Background Albumin has been widely used in clinical practise. While some of these indications are supported by the results of randomised studies, others are based only on clinical experience and have not been proved in prospective studies. Efforts should be made to define the indications for albumin use, so that patients gain the maximum benefit from its administration. Purpose To evaluate the cost saving obtained by the implementation of a guideline for albumin use in a 737-bed hospital. Materials and Methods Retrospective study that compared albumin use in two periods: July–September 2012 vs. July–September 2011. In June 2012 the guideline for albumin use was distributed to the medical staff. Physicians were requested to complete a form for each albumin order indicating the type and amount of albumin, the clinical service, and the indication for use. Albumin use data and costs were obtained from pharmacy service management system (SAP®) and were tabulated using the Excel® software. ResultsThe total amount of albumin ordered during the study period was 29.360 g (€63,246) vs. 53.195 g (€108,617) for the same period during 2011, which means a reduction of 45%. In terms of cost, the saving obtained amounted to €45,371 (58%). The albumin use by specialty had also changed; a major decrease in use of albumin was observed for Anaesthesiology 4,000 g (75%), General Surgery 3,080 g (65%), Nephrology 4,900 g (64%), Internal Medicine 3,860 g (56%), Haematology 1,410 g (53%) and Digestive 1,400 g (30%). On the other hand, Haemodialysis significantly increased its use of albumin to 2,805 g (65%), although within the approved indication of plasmapheresis. Conclusions An albumin use guideline with restrictions focused on albumin prescriptions had suficient efficacy to reduce consumption and save cost. In our hospital guideline the cost of implementation decreased a 58% (€181,484 per year). No conflict of interest.

Background During the last decade healthcare systems have developed different strategies for containing drug costs. Among others, in Spain the Ministry of Health together with regional Health Departments, have published guidelines for drugs considered to have low therapeutic value (LTVDs), through evidence-based studies and drug assessment data, and they encourage healthcare practitioners to avoid prescribing them. Purpose Our aim was to estimate the cost saving obtained by limiting the use of LTVDs in our hospital. Materials and methods The authors reviewed different guidelines published by Healthcare Authorities and compiled those drugs listed as LTVDs. Data was obtained from three sources: ‘Therapeutic usefulness of medical drugs reimbursed by the National Health System’ Spanish Ministry of Health 2001, ‘List of medical drugs considered as Low Therapeutic Value’ Canary Islands Health Department 2011, and ‘Medical drugs with Non-High Intrinsic Value’ Andalucia Health Department. The authors drew up a list of LTVDs and compared it with the formulary and non-formulary drugs purchased during the period August 2010–July 2011. Results A total of 110 drugs were listed as LTVDs, 59 formulary drugs and 51 non-formulary drugs. The potential cost saving obtained by restricting the use of LTVDs during the reviewed period was estimated at €88,142. By ATC classification, the most significant groups were Sensory organs (€36,118), Nervous system (€15,347), Respiratory system (€11,917) and Dermatologicals (€11,440). Conclusions Our drug formulary contains 59 LTVDs. Deleting them from the formulary as well as restricting the prescription of LTVDs through the Pharmacy and Therapeutic Committee would result in a potential saving of €88,142 per year. Furthermore, this approach encourages physicians to implement Healthcare Authorities recommendations and contributes to cost-effective and rational drug treatment.

BackgroundAdalimumab and ustekinumab have demonstrated a high level of efficacy in the treatment of moderate-severe psoriasis in randomised controlled trials. There are, however, no data available on the comparative effectiveness of ustekinumab and adalimumab in psoriasis patients switching from etanercept.PurposeTo evaluate the comparative effectiveness of adalimumab and ustekinumab in patients previously treated with etanercept.Material and methodsA single centre, retrospective, observational, comparative study was carried out from 1 November 2011 to 31 March 2013, with a follow-up of 2 years. Subjects were patients with moderate-severe psoriasis that after etanercept therapy were treated with adalimumab or ustekinumab. A revision of each patient’s clinical history was carried out to asses clinical data. The primary analysis compared the percentages of patients in each treatment group who achieved ≥75% improvement from baseline PASI score (PASI 75) at week 12. Secondary endpoints included the percentages of patients with PASI 75 at week 96. Statistical analysis was performed with the SPSS 22 software.Results28 psoriasis patients were included: 11 (39.3%) patients received adalimumab and 17 (60.7%) received ustekinumab as secondline therapy. Median age in the adalimumab and ustekinumab groups were 58 (SD 6.5) years and 49 years (SD 16.3), respectively (p = 00.08). After 12 weeks of study treatment, 76.5% of ustekinumab treated patients (13/17) achieved a PASI 75 response compared with 36.4% (4/11) in the adalimumab group (p = 0.034). At week 96, more patients had a PASI 75 in the ustekinumab group compared with the adalimumab group, but the difference was not statistically significant (70.6% vs 36.4%, p = 0.07).ConclusionPreviously studies have shown that adalimumab and ustekinumab are effective after anti-TNF inhibitor therapy. However, to our knowledge, the present study is the first to evaluate the comparative effectiveness of ustekinumab and adalimumab in psoriasis patients switching from etanercept. Our study suggests that ustekinumab is associated with a higher effectiveness compared with adalimumab as secondline treatment in patients previously treated with etanercept. Prospective, randomised studies with a large number of patients are required to establish the optimal treatment in psoriasis patients who have previously received etanercept.References and/or AcknowledgementsJ Dermatolog Treat 2015;26:217-22J Eur Acad Dermatol Venereol 2011;25:1037-40No conflict of interest.

BackgroundGlatiramer acetate (GA) is a firstline therapy approved for the treatment of relapsing remitting multiple sclerosis (RRMS). GA 20 mg/mL (GA20) administered once daily by subcutaneous injection has been used since 2009. In 2014, modified treatment regimens–alternative dosages and low frequency administration schedules were introduced—GA 40 mg/mL (GA40) three times weekly.PurposeTo analyse injection related adverse events (IRAEs) reported for GA20 and GA40 in our clinical practice.Material and methodsThis was a retrospective observational study of patients diagnosed with RRMS, receiving treatment with GA for at least for 6 months (January—June 2016). We studied all patients who started on GA40 three times weekly, as well as those converting from GA20 once daily to GA40, including naive and further lines of treatment. We excluded patients who wanted to get pregnant. The IRAEs analysed according to the System Organ Class were general disorders and administration site conditions, including local injection site reactions (ISRs), and symptoms or events related to immediate post-injection reactions (IPIRs).Results52 patients were included: 23 patients (14 women, 9 men; mean age 43 years) were receiving treatment with GA40, 15 (7 women, 8 men) had converted from GA 20 and 10 patients were naive for GA. Five moderate/severe IRAEs related to ISRs and IPIRs were reported (21.7%), 2 of which were in patients who had converted from GA20. 29 patients (19 women, 10 men; mean age 46 years) were receiving treatment with GA20 for at least 6 months. One moderate IRAE associated with IPIR (3.4%) was reported in this group.ConclusionTo our knowledge, post hoc analyses showed that patients receiving GA40 demonstrated a 60% reduction in the annualised event rate of moderate/severe IRAEs compared with GA20. In our study, from the total number of ISRs and IPIRs reported, GA40 had a significantly increased rate compared with GA20 (p<0.04). These outcomes suggest that moderate or severe reactions related to general disorders and administration site conditions were less frequent in GA20 treated patients. Due to the size of group, these results should be interpreted with caution; future analysis in clinical practice is necessary.References and/or acknowledgementsWolinsky JS, et al. Mult Scler Relat Disord2015;4:370–6. Available at No conflict of interest

BackgroundBosentan and ambrisentan, endothelin receptor antagonists, are used as treatment for pulmonary arterial hypertension (PAH), alone or in combination. It is known that elevations in liver aminotransferases (AST/ALT) associated with bosentan and ambrisetan are dose dependent, and hence aminotransferases levels must be monitored.PurposeTo analyse hepatotoxicity in patients diagnosed with PAH treated with bosentan or ambrisentan.Material and methodsA retrospective observational study was conducted from 2010 to 2016. We included all patients receiving treatment with bosentan or ambrisentan for at least 2 months. We registered AST and ALT levels prior to initiation of treatment, at 2 and 8 weeks after initiation and then monthly. Based on the summary of product characteristics, we considered aminotransferases levels 3 times the upper limit of normal (ULN) as hepatotoxicity. Information was obtained from electronic medical records (SAP). ResultsWe enrolled 39 patients (37 women, 2 men) with a mean age of 57 years (20–85) at the start of treatment with bosentan. The mean period of treatment until the end of the study was 57.2 months (2–146). During the study period, we registered 3×ULN in 18% of patients; 57% required a reduced dose, 14% stop treatment and the rest did not required modification of treatment. 6 patients (5 women, 1 man), with a mean age of 51 years (45–77) (at the start of treatment) were treated with ambrisentan. At the end of period of study, mean time of treatment was 18.5 months. We registered 3×ULN in 33% of patients; in any case, medical prescription changed treatment.ConclusionThe hepatotoxicity results registered in our study were very similar to outcomes from clinical trials. The pharmacist must check the correct dose, based on AST/ALT level. Also, side effect are dose dependent and mainly asymptomatic, but nevertheless some cases of liver cirrhosis and liver failure have been reported.No conflict of interest