Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis.

OBJECTIVES: To analyse persistence and adherence in patients with multiple sclerosis receiving first-line treatment with subcutaneous glatiramer acetate 20 mg (GA), subcutaneous interferon ß1a (IFNß1a-sc), intramuscular interferon ß1a (IFNß1a-im) and subcutaneous interferon ß1b (IFNß1b-sc) and to identify associated factors and reasons for discontinuation. METHODS: An observational retrospective study was performed between January 1999 and November 2014. Persistence was defined as the time from treatment initiation until discontinuation, and adherence as the number of units dispensed since treatment initiation until its interruption divided by the theoretical number of units needed to cover said period as a percentage. A patient was considered adherent if ≥95%. Persistence was measured using the Kaplan-Meier method and univariate Cox regression; adherence was measured using a univariate binary logistical regression model. RESULTS: The study included 224 patients. The median persistence was 1349 days (95% CI 1017.4 to 1680.6). Patients receiving IFNß1a-im continued treatment for a longer time (1720 days; 95% CI 1196.8 to 2243.2), while patients treated with IFNß1a-sc had the lowest persistence (771 days; 95% CI 377.4 to 1164.6) (HR=1.7; 95% CI 1.02 to 2.72). Patients with Expanded Disability Status Scale (EDSS) 1.5-6 discontinued treatment earlier than those with EDSS 0-1 (HR 1.5; 95% CI 1.01 to 2.25); 94.4% of patients discontinued treatment due to medical decision, primarily due to lack of efficacy (24.6%) and adverse effects (17.4%), while 80.8% of patients had good adherence. GA had the highest adherence, with no major difference from IFNß1a-im, while IFNß1b-sc showed the highest non-adherence (OR 3.5; 95% CI 1.29 to 9.28). CONCLUSIONS: The persistence levels obtained were lower than in similar studies. EDSS was identified as an independent predictor of treatment interruption. Acceptable adherence was achieved among the population, comparable to other studies and influenced by the drug.

Sclerotherapy and Topical Nasal Propranolol: An Effective and Safe Therapy for HHT-Epistaxis.

OBJECTIVES: Epistaxis is the most frequent clinical manifestation of hereditary hemorrhagic telangiectasia (HHT). Several topical, systemic, and surgical treatments have been tried, but none have been completely effective. The aim of the present study is to evaluate whether a combined treatment sclerotherapy and topical therapy with propranolol 0.5% nasal formulation would reduce the epistaxis due to HHT and improve patient's quality of life. METHODS: An observational cross-sectional study was carried out. The primary outcome measure was frequency and severity of epistaxis as measured by the epistaxis severity score (ESS) at baseline (4 weeks before therapy) and at least 4 weeks after the treatment was implemented. Quality of life was analyzed using EuroQol-5D (EQ-5D) scale and visual analogue (VAS) scale before and after treatment. RESULTS: A total of 38 consecutive patients subjected to the combined treatment were evaluated (mean age: 57.2 years, standard deviation [SD] = 13.9; 60.5% women). The mean time of treatment was 37.1 weeks (SD = 14.9). Combined therapy significantly reduces frequency and severity of epistaxis, with an ESS improvement of 5 points from 6.9 ± 2.6 to 1.9 ± 1.3 (P < 0.05); however, the EQ-5D scale increased from 0.66 ± 0.27 to 0.93 ± 0.12 (P < 0.05). The difference in VAS means showed an increase from 44.6 ± 28.3 to 82.5 ± 12.5 (P < 0.05). The increases in quality of life are in line with the drop in ESS. CONCLUSION: The study demonstrated that combined therapy (sclerotherapy and topical nasal propranolol) significantly reduced the epistaxis due to HHT and increased patients' quality of life. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:2216-2223, 2019.

Estudio de prescripción de opioides mayores para el control del dolor en pacientes hospitalizados / Use of major opioids for control of pain in hospitalized patients

Objetivos: Analizar las características de prescripción de opioides mayores para el tratamiento del dolor en pacientes hospitalizados. Evaluar la influencia de las características epidemiológicas de la población, la prescripción por servicios clínicos, la eficacia de la analgesia pautada, la prescripción de fármacos concomitantes y los efectos adversos secundarios al tratamiento opioide. Material y métodos: Estudio descriptivo, retrospectivo realizado entre marzo y abril de 2016 en el Hospital Universitario Fundación Alcorcón. Se consideró el primer opioide prescrito durante la estancia hospitalaria, haciéndose un seguimiento durante los cinco primeros días de tratamiento o hasta la discontinuación de este. Se excluyeron pacientes con prescripción de opioides en procedimientos quirúrgicos exclusivamente, que no continuaron con el tratamiento de los mismos durante su ingreso. Las variables recogidas fueron: sociodemográficas, clínicas, servicio clínico, prescripción de opioides mayores y otros fármacos, valoración del dolor y efectos adversos. Resultados: Los opioides más prescritos fueron morfina y fentanilo. Fentanilo y oxicodona se prescribieron principalmente en dolor mixto, morfina en dolor nociceptivo y petidina en dolor visceral. Las vías de administración más usadas fueron intravenosa y epidural. La mayoría de los pacientes tomaron otros fármacos concomitantes, siendo el más frecuente paracetamol. Los principales servicios prescriptores fueron traumatología, oncología y medicina interna. Fentanilo se pautó principalmente en traumatología y medicina interna, morfina en traumatología y oncología, oxicodona en oncología y petidina en medicina interna. La unidad del dolor realizó seguimiento de la mitad de los pacientes, especialmente en pacientes quirúrgicos. La mayoría de los pacientes tenían registrado el valor de la escala numérica simple, siendo la media 2,7. Los efectos secundarios fueron leves, destacando náuseas, vómitos y estreñimiento. Discusión: El grado de analgesia conseguido con el tratamiento opioide fue satisfactorio, con un valor aceptable. Los efectos secundarios fueron porcentualmente leves, destacando las náuseas, los vómitos y el estreñimiento propios de los opioides. La prescripción de opioides mayores siguió el patrón habitual de utilización en el ámbito hospitalario. Este tipo de estudios permite conocer y comparar el uso de opioides entre servicios clínicos y hospitales, así como predecir necesidades y reconocer ineficiencias

Objectives: Analyze prescription characteristics of major opioids for treatment of pain in hospitalized patients, influence of the epidemiological characteristics of population, to evaluate prescription for clinical services, efficacy of the analgesia, prescription of concomitant drugs and adverse effects secondary to opioid treatment. Material and methods: A descriptive, retrospective study carried out between March and April 2016 at Alcorcón Foundation University Hospital. It was considered first opioid prescribed during hospital stay, being followed during first five days of treatment or until discontinuation of the same. Patients with opioid prescribing were excluded exclusively in surgical procedures, who did not continue their treatment during their admission. Variables included were sociodemographic, clinical, clinical service, prescription of major opioids and other drugs, pain assessment and adverse effects. Results: Most commonly prescribed opioids were morphine and fentanyl. Fentanyl and oxycodone were prescribed mainly in mixed pain, morphine in nociceptive pain and pethidine in visceral pain. Most commonly used routes of administration were intravenous and epidural. Most of the patients took other concomitant drugs, being the most frequent paracetamol. The main prescribing services were traumatology, oncology and internal medicine. Fentanyl was mainly based on traumatology and internal medicine, morphine in traumatology and oncology, oxycodone in oncology and pethidine in internal medicine. Pain unit monitored half of patients, especially in surgical patients. Majority of patients had value of the simple numerical scale, with the mean being 2.7. Side effects were mild, emphasizing nausea, vomiting and constipation. Discussion: Degree of analgesia obtained with opioid treatment was satisfactory, with an acceptable value. Side effects were mild, with prominent opioid nausea, vomiting and constipation. Prescription of major opioids followed the usual pattern of use in hospital setting. This type of study allows to know and compare use of opioids between clinical services and hospitals, as well as predicting needs and recognizing inefficiencies

Secreción inadecuada de hormona antidiurética secundaria a tratamiento antiparkinsoniano / Inappropriate antidiuretic hormone hypersecretion associated with treatment of Parkinson's disease

No disponible

[Update of the stability of drugs cytostatic drugs by applying the methodology of the matrix of risk for the manufacture of sterile drugs]. / Actualización de la estabilidad de los medicamentos citostáticos y otras mezclas intravenosas aplicando la metodología de la matriz de riesgo para la elaboración de medicamentos estériles.

OBJECTIVE: To establish limits of validity to opened or reconstituted vials and cytostatic mixtures according to their physico- chemical stability and the level of risk and preparation requirements. The level of risk and preparation requirements were assigned by the risk matrix the Guide of Good Practice of Preparation of Drugs in Hospital Pharmacy Services. METHOD: A table of stabilities of cytostatic drugs was developed. Physicochemical stability data were obtained from data sheets and literature reviews. The level of risk was assigned by the matrix of risk depending on the requirements of each preparation. When the physico-chemical stability was equal to or higher than indicated by the matrix, it is assumed the terms of validity of the matrix; otherwise, validity periods coincided with the peak period of physicochemical stability. RESULTS: 61 drugs were reviewed. It was assumed the chemical term of validity in 45.9% of opened/reconstituted vials and 50.8% of cytostatic mixtures, and indicated by the risk in the rest array, respectively. According to the matrix, the level of risk was medium in most of cytostatic drugs. Only one preparation was high risk. No preparation obtained low-risk. CONCLUSIONS: To assign the term of validity of opened/reconstituted vials and cytostatic mixtures not only it is necessary to consider physical and chemical stability. The level of risk and preparation requirements are also important, allowing more adequate validity periods.

Objetivo: Establecer unos plazos de validez de los viales abiertos y/o reconstituidos y de las mezclas citostáticas según su estabilidad fisicoquímica, el nivel de riesgo y los requisitos de preparación asignados por la matriz de riesgo de la Guía de Buenas Prácticas de Preparación de Medicamentos en los Servicios de Farmacia Hospitalaria. Método: Se elaboró una tabla de estabilidades con los medicamentos citostáticos. Los datos de estabilidad fisicoquímica se obtuvieron de fichas técnicas y revisiones bibliográficas. El nivel de riesgo fue asignado por la matriz de riesgo en función de los requisitos de cada preparación. Cuando la estabilidad fisicoquímica era igual o superior a la indicada por la matriz, se asumieron los plazos de validez de la matriz; en caso contrario, los plazos de validez coincidieron con el periodo máximo de estabilidad fisicoquímica. Resultados: Se revisaron 61 fármacos. Se asumió el plazo de validez físico-química en el 45,9% de los viales abiertos/ reconstituidos y en el 50,8% de las mezclas citostáticas, y el indicado por la matriz de riesgo en el resto, respectivamente. Según la matriz, el nivel de riesgo fue medio en todos los medicamentos citostáticos salvo en uno, que resultó de riesgo alto. Ningún medicamento resultó de riesgo bajo. Conclusiones: Para asignar el plazo de validez de los viales abiertos/reconstituidos y de las mezclas citostáticas no solo es necesario tener en cuenta los datos de estabilidad físico-química, sino también el nivel de riesgo y los requisitos de preparación, permitiendo unos plazos de validez más adecuados.

Actualización de la estabilidad de los medicamentos citostáticos y otras mezclas intravenosas aplicando la metodología de la matriz de riesgo para la elaboración de medicamentos estériles / Update of the stability of drugs cytostatic drugs by applying the methodology of the matrix of risk for the manufacture of sterile drugs

Objetivo: Establecer unos plazos de validez de los viales abiertos y/o reconstituidos y de las mezclas citostáticas según su estabilidad fisicoquímica, el nivel de riesgo y los requisitos de preparación asignados por la matriz de riesgo de la Guía de Buenas Prácticas de Preparación de Medicamentos en los Servicios de Farmacia Hospitalaria. Método: Se elaboró una tabla de estabilidades con los medicamentos citostáticos. Los datos de estabilidad fisicoquímica se obtuvieron de fichas técnicas y revisiones bibliográficas. El nivel de riesgo fue asignado por la matriz de riesgo en función de los requisitos de cada preparación. Cuando la estabilidad fisicoquímica era igual o superior a la indicada por la matriz, se asumieron los plazos de validez de la matriz; en caso contrario, los plazos de validez coincidieron con el periodo máximo de estabilidad fisicoquímica. Resultados: Se revisaron 61 fármacos. Se asumió el plazo de validez físico-química en el 45,9% de los viales abiertos/ reconstituidos y en el 50,8% de las mezclas citostáticas, y el indicado por la matriz de riesgo en el resto, respectivamente. Según la matriz, el nivel de riesgo fue medio en todos los medicamentos citostáticos salvo en uno, que resultó de riesgo alto. Ningún medicamento resultó de riesgo bajo. Conclusiones: Para asignar el plazo de validez de los viales abiertos/reconstituidos y de las mezclas citostáticas no solo es necesario tener en cuenta los datos de estabilidad físico-química, sino también el nivel de riesgo y los requisitos de preparación, permitiendo unos plazos de validez más adecuados (AU)

Objective: To establish limits of validity to opened or reconstituted vials and cytostatic mixtures according to their physico-chemical stability and the level of risk and preparation requirements. The level of risk and preparation requirements were assigned by the risk matrix the Guide of Good Practice of Preparation of Drugs in Hospital Pharmacy Services. Method: A table of stabilities of cytostatic drugs was developed. Physicochemical stability data were obtained from data sheets and literature reviews. The level of risk was assigned by the matrix of risk depending on the requirements of each preparation. When the physico-chemical stability was equal to or higher than indicated by the matrix, it is assumed the terms of validity of the matrix; otherwise, validity periods coincided with the peak period of physicochemical stability. Results: 61 drugs were reviewed. It was assumed the chemical term of validity in 45.9% of opened/reconstituted vials and 50.8% of cytostatic mixtures, and indicated by the risk in the rest array, respectively. According to the matrix, the level of risk was medium in most of cytostatic drugs. Only one preparation was high risk. No preparation obtained low-risk. Conclusions: To assign the term of validity of opened/reconstituted vials and cytostatic mixtures not only it is necessary to consider physical and chemical stability. The level of risk and preparation requirements are also important, allowing more adequate validity periods (AU)