Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution

Abstract

Background:Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration.Objective:This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT.Methods:The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range.Results:Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004).Conclusion:The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant.

Clinical pharmacists’ contributions to hematopoietic stem cell transplantation: A systematic review

“…Among the studies included, four were performed in HSCT outpatient clinics, 8,9,19,20 two in HSCT inpatient clinics 21,22 and one in both settings. 23 Regarding the type of transplantation, four publications included both patients undergoing autologous and allogeneic HSCT; 20–23 the others included only patients undergoing allogeneic HSCT.…”

“…Over a long period, patients require a wide range of supportive care to avoid or manage complications related to transplantation such as antiemetics, analgesics, corticosteroids, antifungals, antivirals, antibacterials, antiepileptics, and antihypertensives. 5–9 Some of these drugs have a narrow therapeutic range, interact with other substances, and are affected by genetic, physiological, and/or behavioral factors. 5,7,9…”

Association between potential drug interactions and clinical outcomes in hematopoietic stem cell transplantations

“…However, the evaluation of the effects of DI involving cyclosporin has been somewhat impaired since it is the most widely used immunosuppressant in prophylaxis for graft vs. host disease, 4,22 and its prolonged use increases the risk of long-term onset, short-term toxic effects. This risk of toxicity occurs primarily when used in combination with other potentially interactive and long-term medications, such as acyclovir and fluconazole, 4 used as post-HSCT support drugs.…”

Midostaurin and cyclosporine drug interaction: A case report

“…This warrants close evaluation each time an acute change occurs, either to patient health status or their medication list. It is common, because of this, to involve pharmacists in the care of these patients who can assist other healthcare providers in evaluating, monitoring and adjusting immunosuppression to desired goals while factoring in all these concomitant factors …”

“…It is common, because of this, to involve pharmacists in the care of these patients who can assist other healthcare providers in evaluating, monitoring and adjusting immunosuppression to desired goals while factoring in all these concomitant factors. 10 Cyclosporine is extensively metabolized by the cytochrome P450 3A (CYP3A) enzyme system in the liver and can be altered by coadministration of a variety of medications. 11 When evaluating the metabolic pathways for midostaurin, it was noted in trials that midazolam's area under the curve (AUC), a sensitive CYP3A substrate, was not affected following 4 days of midostaurin administration.…”