META-INSTI: metabolic adverse events following integrase strand transfer inhibitor administration in spontaneous adverse event reports.

Background: Metabolic effects of integrase strand transfer inhibitors (INSTIs) have been reported. The FDA Adverse Event Reporting System (FAERS) is a publicly available database that captures spontaneously reported adverse events. The objective of this study was to evaluate the relationship between INSTIs and metabolic adverse events using the FAERS database. Methods: FAERS data were queried from quarter 4 of 2007 through quarter 4 of 2019 and limited to adults. The Standardized MedDRA Query for 'hyperglycaemia/new-onset diabetes mellitus' (H/DM) was used to identify metabolic adverse events of interest. Weight gain was analysed as a separate event. Reporting odds ratios (RORs) and 95% CIs were calculated for the INSTI class and individual agents. Results: Over 10.1 million FAERS reports were identified. Any INSTI was mentioned as a primary and/or secondary suspect agent in 18,400 (0.18%) reports (bictegravir: 1414 [0.01%]; dolutegravir: 7840 [0.08%]; elvitegravir: 4034 [0.04%]; raltegravir: 5551 [0.05%]). RORs (95% CI) for H/DM and weight gain for any INSTI were 1.20 (1.15-1.27) and 2.16 (1.96-2.38). For individual agents, RORs (95% CI) for H/DM and weight gain were as follows: bictegravir, 1.23 (1.10-1.37) and 6.82 (5.50-8.41); dolutegravir, 1.28 (1.19-1.39) and 1.86 (1.58-2.18); elvitegravir, 0.76 (0.56-1.02) and 1.63 (1.37-1.92); and raltegravir, 1.00 (0.90-1.11) and 3.29 (2.77-3.91). H/DM was noted in 159 bictegravir and 712 dolutegravir reports. Conclusion: Overall, H/DM was associated with bictegravir and dolutegravir and weight gain with all INSTIs. Clinicians should know the potential relationship between INSTIs and metabolic effects and institute appropriate monitoring. This paper was previously presented: META-INSTI: Metabolic Adverse Events Following Integrase Strand Transfer Inhibitor Administration in Spontaneous Adverse Event Reports. Platform Presentation. ID Week. Virtual 2020.

Role of the specialty pharmacist in public health: A focus on sharps disposal.

An intersection of the pharmacy profession and public health is the role of the specialty pharmacist. The specialty pharmacist is in a unique position to prevent unnecessary financial burden on the health care system by preventing community-acquired needlestick injuries through patient education regarding the proper disposal of sharps. Many specialty medications are injectable agents with varying injection frequencies ranging from multiple injections per day to 1 dose per year. Programs should be implemented at specialty pharmacies to fill this patient education gap. This distinct service to patients and the profession will continue to grow alongside the niche of specialty pharmacy.

Barriers to and factors influencing the pursuit of pharmacy student research.

INTRODUCTION: The objective of this study was to identify perceived barriers and factors influencing student pursuit of research during pharmacy school. METHODS: A voluntary, paper-based or electronic questionnaire was administered to all pharmacy students at a private college of pharmacy in mandatory courses during the 2016-2017 academic year. Survey questions collected information pertaining to demographics, factors influencing student pursuit of research, and barriers to pursuit of research. Participation was incentivized with gift cards. RESULTS: A total of 623 students completed the survey (79% response rate). The average respondent was female (69.1%), 25-years old (IQR 23-26 years), employed (69.9%), and had a prior degree (66.6%). During pharmacy school, 27.3% of respondents pursued a research project. Of students not pursuing a research project during pharmacy school, the amount of interest to complete a project differed significantly between professional years (P < .01) with the second-year class having the highest interest. Lack of time (91.3%), unfamiliarity with the research process (81.8%), and too much coursework (80.5%) were cited as the top three perceived barriers that prevented students from pursuing research. A mandatory research class (87.6%), presentations describing faculty research interests (83.4%), and ability to work with a friend (83.9%) would most strongly influence students to complete research. CONCLUSIONS: Students report additional information regarding research opportunities would positively influence their decision to pursue research while in pharmacy school. Future studies should evaluate strategies to familiarize students with the research process.

Potential risk of drug-drug interactions with hormonal contraceptives and antiretrovirals: prevalence in women living with HIV.

BACKGROUND: Family planning services are vital for women living with HIV (WLH); however, the use of concomitant antiretroviral therapy (ART) and hormonal contraceptives (HCs) may pose challenges due to the risk of potential drug-drug interactions (DDIs). The objectives of this study were to assess ART and HC use among WLH and quantify the frequency of potential DDIs between ART and HCs. METHODS: This was a retrospective, observational, cohort study of WLH aged 18-55 years, prescribed ART, with at least one clinic visit from January 1, 2010 to April 30, 2014. Potential DDIs between HCs and ART were assessed using the University of Liverpool HIV Drug Interactions website (www.hiv-druginteractions.org) and categorized as 'weak potential interaction,' 'potential interaction,' or 'do not co-administer.' RESULTS: Overall, a contraceptive method was reported in 167 (54%) of the 309 women included in the study. Of those using contraception, 73 (43.7%) reported using HCs, which was most frequently a progestin intrauterine device (n=43), progestin injection (n=17), or combination oral contraceptive pills (n=9). Out of a total of 449 ART regimens, a potential DDI was identified in 21 of 115 (18.3%) ART-HC combinations from 19 women using ART and HCs. Atazanavir/ritonavir was the most common potentially interacting ART (10, 47.6%); for HCs, these were combination oral contraceptive pills (16, 76.2%) and progestin implants (2, 9.5%). CONCLUSION: In this cohort, one-quarter of WLH on ART-HCs had a potential DDI. Future studies should investigate the impact of DDIs on unintended pregnancies, the side effects of DDIs, and the effects of HC DDIs on ART concentrations.