Antiretroviral treatment switch strategies for lowering the costs of antiretroviral therapy in subjects with suppressed HIV-1 viremia in Spain.

BACKGROUND: The current economic recession in European countries has forced governments to design emergency measures to reduce spending on drugs, including antiretroviral therapy (ART). Switching antiretroviral drugs for others that have the same efficacy and safety profile at a lower cost (cost-reduction measures, CRM) could prove to be a valid means of generating savings. METHODS: Descriptive study of prospective consensus-based CRM undertaken in 2011 in a Catalonian hospital HIV unit among patients with prolonged plasma HIV-1 RNA <50 copies/mL. RESULTS: During the study period, we made 673 switches (87.5% more than the previous year), of which 378 (56.2%) were CRM (16% of all patients treated), leading to a savings of €87,410/month. Switching tenofovir/emtricitabine for abacavir/lamivudine was the most common CRM (129, 31.3%), followed by simplification to boosted protease inhibitor monotherapy (bPImono, 102, 26%). The CRM that generated the greatest saving were switching to bPImono (38%), withdrawal or replacement of raltegravir (24%), switching tenofovir/emtricitabine for abacavir/lamivudine (13%), and switching to nevirapine (5%). Cost savings with CRM were slightly higher than those achieved with medication paid for by clinical trial sponsors (€80,333/month) or through discount arrangements (€76,389/month). CONCLUSION: Proactively switching antiretroviral therapy in selected treated patients with sustained virological suppression can generate significant cost savings in pharmacy spending in developed countries. These findings have implications for decision makers in designing safe strategies that maintain HIV-1 suppression at lower costs.

SureClick® (Darbepoetin alfa) can improve perceived satisfaction and competence for anemia treatment and increase self-administration in non-dialyzed patients with chronic kidney disease.

BACKGROUND AND AIMS: SureClick® is a prefilled pen for administration of darbepoetin alfa (DA) that is ready-to-use. We explored patient satisfaction with SureClick® compared with prefilled syringes (PFS). METHODS: Multicenter, prospective, 6-months, observational study in non-dialyzed patients with chronic kidney disease (CKD) treated with DA in PFS who switched to SureClick® at baseline. Main outcomes were: change in Anemia Treatment Satisfaction Questionnaire (ATSQ-S), Perceived Competence for Anemia Scale (PCAS) and self-administration rate. RESULTS: We enrolled 132 patients with a mean(SD) age of 71.3 (14.6) years, 57.6% women. Mean(SD) ATSQ-S scores at baseline and final records were 25.5 (7.9) and 31.6 (4.9) (on a scale from 0 to 36 maximum satisfaction-, mean change: 6.2, 95%CI: 4.6-7.8, p<0.0001). The PCAS also increased significantly (4.3 (2.0) vs 5.6 (1.6), on a scale from 1 to 7 maximum competence, p<0.0001). At baseline 47.7% of patients self-administered DA with PFS, vs 74.2% with SureClick® (p<0.001). No significant changes in hemoglobin were observed (11.4 (0.5) vs 11.6 (1.3) g/dl, p=0.193). Two patients (1.5%) had adverse reactions to SureClick® (pain on application). CONCLUSIONS: Our results suggest that the change from PFS to SureClick® could increase patient satisfaction and perceived competence in anemia management in non-dialyzed CKD patients, and could increase the self-administration rate, thereby reducing use of health resources.

Consumo de plantas medicinales en los pacientes infectados por el virus de la inmunodeficiencia humana. Patrones de uso y factores relacionados / Use of herbal remedies among HIV-infected patients: Patterns and correlates

Background and objective: To evaluate the prevalence and patterns of use of herbal remedies among HIV-infected patients, and to identify potential health risks and correlates associated with the use of these products. Patients and methods: Cross-sectional survey including 1000 HIV-infected outpatients in Barcelona. Participants completed a questionnaire on the use of herbal remedies and other types of complementary treatments within the previous year as well as on sociodemographic and clinical characteristics. Herbal users’ questionnaires were scrutinized for potential adverse effects and drug interactions with antiretroviral treatment. Correlates of use of herbal remedies were evaluated through logistic regression analyses.Results: One third of patients (n=355) had used herbal remedies, but doctors were informed about such a use by only 69 (19.4%) herbal users. Potential health problems were identified in 193 (54.4%) cases. Herbal remedy use was related to a history of ever discussing complementary and alternative medicine use with the physician (OR: 3.12; 95% CI: 2.30-4.23), having a secondary-school or higher education (OR: 2.63; 95% CI: 1.78-3.88), and perception of complementary therapies as effective (OR: 2.28; 95% CI: 1.18-4.41). Other factors were non-Caucasian ethnicity (OR: 1.65; 95% CI: 1.07-2.56) and the presence of non-HIV-related symptoms (OR: 1.68; 95% CI: 1.24-2.28). Conclusions: Herbal remedy use is common among HIV-infected patients. HIV caregivers and patients should be sensitized to potential risks and the use of these remedies should be routinely monitored in clinical practice (AU)

Fundamento y objetivos: Evaluar la prevalencia y los patrones de uso de plantas medicinales en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) e identificar potenciales riesgos para la salud de los pacientes y factores asociados a dicho consumo.Pacientes y método: Estudio transversal en 1.000 pacientes ambulatorios infectados por el VIH en Barcelona. Los participantes completaron un cuestionario sobre su consumo de plantas medicinales y otros tratamientos complementarios durante el año previo, sus características sociodemográficas y clínicas. Las encuestas de los consumidores de plantas medicinales se revisaron para evaluar potenciales toxicidades o interacciones con el tratamiento antirretroviral. Los factores relacionados con el consumo de plantas medicinales se evaluaron mediante análisis de regresión logística. Resultados: Un tercio de los pacientes encuestados (n=355) había consumido plantas medicinales, pero sólo 69 (19,4%) de ellos habían informado a sus médicos de este consumo. Se identificaron riesgos potenciales para la salud de los pacientes en 193 (54,4%) casos. El consumo de plantas medicinales se asoció a una historia de haber comentado esta posibilidad con su médico en alguna ocasión (odds ratio [OR]: 3,12; intervalo de confianza del 95% [IC 95%]: 2,30-4,23), tener un nivel académico secundario o superior (OR: 2,63; IC 95%: 1,78-3,88), con la percepción de los tratamientos complementarios como efectivos (OR: 2,28; IC 95%: 1,18-4,41), la raza no caucásica (OR: 1,65; IC 95%: 1,07-2,56) y la presencia de síntomas no asociados con el VIH (OR: 1,68; IC 95%: 1,24-2,28).Conclusiones: El consumo de plantas medicinales es frecuente en los pacientes infectados por el VIH. Médicos y pacientes deben concienciarse de los potenciales riesgos que entraña este consumo, que debería ser monitorizado en la práctica clínica (AU)

[Use of herbal remedies among HIV-infected patients: patterns and correlates]. / Consumo de plantas medicinales en los pacientes infectados por el virus de la inmunodeficiencia humana. Patrones de uso y factores relacionados.

BACKGROUND AND OBJECTIVE: To evaluate the prevalence and patterns of use of herbal remedies among HIV-infected patients, and to identify potential health risks and correlates associated with the use of these products. PATIENTS AND METHODS: Cross-sectional survey including 1000 HIV-infected outpatients in Barcelona. Participants completed a questionnaire on the use of herbal remedies and other types of complementary treatments within the previous year as well as on sociodemographic and clinical characteristics. Herbal users' questionnaires were scrutinized for potential adverse effects and drug interactions with antiretroviral treatment. Correlates of use of herbal remedies were evaluated through logistic regression analyses. RESULTS: One third of patients (n=355) had used herbal remedies, but doctors were informed about such a use by only 69 (19.4%) herbal users. Potential health problems were identified in 193 (54.4%) cases. Herbal remedy use was related to a history of ever discussing complementary and alternative medicine use with the physician (OR: 3.12; 95% CI: 2.30-4.23), having a secondary-school or higher education (OR: 2.63; 95% CI: 1.78-3.88), and perception of complementary therapies as effective (OR: 2.28; 95% CI: 1.18-4.41). Other factors were non-Caucasian ethnicity (OR: 1.65; 95% CI: 1.07-2.56) and the presence of non-HIV-related symptoms (OR: 1.68; 95% CI: 1.24-2.28). CONCLUSIONS: Herbal remedy use is common among HIV-infected patients. HIV caregivers and patients should be sensitized to potential risks and the use of these remedies should be routinely monitored in clinical practice.

Prescripciones de medicamentos de pacientes ingresados cumplimentadas inadecuadamente / Inadequate information in the medication orders of hospital impatients

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Risk levels for suffering a traffic injury in primary health care. The LESIONAT project.

BACKGROUND: Literature shows that not only are traffic injuries due to accidents, but that there is also a correlation between different chronic conditions, the consumption of certain types of drugs, the intake of psychoactive substances and the self perception of risk (Health Belief Model) and the impact/incidence of traffic accidents. There are few studies on these aspects in primary health care. THE OBJECTIVES of our study are: Main aim: To outline the distribution of risk factors associated with Road Traffic Injuries (RTI) in a driving population assigned to a group of primary health care centres in Barcelona province. Secondly, we aim to study the distribution of diverse risk factors related to the possibility of suffering an RTI according to age, sex and population groups, to assess the relationship between these same risk factors and self risk perception for suffering an RTI, and to outline the association between the number of risk factors and the history of reported collisions. DESIGN: Cross-sectional, multicentre study. SETTING: 25 urban health care centres. STUDY POPULATION: Randomly selected sample of Spanish/Catalan speakers age 16 or above with a medical register in any of the 25 participating primary health care centres. N = 1540.Unit of study: Basic unit of care, consisting of a general practitioner and a nurse, both of whom caring for the same population (1,500 to 2,000 people per unit). Instruments of measurement: Data collection will be performed using a survey carried out by health professionals, who will use the clinical registers and the information reported by the patient during the visit to collect the baseline data: illnesses, medication intake, alcohol and psychoactive consumption, and self perception of risk. DISCUSSION: We expect to obtain a risk profile of the subjects in relation to RTI in the primary health care field, and to create a group for a prospective follow-up. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00778440.

A meta-analysis of the relative doses of erythropoiesis-stimulating agents in patients undergoing dialysis.

Background. Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa and beta, and darbepoetin alfa have improved the management of anaemia secondary to chronic kidney disease. Numerous studies have reported a dose reduction when patients receiving dialysis were converted from epoetin to darbepoetin alfa using the starting dose conversion of 200:1 as indicated on the prescribing label by the European Medicines Agency. The objective of this meta-analysis was to summarize the existing body of scientific evidence to evaluate the potential dose savings when comparing epoetin alfa or beta to darbepoetin alfa. Method. Medline and EmBase were searched to identify all published trials investigating ESA treatment in anaemic patients receiving dialysis and converted from epoetins to darbepoetin alfa. We selected prospective randomized controlled, non-randomized and observational studies involving patients on dialysis that compared epoetin and darbepoetin alfa dosing. Results. Of 573 articles identified, 9 studies met the eligibility criteria and were included in our analysis. The overall percentage dose savings attained when dialysis patients were converted from epoetin to darbepoetin alfa was 30% (range: 4%-44%). Greater dose savings were noted with intravenous administration (33%) compared with subcutaneous (27%) and between switch-over studies (31%) and RCTs (27%). In all studies, target haemoglobin levels were maintained before and after conversion. Conclusion. This meta-analysis demonstrates that when using an initial 200:1 conversion ratio, as indicated on the European label, from epoetin to darbepoetin, a subsequent reduction in dose was observed and an average 30% dose savings could be achieved.