ABSTRACT
OBJECTIVES: The evidence for tocilizumab in the treatment of COVID-19 is contradictory, with some clinical trials showing benefits in regard to progression to mechanical ventilation (MV) and/or mortality. The aim of this study is to evaluate in real clinical practice the effectiveness of tocilizumab in treating COVID-19 and to identify prognostic factors for patient outcomes. METHODS: This was an observational, retrospective study of COVID-19 patients treated with tocilizumab between March 2020 and February 2021 in a tertiary hospital. Variables were demographics, comorbidities, vital signs, analytical parameters, COVID-19 treatment, progression to MV, intensive care unit (ICU) admission, hospital stay, and mortality. RESULTS: A total of 685 patients (64.7% men, median 68 years) were included. Overall mortality was 23.4% (14.2% in the first 14 days post-tocilizumab) and 93.3% in patients with MV and/or in the ICU at 14 days post-tocilizumab. In addition, 61.5% of discharges occurred during the same period. In patients who died, statistically significant differences were observed in the baseline analytical parameters of C-reactive protein (CRP), D-dimer and higher lactate dehydrogenase (LDH) (p<0.05). CONCLUSIONS: In most patients the clinical results of tocilizumab were observed at 14 days post-administration and could benefit from earlier administration of treatment. Baseline levels of CRP, D-dimer and LDH could be prognostic factors for the evolution of the COVID-19 patient.
ABSTRACT
Introducción: El tratamiento farmacológico del paciente oncopediátrico supone una dificultad para el equipo asistencial ya que muchos medicamen-tos registrados por la administración sanitaria no están indicados en población pediátrica, creándo-se un vacío terapéutico en el tratamiento que es cubierto a través de la formulación magistral (FM). El objetivo del estudio es analizar la elaboración de medicamentos individualizados para oncopediatría en los últimos tres años en el Servicio de Farmacia de un hospital de tercer nivel.Métodos: Estudio descriptivo, observacional, retrospectivo de las FM que se elaboraron para el Servicio de Oncopediatría en el periodo 2019-2021. Para cada FM se detalló su indicación y aplicación clínica. En la descripción cuantitativa se especificó número de fórmulas elaboradas y porcentaje. En la descripción cualitativa se detalló principio activo y concentración, procedimiento para elaborar la for-mulación, dosis de principio activo y de excipientes; condiciones de conservación y fecha de caducidad.Resultados: En el periodo de estudio, se elaboraron 3730 FM para el Servicio de Oncopediatría. Las 4 fórmulas magistrales con mayor peso en la prepa-ración son las de los principios activos: etopósido, fenofibrato, ondansetrón y mercaptopurina. El 57,4% de las FM fueron soluciones orales y el 26,5% suspensiones. La aplicación clínica del 71% de las FM preparadas fue el tratamiento de las patologías onco-hematológicas.Conclusiones: En el paciente oncopediátrico, se acentúa la necesidad de una farmacoterapia más individualizada para asegurar una correcta dosifi-cación y adherencia al tratamiento, siendo la FM la herramienta que solventaría sus necesidades terapéuticas (AU)
Introduction: The pharmacological treatment of the oncopediatric patient represents a difficulty for the health care team, since many drugs registered by the health administration are not indicated in the pediatric population, creating a therapeutic gap in the treatment that is covered through the drug compounding (DC). The aim of this study is to analyze the preparation of individualized drugs for oncopediatrics in the last three years in the Phar-macy Service of a tertiary hospital.Methods: It was carried out a descriptive, observa-tional and retrospective study of the DCs that were prepared for the Oncopediatric Service in the period 2019-2021. For each DC, its indication and clinical application were detailed. In the quantitative de-scription, the number of DC elaborated and percent-age were specified. In the qualitative description, active ingredient and concentration, procedure to prepare the formulation, dose of active ingredient, excipients, storage conditions and expiration date were detailed.Results: During the study period, 3730 DC were prepared for the Oncopediatric Service. It is import-ant to note that the 4 formulations with the greatest weight in the preparation were those of the active ingredients: etoposide, fenofibrate, ondansetron and mercaptopurine. Oral solutions and suspen-sions accounted for 57.4% and 26.5% of the DC. The clinical application of 71% of the DC prepared was the treatment of onco-hematological patholo-gies.Conclusions: In the oncopediatric patient, the need for a more individualized pharmacotherapy is accentuated to ensure a correct dosage and adher-ence to treatment, being the DC the tool that would solve its therapeutic needs (AU)
