Factors associated with long-term persistence of rituximab in rheumatoid arthritis In clinical practice: RITAR Study. / Factores asociados a la persistencia a largo plazo de rituximab en artritis reumatoide en la práctica clínica: Estudio RITAR.

BACKGROUND AND OBJECTIVE: Treatment of rheumatoid arthritis with rituximab (RTX) requires repeated cycles, but there is no well-established retreatment regimen in dose and frequency. The objective was to analyse the persistence of RTX treatment and factors that influence in terms of routine clinical practice. METHODS: Rituximab in Rheumatoid Arthritis (RITAR Study) is an observational, retrospective study that analyses the persistence of RTX in a cohort from 2003 to 2015. Persistence was calculated by the Kaplan-Meier analysis; curves were compared with the Log-Rank test. Cox regression was used to quantify the risk of discontinuation and multivariate analyses were conducted to determine the factors associated with the persistence of the treatment. RESULTS: 454 cycles of RTX in 114 patients were included. Median survival was 10.0 years and incidence rate of discontinuation was 7.7 per 100 patients/year. Factors associated with persistence were autoantibody positivity and use of RTX in combination with csDMARDs. Sex, age, number of comorbidities, rheumatoid arthritis evolution, number of complications, basal DAS28, basal HAQ, number of lines of treatment, fixed or on demand retreatment and year of RTX starting were not associated. Multivariable models confirmed the relationship between autoantibody positivity, monotherapy and persistence of RTX. CONCLUSIONS: The persistence of RTX in clinical practice is higher in seropositive patients and in those who are treated with RTX associated with a csDMARD. Dose per cycle and retreatment frequency do not have a decisive role in rituximab persistence.

Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study / Adecuación de la medicación oral en personas institucionalizadas en residencias de mayores a los que se les tritura la medicación: Estudio ADECUA

Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention). Moreover, health professionals received a training course. Results: Medication was being crushed for 33% (618/1875) of residents (mean: 5 drugs susceptible of crushing). 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted). Switch was the type of intervention more frequent (79%), mainly to immediate release forms or to a different drug. The adaptation index increased from 93% to 95% (p < 0.001). Satisfaction amongst health professionals was high. Conclusions: The pharmacist intervention improved the correct administration of drugs, thereby increasing safety and efficacy (AU)

Objetivo: Evaluar el efecto de la intervención del farmacéutico en la adecuación de formas farmacéuticas en ancianos institucionalizados en residencias de mayores a los que se les tritura la medicación y cuya alteración pueda tener relevancia clínica. Método: Estudio cuasiexperimental, multicéntrico, transversal y prospectivo de diseño antes-después en 10 residencias de mayores. Se identificaron los residentes a los que se les trituraba la medicación y se revisó su tratamiento para identificar los medicamentos que no se pueden triturar. Se comunicó al médico responsable la alternativa disponible y se evaluó el grado de aceptación, su asociación con otras variables medidas y el índice de adecuación pre-post, (comprimidos/cápsulas triturables respecto al total de comprimidos/cápsulas antes y después de la intervención). Se impartió además un curso formativo dirigido a los profesionales sanitarios. Resultados: Se trituraba la medicación al 33% (618/1.875) de los pacientes institucionalizados (media: 5 fármacos susceptibles de trituración). Se realizaron 220 intervenciones, mayoritariamente por tratarse de fármacos de liberación prolongada o gastrorresistentes, de las que se aceptaron el 48%. El tipo de intervención más frecuente fue el cambio (79%), mayoritariamente a formas de liberación inmediata o a otro principio activo. El índice de adecuación pasó del 93% al 95% (p < 0,001). La satisfacción de los profesionales con el curso fue elevada. Conclusiones: La intervención del farmacéutico ha mejorado la correcta administración de los medicamentos, aumentando con ello su seguridad y eficacia (AU)

Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study.

PURPOSE: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. METHODS: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention). Moreover, health professionals received a training course. RESULTS: Medication was being crushed for 33% (618/1875) of residents (mean: 5 drugs susceptible of crushing). 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted). Switch was the type of intervention more frequent (79%), mainly to Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. METHODS: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention). Moreover, health professionals received a training course. RESULTS: Medication was being crushed for 33% (618/1875) of residents (mean: 5 drugs susceptible of crushing). 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted). Switch was the type of intervention more frequent (79%), mainly to.

Objetivo: Evaluar el efecto de la intervención del farmacéutico en la adecuación de formas farmacéuticas en ancianos institucionalizados en residencias de mayores a los que se les tritura la medicación y cuya alteración pueda tener relevancia clínica. Método: Estudio cuasiexperimental, multicéntrico, transversal y prospectivo de diseño antes-después en 10 residencias de mayores. Se identificaron los residentes a los que se les trituraba la medicación y se revisó su tratamiento para identificar los medicamentos que no se pueden triturar. Se comunicó al médico responsable la alternativa disponible y se evaluó el grado de aceptación, su asociación con otras variables medidas y el índice de adecuación pre-post, (comprimidos/cápsulas triturables respecto al total de comprimidos/cápsulas antes y después de la intervención). Se impartió además un curso formativo dirigido a los profesionales sanitarios. Resultados: Se trituraba la medicación al 33% (618/1.875) de los pacientes institucionalizados (media: 5 fármacos susceptibles de trituración). Se realizaron 220 intervenciones, mayoritariamente por tratarse de fármacos de liberación prolongada o gastrorresistentes, de las que se aceptaron el 48%. El tipo de intervención más frecuente fue el cambio (79%), mayoritariamente a formas de liberación inmediata o a otro principio activo. El índice de adecuación pasó del 93% al 95% (p < 0,001). La satisfacción de los profesionales con el curso fue elevada. Conclusiones: La intervención del farmacéutico ha mejorado la correcta administración de los medicamentos, aumentando con ello su seguridad y eficacia.

Equinocandinas: buscando diferencias. El ejemplo de su uso en pacientes sometidos a técnicas continuas de reemplazamiento renal / Echinocandins: searching for differences. The example of their use in patients requiring continuous renal replacement therapy

Las equinocandinas tienen un papel creciente en el tratamiento de las infecciones fúngicas, sobre todo por su novedoso mecanismo de acción. Esto se refleja en las guías de tratamiento recientemente publicadas, pero, ni los estudios "in vitro" o en animales, ni los estudios clínicos muestran diferencias claras entre las tres del grupo. Cuestiones sobre la eficacia clínica comparativa, el perfil farmacocinético en poblaciones especiales, la justificación de su coste o su papel en la terapéutica permanecen sin respuesta. Comparten muchas características comunes pero los tres proveedores mantienen estrategias de marketing que buscan su diferenciación. Aunque existen similitudes en aspectos de su farmacocinética (FC), los datos en pacientes sometidos a técnicas continuas de reemplazamiento renal (TCRR), son limitados. La FC de la eliminación de fármacos en pacientes críticos sometidos a TCRR es muy compleja, con muchas variables que afectan al aclaramiento. Esta revisión esboza los principios básicos que determinan si es necesario el ajuste de dosis y compara las dos publicaciones actualmente disponibles sobre la FC de micafungina y anidulafungina en pacientes sometidos a TCRR(AU)

The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation. Although exist similarities in the pharmacokinetic (PK) profiles of the echinocandins, limited data have been published regarding their pharmacokinetics in continuous renal replacement therapy (CRRT) patients. The pharmacokinetics of drug removal in critically ill patients receiving CRRT is very complex, with multiple variables affecting clearance. This review outlines the basic principles that determine whether a dose adjustment is required. Two studies with data on PK parameters of micafungin and anidulafungin in CRRT patients have been published and are compared following that basic principles in the review(AU)

[Echinocandins: searching for differences. The example of their use in patients requiring continuous renal replacement therapy]. / Equinocandinas: buscando diferencias. El ejemplo de su uso en pacientes sometidos a técnicas continuas de reemplazamiento renal.

The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation. Although exist similarities in the pharmacokinetic (PK) profiles of the echinocandins, limited data have been published regarding their pharmacokinetics in continuous renal replacement therapy (CRRT) patients. The pharmacokinetics of drug removal in critically ill patients receiving CRRT is very complex, with multiple variables affecting clearance. This review outlines the basic principles that determine whether a dose adjustment is required. Two studies with data on PK parameters of micafungin and anidulafungin in CRRT patients have been published and are compared following that basic principles in the review.