Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic.

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

Drug-drug interactions with nirmatrelvir/ritonavir for COVID-19 and the role of hospital pharmacists

4CPS-043 Table 1DDI category, n(%) C: monitor therapy D: consider therapy modification X: avoid concomitant use 24(46.2) 16(30.8) 12(23.1) ATC of DDI, n (%) N-nervous system C-cardiovascular system B-blood and blood forming organs G-genito urinary system H-systemic hormonal preparations L-antineoplastic and immunomodulating agents A-alimentary tract and metabolism M-musculo-skeletal system R-respiratory system 21(40.4) 13(25) 5(9.6) 4(7.7) 3(5.8) 2(3.8) 2(3.8) 1(1.9) 1(1.9) Medical department with DDI, n(%) Haematology Oncology Nephrology Pneumology Emergency room 6(23.1) 4(15.4) 3(11.5) 3(11.5) 3(11.5) Pharmacy intervention on concomitant drugs, n(%) Discontinuation Adverse events monitoring Dose reduction Substitution Efficacy monitoring 23(44.2) 15(28.8) 7(13.5) 5(9.6) 2(3.8) Statistical significant differences were found with ATC and DDI category (p<0.001): cardiovascular system drugs had more X-category DDI (41.7%) and nervous system drugs had more C-category DDI (60.8%).Haematology department had more patients presenting any DDI (23.1%, p=0.047).No DDI provoked any adverse event during treatment with nirmatrelvir/ritonavir.Conclusion and RelevanceA high risk for DDI with nirmatrelvir/ritonavir was found, although most of them were mild and none provoked any adverse event. Cardiovascular system drugs showed the most severe DDI.Haematology patients and those receiving nervous system drugs had higher prevalence for DDI.Almost half of pharmacy recommendations were to discontinue the drug presenting the DDI. None of the pharmaceutical interventions induced any adverse event derived from the modification of concomitant treatment during nirmatrelvir/ritonavir administration.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic

Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years;admission to critically ill units;and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18–97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%);wrong drug combination in 131 (25.5%);prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%);prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%);and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071–5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.

Real-world evidence of anti-CD20 monoclonal antibodies in chilean patients with multiple sclerosis

Introduction: Real-world evidence studies regarding the effectiveness and safety of disease-modifying therapies are useful for clinical practice and for assessing the risk-benefit of some health policy interventions. Objective(s): To evaluate safety and effectiveness outcomes in year 1 and year 2 in patients receiving antiCD20 monoclonal antibodies. Method(s): Longitudinal observational study of MS patients under regular care at the Programa de Esclerosis Multiple UC in Chile who received at least one dose of ocrelizumab or rituximab between June 2018 and April 2022. Result(s): A total of 229 patients were included, 219 using Ocrelizumab and 10 using Rituximab. 163 patients had relapsingremitting MS (RRMS), 68% female, mean age at antiCD20 34.3+8.5 years, mean disease duration 5.6+5.4 years, and median baseline EDSS 1.5(0-6.0). 35 had primary progressive MS (PPMS), 54% female, mean age at antiCD20 47+12 years, mean disease duration 6.3+6.3 years and median EDSS 4.0(1.0-7.0). 31 had secondary progressive MS (SPMS), 64% female, mean age at antiCD20 50.4+9.7 years, mean disease duration 16.4+10.1 years and median EDSS 6.0(1.0-7.0). Before antiCD20, mean annualized relapse rate (ARR) was 0.7+0.5 for RRMS, and 0.2+0.4 for PPMS and SPMS patients, and MRI activity (newT2/Gd+) was observed in 84.8% of RRMS, 60% of PPMS and 40.7% of SPMS patients. Mean ARR in years 1 and 2 was 0 in RRMS and PPMS, 0.05+0.2 in year 1 and 0 in year 2 for SPMS. NewT2/Gd+ in years 1 and 2 were observed in 11.4% and 8.3% in RRMS, 21.4% and 0 in PPMS, and 0 in SPMS. Year 1 and 2 EDSS progression was observed in 0% and 3.6% of RRMS, 0 and 15.4% in PPMS, and 18.1% and 21.4% in SPMS. Years 1 and 2 NEDA3 was obtained in 82.6% and 94.6% of RRMS, 70% and 87.5% of PPMS and 90% and 87.5% of SPMS. Infusion Reactions were observed in 35% during the first dose, decreasing with each infusion (13.5% in the fourth infusion), all were considered mild. The most frequent year 1 adverse event were COVID-19 (n=5), upper tract infection (n=4), diarrhoea (n=4) and urinary tract infection (n=4). The most frequent year 2 adverse events were COVID-19 (n=4) and skin infection (n=3). One patient with previous history of breast cancer developed a tumour recurrence during the second year of treatment. Conclusion(s): This study supports robust effectiveness outcomes in a real-world cohort, with a consistent safety profile in patients receiving care at a specialized MS Unit.

Addressing Threats Through Organization. Neighborhood Associations’ Perspectives and Strategies on the Socio-residential Issues in Vulnerable Areas

Within the framework of a research on social and residential vulnerability, qualitative contributions drawn from associations are particularly relevant, as are the perspectives offered by representatives of the local public administration. Moreover, in the context of the current COVID-19 socio sanitary crisis, it is worth contrasting the capacity for response and the strategies adopted by local organizations in Barcelona neighborhoods. Within a competitive project focusing on the study of urban regeneration projects in vulnerable neighborhoods, the goal of this article is to provide context for the current social and residential issues of five Barcelona neighborhoods. To this end, it collects the perspectives of local associations on their neighborhoods. Special attention is given to how and whether the roles and perspectives of these organizations have been altered by the current crisis, and what tools they use to face the most pressing problems. Interviews with different neighborhood leaders are provided alongside interviews with representatives of the local administration. Each side offers its vision of the most common challenges and opportunities, which are centered on the ever-present factors of social exclusion and migration issues. Furthermore, this article presents some of the strategies neighborhood associations use to face the problems intensified by the current crisis. The main conclusions of this qualitative study allow us to reflect on the importance of having powerful methodological tools to analyze the degree of organization and citizen involvement. © 2022, Universitat Politecnica de Catalunya. All rights reserved.

Impact of the COVID-19 pandemic: Community and hospital shared pharmaceutical care model. Satisfaction and acceptability of patients with HIV infection on antiretroviral treatment.

OBJECTIVE: The health crisis due to the COVID-19 pandemic is a challenge in the dispensing of outpatient hospital medication (OHM). Models of Antiretroviral Therapy (ART) based on community pharmacy support (ARTCP) have proven to be successful. The aim was to evaluate the degree of satisfaction, acceptability and limitations of the implementation of ARTCP, in the context of a pandemic, in our environment. METHODS: Descriptive cross-sectional study carried out in a Barcelona hospital, during the months of July-November 2020. A telephone survey was carried out via a questionnaire on the quality dimensions of the model (degree of satisfaction, acceptability) and associated inconveniences. Data collected: demographics, antiretroviral treatment (ART), concomitant medication, drug interactions (DDIs), CD4 lymphocyte count and plasma viraemia. Data analysis included descriptive statistics. RESULTS: A total of 533 (78.0%) HIV patients receiving ART were included. 71.9% (383/533) of these patients were very satisfied and 76.2% preferred attending the community pharmacy rather than the hospital. The mean satisfaction rating was 9.3 (DS: 1.4). The benefits reported were: 1) proximity to home (406: 76.1%); 2) lower risk of contagion of COVID-19 (318: 59.7%); 3) shorter waiting time (201: 37.1%); 4) time flexibility (104: 19.5%); 5) reduction of financial expenses (35: 6.57%). A total of 11 (2%) patients reported no benefit. Only 22.9% reported disadvantages associated with ARTCP: 1) lack of privacy (65: 12.2%); 2) lack of coordinationorganization (57: 10.7%). CONCLUSIONS: The COVID-19 pandemic has had an impact on the provision of pharmaceutical care for HIV patients. The ARTPC model has proved efficient, with patients reporting a high degree of satisfaction.