Our results support the role of the HER2 655 A>G polymorphism as a genetic marker of trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients.

Background As people with HIV infections age, comorbidities and complications have increased and could affect antiretroviral therapy (ART) adherence. Purpose To determine the comorbidities of patients with HIV infection, as well as to evaluate their contribution to ART adherence. Materials and methods A twelve-month retrospective observational study (from January 2012 to December 2012) was conducted in HIV-infected patients who were being treated with ART. ART adherence was the dependent variable. We collected the following independent variables: sex, age, HCV coinfection, transmission risk, CD4+ T-cell count, HIV viral load, ART-naive, type of ART and comorbidities. We defined polypathological patients as patients with two or more chronic conditions. Adherence was determined through dispensing pharmacy records (Total number of units dispensed/Total number of units needed×100) and the simplified medicines adherence questionnaire (SMAQ). Patients who took at least 90% of their prescribed ART were classified as good adherers. We performed a univariate logistic regression to determine the relationship between the comorbidities and ART adherence. Results We included 536 patients in the study (80.2% men, mean age 47 ± 7.1 years) of whom 49.2% were HIV-HCV co-infected. Injected drug use was the main mode of HIV transmission. The median CD4+ was 574.5 cells/mm3 (IQR: 353.8–776.3) and viral suppression (<20 copies/ml) was noted in 73.5% of the whole study population. 82.5% were ART-naive overall, antiretroviral regimens were mainly NNRTI-based (40.3%), and 31.5% were receiving a PI-based regimen. We identified 51.9% polypathological patients. The most common comorbidities were: dyslipidaemia (19.4%), neuropsychiatric disorders (14.7%), hypertension (13.2%), diabetes (5.6%) and cardiovascular disease (5.2%). The percentage of adherent patients was 86.2%. The variable polypathological patients (OR = 0.44; CI[0.26–.74]; p = 0.002) showed statistically significant relationships with ART adherence. Conclusions There is an important number of polypathological HIV-infected patients. Despite ART adherence being high, the presence of these comorbidities significantly reduces adherence. No conflict of interest.

Background Potentially inappropriate medicines (PIM) use in older adults has been associated with increased medicines-related problems and morbidity. Investigating the prevalence of this problem is important for the initiation of intervention programmes in order to prevent its occurrence. Purpose To estimate the prevalence of PIM use in older adults and determine the drugs involved. Materials and methods Prospective study carried out in a third level hospital over 8 months (from January to August 2013). All patients older than 65 years were included who were taking ≥5 medicines and were admitted to the hospital’s internal medicine service. Each patient’s home medicines profile was revised after admission. The frequency of PIM use was analysed according to the Beers criteria 2012. The criteria reviewed covered 2 types of statements: medicines that should generally be avoided in persons 65 years or older and medicines that should not be used in older persons known to have specific medical conditions (drug-disease interaction). Results A total of 216 patients were evaluated in this study. The average age was 78.8 ± 8.8. A total of 193 PIM were detected in 79(36.6%) patients. Frequency of PIM was: long acting benzodiazepines 35(16.2%), digoxin > 0.125 mg/d 38(17.6%), amiodarone 4(1.8%), amitriptyline 6(2.7%), first-generation antihistamines 12(5.5%), doxazosin 11(5.1%), nifedipine immediate release 2(0.9%), aspirin > 325 mg/d 2(0.9%), non–COX-selective NSAIDs 16(7.4%). Frequency of drug-disease interaction was: heart failure-diltiazem 12(5.5%), dementia and cognitive impairment-benzodiazepines 28(13.0%), Parkinson’s disease- metoclopramide 5(2.3%), history of gastric or duodenal ulcers- NSAIDs 8(3.7%), serotonin-norepinephrine reuptake inhibitors-hyponatraemia 4(1.8%), stress or mixed urinary incontinence-doxazosin 10(4.6%). Conclusions The results of this study showed a high prevalence of PIM use in older adults. Inappropriate chronic use of potentially unsafe medicines must be a key issue in medical and pharmaceutical care. Interventions for decreasing drug-related problems should be planned in order to minimise drug-related costs. No conflict of interest.

BackgroundHormone treatment based on analogues of gonadotropin releasing hormone (GnRH) with antiandrogens is the first-line treatment for prostate cancer. This treatment produces a PSA reduction, improvement of symptoms and tumour regression. When PSA increases again it is considered to have developed resistance and other treatment lines such as abiraterone are used.Abiraterone is an androgen synthesis inhibitor in the testes, adrenals and prostate tumour tissue.PurposeTo analyse the response to, and safety of, abiraterone in the population of a tertiary level hospital.Material and methodsA retrospective observational study was carried out including all patients who started on abiraterone from 2011 to present. Demographical, diagnostic, therapeutic and clinical variables were gathered.The response was assessed by a 50% PSA reduction or more as compared to baseline values. To assess the safety, abiraterone-related adverse events were recorded.Outpatient dispensing application Farmatools and electronic medical records were used for patient identification and data collection.Results18 patients were included, 89% diagnosed with metastatic prostate cancer. 50% had poor tumour differentiation with high aggressiveness (Gleason 7–10).As a first-line of treatment, 83% received GnRH analogues plus an antiandrogen, 11% GnRH analogues alone and 6% ketoconazole. No patients orchiectomized. As a second-line treatment, 28% received docetaxel, 44% estramustine, 22% abiraterone and 6% ketoconazole. Abiraterone was started as third-line or later treatment and after tumour progression, except in 3 patients who received it as second-line treatment.44% were considered responders and 56% non-responders because of an increase or non-reduction of PSA.The median duration of treatment was 5 months (1–25). In all cases, the reason for suspension was disease progression.17% had fatigue as the only adverse effect.ConclusionAbiraterone is a well-tolerated drug that has shown low activity in previously-treated prostate cancer patients who had responded poorly to ketoconazole, docetaxel and estramustine.Best responding patients were those who received only GnRH analogues as pre-treatment.References and/or AcknowledgementsNo conflict of interest.

Background Antiretroviral treatment (ART) has significantly increased the life expectancy of human immunodeficiency virus (HIV)-infected individuals. However, toxicities, comorbidities and treatment failures, among others, may result in frequent ART regimen changes. Purpose To identify and analyse the ART changes and the reasons for them in HIV-infected patients over a 42-month period of study in our hospital. Materials and methods A retrospective observational study was conducted over 42 months in all outpatients on antiretroviral treatment who attended our hospital for HIV monitoring between January 2010 and June 2013. For each patient whose ART was changed we recorded the following data in a database: sex, age, previous and new treatment, reason for treatment change and resistance profile. Data was tabulated using Excel. Results During the period of study, a total of 528 patients changed ART (78% men, mean age 47 ± 7.6 years). The most common cause of change was adverse drug reactions (ADR) (47.5%). The most usual ADR were: gastrointestinal symptoms (48 patients), neuropsychiatric disorders (44 patients), renal disease (33 patients), dyslipidaemia (27 cases) and liver disease (24 cases). The drugs which caused ADR were efavirenz (8.0%), tenofovir (7.2%), atazanavir (6.3%), didanosine (6.1%) and lopinavir/ritonavir (4.4%). Other reasons for ART change were: simplification (14.6%), resistance (10.2%), treatment failure (5.5%), inclusion in a clinical trial (4.4%); and other causes (non-compliance, interactions, pregnancy, clinical decision, dose change and unknown). The most common treatment regimen before the change was tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV). After the change, tenofovir/emtricitabine (TDF/FTC) plus darunavir/ritonavir (DRV/r) was the most usual regimen. Conclusions The study revealed that a large percentage of ART changes were due to ADR. The intervention of hospital pharmacists could play an important role in the overall monitoring of HIV patients. No conflict of interest.