Background Adherence to injectable disease-modifying drugs becomes an imperative to achieve a reduction in the number of relapses and delay disease symptoms in relapsing-remitting multiple sclerosis patients. From our service, we estimate patient adherence by an indirect method, in order to focus our work on patients with adherence problems. Purpose To find out the relationship between the indirectly-calculated adherence from the Pharmacy service, with the real one measured by a self-injection device (Rebismart) in Multiple Sclerosis patients with ongoing Rebif treatment. Materials and methods A personal interview was performed with all the 31 patients currently in treatment with Rebif (all doses) in our Hospital. Sex, age, time on treatment with injectable disease-modifying drugs and time on treatment with Rebif were recorded. Indirect adherence was calculated as units dispensed/units needed x 100, and direct adherence was obtained by reading the Rebismart auto-injector device. The two values were compared using Student’s t test for paired samples, and differences were measured by the intraclass correlation coefficient. Results An intraclass correlation coefficient of 0.75 was obtained, which means that indirect method may be suitable to estimate adherence in our patients cohort. However, the use of this electronic device allowed us to detect some very low-adherence cases, which had not been suspected in the interview. In one case 31.270 € was wasted in two years (the medicine was delivered but the patient never took it). Conclusions In our cohort of patients, indirectly measured adherence correlates well with the directly measured adherence. Thus, we can use this way of measuring the patient’s adherence in order to focus pharmacist effort on those cases that really need it. However, we cannot forget that low-adherence cases can be underestimated. No conflict of interest.

Background Inhaled colistin (IC) is formally indicated to treat Pseudomonas aeruginosa bronchial infections in cystic fibrosis (CF) patients. In patients without CF it is not indicated and must be prescribed off-label if they have pseudomonas-infected bronchiectasis. Purpose To evaluate the way inhaled colistin is used, its effectiveness and economic impact for patients who do not have CF in our hospital. Materials and methods Retrospective study. 24 patients’medical records were evaluated. All of them were undergoing IC treatment for their PA colonised bronchiectasis for at least 6 months from January 2011 to January 2013 in our hospital. None of them was diagnosed with CF. Besides demographics, the frequency and duration of hospitalisation for respiratory exacerbations and emergency episodes were counted in each patient before and after colistin intensive treatment. These two values were considered as efficacy parameters. Data were compared using a student’s t test for paired samples. Regarding the cost analysis, only hospitalisation-related expenditure and inhaled colistin treatment costs were included. Neither concomitant antibiotic treatment, nor expenditure related to medical consultations were measured. Results 13 patients were female and mean age was 74.8. Mean treatment duration was 16.56 months and mean colistin expenditure was 7,504.44 € per patient. Average number of hospital admissions before treatment was 1.52 per patient with a mean duration of 8.37 days. These were reduced after treatment, with 0.79 hospitalisations per patient with a mean duration of 5.45 days. This generated savings of 1402.9 € per patient overall. The emergency episodes also decreased from 1.87 to 1.45. Although these differences showed clinical relevance, they did not reach statistical significance. Conclusions Though the limited sample size does not enable us to demonstrate the real difference, inhaled colistin may be considered a cost-effective option to treat patients with pseudomonas-infected bronchiectasis but no CF. No conflict of interest.