[Analysis of the causes and predictive factors for discontinuing treatment with tenofovir in pretreated HIV patients]. / Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados.

OBJECTIVE: To determine the frequency and causes for discontinuing treatment with tenofovir and analyse possible predictive factors for changing this therapy in pretreated HIV patients. METHOD: A multi-centre, observational and retrospective study of all HIV patients undergoing treatment with tenofovir between July 2002 and December 2005. Data were obtained from databases for outpatients attending the three pharmacy departments participating in the study, and by reviewing clinical histories. The main sociodemographic, clinical and analytical variables at the start of treatment with tenofovir were collected. The causes for discontinuing treatment were classified as follows: adverse effects, virological failure, death and "other causes". A survival analysis was performed using the Kaplan-Meier method to analyse the possible predictive factors for discontinuing treatment. RESULTS: A total of 733 patients were included in the study and the median treatment period was 34.7 months. A total of 23.8% of patients discontinued treatment for the following reasons: adverse effects (43.2%), death (17.7%), virological failure (14.8%) and "other causes" (24.4%). There were 99 cases of lost to follow-up. In the survival analysis an association was found between normal serum creatinine values (p = 0.0042) at the start of treatment and the statistically significant probability of discontinuing treatment. CONCLUSIONS: Almost a quarter of the patients discontinued treatment with tenofovir during the study. The main cause for this was adverse effects. No association was found between any abnormal basal analytical parameter and a greater probability of discontinuing treatment.

Análisis de las causas y factores predictivos de discontinuación del tratamiento con tenofovir en pacientes VIH pretratados / No disponible

Objetivo: Determinar la frecuencia y las causas de discontinuacióndel tratamiento con tenofovir y analizar los posibles factorespredictores de cambio de esta terapia en pacientes VIHpretratados.Método: Estudio multicéntrico, observacional y retrospectivode todos los pacientes VIH en tratamiento con tenofovir entrejulio-2002 y diciembre-2005. Los datos fueron obtenidos a travésde las bases de datos de pacientes externos de los tres servicios defarmacia participantes y de la revisión de las historias clínicas. Serecogieron las principales variables sociodemográficas, clínicas yanalíticas al inicio del tratamiento con tenofovir. Las causas de discontinuaciónse clasificaron en: efectos adversos, fracaso virológico,exitus y “otras causas”. Se realizó un análisis de supervivenciade Kaplan-Meier para analizar los posibles factores predictores dediscontinuación.Resultados: Un total de 733 pacientes se incluyeron en elestudio. La mediana de tiempo en tratamiento fue de 34,7meses. El 23,8% de los sujetos discontinuó el tratamiento. Lascausas fueron: efectos adversos: 43,2%, exitus: 17,7%, fracasovirológico: 14,8% y “otros motivos”: 24,4%. Hubo 99 casos deperdida de seguimiento. En el análisis de supervivencia, se asociótener niveles normales de creatinina sérica (p = 0,0042) alinicio del tratamiento con probabilidad estadisticamente significativade discontinuación.Conclusiones: Durante el estudio, casi una cuarta parte delos pacientes discontinuó el tratamiento con tenofovir. La principalcausa de discontinuación fueron los efectos adversos. No seasoció ningún parametro analítico basal anormal a mayor probabilidadde discontinuación de tratamiento

Objective: To determine the frequency and causes for discontinuingtreatment with tenofovir and analyse possible predictivefactors for changing this therapy in pretreated HIV patients.Method: A multi-centre, observational and retrospectivestudy of all HIV patients undergoing treatment with tenofovirbetween July 2002 and December 2005. Data were obtainedfrom databases for outpatients attending the three pharmacydepartments participating in the study, and by reviewing clinicalhistories. The main sociodemographic, clinical and analyticalvariables at the start of treatment with tenofovir were collected.The causes for discontinuing treatment were classified as follows:adverse effects, virological failure, death and “other causes”.A survival analysis was performed using the Kaplan-Meiermethod to analyse the possible predictive factors for discontinuingtreatment.Results: A total of 733 patients were included in the studyand the median treatment period was 34.7 months. A total of23.8% of patients discontinued treatment for the following reasons:adverse effects (43.2%), death (17.7%), virological failure(14.8%) and “other causes” (24.4%). There were 99 cases of lostto follow-up. In the survival analysis an association was foundbetween normal serum creatinine values (p = 0.0042) at the startof treatment and the statistically significant probability of discontinuingtreatment.Conclusions: Almost a quarter of the patients discontinuedtreatment with tenofovir during the study. The main cause for thiswas adverse effects. No association was found between anyabnormal basal analytical parameter and a greater probability ofdiscontinuing treatment

La situación internacional y la revista Farmacia Hospitalaria / No disponible

No disponible

[An analisys fo causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine]. / Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina.

OBJECTIVE: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the co-formulation of abacavir, lamivudine and zidovudine (ABC-3TC-AZT). METHOD: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients withdrawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. RESULTS: In all, 114 patients (85 males, 74.6%) received this therapy - 25.4% of them were naïve patients - and 34.2% (39/114) withdrew from this regimen, amongst them 44.8% (13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). CONCLUSIONS: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented.

Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina / An analysis of causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine

Objetivo: Identificar y analizar las causas más frecuentes de discontinuación de la terapia antirretroviral que incluye la co-formulación: abacavir, lamivudina y zidovudina (ABC-3TC-AZT). Método: Estudio retrospectivo observacional de los pacientesen tratamiento antirretroviral con ABC-3TC-AZT, atendidos en la unidad de pacientes externos del servicio de farmacia durante el periodo comprendido entre febrero de 2002 y junio de 2004. Se analizó la causa de discontinuación en aquellos pacientes que no siguieron con esta terapia. Se evaluó la adherencia mediante los registros informáticos de dispensación. Se diseñó un análisis de supervivencia de Kaplan-Meier para identificar factores predictivos de discontinuación. Resultados: Un total de 114 pacientes (85 hombres, 74,6%) fueron tratados con esta terapia. Un 25,4% era naïve. El 34,2% (39/114) de los pacientes discontinuó el tratamiento. Entre ellos, el 44,8% (13/29) de los sujetos naïve. En el 92,3% del total de casos esto ocurrió antes de alcanzar las 48 semanas en tratamiento. Las causas de discontinuación fueron: reacciones adversas (46,1%), abandono voluntario (33,3%), decisión clínica (15,4%) y otros motivos (5,1%). Posible reacción de hipersensibilidad a ABC fue descrita en 9 pacientes. Se relacionó tener carga viral detectable al inicio del tratamiento, ser ex-ADVP, y paciente naïve, con mayor probabilidad de discontinuación (p < 0,05). Conclusiones: Se encontró un alto porcentaje de discontinuación debido a efectos adversos y abandono voluntario, principalmente al inicio del tratamiento. Es necesario identificar a aquellos pacientes a los cuales este esquema les puede aportar un beneficio terapéutico, especialmente los sujetos naïve, y realizar intervenciones para mejorar la adherencia y optimizar así los parámetros de recuperación

Objective: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the coformulation of abacavir, lamivudine and zidovudine (ABC-3TCAZT). Method: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department’s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients with drawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. Results: In all, 114 patients (85 males, 74.6%) received this therapy – 25.4% of them were naïve patients – and 34.2% (39/114) with drew from this regimen, amongst them 44.8%(13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). Conclusions: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented

Prescripción de medicamentos en receta y en informe de alta del servicio de medicina interna de un hospital general / Medicines given out on prescription and on discharge reports of the internal medicine service of a general hospital

No disponible

No disponible

[A study of erythropoietin use for myelodysplastic syndrome]. / Estudio de utilización de eritropoyetina en el síndrome mielodisplásico.

OBJECTIVES: To assess the effectiveness of erythropoietin (EPO) and to study the extent of application of published recommendations for use in treating anemia in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS: An observational retrospective study of patients with MDS receiving at least one dose of EPO. Patients were selected from the outpatient database at the Pharmacy Department, and the medical history as well as both clinical and pharmacotherapeutic data were collected. The clinical effectiveness of EPO was assessed at 6, 12, 16 and 24 weeks after treatment using two distinct criteria for erythroid response. Three items were defined and assessed for each patient in order to establish the extent of application of published recommendations on the efficient use of EPO. RESULTS: Eleven patients were enrolled. Three of them responded to EPO at some point during follow-up, according to pre-defined criteria. All three items used in the assessment of the efficient use of EPO showed significantly high inadequacy rates. CONCLUSIONS: In our study, the effectiveness of EPO in the management of MDS-related anemia is similar to that described in the literature. However, upon the assessment of its use in our hospital, this drug was shown not to have been employed according to published recommendations, which promote its cost-effective use. We believe that the cooperation of the Pharmacy Department in the design of a protocol for EPO use in MDS is of interest, and would contribute to EPO's efficient use.