate for solution for infusion (CSI) containing ethanol and the other from a lyophilized powder, without ethanol, which was used as control group. After each administration, patients were surveyed in order to assess the appearance of any alcohol consumption symptoms (dizziness, difficulty speaking, unsteady walking, impaired balance, mood swings and slower reactions). Widmark formula and the amount of alcohol measured on the breath (breathalyzer) were used to estimate blood alcohol concentration. Results Twenty-four patients received both formulations and were included in the analysis. Mean administered ethanol dose when prepared from CSI was 15.81 ± 2.25 g (mean ± SD). When using CSI gemcitabine, estimated blood ethanol concentration was 0.033 g/dl according to Widmark formula and 0.02 g/dl according to breathalyzer results. Although overall incidence of symptoms was higher in the study group, the difference was not statistically significant (33% vs. 25%; p = 0.53). Conclusions These findings prove there is no difference in the onset of ethanol related symptoms when using CSI instead of lyophilized powder on the reconstitution of gemcitabine.
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Nivel de Alcohol en Sangre , Desoxicitidina/análogos & derivados , Etanol/administración & dosificación , Anciano , Pruebas Respiratorias , Estudios Cruzados , Desoxicitidina/administración & dosificación , Método Doble Ciego , Etanol/efectos adversos , Etanol/sangre , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Soluciones Farmacéuticas , GemcitabinaRESUMEN
OBJETIVES: The main objective was to compare the persistence between dolutegravir/lamivudine (DTG/3TC) and bictegravir/emtricitabine/tenofovir-alafenamide (BIC/FTC/TAF) and to analyze reasons for discontinuation. METHODS: We conducted a retrospective, non-interventional, descriptive and longitudinal study. All human immunodeficiency virus (HIV) patients over 18 years treated with DTG/3TC or BIC/FTC/TAF in our center were included. Persistence after first year was compared using the χ2 test. Kaplan-Meier survival analysis was performed. RESULTS: Three hundred fifty-eight patients were included. 99.5% versus 90.99% of patients were persistent after the first year for DTG/3TC and BIC/FTC/TAF respectively (pâ¯=â¯0.001). Persistence with DGT/3TC was 1,237 days (IC95% 1,216-1,258) and persistence with BIC/FTC/TAF was 986 days ([IC95% 950-1,021]; pâ¯<â¯0.001). The difference was remained after adjusting for covariates with the cox regression model (HR= 8.2 [IC95% 1.03-64.9], pâ¯=â¯0.047). The main reasons for discontinuation for BIC/FTC/TAF were toxicity/tolerability. CONCLUSION: In our study patients had a high persistence. Patients on DTG/3TC treatment were more persistent compared to BIC/FTC/TAF, although BIC/FTC/TAF have worse baseline characteristics. The main reason for discontinuation of BIC/FTC/TAF was tolerability/toxicity.
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Fármacos Anti-VIH , Infecciones por VIH , Compuestos Heterocíclicos con 3 Anillos , Lamivudine , Oxazinas , Piperazinas , Piridonas , Humanos , Estudios Retrospectivos , Infecciones por VIH/tratamiento farmacológico , Masculino , Femenino , Piridonas/uso terapéutico , Lamivudine/uso terapéutico , Oxazinas/uso terapéutico , Adulto , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Piperazinas/uso terapéutico , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Tenofovir/uso terapéutico , Emtricitabina/uso terapéutico , Estudios Longitudinales , Alanina/uso terapéutico , Alanina/análogos & derivados , Amidas/uso terapéutico , Combinación de MedicamentosRESUMEN
OBJETIVES: The main objective was to compare the persistence between dolutegravir/lamivudine (DTG/3TC) and bictegravir/emtricitabine/tenofovir-alafenamide (BIC/FTC/TAF) and to analyze reasons for discontinuation. METHODS: We conducted a retrospective, non-interventional, descriptive, and longitudinal study. All human immunodeficiency virus (HIV) patients over 18â¯years treated with DTG/3TC or BIC/FTC/TAF in our center were included. Persistence after first year was compared using the χ2 test. Kaplan-Meier survival analysis was performed. RESULTS: Three hundred fifty-eight patients were included. 99.5% versus 90.99% of patients were persistent after the first year for DTG/3TC and BIC/FTC/TAF respectively (p=.001). Persistence with DGT/3TC was 1237â¯days (IC95% 1216-1258) and persistence with BIC/FTC/TAF was 986â¯days [(IC95% 950-1021); p<.001]. The difference was remained after adjusting for covariates with the cox regression model [HR=8.2 (IC95% 1.03-64.9), p=.047]. The main reasons for discontinuation for BIC/FTC/TAF were toxicity/tolerability. CONCLUSION: In our study, patients have a high persistence. Patients on DTG/3TC treatment are more persistent compared to BIC/FTC/TAF, although BIC/FTC/TAF have worse baseline characteristics. The main reason for discontinuation of BIC/FTC/TAF is tolerability/toxicity.
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Fármacos Anti-VIH , Emtricitabina , Infecciones por VIH , Compuestos Heterocíclicos con 3 Anillos , Lamivudine , Oxazinas , Piperazinas , Piridonas , Tenofovir , Humanos , Infecciones por VIH/tratamiento farmacológico , Estudios Retrospectivos , Masculino , Piridonas/uso terapéutico , Femenino , Lamivudine/uso terapéutico , Piperazinas/uso terapéutico , Oxazinas/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Adulto , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Emtricitabina/uso terapéutico , Tenofovir/uso terapéutico , Alanina/uso terapéutico , Alanina/análogos & derivados , Estudios Longitudinales , Combinación de Medicamentos , Amidas/uso terapéutico , Compuestos Heterocíclicos de 4 o más Anillos/uso terapéutico , Compuestos Heterocíclicos de 4 o más Anillos/efectos adversos , Adenina/análogos & derivados , Adenina/uso terapéuticoRESUMEN
The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: Artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc., as well as including training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber-resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, essential. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.
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Farmacéuticos , Servicio de Farmacia en Hospital , Humanos , Educación en Farmacia , Telemedicina , Inteligencia ArtificialRESUMEN
The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc. as well as training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, inexcusable. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known "burned out worker syndrome" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.
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Farmacéuticos , Servicio de Farmacia en Hospital , Humanos , Educación en Farmacia , Telemedicina , Inteligencia Artificial , PredicciónRESUMEN
Desensitisation protocols allow the continuation of treatment in patients who have presented hypersensitivity reactions. Carboplatin desensitisation solutions are usually prepared in the chemotherapy centralised units of hospital pharmacies and they are diluted under the established concentration limit to guarantee the stability of the preparation. An online survey was sent to hospital pharmacies, inquiring about local desensitisation protocols: reasons for use of desensitisation protocols, the protocols used and the stability given to carboplatin solutions. An important variability among the hospitals in carboplatin desensitisation practice was detected. Six different carboplatin desensitisation protocols were described and discordance with the storage period of the carboplatin solutions was observed. The lack of consensus on which protocol must be followed and data supporting the stability of the diluted product, contribute to distrust of carboplatin desensitisation protocols. Although the efficacy and safety of carboplatin desensitisation protocols has been widely demonstrated, many professionals still have concerns.
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Antineoplásicos/efectos adversos , Carboplatino/efectos adversos , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/epidemiología , Servicio de Farmacia en Hospital/métodos , Antineoplásicos/administración & dosificación , Carboplatino/administración & dosificación , Estudios Transversales , Hipersensibilidad a las Drogas/diagnóstico , Humanos , Infusiones Intravenosas , Soluciones Farmacéuticas/administración & dosificación , Servicio de Farmacia en Hospital/tendencias , Estudios Prospectivos , España/epidemiologíaRESUMEN
OBJECTIVES: Daptomycin is a cyclic lipopeptide with selective action against drug-resistant Gram-positive bacteria. The stability of daptomycin solutions in different containers while stored at different temperatures was assessed. METHODS: Daptomycin vials were reconstituted with NaCl (50â mg/mL). Daptomycin infusion solutions (5.6 and 14.0â mg/mL) were prepared in polypropylene infusion bags. All test solutions were stored either under refrigeration or at room temperature over 7â days. Samples were withdrawn on days 0, 2, 4 and 7 and assayed in triplicate using a stability-indicating high-performance liquid chromatography (HPLC) method. RESULTS: The HPLC analysis revealed no significant loss in daptomycin concentration in vials or bags when stored at 2-8°C. All samples remained clear and colourless and there were no significant changes in pH throughout the study period. CONCLUSIONS: Reconstituted daptomycin vials (50â mg/mL) and infusion bags (5.6 and 14â mg/mL) were found to be physicochemically stable over a period of 1â week when stored at 2-8°C.
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Background The combination of cisplatin or carboplatin with vinorelbine is one of the standard regimens in non-small-cell lung cancer. Some studies have shown that the hemogram on day-8 could be avoided in patients with cisplatin. However, carboplatin had not been studied and is considered to be more myelotoxic than cisplatin. Objective To quantify the incidence of thrombocytopenia, anemia, neutropenia and impaired liver and renal tests on day 8 in patients receiving a doublet protocol including a platinum and vinorelbine. Method The incidence of blood test abnormalities has been quantified in all patients who had received at least one course of cisplatin or carboplatin plus vinorelbine from January 14-December 14. Results Eighty-nine patients and 314 courses on day-8 were evaluated. Moderate or severe hematological toxicity was observed in 5.7 % courses. Dose was skipped in 1.3 % courses related to neutropenia. Renal and liver impairment were not shown. Delayed and reduced doses and early discontinued treatment on day-8 were not caused by blood test abnormalities. Conclusions Blood tests might be spared on day-8 depending on the individual characteristics, above all in patients with carboplatin.
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Anemia/epidemiología , Carboplatino/efectos adversos , Cisplatino/efectos adversos , Pruebas Hematológicas , Neutropenia/epidemiología , Trombocitopenia/epidemiología , Vinblastina/análogos & derivados , Anemia/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/uso terapéutico , Cisplatino/uso terapéutico , Femenino , Humanos , Pruebas de Función Renal , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Neoplasias/sangre , Neoplasias/tratamiento farmacológico , Neutropenia/inducido químicamente , Trombocitopenia/inducido químicamente , Factores de Tiempo , Vinblastina/efectos adversos , Vinblastina/uso terapéutico , VinorelbinaRESUMEN
No disponible
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Humanos , Femenino , Persona de Mediana Edad , Intoxicación por Plomo/etiología , Medicina Ayurvédica , Artritis Reumatoide/terapia , Ácido Edético/uso terapéutico , Metales Pesados/toxicidadRESUMEN
INTRODUCTION: To describe the establishment of a fungal chemoprophylaxis protocol in very low birth weight infants (VLBW). To asses safety, tolerability, and effectiveness of fluconazole administration to these patients. METHOD: According to published scientific evidence (search on MEDLINE 1994-2001) inclusion criteria for the protocol were defined: gestational age <28 weeks and birth weight <1500 g. Fluconazole was given intravenously by infusion. A pharmacotherapeutic follow-up of patients included on the protocol was performed for 1 year. RESULTS: Sixteen patients were included on the protocol, two of them died because of causes not related to the drugs given. Significant drug interactions were not observed. Fluconazole side effects were not reported either. None of the patients who finished the chemoprophylaxis showed signs or symptoms of fungal infection. CONCLUSION: Fluconazole chemoprophylaxis in this small number of patients has shown an excellent safety and tolerability profile. The lack of fungal infection points out the possibility of using fluconazole to reduce morbidity and mortality in VLBW.