Déficit parcial de ornitin-carbamil-transferasa. A propósito de un caso / Partial deficiency of ornithine transcarbamylase. A case report

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Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria / Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose

Objetivo: Analizar si el cambio de tratamiento antirretroviral a efavirenz/emtricitabina/ tenofovir en dosis única diaria (EETu) incrementa la adherencia y mantiene la efectividad del mismo, y establecer el incremento de coste provocado por dicho cambio. Métodos Estudio observacional, retrospectivo e intrasujeto, realizado en la unidad de dispensación a pacientes externos. El periodo de estudio fue un año (seis meses antes y seis meses después del cambio). Se revisaron los registros informáticos de dispensación y los días de hospitalización durante el periodo de estudio y se calculó la diferencia de adherencia al tratamiento. Para determinar la eficacia del tratamiento, se revisaron los datos de carga viral y linfocitos CD4 antes y después del cambio. Se recogió el coste de los tratamientos previo y posterior para cada paciente y se determinó el incremento de coste anual y por paciente. Resultados Se incluyeron en el estudio 127 pacientes. La diferencia de adherencia fue del 0,6%. El porcentaje de malos adherentes fue del 35,43 y del 40,94% antes y después del cambio de tratamiento, respectivamente. Los niveles de linfocitos CD4 y carga viral no cambiaron significativamente con el tratamiento. En análisis económico reveló un incremento de 25.374,60€ anuales y 199,80€/paciente. Conclusiones El uso de EETu no mejora el control de la infección por el VIH en términos de efectividad ni de adherencia y supone un aumento del gasto farmacéutico, por lo que su elección como tratamiento antirretroviral deberá basarse en criterios diferentes a los anteriormente descritos (AU)

Objective: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. Methods: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change).Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. Results: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25 374.60 and €199.80 per patient. Conclusions: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above (AU)

[Analysis of adherence and efficiency when replacing an antiretroviral therapy with efavirenz-emtricitabine-tenofovir in a single daily dose]. / Análisis del cambio en la adherencia y eficiencia del tratamiento antirretroviral con el uso de efavirenz-emtricitabina-tenofovir en dosis única diaria.

OBJECTIVE: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. METHODS: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change). Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. RESULTS: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25,374.60 and €199.80 per patient. CONCLUSIONS: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above.

Adherencia subóptima al tratamiento en la esclerosis múltiple / Adherence to treatment in multiple sclerosis

Objetivo Conocer la adherencia al tratamiento con interferón beta y acetato de glatirámero de pacientes con esclerosis múltiple, así como el porcentaje de discontinuación y sus causas. Método Estudio observacional, longitudinal prospectivo y multicéntrico de ámbito nacional en el que se seleccionaron pacientes con esclerosis múltiple que acudieron a los servicios de farmacia hospitalarios para recoger medicación. La variable principal de valoración fue el porcentaje de adherencia durante un año, medido como la relación entre las dosis de fármaco dispensadas y las necesarias. Secundariamente se midieron las discontinuaciones de tratamiento y sus causas. Resultados Se incluyeron, durante un periodo de seis meses, 543 pacientes en 39 servicios de farmacia. El tiempo medio de exposición a los fármacos durante el estudio fue de 312 días y la adherencia media en ese periodo del 61,5% (IC 95%: 59,4-63,5). De los 543 participantes en el estudio, 34 (6,26%) discontinuaron el tratamiento, en la mayoría de los casos por criterio médico. Conclusiones La adherencia terapéutica durante un año en los pacientes con esclerosis múltiple ha sido inferior a la óptima. Es necesario analizar las causas y establecer medidas correctoras (AU)

Objective To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. Methods Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. Results Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. Conclusions Multiple sclerosis patients’ treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established (AU)

Adherence to treatment in multiple sclerosis.

OBJECTIVE: To find out if patients with multiple sclerosis adhere to treatment with beta interferons and glatiramer acetate, the percentage of withdrawal and its causes. METHODS: Observational, longitudinal, prospective, national, multicentre study which selected multiple sclerosis patients who attended the hospital pharmacy department to collect their medication. The main variable was the adherence percentage during a year, measured as the relationship between the dose of the dispensed and necessary drug. Treatment withdrawals and their causes were then measured. RESULTS: Over a six-month period, 543 patients from 39 pharmacy departments were included. The average time exposed to the drugs during the study period was 312 days and the average adherence in this period was 61.5% (95% CI: 59.4-63.5). Thirty-four (6.26%) of the 543 study participants withdrew treatment, which for most cases was decided by the doctor. CONCLUSIONS: Multiple sclerosis patients' treatment adherence during a period of one year has been lower than the ideal. The causes should therefore be analysed and corrective measures established.