Background No head-to-head clinical trials have been published comparing aflibercept and bevacizumab for the neovascular form of age-related macular degeneration (AMD). Adjusted indirect comparisons may provide useful information on the relative efficacy of competing interventions. Purpose To compare the efficacy of aflibercept and bevacizumab for the treatment of wet AMD using an adjusted indirect comparison. Materials and methods PubMed was searched for randomised controlled trials (RCTs) comparing aflibercept or bevacizumab with ranibizumab. Selection criteria were: 1) phase III RCTs; 2) intravitreal aflibercept 2.0 mg (every two months after three consecutive monthly doses) versus monthly intravitreal ranibizumab 0.5 mg; 3) monthly intravitreal ranibizumab 0.50 mg versus monthly intravitreal bevacizumab 1.25 mg; 4) patients included with active choroidal neovascularisation secondary to AMD and 5) similar duration and methodology. A meta-analysis of RTCs comparing aflibercept versus ranibizumab and bevacizumab versus ranibizumab was performed. Odds ratios and 95% confidence intervals for dichotomous data were calculated by Mantel-Haenszel’s method. An adjusted indirect comparison by Bucher’s method using the ITC software from Canadian Agency for Drug Technologies in Health was done, with ranibizumab as a common comparator. The endpoint was the proportion of patients who improved by ≥15 ETDRs letters at 52 weeks. Results Two RCTs comparing aflibercept with ranibizumab (VIEW-1 and VIEW-2) and two RTCs comparing bevacizumab versus ranibizumab (CATT-1 and CATT-2) met the inclusion criteria. Meta-analysis showed no significant difference between aflibercept and ranibizumab (ARR:1.50% [-3.79 to 6.73]) or bevacizumab and ranibizumab (ARR: 20% [-9.0 to 4.0]). The adjusted indirect comparison didn’t show a statistically significant difference between aflibercept and bevacizumab (ARR: 3.0% [-4.90 to 10.90]). Conclusions Notwithstanding the limitations of an adjusted indirect comparison, no significant differences were found between aflibercept and bevacizumab in AMD. Until head-to head trials are available, adjusted indirect comparisons based on trial data could be relevant to guide therapeutic choices. No conflict of interest.

Background Medication errors with antineoplastic drugs may be catastrophic due to the drugs’ high toxicity and narrow therapeutic index. PurposeTo assess antineoplastic medication errors in terms of frequency, type of error and severity for patients. Materials and MethodsA 1-year prospective study was conducted (2011) in order to identify the medication errors that occurred during cancer chemotherapy for patients in a 500-bed teaching hospital. Wards included both day care and inpatient units. All prescriptions and production forms were verified by pharmacists. The different types of error were defined in a data collection form. For each medication error intercepted, the potential severity was evaluated according to the Ruiz-Jarabo 2000 version2 classification system. Results During the study period, the pharmacy unit prepared 17241 distinct anticancer drugs. In total, 136 medications errors were detected throughout the medicines use process. Prescriptions errors represented 82% of errors, followed by pharmaceutical validation (7%) transcription (7%), preparation (2%) and administration errors (2%). The most common causal drug was carboplatin, which was involved in 25 cases, despite corresponding to only 2.8% of anticancer drugs prescribed at our institution. Overall, in 66 cases erroneous doses of the medicine were recorded (48.5%), 24 errors were linked to the choice of antineoplastic regimen (17.6%) while in 12 cases, erroneous duration of treatment was prescribed (8.8%). Of the 136 medication errors, 124 were intercepted prior to administration while 12 reached the patients (9%). Overall 66% of non-intercepted medication errors had no impact on the patient and only 3 cases required enhanced monitoring. Conclusions In our study pharmaceutical validation mainly allowed us to identify prescription errors (82%), almost all errors were intercepted prior to administration to the patient. Wrong dose represented the most common type of error. Few pharmaceutical errors (transcription, validation, preparation) were detected. No conflict of interest.

Background Improved survival associated with tyrosine kinase inhibitor (TKI) treatment has transformed chronic myeloid leukaemia (CML) into a long-term disease, but therapeutic success is challenged with poor medicines adherence. Controlling side effects in combination with patient education that includes direct communication between the pharmacist and the patient are essential components for maximising the benefits of TKI treatment. Purpose To estimate the adherence to oral chemotherapy and describe side effects with TKI treatment and their impact on adherence in patients with CML. Materials and MethodsAn 18-month retrospective observational study (from January 2011 to June 2012) was made on patients diagnosed with CML in which patients were selected who collected medicines in the pharmacy and who were being treated with selected TKIs (imatinib, dasatinib, nilotinib). The SMAQ interview was used to determinate adherence. Adherence data, side effects and demographic characteristics of the patients were tabulated using Excel. The x2 test was used for categorical variables and the t-test was used for normally-distributed continuous variables using SPSS statistical software. Results 25 patients were included in the study. 16 were men and 9 were women. The mean age was 60 years (25–88). Imatinib was the first line treatment for all patients. The average adherence was 62.5%. Adherence for patients younger than 50 years was 83.3% and in older patients was 55.6% (P = 0.125). Relating to years of treatment: less than 4 years 70.0% but for longer treatment 57.1% (p = 0.521). Patients with side effects showed less adherence: gastrointestinal disorders (80.0% vs. 64.28%, p = 0.402), musculoskeletal pain (70.0% vs. 42.8% p = 0.188). Conclusions Data suggest that more than one-third of patients are poorly adherent to TKI treatment. Identifying risk factors such as side effects, and educating patients on the need to take medicines as prescribed is essential to help patients to achieve maximum benefit from their treatment. No conflict of interest.