Guía de administración de antineoplásicos orales en pacientes con trastornos de la deglución / A guide for the administration of oral antineoplastic in patients with swallowing disorders

Objetivo: Revisar la literatura disponible sobre la administración de antineoplásicos orales en pacientes con trastornos de la deglución y realizaruna síntesis de la información hallada.Método: En el periodo septiembre 2019-junio 2020, tres farmacéuticoshospitalarios elaboraron una lista con los antineoplásicos orales disponibles en España, la cual fue repartida, y cada cual llevó a cabo labúsqueda y revisión bibliográfica de los medicamentos asignados. Serevisaron las fichas técnicas y así como Pubmed, Micromedex, Uptodate,la página web del Cancer Care Ontario, diferentes boletines farmacéuticos, guías de administración por sonda y otras fuentes terciarias deinformación. En último lugar, se contactó con la industria farmacéutica.Posteriormente cada uno sintetizó la información que había hallado ypara concluir, un médico y un cuarto farmacéutico hospitalario revisarontodo el trabajo llevado a cabo.Resultados: Se revisaron un total de 64 fármacos antineoplásicos orales.Se obtuvo información pertinente en el caso de 48, de los cuales 44 presentaban posibilidad de administración en estos pacientes (un 69% de losfármacos investigados). Se realizó una síntesis de la información hallada.Conclusiones: Pese a haber encontrado posibles métodos de preparación y administración para la mayoría de los antineoplásicos orales revisados, se constata que la información es más bien escasa y con bajo nivelde evidencia. Es necesario seguir investigando en este campo, ya que seprecisan formas farmacéuticas líquidas, o preparaciones extemporáneas,que en base a estudios farmacocinéticos y de estabilidad permitan la administración de antineoplásicos orales en este grupo de pacientes. (AU)

Objective: To review the available literature on the administration of oralantineoplastic drugs in patients with swallowing disorders and systematizethe information obtained.Method: Between September 2019 and April 2020, two hospital pharmacists drew up a list of the oral antineoplastic drugs available in Spain,which was then distributed to three hospital pharmacists, each of whomcarried out a literature search and a review. An analysis was made ofthe prescribing information and searches were performed in Pubmed,Micromedex, Uptodate, the Cancer Care Ontario website, different pharmaceutical bulletins, feeding tube administration guidelines, and tertiaryinformation sources. Lastly, the pharmaceutical industry was contacted.The group systematized the information obtained, after which a fourthhospital pharmacist and an independent physician reviewed the workcarried out.Results: A total of 64 oral antineoplastic drugs were reviewed. Relevantinformation was obtained for 48 drugs, of which 44 were amenable toadministration to these patients (69% of the investigated drugs). A systematization of the information found was carried out.Conclusions: Despite having found different methods for preparing andadministering most of the oral antineoplastic drugs reviewed, the information compiled was rather scarce and with a low level of evidence. Further studies, based on pharmacokinetic and stability studies, are necessary inthis field as there is a sore need for oral liquid pharmaceutical forms orextemporaneous preparations allowing administration of oral antineoplastic drugs to these patients. (AU)

A guide for the administration of oral antineoplastic in patients with swallowing disorders.

OBJECTIVE: To review the available literature on the administration of oral antineoplastic drugs in patients with swallowing disorders and  ystematize the information obtained. METHOD: Between September 2019 and April 2020, two hospital  harmacists drew up a list of the oral antineoplastic drugs available in  Spain, which was then distributed to three hospital pharmacists, each of  whom carried out a literature search and a review. An analysis was made  of the prescribing information and searches were performed in Pubmed, Micromedex, Uptodate, the Cancer Care Ontario website,  different pharmaceutical bulletins, feeding tube administration guidelines,  and tertiary information sources. Lastly, the pharmaceutical industry was  contacted. The group systematized the information obtained, after which a fourth hospital pharmacist and an independent physician reviewed the  work carried out. RESULTS: A total of 64 oral antineoplastic drugs were reviewed. Relevant information was obtained for 48 drugs, of which 44 were  amenable to administration to these patients (69% of the investigated  drugs). A systematization of the information found was carried out. Conclusions: Despite having found different methods for preparing and administering most of the oral antineoplastic drugs reviewed, the  information compiled was rather scarce and with a low level of evidence.  Further studies, based on pharmacokinetic and stability studies, are  necessary in this field as there is a sore need for oral liquid pharmaceutical forms or extemporaneous preparations allowing administration of oral  antineoplastic drugs to these patients.

Objetivo: Revisar la literatura disponible sobre la administración de  antineoplásicos orales en pacientes con trastornos de la deglución y  realizar una síntesis de la información hallada.Método: En el periodo septiembre 2019-junio 2020, tres farmacéuticos hospitalarios elaboraron una lista con los antineoplásicos  orales disponibles en España, la cual fue repartida, y cada cual llevó a  cabo la búsqueda y revisión bibliográfica de los medicamentos asignados.  Se revisaron las fichas técnicas y así como Pubmed, Micromedex,  Uptodate, la página web del Cancer Care Ontario, diferentes boletines  farmacéuticos, guías de administración por sonda y otras fuentes terciarias de información. En último lugar, se contactó con la industria farmacéutica. Posteriormente cada uno sintetizó la información que había  hallado y para concluir, un médico y un cuarto farmacéutico hospitalario  revisaron todo el trabajo llevado a cabo.Resultados: Se revisaron un total de 64 fármacos antineoplásicos orales. Se obtuvo información pertinente en el caso de 48, de los cuales 44  presentaban posibilidad de administración en estos pacientes (un 69% de  los fármacos investigados). Se realizó una síntesis de la información  hallada.Conclusiones: Pese a haber encontrado posibles métodos de preparación y administración para la mayoría de los antineoplásicos orales  revisados, se constata que la información es más bien escasa y con bajo  nivel  de evidencia. Es necesario seguir investigando en este campo, ya  que se precisan formas farmacéuticas líquidas, o preparaciones  extemporáneas, que en base a estudios farmacocinéticos y de estabilidad  permitan la administración de antineoplásicos orales en este grupo de  pacientes.

A multicentre observational study of the effectiveness, safety and economic impact of nivolumab on non-small-cell lung cancer in real clinical practice.

Background Immunotherapy has become a standard treatment for lung cancer; however, the high cost makes it necessary to assess health outcomes. Objective The aim of this study was to evaluate the effectiveness, safety and economic cost of nivolumab in real-world clinical practice. Setting Fifteen regional and academic hospitals from Spain participated in this study. Methods This study was a retrospective, multicentre and observational study involving patients who experienced progression after first-line therapy for non-small-cell lung cancer and were treated with nivolumab between January 2016 and July 2017. Effectiveness and safety were evaluated by the oncologist, and the data from the electronic clinical records of the patients were collected by the research team. Economic cost was calculated using the cost of acquiring nivolumab for the public health system. Main outcome measures Effectiveness variables were overall survival (OS) and progression-free survival (PFS). The safety variable was the incidence of adverse events (AEs), and the cost per life-year gained (LYG) was the economic variable. Results A total of 221 patients were enrolled (83.7% men). The mean age was 64.5 years, and 84.6% of the patients had an Eastern Cooperative Oncology Group (ECOG) performance-status score of 0-1. Squamous tumours accounted for 59.7% of the total, and 78.7% of the patients presented a time since platinum therapy (TPT) > 6 months. The mean nivolumab dose was 216 mg (SD 211), and the treatment duration was 7.0 months (95% CI 5.8-8.1). The median PFS was 5.3 months (95% CI 3.2-7.3), and OS was 9.7 months (95% CI 7.6-11.8). The median PFS and OS values were statistically significantly superior for patients with an ECOG score of 0-1 and for patients with a TPT > 6 months. The median OS was also statistically significantly superior for patients with non-squamous histology. Regarding safety, 71% of the patients presented AEs of any grade, and in 18.6%, the nivolumab treatment had to be delayed or discontinued. The cost of nivolumab per patient was €19,910.00 (SD 19,369), and the cost per LYG was €110,026.00 (€77,557.00-€231,171.00). Conclusions This study confirms that the efficacy and safety of nivolumab treatment in a real population are comparable to the results obtained in clinical trials. A greater clinical benefit of nivolumab therapy was observed in patients with an ECOG score of 0-1, a TPT > 6 months or non-squamous histology. Despite the benefit observed, the cost per LYG is above the threshold of efficiency established by public health institutes.

Valoración de la adherencia al tratamiento antibiótico en Atención Primaria mediante la determinación de niveles del fármaco utilizando una técnica de cromatografía líquida / Assessment of adherence to antibiotic treatment in Primary Care by determining levels of the drug using a liquid chromatography technique

Introducción. La falta de adherencia a los tratamientos antibióticos es una cuestión de especial interés, que tiene importantes implicaciones clínicas, pues se asocia a fallo terapéutico y al aumento de las resistencias bacterianas, ocasionando un alto coste sanitario. El objetivo de nuestro trabajo fue valorar, en pacientes ambulatorios, el grado de adherencia a los tratamientos antibióticos prescritos, a través de la detección de éstos en sangre, orina o esputo. Material y métodos. Se determinaron las concentraciones de los antibióticos prescritos en 39 pacientes (34 con sospecha clínica de infección del tracto urinario y 5 de infección de vías respiratorias bajas) atendidos en consultas de Atención Primaria del Distrito Sanitario de Almería (España), mediante una técnica de cromatografía líquida acoplada a espectrometría de masas en tándem. Resultados. El 48,7% de los pacientes no cumplió de manera correcta con el tratamiento indicado, debido a la omisión completa o parcial en la toma de los antibióticos prescritos. Esta falta de adherencia fue independiente de la edad y sexo de los pacientes, del número de dosis diarias del antibiótico y de que estuvieran, o no, recibiendo otra medicación. Conclusiones. Consideramos que técnicas analíticas precisas, como la cromatografía líquida, pueden ser útiles para detectar los tratamientos inadecuados o incompletos, así como el grado de adherencia de los pacientes ambulatorios, y, de esta forma, poder establecer medidas adecuadas que incidan en el control del cumplimiento terapéutico (AU)

Introduction. The lack of adherence to antibiotic treatments is a matter of special interest, which has important clinical implications, as it is associated with therapeutic failure and increased bacterial resistance causing a high sanitary cost. The objective of our study was to assess the degree of adherence to prescribed antibiotic treatment in outpatients through the detection of these in blood, urine or sputum. Material and methods. Concentrations of antibiotics prescribed in 39 patients (34 with clinical suspicion of urinary tract infection and 5 with clinical suspicion of low respiratory tract infection) treated in Primary Care consultations of the Sanitary District of Almería (Spain) were determined by ultrahigh performance liquid chromatography coupled to tandem mass spectrometry. Results. A 48.7% of the patients did not comply correctly with the indicated treatment due to the complete or partial omission in taking the prescribed antibiotics. This lack of adherence was independent of the age and sex of the patients, the number of daily doses of the antibiotic, and whether or not they were receiving another medication. Conclusions. Precise analytical techniques such as liquid chromatography can be useful to detect inadequate or incomplete treatments as well as the degree of adherence of outpatients. Thus, adequate measures could be established that affect the control of therapeutic compliance (AU)