ABSTRACT
DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To summarize the pharmacology, efficacy, safety, dosing, administration, and pharmacist perspectives related to operationalization of new and emerging bispecific therapies indicated for the treatment of various cancers. SUMMARY: In recent years, there have been significant advancements in the expansion of immunotherapeutics in the treatment of various malignancies. Bispecific T cell-engaging therapies represent an emerging therapeutic drug class for the treatment of cancer. These therapies are unique antibody constructs that bind simultaneously to 2 targets, a tumor-specific antigen and CD3 on T cells, to elicit an immune response. Recently, several bispecific therapies have been approved, including epcoritamab, glofitamab, mosunetuzumab, tebentafusp, and teclistamab. Epcoritamab and glofitamab have been approved for diffuse large B cell lymphoma, while mosunetuzumab, tebentafusp, and teclistamab have been approved for follicular lymphoma, uveal melanoma, and multiple myeloma, respectively. As a result of their mechanism of action, the approved bispecific therapies have the potential to cause cytokine release syndrome, and, along with this, they all have unique and specific monitoring parameters and operational considerations that require clinician awareness when administering these therapies. Such operational challenges include within-patient dose escalations at therapy initiation, hospitalization for monitoring, and various pharmacological strategies for prophylaxis of cytokine release syndrome. CONCLUSION: Bispecific therapies have continued to evolve the therapeutic landscape of cancer, primarily in hematological malignancies. Health-system pharmacists have the opportunity to play a key role in the operationalization and management of this new and emerging drug class.
ABSTRACT
OBJECTIVE: To determine the impact of a pharmacy-led medication reconciliation program at a large community hospital. The magnitude of the benefit of pharmacy-led medication reconciliation was evaluated based on the number of medication-related discrepancies between nursing triage notes and medication histories performed by pharmacy technicians or students. Discrepancies identified by pharmacy personnel medication histories that required pharmacist intervention on physician admission orders were further classified based on expected clinical impact if the error were to be propagated throughout hospitalization. METHODS: A retrospective chart review was performed on 200 patients who met the following inclusion criteria: adults admitted from the emergency department from October 1, 2015, to November 17, 2015, with a medication history collected by medication reconciliation personnel (MRP) containing at least three home medications or one high-risk home medication that was reviewed and reconciled by one of the investigators. The primary endpoint was the number of discrepancies between nursing triage notes and pharmacy personnel medication histories. The secondary endpoint was the percentage of pharmacy interventions categorized as "significant," "serious," or "life threatening" on a medication error severity scale. Additional data points included: number and type of clinical interventions; percent of interventions involving high-risk medications; amount of time spent obtaining medication histories and comparing them to admission orders; number and type of sources used; number of home medications; and percent of admitted patients interviewed by the MRP within 24 hours of admission. RESULTS: In a population of 200 patients, 1,762 medication history discrepancies were identified. MRP-collected histories identified issues involving 46 patients that required pharmacist intervention for a total of 235 interventions, of which 68% were related to errors categorized as significant, serious, or life threatening. CONCLUSION: Utilization of a pharmacy-led medication reconciliation program decreased the number of significant, serious, and life-threatening medication reconciliation errors upon hospital admission.
