ABSTRACT
Background and importance The most frequently recorded mental health problem is anxiety disorder and in the context of the SARS-CoV-2 pandemic, where an increase in anxiety cases has been evidenced, benzodiazepine derivatives (N05BA) have been one of the most prescribed pharmacological groups in most developed countries for this problem. Although their short-term benefits have been demonstrated, increasing their consumption may have longterm risks. Aim and objectives The main aim of this study was to find out the prescriptions of benzodiazepine derivatives from 2018 to 2021 in the context of the SARS-CoV-2 pandemic and the variation in them. A secondary objective was to learn which benzodiazepine derivatives varied more. Material and methods Retrospective, observational and crosssectional study. The study period included June 2018, June 2019, June 2020 and June 2021. The study population included the 710 581 inhabitants associated with the prescribing doctors of benzodiazepine derivatives from the study province. Results Total study population N=710 581;21.61% (153.574) with a benzodiazepine prescription, 67.33% (103 416) women, between June 2018 and June 2021. The prescribed benzodiazepine derivatives were: alprazolam, diazepam, diazepam/pyridoxine, clotiazepam, lorazepam, ketazolam, clobazam, pinazepam, clorazepato dipotassium, bromazepam, bentazepam, diazepam/sulpiride and diazepam/sulpiride/ pyridoxine. June 2018: 35 800 prescriptions, 67.30% (24 085) women;June 2019: 37 601, 67.20% (25 262) women;June 2020: 39 547, 67.30% (26 622) women;and June 2021: 40 626, 67.60% (27.477) women. From June 2018 to June 2019 prescriptions increased 5.03% (1801), from June 2019 to June 2020 they increased 5.20% (1946);and from June 2020 to June 2021 they increased 2.73% (1079), which represented a 13.48% increase in prescriptions (4826) from June 2018 to June 2021. The largest prescription increases were diazepam +23%, lorazepam +18%, bromazepam +12.5%, and alprazolam +12.3%. The largest prescription decreases were clotiazepam and bentazepam -100%, pinazepam -96.43% and clobazazam - 22.45%. Conclusion and relevance In the context of the SARS-CoV-2 pandemic we have seen a progressive increase in benzodiazepines of 13.48% (4826 prescriptions) from June 2018 to June 2021, with women being the users of 67.33% of prescriptions on average. These data allow us to know the current situation of the prescription of benzodiazepine derivatives to the population and to focus on mental health both in the validation of treatments and in pharmaceutical care.
ABSTRACT
Background and importance Erenumab was approved for migraine prophylaxis shortly before the COVID-19 pandemic. After 18 months, there was enough data to conduct several studies. Aim and objectives Evaluate effectiveness and safety of erenumab using real-world data and compare the results with clinical trials. Material and methods A retrospective, observational study was performed in a second-level hospital. Evaluation of patients with migraine being treated with erenumab for at least 6 months. Data extraction from clinical histories and prescription software. Patient-related outcomes filled in their clinical history by the neurologist and pharmacist. Results 55 patients recruited to commence treatment with erenumab between January 2020 and April 2021. 48 patients included (7 patients excluded due to lack of follow-up). 44 women, average age 49.7 years, and 21 days per month with migraine (MMD). 26 patients reached a reduction of MMD of ≥50%, and 10 of ≥75% (54.2% and 20.8%, respectively) after a followup of between 3 and 9 months. Of the 22 patients that did not reach at least 50% reduction in MMD, 7 patients tried a dosage increase, with 5 of them achieving an average 61% reduction in MMD. All patients mentioned having softer migraine pain. Regarding safety, only 11 patients experienced adverse reactions, mostly constipation. Three patients needed to cease treatment. Conclusion and relevance Erenumab has established a new treatment in migraine prophylaxis that works even better than in the clinical trials. According to clinical trials results, erenumab can reduce MMD by 50% in about 40% of patients regardless of the dosage, and by 75% in about 18.9% of patients. In our findings, erenumab achieved a 50% reduction in 54.2% of patients, and a 75% reduction in 20.8% of patients, achieving better results in real life than in the clinical trials. Our study has as a limitation the follow-up being carried out by physicians and not by pharmacists, which could improve patient-related outcomes and experiences as hospital pharmacists dispense medication every 2 months in our hospital. The hospital pharmacist's role can be useful for evaluating treatments results described by patients.
ABSTRACT
Background and importance An outbreak of multiple sclerosis (MS) is defined as symptoms and neurological signs typical of demyelinating disease, with a duration of at least 24 hours. It appears in all forms of MS, contributing to short and long term disability. The main treatments for outbreaks are high dose steroids given intravenously or orally for 3-5 days. In our clinical practice, we used oral prednisone 1400 mg for 5 days prepared in a hospital pharmacy to avoid staff attendance at health centres. Aim and objectives To evaluate oral prednisone effectiveness as a treatment for acute MS outbreaks. Material and methods This was a retrospective multidisciplinary study, from March to June 2020 (4 months), during the limited mobility period due to the coronavirus pandemic (SARS-CoV-2). The results of 31 patients were analysed. The following data were collected: sex, age, type of MS, expanded disability status scale (EDSS), treatment at the time of the outbreak, symptoms and evolution. The programmes used were: patient medical history (DIRAYA), outpatient dispensing (DOMINION) and MRI (CARESTREAM). Specialist role was: the neurologist made the clinical evaluation, the pharmacist prepared the prednisone capsules from original tablets and its dispensation, and the nurse provided patient education. Results 31 patients (25 women) with a mean age of 44.85 ±13 years were assessed. Every patient had a diagnosis of recurrent remitting MS. Treatments were: interferon beta (20), dimethyl fumarate (10) and cladribine (1). The mean EDSS was 3. The main symptoms were: paraesthesias, muscle weakness and urinary incontinence. The EDSS progressed positively: 83.78% of patients evolved favourably, a subjective decrease in paraesthesia and weakness was observed and MRI showed less inflammation signs. Another aspect was the comfort of the patient in carrying out this treatment at home rather than attending hospital. Conclusion and relevance The results suggested that 1400 mg of oral prednisone administration for 5 days could be considered a safe, effective and comfortable alternative treatment for acute outbreaks of MS. Multidisciplinary care is essential to obtain better clinical results.