BackgroundBiological based therapies, such as subcutaneous anti-tumour necrosis factor α, including etanercept or adalimumab, or ustekinumab, an agent which targets interleukin (IL)-12 and IL-13 cytokines, has greatly improved treatment of psoriasis. Medication persistence, defined as ‘the duration of time from initiation to discontinuation of therapy’, is an important element in determining the success of any long term therapy.PurposeTo evaluate the persistence of firstline adalimumab, etanercept and ustekinumab in psoriasis.Material and methodsObservational, retrospective, longitudinal study. All adult psoriasis (Pso) patients treated with etanercept, adalimumab and ustekinumab as a firstline biological treatment were included.Persistence was calculated as the number of days from the index prescription to the date of the final dispensing or end of the observation period (September 2015). Persistence was also calculated as a dichotomous variable measured at the end of the first, second and third years of therapy (calculated over patients who started treatment 1, 2 or 3 years before the analysis, respectively).For analysis of persistence, a survival analysis with the Kaplan–Meier estimator was used. Cox regression was used to compare persistence between different drugs, and the hazard ratio was calculated.Data were collected from medical and drug dispensation records (Farmatools). Data management and statistical analyses were performed using SPSS Statistics v.15.0 (IBM, Armonk, New York, USA).Results124 patients were included (38.7% etanercept, 41.9% adalimumab and 19.4% ustekinumab). Mean ± SD age was 52.1 ± 14.5 years. 69.4% were male. Persistence rates at the first, second and third years of treatment were 83.0%, 75.0% and 60.5% for etanercept, 63.3%, 54.3% and 48.8% for adalimumab, and 90.5%, 91.8% and 88.9% for ustekinumab. Hazard ratios for comparisons were 0.20 (95% CI 0.05 to 0.84; p = 0,028) for ustekinumab versus etanercept, 0.18 (95% CI 0.045 to 0.77; p = 0.028) for ustekinumab versus adalimumab and 1.10 (95% CI 0.65 to 1.88; p = 0.720) for adalimumab versus etanercept. Estimated mean persistence time was 1.798 ± 205,1.525 ± 173 and 1.889 ± 106 days for etanercept, adalimumab and ustekinumab, respectively.ConclusionPersistence was greater in Pso patients treated with ustekinumab than those achieved with etanercept or adalimumab. Time to discontinuation was similar between adalimumab and etanercept. Less than 50% of adalimumab patients persisted by the third year.No conflict of interest.

BackgroundFampridine is a drug indicated to improve walking in adult patients with multiple sclerosis (MS). Patients should be evaluated after two weeks and treatment should be stopped for those who have not shown any improvement.PurposeTo evaluate walking improvement in multiple sclerosis patients treated with fampridine and compliance with the condition of stopping the drug at two weeks in the absence of improvement.Material and methodsRetrospective study in MS patients treated with fampridine (January/2014–September/2014). Timed 25-Foot Walk (T25FW) and Twelve Item MS Walking Scale (MSWS-12) were used to evaluate drug response. Data recorded were age, gender, and results of T25FW and MSWS-12 at baseline and after two weeks of treatment. Drug discontinuation in non-responders was evaluated. Means were calculated and comparisons were performed by using Wilcoxon Signed Rank test.Results10 adult MS patients were included in the study (40% male; mean age 55 ± 9.7 years). 90% improved their walking tests. Baseline mean time for T25FW was 12.2 ± 5.9 s initially and 8.96 ± 3.8 s after 2 weeks (p = 0.007).MSWS-12 reflected a significant improvement in the following items: balance, time standing, walking speed and distance (p ≤ 0.05). No difference was detected for the following items: ability to run (p = 0.317) and the need for using a walking support outdoors (p = 0.590) or indoors (p = 0.157).There was only one non-responding patient who didn’t stop drug treatment.ConclusionThe walking of most patients on fampridine had improved at two weeks especially regarding balance, distance and time standing. The stopping criterion was not observed in one non-responder.References and/or AcknowledgementsEMA Product information fampridineNo conflict of interest.

BackgroundThe objective of preoperative antibiotic prophylaxis (PAP) is to reduce the incidence of postoperative wound infection. In our centre, the pharmacy service is actively involved in the PAP antibiotic aseptic compounding in the centralised intravenous admixture unit. The PAP is prepared according to the approved infectious disease commission protocol that is reviewed by the pharmacist and applied for each patient the day before elective surgery. A systematic review of documented allergies has also been implemented since April 2015.PurposeTo evaluate the proportion of detected patients who required PAP with no notified antibiotic allergies in the preoperative patient list, the drugs implicated and pharmaceutical interventions.Material and methodsDescriptive, observational and retrospective study. According to the allergy detection programme, a pharmacist reviewed if the allergies had been notified by the surgeon in order to select appropriate alternative, if needed. Also, pharmacists checked previous patient medical records in order to detect documented allergies that were not notified. When detected, the pharmacist proposed an alternative antibiotic regimen.Data regarding the programme results and pharmacist interventions between April 2015 and September 2015 were analysed.Results1929 (33.7%) patients received PAP from 5724 elective surgeries. 64 patients who received PAP (3.3%) were allergic to antibiotics, had not been notified and required pharmaceutical interventions. 82.8% of unnotified allergies were to β-lactams, 4.7% to aminoglycosides, 6.3% to β-lactams and aminoglycosides, and 6.2% to others, including clavulanic acid intolerance. 57 (89.1%) of antibiotic prophylaxis prescriptions were changed due to an unnotified allergy. More frequent proposed alternative regimens were: intravenous vancomycin as an alternative to intravenous cefazolin (40.6%), moxifloxacin ophthalmic solution to intracameral cefuroxime (15.6%) and the combination of intravenous gentamicin and intravenous clindamycin to intravenous amoxicillin-clavulanate (12.5%).ConclusionA significant proportion of unreported allergies in the preoperative patient list, especially to β-lactams, were detected. Pharmaceutical interventions prevented the error and possible collateral damage. Allergies notification is an improvement approach to guarantee patient safety.No conflict of interest.

BackgroundThe proper methods of storage of medicines are of great importance for the maintenance of their stability and therefore their efficacy and safety. Some factors that may affect the drug are: moisture, light, heat, air, time, bacteria and fungal growth.PurposeThe aim of the study is to research household storage habits of oral drugs dispensed by the outpatient hospital pharmacy service.Material and methodsProspective, observational study. All attendees to the outpatient pharmacy service during a period of 1 month were invited to voluntarily participate in the study. An anonymous survey was conducted including 17 items regarding sociodemographic data, knowledge about package insert conservation information content, conservation of original packaging and leaflet, place of home storage, presence of children at home, review of expiry dates and place where expired medication is discarded. Analysis of the influence of socio-demographic factors on wrong storage practices was performed by Chi-square test.ResultsOne hundred and eighty-five patients were included. Mean age (±SD) was 56 (±14.7) years. 49.7% patients did not have any studies and 50.3% had secondary or university studies. Sixty-two per cent of patients remembered to have been informed by the pharmacist about storage conditions and 53.1% knew that this information was included in the leaflet. Regarding the place of storage, 36.5% used the bedroom followed by the kitchen (33.7%), living room (36.5%) and bathroom (5.5%). Most of the patients admitted to retaining the original container (70.6%) or leaflet (68.8%). Drugs were generally stored in a closed place (79.8%), nevertheless 47% of patients admitted that it was accessible (26.5% lived with children). Some patients stored medicines inappropriately under cool conditions (9.2%) or near to a heat source (6.5%). Thirty-five per cent kept medicines that were no longer needed and 22% did not check the expiration date. 24.5% of patients threw out their medicines in the rubbish. A relationship between level of education and this behaviour was observed. The wrong practice was more frequent among patients with a high level of studies (p<0.01).ConclusionA significant proportion of patients presented an information gap regarding drug storage conditions. Several wrong storage practices were identified. There is room for improvement regarding these issues and the pharmacist’s role in patient education could be important.No conflict of interest