Evolución temporal de la terapia antirretroviral (2017-2021): análisis de la modificación del tratamiento y su impacto económico / Temporal evolution of antiretroviral therapy (2017-2021): analysis of treatment change and its economic impact

Objetivos. Analizar las modificaciones de la terapia antirre troviral (TAR) y su impacto económico en la práctica clínica diaria. Material y métodos. Estudio observacional, retrospectivo de los pacientes que iniciaron TAR entre 01/2017-12/2021 (se guimiento hasta 12/2022). Variables recogidas: TAR, duración, motivo del cambio y costes del tratamiento. Resultados. 280 pacientes iniciaron TAR. La mediana de durabilidad de la 1ª línea fue: 19,9 meses en 2017 (IC95% 13,9-25,9), 12,2 meses en 2018 (IC95% 4,7-19,7), 27,4 meses en 2019 (IC95% 6,8-48,1) y no se alcanzó la mediana para los años 2020 y 2021 (p p<0,001). De un total de 541 líneas prescri tas, la triple terapia con inhibidores de la proteasa se modificó en el 63,8% (81/127), seguido de los inhibidores de la integrasa 52,1% (159/305), mientras que, la terapia dual (DTG/3TC) solo en el 8,3% (7/84). De un total de 261 modificaciones, la simpli ficación/optimización 47,5% (124/261) fue el principal motivo, seguido de efectos adversos 21,8% (57/261), siendo el 2017 el único año donde ambos motivos se encontraban al mismo nivel. El impacto económico de los cambios supusieron una re ducción del coste medio de 34,0€ [-391,4 a +431,4] al mes/ paciente. El año 2019 es el único año donde estos cambios se asociaron con un incremento del coste adicional medio (23,4€ [-358,3 a +431,4]). Conclusiones. Dejando atrás el fracaso virológico, la sim plificación a regímenes de un solo comprimido y de mayor tolerancia han marcado la nueva la era TAR. Con un impacto económico que, a pesar del punto de inflexión del 2019, refleja una reducción progresiva de costes mantenida en el tiempo (AU)

Objectives. To analyze the modifications of antiretrovi ral therapy (ART) and their economic impact on daily clinical practice. Material and methods. Observational, retrospective study of patients who started ART between 01/2017-12/2021 (follow-up until 12/2022). Variables collected: prescribed ART, duration, the reason for the change, and treatment costs. Results. A total of 280 patients initiated ART therapy. The median durability of 1st line was: 19.9 months in 2017 (95%CI 13.9-25.9), 12.2 months in 2018 (95%CI 4.7-19.7), 27.4 months in 2019 (95%CI 6.8-48.1) and the median was not reached for the years 2020 and 2021 (p<0.001). Triple therapy with protease inhibitors was changed in 63.8% (81/127) of cases, followed by integrase inhibitors 52.1% (159/305), while dual therapy (DTG/3TC) only in 8.3% (7/84). The main cause of dis continuation was simplification/optimization 47.5% (124/261), followed by adverse effects 21.8% (57/261), with 2017 being the only year where simplification/optimization was at the same level as adverse effects. The economic impact of ART changes resulted in an average cost reduction of 34.0€ [-391.4 to +431.4] per month per patient. The year 2019 stands out as the only year where these changes were associated with an increase in mean additional cost (23.4€ [-358.3 to +431.4]). Conclusions. Optimization/simplification accounts for almost half of the reasons for TAR change, with an econom ic impact that, despite the inflection point of 2019, each year manages to exceed the previous one, achieving a progressive cost reduction maintained over time (AU)

Adecuación de la prescripción de antibióticos antipseudomónicos tras los cambios en los criterios EUCAST 2019 / Adequacy of the consumption of antipseudomonal antibiotics after changes in the 2019 EUCAST criteria

Introducción. En 2019, el Comité Europeo para el estudio de la sensibilidad antibiótica modificó las categorías de los test de sensibilidad antibiótica incluyendo el término “sensible con exposición incrementada”. Tras la difusión de protocolos locales recogiendo estas modificaciones, el objetivo de nuestro estudio fue analizar si los prescriptores se han adecuado a los mismos y el posible impacto clínico en los casos de inadecuación. Material y métodos. Estudio observacional y retrospecti vo de los pacientes con infección por pseudomonas aeruginosa y que hayan recibido antibiótico antipseudomónico desde ene ro a octubre de 2021 en un hospital terciario. Resultados. La inadecuación a las recomendaciones de la guía fueron un 57,6% en planta y un 40,4% en UCI (p<0,05). Tanto en planta como en UCI el grupo con más prescripción no ajustada a las recomendaciones de la guía fueron los amino glucósidos (92,9% y 64,9% respectivamente) por utilizar dosis subóptimas, seguido de los carbapenémicos (89,1% y 53,7% respectivamente) por no administrarlo en perfusión extendida. En planta, la tasa de mortalidad durante el ingreso o a los 30 días en el grupo de terapia inadecuada fue de 23,3% vs 11,5% en los que recibieron los tratamientos de forma adecuada (OR: 2,34; IC 95% 1,14-4,82); en UCI no hubo diferencias estadísti camente significativas. Conclusiones. Los resultados muestran la necesidad de implementar medidas para garantizar una mejor difusión y co nocimiento de los conceptos claves en el manejo de los antibió ticos, con el objetivo de garantizar exposiciones incrementadas y poder ofrecer una mejor cobertura de la infección, así como de evitar la amplificación de cepas resistente (AU)

Introduction. In 2019, the European Committee for the Study of Antibiotic Susceptibility modified the categories of antibiotic susceptibility tests to include the term “susceptible with increased exposure”. Following the dissemination of local protocols reflecting these modifications, the aim of our study was to analyse whether prescribers have adapted to them and the clinical impact in cases of inadequacy. Material and methods. Observational and retrospective study of patients with infection who received antipseudomonal antibiotics from January to October 2021 in a tertiary hospital.Results. Non adherence to the guideline recommendations was 57.6% in the ward and 40.4% in the ICU (p<0.05). In both the ward and ICU, the group with the most prescriptions not by the guideline ecommendations were aminoglycosides (92.9% and 64.9% respectively) for using suboptimal doses, followed by carbapenems (89.1% and 53.7% respectively) for not administering an extended infusion. On the ward, the mortality rate during admission or at 30 days in the inadequate therapy group was 23.3% vs 11.5% in those who received adequate treatment (OR: 2.34; 95% CI 1.14-4.82); in ICU there were no statistically significant differences.Conclusions. The results show the need to implement measures to ensure better dissemination and knowledge of key concepts in antibiotic management, to ensure increased exposures, and to be able to provide better infection coverage, as well as to avoid amplifying resistant strains (AU)

Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo / Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit

Objetivo: evaluar la contribución del farmacéutico mediante el análisis de la prescripción potencialmente inapropiada y la conciliación del tratamiento domiciliario en la unidad de pacientes crónicos complejos de un hospital terciario. Métodos: estudio observacional, prospectivo y multidisciplinar de los pacientes de la unidad de pacientes crónicos complejos de un hospital durante febrero de 2019 - junio de 2020. El equipo multidisciplinar del crónico complejo elaboró un checklist con una selección de fármacos no recomendados basado en los criterios STOPP/START, Beers y PRISCUS y fármacos susceptibles de desprescripción según los criterios LESS-CHRON. El farmacéutico aplicaba el checklist diariamente en los pacientes que ingresaban en la unidad, además de realizar la conciliación del tratamiento domiciliario revisando el tratamiento prescrito con el detallado en la receta electrónica domiciliaria. Por eso, se recogieron las siguientes variables: edad, sexo y número de fármacos al ingreso como variables independientes, y variables dependientes: número de fármacos al alta, tipo de prescripción potencialmente inapropiada, motivos de conciliación, fármacos implicados y grado de aceptación de la recomendación por parte del médico prescriptor para evaluar la contribución farmacéutica. El análisis estadístico se realizó con IBM® SPSS® Statistics22. Resultados : se revisaron 621 pacientes con una mediana de edad de 84 años (56,4% mujeres), y se intervino en 218 (35,1%). La mediana del número de fármacos fue de 11 (2-26) al ingreso y de 10 (0-25) al alta. Se realizaron 373 intervenciones: 235 por conciliación de la medicación (78,3% aceptadas), 71 por medicamentos no recomendados (57,7% aceptadas), 42 por desprescripción (61,9% aceptadas) y 25 por otros motivos. ... (AU)

Objective: To assess the pharmacist’s contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital.MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22.Results: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). ...(AU)

Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. / [Artículo traducido] Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo.

OBJECTIVE: To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD: Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS: The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.

Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit.

OBJECTIVE: To assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD: Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019-June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge. 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS: The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.

Assessment of the effectiveness of tocilizumab on mortality and progression to mechanical ventilation or intensive care in patients with COVID-19 admitted to a tertiary hospital.

OBJECTIVES: The evidence for tocilizumab in the treatment of COVID-19 is contradictory, with some clinical trials showing benefits in regard to progression to mechanical ventilation (MV) and/or mortality. The aim of this study is to evaluate in real clinical practice the effectiveness of tocilizumab in treating COVID-19 and to identify prognostic factors for patient outcomes. METHODS: This was an observational, retrospective study of COVID-19 patients treated with tocilizumab between March 2020 and February 2021 in a tertiary hospital. Variables were demographics, comorbidities, vital signs, analytical parameters, COVID-19 treatment, progression to MV, intensive care unit (ICU) admission, hospital stay, and mortality. RESULTS: A total of 685 patients (64.7% men, median 68 years) were included. Overall mortality was 23.4% (14.2% in the first 14 days post-tocilizumab) and 93.3% in patients with MV and/or in the ICU at 14 days post-tocilizumab. In addition, 61.5% of discharges occurred during the same period. In patients who died, statistically significant differences were observed in the baseline analytical parameters of C-reactive protein (CRP), D-dimer and higher lactate dehydrogenase (LDH) (p<0.05). CONCLUSIONS: In most patients the clinical results of tocilizumab were observed at 14 days post-administration and could benefit from earlier administration of treatment. Baseline levels of CRP, D-dimer and LDH could be prognostic factors for the evolution of the COVID-19 patient.

Formulación magistral en la atención farmacéutica del paciente oncopediátrico / Drug Compounding in Pharmaceutical Care of Oncopediatric Patients

Introducción: El tratamiento farmacológico del paciente oncopediátrico supone una dificultad para el equipo asistencial ya que muchos medicamen-tos registrados por la administración sanitaria no están indicados en población pediátrica, creándo-se un vacío terapéutico en el tratamiento que es cubierto a través de la formulación magistral (FM). El objetivo del estudio es analizar la elaboración de medicamentos individualizados para oncopediatría en los últimos tres años en el Servicio de Farmacia de un hospital de tercer nivel.Métodos: Estudio descriptivo, observacional, retrospectivo de las FM que se elaboraron para el Servicio de Oncopediatría en el periodo 2019-2021. Para cada FM se detalló su indicación y aplicación clínica. En la descripción cuantitativa se especificó número de fórmulas elaboradas y porcentaje. En la descripción cualitativa se detalló principio activo y concentración, procedimiento para elaborar la for-mulación, dosis de principio activo y de excipientes; condiciones de conservación y fecha de caducidad.Resultados: En el periodo de estudio, se elaboraron 3730 FM para el Servicio de Oncopediatría. Las 4 fórmulas magistrales con mayor peso en la prepa-ración son las de los principios activos: etopósido, fenofibrato, ondansetrón y mercaptopurina. El 57,4% de las FM fueron soluciones orales y el 26,5% suspensiones. La aplicación clínica del 71% de las FM preparadas fue el tratamiento de las patologías onco-hematológicas.Conclusiones: En el paciente oncopediátrico, se acentúa la necesidad de una farmacoterapia más individualizada para asegurar una correcta dosifi-cación y adherencia al tratamiento, siendo la FM la herramienta que solventaría sus necesidades terapéuticas (AU)

Introduction: The pharmacological treatment of the oncopediatric patient represents a difficulty for the health care team, since many drugs registered by the health administration are not indicated in the pediatric population, creating a therapeutic gap in the treatment that is covered through the drug compounding (DC). The aim of this study is to analyze the preparation of individualized drugs for oncopediatrics in the last three years in the Phar-macy Service of a tertiary hospital.Methods: It was carried out a descriptive, observa-tional and retrospective study of the DCs that were prepared for the Oncopediatric Service in the period 2019-2021. For each DC, its indication and clinical application were detailed. In the quantitative de-scription, the number of DC elaborated and percent-age were specified. In the qualitative description, active ingredient and concentration, procedure to prepare the formulation, dose of active ingredient, excipients, storage conditions and expiration date were detailed.Results: During the study period, 3730 DC were prepared for the Oncopediatric Service. It is import-ant to note that the 4 formulations with the greatest weight in the preparation were those of the active ingredients: etoposide, fenofibrate, ondansetron and mercaptopurine. Oral solutions and suspen-sions accounted for 57.4% and 26.5% of the DC. The clinical application of 71% of the DC prepared was the treatment of onco-hematological patholo-gies.Conclusions: In the oncopediatric patient, the need for a more individualized pharmacotherapy is accentuated to ensure a correct dosage and adher-ence to treatment, being the DC the tool that would solve its therapeutic needs (AU)