Many common surgeries and diseases are associated with an increased risk of chronic opioid use, including patients with kidney failure who may experience pain that is multifactorial in nature or related to concomitant comorbidities. [1][2][3] Inadequate pain control has been associated with prolonged hospital length of stay (LOS), increased readmission secondary to pain, and decreased quality of life. 1 One promising strategy for reducing opioid use in the operative setting is the use of multimodal analgesia extrapolated from an enhanced recovery after surgery pathway (ERAS). The ERAS pathways utilize multimodal analgesia and focus on a set of protocols implemented before, during, and after surgery to ensure optimal outcomes. The intended outcomes include reduction or elimination of opioid use postoperatively or at discharge. Compared with traditional management, multimodal analgesia can reduce opioid use, in the immediate and long-term post-surgical periods. 4 To date, there are minimal data published on minimizing and reducing opioid use postoperatively in this surgical transplant population.Existing literature has elucidated the negative effects of opioids in the transplant population. The use of pre-surgical opioid analgesics has been increasingly recognized as a predictor of postoperative complications and resource utilization in a variety of surgical populations, including general, orthopedic, and liver transplant surgeries. [5][6][7] Opioid use prior to kidney transplantation was strongly associated with inferior one-year post-transplant outcomes. High-level opioid

Background: Chronic lymphocytic leukemia (CLL) is a B-cell neoplasm with clonal expansion of small lymphocytes. Ibrutinib, an irreversible inhibitor of Bruton tyrosine kinase (BTK), is a first-line treatment option, and recent data suggest that strict adherence is directly related to clinical outcomes. Objectives: The primary objective of this study was to quantify ibrutinib adherence rates in real-world patients with CLL on ibrutinib; secondary outcomes included progression-free survival and overall survival. Methods: This retrospective study included subjects who were treated at a large academic medical center over approximately 5 years. Subjects were at least 18 years, diagnosed with CLL or small lymphocytic lymphoma, and treated with ibrutinib monotherapy for at least 6 months. Adherence was quantified using the medication possession ratio (MPR), which is the ratio of the sum of days' supply of medication in a period over the number of days in that period, and was based on fill history from the medical center's specialty pharmacy. Results: For the 32 subjects in this study, the mean ibrutinib adherence rate was 91.7% (range, 84.4%-100%). Only 3 subjects had disease progression, and 1 death was recorded while on therapy (all with MPR < 95%); therefore, analyses of clinical outcomes were unable to be assessed due to a low number of events. There were no statistically significant differences in rates of adherence based on baseline characteristics and adverse drug events. Conclusion: In patients with CLL treated with ibrutinib, mean adherence was 91.7%, which is lower than rates seen in clinical trials.

Venetoclax is a BCL-2 inhibitor approved for treatment of adult patients with chronic lymphocytic leukemia (CLL). Due to significant risk of tumor lysis syndrome (TLS) upon treatment initiation, a 5week dose ramp-up is recommended. University of North Carolina Medical Center (UNCMC) utilizes a novel interdisciplinary model of care involving clinical pharmacists (CPs) who oversee the 5-week rampup to minimize treatment-related adverse events. The aim of this study was to investigate the effects of a pharmacist-led venetoclax initiation protocol on patient outcomes. The primary objective was to determine the incidence of venetoclax-induced TLS during dose ramp-up in patients managed by a CP. In this cohort (n=39), there were no cases of TLS during the venetoclax ramp-up. Significantly lower TLS rates were observed in CP-managed real-world patients compared to a previous real-world report (0% vs 13.4%, p=0.014). This real-world analysis supports the utilization of CPs for intensive monitoring of patients initiating venetoclax.