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Background Delayed chemotherapy-induced nausea and vomiting (dCINV) are common adverse events and appear within 24 h of receiving highly emetogenic drugs: cisplatin, cyclophosphamide, doxorubicin. Most published antiemetic guidelines recommend aprepitant to prevent dCINV. However, authors have not considered: first, a two-drug combination (dexamethasone + metoclopramide), the standard treatment in previous guidelines; and second, no studies have compared aprepitant with the previous two-drug combination deemed valid by authors themselves. Purpose To assess the efficiency of a dCINV prophylaxis protocol in patients at high risk of emesis. Materials and methods A protocol/algorithm based on available published trials was designed. This algorithm was applied according to each patient’s needs and was part of pharmacotherapeutic monitoring. Complete response (CR) was defined as no emetic episodes within 5 days of chemotherapy. The standard/initial regimen consists of dexamethasone + metoclopramide. If this regimen was successful, the treatment was sequentially simplified: dexamethasone + metoclopramide if required; dexamethasone alone; low-dose dexamethasone. If there were indications of loss of efficacy by reducing the treatment, we returned to the previous regimen. If the standard/initial regimen was unsuccessful, the following sequential changes were made: dexamethasone + metoclopramide + lorazepam; aprepitant + dexamethasone + lorazepam. Abstract CP-58 Table 1 Anti-nausea regimen Cost / patient Patients with CR Cost of treatment for all patients + 2 APR + DEX + LOR APR (125 mg day 1; 80 mg days 2-3) + DEX (4 mg days 2-3 BID; 2 mg days 4-5 BID) + LOR (0.5-1 mg BID days 2-3) 58.53 € 11 (4.3%) 643.83 € + 1 DEX + MET + LOR DEX (8 mg days 2-3 BID; 4 mg days 4-5 BID) + MET (20 mg TID days 2-5) + LOR (0.5-1 mg BID days 2-3) 4.18 € 10 (3.9%) 41.80 € Standard DEX + MET DEX (8 mg days 2–3 BID; 4 mg days 4–5 BID) + MET (20 mg TID days 2–5) 4.13 € 89 (34.8%) 367.57 € -1 DEX + MET if required DEX (8 mg days 2–3 BID; 4 mg days 4–5 BID) + MET (20 mg TID days 2–5 only if nausea/vomiting) 4.13 € 65 (25.4%) 268.45 € -2 DEX alone DEX (8 mg days 2–3 BID; 4 mg days 4–5 BID) 3.20 € 39 (15.2%) 124.80 € -3 low-dose DEX DEX (4 mg days 2–3 BID; 2 mg days 4–5 BID) 2.46 € 42 (16.4%) 103.32 € APR, aprepitant; DEX, dexamethasone; LOR, lorazepam; MET, metoclopramide. Endpoints examined were: number of patients achieving CR with each regimen and the costs associated with dCINV prophylaxis. An estimate of the efficiency of the protocol was made, considering how many patients were treated with each prophylactic regimen. These results were compared with those that would have obtained if all the patients had received aprepitant. Results A total of 256 patients was evaluated (2.5-year period). About 91.8% of patients achieved CR with the standard regimen or less intensive treatment. Cost of protocol was 1,549.77 €. The cost if all the patients had received aprepitant would have been 14,983.68 euros. The estimated saving w...

Background Intravenous immunoglobulins (IgIV) represent a therapeutic option with high cost and limited availability. As a consequence it is necessary to evaluate their use basing it on the scientific evidence and prioritising the indications. Purpose To examine the suitability of immunoglobulin prescriptions regarding the indication and recommended dose. Materials and methods We studied patients treated with IgIV between January 2012 and June 2013. We checked the prescriptions against The Clinical Guidelines for Immunoglobulin Use edited by the British Department of Health. We recorded the prescribing department, indication for the prescription, dosing regimens and approved or non-approved indications. Results A total of 34 patients were treated with a standard dose of 0.4 g/kg, 44% of prescriptions came from Haematology, 24% from Oncology, 15% Immunology, 9% Neurology and 8% from other services. The distribution of patients according to the prescribing indication was: idiopathic thrombocytopenic purpura (38%), primary immunodeficiencies (23%), secondary immunodeficiencies (15%), autoimmune haemolytic anaemia (6%), Rasmussen’s syndrome (3%) and others (15%). 91% of the prescriptions were for an approved indication, 3% were approved but not scientifically supported and 6% not approved or accepted. The most frequent patterns were 30 g for 4 days and 35 g every 28 days. Conclusions Most of the prescriptions written were for approved indications. A low percentage of prescriptions were for unapproved indications, which were required as compassionate use. The pattern and duration of treatment were appropriate to the treated pathologies. No conflict of interest.