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.

BackgroundA prospective study in which the standard parenteral nutrition prescribed by physicians for adult patients was compared with that designed by a resident pharmacist taking advantage of nutritional knowledge acquired during an internship in the area of nutrition with another hospital.PurposeTo weigh the advantages and disadvantages of individualised and standardised parenteral nutrition formulas.Material and methodsWe selected 20 patients hospitalised in surgical wards in our hospital. The standardised parenteral nutrition prescribed by physicians was studied. We evaluated: indication, nutritional status of the patients, the incidence of complications during the process and the suitability of the standardised parenteral nutrition prescribed according to the clinical practice guidelines established by the Working Group on Nutrition – Spanish Hospital Pharmacists Society.ResultsFrom a total of 20 patients, 40% of them had been prescribed standard parenteral nutrition that did not fit with the recommended guidelines.80% of standardised parenteral nutrition did not fit with the caloric and water requirements recommended in clinical practice guidelines.50% of patients had hypertriglyceridemia that was not controlled with the standardised parenteral nutrition.40% of patients needed a correction in the contribution of electrolytes to suit the requirements published in the clinical practice guidelines.ConclusionThere is an excess of standardisation of parenteral nutrition in our hospital.The consequence is a decrease in the quality of treatment.Parenteral nutrition is used in off-label clinical situations.There is a lack of adequate monitoring.Parenteral nutrition can be adapted to the specific requirements of the patients and this is indicated especially in critical patients.The standard parenteral nutrition is useful in patients with standard energy and nutrient requirements.References and/or AcknowledgementsNo conflict of interest.

BackgroundStrongyloides stercoralis is one of the most common parasites in tropical areas. Nowadays, the treatment of such parasite is based on ivermectin. However, ivermectin is not marketed in Spain. Hospital pharmacists are responsible for permitting this treatment to patients, only after drawing up an exhaustive report. In this article, we have reviewed all the reports as well as classified the information in order to present our clinical practice.PurposeTo present our clinical experience regarding the treatment of strongyloidosis.Material and methodsDescriptive observational study. Patients’ data were obtained from their clinical history. Variables examined: age, sex, nationality, doses, diagnostic methods (ELISA and coproparasitological test), co-infections, eosinophilia and immunosuppressed patients.ResultsIvermectin was first used in February 2012.15 patients were analysed 8 men and 7 women. The average age was 36. Nationality: 12 patients from Bolivia, 1 from Guinea-Conakry, 1 from Cuba and 1 with unknown nationality. Posology: 1 oral dose of 200 mcg/kg/day of ivermectin for two days in 100% of patients. The ELISA test and the coproparasitological test were used in 100% and 86% of the patients respectively. The ELISA test result was positive in 93.3% of patients, whereas the coproparasitological test result was negative in 84.3%. Co-infections: Chaga’s disease, toxocariasis, tuberculosis, schistosomiasis, intestinal amoebiasis, uncinariasis (hookworm) and hymenolepis (tapeworm). Top of Form.Before [JM1] the treatment, the average eosinophilia was 15.99%. However, after the treatment, it decreased to 4.67%. No patients were diagnosed with HIV-1 or treated with corticosteroids.ConclusionThe decrease in eosinophilic cells reveals that ivermectin is effective for the treatment of strongyloidiasis. As our study shows, most of the patients also carry other coexisting parasitic diseases, likewise transmitted by the faecal-oral cycle. Therefore, pharmaceutics could play an important role in the prevention of this type of diseases. both by ensuring the appropriate use of this drug as well as by providing some useful advice on healthy practices.References and/or Acknowledgements[JM1]No conflict of interest.

BackgroundIn different clinical studies, the use of botulinum toxin has shown a reduction in health spending, reducing the number of drugs used for patients and decreasing the number of doctor visits and the frequency of episodes.PurposeTo analyse the demographic characteristics of the population diagnosed with chronic migraine and treated with botulinum toxin, to make a database for a future study.Material and methodsThis was a retrospective observational study. The neurology department reported on all patients who had been administered botulinum toxin for chronic migraine. We created a database, where the mid-point was the first administration of toxin; we registered data 1 year before and 1 year after the first administration of toxin. The variables studied were patient age, sex, obesity, toxic habits, hypertension, primary physician visits, specialist visits, emergency visits and frequency of migraine attacks.Results26 patients were included in the study. Mean age of the patients was 49 years, 3 men and 23 women. 2 patients were obese, 2 had toxic habits and 7 patients had hypertension. In the year previous to the first administration, average family doctor visits was 1.69, average visits to the neurologist was 2.46 with 1.15 emergency visits for migraine headaches. The average number of drugs prescribed per patient was 10, 3 from the family of triptans. The average expenditure on healthcare was €386 and on medicines was €602. The frequency of migraine episodes that year was daily.ConclusionThe demographic characteristics of the patients in our study were similar to other published studies: 88% were women compared with 12% of men. With reference to the risk factors studied, 7% were obese, 7% had toxic habits and 26% had high blood pressure. Once the results from the previous year are analysed, we will use the same protocol for the year after the first administration of toxin, with the goal of comparing the data and checking the reduction in expenditure that botulinum toxin has shown in published studies.References and/or acknowledgementsLainez-Andres JM. Onabotulinumtoxin en el tratamiento de la migrana crónica. Rev Neurol2012;54(Suppl 2): S39–50.Patricia Pozo-Rosic.Migraña crónica: Epidemiología e Impacto. Rev Neurol 2012;54(Suppl 2):S3–11.No conflict of interest

BackgroundTocilizumab (TCZ) is a humanised monoclonal antibody inhibitor of interleukin 6 receptor, indicated in combination with methotrexate in the treatment of rheumatoid arthritis (RA) in patients with inadequate response or intolerance to prior therapy.PurposeThe goal of this study was to compare the efficacy of TCZ obtained in our study with that obtained in a clinical trial.Material and methodsDescriptive observational study of all patients diagnosed with RA and treated with TCZ from March 2009 until January 2015. Demographic data were collected by reviewing the medical records of patients: age, sex, race, weight, height, rheumatoid factor (RF) and erosions, and prior and concomitant therapy.DAS28 is a measure of disease activity in RA, referring to the 28 joints that are examined in this assessment. DAS28 at baseline and 24 weeks for each patient were calculated, and the following were assessed based on the EULAR criteria: remission, DAS28 <2.6, good response, DAS28 <3.2 and change in DAS28 >1.2, moderate response, DAS28 > 3.2 and change in DAS28 between 0.6–1.2.Results176 patients with the following characteristics were included: 79% female, mean age 53,25 years (±12.42), weight 72.85 kg (±13,75) and average height 157 cm (±7.27). 66 patients were RF positive and 125 had erosions. 94.9% of patients were taking DMARD previously (89.2% ​​of patients were treated with methotrexate, 59.1% with leflunomide, 23.3% with sulfasalazine), with an average number of previous DMARD of 1.88. 29% had no prior biological treatment. Concomitant therapy: 56.8% of patients were treated with DMARD; 52.3% ​​of patients were treated with methotrexate; 6.3% with leflunomide; 5.1% with sulfasalazine; and the rest had no concomitant DMARD. Mean DAS28 at baseline was 5.71 (±1.13) and DAS28 at 24 weeks was 2.90 (±1.24). The mean difference between DAS28 at baseline and at 24 weeks was 2.6906. According to the EULAR criteria, a good response was achieved in 49.4% patients, moderate response in 5.7% and remission in 36,9%.In the clinical trial, the results were: 38% good response, 41% moderate response and 27% remission.ConclusionIn our study, TCZ has shown a comparable response with that in the clinical trial; efficacy was higher, as were rates for good response and remission.No conflict of interest.