EAHP Congress 2023 - Abstract Book

27th EAHP Congress

Lisbon, Portugal

22-23-24 March 2023

From drug design to treatment success

What really matters to patients?

SYNERGY SATELLITE EVENT

THE EAHP INVITES YOU TO ATTEND THE 2023 SYNERGY SATELLITE SESSION:

NBCDS

NON-BIOLOGIC COMPLEX DRUGS

AND NANO MEDICINES

Wednesday, 22 March 2023

17:15 to 18:45, Auditorium II

27th CONGRESS OF THE EAHP

Lisbon, Portugal

Facilitator

Speakers

Armando Alcobia

Jon de Vlieger

International Regulatory Advances for NBCDs and their follow-on products

Gunar Stemer

NBCDs – Considerations for hospital pharmacy practice

Non-Biological Complex Drugs (NBCDs) are drugs that comprise large high molecular weight molecules and, often, nanoparticles structures. They differ from typical small chemical molecules and also from biotechnologyderived medicinal products (large proteins).

For NBCDs, the entire complex is the active pharmaceutical ingredient and its properties cannot be fully characterized by physicochemical analysis. Most of these medicinal products will have to be managed in a hospital setting, which is why the interdisciplinary pharmacotherapy committees need to consider all levels of evidence generated, focusing specifically on data related to clinical safety and efficacy comparability, discussing interchangeability decisions more like a biosimilar than a generic approach.

Nanomedicine: revolutionizing medicine

Sponsored by an Educational Grant from CSL Vifor

Manuel Bañobre-López

Abstracts from the 2023 EAHP Congress

A1 National poster winner abstracts

A5 Section 1: Introductory statements and governance

A10 Section 2: Selection, procurement and distribution

A20 Section 3: Production and compounding

A37 Section 4: Clinical pharmacy services

A165 Section 5: Patient safety and quality assurance

A234 Section 6: Education and research

A251 Author index

YOUNG PROFESSIONAL SESSION

Learning from the career journeys of others

Wednesday, 22 March 2023 14.45 - 16.15 - Room 5C

New journal performance metrics released!

We’re pleased to announce that European Journal of Hospital Pharmacy now has a Journal Impact Factor of 1.652 and a Scopus CiteScore of 1.6.

Thanks to all the authors, reviewers and editorial team members who continue to help support our aim to publish the best evidence-based information with clinical impact.

Looking for somewhere to submit your next paper? Visit ejhp.bmj.com for our author guidelines.

Nationalposterwinnerabstracts

NP-001 DEVELOPINGTHEROLEOFPRIMARYCARECLINICAL PHARMACIST

10.1136/ejhpharm-2023-eahp.1

Background Primaryhealthcarehasasignificantroleinpromotingtherationaluseofmedicines.Finland’shealthand socialservicesreformaimstostrengthenprimaryhealthcare servicesandpreventdiseaseswithmulti-professionalteamwork.Pharmacistsshouldbeinvolvedinthedevelopmentof themedicationmanagementprocessinprimarycare.

Purpose Theaimwastoidentifyriskfactorsinthemedication managementprocessinprimarycaretotargetaclinicalpharmacist’sworktaskswhichcouldimprovemedicationsafety.

MaterialandMethods Thisstudywasconductedinpublic healthcentersinEspoo,SouthernFinland.First,amedication safetyaudittoolforprimaryhealthcarewasdevelopedbased ontheaudittoolforhospitals.Second,medicationsafety auditswereconductedatfourpublichealthcenters.Inthe audits,thepharmacotherapyplanandthemedicationmanagementprocesswereobserved,andtherenewalprocessofelectronicprescriptionswasevaluated.Basedontheauditresults, aproposalwasmadeonthekeydevelopmentareasofthe medicationmanagementprocessandtheroledescriptionof theclinicalpharmacist.

Results Thekeydevelopmentareasidentifiedwiththemedicationsafetyauditswere1)updatingandimplementingthe unit-basedpharmacotherapyplans,2)standardizingthemedicationreconciliationprotocol,3)documentingandutilizing thepatient‘spharmacotherapyplan,4)standardizingtheprotocolforreviewinganddocumentingdrugallergies,and5)a needformedicationsafetyprotectionsinemergencycareservices.Furthermore,thelackofup-to-datemedicinesinformationwhenrenewingelectronicprescriptionswasidentified,as mostoftheprescriptionsarerenewedoutsidephysicians’ appointmentswithoutdirectcontactwithapatient.Thesuggestedcoretaskareasoftheprimarycareclinicalpharmacist atpublichealthcenterstoimprovemedicationsafetywere:1) pharmacotherapyplanandqualitycontrol;2)medicationrisk management;3)developmentofthemedicationmanagement process;and4)otherworktasksrelatedtoclinicalpharmacy.

Conclusions Withmedicationsafetyaudits,itwaspossibleto identifythemedicationsafetyrisksinthemedicationmanagementprocessandprioritizeaclinicalpharmacist’sworktasks thatimprovemedicationsafety.Theidentifieddevelopment areasandmedicationsafetyworkwouldsuittheprimarycare clinicalpharmacist’srole.

ConflictofInterest Noconflictofinterest

NP-002

OJouhet*,AGuibert,ACLagrave. Pharmacydepartment,PoissySaintGermainenLaye hospital,Poissy,France

10.1136/ejhpharm-2023-eahp.2

BackgroundandImportance StaffknowledgeofSterileMedical Deviceisweakenedbystaffturnover,acuteunderstaffing,constantchangesintheSMDfield,marketchanges,andnumerousmarketingshortagesanddiscontinuations.However,the dailyuseofmedicaldevicesisasourceofmisuseifimportant conceptsareunknown.Commentsandquestionsfromhospital staffrevealaneedfortrainingsessions.Wehadtoinnovateand buildnewcommunicationtoolsforstaffthatbebettertrained.

AimandObjectives Themainobjectiveofthisworkisto remindSMDstaffofimportantnotionstoimprovethequality andsafetyofSMDusebyavideotool.

MaterialsandMethods Wedefined50technicalorpractical notionsthankstoourinterventionshistoryaboutSMD.They havebeenclassifiedinto5themes:generalinformation,bandages,digestiveapproach,parenteralapproach,andmiscellaneous.Theirknowledgewasevaluatedamonghospitalstaffwith aweb-basedsurvey.Arateofknowledge(RK)wascalculated foreachnotionandtheme,consideredknownifthe RK>70%orunknowniftheRK<40%.Theunknownthemes willbethesubjectofaseriesoftrainingvideosproduced withAdobePremièrePro®.

Results Weobtained266answerstothesurvey.Theaverage rateofknowledgeofthe50conceptswas47%.Only11conceptswerewellknown,while19areunknown.Forexample, theinterviewedstaffdidnotknowthemeaningofthetwo stripeslogoorwhat-ENFitconnectivityis.Thetwotopics withthelowestlevelofknowledgeweregeneralinformation (RK=37%)andthedigestiveapproach(RK=36%).Thefirst videoofthe ‘CapsulePharma’ explainsgeneralitiesin4minutes. Itwassentonlineandtheoverallsatisfactionscorewas9,5/10. ConclusionandRelevance Thisstudyshowshowimportant continuoustrainingisthekeyforhospitalstafftobetter understandSMD.Theformatofshortvideoshasbeenchosen foritsattractivenessanditsunlimitedquickplaybackondifferentmedia.«CapsulePharma»willbecomeaninnovative andinstitutionalcommunicationtoolforSMDandother healthproducts.

NP-003 PHARMACEUTICALINFUSIONSCHEDULESASATOOL TOIMPROVEFLUIDRESTRICTIONINPICUPATIENTS

1MKleinlein*, 2MPNeininger, 1MHoeckel, 2TBertsche. 1Pharmacy,GesundheitNordhessen HoldingAG,Kassel,Germany; 2ClinicalPharmacy-InstituteofPharmacy-MedicalFaculty, LeipzigUniversityandDrugSafetyCenter-LeipzigUniversityandUniversityHospital,Leipzig, Germany

10.1136/ejhpharm-2023-eahp.3

Background Childreninintensivecareunit(PICU)areat increasedriskforfluidoverload,whichisassociatedwith increasedmorbidity.Therefore,unnecessaryfluidadministrationshouldbeavoided.ThevolumeneededforflushinginfusionlinesduringIVdrugadministrationisoftennot consideredinthedailycalculationoffluidintake.

AimandObjectives Theaimofourstudywastoreducethe dailyflushingvolumeandtherebyfluidoverloadinPICU patients.

MaterialsandMethods Aprospectiveinterventionstudywas conductedinourPICU(controlperiod:Jan-July2020;interventionperiod:Oct2020-Aug2021).Patientswith 2i.v. medications,>24hlengthofstay,andage0–18yearswere included.Primaryoutcomewastheoccurrenceoffluidoverload.Theinterventionwasthepreparationofpatient-specific infusionschedulesbyaclinicalpharmacist.Theschedules

1TKoskenkorva, 2CLinden-Lahti, 2LSchepel, 1ECelikkayalar, 2KKvarnström*. 1Universityof Helsinki,00790Helsinki,Finland; 2HUSPharmacy,UniversityofHelsinkiandHelsinki UniversityHospital,00290Helsinki,Finland

‘CAPSULEPHARMA’,ANINNOVATIVEDIGITAL TRAININGTOOLTOLEARNABOUTIMPORTANT STERILEMEDICALDEVICE(SMD)CONCEPTS

indicatedtheIVaccessthroughwhichIVmedications,parenteralnutrition,andinfusionsolutionsshouldbeadministered toavoidincompatibilitiesandwhetherflushingoftheinfusion linewasrequired.

Results Inbothperiods,66patientseachwereincludedinthe evaluation.Flushingvolumewasreducedfromamedianof 0.68ml/kg/day(Q25/Q750.35/1.33)to0.31ml/kg/day(Q25/ Q750.05/0.74;p<0.001).Inthecontrolperiod,themedian fluidoverloadperpatientwas2.3%,while1.5%fluidoverloadoccurredintheinterventionperiod(p<0.001).Also, fewerpatientdayswithfluidoverloadof 10%occurredduringtheinterventionperiod.Fluidoverloadof 20%were onlyobservedinthecontrolperiod.

Conclusion Theuseofpharmaceuticalinfusionscheduleswith recommendationsforflushinginfusionlinesaccordingtocompatibilityhasreducedtheflushingvolume.Thiscanavoidthe administrationofunnecessaryIVfluids.Reducingfluidintake helpstoreducetheoccurrenceoffluidoverloadinPICU patients.

NP-004

MEDICATIONOFDEMENTIAPATIENTSRECEIVING CHRONICHOSPITALCARES

1SaraMerczel*, 1TiborBali, 2LajosBotz. 1SomogyCountyKaposiMórTeachingHospital, DepartmentofPharmacy,TalliánGyulaStreet20

32,7400Kaposvár,Hungary; 2University ofPécs,FacultyofPharmacy,DepartmentofPharmaceutics,HonvédStreet3,7624Pécs, Hungary

10.1136/ejhpharm-2023-eahp.4

ConclusionandRelevance Fromthisinvestigationweconcludedthattheactiveinvolvementofaclinicalpharmacist andtheinternationallyvalidatedclinicaldatabasesystemsare essential.Theyenhancetheclinicaleffectivenessofthemedicationbyreducingmultipledrugusesandbyeliminating adversedrugreactions.Ourreal-worldstudyishighlybeneficialfortheindividualisedmedicationofdementiapatients receivingchronichospitalcares.

NP-005

SELF-ASSESSMENTONTHEIMPLEMENTATIONOF RECOMMENDATIONSOFTHEPERIOPERATIVE PROCESS:INFECTIOUSRISKMANAGEMENTIN SURGERYSETTING

ElaMurrja,SaraPugliese,FrancescoCasoli,MilenaCasciari,SerenaNatalini, AlessandroCaraffa,AngelaGiuliani,CristinaPaolucci,MassimoFarina, AlessandroD’Arpino.

10.1136/ejhpharm-2023-eahp.5

BackgroundandImportance Surgicalsiteinfections(SSIs)are amongthemostcommoncomplicationinsurgery.Theyare associatedwithlongerpostoperativehospitalstays,maynecessitateadditionalsurgicalprocedures,requirelongantimicrobial treatmentleadingtoanincreasedantimicrobialresistancecontributingtoacostlyhealthcare.It’snecessarytoadopta healthcarepolicyaimedatamorerationaluseofantimicrobialstolimitantimicrobialresistance.

BackgroundandImportance

Thoseelderly,dementiapatients whoreceivetreatmentsfortheirvariouschronicdiseases belongtoahighriskcohort.Theirindividualisedmedication shouldavoidtreatmentwithmultipledrugsandwithactive substanceswhichposeahealthriskforthem.Thismayeliminatetheadverseeffectstowhichthesepatientsareparticularly susceptible.

Ouraimwastodevelopaself-assessmentontheimplementationoftherecommendations,inordertoidentifykeygaps andprovideguidanceandrecommendationsforimproving IPC(infectionpreventionandcontrol)practices.

MaterialsandMethods Amultidisciplinarycollaborationhas involvedinfectiousdiseasespecialists,hospitalpharmacists, microbiologists,intensivists,emergencysurgeons,nurses.Itwas conductedathoroughself-assessmentonthefourfollowing surgeryareas:generalsurgery,emergencysurgery,Orthopedic Surgery,CardiosurgeryUnitduringJuly2021 – March2022.

AimandObjectives

Thestudyevaluatesthemedicaltreatment ofdementiapatientsreceivingchronicandpalliativecares simultaneously.Wecollecteddataofindividualisedmedications fromhistoricpatientrecordsin2020–2021.Thestudywas approvedbytheresearchethicscommitteesoftheuniversity andthehospital(IG/02176-000/2022)

MaterialsandMethods Weexaminedthereal-worlddataof drugtreatmentindementiapatientsaged65orolderwho spentatleast5daysinthehospital.Weanalysedtheanonymised,aggregatedata.Weusedinternationaldatabasescompiledfrommeta-analysesandsystematicreviews(Beers Criteria,START/STOPP,WHO,EMAandUCSF).

Results Weanalysedthedrugtreatmenthistoryof108patients (74womenand34menwiththeaverageageof80.5±9 year),whometthepreliminaryselectioncriteria.Weclassified thepatientsintothefollowingcohorts:1.9%directiondiagnosis,20.4%basisofthemaindiagnosis,35.2%maindiagnosis, 38.9%comorbidityand3.7%diseaseunderlyingdeath.The distributionofdementiatypeswere:53.7%vascular,1.9% relatedtootherdiseasesand44.4%unspecified.Theaverage numberofmedicinestakenperdayperpatientwas10.8 pieces.Multipledrugtreatmentoccurredin86.1%ofpatients. 10%ofthepatientsreceivedmedicinetotreatdementia (donepezilin60%ofthecases,memantine40%ofthecases). Atleastonerequiredmedicationwasnotadministeredfor 38.9%ofdementiapatientsbecauseofitsadverseeffect.

Asummaryresultsoftherecommendationscorecomponentsself-assessmentwasprovidedbyascoredchecklistattributedtoaspecificlevelofrecommendationsimplementation (score0:notapplicable;1:noimplementation;2: £50%;3: >50%;4:100%implementation).

Thechecklistreport13macro-requisitestowhichascore isassigned;foreachrequirementwasreportedthenumberof improvementactions.

Results Followingtheassessment,31improvementactions wereidentified.Thecomparisonversustotalaverageofvalues shows4macrorequirementsunderthreshold:Screeningper S.Aureus;Preoperativebathing;mechanicalbowelpreparation andtheuseoforalantibioticsandthemaintenanceof adequatecirculatingvolumecontrol/normovolemia.

Thisself-assessmentreported8improvementactionsin EmergencySurgeon:10inOrthopedicSurgery,6actionsin GeneralSurgeryand7improvementactionsinCardioSurgery.

Furthermore,werehighlightedimportantshortcomingssuch asantimicrobialprophylaxisforthepreventionofSSIincolorectalsurgery:scored1,3(NA);screeningperS.Aureusin orthopedicsurgery:score1.

Conclusion Theassessmentallowedtheidentificationofthe priorityareasintervention,inordertosetinnovativestrategic actionstoimprovesafetyintheperioperativeprocess.

Inthefutureitwillbepossibletoimplementstrategies withproveneffectivenessandaglobalapproach.Theaimis

RETROSPECTIVESTUDYONINDIVIDUALISED

toovercomeandrefiningguidelinesbyprovidingacomprehensiverangeofevidence-basedrecommendationsforthepreventionofSSIs.

administrationviaEFTmayleadtograftrejection.2 AppropriatedrugformsofISforadministrationviaEFTaremissingin ourcountry.

NP-006 IMMUNOTHERAPYINSECOND-LINETREATMENTOF NON-SMALLCELLLUNGCANCER

10.1136/ejhpharm-2023-eahp.6

BackgroundandImportance Theintroductionofimmunotherapyinthetreatmentofpatientswithnon-smallcelllungcancer(NSCLC),whosediseaseprogressedafterfirst-line treatment,wasconsideredanimportantadvance.Real-lifeuse dataforthesedrugsareessentialtomeasuretheirrealadded valueinthetreatmentofthesepatients.

AimandObjectives Ouraimwastostudytheeffectivenessof Atezolizumab(ATZ),Nivolumab(NVL)andPembrolizumab (PMB),inthesecond-linetreatmentofNSCLC,inrealclinical practiceandanalyzeitconsideringtheefficacydescribedin publishedclinicaltrials.

MaterialsandMethods Thisisanobservationalretrospective studyofpatientsdiagnosedwithlocallyadvancedormetastatic NSCLC,treatedinsecond-lineorlateruntiltheendof August2021,withoneofthefollowingdrugs:ATZ;NVLor PMB.EffectivenesswasevaluatedintermsofProgression-Free SurvivalandGlobalSurvival.

Results Thirty-twopatientstreatedwithATZ,46withNVL and17withPMBwereincluded.Ofthetreatedpatients, 59.4%forATZ,39.1%forNVLand100%forPMBhad positiveexpressionofPDL1(>1%).Themedianprogressionfreesurvivalcalculatedwas5.6monthsforATZ;8.4months forNVLand5.0monthsforPMB.Themedianoverallsurvivalcalculatedwas16.3monthsforATZ,15.7monthsfor NVLand32.6monthsforPMB.

ConclusionsandRelevance Theprogression-freesurvivaland overallsurvivalobtaineddemonstratethat,whenusedinclinicalpractice,thedrugsstudiedareeffective,withresultsnot lowerthanthosedemonstratedinclinicaltrials.Immunotherapyprovestobearelevanttherapyinthesecond-linetreatmentofNSCLC.

REFERENCE

1.1.Lancet2016387(10027):1540

1550;Lancet2017389(10066):255–265; NEJM2015;373(2):123

35;NEJM2015;373:1627–39

NP-007 RECOMMENDATIONSFORADMINISTRATIONOF IMMUNOSUPPRESSANTSVIAENTERALFEEDINGTUBE ACCORDINGTOTHEIR IN-VITRO ADMINISTRATION

1KLajtmanová*, 1KSzmicseková, 1,2SPorubcová. 1HospitalPharmacy,NationalInstituteof CardiovascularDiseases,Bratislava,Slovakia; 2DepartmentofOrganisationand ManagementinPharmacy,FacultyofPharmacy,ComeniusUniversity,Bratislava,Slovakia

10.1136/ejhpharm-2023-eahp.7

BackgroundandImportance Immunosuppressants(IS)areused inthetreatmentandpreventionofgraftrejectionaftersolid organortissuetransplantation.1 Theiradministrationviaan enteralfeedingtube(EFT)isproblematicregardingtheirnarrowtherapeuticindex,cytotoxic,teratogenicpotential,and occupationalhazard.Incompleteabsorptionduetoincorrect

AimandObjectives Despitemultiplepublishedguidelinesfor theadministrationofmedicinesviaEFT,availabledrugforms differbetweencountries.OuraimwastocreatelocalrecommendationsforthesafeadministrationofISviaEFTreflecting theavailablemedicinesinourcountry,whilepreventingEFT occlusionandpreservingoptimaleffect.

MaterialsandMethods Aliteraturesearchwasaimedtodeterminethesiteofabsorption,incompatibilities,andmeasuresto decreasetheoccupationalhazard.Thepracticalpartconsisted ofdissolvingtablets,capsules’ content,andtheiradministrationviaEFTsofdiameters10,8,and6Fr.TheadministrationofISwasrealizedbytheadaptedprotocolbyWhiteet al.,2015.3 Weevaluatedtherateofdisintegrationoftablets andtubeocclusion.

Results Onlyonebrandofmycophenolatemofetiltabletsand twobrandsofazathioprinetabletsdisintegratedinasyringe. Alltheothertabletsneedtobecrushed.Twoofthestudied IScausedtheocclusionofa6FrEFT,noEFTofwider diameterwasoccluded.Wesummariesourrecommendations inatable.

ConclusionandRelevance Crushingtabletsoropeningcapsules isoftentheonlypossibilityforISadministrationviaEFT.In thesecases,usingpersonalprotectiveequipmentisalways needed.Ciclosporin,mycophenolatemofetil,andazathioprine canbeadministeredrelativelysafely.Specialattentionis neededwhenanEFTof6Frisusedduetoitseasy occlusion.

REFERENCESAND/ORACKNOWLEDGEMENTS

OurprojectwassupportedbytheNationalInstituteofCardiovascularDiseases, EduPharmpriNÚSCH,BauschHealth,Novartis,Nutricia,Roche.

1.Hartono etal.,ColdSpringHarbPerspectMed.,2013.

2.Silva etal.,JClinPharmTher.,2020.

3.White etal.,Handbookofdrugadministrationviaenteralfeedingtubes,2015.

NP-008 EMERGENCYDEPARTMENTREVISITSOCOREBASED ONPHARMACOTHERPAY

1JesúsRuiz*, 2EmiliVela, 2DavidMonterde, 1LaiaLópez, 1MªAntoniaMangues, 1MireiaPuig, 2MontserratClérigues, 1AnaJuanes. 1HospitalSantaCreuiSantPau. Barcelona,Spain; 2Sistemasanitariintegrald’utilitzaciópúblicadeCatalunya.Barcelona, Spain

10.1136/ejhpharm-2023-eahp.8

BackgroundandImportance Drug-relatedproblems(DRPs)are acommonreasonforvisitingtheemergencydepartments (ED).However,theinformationavailableonriskfactorsassociatedwithnewEDvisitsbasedonthepatient‘spharmacotherapyislimited.

Objective TodevelopapredictivemodeloftheriskofrevisitingtheEDat30daysbasedonpatients’ treatmentat discharge.

Methods Retrospectivecohortstudyinvolvingadultpatients whoattendedtheEDinCatalonia(Period:2019)withatriagelevelof1–3.A30-dayreturnvisitpredictionmodelwas createdinareferralcohort(60%)usingalogisticregression model,beingvalidatedinavalidationsample(40%).Variables includedinthemultivariateanalysiswereassignedascore proportionaltotheregressioncoefficient.Thesociodemographicvariablesconsideredinthisstudywereage,sexand incomelevel,multimorbidityburdenbasedontheAdjusted

AnaSoaresArmandoAlcobia. Pharmacist,PharmacyDepartment,HospitalGarciadeOrta, Portugal

MorbidityGroups(GMA).Forty-fourgroupsofdrugsassociatedwithDRPswereevaluated.

Results 851,649patientswereincluded[201,445(23.6%)with >9drugsprescribedatdischarge],ofwhom134,560(15.8%) visitedtheEDafter30days.Thefourvariablesevaluated (sex,age,GMA,andincomelevel)and34ATCgroupswere associatedwiththeriskofrepeatEDconsultationandwere combinedintoafinalscore(DRP-Score).Thedrugswiththe highestriskscorewereosmoticlaxatives(RR:1.421(95% CI:1.264–1.596)),b-lactamantibiotics(1.333(1.123–1.583)), digoxin(1.282(1.256–1.309)),heparins(1.150(1.112–1.190) andlithium(1,146(1.000–1.315))Themodelachievedan areaunderthereceiveroperatingcurve(AUC-ROC)valuesof 0.648(95%CI:0.646–0.650)inthereferencecohortand 0.647(0.644–0.649)inthevalidationgroup.Threeriskcategoriesweregenerated,withthefollowingestimatedrisksof revisitingtheEDat30days:lowrisk:10.2%,intermediate risk:18.3%,andhighrisk:28.4%.Thescorewasvalidatedin asampleof1437patientswhovisitedtheEDforDRPs, maintainingitspredictivecapacity.

ConclusionandRelevance TheDRP-scoreidentifiespatientsat highriskofreturningtotheEDwithin30daysbasedon pharmacotherapy,beingausefultoolforprioritizinginterventionsfromtheseunits.

Results 120patientswereincludedinthestudywithamedian ageof71years[IQR63.5 – 83.5].71.7%ofpatientswere taking 5medicationsbeforeadmission.Themedianpharmaceuticaltimerequiredtoperformthemedicationreconciliationactivitywas36minutes[IQR29 – 45].60.8%of admittedpatientshadatleastoneUMDonadmissionwitha medianof2perpatient[IQR1 – 3].Unintentionaldrug omission(67.3%)anddosemodification(21.2%)werethe mostfrequentlyencounteredUMD.88.5%ofidentifiedUMD werecorrected.Polymedication( 5medications)wasthe onlyvariableassociatedwith ‘presenceofanUMD’ atalevel veryclosetotheestablishedstatisticalsignificancelevelofp =0.05[OR2.24,p-value0.065].

ConclusionandRelevance Thisstudyconfirmsthemajorinterestofthemedicationreconciliationatadmissioninanorthopaedicandtraumadepartmentinanelderlyandpolymedicated population,exposedtohigh-riskmedicationsandtoarisky process.

NP-010 DEVELOPMENTOFA2%LIDOCAINEGELFORLOCAL ANAESTHESIAOFTHEEYEPRIORTOINTRAVITREAL INJECTION

10.1136/ejhpharm-2023-eahp.10

ADMISSION:APROSPECTIVESTUDYINTRAUMATOLOGY

1,2,3NRatsimalahelo*, 1,2NPerrottet, 4JDaSilvaRaposo, 4OBorens, 1,2,3FSadeghipour. 1ServiceofPharmacy,LausanneUniversityHospital,Lausanne,Switzerland; 2Centerfor ResearchandInnovationinClinicalPharmaceuticalSciences,LausanneUniversityHospital andUniversityofLausanne,Lausanne,Switzerland; 3InstituteofPharmaceuticalSciencesof WesternSwitzerland,UniversityofGenevaandUniversityofLausanne,Genevaand Lausanne,Switzerland; 4DepartmentofOrthopaedicsSurgeryandTraumatology,Lausanne UniversityHospital,Lausanne,Switzerland

10.1136/ejhpharm-2023-eahp.9

BackgroundandImportance Medicationerrorsleadingtopreventableadversedrugeventsoccurmainlyduringtransitions ofcare(admission/dischargefromahealthcarefacility,hospital interdepartmentaltransfers).Dataondrugreconciliationin surgicalwardsarescarce.

BackgroundandImportance Intravitrealinjectionisavery commoneyesurgery.Thepreparationoftheinjectionistimeconsumingandlabour-intensive,becausepatientsreceiveseveralophthalmicdrugsbeforehandlikelocallydisinfecting, pupildilatingandlocalanaestheticeyedrops.Additionally, eyedropscontainingoxybuprocainemustbeapplied3to5 timesatminuteintervalsforasufficientanaestheticeffect.

AimandObjectives Tosimplifytheprocess,alocalanaesthetic eyegelpreparationwasrequested.Theincreasedviscosity leadstoalongerlocalexposuretimeontheeye.Asingle doseisthereforesufficienttoachievetherequiredlocalanaestheticeffect.Asfarasweknow,acorrespondingproductis notavailableontheGermanmarket,soanin-houseproduct wasdeveloped.

AimandObjectives

Thepurposeofthisstudywastoassess theprevalenceofmedicationdiscrepanciesinpatientsadmitted toanorthopaedicandtraumadepartmentduringthemedicationreconciliationprocessperformedbyapharmacistat admission,andtoidentifypotentialriskfactors.

MaterialsandMethods

Thiswasaprospectivesingle-center observationalstudyconductedovera15-weekin2021.Eligiblepatientswereadultshospitalizedintwounitsofanorthopaedicandtraumadepartmentofatertiaryuniversityhospital inSwitzerland,admittedforadurationofhospitalization> 48hours,inthepresenceofachronicpathologyand/ora medicationatriskand/oronthephysicianinchargeofthe patient’srequest.TheBestPossibleMedicationHistorylist wasestablishedforeachpatientandcomparedtotheprescriptiononadmissiontoidentifymedicationdiscrepancies.These discrepancieswereclassifiedasintentional/unintentionalonthe basisofthemedicalrecordand,ifnecessary,adiscussionwith thephysician.Amultivariableanalysisbylogisticregression wasperformedtoidentifypredictorsofthe ‘presenceofan unintentionalmedicationdiscrepancy(UMD)’ .

MaterialandMethods Theactiveingredientlidocainehydrochloride2%(w/w)isdissolvedinhotWFIwith0.48%(w/w) sodiumchlorideasanisotonizingadditive.0.25%(w/w) sodiummonohydrogenphosphatex12H2O,leadstoapH valueof6-7inthefinishedgel.pH7mustnotbeexceeded, topreventprecipitationoflidocainebase.Hydroxyethylcellulose250(Natrosol250Gpharm®),asterilizablegellingagent, isincorporatedintothehotsolutionataconcentrationof 2.5%(w/w).Aftercooling,WFIisaddedtothefullbatch weight,thebatchisstirredvigorouslyandlefttostandcoveredovernight.Ahomogeneousgelofsuitableviscositydevelopsovernight.Thefollowingday,thegelisfilledinto Redipac® single-dosecontainerswithsubsequentautoclaving understandardconditions.

Theidentityandcontentofthepreparationischeckedby UV/VISspectroscopy.

Results Thepreparationdescribedachievesasufficientlocal anaestheticeffectaftersingleapplication,isfreeofpreservativesandcanbestoredatroomtemperature.

ConclusionandRelevance Thelidocainegelinsingle-dosecontainershassignificantlyacceleratedandsimplifiedthepreparationofintravitrealinjectionsintheUKSHEyeClinic.

1HHochbrügge*, 1UWethmar, 1HGStrobel, 2CHeymann, 2SGrisanti. 1DezernatApotheke; 2KlinikfürAugenheilkunde

Section1:Introductorystatementsand governance

1ISG-001 ECONOMICIMPACTGENERATEDBYNATALIZUMAB OPTIMISATION

1MRodriguezGoicoechea, 1VCaoViña, 2ETejedorTejada, 1NGarciaGomez, 1FHorno Ureña. 1ComplejoHospitalarioUniversitariode5Jaén,Pharmacy,Jaén,Spain; 2Hospital Clínic,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.11

BackgroundandImportance Inourhospitalthereare568 patientswithmultiplesclerosis(MS)inactivetreatment. Administrationofnatalizumabisevery4weeks,buttheneurologistsatourhospitalhaveoptimisedtheadministration every5or6weeks.

AimandObjectives Evaluateeconomicimpactfromnatalizumaboptimisation.

MaterialandMethods Retrospectiveobservationaleconomicstudyperformedinathird-levelhospitalbetween January2019andJune2022.Demographicdata(sex, age),clinicaldata(MStreatment,posologyandquantity ofcyclesadministered)andeconomicdata(Laboratory PurchasePrice(LPP)includingVAT)collectedfromprescribingprogrammeandecono micmanagementplatform. Patientsreceivingnatalizumabforatleast3cycleswere included.

Accordingtoposology,calculationofactivetreatmenttime andnumberofcyclessaved.Comparisonbetweentheorical economicimport(associatedtoadministrationevery4weeks) andreal.Analysisofchangesoftreatmentandcosts associated.

Results From568patientswithMS,43arereceivingnatalizumabinourstudyperiod.Only37receivedmorethan3 cyclesofnatalizumab.These37patientsinclude24women, withanaverageageof41.2years(23-65),4patientswere receivingnatalizumabevery6weeks,andtheothersevery5 weeks.111.5weeksofactivetreatmenttime(20-198)averaged,with21.7cycles(4-36)associated,meaning229vialsof natalizumabsaved.

Natalizumab ’ scostsaccordingtoLPP(C ¼ 1302)inour studyperiodcometoC ¼ 1.045.506,00.Ifnatalizumab wouldhavebeenadministeredevery4weeks,itscost wouldcometoC ¼ 1.343.664,00.Savingsamountto C¼ 298.158,00globally,ortoC ¼ 85.188,00annually.Of37 patients,4neededtochanget reatmentduetooutbreaks. Thenewtreatmentwasocrelizumab,withaPPLof C¼ 4.666,64/vial.Totalannualcostofpatients ’ ocrelizumab amounttoC ¼ 74.666,24.

ConclusionandRelevance Natalizumab’soptimisationwith administrationevery5weekshasmeantatotalsavingof C¼ 10.521,76,afterhavingreinvestedpartofthesavingsinthe newtreatmentswithocrelizumab,allowingourpatientsto accessinnovativetherapies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

1ISG-002 MEDICATIONWASTEINANORTHOPAEDIC DEPARTMENT:EFFECTOFPATIENT’SOWN MEDICATIONUSEANDSELF-ADMINISTRATION DURINGHOSPITALISATIONANDTHEVIEWSOF PATIENTSANDHOSPITALSTAFF

1BMaat, 2ABenjaddi*, 1LVanHerpen-Meeuwissen, 3CDiekerhof. 1Elisabeth-Tweesteden Hospital,ClinicalPharmacy,Tilburg,TheNetherlands; 2UtrechtUniversity,Departmentof PharmacoepidemiologyandClinicalPharmacology,Utrecht,TheNetherlands; 3ElisabethTweestedenHospital,DepartmentofOrthopedics,Tilburg,TheNetherlands 10.1136/ejhpharm-2023-eahp.12

BackgroundandImportance Medicationwastehasdetrimental effectsontheenvironmentandhealthcarecosts.Pharmacotherapeuticchangescontributetomedicationwaste(e.g.substitutiontohospitals’ medicationformulary).Patient’ sown medication(POM)wherepatientsbringtheirownmedicines foruseduringadmissionisknowntopositivelyaffectmedicationwaste.Self-administrationofmedication(SAM)canbe combinedwithPOMuseandallowscapablepatientstomanagetheirmedicationregimenthroughouthospitalisation.Itis notclearhowthecombinationofPOMuseandSAMaffects medicationwaste.Furthermore,bothpatientsandhospital staffplayamajorroleinmedicationmanagementduringhospitalisation.Theirawarenesshereofmayaffectmedication waste,buttheirviewsonthisareunknown.

AimandObjectives TodetermineifPOMuseandSAM reducethevolumeandmonetaryvalueofmedicationwaste duringhospitalisation.Todeterminetheviewsofpatientsand hospitalstaffonmedicationwaste.

MaterialandMethods Aprospectivepre-postintervention studywasconducted,includingallpatientsadmittedtoan orthopaedicwardbetweenMarchandMay2022.InApril 2022,POMuseandSAMwereimplemented.Dataonvolume (inpieces)andmonetaryvalue(ineuros(C ¼ ))ofmedication wastewerecollected.A5-pointLikertscalesurveyonmedicationwastewasconductedamongpatientsandhospitalstaff. Datawereanalysedusingdescriptivestatistics.

Results Thevolumeofwastedmedicinesdecreased44.3% from477to331piecesper100inpatientdaysafterthe implementationofPOMuseandSAM.Themonetaryvalue inhospitalpurchasepriceofwastedmedicinesdecreased 151.8%fromC ¼ 283.80toC ¼ 112.70per100inpatientdays. 30patientsand78hospitalstaffmembersrespondedtothe survey.Themajoritywereawareofandinterestedinmedicationwaste.Interestingly,53%ofpatientsdidnotfeelthat theycontributetomedicationwasteasopposedto19%of hospitalstaff.Bothpatientsandhospitalstaffwerepositive towardsPOMuseandSAMasmeanstoreducemedication waste.

ConclusionandRelevance TheimplementationofPOMuse andSAMduringhospitalisationseemstohavethepotentialto reducemedicationwasteandconcomitantcostsatanorthopaedicward.Patientsandhospitalstaffseempositivetowards thistopic.Therefore,werecommendtofurtherimplement POMuseandSAM.

REFERENCESAND/ORACKNOWLEDGEMENTS

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1ISG-012 COST-MINIMISATIONANALYSIS:PROPHYLACTIC TREATMENTOFHAEMOPHILIATYPEA,WHATTO CHOOSEBETWEENFACTORVIII,RECOMBINANT FACTORSVIII(MOROCTOCOG-ALFAANDOCTOCOG) ANDEMICIZUMAB?

1,2HDaoudi*, 1,2OElQabissi, 1,2FZLasri, 1,2SElMarnissi, 1,2MAitElCadi. 1IBNSina HospitalUhcIbnSinaRabat,Pharmacy,Rabat,Morocco; 2FacultyofMedicineand PharmacyRabat,PharmacologyandToxicologyLaboratory,Rabat,Morocco

10.1136/ejhpharm-2023-eahp.13

BackgroundandImportance HaemophiliatypeAisahereditarybleedingdisorderlinkedtoadeficiencyinFVIII,treated byintravenousadministrationofFVIII.Emicizumabrepresents analternativetoFVIIIconcentrates,withoutanti-FVIIIinhibitor,administeredinasinglesubcutaneousdose.1

BackgroundandImportance Theongoingriseinhealthcare costsmakesitnecessarytoestablishcontainmentstrategies,in parallelwiththecommitmenttoimproveaccesstothemost effectiveandsafesttreatments.Theintroductionofbiosimilar medicinesisanopportunityforhealthsystems(HS)and patients.

AimandObjectives Theaimofthestudywastoevaluatethe useandcostevolutionofinfliximabandadalimumabinthe gastrointestinaldepartmentofatertiaryhospitaloverthelast eightyears.Inthisperiod,biosimilarmoleculesofbothdrugs havebeenincorporated.

MaterialandMethods Datawerecollectedbasedonconsumed unitsofadalimumabandinfliximabbetweenJanuary2014 andDecember2021.Wegroupedthedifferentpresentations oforiginalbrandandbiosimilarmoleculesavailableandthe costassociatedatthetimeitwasconsumed.

AimandObjectives

Theaimistoevaluatetheuseofemicizumabcomparedtothethreebiosimilarsusedforprophylaxisin haemophiliatypeA,inordertoensuregoodcarewitha goodqualityoflife.

MaterialandMethods Theanalysisofthecostofusingemicizumabcomparedtothethreebiosimilarswehaveinthehospital, namelyplasmaandrecombinantFVIII(Moroctocog-alfaand Octocog)bycalculatingthedirect,indirectandintangiblecosts, toassesstheadvantagesandconsequencesofemicizumabuse.

Results Accordingtothecostminimisationanalysis,wefound atotalannualcostforFVIIIC ¼ 125,293.7,Octocog

C¼ 252,183.7,Moroctocog-alfaC ¼ 2,753,70.6withasignificant intangiblecostbecausethefrequenttriptothehospitalmakes thepatienttiredandincreasesthenon-medicalcostandthe indirectcost,withthepossibilityin30%ofpatientsofdevelopinganti-FVIIIinhibitorsandthereforetheadministrationof highdoseplasmaFVIIIof6000-9000IUthreetimesaweek withanannualcostofC ¼ 366,565.8.

Ontheotherhand,emicizumabisindicatedevenfor patientswithananti-FVIIIinhibitorwhoseannualcostis C¼ 233,402.9,withagainofC ¼ 136,484.23,inadditiontoa goodqualityoflife.WededucethatplasmaFVIIIisuseful forpatientswithoutaninhibitorandemicizumabshouldbe reservedforhaemophiliacswithananti-FVIIIinhibitor.

ConclusionandRelevance Ourcostevaluationstudyisatool fordecisionsupportandreductionofuncertaintybetween fourdrugs,whichmakesitpossibletoadaptpurchasesaccordingtotheneedsexpressedforanoptimalallocationofresourcesfollowingtheevolutionofhealthexpenditure.

REFERENCES

1.JoelL.Moake,MD,BaylorCollegeofMedicine,lemanuelMSD2022.

ConflictofInterest Noconflictofinterest

Section2:Selection,procurementand distribution

2SPD-001 USEANDCOSTEVOLUTIONOFINFLIXIMABAND ADALIMUMABOVER8YEARSINATERTIARY HOSPITAL

1AGómez, 1VCarrilloLópez*, 1MLopez, 2VRoyo, 1MMSantandreu, 1MFPérez, 2SKhorrami, 1MCIglesias, 1ODelgado, 2DGinard. 1UniversitaryHospitalSonEspases, Pharmacy,Palma,Spain; 2UniversitaryHospitalSonEspases,Gastroenterology,Palma,Spain

10.1136/ejhpharm-2023-eahp.14

Results Both,infliximabandadalimumab,consumptionhave graduallyincreasedoverthepasteightyears,from1,774to 2,765units(+55.9%)andfrom920to3,420unitsperyear (+271.7%),respectively.

Infliximabbiosimilarwasintroducedinthecentrein2015 andwasprogressivelyrolledoutinstartsandswitches, becomingthesolesince2021.Thishasledtoagradual reductionincosts,fromC ¼ 852,022in2014toC ¼ 497,235in 2021(-41.6%).

Adalimumabbiosimilarwasnotintroducedinthehospital until2019.Consumptionrosefrom920to2,153unitsper year(+134.0%)between2014and2018,intandemwith cost:fromC ¼ 442,745toC ¼ 936,175peryear(+111.5%).

Nevertheless,between2018and2021,consumptionincreases from2,153to3,420(+58.9%)withanabsolutecostreductionofC ¼ 563,683(-60.2%).Overall,adalimumabspending hasdecreasedby15.9%overtheeightyearsdespitethe increaseinconsumption.

ConclusionandRelevance Innovationinbiologicaltherapies,as wellastheincreaseincandidatestoreceivethem,hasgrown significantly.Itisassociatedwithanincreaseincoststhatmay becomeunaffordableforpublicHS.

Theintroductionoftwobiosimilarmoleculesinourcentre hasledtosignificantsavings,despitetheincreasein consumption.

Thecommercialisationofbiosimilarmolecules,alongside policiesthatallowtheirintroductioninhealthcarecentres, promotesthesystem’ssustainability,enablesaccesstoagreater numberofpatients,whileallowingforthecontinuedincorporationofinnovativemolecules.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

10.1136/ejhpharm-2023-eahp.15

BackgroundandImportance Boostinggenericsisanindispensableapproachinconductingcost-savingmanagementinhealthcaresystems.Infact,genericscanprovidesimilareffectiveness andsafetytooriginatorsbutwithlowercostsandcanincrease marketcompetition.

2SPD-002 COST-SAVINGIMPACTOFGENERICS:ALOCAL EXPERIENCEONLENALIDOMIDE

JCDelRíoValencia*,RTamayoBermejo,COrtegadelaCruz,IMuñozCastillo. Regional UniversityHospitalofMalaga,PharmacyService,Malaga,Spain

AimandObjectives

Thepurposeofthisworkwastodemonstratetheeconomicadvantageofagenericlenalidomidein realpractice,showingandcomparingcostsandconsumption duringtheperiod2021to2022.

MaterialandMethods Toconductthisanalysis,patients,type ofprescription(originatororgeneric),numberofpatients treated,numberofcycles,administeredmilligramsandpurchaseprices,duringtheperiodSeptember2021toAugust 2022,wereextrapolatedfrompharmacysoftwareand matched.

Results ComparedwithperiodfromSeptember2021toFebruary2022,duringMarchtoAugust2022,thenumberof treatedpatientsremainedsimilar(105vs104)andthenumberofcyclesadministered(388vs390). Abstract2SPD-002Table1

AimandObjectives Thepurposeofthisstudyistoanalyse themedicationerrors(ME)thathaveoccurredduringaspecificperiodoftime,throughouttheprocessofmedication delivery.Theaimisfindingcausesandpossibleimprovements. MaterialandMethods Wecarriedoutaretrospectivedescriptivestudy.TheerrorsthatoccurredbetweenJanuary2021 andAugust2022(20months)inthetelepharmacyprocess wereanalysed,takingintoaccounteverythingfromthepreparationinthehospitalpharmacytothecollectionofthemedicationbythepatientinthecommunitypharmacy.TheMEs werecollectedinalocaldatabase.Wedescribeddate,personal dataofthepatient,codesassignedtothesingleshippingroute anddestinationcommunitypharmacy,typeoferrorandstep inwhichtheMEwasdetected.

Results Intheperiodstudied,atotalof69MEswere recorded.Webreakthemdownintothefollowingtypes:20 caseswithaquantitativelackofmedication(28.99%),19 casesinwhichadifferentmedicationwassent(27.54%),15 withanotherpatient‘smedication(21.74%),10withmedicine withwrongdose(14.49%),2casesinwhichthemedicine wasnotsent(2.90%)andanother2inwhichthemedicine wassentbadlypackaged(2.90%),1caseinwhichtheonein whichthemisidentifiedmedicinewassent(1.45%)and1case inwhichalargerquantitywassent(1.45%).48MEswere detectedbythepatient(69.56%),15weredetectedinthe communitypharmacy(21.74%),4weredetectedinthehospitalpharmacy(5.80%)and2casesweredetectedduringthe transportationofthemedication(2.90%).Noneoftheerrors detectedhadconsequencesforthepatienttoourknowledge.

Thetotalexpenditureofgenericlenalidomidehasbeen C¼ 147,120andoriginallenalidomideC ¼ 1,204,839.15,therefore thetotalsavinghasbeen87.80%.

Likelihood,thegenericlenalidomidehasbeenaswelltoleratedasoriginallenalidomide.

ConclusionandRelevance Currently,costsavingsandrationalisationpolicyareplayinganessentialroleinhealthcaresystems,andgenericsrepresentagreatopportunitytoreallocate availableresources.Thisstudydemonstratedthatenhancinga genericlenalidomideisagoodstrategyforthesustainability ofcare.Lenalidomidecostsdecreasedwhilethenumberof patientsremainedsimilar.Insummary,genericsconstitutean efficientstrategyforthesustainabilityofnationalhealthservices,allowingresourcereallocationandaccesstocaretoa largernumberofpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Noconflictofinterest

ConflictofInterest Noconflictofinterest

2SPD-003 ERRORSDETECTEDINTHETELEPHARMACY PROCEDURE

ASánchezRuiz*,CMuñozCid,NGarciaGomez,JJerezRojas. HospitalUniversitariode Jaén,Farmacia,Jaén,Spain

10.1136/ejhpharm-2023-eahp.16

BackgroundandImportance Aftertheriseoftelemedicinewith theCOVID-19pandemic,atelepharmacyconsultationhas beenimplementedinourhospitalinthepharmacyoutpatient area,sendingmedicinestocommunitypharmacieswithina populationareaof600,000inhabitants.

ConclusionandRelevance AmongtheMEsdetected,themost commonwerethoserelatedtoaquantitydefectorlackofa medicationandthoseinwhichadifferentmedicationwas sent.Ingeneral,theyareerrorsthatcouldbeavoidedby automatingprocessesthatarecurrentlycarriedoutmanually.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

2SPD-004 ECONOMICEVALUATIONANDBUDGETIMPACTFOR AREGIONALHEALTHSERVICEASSOCIATEDWITHTHE INCLUSIONOFTHEFLUOCINOLONEACETONIDE INTRAVITREALIMPLANTINAREGIONAL PHARMACOTHERAPEUTICGUIDELINE

1MIZasGarcía*, 1MAGayosoRodríguez, 1AFernándezPérez, 2DLópezSuárez, 1JNúñez Rodríguez. 1HospitalValleDelNalón,HospitalPharmacyService,Langreo,Spain; 2Complejo AsistencialUniversitariodeLeón,HospitalPharmacyService,León,Spain

10.1136/ejhpharm-2023-eahp.17

BackgroundandImportance Duetothehighcostofthe implantoffluocinoloneacetonide(FAc)190 mg,itisespecially importanttorealiseaneconomicevaluationandbudget impactanalysisbeforeinclusioninthepharmacotherapeutic guideofanyhealthinstitution.

AimandObjectives Realiseaneconomicevaluationanda budgetimpactanalysistoassessitsinclusioninourregional pharmacotherapeuticguide,maintainingthefinancingconditionsofourNationalHealthSystem(NHS).

MaterialandMethods PubMedandreportsfromindependent evaluatorswereconsulted:NationalInstituteforHealthand CareExcellence(NICE)andtheScottishMedicinesConsortium(SMC)amongothers.

Results

Accordingtotheproductinformation,animplant releasesFAcforamaximumof36months,andanadditional implantcanbeplacedafter12monthsifvisiondecreasesor retinalthicknessincreases.PivotalstudiesandtheIRISSobservationalstudyconcludedintheneedtouse1.3implants/eye and1.13implants/eyeaffectedduringthefirst3yearsrespectively,thislastvaluebeingtheoneconsideredbytheERG (EvidenceReviewGroup).Takingthislastreference,thecost oftreatment/affectedeyeatC ¼ 1558.84/eye/yearorC ¼ 4676.53/ eye/3years.

Toestimatethetargetpopulation,weusedthecriteriaof theSMCevaluationreportinwhichtheyconsideredatotal of179patientswithpseudophakicchronicDMEeligiblefor treatmentinthefirstyear,increasingto186inthefifthyear. UnliketheSMC,ourNHSrestrictsitsfundingtothird-line, afteranti-angiogenicagentsandinpatientswithasuboptimal responsetovariousintravitrealdexamethasoneimplantsor pseudophakicpatients.

MakingaparallelismwiththeScottishpopulation,33.5 patients/1styear

34.8patients/5thyearwouldbecandidatesto receiveFAcinourregion.

NICEandtheERGfoundthatinclinicalpractice35%of patientswouldrequirebilateraltreatment.Thus12patients/ yearwouldneedtreatmentinbotheyesinourpopulation. Theeconomicimpactinourregionwouldrangebetween C¼ 5,3000.56/yearifitwereinsertedinonlyoneeyeand C¼ 71,706.64/yearinbotheyes.

ConclusionandRelevance Thefinancingconditionsofour NHSpositionthedruginthethird-line,whichinacertain waycontainsthebudgetimpact.

SinceSMCrestrictingtheconditionsofusemorethanour NHS,thebudgetimpactcouldbeunderestimated.

REFERENCESAND/ORACKNOWLEDGEMENTS

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Eachvialwastransferredtoaclosedtestchamberconnectedtoavapourtrap.Toincreasedrugvapourisation,the chamberwasheatedto50°Candnitrogengaswasconstantly introducedintothevials.Anyvapourspotentiallyreleased fromtheChemfort™ VAweretrappedandthenextracted withsolvent.

QuantificationofCPwasperformedusingavalidatedLC/ MS/MSmethod.

Results NoCPwasdetectedforanyoftheVAswithintact Toxi-Guard® components,whethertestedimmediatelyor28 daysafterreconstitution,evenwhenheatandgasflowwere employedtoencouragetheproductionofvapoursandwhen theVAwasattheendofitsshelflife.Thelimitofdetection ofthemethodwasestimatedat0.02ng.Withoutanintact Toxi-Guard®,110.3ngofCPwerereleasedintothe environment.

ConclusionandRelevance ThemodelCSTDutilisingToxiGuard® air-cleaningtechnologycontaineddrugvapoursaftera 28-dayusageperiod,evenunderextremeconditions.Arecent studyproved28-daypreventionofmicrobialingressbythe sameCSTD.Takentogether,thetwostudiessupportpharmacists’ decisiontousedrugsfortheirfullshelflifeorto extendthebeyond-use-dateupto28dayswhenusingan appropriateCSTD,thusreducingcostandwaste.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Corporatesponsoredresearchorothersubstantiverelationships:

OferRazandElanaSlutskySmithareemployedbySimpliviaHealthcareLtd,themanufacturerofChemfortTM.Dekel NavarroandDanielEpsteindeclarenoconflictofinterest relatingtothematerialpresentedintheabstract.Fundingfor thisprojectwasprovidedbySimpliviaHealthcareLtd,the manufacturerofChemfortTM

2SPD-005 NEWCLOSEDSYSTEMTRANSFERDEVICECONTAINS REALDRUGVAPOURSFORUPTO28DAYS

1DNavarro, 1DEpstein*, 2ORaz, 2ESlutskySmith. 1NextarChempharmaSolutionsLtd., AnalyticalLaboratories,NessZiona,Israel; 2SimpliviaHealthcareLtd.,Designand Development,KiryatShmona,Israel

10.1136/ejhpharm-2023-eahp.18

BackgroundandImportance SeveralClosedSystemTransfer Devices(CSTDs)arecurrentlyapproveda7-dayusageperiod. Increasingpressuretoreducedrugcostsanddatasupporting stabilityofsomedrugsbeyond7dayscreateademandfor CSTDsthatcontainhazardousdrugvapoursfor28days.A previousstudyprovedthatamodelair-cleaningCSTDcontainsdrugvapoursfor7days.

AimandObjectives Theaimwastotestdrugvapourcontainmentofanair-cleaningCSTDunderextremeconditionsfor 28days.

MaterialandMethods Cyclophosphamide(CP)waschosenas therepresentativedrug.AmodelCSTD(Chemfort ™)Vial Adaptor(VA)wasconnectedtoeachvial,andCPwasreconstitutedusingtheCSTDSyringeAdaptor.VAsattheendof theirshelflife,representingextremeconditions,weretested bothimmediatelyfollowingand28daysafterreconstitution, withandwithoutintactToxi-Guard® air-cleaningsystems(an integralpartoftheChemfortTM VA).

2SPD-006 AREALLBIOLOGICAGENTSINTHETREATMENTOF ANKYLOSINGSPONDYLITISEQUIVALENT ALTERNATIVES?

1IGarcíaGiménez, 2OMonteroPerez, 1MRodriguezJorge*, 3SFenix-Caballero, 3EJAlegreDelRey. 1HospitalJuanRamónJiménez,PharmacyDepartment,Huelva,Spain; 2Instituto CatalandeOncologia,PharmacyDepartment,L’hospitaletdeLlobregat,Spain; 3Hospital UniversitarioPuertoReal,PharmacyDepartment,PuertoReal,Spain

10.1136/ejhpharm-2023-eahp.19

BackgroundandImportance Ninedrugsarecurrentlyapproved forthetreatmentofankylosingspondylitis(AS)inadults:adalimumab,certolizumabpegol,etanercept,golimumab,infliximab,ixekizumab,secukinumab,upadacitinibandtofacitinib. Tofacitinibwasthelastofthemtoreceiveitsapproval.However,therearenodirectcomparisonsbetweenthem.

AimandObjectives Toestablishwhetherthedrugsapproved forASinadultscanbeconsideredequivalenttherapeutic alternatives(ATE)inefficacyinAS.

MaterialandMethods Asearchofclinicaltrialsofthesedrugs inadultpatientswithASwasconducted,phaseIIorIII,double-blinded,controlledwithanotherdrugorplacebo.

Otherinclusioncriteriawere

. Endpoint:ASAS40(a 40%improvementandanabsolute improvementfrombaselineoftheAssessmentin SpondyloArthritisInternationalSociety).

. Follow-uptime:12-16weeks.

Forthosedrugswithmorethanonestudy,apreviousmetaanalysiswasperformedusingJoaquinPrimocalculator.An adjustedindirectcomparison(IC)ofthedrugsusedinASversustofacitinibwasperformedusingtheBuchermethod,using JoaquinPrimocalculator.Duetolackofdataintheliterature andconsideringthattherapyfailurecanberecoveredwith secondlines,halfoftheASAS40valueobtainedinmeta-analysiswastakenasdeltavalue.ATEguidewasfollowedinorder toestablishapositioning.

Results

Sixteenstudieswereincluded 4adalimumab,2golimumab,1 infliximab,1certolizumab,2etanercept,1upadacitinib,2 tofacitinib,1secukinumaband2ixekizumab.Thedifference inASAS40ofthedrugsbeforeversustofacitinibexpressedas RAR(IC95%)was:Adalimumab[4(-6,1;14,1)],certolizumab [-7,3(-25,1;10,5)],etanercept[2(-11,5;15,5)],golimumab[5(-16,3;6,3)],infliximab[8,43(-4,8;21,6)],ixekizumab[-9 (-20,6;2,6)],secukinumab[-2,7(-18,3;12,9)],upadacitinib[1,9(-17,8;13,9)].Adalimumab,etanerceptandtofacitinibare consideredATE.Infliximab,upadacitinib,secukinumab,golimumab,certolizumab,ixekizumabandtofacitinibcanalsobe consideredATE,beingtheprobabilityofclinicallyrelevantdifference<50%(mostofthe95%CIisintheequivalence range)andthefailuredoesnotinvolveserious/irreversible damage.

ConclusionandRelevance Tofacitinibandtherestofthese drugscouldbeconsideredATE.Foradefinitivestatement, thecriteriaofsafetyandadequacyshouldbeconsidered.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Theamountderivedfromthepurchaseofgenericlenalidomidecorrespondingtothestudiedperiod,comesupto C¼ 1,601.27.ThatresultsinanestimateofC ¼ 9,607.62for12 months.

Assumingthatthesamenumberofpatientsandtreatments withlenalidomidewerestablethroughouttheperiod,aswell astheexpenditureontherestoftheABCofdrugs,theeconomicimpactgeneratedwouldmeanasavingofapproximatelyC ¼ 1,005,278.84,whichwouldcauseasignificant decreaseinthechapterIIforourHospital(-14.25%).

ConclusionandRelevance Theeconomicimpactcausedbythe introductionofgenericlenalidomideinourHospitalwillproducesavingsofmorethanonemillioneuros.

Speedinguptheauthorisationprocessesforgenericmedicines,aswellasotherpricingpolicies,areessentialmanoeuvrestogetacohesivehealthsystemthatguaranteesequal accesstomedicines.

REFERENCESAND/ORACKNOWLEDGEMENTS

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2SPD-009 AVOIDEDCOSTSFROMTHEINCLUSIONOFBREAST CANCERPATIENTSINCLINICALTRIALS

1AMValleDíazdelaGuardia, 2SSadyrbaevaDolgova, 2CMontero-Vilchez*, 2MIArchilla Amat. 1HospitalUniversitarioVirgendeLasNieves,FarmaciaHospitalaria,Granada,Spain; 2HospitalUniversitarioVirgendeLasNieves,ServiciodeFarmacia,Granada,Spain

10.1136/ejhpharm-2023-eahp.21

2SPD-008 BUDGETARYIMPACTDUETOTHEREPLACEMENTOF ORIGINALLENALIDOMIDEINTOGENERIC LENALIDOMIDE

FPAna*,MAGayosoRodríguez,MIZasGarcía,JNúñezRodríguez. HospitalValleDel Nalón,HospitalPharmacyService,Langreo,Spain

10.1136/ejhpharm-2023-eahp.20

BackgroundandImportance Breastcancerisoneofthe tumourswiththehighestincidenceinSpain,anditspharmacologicaltreatmentgeneratesahugeeconomicimpact.Clinical trialsareessentialforevaluatingtheefficacyandsafetyof newtherapies,andalsoprovideafinancialbenefittothepublichealthsystem.

AimandObjectives Theaimofthisresearchistocalculate thesavingcostsindrugs,derivedfromtheparticipationof breastcancerpatientsinclinicaltrials(basedonthedrugfree supportprovidedbythesponsorofeachstudy).

BackgroundandImportance

Theuseofgenericdrugsisone ofthemosteffectivetoolstoincreaseefficiencyintheeconomicmanagementofthehealthsystem.FromMarch2021 toFebruary2022,theacquisitionoftheoriginalmoleculeof lenalidomide(Revlimid®)representedthemainexpenseinthe ABCofdrugpurchases.Asofthisdate,agenericspecialty wascommercialisedandthePharmacyServiceproposeda replacementbetweenthem,giventhatbothsharethesame indicationsasinthetechnicaldatasheet.

AimandObjectives Quantifyingtheeconomicimpactinthe expensesofchapterIIofageneralhospital,causedbythe acquisitionofgenericlenalidomideinsteadofRevlimid® and itsrepercussiononthebudgetduring12months.

MaterialandMethods Althoughonlytwomonthsofevolution withthenewgenericmoleculeareavailable,wehaveextrapolatedthisdatatooneyearsothatwecancalculatetheeconomicaldifferenceswhenitcomestothebudget.

Results FromMarch2021toFebruary2022,thepurchaseof Revlimid® hasmeantanetamountofC ¼ 1,014,886.46,which represents9.8%ofthetotalexpenseinchapterII (C ¼ 10,246,115.23)andpositionsitasfirstspendintherankingofmedicinespurchasedinthisperiodof12months.

MaterialandMethods Aretrospectiveanalysiswasmadeofall breastcancerclinicaltrialsinitiatedinourhospitalsinceJanuary2020,andallpatientsincludedinthesetrialswere selected.Thedatacollectedwere:trialphase,investigational drug,numberofsubjectsenrolledandnumberoftreatment cyclesreceived.TheOncologyDepartmentwascontactedto discussthetherapeuticalternativeofchoiceanditstheoretical durationifthepatienthadnotparticipatedintheclinical trial.Thecostofeachoptionwascalculatedusingtheacquisitionpriceofthedrug(laboratorysaleprice – discount+4% VAT).Informationwasobtainedfromthedatabaseoftheclinicaltrialsunit.

Results Since2020,8breastcancerclinicaltrials(2phaseII and6phaseIII),wereinitiatedinourhospital.Were included10subjects,receivingatotalof106treatment cycles.Theinvestigationalmedicalproductsstudiedwere: trastuzumabandconjugates,pertuzumab,atezolizumab,olaparib,alpelisibandpalbociclib.Theoverallcostsavingwas C¼ 198.775,32.Thetrialwiththehighestcostimpactoffers asavingofC ¼ 8.269,48percycleofeachenrolledpatient. Thedrugwithhighestavoidedcostwaspemetrexed (C ¼ 32.890,54).

ConclusionandRelevance Clinicaltrialsinbreastcancer patients,inadditiontoofferingthepossibilityofaccessto

newtherapeuticalternatives,representaconsiderableeconomic savingandasignificantreductioninpharmaceuticalcosts.Itis importanttoimprovepatientrecruitmentinthesetypesof studies.

REFERENCESAND/ORACKNOWLEDGEMENTS

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REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

2SPD-013 INTERVENTIONALCARDIOLOGY:ANALYSISOF STERILEMEDICALDEVICE’SCONSUMPTIONAND ASSESSMENTOFDIFFERINGPRACTICES

SChabouni*,OChauvel,JLPons. VictorDupouyHospitalCenter,HospitalPharmacy, Argenteuil,France

2SPD-010 REVIEWOFTHEENVIRONMENTALCRITERIA INTRODUCEDINTHETENDERINGOFDRUGS, MEDICALDEVICESANDNON-MEDICALEQUIPMENT INAHEALTHGROUPPROCUREMENTORGANISATION

1VGarciaLópez, 2AMoratallaRolanía, 2PHorsComadira, 1JMGuiuSegura*. 1Consortium ofHealthandSocialCareofCatalonia,PharmacyandMedicines,Barcelona,Spain; 2ConsortiumofHealthandSocialCareofCatalonia,CentralProcurementBody,Barcelona, Spain

10.1136/ejhpharm-2023-eahp.22

BackgroundandImportance Greenpublicprocurementisa processofcontractingproducts,services,andworkswith theleastpossibledamagetotheenvironmentduringtheir lifecycle.Inordertoimproveknowledgeontheapplicationofenvironmentalcriteriainhealthcareprocurement, itisnecessarytoassessthecurrentimplementation situation.

AimandObjectives Toreviewtheincorporationofenvironmentalcriteriainpublicprocurementproceduresfordrugs, medicaldevicesandnon-medicalequipment(paper,clothing, garbagebags,etc.)inagroupprocurementorganisation.

MaterialandMethods Aretrospectivestudywasperformedin whichallthetenderscarriedoutbythegroupprocurement organisationfrom2017tothefirstquarterof2022were reviewed.Alltendersthathadincludedenvironmentalcriteria intheevaluationcriteriawereidentified.Inordertoevaluate theimpactofthesecriteriainthesuppliers’ bids,itwasconsideredaspositiveifcompliancewiththeenvironmentalcriteriawasgiveninatleastoneoftheproductsoffered. Classificationofthesuppliers(drugs,medicaldevices,and non-medicalequipment)wasmadeonthebasisofsubject matteroftheprocurement.

Results Atotalof117tenderfileswerereviewed,where15 (12.8%)includedenvironmentalcriteriainthetechnical specifications:4(26.6%)fordrugs,6(40%)formedical devicesand5(33.3%)fornon-medicalequipment.Atotal of130supplierspresentedtender bidsinthe15tenders identified:80(61.5%)metoneo rmoreoftheenvironmentalcriteriaincludedinthespecifications.Regardingthesubjectmatterofthecontract,19companiessubmittedbidsto drugtenderfiles,55tomedicaldevicesand6tonon-medicalequipment.Duringtheperiod2018-2021,thehighest numberoftenderswithenvironmentalcriteriawerethose ofmedicaldevices.Overall,agrowingtrendwiththeincorporationofenvironmentalcriteriais observedoverthe years.

ConclusionandRelevance Theintroductionofenvironmental criteriainhealthcareprocurementisstilllowbutwithan increasingtrendtowardsahigherpercentageofthetendered contracts.Thecurrentsustainableprocurementpoliciesin Europeencourageforawiderintroductionofsocialandenvironmentalcriteriaintheprocurementofdrugs,medicaldevicesandnon-medicalequipment.

10.1136/ejhpharm-2023-eahp.23

BackgroundandImportance Therapeuticangioplasty(TA) allowsthedilatationofcoronarystenosis.Thisminimallyinvasiveprocedure,oftencombinedwithdiagnosticangiography, requiresvariouscostlymedicaldevices(MD).

AimandObjectives Thisstudywasconductedtohighlightif thereisadifferenceininterventionalcardiology(IC)practices betweenphysiciansandestimatetheassociatedcosts.

MaterialandMethods First,data(characteristicsofcardiac procedures(CP),numberandtypeofMD(nMD))were extractedfromthecardiovascularinformationsoftware(Cardioreport®)onaperiodofthreemonths.Then,Excel® was usedtocalculatetheaverageMDcost(AC)perprocedurefor eachoperator.Finally,datawereexploredinRStudio® using theMultiple-Regression,ClusteringwithK-meansandWard’ s method,inordertoclassifythesimilitudesandvisualisethe differencesinpractices.

Results Oursampleof74CPincludes11TAand63combinedprocedures.These,concerned63patients(averageage 68years),26%offemalesand76%ofmalesamongwhom 10hadatleast2CP.TheACestimatedperprocedureis C¼ 1125ofwhichC ¼ 602isnotcoveredbyadditionalpayments (NCA)whileC ¼ 523iscovered(CA).FivephysiciansA/B/C/D/ EoperateinICwitharespectivepercentageofactivityof 5%/9%/12%/22%/51%.

Abstract2SPD-013Table1

Multiple-RegressionshowsthatcostofCPisexplainedat 89%bynMDandNCAcostassignificantvariables(adjusted R²=0.891withP-value<5%(1.465e-12)sonull-hypothesis canberejected).ClusteringandWard’sdendrogramgrouped procedureswithcommoncharacteristicsandshowedthatthere weredifferencesinpracticesamongphysicians.Afterexcluding operators,AandE,clusteringshowsthatoperatorCissingularinhispractices(withahigherrateofcomplexprocedures definedaslongerthan90minutesforcombinedprocedures), whileBandDhavesimilaritiesintermsofchoiceofMD.

ConclusionandRelevance Thehospitalpharmacist,asMD expertplaysacentralroleinmanagingconsumptionanalysis. Expandingthesampletoconfirmtheresultswouldbemore relevant.Thus,itwouldbeinterestingtoexploretheimpact ofcommunicatingthisworktophysiciansinordertohomogenisetheirpractices.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

2SPD-014

COSTSTUDY:REUSABLEFLEXIBLEURETEROSCOPES VERSUSSINGLE-USEINAHEALTHCAREFACILITY

1MDufossé*, 2FMartel, 3LBenard, 1APetit. 1CHUAmiens-Picardie,PharmacieÀUsage

Intérieur,Amiens,France; 2CHUAmiens-Picardie,CentraledeDésinfectionDesEndoscopes, Amiens,France; 3CHUAmiens-Picardie,ServiceBiomédical,Amiens,France

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BackgroundandImportance Inourhospital,weuseflexible ureteroscopesforlithiasistreatment,whichisathighriskof materialbreakage.Inthedevicespark,wehavesixadultdevices(inadequateinviewoftheactivity)andonepaediatric (obsolete),whichareoftenunavailable,fordisinfectionor repair.

AimandObjectives Tocompensateforunavailability,wecould usesingle-usedevices.Ourobjectiveistocomparereusable versussingle-usedevices’ costs,todetermineifreferencingsingle-usedevicesisrelevant.

MaterialandMethods Wesetaworkinggroup,includingurologists,pharmacists,biomedicalengineersandhealthexecutive fromdisinfectingcentre.Webasethecalculationofthecost on300usesperyear.Reusablecostgatherthepurchaseprice, theamortisationexpensefora3yearproductlifetime,disinfectionscost(products,equipment,staff),maintenancecontract andrepaircost.Single-usecostisassimilatedwiththepurchasepriceof300units.Themanufacturerprovidestheconsolefreeofcharge.Ourstudydoesnotconsiderwaste treatmentcost.

Results For300uses,reusableureteroscopescostC ¼ 133360 yearlypre-tax(C ¼ 445/unit):C ¼ 27813foramortisation expense,C ¼ 66000formaintenancecontract,C ¼ 20594for therepairs.DisinfectioncostsC ¼ 12900yearly,inadditionto C¼ 4353yearlyformaintenanceandC ¼ 1700foramortisation ofequipment.Ifweonlyusedsingle-useureteroscopes,it wouldcostC ¼ 184500yearly(C ¼ 615/unit).Theincremental costwouldbeC ¼ 51140yearly.

ConclusionandRelevance Ourresultsshowthat,inour case,single-useis moreexpensive,espec iallysincewehave anewdisinfectionfacilityforourreusableureteroscopes. Moreover,thesingle-useureteroscopes ’ picturequalityis lower,whichledthegrouptospeakinfavourofthepark increasetoeightunitsforusualuse.Inaddition,itrecommendspunctualpurchaseofsingle-use incasesofunavailabilityoractathighriskof materialbreakage.Indications forpaediatricusearerare,thegrouprecommendspurchasingafewsingle-useunitsandtowriteoffthereusable ureteroscope.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

toprovideremotepharmaceuticalcareforvulnerablepopulations(elderly,socioeconomicormobilityproblems).

AimandObjectives Todescribetheimplementationofa THDPinahospitalthroughthecommunitypharmacy(CP).

MaterialandMethods Observationalretrospectivestudy between1October2021and30September2022.Patients thatvoluntarilyrequestedtobepartoftheTHDPwere evaluatedtomeettheestablishedcriteria:>3monthsof treatment,compliancewithconsultations,adherent,and properunderstandingoftheinformationontheTHDPand signinganinformedconsentform.Duetothehumanand economicresourcesavailable,p rioritywasgiventoolder patients(>65years),distancetothehospitalcentre,disabilityordependency.Neitherpathologynormedication weretakenintoconsideration.CPrequestedthemedication viaweb.Then,patientsreceivedfollow-upphonecallsby theHPafterreviewingtheelectronicmedicalrecords.The medicationwaspackagedindividuallywithbarcodelabels andsenttothenearestCPthroughapharmaceutical cooperative.

Results 8168patientsattendedtheoutpatientunit,444(5,4%) wereincludedintheTHDP.Rheumatoidarthritis(17.8%) treatmentswerethemostin-demandmedication,followedby multiplesclerosistreatments(10.1%)andantiretroviraldrugs (8.5%).

10.1136/ejhpharm-2023-eahp.25

BackgroundandImportance

TheSARS-CoV-2pandemicacceleratedtheimplementationofalternativewaysofremotepharmaceuticalcareanddispensation.Telepharmacyandhome deliveryprogrammes(THDP)allowhospitalpharmacists(HP)

Eightincidentsoccurred:dosingerror(25%),wrongdrug (12.5%),wrongformulation(62.5%),thatwereresolved. ConclusionandRelevance TheimplementationofTHDPhas beenanewchallengeforHP.Itenablesustoprovidedrugs topatientsintheirimmediateenvironmentwithoutextracost tothehealthcaresystem.However,theevidenceoftheimpact oftheseprogrammesissparse.

2SPD-017 TELEPHARMACYANDHOMEDELIVERYPROGRAMME FOROUTPATIENTSTHROUGHTHECOMMUNITY PHARMACY

MRCantudoCuenca*,MArenasJimenez,AYSalmeronCobos,CMonteroVílchez, MIArchillaAmat. HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada,Spain

2SPD-018 BEZLOTOXUMAB:STRATEGIESTOREDUCEECONOMIC IMPACT

CFernandezCuerva*,RAsensiDiez,IMuñozCastillo. HospitalRegionalUniversitariode Málaga,ServiciodeFarmacia,Málaga,Spain

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BackgroundandImportance Clostridiumdifficile isthemost commoncauseofinfectiousdiarrhoeainhospitalisedpatients andcausesgreatmorbidityduetothehighpercentageof recurrence.Bezlotoxumabwas thefirsthumanisedmonoclonalantibodyagainstC.difficiletoxinBapprovedforpreventionofrecurrent Clostridiumdifficile infection(CDI)in high-riskadultsinconjunctionwithstandardofcareantibiotics.Bezlotoxumabvialpoweris1,000mg,isgivenasaonetimeinfusioninrecommendeddoseof10mg/kgover60 minutes.NewguidelinesonthemanagementofCDIhave beenpublishedin2021:ACGandIDSA/SHEA,whichrecommendusingbezlotoxumabinpatientswithahighriskof recurrence.

Inordertoreduceeconomicimpactoftheadministration ofbezlotoxumab,ourcentrepromotedschedulingselected patientsonthesamedaytousetherestofthevials.

AimandObjectives Toassesstheeconomicimpactofthe appointmentstrategyinpatientstreatedwithbezlotoxumab.

MaterialandMethods Aretrospectiveanal ysisofpharmaceuticalexpenditureofbezlotoxumabprescribedforCDIwas conductedfromJune2019toAugust2022.Datacollected werenumberofpatientstreatedwithbezlotoxumab,weight, dateofinfusion,numberofvialsrequired.Datawerecollectedfromelectronicprescribingprogramandeconomic software.

Results 45adultpatientswereincludedinthestudy.Theyall receivedbezlotoxumabforCDIathighriskofrecurrence,in singleinfusionof10mg/kg.24patients(53.3%)werecited topreventvialwaste.21patients(46.7%)requiredacomplete vial:duetotheirweight,difficultiesinmakinganappointment,orboth.Of24patients,medianweightwas50kg (rank34-66kg).

Intheperiodofourstudy,35vialsofbezlotoxumabwere used.CostofbezlotoxumabvialisC ¼ 1,480.Estimatedexpenditurewas:C ¼ 51,800ifpatientswerecitedvsC ¼ 66,600if not.ThecostoftreatmentdecreasedbyC ¼ 14,800duetothe administrationappointmentstrategy.

ConclusionandRelevance BezlotoxumabisaneffectivetreatmentinpreventingCDIrelapseinhighriskrecurrence patients,followingguidelines.Administrationappointment strategyinselectedpatientshasproventobeefficientsince morepatientscanbetreatedwiththesamebudget.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.ClinicalPracticeGuidelinebytheInfectiousDiseasesSocietyofAmerica(IDSA) andSocietyforHealthcareEpidemiologyofAmerica(SHEA):https://pubmed.ncbi. nlm.nih.gov/34164674/

2SPD-020 IMPACTOFCOVID-19TREATMENTOPTIONSON HOSPITALPHARMACY’SWORKLOAD:LESSONS

LEARNED

1SVonWinckelmann*, 2JMichaux, 1GVanDenBergh, 1VVerheyen. 1ImeldaHospital, HospitalPharmacy,Bonheiden,Belgium; 2CatholicUniversityLeuven,Faculty PharmaceuticalSciences,Leuven,Belgium

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BackgroundandImportance TreatmentguidelinesforCOVID19haverapidlybeenevolving.Differentdrugsagainst COVID-19haveurgentlyemergedtocontrolthepandemic, challenginghospitalpharmaciestomaketheseantiviraland immunomodulatorytherapiestimelyavailableforadmitted patients.

AimandObjectives Toanalysetheprescribingpatternsof COVID-19drugsinourhospitalanditsimpactonthepharmacy ’sworkload.

MaterialandMethods Weretrospectivelyanalyseddrugregistrationdatafrom1January2020to16March2022of COVID-19drugs(dexamethasone,remdesivir,baricitinib, casirivimab/imdevimabandsotrovimab)forhospitalised patients.Consumptiondatawereexpressedasnumberof patientsandnumberofpreparations.Todeterminepharmacy ’sworkload,wemeasuredtheaveragetimefordrug ordering,preparationanddispensing.Hydroxychloroquine andbaricitinibwereexcludedasthesearecommerciallyavailableoraldrugswhicharedistributedaccordingtostandard procedures.

Results ThevolumeofdispensedCOVID-19drugsfluctuated alongwiththehospitalisationwavesoftheCOVID-19epidemic.Oraldexamethasonewasthemostfrequentlyprescribeddrugthroughoutthewholeperiod,whichisconsistent withthestrongrecommendationinthenationalguideline. Remdesivir,introducedinourpracticesinceOctober2020, wasthesecondmostprescribeddrugdespitelowevidence. FromOctober2021untilDecember2021,41infusionsof remdesivirwereadministered,comparedto381infusions fromJanuary2022untilMarch2022.Comparedtodexamethasoneandremdesivir,monoclonalantibodies(casirivimab/ imdevimabandsotrovimab)werelesscommonlyused:48preparedinfusionsbetweenSeptember2021andMarch2022. Mostdrugsweregivenincombination.Remdesivirandmonoclonalantibodiesweremanuallyorderedtofulfilurgentneeds asthesupplyismanagednationwidebythegovernment.Infusionswerepreparedatonceduetolimitedstability.Ordering, preparinganddispensingrequiredanaverageof35minutes perpatienttocomplete.

ACGClinicalGuidelines

Prevention,Diagnosis,andTreatment ofClostridioidesdifficileInfections:https://pubmed.ncbi.nlm. nih.gov/34003176/

ConflictofInterest Noconflictofinterest

ConclusionandRelevance TheCOVID-19pandemicimpacted pharmacy ’sworkload.Wecouldhavemademoretimesaving decisionssuchastheuseofcommerciallyavailablemethylprednisoloneinsteadofdexamethasoneandbatchingremdesivirpreparations.Hospitalpharmacistsshouldbeinvolvedin developingnationalguidelinesandtakeintoaccountthe impactondailypractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Sciensano,InterimclinicalguidanceforadultswithconfirmedCOVID-19,July 2022,Version29

Section3:Productionandcompounding

3PC-001 PREPACKEDBOXESFOROUTPATIENTPARENTERAL ANTIBIOTICTHERAPY(OPAT) – AQUESTIONNAIRE SURVEYONKNOWLEDGE,OPINIONANDWISHES

1TTruelshøj*, 2COlesen, 3LLundRøndbjerg, 4SPaarupKirkebyHerping. 1Hospital Pharmacy – CentralDenmarkRegion,Precurement,Dk-8000AarhusC,Denmark; 2Hospital Pharmacy

CentralDenmarkRegion,ClinicalPharmacy – Auh,Aarhus,Denmark; 3Hospital Pharmacy – CentralDenmarkRegion,Gødstrup,Herning,Denmark; 4HospitalPharmacy –CentralDenmarkRegion,ClinicalPharmacy – Hemidt,Silkeborg,Denmark

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BackgroundandImportance Tosupportasimpleandqualityassuredoutpatientparenteralantibiotictherapy(OPAT)workflow,thehospitalpharmacyoffersspeciallyprepackedboxes foruseinthepatient’shomeafterdischarge.Thereareboxes forthreedifferentantibiotics;benzylpencillin,cefuroximeand piperacillin/tazobactam,containingantibioticpowder,utensils andsolventforthreedaysoftreatment.Anotherboxcontains onlyutensilsandsolventforthreeadministrations.

AimandObjectives Theaimistoexploreknowledge,opinion andwishestotheprepackedantibioticandutensilsboxesin attempttofulfiltheneedsofthehospitalwards.

MaterialandMethods Inanelectronicquestionnairewith17 questions,onenurseateachhospitalwardwasaskedabout theirknowledge,opinionandwishestotheantibioticsand utensilsboxes.

AllhospitalswardsinCentralDenmarkRegionthatdischargepatientstoOPATreceivedaquestionnaire.Thequestionnairewasdesignedafterinterviewwithtwonursesand pilottestedbytwoothernursesondifferentwards. Results 39wardsof53(74%)respondedtothequestionnaire. TheresultsconfirmedthattheboxesarevaluedintheOPAT workflowonthehospitalwards.87%knewaboutsomeof theantibioticsboxes,59%knewabouttheutensilsbox.There wasagreement(97%)thattheuniformitythatcomeswiththe boxes,contributestopatients‘ safetyinprimary-care.

Therewasgeneralsatisfactionwiththenumberoftreatmentdaysintheboxes.Onethirdofrespondentswouldhave likedasupplementaryboxwithonedayofantibiotictreatment,enablingamoreflexiblesolutionandreduceddrug waste.25%wouldlikeboxescontainingotherantibiotics.

Severalcommentedontheavailabilityoftheboxesonthe wards,asafactorthatsometimespreventsuse.

ConclusionandRelevance Thesurveyshowsthattheboxes areknownandhighlyappreciated,butthereisaneedto increaseknowledgeaboutalltheboxesandimprovetheir availability.

Currentlytheexistingprepackedboxescovermostcasesof OPAT,butasupplementofaone-daytreatmentmayprovide amoreflexiblesolutionwithlessdrugwaste.

Toevaluatethewishesforotherantibioticsinprepacked boxes,moredataaboutuseofantibioticsforOPATpatientsis needed.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-002

HAZARDOUSDRUGANDANTIBIOTICRESIDUE SURFACECONTAMINATION – ISTHEREANEEDTO

REDUCEEXPOSURE?

1PSessink, 2BTans, 2ISpriet. 1ExposureControlSweden,MonitoringandConsultancy, Bohus-Björkö,Sweden; 2UniversityHospital,Pharmacy,Leuven,Belgium

10.1136/ejhpharm-2023-eahp.29

BackgroundandImportance ExposuretoHazardousDrugs (HD)isapotentialhealthrisk.Multipleregulatoryagencies haveprovidedguidanceinvolvingenhancedcleaningproceduresandtheuseofClosedSystemTransferDevices(CSTDs) tominimisetheriskofexposure.However,despitethepotentialforsideeffectsinvolvingtheuseofantibiotics(ABs),guidancehasnotbeenprovidedforfacilitiestoreduceor minimisetheserisks.

AimandObjectives Theaimofthisstudywastoidentifythe levelofABandHDsurfacecontaminationinahospitalpharmacyandeightwardstoincreaseawarenessfortheneedfor enhancedcontrolsinvolvedinABuse.

MaterialandMethods SixHDswereanalysedinfoursurface wipesamplesfromapharmacyandtwowards.Samplingwas repeatedfourtimes(trials)overaperiodofeightmonths (288endpoints).ACSTDwasusedforHDpreparationduringtheentirestudy.EightABswereanalysedintwosurface wipesamplesfromsixwardscollectedduringthefourtrials (384endpoints).Samplingwasatthesametimepointsasfor HDsampling.ACSTDwasnotusedinABhandling. Enhancedcleaningwasimplementedfollowingthefirsttrial. Sampleswereanalysedwithliquidchromatographytandem massspectrometry.

Results HDsurfacecontaminationwasdetectedin6%ofthe samplescollectedduringthefourtrials.Sampleswithhigh levelsofcontaminationwerenotfound.ABsurfacecontaminationwasdetectedin68%ofthesamples.15%ofthesamplesshowhighlevelsofcontamination.Despiteenhanced cleaningprocedures,ABcontaminationwasincreasedinthe lasttrialscomparedtotheinitialtrials.

ConclusionandRelevance Thestudyillustratesthatinstitutionalguidance,involvingtheuseofaCSTDandeffective cleaning,hasproventobeeffectivetominimiseunintentional exposureofhealthcareworkerstoHDsurfacecontamination. Onthecontrary,guidance,controlsandcleaningwerenotsufficienttoreducesurfacecontaminationwithpotentialharmful ABs.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AlertandactionlevelsforsurfacecontaminationwithHDsinTheNetherlands (https://www.dokterhoe.nl/fileadmin/user_upload/documents/cytostatica/meetstrategie-werkinstructie.pdf)

ConflictofInterest Corporatesponsoredresearchorothersubstantiverelationships:

ThestudywasfinanciallysupportedbyICUMedicalUSA. PaulSessinkisreceivinganhonorariumfromICUMedicalfor thispresentation.

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3PC-004 ECONOMICSAVINGSOFERENUMABREDOSINGINA THIRD-LEVELHOSPITAL

RLópezRanchal,CCCabañasGimeno,NBáez*,LMRuizLara,EMancillaMontero. HospitalUniversitarioReinaSofía,HospitalPharmacy,Córdoba,Spain

BackgroundandImportance Erenumabisanewmonoclonal antibodyforthetreatmentofmigrainethatbindstothecalcitoningene-relatedpeptide(CGRP)receptortoinhibititsfunction.Erenumabisadrugwithaconsiderableeconomicimpact onthehospital’sannualbudget.

practicalbeyondusedateofdrugvials,throughuseof CSTDs.

AimandObjectives ThisstudyaimedtotestiftheChemfortTM CSTDcanmaintainmicrobiologicalintegrityafter10 withdrawalsfromvialsoveraperiodof28days.

AimandObjectives

Toevaluatethebudgetaryimpactofthe redosificationofthecommercialdoseoferenumab140mg intodosesof70mg.

MaterialandMethods

Anobservational,retrospectivestudy wasconductedinatertiarycarehospitalwithaclean room.Allpatientstreatedwitherenumabbetween1January 2019and30August2022w ereincluded.Thevariablescollectedwere:sex,age,dosepreparedperpatient,numberof redosesperpatient,andnumberofsyringesoferenumab used.Tocalculatethebudgetaryimpactoferenumab,a pharmacoeconomicstudywascarriedoutinwhichthesavingsobtainedbytheredosificationof140mgindosesof 70mgwereevaluatedsincebothcommercialpresentations havethesameprice(PTRerenumab70mgand140mg= C¼ 200).Theactualcostofthetreatmentswithredosingand thetheoreticalcostwithoutredosingwerecalculated,consideringthenumberofdosesandthedurationoftreatment ineachpatient.Theinformationwasobtainedfromthecorporateprescriptionprogrammeandpatients ’ clinical records.

Results Atotalof281patientsweretreatedwitherenumab duringthestudyperiod.Themeanagewas46years(range 17-75),86.8%(n=244)womenand13.2%men(n=37).A totalof1,133syringesoferenumab70mg(mean:2;range 0-29)and1,875of140mg(mean4;range0-28)wereconsumed.Therealannualcostofthetreatmentswithredosing wasC ¼ 519,827;comparedtoatheoreticalannualcostof C¼ 629,282iftheredosinghadnotbeencarriedout.Therefore,theredosificationoferenumab140mginto70mghas saved547.28syringesoferenumab140mgperyear (C ¼ 109,455).AnestimatedsavingofC ¼ 389.52perpatientwas obtainedbytheredosificationoferenumab140mgdoseinto 70mg.

ConclusionandRelevance Theresultsshowthattherepackagingofthe140mgdoseinto70mgisagreateconomicsavingpracticeandeasytoimplementinhospitals.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-005 CLOSEDSYSTEMTRANSFERDEVICE(CSTD)EXTENDS

PRACTICALIN-USESHELFLIFETO28DAYSAFTER FIRSTPUNCTUREOFNON-PRESERVEDSINGLE-USEVIALSINBOTHCONTROLLEDANDUNCONTROLLED ENVIRONMENTS

1RTerkola*, 2CPietrzak, 3ASNebel. 1UniversityofGroningen,MedicalCenter,Groningen, TheNetherlands; 2UniversityofNaturalResourcesandLifeSciences,Food-AndBioTechnology,Vienna,Austria; 3FHCampusWien,AppliedLifeSciences,Vienna,Austria

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BackgroundandImportance Closedsystemtransferdevices (CSTD)wereoriginallydesignedtoprotectoperatorsfrom cytotoxic,mutagenic,andreprotoxicagents.Thereisincreasingpressuretoreducecostburdenbypreservingdrugs,especiallyinthefieldofoncology.Onesolutionisdrugvial optimisation,whichcanbeaccomplishedbyextendingthe

MaterialandMethods TestswereperformedinbothacontrolledGMPClassAenvironmentandanuncontrolledenvironment(350vialsineachenvironment).Environmental conditionsweremonitoredbycontinuousairsampling.The rubberstoppersofallvials,containingtrypticsoybroth(TSB) growthmedium,weredisinfectedpriortomountingChemfortTMVialAdaptors(VAs)onthevials.TheChemfortTMSyringeAdaptor(SA)wasattachedtoa10mLsyringeand subsequentlyconnectedtotheVA.TheseptaofboththeVA andSAweredisinfectedpriortoeveryconnection.Ten5mL aliquotswerewithdrawnfromeachvialat2-weekintervals (days0/3syringes,14/3syringes,and28/4syringes),incubated for7daysat20–25°Candthen7daysat30–35°C.After28 days,thevialcontainingtheremaininggrowthmedium(50 mL)wasalsoincubatedfor7daysat20-25°Candthen7 daysat30-35°C.Vialsandsyringeswereinspectedvisually forsignsofmicrobialgrowthduringeachincubation.Tenpositivecontrolcontainersweresubjectedtoagrowthpromotion test.

Results Nosignsofmicrobialgrowthwereobservedinanyof the7,000samples,norinthegrowthmediumremainingin thevialsaftertransferswereperformedineitheranuncontrolledorcontrolledenvironment.

ConclusionandRelevance Thedatapresenteddemonstratesthe abilityofthetestedCSTDtomaintainmicrobiologicalintegrityandsupportthedecisiontoextendthepracticalin-use shelflifeofdrugproductsforupto28dayswhenusedwith ChemfortTM ineitherasepticconditionsoruncontrolled conditions.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.ThisresearchwassupportedbySimpliviaHealthcareLtd.,Israel,andB.Braun AustriaGesmbH,Austria.

ConflictofInterest Noconflictofinterest

3PC-006 CONTAINERCLOSUREINTEGRITYTESTINGAND PROCESSVALIDATIONOFCLOSEDSYSTEMTRANSFER DEVICESFORASEPTICRECONSTITUTIONOFDRUG VIALSCONNECTEDTOFLUIDBAGS

1RVanDenBerg*, 2KAkgöl, 1ESwart, 2BNuijen, 1MCrul. 1AmsterdamUmc – Vrije UniversiteitAmsterdam,DepartmentofPharmacyandClinicalPharmacology,Amsterdam, TheNetherlands; 2NetherlandsCancerInstitute – AntoniVanLeeuwenhoek,Departmentof PharmacyandPharmacology,Amsterdam,TheNetherlands

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BackgroundandImportance Theclosureintegrityandprocess validationofclosedsystemtransferdevices(CSTD)shouldbe assuredbeforeimplementationinclinicalsettings.However, therearenogoldstandardmethodsforContainerClosure IntegrityTesting(CCIT)ofCSTDs.

AimandObjectives Weaimedtoinvestigatetheclosureintegrityandvalidatetheasepticprocedureoftwotypesof CSTDs(Vial-MatefromBaxter,hereaftercalledCSTDAand EcoflacConnectfromB.Braun,hereaftercalledCSTDB)by usingacombinationofthedyeingresstestandamediafill test.

MaterialandMethods

Thedyeingresstestwithmethylene bluewasusedasCCITforbothCSTDswithtensamplesof meropenemdrugvialsofthreebrands(n=60).Amediafill testwasperformedwithbothCSTDs(n=300perCSTD, 150carriedoutinasafetycabinetand150undernon-classifiedenvironmentalconditions).

Results InallsamplesofbothCSTDsmethylenebluewas absentaftervisualinspectionandspectrophotometricanalysis. ThenutrientmediaofonesamplewithCSTDA,reconstituted inasafetycabinet,wascontaminatedwhereasnoneofthe CSTDBsampleswithreconstitutioninaGMPgradeAenvironmentwerecontaminated.Undernon-classifiedenvironmentalconditions,onesampleofCSTDAandtwosamplesof CSTDBwerecontaminated.

ConclusionandRelevance Inconclusion,bothCSTDsconnectedtomeropenemvialsofthreebrandsareincompliance withtheclosureintegritybyusingthedyeingress.Theaseptic procedureofCSTBBwasvalidatedwiththemediafilltest whenreconstitutedinaGMPgradeAenvironment,butfailed forCSTDA.TheaddedvalueofCSTDsinahospital(pharmacy)remainsdebatablewithoutaclearlydemonstratedclosureintegritywhenbedsidereconstitutionisdone.Hospital pharmacistsarestronglyadvisedtoperformsufficientand adequateclosureintegritytestswithCSTDsbeforeimplementingtheminclinicaluse.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-008 SLOWANAKINRADESENSITISATIONPROTOCOL DESIGNFORDELAYEDHYPERSENSIBILITYREACTION

1HSuñer*, 1MMartínMarqués, 2OEstesoHontoria, 2CBadiaSantolaria, 1ASanjuánBelda, 1ISacanellaAnglès, 1DPascualCarbonell, 1SCondeGiner, 1CJCortésSánchez, 1AGarcia Molina, 3LCanadellVilarrasa. 1HospitalUniversitariJoanXXIII,Pharmacy,Tarragona,Spain; 2HospitalUniversitariJoanXXIII,Allergology,Tarragona,Spain; 3HospitalUniversitaryJoan XXIII,Pharmacy,Tarragona,Spain

10.1136/ejhpharm-2023-eahp.33

BackgroundandImportance Anakinra,arecombinanthuman IL-1receptorantagonist,isindicatedinrheumatoidarthritis (RA)withagoodsafetyprofile,nonethelessitsadministration hasbeenassociatedwithaseveredelayedinjection-sitereactionwithoutafullyunderstoodpathogenesis.Todealwith thatseveraldesensitisationschemeshavebeenpublishedinthe literature.

AimandObjectives Theaimistodescribethedesignofa slowdesensitisationprotocol(SDP)forsubcutaneous(SC)anakinraforpatientswhohavefailedtherapiddesensitisation scheme(RDP).

MaterialandMethods Weintroducea72year-oldpatient diagnosedforRAandtreatedwithSCanakinraafterfailing othertreatmentlineswhopresentssevereinjection-sitereactionsafter3weeksoftreatment.Anattemptwasmadeto desensitisequicklybutitwasnottoleratedeither.Asthere werenomorelinesoftreatmentavailable,itwasdecided,in collaborationwithallergists,todesignaSDP.

Itwasdesignedfor56dosesofincreasingconcentrations (until100mgdose).Lowerdosewas0,1mganddosechange wasperformedevery3-4days.Solutionswereelaboratedin thePharmacyService.Startingfromamothersolution(MS) of100mganakinrainphysiologicserum0,9%(SF)toafinal volumeof1mL(1:1solution)twoanakinradilutionswere

made:1:10,1:5.TheMSwaspreparedfromanakinra100 mg/0,67mlinjection.Thedilution1:10wasmadebytaking 0,5mlfromtheMSandSFuntil10ml(concentration5mg/ ml).Thedilution1:5waspreparedbydiluting1mlfrom 1:10dilutionuntil5mlfinalvolumewithSF(concentration1 mg/ml).

Topreventhypersensibilityreactionsitwasneededtoadd antihistaminesduringtheSDP.

Results AlthoughRDPwasnotwelltolerated,theproposed schemehadsatisfactoryresults.Atfirstthelowestdose(0,1 mg)wasnottoleratedbythepatient,soitwasdecidedto addantihistaminesduringtheprocess.Ifanydosecouldreact, thedosechangewasdoneinsteadof3after5-7days. Actually,thepatienthascompletedthedosesuntil50mg withoutadversereactions.

ConclusionandRelevance TheSDPproposedbyallergistin collaborationwithhospitalpharmacisthasallowedthesafe administrationofanakinra,avoidingalossofthelasttherapeuticlinepossibleinapatientwithRA.

REFERENCESAND/ORACKNOWLEDGEMENTS

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3PC-009 CYCLOPHOSPHAMIDESURFACECONTAMINATIONIN AROBOTICCHEMOTHERAPYCOMPOUNDING PROCESS

1,2ACRiestraAyora, 1MJTamés*, 1AIglesias, 1BGarcía, 1MJArgandoña, 1CRamajo, 1OOlariaga, 1MUrretavizcaya. 1OnkologikoaFoundation,PharmacyService,SanSebastián, Spain; 2UniversityofDeusto – FacultyofHealthSciens,DepartmentofMedicine,Bilbao, Spain

10.1136/ejhpharm-2023-eahp.34

BackgroundandImportance Thereisawildconsensusabout therisksassociatedtotheoccupationalexposuretohazardous drugs,butrecentstudieshaveshownthatthereisstillsurface contaminationinpharmaciespreparingantineoplasticdrugs. Themainreasonfortheimplementationofroboticcompoundingsystemsistoimprovesafety;forthepatientandfor healthcareworkers,avoidingrepetitivestraininjuriesandhazardousdrugsexposure.

AimandObjectives Theaimofthisstudywastoevaluate cyclophosphamideexposureofpharmacynursesduringthe roboticchemotherapycompoundingprocess.

MaterialandMethods Thesamplingareaswereselectedafter beingidentifiedasthehighestriskofpersonalcontamination inariskassessment.Wipesamplesweretakenfromvials, infusionbags,gloves,anddifferentlocationsoftherobotic system.Surfacemonitoringwasperformedusingasemi-quantitativedevicebasedonthinlayerimmunochromatography. Thesamplingwasperformedattheendoftheworkdayover severaldaysbeforecleaningprocesstoidentifythehighest potentialdegreeofcontaminationtowhichhealthcareworkers couldbeexposed.

Results Cyclophosphamidecompoundingwasperformedduring thestudydaysandseveralmonthsbefore.Therewasno cyclophosphamidespillinthethreemonthspriortothestudy. Externalcontaminationwasmeasuredon15vialsand10bags ofcyclophosphamideandon10glovesand5robotareas aftercyclophosphamidecompoundingduring5non-consecutivedays.TherewerenotCyclophosphamidecontamination overthedetectionlimitof0.5ng/cm2 innoneofthesamples

fromtherobot;vial,glovesandbagssampleswerealso negative.

ConclusionandRelevance Theroboticchemotherapycompoundingenablescyclophosphamidepreparationwithlowlevelsofpersonalexposure.Cyclophosphamideisagood standardformeasuringhazardousdrugscontaminationbecause itspreparationmethod,frequencyofuseandtheavailability ofoccupationalexposurestudies.

Toourbestknowledge,thisisthefirststudyinrobotic hazardousdrugcontaminationusingasemi-quantitative method.DespitethistechnologydoesnotallowprecisequantificationoftheamountofHDpresenttheuseofsemi-quantitativemethodscouldfacilitateitswidespreaddetermination duetoalowercostandimmediacyofresults,allowingthe implementationofcorrectivemeasures.

REFERENCESAND/ORACKNOWLEDGEMENTS

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3PC-010 FORMULATIONOFTACROLIMUSSOLUTIONFOR SUBLINGUALUSE

EKasalova*,SKlovrzova,RKadlecova,MHojny. InstituteforClinicalandExperimental Medicine,InstitutionalPharmacy,Prague,CzechRepublic

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BackgroundandImportance Tacrolimusisanimmunosuppressiveagentusedinsolidorgantransplantation(SOT)forprophylaxisofrejection.InourhospitalSOTareperformed includingraremultivisceraltransplantations(MTVx).There areclinicalsituationswhenoraltacrolimuscannotbeadministeredtotheMTVxpatientbecauseofanon-functional bowel.Inhomecare,patientcouldbetreatedwithtacrolimus forsublingualuse.Thereisnocommercialproductforsublingualadministrationavailable,soformulationhastobe developed.

Tacrolimusispracticallyinsolubleinwater;however,suspensioncanbepreparedusingtacrolimuscapsulepowdercontent.Thisformulationisunstablewithriskofsedimentation, thereforeuniformdosecannotbeachieved.Weusedsolubilityoftacrolimusinethanolandpreparedthehomogenous sublingualsolutionfromsubstance.

AimandObjectives Toformulatesolutionoftacrolimus10 mg/mLbasedonethanolandglycerol.Todescribethepreparation,container,storageconditionsandshelf-lifeoftacrolimussolutionforsublingualuse.

MaterialandMethods Tacrolimusbelongstohazardousdrugs, H361.Biologicalsafecabinet(BSC)isrecommendedfor tacrolimuspreparation.

Solutionwaspreparedusingtheglassbeakerandstick. Tacrolimuswasdissolvedinethanol96%,thenglycerol85% wasslowlyadded.ThecitricacidwasusedtoadjustpH5-6, optimalforstabilityoftacrolimus.Orangeflavourwasadded forhigherpalatability.Theamberglasscontainerwithadapter fororalsyringewasused.

Results Turbidandhomogenoussolutionwithorangescent andpH6wasobtained.Concentrationoftacrolimuswas10 mg/mL.Shelf-lifeof30dayswasgiven,storedin15°C–25°C accordingtotheUSP<795>.Oraldosingsyringewasused toapplythesublingualsolution.

ConclusionandRelevance Theformulationoftacrolimuswas developed.Varietyofconcentrationsoftacrolimussolution maybeprepared.Thisallowsustopreparesolutionwith

higherconcentrationwiththesamevolume,ifneeded.Our MTVxpatienthadagoodtolerancetothissolution.Hehas takenthissolutionsinceNovember2021andhasremained stablewithoutrejectionoftransplantedstomach,liverand pancreas.

Itisnecessarytoworkfast,becauseofanairflowinBSC, theethanolevaporatesandthesolutionmayprecipitate.Clinicaleffectivenessmightbeinvestigatedtoconfirmtheutilityof thisformulation.

REFERENCESAND/ORACKNOWLEDGEMENTS

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3PC-011 AVIRTUALSTERILISATIONAREA:ANINTERACTIVE TRAININGTOOL

ACrou*,DBoden,PPerot,GDesautez,VChevalet,RSchofield,AGhazouani. Hôpital MarieLannelongue,Haut-De-Seine,LePlessis-Robinson,France

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BackgroundandImportance Thetrainingofsterilisationtechniciansrepresentsamajorchallengetoensurethesafety, securityandlimitthecontaminationofreusablemedical devices.

AimandObjectives Theobjectivewastodevelopatoolto ensurebasicandcontinuoustrainingofsterilisationtechnicians,takingintoaccounttheirprofessionalbackgroundsand skills.

Thetoolaimstocontributetotheintegrationofnewcomersandthestandardisationoftraining,whichcurrentlyis mainlydonethroughmentoring.

MaterialandMethods Atrainingbookletwasdeveloped,coveringthedifferentstagesofthesterilisationprocess.Itwas usedasabasisfortherealisationofinstructionalvideos, showingtheentiresterilisationprocess.

Thevideoswerethenincludedinavirtualblueprintofthe sterilisationareamadewith3Dmappingsoftware.

Results TheguidewaswrittenfollowingtheFrenchSterilisationGuidelinesandtheinternalpracticesofthetechnicians.It wasdividedinto4mainparts,correspondingtothedifferent stepsofthesterilisationcircuit,whichare:individualoutfitting oftechnicians,washingofthemedicaldevices,assemblyof thesterileboxes,andunloadingsystemsforautoclaves.

Thesepartswereillustratedby4videos,whichwereintegratedintothedifferentroomsofthe3Dlayout.A3Dlayout wascreatedwithKozikaza®,3Dmappingsoftware,fromthe measuredblueprintofthesterilisationarea.Itreplicatedthe technicians’ workenvironmentasrealisticallyaspossible.To completetheirvirtualtraining,theagentdecideseithertofollowtheclassiccircuitortochooseonestepspecifically.Then, theyclickonthehyperlinkinthevirtualroomwhichrefers themtoavideocorrespondingtothestepofthecircuit.

ConclusionandRelevance Thisinteractivetoolallowscatering todifferentprofessionalbackgrounds,takingintoaccountthe technicians’ preferencesregardingtrainingmethods.Itenables animprovementofthequalityofthecircuit,ofsterilisation practices,andfacilitatesthetrainingofsterilisationtechnicians. Thistraining,systematicallyofferedtoemployeesupontheir arrivalandannuallytothewholeteam,willbeevaluatedto identifytheirneeds.

REFERENCESAND/ORACKNOWLEDGEMENTS

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3PC-014 METAMORPHINEINSTEADOFPOLYSUBSTANCEUSE?

1RTrittler*, 1AAbotaleb, 2CBöhlke, 3KOffner, 1MJHug, 2GBecker. 1UniversityMedical Centre,Pharmacy,Freiburg,Germany; 2UniversityMedicalCentre,DepartmentofPalliative Care,Freiburg,Germany; 3UniversityMedicalCentre,AnaesthesiologyandIntensiveCare, Freiburg,Germany

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BackgroundandImportance Opioidtherapyisstillnotoptimal.AsPCApumpswithcombinationsofopioidsand NSARareproducedinmanyhospitalpharmaciestominimisethedoseandthesideeffectsofopioids,thispolysubstanceuseisaccompaniedbyincompatibilityproblems. Severaladmixtureswithopioidsandmetamizolechange theircompositionduring administrationtime.Incaseof admixtureswithmorphineandmetamizole,wecoulddefine andisolatethemainreactionproduct ‘ metamorphine ’ . Dependentonmorphinecon centration,storagetemperature andstoragetime,PCA-pumpswithadmixturesofmetamizol andmorphinecancontain100%metamorphineinsteadof morphine.

AimandObjectives Asthestabilityproblemsdidnotresultin achangeoftheprescribingroutine,thepharmacologyofthis newsubstancewasinterested,especiallybecausethePCA pumpsstillhadtheiranalgesicpotencyandnewadverse effectswereneverreported.

MaterialandMethods AfterpermissionoftheEthicsCommitteeandinformedconsent,morphineandmetamorphinewere determinedinserumsamplesofpatientswithregularmorphine/metamizolePCAtherapy.

Results Uptonow,wehavedeterminedthemorphineand metamorphineconcentrationsinserumoffourpatients treatedwithadmixturesofmorphine/metamizole.Inthree ofthemwecouldidentifyor quantifymetamorphinebeside morphine.Inonepatient ’ sserumwefound0,75 mg/mL metamorphinebesideamorphineconcentrationof0,16 mg/ mL.Nolossoftheanalgesiceffectandnochangeof adverseeffectsduringPCAtherapyofthesepatientswas found.

ConclusionandRelevance Incompatibilitiesofpolysubstance useinPCApumpscanalsoleadtootheractivesubstances thanprescribed.Sincepatientsdonotnoticealossofthe analgesicpotencyorchangeofsideeffectsandtheserum levelofmorphinedecreasedsignificantly,itisverylikely thatmetamorphinehasanalgesicand/orspasmolytic potencyandcomparedtomorphinealoneitseffectsto m-, k -and d -opioidreceptorsmaybedifferent.Thestudyis relevanttounderstandasuccessful,well-establishedtherapyandleadspossiblytoanewoptimisedopioidtherapy infuture.

REFERENCESAND/ORACKNOWLEDGEMENTS

3PC-015 IN-USESTABILITYOFCOMIRNATYANDSPIKEVAX CLINICALSOLUTIONS:PFIZER-BIONTECHAND MODERNACOVID-19VACCINES:ACOMPARATIVE STUDYFROMAHOSPITALPHARMACYPERSPECTIVE 1JHermosillaFernández*, 1AAlonso-García, 2RPérezRobles, 1ATorrenteLópez, 1JRuiz Travé, 1NNavas, 3JCabeza, 3ASalmerónGarcía. 1BiomedicalResearchInstituteIbs. Granada,AnalyticalChemistrySciencesFaculty-UniversityofGranada,Granada,Spain; 2BiomedicalResearchInstituteIbs.Granada-FundacionParalaInvestigaciónBiosanitariade AndalucíaOrientalAlejandroOteroFibao,AnalyticalChemistrySciencesFaculty-University ofGranada,Granada,Spain; 3BiomedicalResearchInstituteIbs.Granada,ClinicalPharmacySanCecilioClinicalUniversityHospital,Granada,Spain

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BackgroundandImportance COVID-19emergedasanovel infectiousdiseasebylate2019,spreadingveryrapidlyand beingcategorisedasapandemicbyMarch2020bythe WHO.Severalvaccineshavebeenauthorisedandadministered worldwide,demonstratingefficacyandsafety,beingPfizerBioNTech(Comirnaty)andModerna(Spikevax)themostly administeredglobally.Althoughhavingdemonstratedefficacy andsafety,oneofthemajorissueshasbeentheirstability, fromwhichhardlyanystabilitydataisavailableinthepublic domain.Analysingthe in-use stabilityofthesenovelvaccines isparamountforensuringrationaleuseinhospitals.

AimandObjectives Thisstudyisaimedatassessingandcomparingthe in-use stabilityofComirnatyandSpikevaxclinical solutionsbycharacterisingtheparticulateprofileusing DynamicLightScattering(DLS).

MaterialandMethods Expiredandnon-expiredclinicalsolutionsofthevaccinesweresubjectedtodifferentstressconditions:visiblelightandmechanicalstresses.TheZaverageand thepolydispersityindex(PDI)ofthevaccinesclinicalsolutions wereevaluatedbyDLS,usingaZetasizerNanoZS-90(Malvern,UK).Forstatisticalanalysis,asimpleANOVAfollowed byDunnett’spost-hoctest,usingGraphPadPrism8Software wasused.Stressedsampleswerecomparedtocontrol(nonstressedsamples).Furthermore,differenceswereconsidered significantatap-value<0.05.Thestudywasconductedin triplicate.

Results ComirnatyDLSparametersweremainlyaffectedby mechanicalagitationandvortexstresses.Inthiscase,theZaverageandPDIincreasedsignificantly,evenintheexpired samples.Ontheotherhand,theDLSparametersweremaintainedinSpikevaxclinicalsamplesregardlessofthestressand theexpirationdate.

ConclusionandRelevance Thisstudyhighlightsthenecessity ofacarefulpreparationofthesevaccines,giventheirdemonstratedfragilityupongentlestress.However,Comirnatyhas proventobemorefragilethanSpikevaxintheirhandlingin real-useconditions.Previousliteraturecommentedonthe stabilityofComirnaty,havingpresentedsimilarresults.Nonetheless,nostabilitydatawereavailableonthein-usestability ofSpikevax.Therefore,thisdatawillbeofinteresttohospital pharmaciststowardsfollowingvaccinationcampaigns.

REFERENCESAND/ORACKNOWLEDGEMENTS

Acknowledgements TotheFarmacyUnitfromtheSanCecilio ClinicalUniversityHospital(Granada,Spain)tosupportand facilitatethisinvestigation.

ConflictofInterest Noconflictofinterest

3PC-016 DOESAHOSPITALCOMPRESSORSYSTEM CONTINUOUSLYDELIVERMEDICINALAIRACCORDING TOTHEEUROPEANPHARMACOPOEIA?

10.1136/ejhpharm-2023-eahp.39

BackgroundandImportance HospitalsinNorwayproduce medicinalairforpatienttreatment.Themedicinalairisproducedbyacompressorcentralandsuppliedbyapipelinesystemforpatienttreatmentatthehospital.Thequalityofthe medicinalairiscontrolledannuallyaccordingtotheEuropean pharmacopoeia.ThemonographformedicinalairintheEuropeanpharmacopoeiaincludestestsforO2,C0,CO2,SO2, NOx,oilandH2O.Bothambientaircompositionandcomponentsinthecompressorcentral haveinfluenceonthemedicinal airquality.Thetimeforperiodiccontrolmaythereforeaffect theresult.Therearenopublicationspresentingresultsfromcontinuousmonitoringofhospitalproducedmedicinalairquality.

AimandObjectives Theaimofthestudywastoconfirmthat hospitalproducedmedicinalaircontinuouslyissafeandin compliancewiththeEuropeanpharmacopoeia.Basedona riskassessmentitwaschosentomonitorO2,C0andH2Oas indicatorsforairquality.OthertestintheEuropeanpharmacopoeiawasincludedintheperiodiccontrol.

MaterialandMethods Thecompressorcentralissituatedin Oslo,about500metresfromamainroad.Thecomponents ofthecompressorcentralarecompressor(AtlasCopcoZR 75VSD),pressuretank(Maskinspecialisten,typeB+F),adsorptiondryer(AtlasCopco,BD185+),carbonfilter/hopcalitecatalyst(AtlasCopco,QDTHOC185)andfilters(AtlasCopco, PDp).TheairqualitywasmonitoreddownstreamthecompressorcentralbydetectorsforO2,C0andH2O(Kimessa Monoline504/404andCS-instrumentsFA500).Theperiod formonitoringwastwoweekstoincludedailyvariations.

Results Theresultsfromthemonitoringcomplieswiththe Europeanpharmacopoeiaatalltimesduringthetestperiod.

BackgroundandImportance Pembrolizumab(Keytruda®)isa humanIgG4monoclonalantibody(mAb)fromthegroupof immunomodulators,whichbindstoprogrammeddeathreceptor1(PD-1).Givenitsstructuralcomplexity,physicalaggregationandchemicaldegradationcanoccurthroughoutitslife, andevenmodestenvironmentalstressescancauseextensive damagewhichmayaffectthesafetyandefficacyofthe medicine.1

AimandObjectives Toassesstheimpactofagitationonpembrolizumab(Keytruda®,25mg/mL)safetyandefficacythrough thestudyofaggregationandfunctionalitywhenmishandling inrealhospitalconditions.

MaterialandMethods Pembrolizumab(Keytruda®,25mg/mL) freshopenedvialswereused.Agitationstresswascarriedout inamechanicallaboratoryshaker(300rounds/min,24h, 25°C)andgentleagitationwasperformedmanually(1min, 25°C).AggregationwasassessedbyDynamicLightScattering (DLS)andSize–ExclusionUltra–High–PerformanceLiquid Chromatography(SE/UHPLC–UV).PembrolizumabfunctionalitywasevaluatedbyEnzyme-LinkedImmunosorbentAssay (ELISA).

Results Pembrolizumabcontrolsample(25mg/mL)showeda singleparticulatepopulationwithhydrodynamicdiameter (HD)of9.5±2.8nmcorrespondingtopembrolizumab monomers.SE/UHPLC–UVchromatogramsofthecontrolsamplerevealedamainchromatographicpeakassignedtopembrolizumabmonomersandasmalloneassignedtonative dimers.DLSandSE/UHPLC –UVshowedthatagitationstress didnotpromoteincreaseinaggregation.However,pembrolizumabfunctionalitywasaffectedafterapplyingagitationstress sinceELISArevealedasignificantlossoffunctionality.Asa consequence,agentleagitationofpembrolizumabwasperformedinordertoinvestigateifthislossoffunctionality couldalsohappeninlessstressfulconditions.Asaresult, ELISAalsorevealedasignificantlossoffunctionalityingently agitatedpembrolizumab.

Monitoringdata:O220,4

21,4%,CO<5 ppm,andH2O <67 ppm.

ConclusionandRelevance Themonitoringdatashowsthata hospitalcompressorcentralisabletocontinuouslydeliver medicinalairaccordingtotheEuropeanpharmacopoeia,even withdailyvariationsintheambientairqualityandcompressorsystem.Thisisrelevantinformationforpharmacistand technicalstaffwhenplanningqualitycontrolstrategiesfora compressorcentral.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TechnicalstaffatOsloUniversityHospital

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3PC-017 IMPACTOFAGITATIONONPEMBROLIZUMAB (KEYTRUDA®)SAFETYANDEFFICACY:AGGREGATION ANDFUNCTIONALITY

1ATorrente-López*, 1RPérez-Robles, 1JHermosilla, 1JRuiz-Travé, 1MAHernández-García, 1ATorres, 2JCabeza, 2ASalmerón-García, 1NNavas. 1BiomedicalResearchInstituteIbs Granada,AnalyticalChemistry-ScienceFaculty-UniversityofGranada,Granada,Spain; 2BiomedicalResearchInstituteIbsGranada,ClinicalPharmacy-SanCecilioUniversity Hospital,Granada,Spain

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ConclusionandRelevance Theexposuretoagitationstressdid notinduceaggregateformationinpembrolizumab.Nevertheless,bothagitationstressandgentleagitationledtoalossof itsfunctionalitynotrelatedtoagitation.Thus,werecommend preventingpembrolizumabfromagitationwhenhandlingin hospitals.

REFERENCE

1.M.R.Nejadniketal.J.Pharm.Sc.107(2018)2013-2019.

Acknowledgements FundedbyprojectsP20-01029(Juntade Andalucía,Spain)andB-FQM-308-UGR20(Universidadde Granada,FEDER2020).A.T-LgrantsaFPUpredoctoralcontract(FPU18/03131,MinistryofUniversities,Spain).J.H benefitsaresearchcontract(P20_01029,JuntadeAndalucía andEuropeanRegionalDevelopmentFunds).R.P-Rholdsa postdoctoralposition(DOC-01694,JuntadeAndalucía, Spain).

ConflictofInterest Noconflictofinterest

3PC-018 TIMETOAVAILABILITYOFINJECTABLEANTICANCER DRUGSFOROUTPATIENTS:REASSESSMENTINA FRENCHCOMPREHENSIVECANCERCENTRE

1EGleditsch*, 2RNilsen. 1SykehusapotekeneHf – OsloHospitalPharmacy,Manufacturing, Oslo,Norway; 2OsloUniversityHospital,HospitalServices,Oslo,Norway

MBrun*,BQuitte,LEscalup,AHurgon,CCros,RDesmaris,AAcramel. InstitutCurie-Psl ResearchUniversity,DépartementdePharmacie,Paris,France

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BackgroundandImportance Excessivewaitingtimeisoneof themaincausesofpatientdissatisfactioninoncologicdaily careunit(DCU).Leanmanagement,dosebanding,advanced prescriptionandautomatisationareusuallyusedinourhospitaltoimprovepatientcarepathway.InouradultDCU(>26 000patients/years),patientshavetowaitfortheirtreatment lessthananhour.

standardforpaediatricpatientsbecausetheyallowbody weightorienteddosingfordifferentagegroups.Sofar,there isnopublishedinformationregardingtheformulation,quality control,andstabilityofpharmacy-preparedbisoprololoral solutions.

AimandObjectives

Theaimofthisworkistoreassessthe timeofavailabilityinthisDCUandtoidentifythefactors influencingthistime.

AimandObjectives Theaimofthisprojectwastoformulate abisoprololfumarate0.5mg/mLoralsolutionforpaediatric use,establishsuitablequality-controlmeasures,andtoperform stabilitytests.

MaterialandMethods

Itisanambispectivemonocentricstudy inwhichhumanfactors(n=2),equipmentfactors(n=7), organisationalfactors(n=4),productivityfactors(n=16)and time-relatedfactors(n=6)wererecordedrandomlybetween September2021andApril2022(i.e.15daysstudied).Data werealsoextractedfromCHIMIO® softwareandfromour institutional ‘ LEANtool’ forreal-timemonitoringofpatients inoncologicDCU,inordertocalculatetimebetweenthe prescriptionofthedayandthedispensationofthe treatment.

Results Theaveragenumberofpatientsandpreparations manufacturedperdaywererespectively105(+/-7)and 146(+/-12);52%ofthesepreparationspreparedtheday before.Theaveragenumberofpreparationsnotprescribed inadvanceis49[18-62](34%)foranaveragenumberof 31patients[14-43](30%).Theaverag etimetoavailability was54min(+/-16)withamedianof60min.Onaverage,12[0-24]patientsperdaywaitedmorethananhour aftertheprescriptionwithamaximumwaitingtimeof 360min.

Fourdays(27%)wereidentifiedwithanaveragedispensingtimegreaterthan60min.Duringthesecritical days,apercentageofanticipatedpreparationslessthan 50%,withahighnumberofprescriptions(>30patients) andparticularlybefore9:45 a.m.orbetween12:00and 14:00p.m.wereobserved.Wenoticedalsoahigherproductivity([174-214]preparations),thelackofcoordination (2of4days),oradditionalproductions(analgesicsyringe preparations).

ConclusionandRelevance Mainimpactingfactorsseemtobe humanfactorsandproductivity.Timetoavailabilitybecame anessentialqualityindicatorofourcompoundinganti-cancer unit.Thisstudyshowedthatourworkingproceduresareefficientforamajorityofpatients,butnotforall.

REFERENCESAND/ORACKNOWLEDGEMENTS

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3PC-022 FORMULATIONANDQUALITYCONTROLOFA BISOPROLOL0.5MG/MLORALSOLUTIONFOR PAEDIATRICUSE

HLinxweiler*,JBoventer,AWalter,IKrämer. UniversityMedicalCenterJohannes GutenbergUniversityMainz,PharmacyDepartment,Mainz,Germany

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BackgroundandImportance Bisoprololisabetablockerindicatedforthetreatmentofheartfailureinpaediatricpatients. Therearenolicensedbisoprololcontainingpaediatricdosage formsavailableintheEU.Pharmacypreparationofpatient individuallydosedbisoprololcapsulesiscommonpracticeby usinglicensedbisoprololtabletsasstartingmaterial.However, thepreparationanduseofbisoprololoralliquidsarethegold

MaterialandMethods Bisoprololoralsolutionwasformulated inanalogytopropranololhydrochlorideoralsolution describedinNeuesRezeptur-Formularium2015/1,Germany. Efficacyofantimicrobialpreservationwastestedregardingto Ph.Eur.5.3.1byanexternallab.AstabilityindicatingRPHPLCmethodwasestablishedandvalidatedbasedonthe knownmethodofJoshietal.1

Results 100mLbisoprololfumarate0.5mg/mLoralsolution containbisoprololfumarate0.05gasactiveingredientas wellaspotassiumsorbate0.15g,anhydrouscitricacid0.07 g,sucrose25g,raspberryflavour0.1g,andpurifiedwater 84.33gasexcipients.Antimicrobi alpreservati onregarding Ph.Eur.5.3.1wasdemonstrated.Aftera6monthsperiod thebisoprololconcentrationamountedto103%±1%of theinitialconcentrationandthepHremainedunchanged (4.6).

ConclusionandRelevance Sweetenedandflavouredbisoprolol fumarateoralsolutionwassuccessfullydevelopedaspharmacy preparationsuitableforpreparationinstock.Adequatein-use preservationisgivenandstabilityisprovenforatleast6 months.Asecondversionofbisoprololoralsolutionwithout sucroseandraspberryflavourisunderdevelopment.

REFERENCE 1.JoshiSJetal.RP-HPLCmethodforsimultaneousestimationofbisoprololfumarate andhydrochlorothiazideintabletformulation. JPharmBiomedAnal.2010Jul 8;52(3):362–71.

ConflictofInterest Noconflictofinterest.

3PC-023 PATCHTESTSWITHETHAMBUTOL10%,ISONIAZID 15%ANDPYRAZINAMIDE25%:ACASEREPORT

1CLeitao, 1RAraújo, 1CFerreira, 2CFerreira, 2MVieira. 1CentroHospitalarTâmegaE Sousa-Epe,PharmacyDepartment,Penafiel,Portugal; 2CentroHospitalarTâmegaESousaEpe,ImunoallergologyDepartment,Penafiel,Portugal

10.1136/ejhpharm-2023-eahp.43

BackgroundandImportance A55yearoldmalepatient,developedaDRESS(drugrashwitheosinophiliaandsystemic symptoms)reactionafterstartingfirst-linetuberculosistreatmentwithrifampicine,ethambutol,isoniazidandpyrazinamide.Toassesstheresponsabilityofasuspecteddrugina DRESSreactionandposteriorsafereintroductionoftherapy, patchtests(PT)arethemostusefultool.Forthepurpose,the HospitalPharmacywasaskedtodevelopmagistralpreparationsofethambutol,isoniazidandpyrazinamide.ThePTwere performedwitheachtuberculostaticdrugdilutedin4IQ UltraChambers,appliedonthepatient’sskinatthebackand keptinocclusionfor48hours.Thereadingswereperformed atday2andday3.Onlyerythema,infiltration,papulesor vesicleswereconsideredpositivereactions.

AimandObjectives Developmentandvalidationofmagistral formulasfortopicalapplicationtoaccomplishpatchtestsof

ethambutol10%(w/w),isoniazid15%(w/w)andpyrazinamide 25%(w/w).

MaterialandMethods

Scarcebibliographicinformation Reviewarticlepublishedby theFrenchSocietyofDermatology,inwhichtheconcentrationsoftheactiveingredienttobeusedineachPTare established.

ApplicationofthegeneralrulesofGoodHandlingPractices,accordingtothePortugueseGalenicFormulary. Results ThepastesusedinthePTwereobtainedbygeometric dilutionofpulverisedethambutol400mg,isoniazid300mg andpyrazinamide500mgtabletsinwhitepetrolatum.

Afterquality-controlteststhatincludescolour,homogeneity andmassverificationassays,thepasteswereplacedina syringeforaneasierapplicationintheskin.Itwasgiven30 daysofstabilityatroomtemperature.

ConclusionandRelevance Thispreparationmadepossibleto developPTforthestudyofadelayedhypersensibilityreaction totuberculostaticdrugs,thatwasnotavailablebeforeinthe market,allowingasaferreintroductionofthetreatment.

AlthoughthePTswerenegativeinthispatient,itwaspossibletodevelopandvalidatethreecompoundingformulas withanadequatesafetyprofileandlowcost.Thisaccomplishmentwillbeusefulinfurthercases.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Ingen-Housz-OroS,AssierH,etal.Hypersensibilitéretardéeauxtraitementsantituberculeux.Propositiond’uneconduiteàtenirpratiquedevantunexanthème: quandarrêter,quellesexplorationsallergologiquesetcommentréintroduirele traitement.AnnalesdeDermatologieetdeVénéréologie

2.PortugueseGalenicFormulary2001

ConflictofInterest Noconflictofinterest

Results 21patientsweretreatedwithinsulineyedrops1UI/ mL,sixofthemwithdiabetesmellitusandother15were non-diabetic.Administrationfrequencywas4timesinaday (QID).Theypresenteddifferentcornealdiseasesthatwere refractorytoconventionaltreatment.Themedianagewas74 (43-89)years.Atotalof52.4%werewomen.38.1%were diagnosedwithnon-herpetickeratitis,19%withherpetickeratitis,23.8%withcornealerosion,and19%withpersistentepithelialcornealdefect(PECD).Themediandurationof treatmentwas6months(2-9months).100%ofpatients respondedtotreatmentandcontinuedwithinsulineyedrops afterepithelialhealing.Allpatientspresentedepithelialhealing inabout30-60days,mostofthemreferredimprovedof symptomsduringfirsttwoweeks.

Nosignificantadverseeffectswerereported.Nonehypersensitivityreactionwerereportedbecauseofm-cresolpresence ininsulineyedrops.

ConclusionandRelevance Theinsulineyedropsformulation1 IU/mLadministeredQIDcanbeaquick,effective,andsafe optionfordifferentcornealdiseasesrefractorytotheusual treatmentsinbothdiabeticandnon-diabeticpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-028 FORMULATIONOFANORALPLATELETLYSATEGEL TOTREATCHRONICGRAFTVERSUSHOSTDISEASE ASSOCIATEDORALMUCOSITIS:EFFECTIVENESSINA SERIESOFCASES

1ATorrent*, 1TLizondo, 1MMestre, 2MLozano, 1MCLópez, 1JRRoma, 1NFernández, 1MAlbanell, 1AEscolà, 1DSoy. 1HospitalClínicdeBarcelona,PharmacyService,Barcelona, Spain; 2HospitalClínicdeBarcelona,HemotherapyandHaemostasis,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.45

3PC-026 EFFECTIVENESSANDSAFETYOFINSULIN1UI/MLEYE DROPS

CApezteguiaFernandez*,MPBautistaSanz,AMelgarejoOrtuño,EMatillaGarcia, BRodriguezVargas,CdeCaceresVelasco,MAAmorGarcia,RMorenoDiaz. Hospital UniversitarioInfantaCristina,ServiciodeFarmacia,ParlaMadrid,Spain

10.1136/ejhpharm-2023-eahp.44

BackgroundandImportance Epithelialcornealdefectsaredamagedareasofthecornealepitheliumasaconsequenceof injury.Theexistenceofinsulinandinsulin-likegrowthfactor receptorsincorneakeratocytesandepithelialcellscould explaintheincrementonthecornealepithelialhealingrates. Clinicalexperiencewithinsulineyedropsislimitedandmore evidenceinbothdiabeticandnon-diabeticpatientsisstill needed.

Recently,theinsulineyedropsformulation1IU/mLhas beenpreparedinPharmacyHospitalforpatientswithkeratitis,dryeyeandapersistentepithelialcornealdefect(PECD).

AimandObjectives Theaimistodescribeeffectivenessand toleranceofinsulin1IU/mLeyedropstreatmentfordifferent refractorycornealdiseases.

BackgroundandImportance Chronicgraftversushostdisease (cGVHD)associatedoralmucositisisacomplicationafter stem-celltransplantation.Corticosteroidsarethestandard treatment,butthereisnoconsensusincaseofrefractory lesions.Plateletconcentratesmaybeasafetreatmentoption. AimandObjectives Designasterileoralformulationableto releaseplateletlysate(PL)onoralcavity,andevaluateits effectivenessinaseriesofcases.

MaterialandMethods PLgel25%wascompoundedbymixinginasepticconditions1:1carboxymethylcellulosesodium base5%previouslyautoclavedwithPLalsodiluted1:1with sodiumchloride0.9%.PLgelwaspackagedin3mLaliquots usingoralsyringes,whichwerestoredinthefreezeruntil theiruse.Galenicvalidationwasperformed.

PatientswithcGVHDassociatedoralmucositisfrom November2021toAugust2022whoacceptedtoinitiateoral PLgelweremonitored.Effectivenesswasevaluatedbasedon severityoftheoralmucositis(NCI-CTCAEGrade1-4). Patientsatisfactionwasself-assessedinavisualscale0-10 accordingtothedegreeofpain/discomfort.Adherencewas assumedbasedonthenumberofsyringesdispensed.

MaterialandMethods

Retrospectiveobservationalstudyina tertiaryhospital.21patientswereincluded,treatedwithinsulineyedropsduringtheperiodbetweenFebruary2022–September2022.Thevariablescollectedwere:demographics, indication,durationoftreatment,clinicalresponseandadverse effects.Alldatawereobtainedfromtheelectronicmedical history.

Results PLgelobtainedwasslightlyyellow,translucent, pH=6,withmediumconsistencythatleadsadequatebioadhesivecharacteristics.NochangesofpH,colour,weight,or microbialgrowthwereobservedduringgalenicvalidations.A beyond-usedateof45daysat-20°Cwasgiven.

Sixpatientswithmoderateoralmucositis(grade3)who failedtofirst-linetopicalsteroidstherapystartedPLgel.Two

ofsixdiscontinuedafteronemonthbecausetheirlifestylepreventedthemfrompreservingthegelproperly.Fourpatients (threemen,onewoman)wentonwiththegelforanaverage of5months(range3-9).Clinicalevaluationshowedan improvementof1degreeinoralmucositisinthreepatients and2degreesinthepatientwiththelongesttreatment(9 months).Theself-assessmentscaleshowedanaveragedecrease ofpain/discomfortof2points.Estimatedadherencein patientswhoreceivedthetreatmentformorethanonemonth was80.8%(95%CI:56.8-104.9).

ConclusionandRelevance Theformulationofagelbasedon sodiumcarboxymethylcellulosewasadequatetoadministerPL ontheoralcavity.FourpatientswithcGVHDassociatedoral mucositisrefractorytostandardtreatmentweresuccessfully treated.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-029 MANAGEMENTOFACHEMOTHERAPYPRODUCTION

AFTERACYBER-ATTACKINAPUBLICHOSPITAL

SMuhammad*,EGaspéri,FBordet,MLMaëstroni. SudFrancilienHospital,Essonnes, Corbeil-Essonnes,France

10.1136/ejhpharm-2023-eahp.46

BackgroundandImportance InAugust2022,ourhospitalwas victimofamassivecyber-attack.Everysoftware,networkand connecteditemswereunusableincludingCHIMIO® which managesproductionofchemotherapyfromprescriptionto administration.OurChemotherapyProductionUnit(CPU) usuallyproducesabout19,000sterilepreparationsayear.

AimandObjectives Theobjectivewastopursuetheproductionofchemotherapyrespectinginmaximumtheusualproductionandqualityprocess.

maintainasafeandalmostnormalproduction.Excel® tool tracingpatientshistorypermitstodetectprescriptionserrors (doseadjustment,intervalsofadministration,protocols respect).Regularbackupsanddevelopmentofadegraded modeprotocolwillbeundertakensoon.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

3PC-031 ADELPHIMETHODTOSTANDARDISETHE PREPARATIONOFAUTOLOGOUSSERUMEYEDROPS?

1LChampmartin*, 2DLannoy, 3RPoulenard, 1PAgius, 1OMarqué, 1EBernikier, 4GMaillan, 3PYRobert, 5JJost, 1VRatsimbazafy. 1CHULimoges,Pui-UnitédesPréparations Galéniques,Limoges,France; 2CHRULille,Pharmacie,LilleCedex,France; 3CHULimoges, ServiceD’ophtalmologie,Limoges,France; 4CHULimoges,Pui-SecteurdePharmacotechnie, Limoges,France; 5CHULimoges,Pui-UnitéD’enseignementetdeRecherche,Limoges, France

10.1136/ejhpharm-2023-eahp.47

BackgroundandImportance Dryeyediseaseisafrequent causeofophthalmologyconsultation(5% – 34%ofpopulationworldwide).Severeforms,refractorytoconventional treatments(artificialtears,topicalcorticosteroids,cyclosporineA,contactlenses,punctualocclusion,systemicdiseases appropriatemanagement),areresponsibleforasignificant visualimpairmentanddisability.Autologousserumeye drops(ASEDs)arethenproventobeaninterestingtherapeuticalternative.First,inMarch2019wecarriedouta nationalinventoryofASEDp reparationspracticethathighlights:lowsupply(13producercentres)andproduction heterogeneity.

AimandObjectives

Generalobjective toimproveASEDsquality,safetyandsupply inourcountrycareinstitutions.

MaterialandMethods

Thefirst3daysprescriptionswere alreadyvalidatedandprintedatthepharmacy,servingas: patienthistory,prescriptionandprotocolmodel.Amolecule dataregisterwascreatedonExcel® listingcytotoxicdrugs data(stability,concentration ).First,ManufacturingSheets (MS)weretotallyhandwrittenthenanExcel® MSwasdeveloped,mimickingCHIMIO®.Atfirst,asinglemodelusing copy-pasteforlabelswasdeveloped.Then,severalmodelsfor bags,syringesorinfuserswerecreated,usingformulasto automaticallyfillthelabels,tosecureandspeeduptheprocess.Aschedulertracedallpreparationsbyauniquenumber. Finally,apatient’shistoryregisterwascreatedwithdata neededforpharmaceuticalvalidation.Asecondpharmacist double-checkedeveryMS.

Results 437preparationsweremadeindegradedmodeduring 6days(73/day).Only5%oftheproductionwasoutsourced inotherhospitals.Thefirst5MSwerehandwritten.Printing everyMSwiththefirstversionofExcel® MStookabout3h/ day.Then,improvingExcelMSreducededitionanddoublecheckingtimetoabout1h/day.Double-checkingMSdetected mostofeditingerrors.Duringfinalcheckingofpreparations, 3errors(<1%)weredetected.Twomajorswithwrong patient’snameanddose(-47%)andoneminorwithwrong schedulernumber.TherecoveryofCHIMIO® databasewas effectiveafter6days.TranscriptioninCHIMIO® foundonly oneundetectedprescriptionerror.

ConclusionandRelevance Developmentofasemi-automated Excel® toolanddoublecontrolofMShasallowedusto

Specificobjectives todefinetheconsensualitems,inorderto establishanationalstandardisedpreparationprotocol.

MaterialandMethods

Methodforconsensusreaching Delphimethod.Fourprotocol partsaborded:sampling,preparation,controls,conservation. Expertpanelrecruitedbyremobilisingcentresapproachedin 2019(ASEDsproducers,non-producers,ordidnotrespond). Localsteeringgroup:pharmacyresident,headofcompoundingunit,pharmacymethodologist.Circuit:questionnaireconstruction,mailingwithlinkaccesstoGoogleForms®,response analyses,consensusratecalculation(consensuswhen 80%), resultsynthesis,anonymousreferraltoexperts.Asmany roundsasnecessarytoachieveconsensus.

Results

Twelveansweringexperts After4rounds:outof39proposals initiallysubmitted,26validatedand10,abandoned.Insampling:15itemsvalidated,5dropped.Preparation:5validated, 1dropped.Control:3validated,4dropped.Conservation:3 validated.Fourroundstook86days.

ConclusionandRelevance AstandardisedprotocolASEDs preparationwillbeproposed.Thiscouldimprovethesupply ofcareacrossthecountry.Methodstrengths:Expertopinion solicitedontheinitialquestionnaire;qualifiedexpertsonthe topic;nogeographicallimitations;anonymityavoidingopinion leaderinfluence;applicabilitycriteria.Limitations:noophthalmologists,biologists,patientsinthepanel;noparticipationof thelargesteyedropproducer(despiterequests).

Acleardefinitionofthiseyedropstatus(pharmaceutical preparationornot)isalsonecessary.

Biochemicalqualitycontrols,abandoned,toberesubmitted (moleculessupposedtosupportASEDsefficacy).Supplementaryroundnecessarytodecidethefateofthelastitem(solutionvolumeineacheyedropbottle).

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Acknowledgementstoallcolleaguesparticipatingto2019studyor/andDelphi method.

ConflictofInterest Noconflictofinterest

3PC-036 CENTRALISEDANDPERSONALISEDPREPARATIONOF INTRAVENOUSKETAMINEFORPATIENTSWITH RESISTANTDEPRESSION

FCostaChing*,ARSantos,SCastro,MBarata,EMarques. HospitalBeatrizÂngelo, Pharmacy,Loures,Portugal

10.1136/ejhpharm-2023-eahp.49

BackgroundandImportance Depressionisthethirdleading causeofdisabilityintheworldandabout1/3ofdepressive disordershaveresistancetosuccessivetreatments.

Intravenousinfusionofoff-labelketamineinsubanaesthetic doseshasfavourabletherapeuticresponsesinarelativelyshort evaluationtime.Accumulatedsafetyevidenceisconsideredan addedvalueinthetherapeuticarsenaltotreatthispathology.

3PC-035 GALENICDEVELOPMENTOFAGENERICSPECIALTY WITHCONVENTIONALRELEASEBASEDONACARBOSE

1MChedly*, 1KBenChaabane, 2FElkara, 3IBenJdidia, 4IBlouzaLimayem. 1HospitalHabib Thameur,Pharmacy,Tunis,Tunisia; 2LaboratoireNationalContrôleDesMedicaments, Chimie,Tunis,Tunisia; 3CentredeMaternitédeMonastir,Pharmacy,Monastir,Tunisia; 4InstitutSalahAzeiz,Pharmacy,Tunis,Tunisia

10.1136/ejhpharm-2023-eahp.48

BackgroundandImportance Inthecaseofthedevelopmentof agenericdrug,theapproachisbasedalmostexclusivelyon galenicandanalyticaldevelopments.However,tofacilitateformulation,itisstillnecessarytogothroughapre-formulation stage.Therefore,agenericdrugmustmeetthesamequality, safetyandefficacyrequirementsastheoriginatordrug.

AimandObjectives Theobjectiveofourworkconsistsona pre-formulationstagefollowedbyaformulationstageinorder toarriveatanoptimal,stableandeffectivegalenicformula andtodevelopagenericoralanti-diabeticdrugbasedon acarbose50mg.

MaterialandMethods Duringthedevelopmentofthisgeneric specialty,apreliminarystudyoftherawmaterialswasconducted(physico-chemicalcharacteristics,rheologicalproperties andcompatibilitystudy)inordertodeterminethequantitative formulaandthemanufacturingprocess.Then,6formulas werepreparedinordertoimprovetheflowtime.Thetablets obtainedweretestedforuniformityofmass,hardness,friability,disintegrationtimeanddissolutioninvitro.Subsequently,a comparativestudyofthedissolutionprofilesobtainedwith thatofthereferencedrugwasmadebycalculatingthedifferencefactorf2andsimilarityf1inordertodeterminethebest formula.

Results ThemethodforthedeterminationoftheactivesubstancebyHPLChasbeenvalidated.Therawmaterialhas beenwellstudiedandthechoiceofexcipientsandthe methodofmanufacturehavebeenjustified.FormulaF5havingafriabilitypercentageequalto0,16%,adisintegration time(5,9min)andadissolutionprofilesimilartothatofthe referencespecialty(f1<15%andf2>50%)wasselected.It wasconsideredtheclosesttotheprinceps.

ConclusionandRelevance Thegenericspecialtyformulated presentedanequivalenceintermsofinvitrodissolutionwith thereferencespecialty.Thus,comparativestudiesin3differentpHenvironmentsneedtobecompletedtojudgethisin vitroequivalence. REFERENCESAND/ORACKNOWLEDGEMENTS

Safetyissuesoftheuseofcentralanaestheticswithoutthe supportofanaesthesiologyareapivotaldriveforimplementingaclinicalprotocolthatincludesthepharmacy.Theuseof fixeddilutionsandrhythmsofadministrationaswellaspersonalisedcentralisedpreparationinthepharmacyovercomes mostconcernsabouttheregularandsafeuseofthisapproach onresistantdepression.

AimandObjectives Evaluatetheimplementedcircuit,characterisationofthepopulationandanalysisoftheimpactonthe effectivenessandsafetyofketamineinresistantdepression.

MaterialandMethods A19-monthretrospectiveanalysiswas madeontheuseofketamineinpatientswithresistantdepression.ThepharmaceuticalservicesdatabaseandtheSoarian Clinicals ® programmewereusedtocollectinformationandto consulttheelectronicclinicalprocessofpatientsthatusedthis therapeuticapproach.

Results Indicationforketaminetreatment,inadditiontothe absenceofcontraindications,meansthatthepatientisnot responsivetoatleastthreeantidepressantsSNRIsandatricyclic,apotentiationstrategiesandascore 9in thePatient HealthQuestionnaire-9(PHQ-9).

Thedatacollectedcorrespondtotheperiodbetween01/ 2021and07/2022andaresummarisedintable1.

Abstract3PC-036Table1

Totalofpatients9

SexF(%)77.8

Averageage45

Totalnumberofpreparations118

Numberofsessions(median)12

Averagedose(mg/kg)Total0.51

Initial0.27

Final0.66

Averagedurationoftreatment58days

Allcasesreportedpsychopathologicalimprovementrecognisedbythemselvesaswellasbyassistantpsychiatrists.

ConclusionandRelevance Ketaminehasshowntobeasafe alternativeprovidedthatlocalstrategiesarecreatedtoensurethe implementationof criteriainpatientselection,preparation,administration,andfollow-upprotocols.Theacceptanceandshort-term recognitionofthebenefitofthetreatmentbypatientsand professionalsallowforachievingthegoalofclinicaldischarge.

ConflictofInterest Noconflictofinterest

REFERENCESAND/ORACKNOWLEDGEMENTS

1.CORRIGERA.(2022)Ketamineanddepression:anarrativereview.

ANALYSISOFDOXORUBICINANDEPIRUBICINAFTER FREEZING

10.1136/ejhpharm-2023-eahp.50

BackgroundandImportance Erenumab,galcanezumabandfremanezumabwereapprovedin2019formigrainecrisisprevention.Efficacyandsafetyweredemonstratedinthree-months lastingclinicaltrials.Atpresent,long-termeffectivenessand safetycanbeanalysed.

AimandObjectives Toevaluatetheeffectivenessandsafetyof monoclonalantibodies(mAb)utilisedinmigraineaftertwoand-a-halfyearsofclinicaluse.

BackgroundandImportance

Thechemical-physicalstability, reportedamongthetechnicalcharacteristicsofthedrugs, indicatestheparameterstoberespectedforthesafetyuse ofthepreparationsbutoftentheconditionsofstorageof thedrugscanundergosignificantvariations.Thestability datareportedbythemanufacturersareoftenlimited whileinclinicalpracticeitisnecessarytoextendthe conditionsofuseandthevaliditytimesofthepreparations.Inreality,itmayhappenthatdrugsaretransported, storedandusedintemperatureconditionsotherthan thoseindicatedbythemanufacturerwithout,however, havingsufficientdataonsafetyandstabilityforuseoutsidethecertifiedconditions.

MaterialandMethods Prospective,observationalstudyconductedinatertiaryhospital(December2019toJune2022). Datawereobtainedfrompatients’ medicalrecords(approved byourEthicsCommittee).

AimandObjectives

Theobjectiveoftheanalysisperformedis toevaluatethechemicalandphysicalstabilityofdoxorubicin andepirubicinafterbeingstoredinthefreezer.

MaterialandMethods Theformulationsofdoxorubicinand epirubicinstoredinthefreezerforaperiodoftimeexceeding 48hwereanalysed.Thedrugsolutionswerethawedatroom temperatureandstoredintherefrigeratoruntilthetimeof thechemical-physicalanalysis.Foranalysis10microliterswere subsequentlydilutedfromeachvialandinjectedintoLC QTOFMS(n=4).

Results Dataobtainedfromtheanalysiscarriedoutwitha masschromatographictechniquehighlightedthechemicaland physicalstabilityofthedrugsanalysed.Themeasuredconcentrationofdoxorubicinfortheoverrangesamplewas1.995± 0.005mg/mlwhilefortheexternaldoxorubicinstandardwas 1.996±0.008mg/ml.Sometrendwasobservedforepirubicin,2.009±0.007mg/mlversus2.005±0.005mg/mlfor theoverrangesample.

ConclusionandRelevance Theanalysisshowedthechemicalphysicalstabilityofthecompoundsstudiedallowingtheiruse evenoutsidethestorageconditionsindicatedinthetechnical datasheet.Theresultsshowedthattherewerenostatistically significantdifferencesintheconcentrationofoverrangedoxorubicinandepirubicinsamplesevenafteraccidentalfreezing. Thisconsistsinareductionofdrugwasteinrealconditions. Aneasyaccesstomassspectrometryanalyticalplatformmay allowtheevaluationofdrugstability,redefiningthechemicalphysicalstabilitywithcertifieddata.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Section4:Clinicalpharmacyservices

4CPS-002 EFFECTIVENESSANDSAFETYOFMONOCLONAL ANTIBODIESFORMIGRAINEPREVENTIONAFTERTWO ANDAHALFYEARSOFCLINICALEXPERIENCE

10.1136/ejhpharm-2023-eahp.51

Effectivenessandtoleranceareevaluated3monthsafter initiationandifitiseffectiveandwelltolerateditismaintainedupto12months.Responseisdefinedasadecreasein headacheand/ormigrainedayspermonth 50%comparedto baselineand/orasignificantimprovementinqualityoflife (measuredbyHIT-6andMIDASscales).Ifpartialresponse (PR)(decrease £50%)oradverseeffects(AE)anothermAb canbeemployedwithdifferentmechanismofaction.Iflack ofresponse(LR)(decrease £25%)treatmentissuspended.If responseisachievedduringthelastmonths,themAbcanbe maintainedforanotheryear.

Results 253patientsinitiatedtreatmentwithamAb.69% (n:175)completed12monthsoftreatmentwitheffectiveness (responders)and31%(n:78)stoppedatthird-monthevaluation(PR/LRpatientsandAE-sufferingpatients),42ofwhich changedtoasecondmAb.Endingreasonswere:PR/LR (n:52),PR/LRandAE(n:9),AE(n:8)andothersnotrelated tothetreatment(n:9).

Aftercompleting12months,140patientsstoppedthe treatment;25maintaineditforanothertreatmentcourse, someofwhichhavealreadystartedathirdcourse(median duration:23[17-37]),and10switchedtoasecondmAb.

Regardingsafety,33%(n:83)ofpatientsreportedatleast oneAEduringthetreatmentwiththefirstand/orsecond mAb,beingthereasonfordiscontinuationin7%(n:17)of patients(duetovertigoandconstipation,mainly).MostfrequentAEwerevertigo/dizziness(17%,n:45),constipation (13%,n:33)andskinrashesafterinjection(4%,n:11).

ConclusionandRelevance Anti-CGRPmAbareeffectiveand safetreatmentsthatimprovemigrainesufferingpatients’ qualityoflife.Asignificantpercentageofpatientscompletesthe treatmentcourseandonly7%ofpatientsdiscontinuesthe mAbduetointolerance.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-003 EXPERIENCESWITHABESTPOSSIBLEMEDICATION HISTORY(BPMH)CONDUCTEDBYPHARMACY STUDENTSINTHEHOSPITALSETTING:ASCOPING REVIEW

AWeidmann*,JSchintler. InnsbruckUniversity,ClinicalPharmacy,Innsbruck,Austria 10.1136/ejhpharm-2023-eahp.52

BackgroundandImportance Improvementofpatientsafetyat transitionofcarepointsisakeystrategicaimofthe3rd WHOGlobalPatientSafetyChallenge.1 Medicationreconciliationonadmissionintohospitalincreasespatientsafetyby reducingmedicationerrorsandadverseeventsandhasbeen showntoreducehospitalreadmissions.2 Collectionofan

3PC-037 LIQUIDCHROMATOGRAPHYMASSSPECTROMETRY

1VGarau*, 2MCrobeddu, 1GACarrucciu, 1PSerra, 2PCaboni. 1ABusinco’ Oncology Hospital,HospitalPharmacy,Cagliari,Italy; 2UniversityofCagliari,Pharmacy,Cagliari,Italy

DFresan,AYerro,APastalle,CGarcia,MCalvo,IOrtega,ELacalle,RJuanbeltz,AIIdoate, MTSarobe,MMNoceda*. HospitalUniversitariodeNavarra,Pharmacy,Pamplona,Spain

accuratebestpossiblemedicationhistory(BPMH)isthefirst step.Thisisoftenresourceintensive.FinalyearpharmacystudentsarenowbeingassignedtoobtainBPMHs,asacosteffectivealternative.

AimandObjectives Theaimofthisscopingreviewwasto determinetheexperienceswithabestpossiblemedicationhistory(BPMH)conductedbypharmacystudentsinthehospital setting.

MaterialandMethods AscopingreviewwasconductedinvolvingPubMed,PubPharm,LIVIVOandWebofScience(20102021)includingoriginalstudiesandsystematicreviewsand theirreferencelists.OnlypapersinvestigatingpharmacystudentsBPMHcomparedtootherhealthcareprofessionalsin hospitalpracticewereincluded.Twoindependentreviewers screenedtitles,abstractsandfulltextarticlesandcompleted dataextractionwithdiscrepanciesbeingverifiedbyathird. Datachartingwasusedtoidentifyvariablescorrespondingto theresearchquestion.Reportingwascompletedinaccordance withPRISMA-ScR.

Results Outof235papers,18papersmettheinclusioncriteria.Australia(n=1);Canada(n=1)andtheUSA(n=16) includedatotalof7293patients.Pharmacystudentsusemore informationresources(77,6%;n=972)comparedtopharmacy technicians(58,4%;n=743);identifiedmoreprescription/nonprescriptionsdrugs(n=10,2)comparedtonurses(n=6,8)and medics(n=7,1);makefewermistakesidentifyingallergies/ intolerances(n=6)comparedtonurses(n=27)andreduced the30-dayre-admissionrate(0,6%).

ConclusionandRelevance Pharmacystudentsareabletoeffectivelycontributetopatientsafetybycarryingoutverydetailed bestpossiblemedicationhistories,offeringaneconomicalalternativetotechnicians,nurses,pharmacistsandmedicalhealthcareprofessionals.Inadditiontothebenefitstothehealthcare systemthisoffersadditionalopportunitiesforeducation/interdisciplinarytrainingbetweenpharmacyandmedical/nursing students.

REFERENCES

1.WorldHealthOrganisation. GlobalPatientSafetyActionPlan2021-2030. Towardseliminatingavoidableharminhealthcare.2021.ISBN978-92-4003270-5.

2.MekonnenAB, etal.Effectivenessofpharmacistledmedicationreconciliationprogrammesonclinicaloutcomesathospitaltransitions. BMJOpen.2016; 6(2): e010003.

ConflictofInterest Noconflictofinterest

AimandObjectives Ouraimistoanalysethechangesinthe epidemiologyandprevalenceofuseofthedifferenttreatments usedagainstCOVID-19anditsclinicaloutcomesthroughout thepandemic(fromMarch2020toMay2021)inaretrospectiveunicentrestudy.Wepresentthedataofauniversity tertiaryhospital.

MaterialandMethods WeidentifiedallCOVID-19patients admittedtoourhospital>48hthroughtheelectronicmedical records(SAPMedication®).Weevaluateddemographicdata (ageandsex),clinicalfeatures(numberofadmissions/month inICUorregularwards,meanlengthofstayanddeaths includingthose<48h)aswellasmonthlydrugconsumption ofremdesivir,hydroxychloroquine,lopinavir/ritonavir,betainterferon,tocilizumab,baricitinib,anakinra,corticoids(dexamethasone6mg/dayand>20mg/day,methylprednisolone >40mg/day,prednisone>30mg/day,hydrocortisone>100 mg/day)andantibiotics.

Results Atotalof4406patientswithSARS-CoV-2infection wereadmittedofwhich3723mettheinclusioncriteria.The medianagewas66years,withhigherpercentageofmen (59%).ThenumberofpatientsadmittedtoICU,semicritical careoraregularwardwas,respectively20%,5,3%and 74,7%.Thepercentageofdeathsafterthelargepeakofmortality(15,2%)inMarchprogressivelydecreasedto7,7%in thefirsttrimester2021.ThemedianlengthofstayforICU/ semicriticalcareorregularcarewas26,2and8,7days. Trendsinmonthlyuseofthemostfrequentdrugsareshown inthefigurebelow.Morethan80%ofinpatientstooklopinavir/ritonavirandhydroxychloroquineatthebeginning,but consumptionwasdrasticallyreducedafter.Theuseofbeta interferonwasanecdoticalafterfirstmonths.Themostused antimicrobialswereceftriaxone(45,5%)andazithromycin (34,9%),followedbylevofloxacin(8,9%),amoxicillin/clavulanate(7,1%)andceftaroline(6,0%).

4CPS-004 TRENDSINTREATMENTSDURINGCOVID-19 PANDEMICINAUNIVERSITYTERTIARYHOSPITAL

1MAlbanell*, 1MTuset, 2FMeira, 1AEscolà, 1DSoy, 2ASoriano, 2CGarcía-Vidal, 3AMurgadella, 4IOriol. 1HospitalClínicdeBarcelona,Pharmacy,Barcelona,Spain; 2HospitalClínicdeBarcelona,InfectiousDiseases,Barcelona,Spain; 3HospitalMoisés Broggi,Pharmacy,Barcelona,Spain; 4HospitalMoisésBroggi,InfectiousDiseases, Barcelona,Spain

10.1136/ejhpharm-2023-eahp.53

BackgroundandImportance Pharmacotherapeuticmanagement ofSARS-CoV-2infectionfromthebeginningofCOVID-19 pandemictonowhasevolvedinaccordancewithresearch andclinicalexperience,improvingtreatmentsandthusclinical outcomes.

Abstract4CPS-004Figure1

ConclusionandRelevance TheuseofdrugsduringthepandemicofCOVID-19hasshownaclearevolutionovermonths towardsmorestandardisedtreatments,withremdesivirasantiviralanddexamethasone,tocilizumabandbaricitinibstanding outasanti-inflammatorydrugsinourcentre.Homogenisation andstandardisationofCOVID-19treatmentshavebeenmanagedasareflectionofthescientificevidenceaccumulated throughoutthepandemic.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-005

SUCCESSFULTREATMENTOFOSTEOMYELITISCAUSED BYDIFFICULT-TO-TREATRESISTANTPSEUDOMONAS

AERUGINOSAWITHCEFIDEROCOLAS

MONOTHERAPY:ACASEREPORT

1ARodríguezEsquíroz*, 2EMorenoGarcia, 1MSarobeCarricas. 1UniversityHospitalof Navarre,Pharmacy,Pamplona,Spain; 2UniversityHospitalofNavarre,InfectiousDiseases, Pamplona,Spain

10.1136/ejhpharm-2023-eahp.54

BackgroundandImportance Cefiderocolisanewsiderophore cephalosporinwhicheffectivelypenetratestheoutercellmembraneofgram-negativebacteria.Althoughseveralstudieshave demonstratedtheefficacyofcefiderocolinthetreatmentof severeinfectionscausedbymultidrug-resistantgram-negative bacilli,currentinformationonefficacyinosteoarticularinfectionisscarce.

AimandObjectives Weaimedtoreportacaseofdifficult-totreatresistant Pseudomonasaeruginosa osteomyelitissuccessfullytreatedwithcefiderocolfor6weeks.

MaterialandMethods Thisisa64-year-olddiabeticmale patientwhodevelopeda P.aeruginosa osteomyelitissecondary toasurgicalwoundinfectionfollowingasupracondylaramputation.Itwastreatedwithmultiplesurgicaldebridementand severalantibioticseries(ciprofloxacin,piperacillin/tazobactam andmeropenem).Despitethis,culturesfromsurgicalsitecontinuedtogrow P.aeruginosa whichbecamemultidrug-resistant, (onlyitwassusceptibletocolistin,aminoglycosides,ceftolozane/tazobactamandcefiderocol).Ceftolozane/tazobactamdistributionwastemporarilystoppedatthistimeandamputation ofthelowerlimbwasbelievedtobetheonlyoption remaining.

Thepatientwastreatedwithcefiderocolasamonotherapy for6weeks(June-August2021)atatertiaryhospital,ata doseof2gevery8hoursadministeredina3-hourinfusion. Inaddition,foursurgicaldebridementswereperformedduring thistime.

Results After3weeksoftherapywithcefiderocol,thewound swabcultureswerenegative.Thepatientremainedafebrile duringandattheendoftheantibiotictherapy.Nodrugrelatedadverseeffectsorinfusionreactionswerereported. Therewasnoleukopenia,leucocytosis,orworseningrenal function.Theinflammatorymarkervaluesdecreaseduntilthey normalisedandthemagneticresonanceimprovedconsiderably after6weeksoftreatment.

Two-controlmagneticresonanceandbloodtestswereperformed,atweek15and45.Theyshowednoevidenceofpersistentorrecurrentinfectionandnoelevationsofacutephase reactants.Furthermore,thepatientwasfebrile,asymptomatic andpain-free.

ConclusionandRelevance Thiscaseaddsmoreexperienceto thescarceliteratureontheuseofcefiderocolin P.aeruginosa osteomyelitis.

Itssuccessinthetreatmentofosteomyelitissuggeststhat thisdrugpenetrateswellinbonetissueandcouldbeagood therapeuticoption,inconjunctionwithsurgicaldebridement.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-006 COMPLETECLINICALRESPONSEINMETASTATIC BREASTCANCERAFTERFRONT-LINETREATMENT WITHRIBOCICLIB/TAMOXIFEN

1JCDelRíoValencia, 1RTamayo-Bermejo, 2LRodelo-Haad, 1IMuñozCastillo. 1Regional UniversityHospitalofMalaga,PharmacyService,Malaga,Spain; 2HospitaloflaLineadela Concepción,OncologyService,laLinea,Spain

10.1136/ejhpharm-2023-eahp.55

BackgroundandImportance Endocrinetherapywithovarian suppressionorablationisthestandardfirst-linetreatmentfor perimenopausalorpremenopausalwomenwithhormone receptor(HR)positive,HER2-negative,advancedbreastcancer;however,endocrinetherapyresistanceanddiseaseprogressionoccurinmostcases.Ribociclibisaselective,small moleculeinhibitorofcyclindependentkinases(CDKs)4and 6hasshowedthatalongsideendocrinetherapycanimprove progression-freesurvivalandachievehigherproportionsof overallresponsesthanendocrinetherapyaloneinpremenopausalwomenwithHR-positive,HER2-negative,advanced breastcancer.

AimandObjectives Wepresentthecaseofawomanpatient diagnosedwithstage-IVHR+/HER2-breastcancer(Ki6725%)whoachievedcompleteresponsetofirst-lineribociclib treatment.

MaterialandMethods Thiswasanobservationalretrospective studyoftheuseofribociclibina60-year-womandiagnosed withHR+/HER2-metastaticbreastcancer.Datawere obtainedoftheelectronicmedicalrecords.

Results Thepremenopausal54-agedpatientwasdiagnosed withHR+/HER2-(Ki67-10%)localisedinfiltratingductalcarcinomaofleftbreast(1.5cm-sizetumour)inJuly/2015.She underwenttumorectomyandreceivedadjuvantradiotherapy andfive-yeartamoxifen20mgtreatment.InMarch2021,she sufferedfromlossofstrengthofleftupperlimb.CT-scan revealedamassintheleftaxillaryregionbetweenpectoral regionandfirstribandhypermetabolicbonelesionsinthe trochanteroftheleftfemur,compatiblewithbonemetastases. HR+/HER2-breastcancerwasconfirmedbytumourbiopsy. Ki67expressionwas25%.InJune/2021,thispremenopausal 60-yearwomanwastreatedwith3-monthly10.8mggoserelin,daily20mgtamoxifenandribociclib600mgoncedaily for21consecutivedaysfollowedby7daysofftreatment, resultinginacompletecycleof28days.InSeptember2021, sheachievedcompletemetabolicresponseofthelesions describedintheaxillaandbone,withoutcurrentfociofneoplasticdisease.InJune2022,thelastCT-scanrevealed absenceofneoplasticdisease,therefore,shecontinueswiththe sametreatmentwithoutdosemodificationsordelays.Side effects:treatmentwaswelltolerated;sheunderwentgradeI haematologicaltoxicity.

ConclusionandRelevance Thiscasereportdocumentsan exceptionaltumourresponseofafastgrowing,locally advanced,bonemetastaticHR+/HER2– denovobreastcancer treatedbyribociclib/tamoxifen/goserelincombinationtherapy. Treatmentsuccessislonglastingwithfewsideeffects.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-007

TARGETINGPATIENTSWITHPNEUMONIABYCOVID19THATCOULDBEBENEFICIATEDBYCOLCHICINE

1EVillamañán*, 1CSobrino, 1CMateos, 1VCollada, 1AHoyo, 1SMallón, 2JPavón, 1IJiménez, 3YLarrubia, 1AHerrero. 1HospitalUniversitariolaPaz,Pharmacy,Madrid,Spain; 2HospitalUniversitariolaPaz,Pneumology,Madrid,Spain; 3HospitalInfantaSofía, Pharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.56

BackgroundandImportance Availabledatareporteddifferent resultsabouttheeffectofcolchicineinpatientswithCOVID19pneumonia(CN)provingtheneedformoreanalysis.Currently,manyofthesepatientsaretreatedwithhigh-costnew drugswithpoorresults.

AimandObjectives ToevaluatewhethertreatmentwithcolchicineaddedtothestandardtherapyforCNwasrelatedto deathsreduction.Secondaryobjectives:toanalysedifferences inlengthofstay(LOS)andcombinationofdrugsintreatment protocolswithbetterresults.

MaterialandMethods Multicentre,real-world,controlled,retrospectivecohortstudy(March-June2020).Inclusioncriteria: hospitalisedadultpatientswithCN.Admittedtocriticalcare unitswereexcluded.Experimentalgroup:Patientstreatedwith colchicinewhometinclusioncriteria(colchicinetherapygroup [CG]).Controlgroup:thosewhometinclusioncriteriaand didnotreceivedcolchicine(non-colchicinetherapygroup [NCG]).Patientswerematched1:1byage(±2years),sex, severityofthediseaseandcomorbidity.Toselectcontrols,we chosetheconsecutivelynextadmittedpatientafteronetreated withcolchicine.Thisallowedustoselectcontrolsubjectsata closetimeandplacetocases,thatis,undersimilarcircumstancesintermsofpatientcareprotocols.

Results 222(111treatedwithcolchicine)patientswereanalysed.Medianage79years[66–88](81years[66-87]inCG vs79years[66-88]inNCG,p=0.978).52.3%men(54.1% CGvs50.5%NCG;p=0.591).Primaryendpointofdeath occurredin19(17.1%)patientsintheCGascomparedwith 32(29.4%)intheNCG(OR:0.497;95%CI:0.261–0.946; p=0.031).HospitalLOSwasdichotomisedbythemedian value(10days),theuseofcolchicinewasassociatedwitha longerhospitalLOSwhencomparingwiththecontrolgroup (OR=1.856;95%CI:1.089–3.162;p=0.022).Proportionof deathswerehigherinNCGthaninCGinpatients 70years (p=0.012).Withrespecttosexandcomorbidity,distribution ofdeathsshowednosignificantdifferences.Almostallpatients receivedantimicrobials(91.9%)concomitantly,deathrate:19/ 50(38%)CGvs.31/50(62%)NCG;p=0.023),byantimicrobial:azithromycin(9/19)(47.4%)inCGvs.10/19(52.6%) NCG;p=0.517;ceftriaxone16/44(36.4%)CGvs28/44 (63.6%)NCG;p=0.022andlevofloxacin4/12(33.3%)CG vs8/12(66.7%)NCG;p=0.232.

ConclusionandRelevance Ourstudyshowedlowermortality inhospitalisedpatientswhoreceivedcolchicinetotreatCN. Thistreatmentwasparticularlybeneficialforelderlytreated withantibioticsconcomitantly.Findingsinourstudysupport theneedofmorerandomisedclinicaltrialsthatcouldfully elucidatethetypeofpatientswhomaypotentiallybenefit fromthislow-costdrug.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KalilAC.TreatingCOVID-19-Off-LabelDrugUse,CompassionateUse,and RandomizedClinicalTrialsDuringPandemics. JAMA 2020;323(19):1897–1898.

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4CPS-008 DOESCOMORBIDITYAFFECTADHERENCETO INHALERSINSEVEREASTHMAPATIENTSTREATED WITHBIOLOGICS?

1PGranda, 1EVillamañán*, 2CCarpio, 1CSobrino, 2DLaorden, 1EPérez, 1CLara, 1Sde Andrés, 1MEscario, 1AHerrero. 1HospitalUniversitariolaPaz,Pharmacy,Madrid,Spain; 2HospitalUniversitariolaPaz,Pneumology,Madrid,Spain

10.1136/ejhpharm-2023-eahp.57

BackgroundandImportance Comorbiditiesareoftenassociatedwithsevereasthmaincludingthosepatientstreatedwith biologics.Thatoftencontributestopoorlycontrolled asthma1 ,whichcouldberelatedtodeficientadherenceto inhalers.

AimandObjectives Toevaluateproportionofnon-adherence toinhalersinpatientswithsevereasthma(SA)treatedwith biologicsaccordingtotheircomorbidityandtocomparetwo methodstoassessnon-adherence.

MaterialandMethods Cross-sectionalretrospectiveobservationalstudyofpatientswithSArecruitedfromtheSAunitofa tertiaryhospitalinMadridfromJunetoDecember2020.We registereddemographicdata,comorbiditiesandconcomitant therapyforasthma.Non-adherencewasdefinedaspharmacy refilldata(PRD)<80%totheprimaryinhaler2 and/orTest ofAdherencetoInhalersquestionnaire(TAI)results<503 ConcordancewasassessedbydeterminingtheCohen’skappa statistic.Primaryvariable:Proportionofpatientsclassifiedas nothavingtherapeuticadherencemeasuredbybothofthefollowingmethods:PRD<80%intheprevious6months,and TAIquestionnaire:avalue<50.Comorbiditiesconsidered: rhinoconjunctivitis,nasalpolyposis,anxietyanddepression, gastroesophagealreflux,bronchiectasis,aspirin-exacerbatedrespiratorydisease(AERD)andallergicbronchopulmonary aspergillosis.

Results 53patientswereevaluated.Medianagewas61years (IQR51.8-67)and33(61%)werewomen.41(77%)had comorbidity:25(61%),rhinoconjunctivitis,16(38%)nasal polyposis,15(36%)anxietyanddepression,7(17%)gastroesophagealreflux,6(15%)bronchiectasis,5(12%)AERD and1(2%)allergicbronchopulmonaryaspergillosis.Thehighestnon-adherencewasdetectedinpatientswithrhinoconjunctivitisbythetwomethods:50%and55%accordingto TAIandPRD,respectively(k=0.02295%CI-0.256

0.3). Agreementofbothmethodswaslowinallcomorbidities; nasalpolyposis:42%vs23%(k=-0.04995%CI-0.421–0.519);anxietyanddepression:25%vs32%(k=095%CI -0.317–0.317);gastroesophagealreflux:8%vs10% (k=0.36495%CI-0.21-0.938)andAERD17%vs10% (k=-0.15495%CI-0.659–0.967).

ConclusionandRelevance Ourresultshighlightahighprevalenceofnon-adherencetoinhalersinpatientswithSAand othercomorbiditiestreatedwithbiologics.Therefore,hospital pharmacistsshouldfocusonthispatient´sadherenceto inhalers,especiallythosewithrhinoconjunctivitis,whenprovidingpharmaceuticalcaretoSAtreatedwithbiologicsin practice.

REFERENCESAND/ORACKNOWLEDGEMENTS

1. JPrecisRespirMed,2019;2:5–9.

2.Assessingadherencebycombiningthetestofadherencetoinhalerswithpharmacyrefillrecords. JInvestigAllergolClinImmunol 2021;31:58–64.

3.TestofAdherencetoInhalers. ArchBronconeumol 2017;53:360–1.

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4CPS-009 D-9-TETRAHYDROCANNABINOLFORTHETREATMENT OFMULTIPLESCLEROSISSPASTICITY:EVALUATION OFEFFECTIVENESSANDSAFETY

10.1136/ejhpharm-2023-eahp.58

BackgroundandImportance Multiplesclerosis(MS)hasa rangeofsymptoms,suchasimpairedsleep,bladderdysfunctionandmobilityrestrictionslikespasticitythatworsenasthe diseaseprogresses.Spasticityiscommoninthepatients affectedofmultiplesclerosis.Itsimpactonpatientsfunctioningandqualityoflifeisprofound.Themanagementofspasticityisfocusedonfunctionimprovement,evaluatedwiththe ExpandedDisabilityStatusScale(EDSS).Themostofpatients becomeresistanttoantispasticdrugsornottolerate. D-9-tetrahydrocannabinol,oromucosalspraycontainingcannabinoid, improvesthespasticity 20-30%frombaseline,1 evaluated withanumericalratingscale(NRS).

AimandObjectives Theaimofthisstudyistoevaluateeffectivenessandsafetyof D-9-tetrahydrocannabinolinthepatients withMS.

MaterialandMethods Aretrospectivecohortstudywasconductedinallpatientswhobegan D-9-tetrahydrocannabinol betweenJanuary2021andAugust2022(18months)andthe datawasretrievedfromtheweb-basedregisteroftheItalian MedicinesAgencyandthroughtheanalysisofclinicalprescriptions.Thepatientswerebrokendownbygender,itwas calculatedtheaverageageandthevaluesofNRSandEDSS.

Results 213patientswereevaluated,58%ofthesewere female.Theaverageagewas58±11years,themeanNRS andthemeanEDDSscorebeforetreatmentwas6,82±1,35 and5,45±1,73respectively.Amediumcorrelationwas foundbetweenNRSandEDSSscore(R=0,458),whilealow correlationwasfoundbetweenageandNRSscore(R=0,119). TheNRSscoreaftertreatmentwas4,87±1,11(D=2,03± 0,86)witha30%mediumreductionofNRSscore.The adverseeffectdetectedwerenausea(7%),fatigue(6%),headache(5%)andvertigo(4%),and1%ofpatientshadtodiscontinuethetherapyforadverseeffects.

ConclusionandRelevance Thesymptomaticreliefofspasticity ledtoquantifiableandsustainablebenefitsintheabilityto performdailyactivitiesandimprovedtheirqualityoflife.The useof D-9-tetrahydrocannabinolwaseffectiveandwelltoleratedinthemanagementofthespasticityofpatientswithMS, andisaneffectivealternativefortheclassicalantispasticity medications.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.ConteA,VilaSilvánC.ReviewofAvailableDatafortheEfficacyandEffectiveness ofNabiximolsOromucosalSprayinMultipleSclerosisPatientswithModerateto SevereSpasticity, NeurodegenerDis.2021;21(3-4):55

62.doi:10.1159/ 000520560

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4CPS-010 DUPILUMABFORTHETREATMENTOFATOPIC DERMATITIS:EVALUATIONOFEFFECTIVENESSAND SAFETY

BackgroundandImportance Atopicdermatitis(AD)isa chronicinflammatoryskindisease.itaffects20%ofchildren and3%ofadults.Theclinicalstrategyusedinthetreatment ofmoderateandsevereformsofADistheuseofdupilumab inadultsandadolescentseligibleforsystemictherapy.Dupixentisusedforthetreatmentofsevereatopicdermatitiswith aEASI(EczemaAreaandSeverityIndex)score>=24,who haveanEASIscore>=24;evaluationofprurituswithNRS scale>=7;qualityoflifeassessmentwithDLQIindex>=10. AimandObjectives Theaimofthestudywastodetermine effectivenessandsafetyoftreatmentwithdupilumabin patientswithmoderatetosevereAD.

MaterialandMethods AretrospectivecohortstudywasconductedinallpatientswhobegandupilumabbetweenJanuary 2020andJune2022andthedatawasretrievedfromthe web-basedregisteroftheItalianMedicinesAgency.Theprimaryendpointwasthechangeinthedegreeofseverityof ADassessedbytheNRSscale,EASIscore,DLQIscoreand theevaluateofadverseeffectstoassesssafety.Theefficacyof dupilumabwasestablishedbyreductionaccordingtotheNRS, EASIandDLQIscale,fromthevalueatthebaselinetothe valueofthelastre-evaluationofthedisease,carriedoutafter 6months,andtheadverseeffectswereevaluatedduringthe wholeperiodconsidered.

Results 134patientswereevaluated,56%ofthesewere female.Themediumagewas40±19years,themean NRS,EASIandDLQIscorebeforetreatmentwas8,0± 2,0,26,0±4,0and15,0±7,0,respectively.TheNRS scoreaftertreatmentwas3,2±2,0( D=-5,0±2,0; <0,000).TheEASIscoreaftertreatmentwas5,0±4,0 ( D=-21,0±4,0; <0,000),andtheDLQIscoreafter treatmentwas3,0±3,0( D=-12,0±7,0; <0,000).90% ofpatientsobtainedareduction>20%oftheNRSscore; >50%oftheEASIscoreand33%reductionoftheDLQI score.Theadverseeffectdetec tedwerenon-infectiousophthalmological(45%),injection-sitereaction(12%),nausea (5%)andheadache(4%).

ConclusionandRelevance ThesymptomaticreliefofADled toimprovedpatient’squalityoflifeandledtoquantifiable benefitsintheabilitytoperformdailyactivities.Inagreement withotherstudies,theuseofdupilumabwaseffectiveand welltoleratedinthemanagementofatopicdermatitisandis aneffectivealternativefortheclassicalmedications.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-012

BIOLOGICALMARKEROFINTERESTIN IMMUNOTHERAPY

MAToledoDavia*,NLabradorAndújar,ARRubioSalvador,CBlázquezRomero,LTorralba Fernández,CJiménezMéndez,RPrietoGalindo,PAguadoBarroso,EGómezFernández, PMoyaGomez. HospitalUniversitariodeToledo,HospitalaryPharmacy,Toledo,Spain

10.1136/ejhpharm-2023-eahp.60

BackgroundandImportance Inflammationplaysamajorrole intheprogressionofneoplasmssuchasnon-small-celllung cancer(NSCLC),soitisvitallyimportanttofindbiomarkers thatareeasilyapplicableandreproducibleinroutineclinical practicethatallowustoclassifypatientsaccordingtotheir forecast.

10.1136/ejhpharm-2023-eahp.59

GCasini,GPolito*,GBattistini,MFLioni,CCollice,EOrlandi,EMProli. AouPoliclinico UmbertoI,UocPharmacy,Rome,Italy

GCasini,GPolito*,GBattistini,EOrlandi,CCollice,VCioffi,EMProli. AouPoliclinico UmbertoI,UocPharmacy,Rome,Italy

PLATELETTOLYMPHOCYTERATIO(PLR)AS

AimandObjectives

Toanalysetheinflammatorymarkerplatelet/lymphocyteratio(PLR)asapredictorofefficacyinimmunotherapytreatments;toassesswhetherthereisarelationship betweenPLRvalueandresponsetotreatment.

MaterialandMethods Retrospectiveandobservationalstudyof patientsdiagnosedwithNSCLCandtreatedwithpembrolizumabinatertiaryhospital,fromJanuary2018toDecember 2021.Wecollecteddemographicvariables(sexandage), ECOG,histology,presenceofmetastases,PD-L1expressionand previoustreatments.Progression-freesurvival(PFS)andoverall survival(OS)werecalculatedbytheKaplan-Meiermethodand log-rankashypothesistesting.;PLR(absoluteplateletcount/ absolutelymphocytecount)wascalculatedandPLR=200 wasconsideredthecut-offpoint.Coxregressiontestwas usedtoassesstheinfluenceofPLRontreatmentefficacy.

Results Seventy-threepatientstreatedwithpembrolizumab (80.8%male,n=59)andmedianage65[83-37]years. Adenocarcinomahistologywas90%(n=66);40patients ECOG=0,31patientsECOG=1and2patientsECOG=2;26 patientsPD-L1<50%,19patientsPD-L1>50%andfor28 patientsitwasunknown;12patientsCNSmetastasesand22 patientshadliver/bonemetastases.Significantdifferenceswere obtainedinthegroupofpatientswithliver/bonemetastasesin PFSwithmedianof6.3(2.9-9.6)CI95%vs17.3(11.4-23.2) CI95%months(p=0.03),andinthegroupofpatientswith CNSmetastasesinOSwithamedianof9.6(1.2-17.9)CI 95%vsat24.9(18.6-31.2)95%CImonths(p=0.003). MedianPFSwas15.6[10.15-21.1]95%CIforPLR<200vs 9.97[2.86-17.1]95%CImonthsforPLR>200(p=0.04); medianOSwas26.25[19.87-32.64]95%CIforPLR<200 vs11.31[3.86-18.79]95%CImonthsforPLR>200 (p=0.001).Coxregressiontest:HR=1.001(p=0.017)for PFSandHR=1.002(p=0.003)forOS.

ConclusionandRelevance PLRandthepresenceofmetastases correlateswithPFSandOS.PLR,withacut-offpoint=200, appearsusefulasaprognosticbiomarkerforpatientswith NSCLCtreatedwithpembrolizumab;higherPLRvalues,result inlowerPFSandOS(HR>1inPFSandOS).

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-014 COMPARISONOFTWOPROTOCOLSFORTHE ADMINISTRATIONOFLEUCOVORINRESCUESAFTER HIGHDOSEMETHOTREXATEINFUSIONOF24HOURS

AEscolàRodríguez*,NArranzPasqual,CBastida,MAlbanell,IMongeEscartín,PMaté Arbaiza,SRuizBoy,ECarceleroSanMartín,DSoyMuner. PharmacyService,Divisionof Medicines,ClinicBarcelona

UniversityofBarcelona,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.61

BackgroundandImportance Therapeuticdrugmonitoring (TDM)ofmethotrexate(MTX)inplasmaisastandardproceduretoearlyidentifypatientswithdelayeddrugelimination andadjustleucovorindose.Adequateleucovorinrescues(LR) shouldstartwithin42-48hofthebeginningofhighdose (HD)-24h-MTXinfusiontoavoidMTXtoxicitybutextending LRmorethanneededcanreduceMTXantitumoureffect.

BeforeimplementationofnewPETHEMA-2019protocolat ourhospital,standardLRwereprescribedandMTXplasma concentrationwasdetermined48hafterinfusioncompletion. Followingnewprotocolrecommendations,pharmacistsstarted TDM.

AimandObjectives

Toassesswhethertheimplementationof thenewprotocolallowedreducingthetotalleucovorindose administeredafterHD-24h-MTXinfusion.Secondaryoutcomes:comparetheincidenceoftoxicityandthelevelof complianceofappropriateMTXsamplingtimesandLR betweenbothprotocols

MaterialandMethods Retrospectiveobservationalstudyconductedatauniversitytertiaryhospital.Adultstreatedwitha HD-24h-MTXinfusionastreatmentforacutelymphoblastic leukaemia(ALL)andBurkittlymphomafromMay2019to June2022wereincluded.Patientswerestratified(1:1)accordingtotheprotocolfollowed.Datacollectedwere:age,sex, haematologymalignancy,MTXdose,LRandserumcreatinine. Results Fifty-eightHD-24h-MTXinfusionswereanalysedcorrespondingto20patientsforthenewprotocol(75%males; mean±SDage49±15years;7withlymphoma,11ALLB,2ALL-T)andto20fortheoriginal(65%male;mean± SDage49±16years;10lymphoma;7ALL-B,3ALL-T). Themedian[interquartilerange]leucovorindoseadministered percyclefollowingtheoriginalprotocolwasan87%higher thanthedoseadministeredwiththenewprotocol(597mg/ m2[475,700]vs75mg/m2[45,180],p<0,001).Nephrotoxicityincidence(increaseof0,3mg/dlfrombasalcreatinine)was 21%intheoriginalprotocolvs19%inthenewone (p=0,84).SampleextractionsforTDMwerecorrectlydrawn in93%ofthecasesandLRwerecorrectlyadministeredin 76%ofthecaseswhenusingthenewprotocol,incomparison with97%and55%whenusingtheoriginalprotocol).

ConclusionandRelevance Implementationofthenewprotocol allowsasignificantreductionoftheleucovorindoseby87% withoutanincreaseinnephrotoxicity.Measurestoincrease adherencetothenewprotocolmaybeimplementedhereafter. REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-015 ROLEOFCLINICALPHARMACISTINTHE OPTIMISATIONOFNIRMATRELVIR/RITONAVIR PRESCRIPTIONINTHEEMERGENCYDEPARTMENT MDMSánchezSuárez,AMartínRoldan,MRCantudoCuenca,MIArchillaAmat, CMontero-Vilchez*. HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada,Spain 10.1136/ejhpharm-2023-eahp.62

BackgroundandImportance Nirmatrelvir/ritonavir(Paxlovid®) hasbeenrecentlyauthorisedfortreatingcoronavirusdisease 2019(COVID-19)inadultswhodonotrequiresupplemental oxygenandwhoareatincreasedriskforprogressingto severedisease.DuetomultipledrugsmetabolisedbyCYP3A mayhavesignificantinteractionswithritonavir,physiciansand pharmacistsshouldworktogetherforthesafeandeffective useofpaxlovid.

AimandObjectives Todescribethepharmacistinterventions (PIs)intheemergencydepartment(ED)regardingoptimisation ofpaxlovidprescriptionsinnon-hospitalisedCOVID-19 patients.

MaterialandMethods Anobservationalprospectivestudywas conductedfrom1April2022to31August2022ina1000beduniversityhospital.Clinicalvariableswereobtainedusing electronicmedicalrecords.Weregistereddemographicdata (sex,age),vaccinationstatusandcomorbidities,hospitalisation andprescriptionwithothertherapies(suchasremdesivirand baricitinib)afterpaxlovidtreatment,posology,potentialdrug

interactionsandcontraindications.PIswereclassifiedintothe followingtypes:(1)doseadjustment,(2)contraindication,(3) potentialinteraction,(4)non-compliancewiththeindication.

Wealsoidentifiedprimarynon-adherencetopaxlovid.

Results Weincluded77patients,56%female,medianageof 67years(IQR52-81).Mostpatients(87%)werefullyvaccinated(includingboosterdose),12%requiredsubsequenthospitalisationforCOVID-19,noneofthemdiedandonlyone patientrequiredremdesivirasothertherapies.Inrelationto comorbidities,86%ofpatientshadrespiratorydiseases,33% hypertension,30%cancertreatedwithchemotherapy,21% autoimmunediseases,17%renaldisease,16%diabetesmellitus,9%liverdisease.ThepercentageofpatientswithPIswas 70%.ThetotalofPIscarriedoutwas87:(1)31%,(2)13%, (3)33%,(4)23%.Forty-sixpotentialinteractionswere detectedbeingthemostfrequent:statins(33%),antihypertensives(11%),anticoagulants(6%),immunosuppressants(6%), amongotherdrugs,aswellas,14contraindications,inwhich statinsagainstoodout.Primarynon-adherencewasdetected in10%ofpatients.100%ofPIwereaccepted.

ConclusionandRelevance Hospitalpharmacistsarekeyinthe optimisationofpaxlovidprescriptionsintheED.Thisincludes assessingforpotentialdruginteractions,aswellascontraindications,amongotherPIs.Duetotherecentconditionalmarketingauthorisationofpaxlovid,itisimportanttoencourage multidisciplinaryworktoreducepotentialdosingerrorsand adversereactions,increasingpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-016 PREDICTIVEPERFORMANCEOFGLOMERULAR FILTRATIONRATEEQUATIONSBASEDONCYSTATIN C,CREATININEANDTHEIRCOMBINATIONIN CRITICALLYILLPATIENTS

1MAlbanell*, 1CBastida, 1ÁMarcos-Fendian, 1AEscolà, 2JMercandal, 3,4,5PCastro, 1,5DSoy. 1PharmacyService,DivisionofMedicines,HospitalClinicofBarcelona,Barcelona, Spain; 2SurgicalIntensiveCareUnit,AnaesthesiologyDepartment,HospitalClinicof Barcelona,Barcelona,Spain; 3MedicalIntensiveCareUnit,HospitalClinicofBarcelona, Barcelona,Spain; 4IDIBAPS,HospitalClinicofBarcelona,Barcelona,Spain; 5Universityof Barcelona,HospitalClinicofBarcelona,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.63

BackgroundandImportance Twenty-fourhoururinecreatinine clearance(24h-ClCr)remainsthegold-standardforestimating glomerularfiltrationrate(GFR)incriticallyillpatients;however,ithasseveraldrawbacks.Serumcreatinine(SCr)isthe mostfrequentlyusedparametertoestimateGFR,however, Cystatin-C(CystC)mayreflectGFRchangesearlierthanSCr.

AimandObjectives Toassesstheperformanceofequations basedonSCr,CystC,andtheircombination(SCr-CystC)for estimatingGFRincriticallyillpatientsincomparisonto24hClCr.

MaterialandMethods Retrospective,observationalstudyina tertiary-carehospital(May2020toJuly2022).Patientswith CystC,SCrand24h-ClCrmeasurementswithin±2days wereincluded.Alteredthyroidstatusandcorticosteroidsuse for>5dayswererecorded,asbothcanalterCystCvalues.

24h-ClCrwasconsideredthereferencemethod.GFRwas estimatedusingSCr-basedequations:CKD-EPI-CrandCockcroft-Gault(CG);CystC-basedequations:CKD-EPI-CystCand CAPA;andCr-CystC-basedequations:CKD-EPI-Cr-CystC.

Bland-AltmanplotswereusedtocompareGFRestimations with24h-ClCr.Pearson´scorrelationcoefficientsandconcordancecorrelationcoefficients(CCC)werecalculated.Biaswas assessedas(estimatedGFR – 24h-ClCr);andprecisionasthe SDofbias.Furtheranalysiswasperformedwithstratifieddata into24h-CrCl<60mL/min/1.73m2,60-130mL/min/1.73m2 and 130mL/min/1.73m 2

Results Weincluded275measurements,correspondingto186 patients.Mean(SD)SCr,CystCand24h-ClCrwere1.3(1.1) mg/dL,1.8(1.2)mg/L,and77.0(57.7)mL/min,respectively. Theinfluenceofalteredthyroidstatus(N=22)andcorticosteroidstherapy(N=64)onCystCvalueswasstatisticallysignificant(p:0.0138andp<0.000,respectively);however,asboxplotwereoverlapped,wedidnotexcludethemfromthe analysis.

Bland-Altmanplotsareshowninfigure1.Intheoverall population,CKD-EPI-Crequationshowedthelowestbias (2.6)andbestprecision(33.1).Inpatientswith24h-CrCl <60mL/min/1.73m2 (N=124),CystC-basedequationsshowed thelowestbias(<3.0)andCKD-EPI-Cr-CystCwasthemost accurate(13.6).Inthesubgroupof60 £24h-CrCl<130mL/ min/1.73m2 (N=100),CKD-EPI-Cr-CystCwasthemostprecise(20.9).However,inpatientswith24h-CrCl 130mL/min/ 1.73m2 (N=51),CystC-basedequationsunderestimateGFR, whileCGoverestimatesit(22.8).CKD-EPI-Cr-CystCobtained thehighestPearson´scoefficient(0.742)andCKD-EPI-Crthe highestCCC(0.785).

Abstract4CPS-016Figure1 Bland-Altmanplotsshowingmean differencesbetweenestimatedGFRandmeasured24h-CICr

ConclusionandRelevance Ourstudyshowednoevidenceof superiorityofanyequationoverothersforallevaluated parameters.CystC-basedequationswerelessbiasedinindividualswithimpairedrenalfunction(GFR<60mL/min/1.73m2), CKD-EPI-Cr-CystCperformedproperlyinGFRfrom60130mL/min/1.73m2 andCGinpatients>130mL/min/1.73m2.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-018 EVOLUTIONOFANTIMICROBIALUSEINCOVID-19 PATIENTS

1MAlfonsínLara, 1APérezLandeiro, 1NGarcíaBeloso, 1MCouñagoFernández, 1DRobles Torres, 1PPradoMontes, 1IAgraBlanco, 1ALópezLópez, 2SBaltazar, 1NMartínezLópez deCastro. 1HospitalÁlvaroCunqueiro,FarmaciaHospitalaria,Vigo,Spain; 2Institutode InvestigaciónSanitariaGaliciaSurIisgs,UnidaddeMetodologíaYEstadística,Vigo,Spain

10.1136/ejhpharm-2023-eahp.64

BackgroundandImportance AntimicrobialprescribingprevalenceinCOVID-19patientsisestimatedtobearound75%, whereasbacterialcoinfectionpr evalenceisestimatedtobe lessthan10%.Thisdatashowstheunnecessaryuseof antibiotics.

AimandObjectives TocomparetheevolutionofantimicrobialconsumptioninCOVID-19patientsbetweenthebeginningofthepandemicandthethirdCOVID-19waveinour hospital.

MaterialandMethods ObservationalretrospectivestudyconductedinatertiarycarehospitalduringMarchtoJune2020 andMaytoAugust2021inCOVID-19IntensiveCareUnit (CICU)andCOVID-19medicalward(CMW)patients.We extractedantimicrobialconsumptiondatafromthePharmacy database(Silicon)andbed-daysdatafromAdmissionService.

Westandardisedantimicrobialconsumptiontodefineddaily doses(DDD)/100bed-days.ThedescriptiveanalysiswasperformedwithSPSS.Weconductedanormality,anindependenceandacorrelationtest.

Results An8%decreaseinglobalantimicrobialusewas observed.However,wefounda30%decreaseinCMW,and a39%increaseinCICU.

Theantibioticuseinthetwoperiodsshowedasignificance correlation(p<0,001).

ConclusionandRelevance

. Thereisalightdecreaseofantimicrobialprescriptionsinall COVID-19patients.

. ThereisanimportantdecreaseinantimicrobialuseinCMW andaconsiderableincreaseinCICU.

. Theseresultssuggesttheneedformoreantimicrobial stewardshipprogrammesinCICU

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Abstract4CPS-018Table1

4CPS-019 QUALITYASSESSMENTOFTHEEVIDENCE UNDERPINNINGPHARMACIST-LEDANTIMICROBIAL STEWARDSHIPSINTERVENTIONS

1CCastaño-Amores*, 2IGarcía-Giménez, 1MNúñez-Núñez, 3JPérezdeRojas, 1JCabezaBarrera. 1HospitalUniversitarioSanCecilio,Pharmacy,Granada,Spain; 2HospitalJuan RamónJiménez,Pharmacy,Huelva,Spain; 3HospitalUniversitarioSanCecilio,Preventive Medicine,Granada,Spain

10.1136/ejhpharm-2023-eahp.65

BackgroundandImportance Antimicrobialresistance(AMR)is aglobalproblemthreateningpublichealth,securityandeconomicdevelopment.Antimicrobialstewardship(AMS)programmeshavebeenimplementedworldwideastheyhave demonstratedclinical,economicalandecologicalbenefitspromotingtheadequateuseofantibiotics.Pharmacist-ledantimicrobialstewardships(AMS)interventionsareproposedaskey strategiestooptimiseantibioticuseandreduceadverseevents, includingtheselectionofantimicrobialresistance.Systematic reviewsareatthehighestleveloftheevidencevalidityhierarchyandprovideinsightandsupportpolicy-makersinclinical practiceandresearch.

AimandObjectives Toevaluatethequalityofthesystematic reviewsmeasuringtheimpactofPHARMACIST-LEDAMS interventions.

MaterialandMethods Anumbrellareviewofthesystematic reviewsonAMSwasconductedfollowingthePRISMA-P(PreferredReportingItemsforSystematicreviewandMeta-AnalysisProtocols)guideline.Followingprospectiveregistration (ProsperoCRD42022333928),tworeviewersindependently searchedinPubMed,Scopus,CochraneLibraryandGoogle Scholar,withoutlanguageortimerestrictionsuntilJune2022. Weincludedsystematicreviewscoveringpharmacist-ledAMS interventions.TworeviewersindependentlyassessedmethodologicalqualityusingamodifiedAMSTAR-2toolandcollated themainfindings.

Results From1004citations,20reviewswereeligiblefor inclusionsummarisingatotalof648studies.Theoverall qualityof15(75%)reviewswascriticallylow.Fourstudies (20%)wereoflowqualityandonestudywasofhighquality (5%).Themostloss-makingdomainsinvolveprovidingalist ofexcludedstudies,measuringtheriskofbias(RoB)withan appropriatetool,toexplicitlystatethatthereviewmethods

werepreviouslyestablishedandtakingRoBintoaccountin theinterpretationofresults.Theonlyhigh-qualitystudy(5%) reportedonthesourcesoffundingforthestudiesincludedin thereviewandprovidedalistofexcludedarticles.

ConclusionandRelevance Systematicreviewsprovidethebest levelofevidence,buttheirqualitymustbeassured.Theoverallqualityofthesystematicreviewsmeasuringtheimpactof PHARMACIST-LEDAMSinterventionsislow.Thereisa needforhighlevelliteraturecoveringtheparticipationand implicationofpharmacistsinAMS.TherealimpactofAMS isunknowntosupportpolicymakersandefficientdesignsin bothclinicalpracticeandresearch.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-021 EFFECTIVENESS,PERSISTENCE,ANDADHERENCEOF BARICITINIBINRHEUMATOIDARTHRITIS:LONG-TERM REAL-WORLDEVIDENCESTUDY

1ACalvoGarcía*, 1ERamirezHerraiz, 2ILlorenteCubas, 3BVarasdeDios, 1AMorell Baladrón, 4JBenedíGonzález, 2RGarcíadeVicuña. 1HospitalUniversitariodelaPrincesa, Pharmacy,Madrid,Spain; 2HospitalUniversitariodelaPrincesa,Rheumatology,Madrid, Spain; 3HospitaldeSantaCristina,Rheumatology,Madrid,Spain; 4Universidad CompluetensedeMadrid,Farmacology,Madrid,Spain

10.1136/ejhpharm-2023-eahp.66

BackgroundandImportance Baricitinib(BAR)isaJanuskinase inhibitor(JAKi)selectiveforisoenzymes1and2.Itisusedin rheumatoidarthritis(RA)withaninadequateresponsetoconventionalsyntheticdisease-modifyingdrugs(csDMARD).

AimandObjectives Theobjectivewastoevaluatetheeffectiveness,persistence,andadherenceofBARinRAinareal-world setting.

MaterialandMethods Anambispectiveobservationalstudywas designedinathird-levelhospital.PatientswithRAwho startedBARbetweenSeptember2017andJune2021were includedandsignedaninformedconsent.Patientsparticipatinginaclinicaltrialwereexcluded.Patientswerefollowed upuntilDecember2021.EffectivenesswasevaluatedbyvariationoftheDiseaseActivityScore(28-jointcount)usingCreactiveprotein(DAS28PCR);andbythepercentageof patientsachievingtherapeutictarget:lowdiseaseactivity (LDA)(DAS28CRP£3.2)ordiseaseremission (DAS28CRP<2.6).Adherencewasanalysedusingthe5items Compliance-Questionnaire-Rheumatology(CQR5)appliedto patientsevery6months,andthemedicationpossessionratio (MPR).ThestudywasapprovedbytheInstitutionalReview Boardofthehospital.

Results 61patientswereincluded,51/61(83.6%)werefemale. Themeanagewas58.1(15.4)andthemeandiseaseduration was13.9(8.3)years.47/61(77.0%)and43/61(70.5%) patientspresentedanti-citrullinatedproteinantibodiesand rheumatoidfactor,respectively.44/61(72.1%)patientshad priorexposuretobiologicDMARDs.10/61(16.4%)patients wereonBARmonotherapy.Asignificantdecreasewas observedinDAS28PCRfrombaselinetotheendoftreatment/follow-up(3.9(0.9)vs2.7(1.3),adifferenceof1.2, p=0.000).Inaddition,6/61(9.8%)and37/61(60.7%) patientsachievedLDAorremission,respectively.31/61 (50.8%)patientsremainedontreatmentattheendoffollowup,withamedianpersistenceof31.3(14.1-47.7)months.

ThemeanMPRwas0.96(0.08),andallbutonepatientwere

adherent(MPR>0,8).AccordingtotheCQR5,allpatients were ‘goodadherers’

ConclusionandRelevance JAKiarethemostrecentalternative availableforRAtreatment.BARdemonstratedeffectivenessin ourstudycohort,withasignificantdecreaseinDAS28PCR,a highpercentageofpatientsreachingthetherapeutictarget, andapersistenceexceedingtwoyears.Adherencetotreatment wasveryhigh,almost100%.Morestudiesinreal-worldsettingareneededtoconfirmtheseresults.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-022 ADHERENCETOEVOLOCUMABANDITSIMPACTON LDLCHOLESTEROLREDUCTION

BBertrandelisBartolome*,MGonzálezSevilla,JMFerrariPiquero. HospitalUniversitario 12deOctubre,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.67

BackgroundandImportance Accordingtothelatestrecommendations,theneedtoachievelowercholesterollevelshas becomemoreimportant.Therefore,theuseofproteinconvertasesubtilisin/kexintype9(PCSK9)inhibitorshasbeen increasingrecently.

AimandObjectives Toestablishpatients’ adherencetoevolocumabtherapy,aPCSK9inhibitor,andtoanalysethereductionofpatients’ LDL-Clevels.

MaterialandMethods Descriptiveretrospectiveobservational studycarriedoutbetweenJanuaryandDecember2021ina third-levelhospital.Patientswiththreeormoredispensations ofevolocumabwereselected.Thenumberofprefilledpens andthedatewhenitwassuppliedwereconsideredtocalculatecompliance.Demographicsandclinicaldata(prescription andLDL-Cvalues:pre-treatment,after12weeks,andatthe endofthestudy)werecompiledthroughthemedicalrecord. Results 139patientswereincludedinthestudy,79males (57.25%)withamedianageof62.97years(IQR15.53).73 patients(52.90%)wereprescribedduetosecondarypreventionandtheremainderduetofamilialhypercholesterolemia. Allpatientsreceived140mgevery2weeks.

Patientsweredividedintothreegroups(1,2,and3)accordingtotheirmedicationadherence( 90%,75 – 89.99%,and <75%respectively).90patients(65.22%)wereingroup1, 30(21.74%)ingroup2and18(13.04%)ingroup3.

After12weeksoftreatment,areductionofLDL-Clevels byatleast50%wasobservedin71patients(78.79%)from group1,23(76.67%)fromgroup2,and11(61.11%)from group3.Thereductionpercentagemedianswere-69.18% (IQR26.69),-68.64%(IQR28.89),and-54.56%(IQR44.69) respectivelyforeachgroup.Resultsingroup1and2arebetterthanexistingliteraturedata(table1).Group3obtained worseefficacyresults.

Abstract4CPS-022Table1

PhaseIIIclinicaltrial(N)Reductionpercentage(CI95%)

20110114MENDEL-2(614)-58(-60,-55)

20110115LAPLACE-2(1896)-64(-66,-62)

20110117RUTHERFORD2(329)-63(-66,-59)

20110116GAUSS-2(307)-57(-61,-54)

ConclusionandRelevance Lowadherenceseemstodecrease LDL-Creductioncapacity,whilemoderatecomplianceseems tomaintainit.Furtherresearchisrequired,nevertheless,these resultswouldsupportthepossibilityofdecreasingthefrequencyofadministration,favouringtheadherencetotreatmentandreducingcosts.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-026 EFFECTIVENESSOFSODIUMZIRCONIUM CYCLOSILICATEINREDUCINGPOTASSIUM CONCENTRATIONSINHOSPITALISEDPATIENTS

DMarinDelgado*,RPuértolasVal,SGarcíaMuñoz,APupláBartoll,MMendozaAguilera, JMaiquesLlácer,VBosóRibelles,RFerrandoPiqueres. HospitalGeneralUniversitariode Castellón,HospitalPharmacy,Castellón,Spain

10.1136/ejhpharm-2023-eahp.69

4CPS-024 COMPARISONOFCHANGESINCLINICALVALUESOF INTENSIVECAREPATIENTSATVETERANSHOSPITAL ACCORDINGTOVARIOUSFATEMULSIONSFOR PARENTERALNUTRITION

JShin*,SSeob,SLima,SBaek,HJeonga. VHS,Pharmacy,Seoul,Korea-South 10.1136/ejhpharm-2023-eahp.68

BackgroundandImportance Thepurposeofthisstudywasto comparethechangesintheclinicalvaluesoffishoiland non-oil-basedTPNincriticallyillpatientsandtoprovidea clinicalrationaleforTPNadministration.

AimandObjectives Datawerecollectedfromcriticallyill patientswhoreceivedTNA(Fishoil-basedornon-FishoilbasedTNA,thelatterconsistingofolive-soybeanoil-based TNAorsoybeanoil-basedTNA)atVeteransHealthService medicalcentrefrom1June2019to31May2021.

MaterialandMethods Albumin,hsCRP,AST,ALT,TotalBilirubin(TB),PT.INR,WBC,Hb,Hct,PLT,Lymphocyte(LYT) levelswereanalysed.

Results Thisstudycollected224subjects(172fishoil-based TNA,45olivesoybeanoil-basedTNA,and7soybeanoilbasedTNA).Themeanchangesinhs-CRPbeforeandafter TNAinjectionwere-8.71,-47.48,and-33.33intheorderof fishoil,olive-soybeanoil,andsoybeanoil.Thealbuminlevel changeswere-0.26,+0.05,and-0.03,respectively.Other thanthat,therewerenostatisticallysignificantchanges.

Intheolive-soybeanoilgroup,thedecreaseinhs-CRP showedatendencytoincreaseasthenumberofprescription daysincreased.Onlyinthefishoilgroup,astheAPACHE2 scoreincreased,theTB(p<0.01)andAST(p<0.01)tended toincrease,andthethrombocytopeniatendedtoincrease (p<0.01).Intheolivesoybeanoilgroup(p<0.01)andsoybeanoilgroup(p=0.037),theincreaseinINRtendedto increaseastheBMIincreased.Inthefishoilgroup,ALT increasedwithage(p=0.014).

ConclusionandRelevance Asaresultofthestudy,therewas nosignificantdifferenceinclinicalvaluesbetweenthepreparationscontainingfishoilandthepreparationscontainingnonfishoilexceptforhs-CRPandalbumin.Therefore,itis judgedthatconsideringthenutritionalcomponentsandeconomicfeasibilityofTNApreparationswhenadministering TNAwillbehelpfulinimprovingthenutritionalstatusof patientsandreducingtheeconomicburden.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

BackgroundandImportance Hyperkalaemiaisacommonbut hazardouscomplicationinpatientswithchronickidneydisease (CKD).Recentstudiesshowedthatnewresinsareeffectivein reducingpotassiumserumlevelsbutitseffectivenessisusually testedaccordingtostandardrecommendationsofshockand maintenancedoses.Aretheserecommendationsfollowedin clinicalpractice?Ifnot,isitequallyeffective?

AimandObjectives Toevaluatetheuseandeffectivenessof sodiumzirconiumcyclosilicate(SZC)treatmentinroutineclinicalpractice.

MaterialandMethods Observationalandretrospectivestudy carriedoutinatertiarylevelhospitalthatincludedpatients admittedwithhyperkalaemiawhostartedtreatmentwith sodiumzirconiumcyclosilicatesinceDecember2021.

Drug’stechnicaldatarecommendsshockdoseof10g/8h foramaximumof72huntilnormokalaemiaandfromthere, maintenanceregimenwiththeminimumdosethatallowsconcentrationsbetween3.5-5mmol/L.TherapeuticPositioning Reportrecommendsreservingitsuseforpatientswithfailure orintolerancetoexchangeresinslikecalciumpolystyrenesulfonate(CPS).

Results 32patientswithamedianageof83years(IQR14) wererecruited,17men.MainunderlyingcauseofhyperkalaemiawasCKD,78%ofcases.

Only12.5%ofallpatientsreceivedashockregimenof 10g/8h,37.5%received10g/24h,6.3%received5g/8hand 43.8%didnotreceiveshockdose.

Regardingmaintenanceregimen,mostcommondosagewas 5g/24hin59.4%ofthepatients,followedby10g/24hin 9.4%and5g/48hin3.1%.Remaining28.1%didnotreceive amaintenance.44.4%werenevertreatedwithresinsand 3.7%showedintolerancetothem.

Meanpotassiumconcentrationbeforetreatmentwas5.9 ±0.7mmol/L.46.9%ofthepatientsreachedtargetpotassiumlevels(3.5-5mmol/L)at48hoftreatment,15.6%were below3.5mmol/L;and37.5%continuedwithconcentrations above5mmol/L,halfofwhomhadreceivedSZCasasingledose.

ConclusionandRelevance

Asignificantpercentageofpatients didnotreachthepotassiumconcentrationtargetaftertreatmentwithSZC,whichcouldberelatedtothelackofshock dose.Thisagreeswithavailableliterature,whichconcludes thatdoseshigherthan10g/dayleadtoagreaterpotassium depletion.Almostonethirdofpatientshadnotpreviously receivedresinssothemostefficientoptionwasprobablynot usedsince,ascost-comparisonstudiesclaim,CPShasa slightlybettercost-effectivenesscomparedtoSZC.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-029 ECONOMICIMPACTOFBIOLOGICALTREATMENT OPTIMISATIONSINRHEUMATOLOGICALAND DERMATOLOGICALDISEASES

1MDGil-Sierra, 2MDPBriceñoCasado*, 1CMoreno-Ramos, 1MABlanco-Castaño, 3CMCuadros-Martinez. 1HospitalUniversitariodePuertoReal,Pharmacy,PuertoReal, Spain; 2HospitalUniversitariodeJerezdelaFrontera,HospitalPharmacy,Jerezdela FronteraCádiz,Spain; 3HospitalUniversitarioJerezdelaFrontera,Pharmacy,Jerezdela Frontera,Spain

10.1136/ejhpharm-2023-eahp.70

BackgroundandImportance Appropriateoptimisationofbiologicagentsinimmune-mediatedinflammatorydiseasescan improvetreatmentefficiencybydecreasingnumberofdrug administrations.

AimandObjectives Toestimateeconomicimpactofoptimising theuseofetanerceptandadalimumabinpatientswith immune-mediateddermatologicalandrheumatologicaldiseases.

MaterialandMethods Adescriptiveretrospectivestudywas conductedbetweenNovember2021andSeptember2022. Patientswithpsoriasis,spondyloarthritis,rheumatoidarthritis andpsoriaticarthritistreatedwithetanerceptoradalimumab therapiesforatleast6monthsuninterruptedlywerescreened. Therapyoptimisationswerequantified.Optimisedtherapies weredefinedastreatmentswithextendeddosingregimensor treatmentdiscontinuationsduetoadequatepathologycontrol. Thesetherapyoptimisationswereappliedaccordingtoamultidisciplinaryprotocolofclinicaldecisionsbasedonbiochemicaltests(includingserumdruglevelsandpresenceofantidrugantibodies),pharmaceuticalinterviewsaboutpatients’ perceptionoftheirdiseasecourseandmedicalcriteria.Data recorded:medicaldepartments,drugs,biochemicaltests,pharmaceuticalinterviews,serumdruglevelsandpresenceofantidrugantibodies.Regardingeconomicimpact,savingsfrombiologicaltherapyoptimisationswereestimatedasthedifference betweencostsofrealdosesusedwithoptimisedregimensand thehypotheticalcostswithdosesusedpriortotreatmentoptimisations.Thenumberofdecreaseddrugadministrationswas estimated.

Results Thisstudyscreened256patients:182ofInternal MedicineDepartmentand74ofDermatology.Distributionof drugswas:171patientsreceivedetanerceptand85adalimumab.Therewere258biochemicaltestand258pharmaceutical interviews(2patientsrequired2biochemicaltestsand2pharmaceuticalinterviews).Serumdruglevelswereoutsidethe optimaltherapeuticrangesofdrugsaccordingtotheliterature in71.6%ofcases.Presenceofanti-drugantibodieswere foundin15patients.Treatmentoptimisationswereperformed in115patients:86(74.8%)ofInternalMedicineDepartment and29(25.2%)ofDermatology.Totaleconomicsavingsassociatedwithoptimisationofbiologicaltherapieswere C¼ 68804.96,C ¼ 53169,58savedinInternalMedicineDepartmentandC ¼ 15635.38savedinDermatology.Theaverage monthlysavingsforthesetreatmentoptimisationswasC ¼ 6255/ month.Numberofdrugadministrationsavoidedwas777.

ConclusionandRelevance Theoptimisationofetanerceptand adalimumabregimensinourpatientswithimmune-mediated dermatologicalandrheumatologicaldiseasesprovidedhigh efficiencybydecreasingthenumberofdrugadministrations.

REFERENCESAND/ORACKNOWLEDGEMENTS

None

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4CPS-030 IMPACTOFPHARMACEUTICALPROPOSALSIN MULTIDISCIPLINARYPROGRAMMEFORCLINICAL DECISION-MAKINGINIMMUNE-MEDIATED INFLAMMATORYDISEASES

1MDGil-Sierra, 2MDPBriceñoCasado*, 1CMoreno-Ramos, 1MABlanco-Castaño, 3CMCuadros-Martinez. 1HospitalUniversitariodePuertoReal,Pharmacy,PuertoReal, Spain; 2HospitalUniversitariodeJerezdelaFrontera,HospitalPharmacy,Jerezdela FronteraCádiz,Spain; 3HospitalUniversitariodeJerezdelaFrontera,Pharmacy,Jerezdela Frontera,Spain

10.1136/ejhpharm-2023-eahp.71

BackgroundandImportance Pharmaceuticalproposals(PPs)in amultidisciplinaryprogramme(MP)forimmune-mediated inflammatorydiseasescouldimprovedrugeffectivenessand efficiencyofclinicaldecision-making.

AimandObjectives ToevaluatetheimpactofPPsinaMP forthemanagementofimmune-mediatedinflammatorydermatologicalandrheumatologicaldiseases.

MaterialandMethods Patientswithrheumatoidarthritis (RA),spondyloarthritis,pso riasisandpsoriaticarthritis(PA) receivingetanerceptoradalimumabforatleast6months continuouslywerescreenedinMPduringMay2021to September2022.Internists,dermatologists,pharmacologists andpharmacistscomposedtheMP.Bibliographicsearchon optimaltherapeuticranges(OTRs)ofdrugswasdeveloped andPPprotocolbasedonbiochemicalandclinicalcriteria wasdesigned.Biochemicaltestsonserumdruglevelsand anti-drugantibodieswereprovidedbypharmacists.Pharmaceuticalinterviews(PIs)aboutdiseaseevolutionwereconductedbeforePPs.PPsweretreatmentoptimisation(TO) basedonextendeddosingregim ensortreatmentdiscontinuations,drugswitching(DS) duetolossofeffectiveness,or unchangedtherapy(UT).PatientswithacceptedTOhadtelematicPIsafter1and3months(answers: ‘ goodcourse ’ / ’ milddisease ’ / ’ poorcourse ’ ).Recordeddata:drugs,multidisciplinarymeetings,biochemicaltestandPIs,drugslevels andanti-drugantibodies,typeofacceptedPPsandtelematic PIanswers.

Results MPincluded645patients.Drugsdistribution:51.8% etanerceptand48.2%adalimumab.Therewere25multidisciplinarymeetings.Uptostudycut-offtime,408biochemical testsandPIswereperformed.Resultsofbibliographicsearch presentedadalimumabOTRsof5-8 mg/mLforRAandPA, 3.2-7 mg/mLforpsoriasisand4.6-12 mg/mLforspondyloarthritis.EtanerceptOTRs:2-3 mg/mLforRAandspondyloarthritis,and2-7 mg/mLforPAandpsoriasis.Serumdruglevels wereoutsidetheOTRin72.9%ofpatients.Anti-drugantibodieswerefoundin18patients.PPsacceptedwere305: 183(60%)TO,52(17%)DSand70(23%)UT.Telematic PIsanswers1monthafterTOwere:81.8% ‘goodcourse’ , 3.6% ‘milddisease’ and14.6% ‘ poorcourse ’.At3months were:69.8% ‘goodcourse’,5.7% ‘milddisease’ and24.5% ‘ poorcourse ’ .

ConclusionandRelevance MostofacceptedPPsinourMP (DSandTO)canimproveeffectivenessandefficiencyoftreatmentsforimmune-mediatedinflammatorydiseasesinclinical decision-making.AlmostthreequartersofpatientswithTO presentedgooddiseaseevolution.

REFERENCESAND/ORACKNOWLEDGEMENTS

None

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4CPS-031 THERAPEUTICDRUGMONITORINGOFCEFTAZIDIME/ AVIBACTAMADMINISTEREDBYCONTINUOUS INFUSION:PK/PDTARGETACHIEVEMENTAND

CLINICALOUTCOMES

1DFresan, 2SLuque, 2JMiedes*, 2CBosch, 3ABenítez-Cano, 4LSorlí, 2MDe-Antonio, 5NPrim, 6VVega, 4JPHorcajada, 2SGrau. 1HospitalUniversitariodeNavarra,Pharmacy Service,Pamplona,Spain; 2HospitalDelMar,Pharmacy,Barcelona,Spain; 3HospitalDel Mar,AnaesthesiologyandSurgicalIntensiveCare,Barcelona,Spain; 4HospitalDelMar, InfectiousDiseases,Barcelona,Spain; 5LaboratorideReferènciadeCatalunya,Microbiology Department,Barcelona,Spain; 6LaboratorideReferènciadeCatalunya,Analytical Department,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.72

BackgroundandImportance Ceftazidime/avibactam(CAZ/AVI) isanovelbetalactamantibioticutilisedformulti-drugresistant(MDR)gram-negativebacteria.Therapeuticdrugmonitoring(TDM)ensuresthatCAZ/AVIlevelsachievethe pharmacokinetic/pharmacodynamic(PK/PD)target.Continuousinfusion(CI)hasbeenusedtooptimiseCAZ/AVI pharmacodynamics.

AimandObjectives ToanalysethecorrelationbetweenPK/PD targetattainmentofCAZ/AVIadministeredbyCI,clinicaloutcomesandtoxicity.

MaterialandMethods PatientstreatedwithCAZ/AVIadministeredbyCIandundergoingTDMoftheCAZplasmaconcentrationswereincluded.Definitions:

CAZ/AVIPK/PDtarget:

. timethatCAZfreeconcentrationsremain4timesabovethe minimuminhibitoryconcentration(MIC)ofthecausative pathogen(%fT>4xMIC).

. Overexposure:%fT>10xMIC.

. Clinicalcure:disappearanceofallsignsandsymptomsrelated totheinfectionandnorequirementforadditionalantibiotic treatmentinitiation(exceptaspartofde-escalationstrategy) forthediseasetobeinvestigatedwithin48haftercompletion ofthestudydrug.

. Thirty-dayall-causemortality:deathfromanycauseduring the30daysfollowingtheendoftreatment.

WhenrealMICwasnotavailable,aMICof8mg/Lwas assumed.

Results Thirty-onepatients(28males,median(range)ageof 64(37-78)years)infectedwithextensivelydrug-resistant Pseudomonasaeruginosa andextended-spectrumbetalactamase-producing Klebsiellapneumoniae wereincluded(26directed treatmentsand5empirical).

Twenty-six(83.9%)achievedthePK/PDtarget,15ofwhich presentedoverexposure.Only4(26.6%)overexposedpatients presentedadversereactions(3increasedliverenzymesand1 thrombocytopenia).

Twenty-one(67.7%)patientsachievedclinicalcure,18 (85.7%)ofwhichachievedthePK/PDtarget.Therewasa higherfrequencyofpatientswitha%fT>4xMICthatachieved clinicalcure(18/26(69.2%)inpatientswithclinicalcure vs 2/5(40%)withclinicalfailure,p=0.686).

The30-dayall-causemortalitywas19.4%(6patients).A lowermortalityratewasobservedinpatientsthatdidachieve a%fT>4xMIC(14.8%)inpatientswhosurvivedvs50%in thosewhodied,p=0.096.

ConclusionandRelevance CIseemsausefulstrategytoreach thePK/PDtargetofCAZ/AVI.Fewpatientswithoverexposure presentedadverseevents.Thereseemstobeacorrelation betweenPK/PDtargetattainment,clinicalcureand30-dayall-

causemortalitybutlargerstudieswithbiggersamplesare needed.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-034 ANALYSISOFTHEEFFECTIVENESSOFSOTROVIMAB INPATIENTSDIAGNOSEDWITHCOVID-19

BSánchezRodríguez,RGazquezPerez,MTGomezSánchez,DGamezTorres,MSánchez Valera,TMorenoDiaz*. HospitalUniversitarioTorrecárdenas,Pharmacy,Almeria,Spain 10.1136/ejhpharm-2023-eahp.73

BackgroundandImportance SotrovimabisindicatedintreatmentofCOVID19inadultsandadolescentswhodonot requiresupplementaloxygenandwhoareatincreasedriskof progressingtoCOVID-severe.Thedrugisadministered accordingtoprioritisationcriteriapublishedbytheSpanish AgencyofMedicinesandHealthProducts(AEMPS)1.

AimandObjectives Toanalysetheeffectivenessofsotrovimab andtoknowtheprofileofpatients.

MaterialandMethods Observational,retrospectiveanddescriptivestudyinatertiarylevelhospital.Patientswhohad receivedsotrovimabfromJanuary/2022-May/2022were included.Variables:sex,age,mild-moderate/severedisease,vaccination-COVID,riskfactors,hospitalisation/deathat29day. EffectivenesswasmeasuredasrateofpatientswithoutprogressiontoCOVID-severe(definedashospitalisation/deathat 29days).Variableswerecollectedfromdigitalmedicalrecords andin-hospitalelectronicprescribing.

Results Thirty-sevenpatientswereincluded,meanage=61 years(21-82),20women(54.05%).Twenty-ninepatients (78.38%)hadmild-moderateCOVID.29patients(78.38%) hadreceivedacompletevaccinationregimen(3doses),6 patients(16.22%)twodosesand2patients(5.41%)not vaccinated.Riskfactors:23hypertension(62.16%),13diabetes(35.14%),5obesity(13.51%)and4asthma (10.81%).Allpatientswereimmunosuppressed.17patients (45.94%)with2riskfactors, 9with3riskfactors (24.32%),7with1riskfactor(18.91%)and2patients (5.40%)with4riskfactors.AccordingtotheAEMPSprioritisationcriteria,allbelongedtothegroupof ‘ Immunocompromisedpersonsandhigh-riskconditions,regardless ofvaccinationstatus ’ .Thehigh-riskconditionswere:23 patients(62.16%)hadrecei vedsolidorgantransplantation withimmunosuppressivetreatment,13patients(35.14%) hadreceivedimmunosuppressivetreatmentwithantiCD20 intheprevious6months(100%rituximab)and1patient (2.7%)wasreceivingactivetreatmentwithmyelotoxicchemotherapy(inotuzumab)foracutelymphocyticleukaemia. 7patients(18.9%)werehospitalised/deadat29days(3 exitus).Allthesepatientshadreceivedrituximab.30 patients(81.1%)didnotprogresstosevereCOVID.Duringthestudyperiod,6patientsattendedtheemergency department,withoutadmission.

ConclusionandRelevance Mostpatientspresentedgood responseandtolerancetotreatment.Thisresultwasindependentofprevioustreatmentsorriskfactors.Previoustreatment withanti-CD20seemstoshowatendencytoprogressionto severeCOVID.Long-termstudiesareneededtoconfirm results

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.aemps.gob.es/medicamentos-de-uso-humano/acceso-a-medicamentosen-situaciones-especiales/criterios-para-valorar-la-administracion-de-las-nuevasalternativas-terapeuticas-antivirales-frente-a-la-infeccion-por-sars-cov-2/

ConflictofInterest Noconflictofinterest

4CPS-037 INDIRECTCOMPARISONSOFBIOLOGICAL TREATMENTSINPSORIATICARTHRITIS

1CMorenoRamos*, 1MDGil-Sierra, 2MDPBriceño-Casado, 1SFénix-Caballero, 1MABlanco-Castaño. 1HospitalUniversitariodePuertoReal,FarmaciaHospitalaria,Cádiz, Spain; 2HospitalUniversitarioJerezdelaFrontera,FarmaciaHospitalaria,Jerezdela Frontera,Spain

10.1136/ejhpharm-2023-eahp.74

BackgroundandImportance Psoriaticarthritis(PA)isacomplexinflammatorymusculoskeletalandskindisease.Nowadays,thereareseveraltherapeuticoptionstotreatthisdisease. AimandObjectives Toconductindirectcomparisons(ICs) betweenabatacept,brodalumab,guselkumab,ixekizumab, risankizumab,secukinumabandustekinumabusingacommon comparatorinpatientsdiagnosedwithPA.

MaterialandMethods AreviewinPubMedandEuropean MedicinesAgencydatabaseswasperformed.Inclusioncriteria: phaseIIIrandomisedclinicaltrials(RCTs)oftreatmentscited withadouble-blindandplacebo-controlleddesign,which includedpatientspreviouslytreatedwithanti-tumournecrosis factoragents.Exclusioncriteria:RCTwithoutacomparator commontoalternativesconsideredandrecruitingtreatmentnaivepatients.AmericanCollegeofRheumatology50% improvementcriteria(ACR50)at24weeksinRCTswere selectedasendpointtoestimateabsoluteriskreduction(ARR) foreachdrug.WeconductedadjustedICsusingBucher method.ThetherapeuticalternativewiththegreatestmagnitudeofeffectinRCTswasselectedasreferencetherapy.The maximumdifferencewithoutclinicalrelevance(D)wasdefined as±16%accordingtopreviouspublishedliterature.

Results

Sevenstudieswereincluded Alltreatments –exceptabatacept–showedbenefitoverplacebo.Regardingixekizumab80mg monthly(referencetherapy),ARRswere:-4.2%[95%confidenceinterval(CI),-15.43to7.03]vsbrodalumab210mg biweekly;-9.20%[95%CI,-22.53to4.13]vsguselkumab 100mgevery8weeks;-12.20%[95%CI,-32.37to7.97]vs secukinumab300mgmonthly;-13.60%[95%CI,-25.25to1.95]vsrisankizumab150mgevery12weeks;-19.5%[95% CI,-32.30to-6.70]vsustekinumab45mgevery12weeks; and-25.50%[95%CI-37.87to-13.13]vsabatacept125mg weekly.Ixekizumabshowedstatisticallysignificantbenefitcomparedtorisankizumab,ustekinumabandabatacept.Nevertheless,nostatisticaldifferencewasfoundcomparedto brodalumab,guselkumabandsecukinumab.Ixekizumabonly demonstratedaclinicallyrelevantbenefitversusustekinumab andabatacept.

ConclusionandRelevance OurICsprovidecomparativeefficacydatabetweencurrenttherapeuticalternativesforPAin termsofACR50.Nostatisticallysignificantbenefitwas observedbetweenixekizumab,brodalumab,guselkumaband secukinumab.Ixekizumabdidnotshowrelevantclinicalsuperiorityoverbrodalumab,guselkumab,secukinumaband

risankizumab.Theseresultscouldpromotepricecompetition betweenthesedrugsandimprovetheefficiencyofPA treatments.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-038 CHALLENGESRELATEDTOTRANSITIONINGFROM HOSPITALTOTEMPORARYCAREATASKILLED NURSINGFACILITY

LVRavn-Nielsen*. HospitalPharmacyofFunen,ClinicalPharmacyDepartmentandResearch Department,OdenseC,Denmark

10.1136/ejhpharm-2023-eahp.75

BackgroundandImportance Withdecreasingnumberofhospitalbeds,morepatientsaredischargedfromhospitalstotemporarycareatskillednursingfacilitiesrequiringhandlingof morecomplexandfrailcitizensinanon-hospitalsetting.

AimandObjectives Weaimedtosystematicallymapchallenges relatedtothetransitionofpatientsfromhospitaltotemporarycareataskillednursingfacilityinrelationto(i)medicationmanagement,(ii)responsibilityofthemedicaltreatment, and(iii)communication.

MaterialandMethods Thisdescriptivestudyincludedmedical orsurgicalpatientsadmittedtohospitalanddischargedto temporarycareataskillednursingfacilityfromMay-December2022.

Results Preliminaryresultsareavailablefor67patients(52% womenandmeanage77years).Anursefromtheskilled nursingfacilityusedinaverageatenminutephonecallto coordinatewithanursefromthehospitalbeforedischarge.In 100%(n=67)ofthepatientsthemedicationtothefirstday sentfromthehospitalwasused,eveniftherein30%(20of 67)wasproblemsduetomissingupdateoftheSharedMedicationRecord,changedstrength,missingorunidentifiedmedication,orotherdiscrepancies.Only58%(n=39)receivedall neededmedicationduringthefirstdayneededforfurther medicationdispensing.Thenursesmadeinaveragethree (range0-10)callsandsentthreeelectronicallycorrespondences perpatientaboutmedicationwithinthefirstfivedays.In36 of60(60%)patientsdidthediscrepancybetweenthedischargenoticefromthenursesandthedischargeletter,not resultinanyfurtheractionfromtheskillednursingfacility. Howeverin38%(n=9)ofthe24patientrecordsthat requiredextraactionfromtheskillednursingfacility,the actioncouldhavebeenavoidedifthenursesfromtheskilled nursingfacilityhadhadthedischargeletter.Fullresultsforan expected200patientswillbeavailableandpresentedatthe EAHPconference.

ConclusionandRelevance Weidentifiedchallengesrelatedto, inparticular,lackofneededmedicationandcommunication. Athirdoftheactionsrelatedtomedicationmanagementwere consideredavoidablewithimprovedpracticesaround communication.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Corporatesponsoredresearchorothersubstantiverelationships:Thestudywasfundedbythepublic healthresearchfundoftheRegionofSouthernDenmark.

4CPS-039 CLINICALANDECONOMICIMPACTOFMULTI-

SWITCHINGFROMORIGINALADALIMUMABTO

BIOSIMILARS

1BMMuñozCejudo*, 2MRCantudoCuenca, 1BCancelaDíez, 1TChinchillaAlarcón, 1MLuqueJimenez, 1MAMoraMora, 1SGarcíaAgudo, 1GGilGonzález-Carrascosa. 1HospitalSanAgustin,Pharmacy,Linares,Spain; 2HospitalUniversitarioVirgendeLas Nieves,Pharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.76

BackgroundandImportance Astheaccesstobiosimilarsat competitivepricesincreases,itisnecessarytoevaluatemultiple switchestoprovidedataontheirinterchangeability.Recently, theEuropeanMedicinesAgency(EMA)hasnotifiedthatmedicinesapprovedasbiosimilarsintheEUmaybeprescribed interchangeably.

AimandObjectives Theobjectiveistoassesstheefficiency andsafetyofswitchingfrominnovatoradalimumab(Humira®) tobiosimilaradalimumab(Imraldi®)andsuccessivetoanother biosimilar(Hyrimoz®)inareal-lifesetting.

MaterialandMethods Retrospectiveobservationalstudyconductedina200-bedhospital.Weincludedallpatientswho hadbeentreatedwiththeinnovatoradalimumabbetween1September-2019and31-March-2022andswitchedtotwo adalimumabbiosimilars.Variabl esanalysed:clinicalprescribingservice,disease,patientswhodiscontinuedtreatmentwith biosimilarandreason.Clinicalandeconomicdatawere obtainedfromelectronicmedicalrecordsandmanagement programs.

Results Thefirstswitchfrominnovatoradalimumabtothe firstbiosimilaradalimumabincluded114patients:47.4%prescribedbytherheumatologydepartment,28.0%bythedigestiveunitand24.6%bydermatologists.

Themostfrequentdiseasewasrheumatoidarthritis (26.3%),followingbyCrohn’sdisease(23.7%),psoriasis (17.5%)andpsoriaticarthritis(13.2%).

Thepercentageofpatientsthatdiscontinuedthefirstbiosimilarwas15.8%.While61.1%ofpatientsdiscontinueddue toinefficacy,38.9%hadadverseeffects.Atotalof96patients switchedtwice.Theretentionrateafterthesecondswitchwas 96.9%.Nomajorchangesindiseaseactivitywereobserved.

Inthefirstswitch(January2019),theacquisitioncostin ourhospitalofoneunitoftheoriginaldrugwasC ¼ 431.10, whilethatofthebiosimilar(Imraldi®)wasC ¼ 176.80.Inthe secondswitch(August2019)thepriceofImraldi® wasthe sameandforHyrimoz® wasC ¼ 158.0.Ifweconsiderthemost frequentposologyinourpatients(adosageeverytwoweeks), thefirstswitchresultedinannualsavingsofC ¼ 753,745.20 andthesecondswitchresultedinC ¼ 46,949.76.Themultiswitchingof96patientsresultedinatotalsavingof C¼ 681,682.56.

ConclusionandRelevance Theretentionrateaftermultiple switchesfrominnovatoradalimumabtoadalimumabbiosimilarsishigh.Consideringthismulti-switchingsuccessfulexperiencewithbiosimilarsregardingsafetyandeconomicimpact, interchangeabilitybetweenbiologicalmedicinalproductsshould becommoninclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-040 ELECTRONICCLINICALDECISIONSUPPORTFOR PHARMACOTHERAPEUTICINTERVENTIONSTO REDUCEANTICHOLINERGICBURDENINOLDER HOSPITALISEDPATIENTS

1BMaat, 2MVanGeel*, 1TLeenders, 1AKeyany, 3DArnoldussen, 4TVanAsseldonk. 1Elisabeth-TweestedenHospital,ClinicalPharmacy,Tilburg,TheNetherlands; 2Utrecht University,DepartmentofPharmacoepidemiologyandClinicalPharmacology,Utrecht,The Netherlands; 3Elisabeth-TweestedenHospital,DepartmentofGeriatricMedicine,Tilburg,The Netherlands; 4Elisabeth-TweestedenHospital,DepartmentofNeurology,Tilburg,The Netherlands

10.1136/ejhpharm-2023-eahp.77

BackgroundandImportance Patients’ anticholinergicburdenis thecumulativeeffectoftakingoneormoreanticholinergic medications.Itisassociatedwithadverseoutcomessuchas falls,cognitiveimpairment,deliriumandincreasedmorbidity, especiallyinelderly.Previousstudiesdemonstratedthathospitalisationmayincreaseanticholinergicburden.Pharmacotherapeuticinterventionssupportedbyelectronicclinicaldecision support(eCDS)mayhavethepotentialtopreventthis.

AimandObjectives Theaimofthisstudywastoinvestigate whethertheanticholinergicburden,expressedasscoreonthe AnticholinergicBurdenScale(ACBscore),inolderhospitalised patientscouldbereducedthroughperformingeCDS-based interventionsduringhospitalisation.

MaterialandMethods

ProspectiveinterventionstudyinApril andMay2022.Studypopulation:patients 65yearswithan ACBscore 8andahospitalstayof 3days.AneCDStool wasusedtodetectpatientsthatmetinclusioncriteria. Patients’ anticholinergicmedicationwasreviewedandintervenedifpossible.Aninterventionconsistedofpharmacist-led advicetothepatient’sattendingphysicianbyphone.Primary outcome:numberandproportionofpatientswhoseanticholinergicburdenwasreducedbytheinterventions.Secondary outcomes:(i)acceptancerateofpharmacotherapeuticinterventionsbyattendingphysiciansand(ii)natureandfrequencyof anticholinergicsideeffects.Descriptivestatisticswereusedto analysetheresults.

Results 208patientswereincluded(44.7%female;meanage 75.7(±6.6)years).Anticholinergicmedicationof43 patientswasreviewedwhichledto43interventionsfor23 patients(53.5%,mean1.87(±0.81)interventionsper patient):7suggestionsfordosereduction(16.3%),4suggestionsforalternativemedication(9.3%)and32suggestions fordiscontinuationofmedication(74.4%).28ofthe43 interventionsweredirectlyacceptedbytheattendingphysician(acceptancerate65.1%)leadingtoatotalACBscore reductionof41pointsi.e.anaverageACBscorereduction of1.46points(±0.79)perintervention.33ofthe43 reviewedpatients(76.7%)experiencedoneormoreanticholinergicsideeffects.Constipationoccurredmostoften (45.2%).

ConclusionandRelevance Anticholinergicburdenwasreduced througheCDS-basedpharmacotherapeuticinterventionsin morethanhalfofreviewedpatientsandacceptancebyattendingphysicianswashigh,indicatingapromisingpotentialfor thisinitiativeinclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-041 ASSESSMENTOFQUALITYOFLIFEINPATIENTS UNDERGOINGANTIMIGRAINETREATMENT

MHernándezSánchez,MDNájeraPérez,JAGutiérrezSánchez,MACarvajalSánhez, PTorranoBelmonte,JIbanez-Caturla*,LFructuosoGonzalez,MGuillénDíaz,PPacheco López,AMartinezOrea. HospitalJoseMaríaMoralesMeseguer,Pharmacy,Murcia,Spain

10.1136/ejhpharm-2023-eahp.78

BackgroundandImportance Migraineaffects15%ofthe world’spopulationsoisnecessarytocarryoutinterventions tohelpimprovethequalityoflifeofpatients.

AimandObjectives Evaluationofqualityoflifeinmigraine patientstreatedwitherenumaborgalcanezumabbeforeadministration,threemonthsafterandoneyearlater.

MaterialandMethods RetrospectivestudyconductedinahospitalbyEQ-5D-5Lquestionnairesbeforedrugadministration, threemonthsandoneyearlater.Thefollowingdatawerecollected:sex,age,educationallevelandqualityoflifedimensions(mobility,self-care,activitiesofdailyliving,pain/ discomfortandanxiety/depression).Patientscompletedthevisualanaloguescale(VAS),graduatedfrom0(worstcondition) to10.

Results Ofthe67patients,45completedthequestionnaire afterthreemonths.16patientsdiscontinuedtreatmentbefore oneyear,sothepercentageofsurveysreceivedwas50%. Meanage48.9years(85.1%women).37.3%hadhighereducationand43.3%primaryorsecondaryeducation.Therest didnotprovidedata.

-Mobilitydimension 76.1%describedmildsymptomsand 2.98%severe.Afterthreemonths:55.22%and2.8%.One yearlater,mildsymptomsdecreased(28.87%).

-Mildself-caresymptomsweredescribedby91.1%and severeby2.98%.Threemonthslater:52.23%mildsymptoms. Oneyearlater:37.31%and0%.

-35.8%reportedmildproblemsinperformingdailyactivitiesand22.38%showedseverity.Threemonthslater,13.4% continuedwithsevereproblems.Atoneyear,mildsymptoms: 29.9%.

-Pain/discomfort severesymptomswere68.6%,threemonths later25.4%andoneyearlater4.5%.Mildsymptomsdidnot improve.

-Severeanxiety/depression initially26.9%.Threemonthslater 13.4%andoneyear6%.Mildsymptomsdecreasedfrom 52.2%to23.9%atoneyear.

OntheVASscale,amedianof5wasobtainedatthe beginningoftreatmentcomparedto6.25threemonthslater and7oneyearlater.

ConclusionandRelevance “Pain/discomfort’’ and ‘’depression/ anxiety ’’ arethemostaffecteddimensions.

Afterthreemonthsandafteroneyear, ‘’pain/discomfort’’ wasthemostimprovedand ‘’activitiesofdailyliving’’ was notaffected.

TheVASscaleshowedanincreaseinqualityoflifeafter threemonthsbyamedianof1.25pointsand2pointsafter oneyear.

Thisquestionnairehelpsustoassessthepatients‘ perspective,althoughwedonotyethavethetotalnumberof surveys.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-042 OFF-LABELUSEOFUSTEKINUMABINNONBULLOUS CONGENITALICHTHYOSIFORMERYTHRODERMA:A CASEREPORT

RPlaPasán*,CRodríguezMoreta,AGanforninaAndrades,MVManzanoMartin,SSiles Morris. HospitalPuertaDelMar,Farmacia,Cádiz,Spain

10.1136/ejhpharm-2023-eahp.79

BackgroundandImportance Nonbullouscongenitalichthyosiformerythroderma(NBCIE)isararediseasethatpredominantlyaffectstheskin,courseswithpalmoplantarkeratoderma anhidrosis,andnaildystrophy.Inseverecases,thereisalopeciaincertainareas.

AimandObjectives Theobjectiveofthisreportistodescribe theoff-labeluseofustekinumabinapatientwithNBCIE,and toassessthesafetyofthetreatmentandtolerabilityprofile.

MaterialandMethods Weranadescriptivestudyof6year oldmanwithNBCIEdiagnosedatthetimeofbirth.The patientpresentedveryitchygeneralisedNBCIEaffecting patient’squalityoflife.Patient’sskinwasentirelyaffected withvisiblerednessofapprox90%ofbodysurface.Patient wentthroughseveraltreatmentswithnosuccess:emollients emulsions,topicalandoralcorticosteroidsandH1antihistamines.

InFebruary2021,anewoutbreakoccurredthatledthe Dermatologydepartmenttorequesttheoff-labeluseof Ustekinumab.

ThePharmacyandTherapeuticsCommitteeapprovedthe treatmentinitiationbasedonthepublishedefficacystudies.

NBCIEpatientshaveadominantprofileofTH17/IL-23and ithaspreviouslybeendemonstratedthesuccessfuluseofustekinumabinpatientsaffectedbyichthyosis.

EfficacywasevaluatedbasedonIASIscheme(Ichthyosis AreaSeverityIndex).

Results Thepatientstartedtreatmentwithustekinumabin May2021withadoseof1.2mg/kg.Dosingwasprovidedby theHospitalPharmacyDepartmentadjustedasperpatient’ s weight.Thefirst2months,thepatientreceivedmonthly doseswhilehereafterthedosingwasadjustedtoabi-monthly frequency.

Atthe3rd monthoftreatment,thepatientobservedamild improvementwhilepresentingdiffusederythemawithscaling androughskininthefolds,withanimpactof60%ofbody surface.Atmonth6,afourthdoseof27,6mgofustekinumabweight-adjustedwasprovided.Thereafter,thepatient observedasignificantimprovementthatdirectlyaffectedhis qualityoflife,achievinga60%reductionextensionaccording toIASIanda66%reductionerythemaaccordingtoIASIand nosideeffectswerereported.

NeverthelessDermatologydepartmentrequesttheoff-label useofdupilumab.

ConclusionandRelevance Resultsdemonstrateustekinumab providesonlypartialresponseatmonth6ofNBCIEtreatment,withmodestbutsignificantimprovementinthe patient’squalityoflifewithagoodsafetyprofile.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-043

DRUG-DRUGINTERACTIONSWITHNIRMATRELVIR/ RITONAVIRFORCOVID-19ANDTHEROLEOF HOSPITALPHARMACISTS

JMiedes*,ARodriguez,JBarceló,DEcheverría,SGrau. HospitalDelMar,Pharmacist, Barcelona,Spain

10.1136/ejhpharm-2023-eahp.80

BackgroundandImportance Nirmatrelvir/ritonavirhasrecently beenapprovedfortreatingCOVID-19,butanelevatedriskof drug-druginteractions(DDI)hasbeenexposed.

AimandObjectives Theaimofthisstudywastoevaluate DDIwithnirmatrelvir/ritonavirandtheroleofhospital pharmacists.

MaterialandMethods Retrospectivestudyinatertiaryhospital betweenMay-September2022.Allpatientsthatreceivednirmatrelvir/ritonavirwereincluded.

Datacollected demographic,age-adjustedCharlsoncomorbidity index,medicaldepartment,concomitantdrugs.AllDDIand pharmacyinterventionswerescreenedandcategorised.

Continuousdataexpressedasmedian(IQR).U-MannWhitneyforcontinuousvariablesandChi-squareforqualitative data.

Results Atotalof48patientswith350concomitantdrugs wereselected.Female24(50%),age69(24-95)years,CHARLSON5(0-12).

DDIweredetectedin26(54.2%)patientsandin52 (14.9%)drugs.Seven(0-16)concomitantdrugsperpatient.

StatisticalsignificantdifferenceswerefoundwithATCand DDIcategory(p<0.001):cardiovascularsystemdrugshad moreX-categoryDDI(41.7%)andnervoussystemdrugshad moreC-categoryDDI(60.8%).

Haematologydepartmenthadmorepatientspresentingany DDI(23.1%,p=0.047).

NoDDIprovokedanyadverseeventduringtreatmentwith nirmatrelvir/ritonavir.

ConclusionandRelevance AhighriskforDDIwithnirmatrelvir/ritonavirwasfound,althoughmostofthemweremildand noneprovokedanyadverseevent.Cardiovascularsystemdrugs showedthemostsevereDDI.

Haematologypatientsandthosereceivingnervoussystem drugshadhigherprevalenceforDDI.

AlmosthalfofpharmacyrecommendationsweretodiscontinuethedrugpresentingtheDDI.Noneofthepharmaceuticalinterventionsinducedanyadverseeventderivedfromthe modificationofconcomitanttreatmentduringnirmatrelvir/ritonaviradministration.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-044 EFFECTIVENESSANDSAFETYOFDIFFERENTINITIAL DOSESOFARIPIPRAZOLEINTRAMUSCULARDEPOT MMoraCortes*,MDGil-Sierra,CMDominguez-Santana,MBlancoCastaño,GCano Martinez. HospitalUniversitarioPuertoReal,PharmacyDepartment,PuertoReal,Spain 10.1136/ejhpharm-2023-eahp.81

BackgroundandImportance Aripiprazoleintramusculardepot treatmentisusedformaintenanceofschizophreniainadult patientsstabilisedwithoralaripiprazole.Thisdrugcanbe startedwithsingleordoubleinjection(400or800mg).Real clinicaldataofthesetworegimenscouldberequiredtooptimisetreatments.

AimandObjectives Todescribeefficacyandsafetyoftwodifferentdosesforstartingaripiprazoledepottherapy.

Abstract4CPS-043Table1 21(40.4) 13(25) 5(9.6) 4(7.7) 3(5.8) 2(3.8) 2(3.8) 1(1.9) 1(1.9) MedicaldepartmentwithDDI,n(%) Haematology Oncology Nephrology Pneumology Emergencyroom

H-systemichormonalpreparations 6(23.1) 4(15.4) 3(11.5) 3(11.5) 3(11.5) Pharmacyinterventiononconcomitantdrugs,n(%) Discontinuation Adverseeventsmonitoring Dosereduction Substitution Efficacymonitoring

23(44.2) 15(28.8) 7(13.5) 5(9.6) 2(3.8)

MaterialandMethods Retrospectivedescriptivestudywith periodbetweenMarch2019andJuly2021.Hospitalised patientswhostartedtreatmentwitharipiprazoledepotwere included.Outcomeswerecollectedfrommedicalrecordsand electronicprescriptionprogramme:gender,age,diagnosis, startdoses,oralaripiprazoleconcomitanttreatment,concomitantantipsychotictherapy.Effectivenessendpointwaspercentageofpatientswithrequirementofhospitalisationfor singleanddoubleinjectiongroupswitharipiprazoleintramusculardepottreatmentat12and26weeks.Safetywasevaluatedbytherateofadverseeffects(AEs)andtypesineach scheme.

Abstracts A38 EurJHospPharm 2023;30(Suppl1):A1–A180

anxiety(18.8%),somnolence(18.8%)akathisia(12.5%)and others(24.9%).MostfrequentAEsindoubledosepopulation: akathisia(33%),anxiety(22%),sedation(11%),somnolence (11%)andothers(23%).

ConclusionandRelevance Startwithdoubledosearipiprazole depottreatmentshowedlowerpercentagesofre-hospitalisation thansingle-doseregimenformaintenancetreatmentofpatients withschizophrenia.SimilarAEswereobservedforboth regimens.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-046 AQUALITATIVESTUDYOFFEASIBILITYAND ACCEPTABILITYOFAPHARMACYPRIORITISATION

TOOLKITBYAFRAILTYFOCUSEDMULTIDISCIPLINARY TEAMINANACUTEHOSPITALEMERGENCY DEPARTMENT

EKennedy*,VSilvari. CorkUniversityHospital,Pharmacy,Cork,IrelandRep

10.1136/ejhpharm-2023-eahp.82

BackgroundandImportance Thenumberoffrail,older patientspresentingtotheemergencydepartment(ED)is increasing.Asfrailtyishighlylinkedtomedicationissues,a pharmacyprioritisationtoolkit(PPT),completedbyafrailty multidisciplinaryteam(MDT),iseffectivetoidentifypatients whowouldbenefitthemostfromthefrailtypharmacist’ s medicationreview.

AimandObjectives Toinvestigatefeasibilityandacceptability ofafive-questionPPTbytheMDTafterfourmonthsofuse.

MaterialandMethods Ananonymised,mixedmethodsquestionnaire(open/closedquestions)wasdistributedtotheMDT (consultant,registrarandclinicalnurseingeriatrics,dietician, occupational,physioandspeech&languagetherapists).The questionsaimedatestablishingbarriersandfacilitatorstothe PPT.Thestraightforwardnessofthetoolkitquestionswas rankedusingaLikertscale.Afocusgroupwasheldto expandontheresultsofthequestionnaireandinformfuture worktoenhancethetoolkituse.

Results Of8questionnairescirculated,7werereturned.Barriersidentified,inordermostmentionedthemetoleast:

·difficultyidentifyinghighriskmedications

·lackoffullmedical/medicationhistoryinED

·difficultyinterpretinghandwrittennotes

·timetakentocompletethetoolkit

AlthoughtimetakentocompletethePPTwasabarrier,5 respondentsreportedanaverageof4minutesforcompletion, whichwasdeemedacceptablewhendiscussingatthefocus group.Thegroupagreed,thatsomebarriersarenotmodifiablesuchlackoffullmedical/medicationhistoryinED.The mostcommonfacilitatorwasrecognitionthatthetoolclearly identifieswhenapharmacyreviewisneeded.Furthereducation,self-learningandpracticeofthetool,butalsoupskilling onhighriskmedicationsandfallsrelatedmedications,were consideredpotentialfuturefacilitators. ‘Regularuseofmore than10medications’ wasthemoststraightforwardquestionto answerinthetoolkitwhiletheleastwas ‘Reasonforadmissionpotentiallyrelatedtomedicationsoradmittedwithnonmechanicalfall’

ConclusionandRelevance Thetoolkitwasgenerallyaccepted bytheMDT,theconcisecompletiontimewasconsidered adequatetakingintoaccountthehighprevalenceof

medicationissuesinfrailpatients.Basedontheresponses,furthereducationtothefrailtyMDTisplanned,withmainfocus onrecognitionofhighriskmedicationsandfallsrelated medications.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-047 IMPACTOFCORTICOSTEROIDONTHEEFFECTIVENESS OFIMMUNOTHERAPY

AGándara*,CAparicio,SFuertes,AForneas,PNTerroba,AFernandez,RPampin, CDuran,CMartínez-Múgica. CabueñesUniversitaryHospital,PharmacyDepartment,Gijon, Spain

10.1136/ejhpharm-2023-eahp.83

BackgroundandImportance Symptomaticmanagementofcancerpatientsofteninvolvestheuseofcorticosteroids.Recently, anassociationhasbeenfoundbetweenbaselinecorticosteroid levelsandtheresponseratetoimmunotherapyinnon-smallcelllungcancer(NSCLC).

AimandObjectives Analysetheimpactofcorticosteroid administrationontheeffectivenessofimmunotherapy.

MaterialandMethods Retrospectiveanddescriptivestudy includingpatientswhoinitiatedimmunotherapybetween2014 and2021forthetreatmentoflocallyadvancedormetastatic stageNSCLC.Patientswithoutaresponseassessmentwere excluded.

Thefollowingvariableswerecollectedandanalysed throughtheoncologypatientmanagementprogrammeandthe electronicmedicalrecord:age,sex,EasternCooperative OncologyGroup(ECOG),histology,drug,durationof treatment.

Accordingtotheirpharmacydispensingrecord,patients wereclassifiedintotwogroups:thosewhohadreceivedcorticosteroidsatdoseshigherthan10mgofprednisoneorequivalentwithintwomonths(beforeorafter)ofimmunotherapy initiationthestartofimmunotherapyandpatientswhodid notreceivecorticosteroidsinthatperiodoftime.

EffectivenesswasassessedbycomparingProgressionFree Survival(PFS)betweenthetwogroupsofpatients.

Results Thestudyincluded144patients(103men)witha meanageof66years.97%ofpatientshadanECOG £ 1at baseline.Intermsofhistology,65%wereadenocarcinomas, 33%wereepidermoidandtheremaining2%wereundifferentiatedNSCLC.47%ofpatientsweretreatedwithpembrolizumab,51%withatezolizumabandtheremaining,26%with nivolumab.

Thecorticosteroidsprescribedwere prednisone(50%),dexamethasone(38%)andmethylprednisolone(3%).

Thegroupofpatientswhoreceivedcorticosteroidshada PFSof3,72months(95%CI;2,76-6),whilethegroupof patientswhodidnotreceivecorticosteroidshadaPFSof 5,52months(95%CI;4,56-9).Thedifferencesfoundwere statisticallysignificant(p=0,021).

ConclusionandRelevance Theuseofcorticosteroidsatdoses higherthan10mgprednisoneorequivalentwithintwo months(beforeorafter)ofimmunotherapyinitiationhasbeen showntoreducePFSofpatientswithNSCLC.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-049 TELEPHARMACYANDNEWHEALTHCAREMODELS: CLOSERTOPATIENTS

MMartínez-Pérez,CCastaño-Amores*,MTNieto-Sánchez,MÁUrbano-Fernández, JCabeza-Barrera. HospitalUniversitarioSanCecilio,Pharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.84

BackgroundandImportance TheWHOdefinestelemedicineas ‘theprovisionofhealthservices(wheredistanceisadeterminingfactor)byhealthprofessionalsthroughtheuseofinformationandcommunicationtechnologies(ICTs)fortheexchange ofinformationrelevanttodiagnosis,treatment,diseaseprevention,researchandevaluation,andforthecontinuingeducationofhealthprofessionals,withtheultimategoalof improvingthehealthofpopulationsandcommunities’.Telepharmacyispartofthetransformationprocessofourcurrent healthcaresystemthatallowsustoprovidepharmaceutical caretospecificgroupsofpatients,suchasfrailpatientsor thosewhohaveproblemstravelingtothehospital.

AimandObjectives Theaimofthisstudyistodescribeand analysetheimplementationofa telepharmacyconsultation in asecond-levelhospital.

MaterialandMethods ThestudywasconductedfromFebruary 2021toMay2022.Patientswereselectedascandidatestobe includedinthetelepharmacyconsultationforpharmacotherapeuticfollow-up,todetectandresolveanymedication-related problems,toanalyseandimprovepatientadherenceandto checkthatthefollow-upbythemedicalspecialistwas effective.

Results Atotalof262patientswereidentifiedascandidates toparticipateintheprojecttosendmedicationtotheir respectivehealthcentresduetodifficultiesinaccessingour hospital;247patients(94%)wereselectedforregularappointmentsandinterviewsinthetelepharmacyconsultationevery 3,6or12months.Atthetimeoftheconsultation,5.70% (n=15)ofthepatientscouldnotbecontacted.Theaverage telepharmacytimewas12h/monthwithanaverageof15 minutesperpatient.

In86(32.8%)patientsamedication-relatedproblem(MRP) wasdetected:23.2%occurrenceofadverseeffects,22.4%dispensingerrors,9.6%prescriptionerrors,8.0%insufficiently treatedhealthproblems,7.2%pooradherencetotreatment, 4%incorrectadministrationofmedication,0.8%inadequate storageofmedication,24.8%other.

ConclusionandRelevance Telepharmacyinvolvesimproving adherencetotreatmentanditsmonitoring,detectionofpharmacologicalinteractionsorsideeffects.Telepharmacyallows achievinginternaloptimisationofresourcemanagementand careburdenandimprovesaccessibilitytohealthservicesfor patients,byreducingtripstohospital,timeandresourceconsumption.Telepharmacyguaranteesacontinuous,patient-centredcaremodel.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-050 ANALYSISOFREAL-LIFEUSEOFIBRUTINIBAFTER RELAPSETOCONVENTIONALCHEMOTHERAPYIN PATIENTSWITHCHRONICLYMPHOCYTICLEUKAEMIA

AMartínRoldán,MDMSanchezSuarez,CAlarcón-Payer,CMontero-Vilchez*,AJimenez Morales. VirgendeLasNievesUniversityHospital,PharmacyDepartment,Granada,Spain

10.1136/ejhpharm-2023-eahp.85

BackgroundandImportance Ibrutinibhasrevolutionisedthe treatmentofchroniclymphocyticleukaemia(CLL).Clinical trialdatashowedsimilarsurvivalbetweenpatientsrandomised toibrutiniborchemoimmunotherapywithcrossovertoibrutinibatprogression.

AimandObjectives Outcomeanalysisofthereal-lifeuseof ibrutinibafterrelapsetoconventionalchemotherapyin patientswithchroniclymphocyticleukaemia.

MaterialandMethods Observationalretrospectivestudyof patientstreatedwithibrutinibassecondlinefrom2017to thepresentatatertiarylevelhospital.Clinicalvariables:sex, age,diagnosisdate,comorbidities,EasternCooperativeOncologyGroupscale(ECOG),BinetStagingSystem,cytogenetics (mutationTP53,immunoglobulinheavy-chainvariableregion gene(IGHV),chromosomedelection(11,13,12and17), treatment,duration,response(complete,partial)andrelapse, progression-freesurvival(PFS),adverseeffects,dosemodificationordiscontinuation.Datawasobtainedfromelectronic prescriptionwiththeapplicationPrisma® andelectronichealth recordswithDiraya®.

Results 31patientsweretreatedwithibrutinib(18patientsas secondlineand13asthird).Medianage71years(IQR6578),51.6%male.Medianageofdiagnosis2012(IQR20082014).29.5%ofpatientshadprevioushypertension,23.6% kidneydisease,17.3%diabetesmellitus,11.8%cardiacdiseasesand5.5%respiratorypathologies.41%ofpatientshad BinetStagingA,28.4%Band5.8%C.Allpatientshad ECOG0.TP53mutatedin16patients,15withunmutated IGHV,24with11qnegativeand18with13qand17qnegative.Treatmentsusedasfirstlinewerechlorambucil(9),fludarabine,cyclophosphamideandrituximab(7),bendamustine andrituximab(5).14patientsachievedcompleteresponse,4 partialand7discontinuedduetotoxicity.PFS19.17months. Assecondlineinpatientswithoutibrutinib,themostfrequent treatmentwasbendamustinewithrituximab(50%).Allexcept onestartedwith420mgdose.Mediandurationoftreatment was32months.11patientsreduceddoseduetotoxicity (66.6%diarrhoea,16.6%renalfailureandskintoxicity),7 suspendedindefinitelyduetocardiactoxicityand4temporarilyduetocardiacandgastrointestinaltoxicity.4patientsdied fromcausesotherthanthedisease.Nopatientlostresponse totreatment.

ConclusionandRelevance Treatmentwithibrutinibproved effectivenessassecondorthirdlineinCLL.However,adverse effectsrequiredoseadjustmentsandsometimes discontinuation.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-051 IMPACTOFTHENEWANTIEPILEPTICDRUG MONITORINGPROGRAMMEONTHEACTIVITYOFTHE PHARMACYANDNEUROLOGYDEPARTMENTS

1RJuvanyRoig, 1NMasBauza, 1PCleriesRovira*, 2MFalipCentellas, 1ÍGonzalez Caballero, 1CRiberaPuig, 1CPorredonAntelo, 3RRigoBonnin, 2JXSalaPadró, 1MBBadia Tahull. 1BellvitgeUniversityHospital,Pharmacy,L’hospitaletdeLlobregat,Spain; 2Bellvitge UniversityHospital,Neurology,L’hospitaletdeLlobregat,Spain; 3BellvitgeUniversity Hospital,ClinicalLaboratory,L’hospitaletdeLlobregat,Spain

10.1136/ejhpharm-2023-eahp.86

BackgroundandImportance In2016therapeuticdrugmonitoringprogramme(TDMP)beganfornewanticonvulsantdrugs

(NAD)forinpatientsandoutpatientsatourhospital.Weekly multidisciplinarymeetingswereheldtoreviseout-of-range troughdruglevels(TDL)onepilepticoutpatients,andto makeearlydrugadjustmentinterventions(EDAI)beforetheir scheduledclinicalfollow-up.

AimandObjectives ToevaluatetheimpactofNADTDMPon theactivityofthePharmacyandNeurologydepartments.

MaterialandMethods

Inpatients Quantificationofpharmacokineticinterventions(PI) andpatientsmonitoredbetween2016-2021.

Outpatients ActivityanalysisbetweenJuly2017andMay 2019:TDLrevision,patientsmonitoredandnumberofEDAI made.TDLandEDAIpercentagecalculationforeachdrug.

Results

Inpatients AnticonvulsantdrugPIwere56%ofallPI(6.067 of10.910)duringthestudyperiod.PIofclassicanticonvulsantdrugs(CAD)decreasedfrom934in2016to348in 2021(63%).In2021thepercentageofPIofNADandCAD were27%and16%(602and348outof2.209)respectively.

LevetiracetamandLacosamideaccountedfor63%(380)and 27%(163)ofallmonitoredNAD.RegardingCADmonitoring Valproatewasthemost86%(299)andFenitointheleast4% (15)monitored.

Outpatients 1.096TDLoutof2.324orderedwererevised (47%)whichbelongedto424patientsofatotalof877 monitored(48%).273TDL(25%)ledtoanEDAI,which affected196patients,thatis46%ofrevisedpatientsand 22%ofallmonitoredpatients.MostEDAIsupposedan increaseorreductionofdosage,51%and34%(139and 92outof273)respectively.Lev etiracetam,Perampaneland LacosamidewerethemostmonitoredNAD:26%(286), 13%(145)and10%(110)respectively,andthemost EDAI-prone:29%(79),27%(73)and11%(29) respectively.

ConclusionandRelevance InclusionofoutpatientstoTDMP allowedearlydrugadjustmentofalmosthalfoftherevised patients.

Thecreationofamultidisciplinaryteamthatincludespharmacistsandneurologistswithafocusonactivemonitoringof NADTDLmightbesignificanttobettercareforepileptic outpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-052 LONG-TERMMONITORINGOFUREAASTREATMENT FORHYPONATREMIAASSOCIATEDTOINADEQUATE SECRETIONOFANTIDIURETICHORMONE(ISADH)

PTorrano-Belmonte,LFructuoso-González,JIbanez-Caturla*,MHernandez-Sánchez,

Sanchez,MVentura-Lopez. HospitalMoralesMeseguer,Pharmacy,Murcia,Spain

10.1136/ejhpharm-2023-eahp.87

BackgroundandImportance Normalbloodsodiumlevels(BSL) isbetween136-145mEq/L.ISADHcourseswithhyponatremia,plasmatichypoosmolality,highurineosmolality,andhigh natriuresis.Availabledrugsaredemeclocyclineandlithium, bothnephrotoxic,andvasopressinreceptorinhibitors,suchas tolvaptan,whichareeffectivebuthighlycostly.

AimandObjectives Todescribetheexperienceofuseofurea asanalternativefortreatmentofISADHandresultsmonitoredoneyearaftertreatment.

MaterialandMethods

Retrospectiveobservationalstudyin whichpatientstreatedwithurea(powderfororalsolution) wereanalysedalongtwoyears(January2020-December2021) andoneyearaftertreatment.Datacollectionof:age,sex, quantificationofBSL(atadmission,duringureatherapy,60 daysafterdrugadministrationandoneyearaftertreatment), initialtherapy,durationofureatreatmentandneedoftolvaptanuse.

Results Totalofpatientswas11.Meanagewas82years(7194years).45%werewomen.Averagedurationoftreatment was15days(3-60days).Initialtherapywashypertonicsaline solution,waterrestrictionand/orloopdiureticsorpotassium sparingagents.Onlyonepatientdidnottolerateurea.Dosage wasvariable:in54%was15gdaily,27%15gbidand18% 30gdaily.

Patientswereclassifiedaccordingtoinitialhyponatremia: 27%hadmildhyponatremia(130-135mEq/L),45%moderate (125-129mEq/L),and27%severe(<125mEq/L).

Resultswere

-Mildhyponatremia 66%recoveredBSL,while33%remained mildlyhyponatraemic.

-Moderatehyponatraemia,60%normalisedBSLand20% worsenedtoseverehyponatraemia.20%didnotanalised.

-Severehyponatremia,66%normalisedBSL.33%didnot haveanalyticalcontrol.

45%ofpatientsachievedBSLoncetreatmentended.27% requiredtreatmentwithtolvaptan15mgdaily.

50%ofpatientswithureaasmonotherapymaintainedBSL 60daysafterfinishingtreatmentand81.8%keptnormalBSL afteroneyearoftreatment.Just9%isstillintreatment.

ConclusionandRelevance Mostclinicalguidelinescontemplate ureaasanoptionforhyponatremiaforISADH,butitisnot clearitspreferencerespectotheralternatives.Ureaisshown tobeasafeandmoderatelyeffectiveoption,andalso,more effective.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-053 KOUNISSYNDROMESECONDARYTOMETAMIZOLE:A CASEREPORT

1COrtíJuan*, 1RAguilarSalmeron, 2CEscobarBolaños, 1XLarreaUrtaran, 1MBruguera Teixidor, 1CSubiranaBatlle, 1RSacrestGüell. 1HospitalUniversitariDr.JosepTrueta, PharmacyDepartment,Girona,Spain; 2HospitalUniversitariDr.JosepTrueta,Allergology Department,Girona,Spain

10.1136/ejhpharm-2023-eahp.88

BackgroundandImportance Kounissyndrome(KS)isanacute coronarysyndrome(ACS)triggeredbymastcellandplatelet activationinthecontextofanaphylacticreactions.ThediagnosisofKSrequiresahighindexofsuspicionandshouldbe consideredinpatientspresentingwithACS,plusotherassociatedsymptomssuchaspruritus,rash,urticariaorangioedema, shortlyafteradministrationofanewdrugorpossibleallergic stimulus.

AimandObjectives Todeterminethecontributionofpharmacistinallergicreactions.

MaterialandMethods A75-year-oldpatientwasadmittedtoa regionalhospitalforscheduledsurgeryforanteriorrectus dehiscence.Duringsurgery,coincidingwiththeadministration ofmetamizole,hepresentedhypotension,tachycardiaand decreasedoxygensaturation,sotheinfusionofthisdrugwas

JAGutierrez-Sánchez,MGuillén-Diaz,AMartínez-Orea,PPacheco-Lopez,MACarvajal-

immediatelywithdrawn.DespiteadministrationofIVhydrocortisone,hypotensionanddesaturationpersist.Thepatient begantofibrillateandwentintocardiorespiratoryarrestand cardiopulmonaryresuscitationmanoeuvreswerestarted.The patientrequiredtheadministrationofadrenaline,amiodarone, noradrenaline,atropineanddobutamine.

Results Hewastransferredtoourcentreforintraoperative anaphylacticshockwithtroponinsincreasingfrom41ng/Lto 3144ng/Linthefollowingdeterminationandelevationof serumtryptaseconcentrationto15.4 mg/L,whichsupportsthe suspicionofanaphylaxissecondarytometamizole.Allergology Departmentperformsdiagnosticskintestsforlatexandmetamizoleallergy.Theskintestswereperformedaccordingto internationalguidelinesandincluded15-minutereadingsfor immediatereactions.PharmacyDepartmentperformedthe preparationforskintestssolutionsformetamizole,PRICK (400mg/ml)andintra-dermoreaction(IDR14mg/mland IDR210mg/ml)inthehorizontallaminarflowcabinet.The IDRisonlyperformedonthepatientifthePRICKskintest isnegative.

TheskintestwasnegativeforlatexandpositiveinIDR2 formetamizole.Pyrazoloneallergywasconfirmedandwas probablythecauseofKounissyndrome.

ConclusionandRelevance Drugallergiescansometimescause severereactionssuchasanaphylacticreactionsorKounissyndrome.Theprognosisofthesereactionsdependsonacorrect andimmediatediagnosisandrapidtreatment.

Electrocardiogramsanddifferentlaboratorymarkerssuchas tryptaseandtroponinsareavailablefordiagnosticorientation. SuspectedallergyshouldalwaysbeconfirmedbyallergytestingandthePharmacyDepartmentcanensurecorrect preparation.

REFERENCESAND/ORACKNOWLEDGEMENTS

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AimandObjectives TodescribetheuseofintrathecalL-AmB inCandidameningitisinonepatient.

MaterialandMethods A59-year-oldwomanwithahistoryof obesitywithmetabolicsyndromewasadmittedtotheNeurosurgeryServiceforbilateralcerebellarischemicinfarction needingdecompressivecraniectomy.Duringherevolutionshe presentedasacomplicationCSFfistularequiringlumbar drainingofCSFandsubsequenturgentsurgicalintervention. CSFanalysisrevealedleukocytes1398/mm3,6.38mg/dLof glucoseand315mg/dLofprotein. C.albicans and Nakaseomycesglabrata (previouslynamed C.glabrata )wereisolatedin removedadiposeflapandCSF,respectively.Intravenousand intrathecalantifungaltherapywasrequiredandso,thePharmacyServicewasaskedtodevelopaL-AmBintrathecal injection.

Results TreatmentwithintravenousL-AmB(5mg/kg/day)and oralflucytosine(25mg/kg/6hours)wereinitiated.Afterten days,duetotheinabilityofremovingthelumbardrainand thepersistenceofCNSinfection,L-AmBintrathecalwas added(0.5mg/day,dissolvedin3mLof5%dextrose).Given thegoodevolution,itwasproposedtode-escalatetovoriconazole,flucytosineandintrathecalL-AmB.IntrathecalL-AmB wasdiscontinuedatthe20thdayoftreatmentwhentheCSF cellcount,glucoseandproteinlevelsreturnedtonormallevelsandthelastfourCSFcultureskeptsterile.L-AmBtreatmentwaswelltolerated,andnosideeffectswereobserved. ConclusionandRelevance Despitethelimitationsintheinterpretationofthiscasereport,theadministrationofintrathecal L-AmBmayconstitutealesstoxictherapeuticalternativeto conventionalAmB(deoxycholate)forCandidameningitis.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.DOI:10.1155/2015/340725.

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4CPS-054 USEOFINTRATHECALLIPOSOMAL-AMPHOTERICINB FORCANDIDAMENINGITIS:ACASEREPORT

1PGrandaLobato, 1MSánchezdeCastro, 1SGarcíaSánchez, 1SHeinzMorán, 1ÁmyusteGutiérrez, 1PSánchezLópez, 1PPratsOliván, 2GRamírezOlivencia, 1ACorrea Pérez, 1MHGonzaloSalado. 1HospitalCentraldelaDefensaGómezUlla,Pharmacy, Madrid,Spain; 2HospitalCentraldelaDefensaGómezUlla,InfectiousDiseases,Madrid, Spain

10.1136/ejhpharm-2023-eahp.89

BackgroundandImportance AmphotericinB(AmB)isastandardtreatmentforopportunisticfungalpathogenssuchascryptococcalmeningitis.Itstoxicityhasbeenreducedbyusing lipidformulationsofAmb(L-AmB),allowingtheadministrationofhigherdoses.However,AmBshowsslowandpoor penetrationtothecerebrospinalfluid(CSF)whenadministeredbyintravenousinjection.Toachievehigherconcentration inCSF,intrathecaladministrationofL-AmBhasbeensuccessfullyused.AppearanceofdifferentCandidaspeciesinCSF areinfrequentbutcritical.Therearestillsignificantknowledge gapsinpharmacodynamicsandpharmacokineticsastheexperienceofcentralnervoussystem(CNS)Candidainfections treatedwithL-AmBintrathecalliteratureislimitedtoone casereport.

4CPS-057 SEARCHINGFORATREATMENTFORPERIPHERAL TISSUEISCHEMIAINNEWBORNS:ACASEREPORT RDíazPerales*,LYunqueraRomero,RSaldañaSoria,CGallegoFernández. Hospital MaternoInfantildeMálaga,UnidaddeGestiónClínicadeFarmacia,Málaga,Spain 10.1136/ejhpharm-2023-eahp.90

BackgroundandImportance Peripheraltissueischemia(PTI)is acomplicationofvascularcatheterisationinnewborns.Conservativemeasuresareofteninsufficient.Topicalnitroglycerin hasbeenusedoff-labelassalvagetherapy.Wewererequested 2%topicalnitroglycerinointment(TNO)asacompounding formulaforPTIintwoprematures.Duetotheshortageof rawmaterial,aneffectiveandsafealternativehadtobe soughtout.

AimandObjectives Toidentifyanalternativefor2%TNOas therapyforPTI,andthus,todescribetheeffectivenessand securityofapplying0,4%rectalnitroglycerinointment(RNO) intheaffectedareas.

MaterialandMethods ProspectivestudybetweenJanuary-June 2022,of2newbornswithPTI.Patient1:female,31+5;2 days,1500g,ecchymosisin4fingers.Patient2:female,24 +6;5days,595g,markednecrosisinthepadsof5fingers.

Themanufacturinglaboratoryandotherhospitalswerecontactedtofindouttheavailabilityoftherawmaterial.Wealso

consultedtheSpanishPharmacyPreparationsandCompoundingGroup,andtheSpanishAgencyforMedicinesandMedicalProducts(AEMPS)databaseforalternatives.We systematicallysearchedMEDLINE,PubMed,Embase,Google Scholar.Aclosefollow-upwascarriedoutincoordination withpaediatricians,andelectronicprescriptionandcomputerisedmedicalrecordswereconsulteddaily,toevaluateeffectivenessandsecurity.

Results Duetothelackofrawmaterialandalternativesinits preparation,othermarketedpharmaceuticalformsofnitroglycerinwereevaluated(intravenoussolution,transdermal patches,sublingualtablets,rectalointmentandsublingual spray).Applicationof0.4%RNOintheaffectedareaswas consideredthemosteffective,safest,easytodose,andquickesttoacquirealternative.

Patient 1:ecchymosiscompletelydisappearedin48hoursof treatment.Noadverseevents,normalcontrolofmethaemoglobin.Goodperfusionwithoutvasoactives.Patient2:10daysto remitthemarkednecrosis.Welltolerated,initialslightdropin bloodpressure,needinganincreaseofdopamine.Lossofthe phalangeswasavoidedinbothpatients.

ConclusionandRelevance Commercialised0.4%RNOinPTI waseffectiveandsafeinlowbirthweightprematurenewborns.However,itisnecessarytobestudiedinmore patients.

Pharmacist’sroleinthepreparation,controlanddispensing ofmedicinesisessential,anditsintegrationinthemultidisciplinaryteamiscrucialtoensureaquickresponseinemergencysituations.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

parametricmethodswereperformedforhospitalstay, expressedbymedian(Q1-Q3).

Results Atotalof286patientswereincluded(105beforegroup,181after-group).Age69.9(12.7)years,women 40.6%.SAPSII28.8(8.1),FEV148.5(19.1).Nosignificant differenceswereobservedbetweengroups.

Pneumonia(18.7%vs18%,[CURB-652vs1,p=0.290]), COPDexacerbation(51.4%vs60%,p=0.351),bronchoaspiration(11.2%vs14%,p=0.120).Beta-lactams62.2%,quinolones31.1%,clindamycin2.1%.

Inafter-group,5.5%patientswereinsemi-criticalunit.No oxygentherapy27.1%,nasalcannula37.6%,ventimask 37.6%,noninvasivemechanicalventilation1.7%.

Hospitalstaywaslowerafterprotocolimplementation:8 (6-13)vs10(7-15)days(p=0.120),alsodaysofintravenous administration:8.3(4.9)vs12.3(19.1)days(p=0.007),days tooraladministration:3.6(2.3)vs5.3(2.9)days(p=0.000), andtreatmentduration:7.7(4.1)vs10.1(4.2)days (p=0.000).Nostatisticalsignificantdifferenceswerefoundin 7-daymortality,30-daymortality,30-dayreadmissionorclinicalcure.Clinicalfailurewasduetosuperinfection(11.1%vs 40%,p=0.165),inadequateempiricaltreatment(77.8%vs 60%,p=0.211)andfailureafterswitchtooraladministration (11.1%vs0,p=0.240).Nodifferencesobservedinthrombophlebitis,catheterbacteremiaorgastrointestinaltoxicity incidence.

ConclusionandRelevance Despitenotachievingstatisticalsignificance,probablybecauseofthelackofstatisticalpower,a 2-dayreductioninhospitalstaywasobserved.

Earlyswitchtooralantibiotherapywassafewithoutan increaseinadverseeventsorworseclinicaloutcome.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-059 EFFICACYANDSAFETYOFEARLYSWITCHTOORAL

ANTIBIOTHERAPYINPNEUMOLOGY:PROPENSITY SCORE-MATCHEDANALYSIS

1DEcheverría, 1ARodriguez, 2MDomínguez, 2PAusin, 2EBalcells, 1JMiedes*, 3SGómezZorrilla, 3JPHorcajada, 1SGrau. 1HospitalDelMar,Pharmacy,Barcelona,Spain; 2Hospital DelMar,Pneumology,Barcelona,Spain; 3HospitalDelMar,InfectiousDisease,Barcelona, Spain

10.1136/ejhpharm-2023-eahp.91

BackgroundandImportance Sequentialintravenous-to-oralantibiotictherapyhasbeenassociatedtonumerousbenefits.This strategyhasnotbeenstudiedinthecaseofpatientswithlung diseasewhoselateresolutionofrespiratoryfailurecoulddelay theswitchtooraltreatment.

AimandObjectives Theaimofthisstudywastoevaluatethe efficacyandsafetyofearlyswitchtooralantibiotherapyin pneumologydepartment.

MaterialandMethods Quasi-experimentalstudybefore-afterin atertiaryhospital.

TheprotocolwasestablishedbyAntimicrobialStewardship PrograminFebruary2018.

Inclusioncriteria intravenousantibiotictreatmentpotentially modifiabletooraladministrationatthetimeofadmissionto pneumology.Before-groupincludedpatientsfromDecember 2015toFebruary2018.After-groupfromMarch2018.

Dataexpressedbymean(standarddeviation)andabsolute frequencies.Propensityscorematchingadjustedbyage,pulmonaryhypertension,genderandpulmonaryfibrosis.Non-

4CPS-060 EFFECTIVENESSANDECONOMICANALYSISOF WEIGHT-BASEDVERSUSFIXEDDOSINGOF PEMBROLIZUMABINNON-MALLCELLLUNGCANCER 1JIbanez-Caturla*, 1PTorrano-Belmonte, 1LFructuoso-González, 1JAGutiérrezSánchez, 2PPachecoLópez, 1MÁCarvajalSánchez, 1MGuillénDíaz, 1AMartínezOrea, 1JLeónVillar, 1JCTitosArcos. 1HospitalMoralesMeseguer,PharmacyService,Murcia,Spain; 2Hospital RafaelMendez,PharmacyService,Lorca,Spain

10.1136/ejhpharm-2023-eahp.92

BackgroundandImportance Pembrolizumabisananti-PDL-1 monoclonalantibodywidelyusedinavarietyoftumouraldiseases.Initiallyusedinafixed-doseregime,trialsshowedthat aweight-baseddosingwasmorecost-effectiveandthusitwas authorisedbythePharmacyCommitteeinourcentre.

AimandObjectives Tocomparetheeffectivenessofpembrolizumab,eitherasafixed200mgdoseorasaweightbased2 mg/kgdoseeverythreeweeks,incombinationwithpemetrexedandplatinum,usedinthefirstlinesettingastreatment ofnon-squamousnon-small-celllungcancer(NSCLC),witha CPScount<50%.Inaddition,toevaluatetheeconomic impactofthisdosingchange.

MaterialandMethods Retrospective,observational,descriptive studyofallpatientstreatedwithpembrolizumab,pemetrexed andplatinuminnon-squamousNSCLCbetweenJanuary 2018-August2022.Collectedvariables:age,sex,weight,dosing,numberofcycles,bestresponse,progresion-freesurvival (PFS),overallsurvival(OS).Actualcostwascalculated

accountingforeachpatient,cycleandmilligramofpembrolizumabadministered.

Results Forty-sixpatients(38menand8women),witha medianof65yearsold(range39-77)wereincluded.26 patients(57%)receivedaweightbased,2mg/kgdose(WD group).Themedianbodyweightwas73kginbothgroups (range49-105).Overallresponserate(complete/partial response)was60%intheWDand50%intheFDgroup.

PFSwas13.24months(CI95%10-16.5)onaverageinthe WDgroupand13.7months(CI95%8.1-19.1)intheFD group.OSwas18.15months(CI95%14.3-22)intheWD groupand18.16(CI95%12.6-23.6)intheFDgroup.Nosignificantdifferenceswerefoundinthelog-ranktest.

PatientsintheWDgroupreceivedanaverageof148± 27mgofpembrolizumabforamedianof22cycles;the FDgroupreceived200mgandamedianof41cycles. Mostpatients(95%)receivedalowerdosethanthosein theFDgroup.Onaverage,thetotaltreatmentcostper patientwasreducedby34%intheWDgroup.TheestimatedsavedpublicexpenditurewasC ¼ 420852inthis pathology.

ConclusionandRelevance Pembrolizumabweight-baseddosing wasaseffectiveasthefixeddoseregimeandreducedcostsin patientswithNSCLC.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-061 APPLICATIONOFPROPORTIONOFDAYCOVERED (PDC)TOEVALUATEADHERENCEANDPERSISTENCE TOTREATMENTWITHFINGOLIMODINPATIENTS WITHMULTIPLESCLEROSIS

1CBotto*, 2APalazzo, 1MSantonocito, 1GCancellieri, 1EdeLuca, 3SRealmuto, 3DLo Coco, 2PPolidori. 1UniversitàDegliStudiDiPalermo,ScuolaDiSpecializzazioneInFarmacia Ospedaliera,Palermo,Italy; 2AoorVillaSofia – Cervello,UocFarmacia,Palermo,Italy; 3Aoor VillaSofia – Cervello,UocNeurologiaEStrokeUnit,Palermo,Italy

10.1136/ejhpharm-2023-eahp.93

BackgroundandImportance Multiplesclerosis(MS)isa chronic,neurodegenerativediseaseofthecentralnervoussystemwithanunpredictableandpotentiallydisablingcourse. AlthoughthereisnodefinitivecureforMS,thedisease-modifyingdrugs(DMDs)representavailablestrategiestoimprove thepatient’squalityoflifetreatingrelapses,modifyingthediseasecourseandmanagingsymptoms.Therapeuticadherenceis essentialtoobtaintheefficacyofthesetreatments:poor adherencereducesitsclinicaleffectivenesswhichcanadversely impactdiseaseprogression,MS-relatedhospitalisationand mortalityrates.

AimandObjectives Theaimofthisstudywastoevaluate adherenceandpersistencetotherapywithfingolimod,anoral DMD,inpatientsfollowedupbyaMSreferencecentre.

adherence(PDC<40%),partialadherence(PDC=40–79%) andadherence(PDC 80%)1

Results ThestudyfindingsshowedPDCvalues>80%in41 patients(89.1%),40%<PDC<80%in1patient(2.2%)and PDC<40%in4patients(8.7%).Amongthepatientswithlow adherence,twoofthesesuspendeddefinitivelythetreatment withfingolimod,twosuspendedittemporarilyduetobad compliance,whileonewaslostatfollowup.Anyway,41 patientsshowedpersistencetofingolimodtreatmentover365 days.

ConclusionandRelevance Fromthedataobtaineditispossible toassertthattheoraltherapywithfingolimodpresentsgood adherenceandcompliance,veryimportantfactorstogetclinicaleffectivenessofMSpharmacologicaltreatment.Thisstudy showedalsotheimportantroleofhospitalpharmacist, togetherwiththeclinician,inmonitoringmedicationadherence.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.DegliEsposti etal.ClinicoeconOutcomesRes.2022; 14:139–147.

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4CPS-062 EVALUATIONANDFOLLOW-UPOFPAEDIATRIC PATIENTWITHSHORTBOWELSYNDROMEON TREATMENTWITHTEDUGLUTIDE:CASEREPORT MTGomezSanchez,FDFernandezGines,BSanchezRodriguez,DGamezTorres, MSanchezValera,TMorenoDiaz*. HospitalTorrecardenas,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.94

BackgroundandImportance Shortbowelsyndrome(SBS)is anunusualdisordercausedbyresectionofapartofthe smallbowel.Frequentlythesepatientsaredependenton totalparenteralnutrition(TPN)becausetheysuffermalnutrition.Long-termTPNisassociatedwithcomplications suchasinfectionsandthr ombosis.Teduglutideisaglucagon-likepeptide(GLP-2)analoguethatincreasestheproliferationofintestinalmucosalcellscausinganincreaseinthe absorptionsurfaceareaanda reductioninthevolumeof TPN.

AimandObjectives Toevaluatetheeffectivenessofteduglutide inaPN-dependentpaediatricpatientwithSBS.

MaterialandMethods Aretrospective,observationaland descriptivestudyoftheonlyreferencedcasewasdesignedto evaluatetheeffectivenessoftreatmentwithTeduglutide.For thispurpose,thereductionofthevolumeofTPNuntilits withdrawalwasanalysed.Thiswithdrawalmustbecomplete toestablishthesuccessoftreatmentwithteduglutide.Data wereextractedfromtheclinicaldatabaseoftheAndalusian HealthSystem(Diraya).

MaterialandMethods

Withtheaimtoevaluatetherapeutic adherenceandpersistence,aretrospectivestudyhasbeenconductedincollaborationwithaneurologyward,byanalysing thefingolimodprescriptionsregisteredina12months’ period (June2021 – May2022).Thisstudyhasinvolved46patients. Datawereobtainedbyconsultinganinformaticprogramindicatingforeachpatient:age,therapystartandeventualend date,switchfromortootherdrugs.Adherencewascalculated asproportionofdayscovered(PDC)andclassifiedinlow

Results ThepatientneededaTPNperday.Thefollowing figureshowsthepercentageofvolumeofTPNvariedevery twomonthsfromthestartoftreatmentinourpatient.The volumeofTPNwas500mLwhenthefirstdoseofteduglutide(0.05mg/kg/day)wasadministered.However,thevolumedecreasedby45.6%(272mL)after14months. Subsequently,volumeincreasesofupto8%(month18) weredetectedduetoadmissionsfordiarrhealcrises.Finally, PNwassuspendedduetomultiplecomplicationsafter22 months.

Abstract4CPS-062Figure1

ConclusionandRelevance Inourcase,thepercentageofTPN volumereductionishighercomparedtootherstudiescollectedinarecentmeta-analysis.1 Moreover,theTPNwas totallywithdrawninlessti methandescribedinsome studies.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Bioletto,F.,D’Eusebio,C.,Merlo,F.D.,Aimasso,U.,Ossola,M.,Pellegrini,M., Ponzo,V.,Chiarotto,A.,deFrancesco,A.,Ghigo,E.,Bo,S.EfficacyofTeduglutideforParenteralSupportReductioninPatientswithShortBowelSyndrome:A SystematicReviewandMeta-Analysis. Nutrients 2022, 14,796.https://doi.org/ 10.3390/nu14040796

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4CPS-063 USINGMACHINELEARNINGTOPREDICT PHARMACEUTICALINTERVENTIONSINAHOSPITAL SETTING

1EJohns*, 2JGodet, 3AAlkanj, 1MBeck, 1LDalMas, 4BGourieux, 2EASauleau, 4BMichel. 1AgenceRégionaledeSantéGrandEst,DirectiondelaQualité-delaPerformanceEtde L’innovation,Strasbourg,France; 2HôpitauxUniversitairesdeStrasbourg,Départementde SantéPublique – GroupeMéthodesRechercheClinique,Strasbourg,France; 3Centrede RechercheEnBiomedecinedeStrasbourg,LaboratoiredePharmacologieEtdeToxicologie Neurocardiovasculaire – FacultédeMédecine,Strasbourg,France; 4HôpitauxUniversitaires deStrasbourg,ServicePharmacie-Stérilisation,Strasbourg,France

10.1136/ejhpharm-2023-eahp.95

BackgroundandImportance Thedigitisationofhospitaldrug prescriptionshasenabledthecollectionofahugeamountof data.Developingpharmaceuticaldecisionsupportsystemsis facilitatedthankstoartificialintelligenceandthecollected data.

AimandObjectives Buildapredictivealgorithmthatcan detectprescriptionsrequiringpharmaceuticalintervention (PI).

randomforeststatisticalmodelareencouraging,yetperfectible,especiallythesensibility.

Anewapproachofmodelconstructionisundergoing includingapharmaco-ontologygatheringthecharacteristicsof thedrugsbasedonthesummariesofproductcharacteristics. ThiswillallowthemodeltolearnthecontextoftheprescriptionleadingtoaPIanddetectPIswithnewdataina similarcontext.Suchpharmaco-ontologyexistsregrouping onlydrug-druginteractions.1

ConclusionandRelevance PharmaceuticaldecisionsupportsystemsusuallypredictPIsthankstorulesdesignedbypharmacists.Ourmodelaimstodetectthesehigh-riskprescriptions thankstomachinelearningandpreviousdatavalidatedby clinicalpharmacistsintheirdailypractice.Theontologywill helpassociateacontexttoeachPIpreviouslydetectedand predictPIsonnewdata.IntegratingthismodelintoprescribingassistancesoftwarewillmakeiteasierforclinicalpharmaciststodetectPIs.

Thepredictivealgorithmdevelopedinourresearchproject isnotasubstituteforpharmaceuticalanalysisofprescriptions. Itisanexpertsystemfortheidentificationofrisksituations thatwillbeintegratedintoateamapproachtoclinicalpharmacypractices.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.CossinS,LebrunL,LobreG,LoustauR,JouhetV,GriffierR,MouginF,DialloG, ThiessardF.Romedi:AnOpenDataSourceAboutFrenchDrugsontheSemantic Web. StudHealthTechnolInform.2019Aug21; 264:79–82.doi:10.3233/ SHTI190187.PMID:31437889.

4CPS-066 BIOLOGICALTREATMENTSUSEDTOTREAT HIDRADENITISSUPPURATIVAINATERTIARYHOSPITAL MMMestreRibot*,RGonzálezGarcía,MTMartínConde,JRRomaMora,NArranz Pascual,DSoyMuner. HospitalClínicIProvincialdeBarcelona,Farmàcia,Barcelona,Spain 10.1136/ejhpharm-2023-eahp.96

BackgroundandImportance Hidradenitissuppurativa(HS)isa chronicinflammatoryskindiseasewhichcausespainful inflamedlesionsintheapocrinegland-bearingareasofthe body,withhighimpactonpatients’ qualityoflife.Treatment isbasedonacombinationofsurgicalandmedicaltherapies, withinbiologicalagentsplayakeyrole.Adalimumabiscurrentlytheonlybiologicapproved,whatleadstouseoff-label biologicaltreatmentswhenadalimumabfails.

AimandObjectives Ourobjectiveistoanalysetheprescription ofbiologicaltreatments,dosagesusedandadherenceinatertiaryhospitaltotreatHS.

MaterialandMethods

Thealgorithmwasdevelopedusing machinelearningtechniques.Datacollectedduringfour yearswereextractedfrompatients ’ recordsfromtheprescriptionassistancesoftwareofaselectedhospital.Various variableswereused,includingPIsgeneratedbyclinical pharmacists.

Results Weused1,961,176drugprescriptions,including 312,591PIs,todevelopthematrixofthepredictivealgorithm inR.Themodelclassifieseachdrugprescriptionaccordingto thepresenceortheabsenceofaPI.Theresultsaftera

MaterialandMethods Medicalchartsofpatientstreatedwith biologicaldrugsforHSwherereviewed.Demographicfeatures (sex,age,weight,height,smokingstatus),clinicalstage(hurley score)andbiologicaltreatmentused –includingdosages,numberofpreviouslinesandadherence– wererecorded.

Results Forty-onepatientswereincluded.Medianagewas43 (IQR30-52)andmedianbodymassindexwas27(IQR2433).Nineteenoutof41hadahurleyscoreof3(H3)and22 hadahurleyscoreof2(H2).Twenty-sevenpatientswereon adalimumab,includingallpatientsH2and5patientsH3.Sixteenoutof27wereon40mgq.wk,and11wereon80mg q.wk.TherestofH3patientswereon:infliximab10mg/kg (4),infliximab7.5mg/kgq.4.wk(1),subcutaneousinfliximab

ConflictofInterest Noconflictofinterest

240mgq.wk(2),brodalumab210mgq.wk(3),tocilizumab 8mg/kgq.4.wk(1),guselkumab100mgq.4.wk(2),andustekinumab90mgq.8.wk(1).MedianpreviouslinesinH3 patientswere1(IQR1-3),andfiveofH3patientsdoesnot showasatisfactoryimprovementwithcurrenttreatment.Only 3patientsshowedanadherence<80%totreatmentbasedon recordeddispensations.

ConclusionandRelevance Mostpatientswithmoderateto severeHSdonotrespondatapproveddoseofadalimumab, forcingtousehigherdosesorswitchingtootherbiological treatments,whicharealsousedathigherdosesthanindicated intheSummatyProductCharacteristics.Unfortunately,these treatmentsarenotalwayseffective,andthereisnoconsensus abouthowtomanageit.Itisnecessarytokeepaclosefollow upofthesepatients,lookingforadverseeventsandlackof adherence.

REFERENCESAND/ORACKNOWLEDGEMENTS

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Hospitalmedicationchangesoccurredin79%ofpatients; 71%werecommunicatedtotheGPand42%tohomecare nurses.

Medicationreviewsrevealed55DRPsin67%ofpatients, mostlyrelatedtomedicationreconciliation,doseor interactions.

Follow-uptelephonecallson23patientsrevealedDRPsin 30%ofthese.

TestinfourGPs:

Seveninterviewswereperformed – oneperGP,threewith thepharmacistsinvolved(mean71minutes).

Clinicalstaffhadpositiveattitudestowardstheintervention andsawtheadvantagesofapharmacistwithashared employment.Economicswereidentifiedasabarrierforfuture implementation.

PharmacistsinsmallerGPclinicshadeasieraccesstocliniciansandfeltamoreintegratedmemberoftheteam.

Thelargerclinicsweremorestructuredandusedtointerdisciplinarycollaboration,allowingthepharmacistmorefreedomtoworkindependently.

4CPS-067 ACROSS-SECTORALPHARMACISTINTERVENTIONFOR PATIENTSINTRANSITIONBETWEENHOSPITALAND

GENERALPRACTICE:APILOTSTUDY

1CASørensen, 2LJeffery, 3JFalhof, 4PHarbig, 5KRoelsgaard, 6SGram, 1COlesen. 1Hospital PharmacyCentralDenmarkRegion,ResearchandDevelopment-ClinicalPharmacy,Aarhus N,Denmark; 2HospitalPharmacyCentralDenmarkRegion,ClinicalPharmacy,Silkeborg, Denmark; 3GeneralPractice,Laegefaellesskabet,Grenaa,Denmark; 4AarhusUniversity, PublicHealth,Aarhus,Denmark; 5RandersRegionalHospital,MedicalDepartment,Randers, Denmark; 6RandersRegionalHospital,Administration,Randers,Denmark

10.1136/ejhpharm-2023-eahp.97

BackgroundandImportance Drug-relatedproblems(DRPs) incross-sectoraltransitionsareoftenseen,primarilydue toinconsistentinformationaboutpatients ‘ medicinesat transfer.

AimandObjectives Totestacross-sectoralpharmacistinterventionforpatientsinhealthcaretransitions.

MaterialandMethods ThestudywasperformedinonehospitalandfourGeneralPractices(GPs).Thepharmacistshad sharedemploymentbetweentheHospitalPharmacyandthe GPs.

Intervention Transition GPtoHospital

Medicationhistory,medicationreconciliation,updatingthe SharedMedicationRecord(SMR).

Transition HospitaltoGP

Medicationreview,overviewofmedicationchanges,followuptelephonecalls,communicationwithGPonDRPs.

TheinterventionwastestedinoneGPandevaluated descriptively.

Afterwards,theinterventionwastestedinfourGPswith differingcharacteristicsandevaluatedqualitatively(semi-structuredinterviews).

Results TestinoneGP:

Transition GPtoHospital(n=14)

TheGPupdatedtheSMRin86%ofpatients.ThemedicationhistoryrevealeddiscrepanciesbetweenSMR-prescriptions andactualmedicationintakein64%ofthesepatients;91% ofdiscrepancieswereeasilysolvedbycorrectingtheSMR.

Transition HospitaltoGP(n=30)

ConclusionandRelevance GPshadlittlefocusonupdatingthe SMRpriortoadmission.Medicationchangesandfollow-up planswerenotalwayscommunicatedtothepatient,GPor homecareatdischarge.

Sharedemploymentwithuniqueaccesstohealthrecordsin bothsectorswasthemostimportanttoolinidentificationand resolutionofDRPs.

TheinterventionwastransferabletootherGPsandwas consideredacceptableandrelevantbyall.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest

4CPS-068 CONDUCTIONOFANAUDITTOREDUCETHE ECONOMICLOSSDUETOUNUTILISEDONCOLOGICAL DRUGPREPARATIONS

1MSantonocito*, 1GCancellieri, 1CBotto, 1EDELuca, 2SGambino, 2PPolidori. 1Università DegliStudiDiPalermo,Ssfo-ScuolaDiSpecializzazioneInFarmaciaOspedaliera,Palermo, Italy; 2OspedaliRiunitiVillaSofia – Cervello,UOCFarmacia,Palermo,Italy

10.1136/ejhpharm-2023-eahp.98

BackgroundandImportance Thecostsrelatedtounutilised oncologicaldrugspreparationshavethegreatestimpactonthe expenseofahospital.Inordertoreducewastes,itispossible toactonprocedurethatleadstofailuretoadministeran alreadycompoundedoncologicaldrug.Thisrepresentsaneconomiclossforhospital.

AimandObjectives Theaimofthestudyistoidentifythe reasonsthatledtothefailuretoadministerthecompounded oncologicaldrugs,inordertoreduceerrorsand,wastesand economicloss.

MaterialandMethods Theanalysiswasconductedbetween January-August2022.Datawerecollectedthroughanarray includingprotocol,dosage,wardandreasonfornon-administration.Italsoincludedwhetherthedrughadbeenreused (totallyorpartially)orthrownawayandtheeconomicloss. Toconducttheanalysisanauditwascarriedoutbetween doctors,pharmacistsandnursesaimedatidentifyingboththe reasonsthatcausestheeconomiclossandpossible improvements.

Results Of14.000preparations,92werenotadministered; 27/92weretotallyorpartiallyreused,65/92werethrown awaycausinganeconomiclossofC ¼ 31.461,09.Thereasonsthatledtothenon-ad ministrationweremainlyattributabletotheunsuitableclinicalconditionofthepatientat thetimeofadministration(64%-59/92).In19%(17/92)of casestheadministrationwasnotcarriedoutduetoerrors intheprescribingphase(therapeuticindicationinadequate totheprotocol,absenceofofflabelauthorisation,etc.).In 12%(11/92)ofcases,the causewasinadequatecommunicationbythedepartment(therapyconfirmedintheabsence ofthepatient).5%(5/92)ofcaseswerecausedbyinterruptionofadministrationduetoadversereactionsduringthe infusion.

ConclusionandRelevance Theresultsobtainedhavehighlightedtheinterventionsneeded.Itwouldbeadvisableforthe confirmationofthetherapytotakeplaceonthesamedayas thespecialistvisitandclinicaltests.Inthisway,wasterelated tothepatient‘snon-presentationand/orthepresenceofclinicalconditionsincompatiblewiththeadministrationwouldbe avoided.Itisalsoimportantthatthevalidationofaprotocol iscarriedoutbyatleasttwospecialists(includinganoncologist)inordertoavoidinappropriateprescriptions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-070 THECLINICALPHARMACIST:ANESSENTIALACTORIN TIMESOFCRISIS

1CRhaymi*, 2AChaibi. 1MohammedVUniversity-FacultyofMedicineandPharmacy, Pharmacy,Rabat,Morocco; 2MohammedVUniversity-FacultyofMedicineandPharmacy, ClinicalPharmacy,Rabat,Morocco

10.1136/ejhpharm-2023-eahp.99

BackgroundandImportance Duringthehealthemergency periodrelatedtotheemergenceoftheCOVID-19pandemic,clinicalpharmacistshaveplayedavitalroleinmitigatingmedicationerrors,especiallyprescriptionerrorsin hospitals.

AimandObjectives Theaimofthisstudywastocarryouta descriptiveanalysisofthepharmaceuticalinterventions(PI)on theprescriptionsofthepatientsoftheCOVIDunitsofour establishment.

MaterialandMethods Aprospectivestudywasconductedon patientswithpositiveCOVID-19statusadmittedtoahospital COVIDunitoveraperiodoffourmonths.Thepharmaceuticalanalysispromptedinterventionstorectifymedicationrelatederrors.

Results Thestudyincluded108patients.Prescriptionanalysis ledto63PIs.Thesexratio(M/F)was0.5inafavourof femalepredominance.Hypertensionwasthemostcommon cardiovasculardisease,affecting34%ofpatients.Mostdrugrelatedproblemswereoverdoseaccountingfor38%(16/63). ThemostcommonPIin40%ofcaseswasdosageadjustment (18/63).Themaindrugclassesconcernedweregeneralantiinfectiveagentsforsystemicuse25%(16/63),followedby corticosteroids23%(15/63)andhydroxychloroquine19%(12/ 63)especiallyintheeventofinteractionwithdrugsthat lengthentheQTinterval.

ConclusionandRelevance Thecommitmentofclinicalpharmacyinsuchapandemicisthereforeimportant.Itspresence hasledtoareductionintheproblemsofdrugprescriptions.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Noconflictofinterest.

ConflictofInterest Noconflictofinterest

4CPS-072 REAL-WORLDEXPERIENCEINHAEMOPHILIAB PATIENTSAFTERSWITCHINGTOFIXEXTENDEDHALFLIFEUSINGPHARMACOKINETICPOPULATION SOFTWAREANDMONOCOMPARTMENTALMODEL

1JCJuárez-Giménez*, 2OBenítez-Hidalgo, 3JARomero-Garrido, 4CMateos-Salillas, 5SGonzález-Piñeiro, 6JBMontoro-Ronsano. 1HospitalUniveristarioVallD’hebron, Pharmacy,Barcelona,Spain; 2HospitalUniversitarioVallD’hebron,Faramcia,Barcelona, Spain; 3HospitalUniversitariolaPaz,Farmacia,Madrid,Spain; 4HospitalUniversitariolaPaz, Faramcia,Madrid,Spain; 5ComplejoHospitalarioUniversitarioACoruña,Farmacia,A Coruña,Spain; 6HospitalUniveristarioVallD’hebron,Farmacia,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.100

BackgroundandImportance NewstrategieshavebeendevelopedfortheprophylactictreatmentofpatientswithhaemophiliaB(HB)suchasextendedhalf-liferecombinantfactorIX concentrates(rFIXEHL).Theseproductshaveshownfavourablepharmacokineticproperties,attainingahalf-life3-to5foldlongerinrFIXEHLcomparedtostandardFIX concentrates

AimandObjectives Efficiencyofapharmacokinetic-basedtailoredprophylaxis-dosingscheduleversusstandarddosing(DS) iscompared,inHB,treatedwithtworFIX-EHL.

MaterialandMethods Observational,analytical,prospective, multicentrestudy,involvingHBpatients,beingtreatedwith rFIX-EHLlinkedtoalbumin(rFIX-FP)ortofragmentcrystallisable(rFIX-Fc).Demographicandclinicaldata,andDSand dosinginterval(DI)andactualFIXtroughlevelswere recorded.Pharmacokineticcharacterisationwasperformedfollowingbothapopulation(WAPPS-HEMO)andalinearonecompartment(OC)approach.ForeachapproachandrFIX preparation,anestimationofthetimetothetargettrough(5 IUFIX/dL)wasmade.Statisticalanalysiswasperformedby meansoftheStudent-Fishert-test.

Results Fifteenpatientswereincluded,ninebeingtreated withrFIX-FP(meanage,33years;weight60kg),andsix withrFIX-Fc(49years,86kg).MeanDSwas3222UI(SD, 1716)every11,9days(SD,4,4)forrFIX-FPpatients;and 4333UI(SD,606)every14,0days(SD,0,0)forrFIX-Fc patients.TheindividualtailoredDI,fora0,05UI/dLtrough targetwas:applyingOC;13,6days(SD,5,1),-1,8days(SD, 5,9)vsDS,representing240IU/day(SD,136,1)forrFIX-FP (p=0,40),and8,6days(SD,1,2),+5,4days(SD,1,2)vs DS,representing508IU/day(SD,65,6),forrFIX-Fc, (p<0,001).ApplyingWAPPS-HEMO;itwas15,0days(SD, 5,1),-3,1days(SD,5,3)vsDS,217IU/day(SD,114,7),for rFIX-FP(p=0,12),and10,2days(SD,2,5),+3,8days(SD, 2,5)vsDS,449,7UI/day(SD,129,1),forrFIX-Fc, (p=0,012).

ConclusionandRelevance EfficiencyofrFIX-EHLtreatment followingapharmacokinetic-basedtailoredprophylaxis-dosing scheduleversusDSinHBpatients,issignificantlybetter. Dependingonthecommercialpreparation,rFIX-FPorrFIXFc.Daily-adjusteddose,fora5IUFIX/dLtroughtarget, rangesbetween217-240IU/dayforrFIX-FP,or449-508IU/ dayforrFIXFc,accordingtothetwopharmacokinetic approaches(OCandpopulationbased).

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-073 ANALYSISOFEFFECTIVENESSANDPOSITIVE PREDICTIVEVALUEOFANTIMICROBIALSTEWARDSHIP ALERTSUSINGACLINICAL-DECISIONSUPPORT

SYSTEM

1MÁAmor*, 1CdeCáceres-Velasco, 1AMelgarejo-Ortuño, 2XGarcía-González, 1EMatillaGarcía, 1BRodríguez-Vargas, 1PBautista-Sanz, 1CAApezteguia-Fernández, 3JAMeleroBermejo, 3MMateos-González, 1RMoreno-Díaz. 1HospitalUniversitarioInfantaCristina, ServiciodeFarmacia,Parla,Spain; 2HospitalGeneralUniversitarioGregorioMarañón, ServiciodeFarmacia,Parla,Spain; 3HospitalUniversitarioInfantaCristina,Serviciode MedicinaInterna,Parla,Spain

10.1136/ejhpharm-2023-eahp.101

BackgroundandImportance Clinical-decisionsupportsystems (CDSS)arecommonlyusedinclinicalpracticetogenerate antimicrobialstewardship(ASP)-alerts,whichcouldhelpimplementevidence-basedrecommendations.

AimandObjectives Toanalyseuse,effectiveness,andpositive predictivevalue(PPV)ofabundleofASPalertsgeneratedby CDSSinafirst-levelhospital.

MaterialandMethods Observational,retrospectivestudy.Inclusioncriteria:ASPalertsgeneratedbetween1November2021 and31August2022.Thebundleofalertsincluded(1)>7 daysofintravenousantimicrobialtherapy(IAT),(2)transition fromIATtooraltherapy,(3)antimicrobialdosageadjustment inrenalimpairment,(4)therapeuticantibioticmonitoring (TAM)and(5)durationofrestrictedantimicrobials(RA)(carbapenems,daptomycin,piperacillin/tazobactam,linezolid,tigecycline,ceftazidime/avibactam,echinocandinsandvoriconazole) >72hours.Totalnumberofgeneratedalerts,numberof patientswithatleastonealertduringtheirhospitalstay,type ofalertandantimicrobialrelatedthattriggeredthealertwere recordedandanalysed.

Effectivenesswascalculatedasaproportionbetweenalerts requiringinterventionandtotalnumberofalerts.PPVwas calculatedasaproportionbetweenacceptedinterventionsand totalnumberofalerts.Bothproportionswereexpressedas percentages(%).

Results Atotalof2,546alerts(on927patients)generated duringthetimeofstudy.Mostfrequentantimicrobialsthat triggeredthealertswere:28.6%piperacillin/tazobactam(727/ 2,546),13.6%meropenem(346/2,546),7.5%linezolid(190/ 2,546),6.7%levofloxacin(171/2,546)and6.2%ceftriaxone (158/2,546).ThetypeofASP-alertgeneratedwas:>7daysof AIT(32.0%),durationofRA>72hours(31.6%),antimicrobialdosageadjustmentinrenalimpairment(19.2%),transition fromIATtooraltherapy(13.2%)andTAM(4.0%).

Theeffectivenesswas14.5%,withaPPVof9.6%.By type,effectivenesswas9.5%(type1),21.1%(type2),11.0% (type3),19.6%(type4)and18.1%(type5).PPVforthese alertswas6.2%(type1),19.9%(type2),9.2%(type3), 11.8%(type4)and8.7%(type5).

ConclusionandRelevance ThemostfrequentlytriggeredASPalertsweredurationofIATandRA,andantimicrobialdosage adjustmentinrenalimpairment.However,thosealertswitha higherPPVweretransitionsfromIATtooraltherapyand TAM.FurtherstudiesareneededtodetermineASP-alertswith ahighereffectivenesstooptimisetheiruseandtoavoidalert fatigue.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-074 EFFICACYANDSAFETYOFSOTROVIMAB:RESULTSOF ARETROSPECTIVEOBSERVATIONALSTUDYINA FRENCHHOSPITAL

1TBrandin*, 1HCapelle, 2JAllemand, 3LFooCheung, 1CDumazer. 1CentreHospitalier EdmondGarcin,Pharmacy,Aubagne,France; 2CentreHospitalierEdmondGarcin, Infectiology,Aubagne,France; 3CentreHospitalierEdmondGarcin,NursingHome, Aubagne,France

10.1136/ejhpharm-2023-eahp.102

BackgroundandImportance COVID-19resultsinhospitalisationordeathinolderpatientsandthosewithunderlyingconditions.Sotrovimabisamonoclonalantibodythatwas designedtopreventprogressionofCOVID-19inhigh-risk patientsearlyinthecourseofdisease.

AimandObjectives Weaimedtoassesstheefficacyandsafety ofsotrovimabforadultsinfectedwithCOVID-19ina400bedFrenchhospital.

MaterialandMethods Thisisamonocentricretrospective observationalstudyconductedon36patients,whichreceived sotrovimabfromJanuarytoMarch2022inourhospital. Adultpatientswhohadapositiveresultonrt-PCRorantigen SARS-CoV-2testingandanonsetofCOVID-19symptoms withintheprevious5dayswereeligibletotreatmentby sotrovimab.Thepatientswereathighriskofprogression becauseofolderage( 80y)ordiabetes,obesity,chronickidneydisease,congestiveheartfailure,chronicobstructivepulmonarydisease,asthmaandcancer.Allthepatientsprovided writteninformedconsent.

Results Outofthe36patientstreated,meanagewas82.6± 9.5ywith80%patients 75y,BMI25.3±4.7andsexratio 0.3.Almostallofthemwerelivinginnursinghomes(30 patients).83%had 2conditionsconsideredtoberiskfactorsforprogressionofCOVID-19.Themostcommonrisk factorswere:age 80,congestiveheartfailureandcancer.30 patients(83%)hadreceivedacompleteschemaofCOVID19vaccineand18patients(50%)hadalreadybeeninfected withtheSARS-CoV-2virus.Amonghospitalisedpatients, nonewhoreceivedsotrovimabwasadmittedtoICU.Among thoselivinginnursinghome,nonewasadmittedtohospital. Mostofthepatientshadfewsymptoms.3patientshaddiseaseprogressionleadingtolowflowoxygenation.2patients diedthemonthfollowingtheinfection,including1related toCOVID-19.Amongunvaccinatedpatients,33%(2/6)had diseaseprogression.3patientsreceivedcorticosteroid,5anticoagulantand4antibiotictherapy.Adverseeventwas reportedfor1patient(itchyskinreaction)butnonehad seriousadverseevent.

ConclusionandRelevance Sotrovimabreducestheriskofdiseaseprogressiontohospitalisationordeathamongpatients withmild-to-moderateCOVID-19.Thisseemstobelegitin ourstudy,asdoesthesafety,especiallyforelderlypatients. Also,theeffectivenessofthisantibodyagainstdiseaseprogressionappearstobebetterforvaccinatedpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-075

PERSISTENCEANDCOSTANALYSISOFSECUKINUMAB INPATIENTSWITHPSORIATICARTHRITIS, ANKYLOSINGSPONDYLITISANDPSORIASIS

10.1136/ejhpharm-2023-eahp.103

BackgroundandImportance Weknowthatthelackofpersistenceofthetreatmentaffectsitsefficacyandcanleadtoan increaseinthedose,whichtriggersanincreaseinriskand cost.Knowingthepersistenceoftreatmentwithsecukinumab inpsoriaticarthritis(PsA),ankylosingspondylitis(AS)and psoriasis,couldleadtonewlinesofresearchthatcompare thedifferenttherapeuticalternativesforthesepathologies basedonthecostperpersistenttreatment.

AimandObjectives Todeterminethepersistenceoftreatment withsecukinumabandthecostofpersistenttreatmentinits approvedindications:PsA,ASandpsoriasis.

MaterialandMethods Descriptive,retrospectiveobservational study,whichincludedadultpatientswithPsA,ASandpsoriasistreatedwithsecukinumabbetweenNovember2017and August2021.Thedemographicvariablesofageandsexwere considered.Themainvariableswerethepersistenceofsecukinumabtreatmentandtheannualcostperpersistenttreatment. TreatmentpersistencewasanalysedusingtheKaplan-Meier testforeachindication.Thecostperpersistenttreatmentwas calculatedbasedontheprobabilityofpersistence,whichwas estimatedwiththeareaunderthecurveforeachofthethree curvesobtainedintheKaplan-Meieranalysis.Thesecondary variablescollectedwerediagnosis,durationandinterruption ofsecukinumabtreatmentandpreviouslinesoftreatment.

Results Weincluded138patientswithameanageof52.2± 13.9years,ofwhom67(48.6%)werewomen.ThemeanpersistenceofsecukinumabtreatmentinPsAwas36.5(95%CI 30.7-42.2)months,forASitwas39.7(95%CI34.3-45.2) monthsandinpsoriasisitwas40.4(95%CI35.1-45.7) months.Arelationshipbetweenage,gender,indication,and lineoftreatmentwithsecukinumabpersistencecouldnotbe established.Medianpersistencewasnotreachedforanyof thethreediagnoses.Theannualcostperpersistenttreatment, calculatedbasedontheprobabilityofpersistence,was C¼ 11,064forPsA,C ¼ 8,183forAS,andC ¼ 15,420for psoriasis.

ConclusionandRelevance Meansecukinumabpersistencewas higherforpsoriasiscomparedtoPsAandAS(p>0.05).The highestannualcostperpersistenttreatmentwasforpsoriasis. Morestudieswithreal-lifedataandlargersamplesizesare neededtoestablishthefactorsthatplayakeyroleinthepersistenceofsecukinumabtreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

BackgroundandImportance Doravirineisanon-competitive, non-nucleosidereversetranscriptaseinhibitor(RTI),usedin combinationregimenswithotherantiretroviralsforthetreatmentofHIV-1withoutevidenceofresistancetonon-nucleosideinhibitors.

AimandObjectives Todescribetheclinical-epidemiological characteristicsandtheclinicalandanalyticalevolutionof DORAassociatedwith(ABC/3TC),(DTG)and(RPV).

MaterialandMethods ToassesstheefficacyofDORA,clinical responsewasanalysedthroughfollow-upconsultationsand serologicaltests,measuringviralload(VL),CD4-Tlymphocytes,liverprofile,andrenalfunction.Follow-upwasperformedat2,4and6monthsfromthestartoftreatment.

Results Wefollowedup36patients(31men),withamean ageof53.8years(26-64),20werebeingtreatedwith(ABC/ 3TC+DORA),9with(RPV+DORA)and7(DTG+DORA). 77%weresmokersand7ofthemdiagnosedwithalcohol habit.Atthebeginning,94.4%hadundetectableviralload (VL<50cop/ml),exceptfortwothatshowedVL>10x6cop/ ml,probablyduetonon-complianceorabandonmentoftreatment.VL<50cop/mlwereobservedduringthestudy,except forthosepreviouslymentionedthatachievedamaximum reductionof110and150cop/ml.Allwereclassifiedinstages A2andA3,excepttwoofthemclassifiedasB3.Themost commonsideeffectswerediarrhoea,nauseaand/orvomiting, andmildheadaches.Twoofthemreportedmyalgia,although wesuspectitwasunrelatedtoDORA,astheyweretreated withatorvastatin80mg/24hforhypercholesterolemia.The patientswith(RPV+DORA)camefrom(ABC/3TC+DORA), whowerereplacedbyRPVduetohypercholesterolemia,liver disordersorintakeofPPIsorNSAIDs.ThemeanCD4-Tlymphocytecountwas720/mL(262-1169/mL)andthemeancreatininewasnormalandbetween0.9and1.1mg/dl(laboratory range),exceptfortwopatientswith1.13mg/dland1.29mg/ dl.

ConclusionandRelevance Doravirinehasbeenshowntobea safeandeffectivetherapeuticalternativeforHIV-1infection, especiallyinpatientswithmetabolicdisordersorinteractions withotherdrugs.Theroleofhospitalpharmacistswasto guaranteeadherencetotreatmentandtodocumentthemost frequentsideeffectsbyreportingthemtotheLocalHIV Commission.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Fichatécnica:https://cima.aemps.es/cima/pdfs/es/ft/1181332001/FT_1181332001. pdf

ThankstoInfectiousdiseaseUnit DORA:doravirine, RPV: rilpivirine, ABC/3TC:abacavir/lamivudine, DTG:dolutegravir, PPIs:proton-pumpinhibitors, NSAIDs:non-steroidalantiinflammatorydrugs ConflictofInterest Noconflictofinterest

4CPS-078 ASSESSMENTOFTHEQUALITYOFAHOSPITAL’S CLINICALTRIALINITIATIONVISIT

4CPS-077 CLINICAL-EPIDEMIOLOGICALCHARACTERISTICSOFA COHORTOFPATIENTSTREATEDWITHDORAVIRINE

1FGomezdeRueda*, 2LRendóndeLope, 3BCancelaDíez. 1VirgenMacarenaUniversity Hospital,HospitalPharmacyExternalPatientsUnit,Seville,Spain; 2VirgenMacarena UniversityHospital,HospitalPharmacy,Sevilla,Spain; 3SanAgustinUniversityHospital, HospitalPharmacy,LinaresJaén,Spain

10.1136/ejhpharm-2023-eahp.104

1ETejedor*, 2JPeralta, 1MAlbanell, 1BGomez, 1DSoy. 1BarcelonaClinicHospital, Pharmacy,Barcelona,Spain; 2BarcelonaClinicHospital,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.105

BackgroundandImportance Theclinicaltrial(CT)initiation visitisthemeetingdesignedtopreparetheinvestigationalsite thatwillconductthestudy.Thisprocedureisperformedwith thesitepersonnelwhowillassumestudyresponsibilities.The

RSanchez*,MAlmiñana,CCortell,AGarcia,MAnton,AJimenez,BCorpa. Hospital ClinicodeValencia,Pharmacy,Valencia,Spain

staffisdividedintoaninvestigatorteamandapharmacy team.

AimandObjectives Qualityassessmentattheinitiationvisits ofaclinicaltrial.

MaterialandMethods Observational,prospective,single-centre, prospectivestudytoevaluatethequalityatthestartofaCE inatertiarylevelhospital.ThestudyperiodwasfromJune toAugust2022.A16-itemsurveywascarriedout,which includestheaspectstobetakenintoaccountintheperformanceofaCE.Thequestionscollectedwere:investigatorservice,phaseofthetrial,knowledgeofthepresentationand stabilityofthedrug,modeofpreparation,administrationand destructionoftheexperimentalproduct.Whenthetrialmonitor(CRA)knewthequestion,ascore=1wasassignedifhe/ shedidnotknow=0.Thetoolsusedwere:Excel® fordata collection,Fundanet® forEECCregistrationandGoogle Teams® formeetings.Themaximumscoreobtainedwas20 andapoorstartwasconsideredwithscoresbelow13.

Results ThirtyCTonsetswereanalysedduringthestudy period.Themainclinicalservicesunderinvestigationwere: oncology>dermatology>haematology.Thephasesofthe trialstobeinitiatedwere:III(14),II(10),I/IB(6)andIV (0).Themeanqualityscoreobtainedwas16.62.Therewere 4clinicaltrialswithascorebetween10-13and2trialswith ascoreoflessthan10.Thisledtoasecondreviewofthe CEbythesponsor,whichmeantadelayinthestartofthe investigation.

ConclusionandRelevance Althoughmostoftheclinicaltrials metthequalitycriteriaforinitiation,thereisanon-significant proportionwithpoorresults.Inthoseclinicaltrialsthatdo notmeettheminimums,adelayininitiationisnecessaryfor theresolutionofdoubtsonthepartofthesponsor.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Liu,M.B.andDavis,K.;Chapter6:Monitoring. LessonsfromaHorseNamed Jim:aClinicalTrialsManualfromtheDukeClinicalResearchInstitute.Durham, NC:DukeClinicalResearchInstitute,2001.Print.

ConflictofInterest Noconflictofinterest.

inhalationtechniquemainlybytheirdoctor.Among50participants,30(60%)performedtheinhalationtechniqueincorrectly.Errorsweremostcommonatthestageofslow,full, deepbreathingasrecommendedbytheguidelines(70%),followedbynosprayagitation(15%).

ConclusionandRelevance Ourresultssupportpoorinhaler techniqueinchildrenthatmayhaveadverseconsequenceson therapeuticefficacy.Theeducationalroleoftheclinicalpharmacistisveryimportanttoimprovetheproperuseofthe inhalationtechniqueandthemanagementofpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Noconflictofinterest.

ConflictofInterest Noconflictofinterest.

4CPS-083 CREATININEANDCYSTATIN-BASEDESTIMATED RENALFUNCTIONINVANCOMYCINMONITORING 1ASCardoso*, 1CDuarteSilva, 1PASilva, 1,2APCarrondo, 1,2JPLopesDaCruz. 1Centro HospitalarUniversitárioLisboaNorte,PharmacyService,Lisbon,Portugal; 2PharmacyFaculty ofUniversityofLisbon,Imed.Ul-ResearchInstituteForMedicines,Lisbon,Portugal 10.1136/ejhpharm-2023-eahp.107

BackgroundandImportance Glomerularfiltrationrate(GFR) isusuallyestimatedbyusingrenalmarkerslikecreatinine(cr) orcystatinC(cysC),butresultsarenotalwaysoverlapping.

AimandObjectives EvaluatetheeffectofusingCockroft-Gault (CGcr)andChronicKidneyDisease-EpidemiologyCollaboration(EPIcr,EPIcysCandEPIcr/cysC)equationsinvancomycin monitoring.

MaterialandMethods Datafromthelast5yearswerecollectedretrospectively.Allpatients(n=34)whohadsimultaneouslycr,cysCandobservedvancomycinconcentrations(Cobs) obtainedwithinarangeof48h(n=47),wereincluded.PharmacokineticBayesianestimationwasperformedwithPKS

4CPS-082 MOSTFREQUENTERRORSINTHEINHALATION TECHNIQUEOFASTHMATICCHILDREN

1CRhaymi*, 2AChaibi. 1MohammedVUniversity-FacultyofMedicineandPharmacy, Pharmacy,Rabat,Morocco; 2MohammedVUniversity-FacultyofMedicineandPharmacy, ClinicalPharmacy,Rabat,Morocco

10.1136/ejhpharm-2023-eahp.106

BackgroundandImportance Asthmaisarealpublichealth problem.Inhalationtherapyisthemainstayofthemanagementofthischronicdisease.oneofthemostimportantreasonsforfailedtherapyisimproperinhalertechnique.

AimandObjectives Demonstratethemostfrequenterrorsin thetechniqueofinhalationinasthmaticchildrentreatedin ourestablishment

MaterialandMethods Aprospectiveobservationalstudywas conductedwithasthmaticchildrenadmittedtoourestablishmentoveraperiodof2months.Wehavedevelopedanevaluationgridfortheinhalationtechnique.itwasconsidered correctwhenallstepswereperformedcorrectly.

Results Atotalof50patientswereincluded.Theaverageage was3.7years.Inhalersobservedweremetered-doseinhalers. Allpatientsdeclaredhavinghadademonstrationofthe

Abbott®.ForeachpairGFRs/Cobs,thepredictedconcentration (Cp)andthedailydoserequiredtoobtainamaximumand minimumconcentrationof25and15 mg/ml,respectively, weredetermined.Theabsoluteerror(E),E=Cobs-Cp=0,was usedasanindicatoroftheadequacyoftheequationsused. Results EstimatedGFRshowedstatisticallysignificantdifferences(mean±standarddeviation):CGcr=110.6±76.5, EPIcr=97.5±36.3,EPIcysC=42.8±18.6andEPIcr/ cysC=64.3±25.2ml/min/1.73m2 (p<<0.05).

CGcr,EPIcrandEPIcr/cysCequationsoverestimated(E>0) renalfunction:E=1.50±1.53(95%confidenceinterval[CI]: 1.05to1.95),E=1.62±1.35(95%CI:1.22to2.02)and E=0.47±1.14(95%CI:0.14to0.81) mg/ml,respectively. Renalfunctionwasunderestimated(E<0)withEPIcysC,E=1.06±1.54(95%CI:-1.51to-0.60) mg/ml.

Theestimateddifferencesindailydosesrangedfrom100 to1600mg/70Kg/day,consideringCGcrequationasreference. ConclusionandRelevance TheoverestimationofGFRwith equationsdependentoncr,CGcr,EPIcrand,toalesser extent,EPIcr/cysC,wasmarkedinpatientswithabnormally lowcr.Conversely,withEPIcysCequation,whichdependson cysC,abiomarkerindependentofmusclemass,GFRwas underestimated.Thismaybeduetofactorsthatincrease cysC,withoutrenalfunctionimpairment,suchashypertension,corticosteroidtherapyandmalignancy,allcommonin hospitalisedpatients,butpoordatadidnotallowtoexplore thisassociation.

ThedifferencesintheGFRestimatesareclinicallyrelevant ondosingadequacy,beingsuggestivethatinthepresenceof abnormallylowcr,equationswithcysCarepreferred.

Studiesareneededtoidentifythevariablesresponsiblefor theobservedvariability,inordertopreviouslyselectthemost appropriateequationforeachcase.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TeafordHR,etal.CystatinC:APrimerforPharmacists.Pharmacy.2020Mar;8 (1):35

ConflictofInterest Noconflictofinterest.

4CPS-084 EFFECTIVENESSANALYSISOFPEMBROLIZUMABIN PATIENTSWITHADVANCEDNON-SMALL-CELLLUNG CANCERWITHVERYHIGHVSHIGHPD-L1 EXPRESSION

BSánchezRodríguez,MSánchezValera,RGazquezPerez,PNietoGuindo,TMoreno Diaz*,DGamezTorres. HospitalUniversitarioTorrecárdenas,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.108

BackgroundandImportance Pembrolizumabshowedlonger overallsurvivalcomparedwithchemotherapyinthefirst-line treatmentofadvancednon-small-celllungcancer(aNSCLC)

AimandObjectives ToevaluatetheeffectivenessofpembrolizumabinhighlyexpressingpatientswithaNSCLC,comparing patientswithPD-L1expression 90%(veryhigh)vsthose withPD-L150-89%(high)inatertiaryhospital.

MaterialandMethods Observational,retrospectivestudy.Inclusioncriteria:patientswithNSCLCawithpembrolizumabfrom August2018toAugust2022.Theclinicaldatabaseofthe AndalusianHealthSystem(Diraya),itsanalyticalmodule (Modulab)andthepharmaceuticalvalidationprogram(FarmisOncofarm)wereconsulted.Variablescollected:sex,age, ECOG(initial),smoking(current/past/non-smoker),percentage ofPD-L1expressionanddateofadministration(first/last). StatisticalanalysisusingthenonparametricKaplan-Meier modelwithrandomcensoringstudyingwhetherthereisan increaseinoverallsurvivalprogressioninveryhighversus highPD-L1groups.ACoxregressionmodelwasincludedto analysewhethertherestofthevariablesstudiedaffectoverall survival.

Results 65patientsenrolled,40wereincluded,16withvery highPD-L1and24withhighPD-L1expression(excluded 14patientsPD-L1<50%and11with1singleadministrationofpembrolizumab).73.17%patientsweremalewith medianage43years[80-37]andECOG=1[0-2].39.02% werecurrentsmokers,53.65%wereformersmokersand 4.8%werenon-smokers.Me dianoverallsurvivalinPD-L1 (high)patientswas16.46month svs21.57monthsmedian overallsurvivalinPD-L1(veryhigh)patients.P=0.92is obtainedfromthePD-L1(High)versusPD-L1(veryhigh) survivalcurves.Currentsmokingistheonlyvariablewith p=0.49thatpositivelyaffectstheprobabilityofdeathwith respecttothosestudied(age,sex,ECOG,pastsmoking/ non-smoking,PDL).

ConclusionandRelevance SurvivalresultsinPD-L1patients ( 90%)comparedtolessexpressorswerepositivebutwithoutstatisticallysignificantdifferences.Itcouldbeduetothe smallstudysample.However,themediansurvivalobtainedis consistentwithdatafrompreviousstudies,itwouldbeadvisabletostudythishypothesisinlargercohorts.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-088 CORRELATIONBETWEENIMMUNE-RELATEDADVERSE EVENTSANDEFFICACYINNON-SMALL-CELLLUNG CANCERTREATEDWITHNIVOLUMAB

1ACodonalDemetrio*, 1IMendozaAcosta, 1MBlancoCrespo, 1GICasarrubiosLázaro, 1EMartínezRuiz, 1PTardáguilaMolina, 1AMirandaDelCerro, 2LECharaVelarde, 1Pde Juán-GarcíaTorres. 1HospitalPharmacy,HospitalEmergencyDepartment,Guadalajara, Spain; 2Oncologist,HospitalEmergencyDepartment,Guadalajara,Spain

10.1136/ejhpharm-2023-eahp.109

BackgroundandImportance Nivolumab,animmunecheckpointinhibitor,hasshownarelationshipbetweenimmunerelatedadverseevents(irAEs)andefficacyindifferentstudies, althoughthesearenotveryconsistent.

AimandObjectives Theaimwastoassesstheassociation betweenirAEsandtheefficacyofnivolumabinadultswith locallyadvancedormetastaticnon-small-celllungcancer (mNSCLC)afterpriorchemotherapy.

MaterialandMethods RetrospectiveobservationalstudyincludingallpatientswithmNSCLCwhoreceivednivolumab3mg/ kgorflatdoseof240mgeverytwoweeksfromAugust 2015toJune2022inasecond-levelhospital.Datacollected weredemographic(age,sex)andclinical(histology,smoking habit,performancestatus(ECOG),lineoftreatment,response topreviouschemotherapyandirAEs).

Overallsurvival(OS)andprogression-freesurvival(PFS) analysiswasperformedusingKaplan-Meier.Theassociation betweenirAEsandOSwereanalysedbyCoxRegression. Results 67patients(88%men)withamedianageatthe beginningoftreatmentof67years(IQR:59-75)were included.Histologywassquamousin40%ofpatients.The smokinghabitwas:formersmokers(53%),smokers(39%) andnon-smokers(8%).52%presentedanECOG0-1.73% ofthepatientsreceiveditasasecondlinetreatment.Disease ControlRate(DCR)was78%.

MedianOSintheirAEpatientgroupwas12.1months (95%CI7.9-16.3;p<0.05)vs4.4months(95%CI1.9-7.0; p<0.05)inthenon-irAEpatientgroup;hazardratio:0.35, 95%CI0.2-0.6;p<0.05.ThemedianPFSwas8.7months (95%CI0-41.2;p<0.05)vs3.3months(95%CI1.9-4.7; p<0.05),respectively.

SubgroupanalysisoftheassociationbetweenirAEsandOS was:

Abstract4CPS-088Table1

IrAEstypeN=28irAEs(22patients)HR(95%CI)p Pneumonitis100.62(0.3-1.3)0.2 Endocrine60.23(0.1-0.7)0.014 Gastrointestinal60.59(0.2-1.6)0.3 Skin60.2(0.1-0.7)0.008

ConclusionandRelevance InthisstudyourdatasuggestarelationshipbetweenirAEsandincreasedOS,speciallyendocrine andskin.

Asourstudywasobservational,otherfeaturesassex, ECOGorsmokinghabitthatcouldbiasresultswerenotbalancedbetweenthestudygroups.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-089 CURRENTSTATUSOFHEPATITISCVIRUSINFECTION

EFragaBueno*,ACasásMartínez,IRodríguezPenín.

10.1136/ejhpharm-2023-eahp.110

BackgroundandImportance Accordingtothe ‘Globalhealth sectorstrategyonviralhepatitis2016-2021’ publishedbythe WorldHealthOrganization(WHO),oneoftheobjectivesto beachievedbefore2030istodetect90%ofpeopleinfected byHepatitisCvirus(HCV)andprovidetreatmentto80%of them.

AimandObjectives TodescribeandanalysethecurrentsituationofHCV-infectedpatientstreatedwithdirect-actingantivirals(DAAs)inasecond-levelhospital.

MaterialandMethods Aretrospectiveobservationalstudyof allpatientstreatedwithDAAsin2021wasconducted.Data collectedfromtheelectronicalmedicalhistoryandelectronicprescriptionprogram mewere:demographicdata, dateandsettingofdetectionofHCVinfection,coinfection withhumanimmunodeficiencyvirus(HIV)and/orhepatitis Bvirus(HBV),viralload,degreeoffibrosis,previoustreatmentsforHCV,therapeuticoptionused,toleranceand effectiveness).

Results Thirty-sevenpatients(70%men)wereincluded,witha medianageof56years[interquartilerange(IQR):49-65]. Themediantimefromdiagnosistostartoftreatmentwas49 months(IQR:2-145).Only5patients(13%)hadbeenpreviouslytreated.

Diagnosiswasmadebythegeneralpractitioner(25 patients),acarecentrefordrugaddicts(4patients)and externalconsultationsofdifferentspecialties(8patients). ThreepatientswerecoinfectedwithHIV.Regardingthe degreeoffibrosis,F0-F1:19patients,F2:5patients,F3-F4: 12patients(6withcirrhosis).Themedianviralloadatthe startoftreatmentwas3,870,000IU/ml(IQR:1,160,0006,430,000).

Thetherapeuticoptionsusedincludedsofosbuvir/velpatasvir for12weeks(25patients),sofosbuvir/velpatasvirfor24weeks (1patientwithlivercirrhosiswithpreviousdecompensation, pretreatedwithpeginterferon/ribavirin),glecaprevir/pibrentasvir for8weeks(9patients),andledipasvir/sofosbuvir8weeks(2 patients).Therewasnotherapeuticfailurerequiringrescue withanotherDAA.Nopatientsufferedadverseeffectsrelated toantiviraltreatment.

ConclusionandRelevance Mostofthepatientsweredetected throughthescreeningprogramscurrentlyimplementedinthe differentcaresettingsofourhealtharea,whichmayallow achievingtheobjectivesoftheWHO.

Withtheseprogramsanearlydetectionoftheinfection wasachieved,whichleadstolessliverdamage.

Allourpatientsweretreatedaccordingtothepharmacotherapeuticoptionsofficiallyrecognisedasmorecost-effective.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-091 WHATYOUNEEDTOKNOWABOUTBRUGADA SYNDROMEIFYOUAREAHOSPITALPHARMACIST

RMorenoDiaz*,AMelgarejoOrtuño,MAAmorGarcía,CdeCáceresVelasco,EMatilla Garcia,MPBautistaSanz. HospitalUniversitarioInfantaCristina,HospitalPharmacy,Parla, Spain

10.1136/ejhpharm-2023-eahp.111

BackgroundandImportance Brugadasyndrome(BRS)isarare inheritedheartrhythmdisordercharacterisedbyST-segment elevationandapotentialriskoffatalarrhythmias.Itisadisorderoftransmembraneionchannelsthatpredisposesto arrhythmias.Channelopathiesarepureelectricaldiseasesthat arenotassociatedwithunderlyingstructuralheartdisease, makingearlydiagnosisdifficult.

AimandObjectives ReviewtheliteraturerelatedtocontraindicateddrugsinRBS;createanupdatedlisttofacilitatepharmaceuticalvalidationinthesepatientsandcomparethelist createdwiththeknownlistofQT-modifyingdrugs.

MaterialandMethods AcriticalanalysisofEMBASEand PUBMEDstudieswasperformed.Theterms ‘brugadasyndrome’ AND ‘drugs’ wereused.Includedstudiesmetthefollowingcriteria:reviews,withinthelast5yearsandinhumans only.Thelistofdrugsdescribedonthe brugadadrugs.org websitein2017wasusedasapreliminarybasis.Themedicines finallyidentifiedwereclassifiedintotwogroups,accordingto theirlevelofrisk.Thegroupofcontraindicateddrugs(should notbeusedunderanycircumstances)andgroupofpotentially dangerousdrugs(withinconclusivedata.Useshouldbeevaluatedonanindividualbasis).ThelistofQT-modifyingdrugs wasobtainedfromthe crediblemeds.org websiteandcompared withthelistofdrugsidentifiedforBRS.

Results Ninearticlesmettheinclusioncriteria.Themedicines classifiedinbothgroupsareshownintable.

Abstract4CPS-091Table1

ContraindicateddrugsinBRSPotentiallyhazardousdrugsinBRS

AjmalineAmiodarone

AlapinineAtropine

AcetylcholineBupropion

AmitriptylineCarbamazepine

BupivacaineCybenzoline

ClomipramineCyamemazine

DesipramineClotiapine

DopamineDesflurane

EtacyzineDexamethasone

ErgonovineDiphenhydramine

PhenylephrineDimenhydrinate

FlecainideDisopyramide

LevobupivacaineDobutamine

LithiumDosulepine

LoxapineDoxepin

MethoxamineEtomidate

NeostigminePhenytoin

NorepinephrineFluoxetine

OxcarbazepineFluvoxamine

PilsicainideGlycopyrrolate

PyridostigmineGranisetron

ProcaineImipramine

ProcainamideIndapamide

ComplexoHospitalarioUniversitario deFerrol,Pharmacy,Ferrol,Spain

PropafenoneIsoflurane

PropofolIsoprotenerol

RopivacaineKetamine

TrifluoperazineLamotrigine

Lidocaine

Maprotiline

Metoclopramide

Ondansetron

Nitrousoxide

Paroxetine

Perphenazine

Propranolol

Sevoflurane

Sugammadex

Terfenadine/fexofenadine

Thiopental

Thioridazine

Tramadol

Verapamil

Vernakalant

ThedegreeofagreementobtainedwiththelistofQT-modifyingdrugswas29.21%.

ConclusionandRelevance Thelowconcordancewithrespect tothelistofQT-modifyingdrugsmakesitnecessarytodefine aspecificdruglistforpatientswithRBS.Thiscouldimprove thequalityoftreatmentvalidationbythehospitalpharmacist.

ConflictofInterest Noconflictofinterest

4CPS-092 STATISTICALRELATIONSHIPBETWEENBIOMARKERS WITHPROGNOSTICVALUEINANTI-PDL1 TREATMENTSINCANCERPATIENTS

MAToledoDavia*,NLabradorAndujar,ARRubioSalvador,CBlazquezRomero,LTorralba Fernandez,CJimenezMendez,RPrietoGalindo,ADominguezBarahona,PAguado Barroso,EGomezFernandez,PMoyaGomez. HospitalUniversitariodeToledo,Hospitalary Pharmacy,Toledo,Spain

10.1136/ejhpharm-2023-eahp.112

BackgroundandImportance Theprognosticvalueofbiomarkerssuchasneutrophil/lymphocyteratio(NLR),derived neutrophil/lymphocyteratio(dNLR)andplatelet/lymphocyte ratio(PLR)isincreasinglystudied,showingtheirusefulnessin patientswithdifferentanti-PDL1treatmentsinthecontextof oncologicalpathologies.

AimandObjectives Toanalysewhetherthereisastatistical relationshipbetweenthesethreeparametersandtoanalysethe biomarkersandtoanalysetheireffectonsurvival.

MaterialandMethods Observationalandretrospectivestudyin patientstreatedwithpembrolizumabanddiagnosedwithnonsmall-celllungcancer(NSCLC)inatertiarylevelhospital. Demographicvariables(sexandage)werecollected,NLRas neutrophil/lymphocytecount,dNLRasneutrophil/leukocyte/ neutrophilcountandPLRasplatelet/lymphocytecountwere calculated.Progression-freesurvival(PFS)andoverallsurvival (OS)werecalculatedusingtheKaplan-Meiermethodandlogranktestasahypothesistest.Thecut-offpointswere NLR=5,dNLR=3andPLR=200.Spearman’scorrelationtest wasusedtocheckthecorrelationbetweenthethree

biomarkers(previouslythenon-normalityofthesampleswas checkedbyKolmogorov-Smirnovtest).

Results Atotalof74patientstreatedwithpembrolizumab wereregistered,59men(80,8%)and14women,witha medianageof65[83-37]years.Medianneutrophilcountwas 5.45[6.1-1.5]x109neut/L,lymphocytecountwas1.45[3.90.2]x109linf/Landplateletcountwas174.7[56.92-1345] x109platelets/L.Table1showsthesurvivalresultsobtained.

Abstract4CPS-092Table1 ResultsofKaplan-Meiersurvival methodandlog-ranktest

Progression-freesurvival

Spearman’scorrelationtestshowedstatisticalsignificancein therelationshipbetweenthethreebiomarkersshowinga strongassociationbetweenthem,Spearman’scoefficients obtainedareshown:NLR-dNLR0.934(p=0),NLR-PLR 0.697(p=0)dNLR-PLR0.616(p=0).

ConclusionandRelevance Forthethreebiomarkersthereare significantdifferencesinsurvivaloutcomesfortheselected cut-offpoints,offeringprognosticvalueforourpatients. Spearman’stestindicatesthatthereisacorrelationbetween thebiomarkers.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-093 POLYPHARMACYANDINAPPROPRIATEDRUGSIN PATIENTSWITHOROPHARYNGEALDYSPHAGIA

MRodríguezMarín,EDelgado-Silveira,EMora-Rivas,LEMontes-Jovellar-Gonzalez, MMuñoz-Garcia,NVicente-Oliveros,CPalomar-Fernandez,AMAlvarezDiaz*. 1Hospital RamónYCajal,Pharmacy,Madrid,Spain; 2HospitalRamónYCajal,Otorhinolaryngology, Madrid,Spain

10.1136/ejhpharm-2023-eahp.113

BackgroundandImportance OropharyngealDysphagia(OD)is asymptomwherepatientswhopresentitusuallyhavemultiplenutritional,functional,morbidityandqualityoflifecomplications.Itisassociatedwithahigherincidenceof aspirationpneumonia.ODcanbecausedbyadverseeffectsof medications,suchasdopamineantagonists(DA),centralnervoussystemdepressants(CNSD),anticholinergicdrugs,which blocktheactionofacetylcholine,amongothers.

AimandObjectives Toanalysetheprevalenceofpolypharmacy( 5chronicdrugs)andinappropriatedrugs(anticholinergicsandCNSD)inpatientswithOD.Itwasalso

calculatedanticholinergicrisk(AR)usingdifferentanticholinergicscales(AS).

MaterialandMethods Aretrospectiveobservationalstudywas carriedoutinageneraltertiaryhospital.Datafrompatients diagnosedwithODwerecollectedfromtheotorhinolaryngologyconsultationofyears2019-2021.Demographical,clinical andpharmacotherapeuticdatawereobtainedfromtheelectronicmedicalrecord.ARwascalculatedusinganticholinergic scales(AS)withtheanticholinergicburdencalculator(available atwww.anticholinergicscales.es).

Results Sixtypatientswererecruited;4werelowduetonot havingtheirmedicationprescriptionrecord.Ofthe56 remainingpatients,28(50%)weremen.Theaverageagewas 73.2years[14.5-90.3].

Forty-three(76.79%)patientswerepolymedicated.461 drugswereanalysed,finding104(22.56%)potentialmedicationstocauseOD.Ofthese,91(19.74%)weredrugged withAR,13(2.82%)wereCNSDand7(1.52%)wereDA. WhenanalysingtheASscaleitwasfound:that12(21.42%) patientshadahigh-riskAR,15(26.78%)hadmediumrisk loadand3(5.36%)patientshadlowriskARbeingmostly men(56.66%).Themostrepeateddrugwastamsulosin (1.73%).

ConclusionandRelevance Itisobservedthatthereisahigh percentageofpatientswithODarepolymedicated.TheprevalenceofARishigh.AgoodpharmacologicalreviewwithAS mustbecarriedoutandtrytomakeadescription,toreduce theanticholinergicloadandthenumberofdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-095 INFUSIONAUDITINHAEMATOLOGY:IMPORTANCEOF EVALUATIONANDOPTIMISATIONOFPROFESSIONAL PRACTICES

CLeGuen*,WAmmor,JClouet,KOSellal,DFeldman,CFronteau,FLindenberg. Nantes UniversityHospital,Pharmacy,Nantes,France

10.1136/ejhpharm-2023-eahp.114

BackgroundandImportance Intravenousadministrationisthe sourceofnumerousidentifiedrisksrequiringperiodicevaluationofprofessionalpractices.InFebruary2022,anobservationalauditinthehaematologyunitwascarriedoutinorder tooptimisetheinfusionsetups.

AimandObjectives Theobjectiveofthisauditistoevaluate theprofessionalpracticesofthenursingteamandthusto implementpermanentcorrectiveactions.

MaterialandMethods Anevaluationgridbasedonthegood infusionpracticesdefinedbythe ‘ObservatoireduMédicament,desDispositifsmédicauxetdel’InnovationThérapeutique’ Centrewasupdatedandvalidatedbyamultidisciplinary group.

InFebruary2022,twopharmacyinternsobserved62drugs administeredbyanalysingtheprescriptionsofallhospitalised patientsintheunit.

Results Regardingtheinfusionconfiguration,only90%ofthe peripheralinfusionlinewereclosedusinganadaptedplug. Nomisusewasobservedontheadministrationofparenteral nutrition.

Regardingflowrateproblems,onlyoneinfusionconfigurationexhibitsaninfusiondripchamberfilledbeyondthemaximumlimit.Interestingly,duringaflow-sensitivedruginfusion

andcontrarytoguidelines,absenceofnon-returnvalvewas observedin9%oftheinfusionconfiguration.

Apotentialriskofdrugincompatibilityhasalsobeenidentifiedwiththecurrentperfusionset-up.

ConclusionandRelevance Theresultsofthisauditappearto beverypositive.Thehaematologyunit,whosenursingteamis awareoftherisksassociatedwiththeadministrationofchemotherapy,isaunitaccustomedtotheavailabilityof pharmacists.

Thisauditallowedustoobservesomeerrorsduringinfusionpractice:inadequateprogrammedflowrate,absenceof plugsandabsenceofnon-returnvalveduringflow-sensitive drugsinfusion.

Inordertoimproveinfusionpractice,anewstandardised infusionset-upwillbeproposedtotheunitincludingnonreturnvalves.Thisset-upshouldmakeitpossibletoreduce therisks,particularlythoserelatedtoflowrateand incompatibilities.

However,thischangeinpracticewillrequiresupportfor theteamsandanewaudittoevaluatetheimpactofthis work.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-096 EVOLUTIONOFSELECTIVEIMMUNOMODULATE

THERAPYINSPECIALSITUATIONS

1JBarceló-Vidal, 1XFernández-Sala, 1NCarballo, 2JFloresLe-Roux, 3AAldea-Perona, 3PDíaz-Pellicer, 1JMiedes*, 1OFerrández, 1SGrau. 1HospitalDelMar,Pharmacy, Barcelona,Spain; 2HospitalDelMar,Endocrinology,Barcelona,Spain; 3IMIM

InstitutMar D’investigacionsMèdiques,Pharmacology,Barcelona,Spain

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BackgroundandImportance Biologicaltherapyhassupposeda greattherapeuticalprogressonimmunomodulateddiseases. Nevertheless,somepathologieshavenolabelledindication. Therefore,medicationaccessonspecialsituationsareessential andmorefrequent.

AimandObjectives Theobjectiveofthisstudyistoanalyse therequestonimmunomodulatetherapyinspecialsituations amonglastyears.

MaterialandMethods RetrospectivestudyperformedinatertiaryhospitalbetweenJanuary2017-December2021.Off-label (OL)andcompassionateuse(CU)requestsonselectiveimmunomodulatorydrugsreceivedbythePharmacyandTherapeuticscommitteewereincluded(P&T).

Datacollected:number,typeanddrugsrequested,indication,clinicaldepartment,andapprovementbyP&T.Atemporalevolutiononthenumberofrequests,drugsandclinical departmentswasanalysed.Onthosewhichshowedan increase,anexhaustiveanalysiswasperformed.

Results Atotalof95requestswereidentified,78(82.1%)OL and17(17.9%)CU,representinga17.3%(95/549)ofall kindofrequeststotheP&T.Twenty-onedrugsand42differentindicationswereidentified.Eighty-seven(91.6%)were approved;sixweredeniedduetolackofevidenceandtwo duealackoffundingbythenationalhealthsystem.

Maindrugsrequested ustekinumab(18(18.9%)),dupilumab (15(15.8%)),rituximab(14(14.7%)),tofacitinib(9(9.5%)), tocilizumab(7(7.4%)),adalimumab(5(5.3%)).

Requestingclinicaldepartments dermatology(48(50.8%)), digestology(20(21.1%)),rheumatology(18(18.9%)),

nephrology(5(5.2%)),internalmedicine(2(2.1%)),pneumology(1(1.1%)),coronaryunit(1(1.1%)).

AnexponentialincreasewasobservedamongOLandCU duringthestudyperiod(requests/year:8/2017,12/2018,14/ 2019,21/2020,40/2021;y=5.2269e0.3778x,R2=0.9559).

Themaingrowthwasobservedindermatology (y=1.99e0.4277x,R2=0.768)anddigestology(y=1.5x-0,5, R2=0.9375).

Indicationsrequestedbydermatology:atopicdermatitis(15 (31.3%)),hidradenitissuppurativa(8(16.7%))folliculitisdecalvans(4(8.3%)),others(21(43.8%)).

Drugsrequestedbydermatology:dupilumab(15(31.3%)), ustekinumab(5(10.4%)),tofacitinib(4(8.3%)),mogamulizumab(4(8.3%)),adalimumab(4(8.3%)),secukinumab(3 (6.3%)),rituximab(3(6.3%)),infliximab(2(4.2%))and others(8(16.7%)).

Indicationsrequestedbydigestology:ulcerativecolitis(13 (65.0%)),Crohn’sdisease(4(20.0%)),collagenouscolitis(3 (15.0%)).

Drugsrequestedbydermatology:ustekinumab(13 (65.0%)),tofacitinib(4(20.0%)),vedolizumab(2(10.0%)), infliximab1(5.0%)).

ConclusionandRelevance

. Dermatologyperformedhalfofrequests,speciallyinatopic dermatitisandhidradenitissuppurativa,whichhaveobtained moreevidenceontheirtreatmentlastyears.

. Theexponentialincreaseonnumberofrequestsinspecial situations,speciallyoff-labelones,revealstheneedtoincrease theresourcesassignedtoevaluationcommittees.

REFERENCESAND/ORACKNOWLEDGEMENTS

Results 41patients,30ofthemmen,wereincluded.24 treatedwithnintedaniband17withpirfenidone,bothgroups hadamedianageof73yearsold(range54-89).

AveragedifferencefrombasalFVCwas+4,82%at6 months,+1,85%at12m,+1,85%at16mand-6,25%at 24mwithnintedaniband+2,4%at6m,-5,5%at12m,5,5%at16mand-18,5%at24mwithpirfenidone.

Mediandurationoftreatmentwas26monthswithnintedaniband45monthswithpirfenidone.Overallsurvivalwas65 months(CI95%57.5-73.9)onaveragefornintedaniband33 months(CI95%23.4-42.5)forpirfenidone(log-rank p=0.009).

Treatmentwaspoorlytolerated,withahighincidenceof AE(nintedanib:noAE:21%,G1:4%,G2:42%,G3:29%, G4:4%;pirfenidonenoAE:53%,G1:12%,G2:29%,G3: 6%).MostfrequentAEwasgastrointestinalreactionsin17 (71%)withnintedaniband6(35%)withpirfenidone,followedbyheadachein3(13%)withnintedaniband4(24%) withpirfenidone,hepaticenzymealterationin5(21%)with nintedanib,dermatological4(17%)nintedanib,renaltoxicity in2(8%)withnintedanib,haematological1(4%)with nintedanib.

AEcausedthediscontinuationoftreatmentin11(46%) patientswithnintedanibandin4(24%)withpirfenidone.

ConclusionandRelevance Nintedanibwassignificantlymore effectiveintermsofoverallsurvival,withaslowerdecrease inFVC,althoughpresentedworsetolerancethanpirfenidone, astreatmentofIPF.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-099 NINTEDANIBANDPIRFENIDONEINIDIOPATHIC PULMONARYFIBROSIS:COMPARATIVE EFFECTIVENESSANDSAFETYINATHIRD-LEVEL

HOSPITAL

1JIbanez-Caturla*, 1PTorranoBelmonte, 1LFructuosoGonzález, 1JAGutiérrezSánchez, 1MHernándezSánchez, 2PPachecoLópez, 1MÁCarvajalSánchez, 1MGuillénDíaz, 1AMartínezOrea, 1MDNajera-Perez. 1HospitalMoralesMeseguer,PharmacyService, Murcia,Spain; 2HospitalRafaelMendez,PharmacyService,Lorca,Spain

10.1136/ejhpharm-2023-eahp.116

BackgroundandImportance Idiopathicpulmonaryfibrosis (IPF)isachronicandprogressivediseasecharacterisedbya badprognosis.Theonlyavailablepharmacologicaltreatments aretwoantifibroticdrugs,pirfenidoneandnintedanib,which slowdownthedevelopmentofthediseasebuthavean unfavourablesafetyprofile,withahighincidenceofadverse effects.

AimandObjectives Tocomparetheeffectivenessandsafetyof thetwoavailableantifibroticdrugs,nintedanibandpirfenidone,usedastreatmentofidiopathicpulmonaryfibrosis.

MaterialandMethods Retrospective,observationaland descriptivestudyofallthepatientsdiagnosedwithidiopathic pulmonaryfibrosistreatedwithpirfenidoneornintedanib betweenJanuary2014andFebruary2022.Thecollectedvariableswere:age,sex,for cedvitalcapacity(FVC),durationof treatment,adverseeffects(AE)andgrade,andsurvival. Patientconfidentialitywaspreservedthroughoutthedata gathering.

4CPS-100 VALIDITY,RELIABILITYANDUSER-PRACTICABILITYOF ACLASSIFICATIONTOOLFORDRUG-RELATED PROBLEMSANDPHARMACISTINTERVENTIONS WITHINANUPPERAUSTRIANHOSPITALTRUST

TRedinger*,APointinger,AWeigl. KeplerUniversityHospital,PharmacyDepartment MedcampusIii,Linz,Austria

10.1136/ejhpharm-2023-eahp.117

BackgroundandImportance Inordertofullycapturethecontributionofclinicalpharmaciststopharmacotherapy,astandardisedandvalidatedclassificationtoolfordrug-related problems(DRP)andpharmacistinterventions(PI)isessential forbothresearchpurposesandmanagementtasks.Suchan instrumentisnotyetavailableinAustria.Therefore,thedocumentationsystem, ‘DokuTool’,hasbeendevelopedbyan UpperAustriahospitaltrustfollowingtheexpansionofits clinicalpharmacyservices.

AimandObjectives Thisstudyaimedtoassessthereliability, validityanduser-practicabilityoftheclassificationsystem, ‘DokuTool’,withinanUpperAustrianhospitaltrust.

MaterialandMethods Two-phasequantitativemethodology:1) Twenty-nineclinicalpharmacistsclassified24samplecases with ‘DokuTool’.Inter-raterandtest-retestreliabilitywas determinedusingthekappastatistic.Validitywasdetermined bycorrelatingtheindividualratingswithagoldstandard (majorityvoteofexperts)usingcontingencycoefficient.2) User-practicabilitywasassessedbyanonlinesurveyusinga5pointLikertscale.

Results ‘DokuTool’ achievedmoderateagreementintheinterraterreliabilitytestofthetwomaincategories ‘TypeofDRP ’

(k=0.528[95%confidenceinterval(CI):0.514 – 0.541]) and ‘CauseofDRP ’ (k=0.594[95%CI:0.587 – 0.601]).

Thecategory ‘PlannedPI’ showedsubstantialagreement(k= 0.638[95%CI:0.629

0.647]).Test-retestreliability achievedanalmostperfectagreementforallthreemaincategories: ‘TypeofDRP ’ (k=0.825[95%CI:0.734 – 0.915]),

‘CauseofDRP’ (k=0.896[95%CI:0.825 – 0.967])and

‘PlannedPI’ (k=0.891[95%CI:0.819 – 0.964]).The medianrater-specificcontingencycoefficientwas0.84[range: 0.75

0.89],0.95[0.94

0.96]and0.93[0.91 – 0.94].

‘DokuTool’ wasratedcomprehensive(median:2[interquartile range:1.75]),user-friendly(2[1])andpractical(2[1]).Time expenditurewasconsideredadequate(3[1]),butthecompletenessandclarityofthecategorieswereratednegatively(3 [2]).

ConclusionandRelevance Moderatetosubstantialinter-rater reliability,almostperfecttest-retestreliability,goodcriterion validityandacceptableuser-practicabilitydemonstratedthat

‘DokuTool’ isavalidandreliableclassificationinstrumentof DRPsandPIs,thatiswell-suitedforAustria.

However,theevaluationofusabilityledtosuggestionsfor improvementforfutureversions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

treatment(25men(48%)versus27women(52%),median age56[IQR51 – 60]);whilethesecondcohortconsistedof 132patients(10.4%)whomaintainedsuchantiretroviraltreatment(107men(80.5%)versus25women(18.8%),median age45[IQR33 – 55]).Intotal266ADRsweredetected: 216probable,46possibleand4improbablerelationship.A 27.8%wereheadachesADRs,18.8%gastrointestinaleffects (diarrhoea,abdominalpain,nausea),16.2%sleepdisorders (insomnia)and37.2%others.

ConclusionandRelevance ThefrequencyofADRsofHIVpatientsintreatmentwithBIC/FTC/TAFislowandmostof peoplewhosufferitcancontinuewiththeirtreatment.Most ADRswereconsiderasprobablyandthemostcommonwas theheadaches,thegastrointestinaldisordersandtheinsomnia.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-103 PHARMACOKINETICINTERACTIONSTUDYOF OSIMERTINIBANDDIGOXIN:ACASEREPORT

1CMagroVázquez*, 2CGonzálezTrigueros, 3ALSalcedoMingoarranz, 1MMNoceda Urarte, 2MHerreroFernández, 1MTSarobeCarricas, 2GBaldominosUtrilla, 3BGarcíaDíaz. 1HospitalUniversitariodeNavarra,PharmacyDepartment,Pamplona,Spain; 2Hospital UniversitarioPríncipedeAsturias,PharmacyDepartment,AlcaládeHenares,Spain; 3HospitalUniversitarioSeveroOchoa,PharmacyDepartment,Leganes,Spain

10.1136/ejhpharm-2023-eahp.119

4CPS-101 CAUSALITYOFADVERSEDRUGREACTIONSINHIVPATIENTSTREATEDWITHBICTEGRAVIR/ EMTRICITABINE/TENOFOVIRALAFENAMIDE

1SJimenoAguado, 1SJimenoAguado*, 1MVélez-Díaz-Pallarés, 2AMMoreno-Zamora, 1MLavandeira-Pérez, 1HMartinez-Barros, 1PMartín-Sanz, 1EGemeno-López, 1MRodríguez-Marín, 1AMÁlvarez-Díaz. 1HospitalUniversitarioRamónYCajal,Pharmacy, Madrid,Spain; 2HospitalUniversitarioRamónYCajal,InfectiousDiseases,Madrid,Spain

10.1136/ejhpharm-2023-eahp.118

BackgroundandImportance Bictegravir/emtricitabine/tenofovir alafenamide(BIC/FTC/TAF)hasbeenpositionedasapreferencedruginthemainguidelinesinthetreatmentofHIV. BIC/FTC/TAFhasdemonstratedanexcellentsafetyandefficacyprofileinpivotalstudies.Inclinicalpracticefewstudies havebeenpublishedconcerningthesetwoaspects.

AimandObjectives Toassessthecausalityofadversedrug reactions(ADRs)ofHIV-patientstreatedwithBIC/FTC/ TAF.

BackgroundandImportance Tyrosinekinaseinhibitors(TKI) havemeantachangeofparadigminthetreatmentofnonsmall-celllungcancer(NSCLC)withdrivermutations.Many TKIdrugsinteractwiththedrug-effluxpumpP-glycoprotein (P-gp)involvedintheabsorptionand/ortransportofdrugs andxenobiotics.P-gpinhibitors,asosimertinib,mayincrease theserumconcentrationofP-gpsubstrate.Thisiskeyinnarrowtherapeuticrangedrugs,likedigoxin,aslevelshigher than1.2ng/mlareassociatedwithincreasedrisksofdeath. Althoughthisinteractionhasbeendescribedintheory,thisis thefirstcasereportinscientificjournals.

MaterialandMethods

Observationalandretrospectivestudy fromMay2019toMarch2021inageneralhospital.The patientswereclassifiedintotwocohortsbasedonwhether theycontinuedtreatmentornotafterreportingADRs.The variablesanalysedwere:age,sex,priorandsubsequentantiretroviraltreatment(ifapplicable).AllADRswereclassified accordingtotheorganclasssystem.ThecausalitywasevaluatedwithTheNaranjoAlgorithm.Thisisamethodto assesswhetherthereisacausalrelationshipbetweenanidentifieduntowardclinicaleventandadrug,usingasimple questionnairetoassignprobabilityscores.Thetotalscore are:definite(>9),probably(5-8),possible(1-4)anddoubtful (0).

Results Atotalof1,275patientswerecollected,ofwhich185 patients(14.5%)withatleastoneADRwereevaluated.The firstcohortconsistedof53patients(4.1%)whochangedtheir

AimandObjectives Todescribethepotentialdrug-druginteractionbetweenosimertinibanddigoxinmediatedbyP-gpina 77yearoldwomanwithahistoryofpermanentatrialfibrillation.ThepatientwasdiagnosedwitheGFRmutantNSCLC stageIIB.Leftlowerlobectomywasperformed.Subsequent tumourprogressionprovokedosimertinibtreatmentandafter thatanincreaseofpreviouslyinrangedigoxinlevelsis recorded.

MaterialandMethods

Descriptiveandretrospectivecasereport Datawereobtained fromcomputerisedmedicalrecords.Mediwaresoftwarewas usedtomakepharmacokineticspredictionandadjustdosage recommendation.

Results Osimertinibtreatmentstartedatdosesof80mg/dayin March2022andaftertwomonthsitwasinterruptedbecause ofdiarrhoeaandmucositis.Twoweekslaterthepatientshows severehypomagnesemiarequiringhospitalisation.Laboratory resultsrevealedserumdigoxinlevelof1.38ng/ml,thus digoxindosewasreducedfrom125mcg/dayto100mcg/day. Athospitaldischargeosimertinibtreatmentwasrestartedwith half-dosereduction.Thenextdigoxinlevelswentupto1.9 ng/ml,sothePharmacyDepartmentrecommendedtoreduce thedigoxindoseto75mcg/day.Thereafter,digoxinlevels

increasedupto1.31ng/mland1.45ng/ml,requiringdose reductionto50mcg/day.

ConclusionandRelevance Inourcasereport,therapeuticdrug monitoringofdigoxinhasallowedforthedetectionof increasedlevelsofdigoxinandhigherrisksoftoxicity.Itcoincideswiththestartofosimertinibexposure,beingtheP-gp inhibitionthemostplausiblefactorforthisfinding.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-105 CEFIDEROCOLTREATMENTINCOVID-19POSITIVE PATIENTSCO-INFECTEDWITHPAN-RESISTANT PSEUDOMONASAERUGINOSA

CGastalver-Martín,OSerna-Romero*,SBuendia-Bravo,AIglesias-Bolaños,CCapillaMontes,IEscribano-Valenciano,TCruz-Cruz. HospitalUniversitarioDelSureste,Pharmacy Department,ArgandaDelRey,Spain

10.1136/ejhpharm-2023-eahp.121

4CPS-104 ANALYSISOFINTERVENTIONSINPHARMACEUTICAL VALIDATIONINATHIRDLEVELHOSPITAL

MMuñozVillasur*,CRodríguez-TenreiroRodríguez,VJiménezGarcía,CLFernández Laguna,LMacíaRivas,IdelaFuenteVillaverde,SFernándezLastras,MEiroaOsoro, LOyagueLópez,ALozanoBlázquez. HospitalUniversitarioCentraldeAsturias,Hospital Pharmacy,Oviedo,Spain

10.1136/ejhpharm-2023-eahp.120

BackgroundandImportance Pharmaceuticalvalidationisnecessarytoachievemaximumclinicalbenefit.Thankstoclinical pharmaceuticalinterventions(CPI)manyprescriptionerrors, druginteractionsandadversereactionsareprevented.

BackgroundandImportance ImmunosuppressionduetoSARSCoV2infection(COVID19)hascausedanincreaseinidentificationofmulti-resistantorganismsinIntensiveCareUnits (ICU),amongwhichmulti-resistant Pseudomonasaeruginosa riseaboutothers.Cefiderocolisacostlynewcephalosporin againstextensivelyresistantGram-negativebacteria.

AimandObjectives Theobjectiveofthisstudyistodescribe thecharacteristicsandclinicalresultsofpatientstreatedwith cefiderocol,aswellasthedosageofthistreatment,inICU inpatientswithCOVID19pneumoniaandco-infectedwith pan-resistant Pseudomonasaeruginosa

AimandObjectives

ToanalyseCPIcarriedina1040-bedhospitalandtoassesstheacceptancerateoftheseinterventions.

MaterialandMethods Observationalandretrospectivestudyof CPIperformedbetweenJuneandAugust2022inhospitalised patients.TheywererecordedinthepharmaceuticalinterventionmoduleofPharmNetapplicationofMilleniumprogramme.Thevariablesevaluatedwere:episodenumber,date, typeofintervention,prescribingservice,drugandindication. Interventionsthatledtoachangeintheprescriptionwithin 48hoursoftheCPIwereconsideredaccepted.

Results Atotalof324interventionswereanalysedin293 patients,whichwere100%ofthoseperformed.Morethan halfoftheinterventionsweretherapeuticduplications (36.4%;n=118)anddosingerrors(25.9%;n=84)(overdose 62%andunderdose23%).Theywerefollowedinfrequency by:incompletemedicalorders(18.5%;n=60);drugsnot indicated(6.8%;n=22);druginteractions(4.6%;n=15); inappropriatedosageform(4.6%;n=15)andadverseevents (3%;n=10).Thedistributionofthenumberofinterventions accordingtoprescribingservicewas:cardiology(n=54);gastroenterology(n=44);pneumology(n=32);internalmedicine (n=30);vascularmedicine(n=29);neurology(n=23)and traumatology(n=28).TheacceptancerateoftheCPIwas 80,3%(n=260)withthefollowingservicedistribution:90% internalmedicine;87.5%pneumology;84%gastroenterology, 82.7%neurologyand79.3%cardiology.Drugswhichcaused mostinterventionswereantibiotics(17%),anti-inflammatory drugs(11.4%),cardiovascularagents(11.1%)andantidepressants(9%).

ConclusionandRelevance Theclinicalpharmaceuticalinterventionsproposedtotheprescribingserviceswerehighly accepted.Thisshowstheimportanceofpharmaceuticalvalidationbythehospitalpharmacisttobettermanagethequality andsafetyofpharmacologicaltreatmentprescribedtopatients duringtheirhospitalstay.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

MaterialandMethods Retrospectiveobservationalstudycarried outinageneralhospitalfromSeptember2020toDecember 2021.InpatientsatICUdiagnosedwithCOVID-19pneumonia thatweretreatedwithcefiderocoldueto P.aeruginosa infectionwereincluded.Collecteddatawere:daysadmittedin ICU,daysoftreatmentwithcefiderocol,concomitanttreatment,cefiderocoldosageandresultsofthetreatment.

Results Threepatientsfulfilledtheinclusioncriteriaamong70 patientsadmittedtoICUwithCOVID-19inthestudyperiod (4.3%).Allpatientsincludedweremenandthemedianage was66.6±6.5yearsold.Theypresentedascomorbidities obesity,hypertensionanddiabetesmellitus.Theywereadmittedduring87±28.6days,withdetectionofpan-resistant P. aeruginosa intherangeof32.5±2.1daysafteradmissionat ICU.Allofthesecultureswereonlysensitivetocefiderocol, beingresistanttoallothertestedantibiotics.Duetothat,all patientsreceivedcefiderocolduringtheirstayanddoseadjustmenttotheirrenalfunctionorrenalreplacementtherapy wereapplied.Everypatientreceivedabolusof2gramsin30 minutesandthemaintenancedoseinatleast3hours.The averageoftreatmentdayswas20.5±4.5days.Inallcases, theisolatedstrainsweresensitivetocolistin,socefiderocol wasusedincombinationwithit.Theresultsofthetreatment weredisparate:onecure,onedeath,andonedevelopmentof resistancetocefiderocol.

ConclusionandRelevance Cefiderocoluseformulti-resistant bacteriatreatmentrequirespriorknowledgeofitspharmacokinetics,takingintoaccountthephysiologicalfactorsofpatients initsdosage.Newtreatmentsarenotexemptfromthedevelopmentofresistance.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

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4CPS-107 EFFECTOFPATIENTBODYWEIGHTONTHE PHARMACOKINETICBEHAVIOUROFAMIKACIN 1OSerna-Romero*, 1CGastalver-Martin, 1SBuendia-Bravo, 1AIglesias-Bolaños, 1CCapillaMontes, 1IEscribano-Valenciano, 2ALSalcedo-Mingorranz, 1TCruz-Cruz. 1Hospital UniversitarioDelSureste,PharmacyDepartment,ArgandaDelRey,Spain; 2Hospital UniversitarioSeveroOchoa,PharmacyDepartment,Leganés,Spain

BackgroundandImportance Obesityisadiseasethatinfluences numerousphysiologicalprocesses.Currentlythereislittle pharmacokineticdatainobesepatientsandextrapolateddata frompatientswithnormalweightareoftenused.Inorderto optimisethedosageofdrugsinobesepatients,itisnecessary todesignspecificpopulationmodelsinthisgroupofpatients.

AimandObjectives Toanalysethedifferencesinthepharmacokineticparametersofamikacininhospitalisedpatientsbased onbodymassindex(BMI).

MaterialandMethods Retrospectiveobservationalstudyin whichpatientstreatedwithamikacinbetweenJanuaryand August2022wereanalysed.Thevariablescollectedwere:age, weight,height,sex,serumcreatinine,dosageregimenandamikacinlevel.

PatientswereclassifiedaccordingtotheirBMI:lessthan 30Kg/m2(non-obese)andgreaterthan30Kg/m2(obese). Themeanandstandarddeviationofthevolumeofdistribution(Vd)andclearance(Cl)ofthetwogroupswerecalculatedusingapharmacokineticprogramme(MwPharm)based onasinglecompartmentmodel.

StatisticalanalysiswasperformedusingStudent’st-testfor independentsamples.

Basedonthedatacollected,BMIandcreatinineclearance (accordingtotheCockcroft-Gaultequation)werecalculated. Patientswithaglomerularfiltrationrateoflessthan30mL/ minwereexcluded.

Results 42patients(52%women)with156levelsofamikacin andameanageof69±28yearswereincluded.ThedistributionofpatientsaccordingtoBMIwas:59%normalweight and41%obese.

ThemeanandstandarddeviationofClofobesepatients andnormalweightwere2.67±1.41L/hand1.92±1.04 L/h,respectively.P-valuefromt-testwas0.04(p<0.05)for Cl.

Vddatawere0.314±0.068L/Kg(obese)and0.28± 0.034L/h(normalweight).P-valuewas0.648(p>0.05)for Vd.

ConclusionandRelevance Statisticallysignificantdifferences werefoundinClbetweenbothgroups:inobesepatientsamikacinClwashigherthaninpatientswithnormalweight.

NosignificantdifferencesinVdwerefoundbetweenthe twostudygroups.

Futurestudiesareneededtodesignpopulationpharmacokineticmodelsofamikacininobesepatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Therefore,aclinicalpharmacyservicewasinitiatedonthe haematologywardatourhospital.

AimandObjectives Todeterminethesatisfactionrateofthe clinicalpharmacyserviceinpatientswithhaematological malignanciestreatedwithoralanticancertherapyandinhaematologists-in-training.

MaterialandMethods BetweenJanuaryandMay2022,a surveywasdevelopedtoassesspatientandhaematologists-in – trainingsatisfactionandperceivedvalueofhealthcareservicesprovidedbyclinicalpharmacistsatatertiarycarehospital.Thesurveywastakenbyapharmacistnotinvolvedin dailyclinicalpharmacypractice.Thesurveycontainedquestionsaddressingdemograph ic,typeoforalanticancertherapyandpharmacist-specificitems.Responseswereanalysed usingdescriptivestatistics.Satisfactionwasassessedby5 Likert-scalequestionsandeither8or4open-endedquestionsforcancerpatientsandforhaematologistsintraining, respectively.Weaimedtohaveasatisfactionrateofatleast 80%.

Results Atotalof65patientsand11haematologists-in-trainingparticipatedinthesurvey.Allpatients(100%)ranked thepharmacists ’ explanationaboutmedicationintakeand side-effectsaseitherverysatisfyingorsatisfying.Counsellingaboutdruginteractionswastheonlycriterionthatdid notresultintheachievementofthepredefined80%satisfactionrate,with27.6%ofpatientsbeingverysatisfiedand 51.7%ofpatientsbeingsatisfiedaboutthistopic,respectively.Overall,themajorityofpatients(89.7%)indicated thatpharmacistcounsellingandfollow-upvisitswereof addedvalue.All11includedhaematologistsintraining expressedhighlevelsofsatisfactionwiththeclinicalpharmacistservice.

ConclusionandRelevance Highlevelsofsatisfactionwiththe clinicalpharmacistservicewasreportedbybothpatientswith ahaematologicalmalignancyandhaematologists-in-training. Thissurveyidentifiedthatcounsellingondruginteractionsof oralcancertherapymightbeimproved.Furtherstudiesmay includeassessmentoftheassociationbetweenpatientsatisfactionandcomplianceandtreatmentoutcomes.Alsotheadded valueandcosteffectivenessoftheclinicalpharmacistservice needstobeinvestigatedinfutureresearch.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-109 THERAPEUTICDRUGMONITORINGOFVANCOMYCIN INONCOLOGICANDHAEMATOLOGICPATIENTS:

REAL-WORLDDATA

4CPS-108 PATIENTANDPHYSICIANS’SSATISFACTIONWITH CLINICALPHARMACYSERVICESONAHAEMATOLOGY WARDINALARGETERTIARYCAREHOSPITAL

1JNeefs, 1ESimons, 2AJanssens, 1,3ISpriet*, 1TVanNieuwenhuyse. 1UniversityHospitals Leuven,DepartmentofPharmacy,Leuven,Belgium; 2UniversityHospitalsLeuven, DepartmentofHaematology,Leuven,Belgium; 3KuLeuven,DepartmentofPharmaceutical andPharmacologicalSciences,Leuven,Belgium

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BackgroundandImportance Oralanticancertherapyisincreasinglyusedforthetreatmentofhematologicmalignancies. Despiteitsconvenience,severalchallengessuchasmedication adherencemayimpacttherapeuticeffectivenessandoutcome.

MBardollCucala,MGilabertSotoca,JRiusPerera,IManguesBafalluy,BMartinezCastro, MMirCros,AMoralesPortillo,JASchoenenbergerArnaiz. HospitalArnaudeVilanovade Lleida,ServiciodeFarmacia,Lleida,Spain

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BackgroundandImportance Vancomycinclearancetendstobe higherinpatientswithneutropenia1;consequently,therapeutic drugmonitoring(TDM)ishighlyrecommended.2

AimandObjectives Toassesstheachievementofatherapeutic pharmacokinetics/pharmacodynamics(PK/PD)targetofvancomycininoncologicandhaematologicpatientsusingtroughonlyTDM.

MaterialandMethods Weconductedaretrospectiveand descriptivestudythatincludedoncologicalandhaematological

patientsadmittedtoasecond-levelhospital,startingtreatment withvancomycinanddosingadjustmentguidedbyTDMat thePharmacyservice.

Demographicvariables,Cockcroft-Gaultcreatinineclearance (CrCl),initialdosage,doseadjustments,thefirsttroughlevel, durationoftreatment,andreasonforwithdrawalwerecollected.RenalimpairmentwasdefinedasCrCl<60ml/min. Dosagesof15-20mg/kg/doseandtroughlevelsbetween10 and20 mg/mlwereconsideredoptimalforintermittentinfusionschedules.TDMusedthePKS® software. Results Vancomycintroughlevelswereobtainedin49 patients;12wereoncological,and37werehaematological.

Dosageadjustmentwasnecessaryfor30patients(61%), 25/30duetosubtherapeuticlevel(troughlevel<10 mg/ml) and5/30duetosupratherapeuticlevel(throughlevel>20 mg/ mlwithorwithoutrenalimpairment).

Theinitialmeandosagewas13,7±2,5mg/kg/12h,except inthreepatientswhostartedevery24hduetorenalimpairment.Afterthedosageadjustment,therecommendedmean dosagewas14±3mg/kg/8hin18patientsand13,6±7,6 mg/kg/12hin12patients.

Themeandurationofantibiotictreatmentwas7±4,2 days.Thereasonsforstoppingthetreatmentwere:clinical improvement(n=29),switchtoatargettreatment(n=10), clinicaldeterioration(n=9)andnephrotoxicity(n=1).Nine patientsdied.

ConclusionandRelevance Morethanhalfofthepatientshad subtherapeuticvancomycinlevelsandrequiredantibioticdose adjustment.

Mostpatientsrequiredshorterdosingintervalsratherthan increaseddosestoreducetheincidenceofnephrotoxicity.

REFERENCES

1.BuryD, etal.EurJClinPharmacol 2019;75:921–928

2.RybakMJ, etal.AmJHealth-SystPharm.2020;77:835–864

ConflictofInterest Noconflictofinterest

MaterialandMethods PatientswithHER2-negativeadvanced gastroesophagealadenocarcinomadiagnosedbetween2008and 2021fromamulticentreregistry(34centres)wereincluded. Patientsreceivedchemotherapybasedonplatinum(cisplatinor oxaliplatin)andfluoropyrimidine(5-fluorouracilorcapecitabine).Associationbetweenthefollowingbaselinevariables: specialtyoftheprescribingoncologist,ECOG-PS(Eastern CooperativeOncologicGroupPerformanceStatus),serum albumin,tumourlocation,Laurenclassificationandplatinum andfluoropyrimidineregimenswereevaluatedandChi2test wasperformed.

Results Atotalof1334patientswereregistered,66.49% (n=893)weremale.Seventypercentofourpopulationwas treatedalmostequallywithFOLFOX6(n=468)andXELOX (n=466),followedbyXP19%(n=252),FP3w7%(n=95) andinfewerpercentwithFUOXmodified3%(n=44),FP4w 1%(n=12)andFLO(n=6).Oxaliplatinwasthemostcommonlyusedplatinum(73%,p=971)whilebothfluoropyrimidineswhereadministeredinasimilarproportion(capecitabine 54%).Patientsweremainlytreatedbyanoncologistspecialisingingastriccancer(95%).Generaloncologistpreferredoxaliplatin-basedregimens(46%vs6%)andspecialistoptedmore forcisplatinandcapecitabineassociatedregimens(p=0.031). Patientswithworstperformancestatus(ECOG=2)were treatedtoagreaterextentthantheoverallpopulationwith schemesbasedonoxaliplatinand5-fluorouracil50%versus 38%ofthegeneralpopulation.ThosewithECOG=0received morethanexpectedschemeswithcisplatinandcapecitabine (21%,n=55).Patientswithbaselinehypoalbuminaemia(albumin<35g/dL)receivedintravenousfluoropyrimidinescheduleswithbothoxaliplatin(47%,n=156)andcisplatin(9%, n=3)inahigherproportionthanexpected(p<0.000).AccordingtoLauren`sclassification,therewasahigheruseofcapecitabineversus5-FUinintestinaltumours.Thistrendis reversedindiffusetumours(p<0.000).

ConclusionandRelevance Inthisstudywefoundanassociationbetweentheplatinumandfluoropyrimidineselectedin patientswithadvancedgastriccancerandcertainbaselinevariables.Futurestudiesareneededtoevaluatewhetherthis choicehasanimpactonpatientbenefit.

4CPS-110 ASSOCIATIONBETWEENBASELINECHARACTERISTICS ANDFIRST-LINECHEMOTHERAPYINADVANCED GASTRICCANCERPATIENTS

1AArias*, 2FJAlvarezManceñído, 3AMartinezTorron, 3LMaciaRivas, 4ACalvo, 5LVisa, 6MLLimón, 7GIglesiasÁlvarez, 7AMariñoMéndez, 8PPimentel, 3ALozano-Blázquez.

1UniversityofGranada/HospitalUniversitarioGermansTrias,DoctoralProgrammeIn Pharmacy,FacultyofPharmacy/PharmacyDepartment,Granada,Spain; 2Hospital UniversitarioCentraldeAsturias/UniversityofGranada,PharmacyDepartment/Doctoral ProgrammeInPharmacy,FacultyofPharmacy,Oviedo,Spain; 3HospitalUniversitarioCentral deAsturias,PharmacyDepartment,Oviedo,Spain; 4HospitalUniversitarioGregorio Marañon,DepartmentofMedicalOncology,Madrid,Spain; 5HospitalUniversitarioElMar, DepartmentofMedicalOncology,Barcelona,Spain; 6HospitalUniversitarioVirgenDel Rocío,DepartmentofMedicalOncology,Sevilla,Spain; 7HospitalUniversitarioCentralde Asturias-UniversidaddeOviedo-Ispa,DepartmentofMedicalOncology,Oviedo,Spain; 8HospitalGeneralUniversitarioSantaLucía,DepartmentofMedicalOncology,Cartagena, Spain

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BackgroundandImportance Thereisnostandardfirst-lineregimenforHER2-negativeadvancedgastroesophageal adenocarcinoma.

AimandObjectives Tostudythevariabilityinthechoiceof regimensaccordingtotumour,patientbaselinevariablesand prescribingphysician.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.ThisstudyispartofadoctoralthesisoftheDoctoralProgrammeinPharmacyof theUniversityofGranada.Thanksforyoursupportinthisresearch.

ConflictofInterest Noconflictofinterest

4CPS-111 IMPORTANCEOFIMPLEMENTINGACLINICAL PHARMACOKINETICUNITINHOSPITALPHARMACY SERVICE

1OSerna-Romero*, 1SBuendia-Bravo, 1CGastalver-Martin, 1CCapilla-Montes, 1AIglesiasBolaños, 1IEscribano-Valenciano, 2ALSalcedo-Mingorranz, 1TCruz-Cruz. 1Hospital UniversitarioDelSureste,PharmacyDepartment,ArgandaDelRey,Spain; 2Hospital UniversitarioSeveroOchoa,PharmacyDepartment,Leganés,Spain

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BackgroundandImportance Pharmacokineticmonitoringisa toolusedintherapeuticoptimisationtoachievethebestclinicalresultsandminimisetheincidenceofadverseeffects.

Itisparticularlyusefulindrugswithadose-dependentclinicalresponseandtoxicityrelationshipandwithanarrowtherapeuticmargin.Computingsoftwareareusedtointegrate

patientdataintopopulationmodelsthroughwhichpharmacistscanestablishtheoptimaldosageregimen.

AimandObjectives

Toanalysetheinfluenceofpharmacokineticreportsonclinicaldecision.

MaterialandMethods Aretrospectiveobservationalstudywas conductedfromJanuarytoAugust2022inageneralhospital.

Patientswithatleastoneplasmaconcentrationofamikacin, amitriptyline,carbamazepine,digoxin,phenytoin,phenobarbital,gentamicin,lithium,theophylline,tobramycin,valproic acid,andvancomycinwereincluded.

Collecteddataincluded gender,age,weight,height,serumcreatinine,drug,dosage,plasmaconcentrationsandconcomitant medication.

Apharmacokineticsoftwarewasused.ByBayesianestimation,optimaldosageregimenwascalculated.Basedonthese data,thepharmacistpreparedthepharmacokineticreportand dosagerecommendationsforthephysician.

Recommendationsmadebythepharmacistwererecorded andclassifiedaccordingtofollowingcriteria:Underdosing, intoxication,noadjustmentrequired,lackofadherenceand interactionadjustment.Thepercentageofacceptanceofthe interventionswasanalysed.

Results 182patientsand395interventionswereevaluated.

Clinicalservicesthatreceivedmorepharmacokineticreports wereinternalmedicine(48%)andpsychiatry(19%).Themost commonmonitoreddrugsweredigoxin(24%),valproicacid (22%)andvancomycin(18%).

In21%ofthepatientsadjustmentsweremadedueto underdosing,13%duetooverdosing,4%duetolackof adherence,and2%duetodrug-druginteractions.Therewas noneedtoadjustdosagein40%ofmonitoredpatients.The remaining20%wereinterventionsrelatedtoerrorsinthe extractionoftheanalytics.

71%oftherecommendationsaddressedtophysicianswere accepted.

ConclusionandRelevance Themostcommondosageadjustmentwasduetounderdosingsothattheefficacyofthetreatmentwascompromised.Itshouldalsobenotedthatthereis ahighpercentageoferrorsintheanalyticextractionprocedure.Healthprofessionalswhoperformthesamplecollection mustbeproperlytrained.

Clinicalpharmacokineticsisatoolthatallowsustooptimisethepatient‘sdosageregimen.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

AimandObjectives Developmentofawebtoolforthereview andanalysisofpolymedicatedpatients(>15drugs/month) whoattendoutpatientconsultationsinordertoimprovethe prescriptionofpolymedicatedpatientsandincreasethepresenceofthepharmacistinoutpatientconsultations.

MaterialandMethods AwebapplicationnamedVIGÍAwas developed(VIewerofPotentially InAdequatePharmacotherapeutic Groups).Itcancalculateadherencetotreatment accordingtopharmacydispensingrecordanddetectinadequaciesinpharmacotherapy:duplicities,prescribingcascades, drugswithlowtherapeuticvalue,drugsthatprolongtheQTintervalanddrugscontributingtoanticholinergicburden,givingascorenamedPotentialInadequacyIndex(PII):

PotentialInadequacyIndex(PII)

Duplicity1point

Lowtherapeuticvalue1point

Prescribingcascades0,5points QTintervalprolongation0,5points Anticholinergicburden0,5points

VIGIAcanfilterpatientsbyconsultationdate.Doctors havethereviewsavailableonlinewiththepharmacistrecommendations,beingableornottomodifytheprescriptionat theirchoice.

PIIbeforeandafterthestudywascalculated,comparing themeansthroughStudent’st-testfortwomeansofthesame population(twotails,significanceat5%).

Results Afterastudyperiodof120days,weelaborated486 reviewreportsfromrheumatologyanddigestiveconsultations, achievingtoreducethePIIscorefrom1.58to1.46,and averagenumberofmedicationswentfrom18to17.3.Student’sttestforthePIIvaluebeforeandafterthestudy periodwassignificant(p<0.05).

Abstract4CPS-115Table1

Prescribingcascades0.150.13

Drugswithlowtherapeuticvalue0.310.28

DrugsthatprolongtheQTinterval0.330.33

Drugscontributingtoanticholinergic burden 0.410.38

4CPS-115 DEVELOPMENTANDIMPLEMENTATIONOFAREVIEW PROGRAMMEASSISTEDBYTHEPHARMACISTTO IMPROVETHEADEQUACYOFTREATMENTIN POLYMEDICATEDPATIENTSINHOSPITALOUTPATIENT SETTING

AAlcalaSoto,MVázquezReal,DSRuizPérez,CMCuadrosMartínez*,JFSierraSánchez. HospitalUniversitarioJerezdelaFrontera,PharmacyService,JerezdelaFrontera-Cádiz, Spain

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BackgroundandImportance Ahighnumberofpolymedicated patientspassthroughoutpatientconsultationsandprescribers oftendon’thavethetimeorcapacitytodealwiththeir polypharmacy.

PII1.581.46**(p<0.05)

Averagenumberofmedications1817.3

ConclusionandRelevance Reviewofpolymedicatedpatientsby thepharmacistseemstoreduceinadequaciesoftheir pharmacotherapy.

ThisPIIscore,madeupofdifferentsituationsconsidered tobeatrisk,cangiveanideaofthebenefitofitsreduction, notonlyintermsofpatientsafetybutalsoeconomic,by reducingtheaveragenumberofdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-116 THEEFFICIENCYANDCOST-EFFECTIVENESSOF HEALTHCAREANDNUTRITIONALINTERVENTIONSIN THEMANAGEMENTOFPOST-STROKE

OROPHARYNGEALDYSPHAGIA,RESULTSOFA SYSTEMATICREVIEW

1SMarin*, 2OOrtega, 3MSerra-Prat, 1EValls, 4LPérez-Cordón, 1CCodina-Jiménez, 2PClavé. 1HospitalUniversitariGermansTriasIPujol,PharmacyDepartment,Badalona, Spain; 2HospitaldeMataró,GastrointestinalPhysiologyLaboratory,Mataró,Spain; 3Hospital deMataró,ResearchUnit,Mataró,Spain; 4HospitaldeMataró,PharmacyDepartment, Mataró,Spain

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BackgroundandImportance Post-strokeoropharyngealdysphagia(PS-OD)causessignificanthighcostsduringhospitalisation thatincreasewiththedevelopmentofmalnutritionandrespiratoryinfectionsatlong-term.Thisdatasuggeststhatthe appropriatemanagementofPS-ODincludingtheuseofearly detectionprogrammes,texture-modifieddiets,commercially thickenedfluids,domiciliaryenteralnutrition,andrehabilitationprogrammesincludingrestorativetreatmentscouldleadto cost-effectivereductionofclinicalcomplications.1

AimandObjectives Toassessliteratureontheefficiencyand cost-effectivenessofavailablehealthcareinterventionsonthe managementofPS-OD.

MaterialandMethods SystematicreviewfollowingPRISMA recommendations.MEDLINE,Embase,NHS-EEDandCEARegistryweresearchedupto30June2021toincludestudies onPS-OD.Outcomesofinterestweretheefficiencyandthe cost-effectivenessofhealthcareinterventionsonthemanagementofPS-OD.Economicevaluationstudieswereincluded. Oesophagealdysphagiaandnon-strokestudieswereexcluded.

Results 235studieswereidentifiedand10included.Svendsenet-al foundlowerhospitalisationcosts(HC)(USD12,556 CI95%9,751-15,361)whenPS-ODwasassessedduringthe first24hoursafteradmission.Liu-et-al didnotfinddifferencesinHCwhenPS-ODwasassessedwiththewaterswallowingvsvolume-viscosityswallowingtestifthewatertestfailed.

Schwartz-et-al foundanon-significantreductiononHC(Australiandollars18,053vs16,548,p=0.722)usingaprotocolto manageODafterthrombolysis.Wilsonet-alshowedvideofluoroscopyasthemostcost-effectivescreeningmethodcomparedtobedsideevaluationandacombinationofboth.

Khiaocharoenet-alandSuksathienet-alshowedcost-effective rehabilitationprogrammesthatincludedODmanagement.

Pelczarskaet-alshowedthattheuseoftexture-modifieddiets usingagum-basedthickener(NutilisClear®)wascost-effective (PLN21,387-20,977perQALY),andKoteckiet-althatcommerciallythickenedfluidsusewasmoreefficientthan insitu preparation.Eliaet-alshoweddomiciliaryenteralnutrition cost-effective(£12,817perQALY)andBeavan-et-al showed highernutrientintakeandlowHCincreaseusingloopednasogastrictube(5,20sterlingforevery1%increase).

ConclusionandRelevance Healthcareinterventionstomanage PS-ODwithapositiveclinicaleffecttendtobecost-effective. Futurestudiesassessingthecost-effectivenessofapplyingcompensatoryand/orrestorativestrategiesamongwithreporting cost-savingsbyappropriatePS-ODearlyevaluationandmanagementarene

ConflictofInterest Noconflictofinterest

REFERENCES

1.MarinS, etal. Economicevaluationsofhealthcareinterventionsinoropharyngeal dysphagiaafterstroke:protocolforasystematicreview. SystRev.2022;11(1): 92.

4CPS-117 USEOFERYTHROMYCINASPROKINETICIN CRITICALLYHOSPITALISEDPATIENTS

MJLucasMayol,MRodriguezMorote,CMatosesChirivella,MIbañez,AMurciaLópez, ANavarroRuiz*. HospitalGeneralUniversitariodeElche,ServiciodeFarmacia,ElcheAlicante,Spain

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BackgroundandImportance Criticallypatientssometimessuffer fromgastrointestinaldisorderswhicharenecessarytotreatto improveclinicaloutcomes.Erythromycinisanantibioticwith prokineticactivityduetoitsagonistactivityonmotilinreceptors,acceleratinggastricemptying.

AimandObjectives Toevaluatetheefficacyofintravenous erythromycinasaprokineticincriticallyillhospitalised patients.

MaterialandMethods Retrospectiveobservationalstudyin criticallyillpatientsoveraperiodof12months(04/ 2021-03/2022).PatientdatawereobtainedusingFarmasyst ® andOrionClinic ® software:sex,age,weight,start andenddateoftreatment,dosage,clinicalservice,diagnosis,concomitantprokinetics(metoclopramide,dexpanthenol)andclinicalcourse.Theefficacyoferythromycin usewasassessedbytheabsenceofsymptomssuchas abdominaldistension,flatusandhydroaerialsoundsor nausea.

Results 39patientswerestudied,64%weremenand36% women,withameanageof64yearsandanaverage weightof71kilograms.85%wereinsurgicalintensive careunit,therestinintensivecareunit.Allpatientswere prescribederythromycinatdosesof250milligramsevery 8hours,maintainingtreatmentforanaverageof5days. Thediagnosesforwhicherythromycinwasprescribed were:weakperistalsisin13pat ients,absentperistalsisin 18,intolerancetoenteralnutritionin6patients,and uppergastrointestinalbleedingin2.Ontheotherhand, 39%ofallpatientshadalreadybeenprescribed10mgof intravenousmetoclopramideevery8hoursasaprokinetic priortostartingerythromycin,andthiswasmaintained whentreatmentwiththemacrolidewasinitiated.In41.5% ofpatients,metoclopramidewasprescribedtogetherwith erythromycin.Erythromycintreatmentwasendingin37 patientsduetoclinicalimprovementwithresolutionof abdominaldistension,auscultationofperistalsisandpresenceofstool,in1patientduetotolerancetoenteral nutritionand1patientdied.

ConclusionandRelevance Theuseoferythromycinasaprokineticinthepopulationevaluatedhasbeenshowntobe effectiveinimprovingintestinalmotility.Therewasnodifferencebetweengroupswhichwereadministeredmetoclopramideornotbeforeorduringthetreatmentwith erythromycin.Giventhevariabilityobserved,intermsof duration,concomitantprokineticsorindication,thereisa needtoestablishaprotocolfortheuseoferythromycinasa prokinetic.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-118

HEALTHOUTCOMESINACOHORTOFHIV+PATIENTS STRATIFIEDUSINGTHEKAISERPERMANENTE PYRAMIDPOPULATION-BASEDRISKSTRATIFICATION

MODEL

1XAntón*, 1JCasas, 1AdeBasagoiti, 2JGoikoetxea, 2EBereciartua, 1MLigros, 1JBarroso, 1BMoñino. 1HospitalUniversitarioCruces,HospitalPharmacyDepartment,Barakaldo –Biscay – BasqueCountry,Spain; 2HospitalUniversitarioCruces,InfectiousDiseases Department,Barakaldo – Biscay – BasqueCountry,Spain

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BackgroundandImportance Inrecentyears,hospitalpharmacistshavebeenapproachingpopulation-basedriskstratification modelsforselectedgroupsofpatients.Theimplementationof thesestrategiesasroutinewouldfacilitatetheadequationof thepharmaceuticalcaretopatientcomplexity.

AimandObjectives ToanalysethehealthoutcomesofHIV+ patientsonAntiretroviralTherapy(ART)inacomparative manneraccordingtotheirclassificationintheKaiserPermanentePyramid(KPP).

MaterialandMethods RetrospectiveobservationalstudyincludingallHIV+patientswithactiveARTon2022/01/03followedupintheoutpatientpharmacyofatertiaryhospital. Theresultsextractedon2022/01/03fromtheclinicalhistory wereanalysedaccordingtotheKPPriskstratificationmodel. Datacollected:sex,age,HIVViralLoad(VL),CD4+,polypharmacy( 6drugs,ARTincluded),ARTcost/patient/UndetectableVL(UVL;<50copies/mL),EmergencyDepartment Attendances(EDA)/previousyear,andstratumofKPP(General population:PromotionandPrevention(PP);Chronicpatients: Self-managementSupport(SS);High-riskpatients:IllnessManagement(IM);Patientswithseverecomplications:CaseManagement(CM)).

Results 947(68%men)withamedian(IQR)ageof54years [46-59]wereincluded.92%hadUVLand2%>200copies/ mL.5%had<200CD4+/mL,23%200-500CD4+/mLand 72%>500CD4+/mL.39%ofpatientshadpolypharmacy. EDA/previousyearwas:0,67%patients;1-3,29%patients; 4-8,3.5%;>8,0.5%.

ClassificationaccordingtoKPP:3.5%unclassified,3%PP, 45%SS,33%IMand15.5%CM.4%ofPP,16%SS,88%IM and85%CMhadpolypharmacy.

91%ofPP,93%SS,93%IMand87%CMhadUVL.NoPP patients,2%SS,1%IMand5%CMhadCV>200copies/mL.

NoPPpatients,3%SS,4%IMand10%CMhad<200 CD4+/L.82%ofPPpatients,79%SS,71%IMand57% CMhad>500CD4+/L.

EDA/previousyearwas0,77%PP-75%SS-65%IM-38% CM;1-3,23%PP-23%SS-33%IM-44%CM;4-8,NoPP-1% SS-2%IM-16%CM;>8,NoPPorSS-1%IM-2%CM.

TheART/patient/UVLcostwasthesameastheoverallcost inPPandIMpatients,9%lowerinSSand22%higherin CM.

ConclusionandRelevance Thestudyshowsaworseningin HIVhealthoutcomesandanincreaseinresourceconsumption aspatientcomplexityenhances.

TheKPPmodelallowsustoidentifypatientsatgreater riskofsickness-relatedcomplicationsandwithapotentially highconsumptionofresources,whomayrequireanindividualisedandmorespecificpharmaceuticalcareinoursetting.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-119 PNEUMONOLOGY-PHARMACYCOLLABORATIONIN THEPHARMACOTHERAPEUTICOPTIMISATIONOF MONOCLONALANTIBODIESINPATIENTSWITH SEVEREUNCONTROLLEDASTHMA

1AAlcalaSoto, 2FPérezGrimaldi, 2JGSotoCampos, 1CMCuadrosMartínez*, 1MTGómez deTravecedoYCalvo, 1JFSierraSánchez. 1HospitalUniversitarioJerezdelaFrontera, PharmacyService,JerezdelaFrontera-Cádiz,Spain; 2HospitalUniversitarioJerezdela Frontera,PneumologyService,JerezdelaFrontera-Cádiz,Spain

10.1136/ejhpharm-2023-eahp.131

BackgroundandImportance Inchronicdiseases,concernabout safetyandeconomicimplicationsoftreatmentwithbiological drugshaveraised,theneedtoadapt,byreducingdoses,the treatmentusedoncereachedtheindividualisedtherapeutic goalforeachpatient.

AimandObjectives Implementationofapharmaceuticalcare consultationforpatientswithSevereUncontrolledAsthma (SUA).

ToestablishacollaborationwiththePneumologyService forthereferralofcandidatepatientsforpharmacotherapeutic optimisation.

MaterialandMethods Pharmaceuticalcareconsultationswere scheduledforallSUApatients.

Candidatesforoptimisationwerethosetreatedwithany monoclonalantibodyformorethan1year,hadnoexacerbationsinthelast12months,ACTscore>20,FEV1>80%, withdrawaloforalcorticosteroids,hadgoodadherenceto treatmentmeasuredbytheTestofAdherencetoInhalersand thepharmacydispensingrecord.

Ifapatientmettheserequirementswasreferredtopneumologistwithatreatmentoptimisationproposal(lengthening theintervalbetweendosesorreducingthedose).Pneumologistswereabletoaccepttheoptimisationproposalornot.If therewasworseningafterdoseoptimisation,theinitialprescriptionwasreturned.

Results Duringa2-yearperiod,fromMay2020toMay 2022,38patientsreceivedMepolizumab,20Benralizumab,14 Reslizumaband59Omalizumab.125patientscametopharmacyconsultation.

35patientsthatmetthecriteriaforoptimisingtreatment andwereproposedtopulmonologist,withacceptanceofthe proposal:9withmepolizumabevery5weeks,1withbenralizumabevery9weeks,5withbenralizumabevery5weeks, and20withomalizumabathalfinitialdose.

InSeptember2022,25patientscontinuetobeoptimised, 10patientshavereturnedtotheusualdosebecausetheywere notfullycontrolledwiththeoptimisedregimen,noneof whomhadasthmaexacerbations.

ConclusionandRelevance Pharmacotherapyoptimisation exposespatientswithtotalcontrolofasthmatolessdrugand lessprobabilityofdevelopingadverseeffects,whileminimising costsinthehealthsystem.

Abstract4CPS-119Table1

MonoclonalantibodyNpatientsNoptimisation%optimisation Mepolizumab38923,7% Benralizumab2015% Reslizumab14535,7% Omalizumab592033,9% Totalpatients1313527%

Thecollaborationpneumology-pharmacyallowstheidentificationofpatientcandidatesforoptimisation,managingto optimisealmost1outofevery3patientsintreatmentwith monoclonalantibodies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

MGuerfali*,IFadhel,EFerchichi. UhclaRabta,PharmacyDepartment,Tunis,Tunisia 10.1136/ejhpharm-2023-eahp.132

BackgroundandImportance Antiretroviral(ARV)drugsare usedinthetreatmentandpreventionofHIVinfection,they haveimprovedtheprognosisofthedisease.1

However,ARVsexposetomanyadverseeffects,whichcan compromisethequalityoflifeandvitalprognosis.2

AimandObjectives Theaimofthisstudyistoevaluatethe frequencyandintensityoftheadverseeffectsofARVs observedwithPLHIV(peoplelivingwiththehumanimmunodeficiencyvirus)andtheactiontobetakeninordertoreduce theseeffects.

MaterialandMethods Itisaprospectivestudyconductedover aperiodof3monthson40patientsconsultingforHIVin theinfectiousdiseasedepartment.

Datacollectionwasdoneusingaquestionnaire:acollection sheetwith2sections:

. thefrequencyandintensityofadverseeffectsofARVs . whattodotoreducetheadverseeffectsoftheirantiretroviral treatment.

Thedatacollectedwasenteredintoadatabase(Excel 2007).

Results Thesampleiscomposedof45%(n=18)womenand 55%(n=22)men.

ThemainadverseeffectsofARVsobservedwithPLHIV aredizzinesswithafrequencyof(F=92%)andintensity (I=85%),diarrhoea(F=80%,I=75%),headache(F=78%, I=69%),sleepdisordersandskinproblems.

52.5%ofpatientsareuninformedonhowtoreduceside effects.

40%stoppedtheirtreatmentduetoadverseeffects,50% chosetheself-medicationandothersconsultedspecialistdoctorsbecause,forthem,certaineffectsarenotconsideredas warningsigns.

Only10%ofpatientsfeelthatsideeffectsarewellmanaged,whereasaremarkablepercentageof77.5%are ‘without opinion’

ConclusionandRelevance MostPLHIVdonottalkabouttheir sideeffectstotheirdoctororpharmacistdespitetheirhigh frequencyandintensity.Itisurgenttostrengthenandimprove informationtopatientonthemanagementofadverseeffects andespeciallytopassfrominformationtotherapeutic education.

REFERENCES

1.DioufL.M.EffetssecondairesetcomplicationsliesauxtraitementsARVinAccess tocare13thICASA-NAIROBISeptembre24th-26th2003:[A54220];p132.

2.ASSALJP – Traitementdesmaladiesdelonguedurée:delaphaseaiguëau stadedelachronicité.Uneautregestiondelamaladie,unautreprocessusde priseencharge.EncyclMédChir,Thérapeutique,25-05-A-10,18pages

4CPS-121 ANALYSISOFTHEUSEOFINTRAVENOUSIRONIN OUTPATIENTS

1ARodríguezEsquíroz*, 1NGLizamaGómez, 1AMGascónVillacampa, 1MPíoAsín, 2LLorzaGil, 2DPMillacoyAustenrritt, 3MSarobeCarricas. 1HospitalReínaSofía,Pharmacy, Tudela,Spain; 2HospitalReínaSofía,Haematology,Tudela,Spain; 3HospitalUniversitario Navarra,Pharmacy,Pamplona,Spain

10.1136/ejhpharm-2023-eahp.133

BackgroundandImportance Forthelastseveralyears,there hasbeenagrowingtendencyofadministeringferriccarboxymaltoseinhospitals.Thisstudyhasbeencarriedoutdueto thefactthatintravenousirontreatmentsrequireveryspecific occasions.

AimandObjectives Evaluatingtheamountofferriccarboxymaltoseadministeredtooutpatients.

MaterialandMethods Aretrospective,descriptivestudy.All patientsadministeredwithintravenousferriccarboxymaltose fromJanuary2022toJune2022wereincluded.

Thefollowingdatawascollected:demographicparameters (ageandsex),clinicsandbloodtest:administereddose,haemoglobin,ironprofile,comorbiditiesthataffectsaidprofile (kidneyfailure,heartfailure,immune-mediateddisorders, oncologicalprocedure,infection)andtheconcomitantuseof oraliron.

Theindicationwasassessedfollowingthedatasheet.Cases withdiscrepancieswererevisedbythehaematologyward.It wascheckedwhetheracontrolbloodtesthadbeencarried outwithinthreemonthsandwhetherironoverloadhad occurred.

Results 273patientswereincluded,60%werewomenwith anaverageageof63,7±19,03yearsold.26.4%of patientshadnormalvaluesofhaemoglobin.79.9%of patientshadtheirironprofilerequested.26.4%hadan oralirontreatmentand12.1%haditprescribeitafterwards.In29.7%ofpatients,thetreatment ’ seffectiveness wasnotprovensincetherewasnotasubsequentanalysis withinthenextthreemonths.Anironoverloadafterthe intravenousirontreatmentwasnoticedin2.2%of patients.

26%oftreatmentswerenotindicated:8.3%duetothe briefdurationoftheoraltreatment,56.3%duetotheinexistenceofapreviousironprofileand35.2%sinceanirondeficiencywasnotfound.

ConclusionandRelevance Thisstudyconcludedthatahigh percentageofpatientsreceivedintravenousirontreatment whenitwasnotindicated.Themainreasonswerethelackof anironprofileandtheabsenceofapreviousoralirontreatment.Anintravenousironusageprotocolshouldbesetin motioninthehospitaltoensureitscorrectuseandtocarry outasubsequentstudytoanalysetheresultsafterits implementation.

4CPS-120 ADVERSEEFFECTSOFANTIRETROVIRALS: EXPERIENCEOFPATIENTS.«TALKABOUTITTO BETTERMANAGEIT»

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-123 CASE-CONTROLSTUDYONTHEASSOCIATION BETWEENNOSOCOMIALBLOODSTREAMINFECTIONS ANDGLUCOCORTICOIDS,TOCILIZUMAB,SYSTEMIC ANTIBIOTICS,MECHANICALVENTILATIONAND LENGTHOFHOSPITALSTAYINCOVID-19

HOSPITALISEDPATIENTS

CCodinaJiménez*,SMarin,MÁlvarez,ETerricabras,LEstrada,EValls,CGarcíaCastiñeira,ABocos-Baelo,CQuiñones. HospitalUniversitariGermansTriasIPujol, PharmacyDepartment,Badalona,Spain

10.1136/ejhpharm-2023-eahp.134

BackgroundandImportance Hospitalisedpatientswith COVID-19areoftenexposedtoimmunosuppressiveandantiinflammatorydrugsinadditiontosystemicantibiotictreatments.Nosocomialbloodstreaminfections(nBSI)havebeen associatedwiththeneedformechanicalventilationorvenous catheterinsertion.However,thereiscurrentcontroversy regardingtheinfluenceofimmunosuppressive,anti-inflammatoryandantimicrobialdrugsonnBSIoccurrence.

AimandObjectives Assesstheassociationbetweenglucocorticoids,tocilizumab,systemicantibioticsandnonpharmacologic healthinterventionsandtheoccurrenceofnBSIinhospitalised patientswithCOVID-19.

MaterialandMethods Case–controlstudyincludingcasesof nBSIepisodesinadultinpatientswithSARS-CoV-2pneumonia overaone-yearperiodandcontrolswithoutnBSI.Sociodemographicandclinicaldatawerecollectedduringhospitalisation. Bivariableanalysiswasperformed.Numericalvariableswere comparedusingtheStudent’st-testortheMann-Whitneytest andcategoricalvariablesusingthe c2orFisher ’sexacttest. Variableswithap-value<0.1inbivariableanalysiswere includedinamultivariablelogisticregressionmodeltoassess thefactorsindependentlyassociatedwithnBSIoccurrence(pvalue<0.05).

Results 50caseswithCOVID-19and50controlswere included.Meanagewas63.0±12.4(66%men,2.3±2.1 meanCharlsonindexandcomparablebetweengroups).nBSI episodesshowedsignificantlyhigherlengthofhospitalstay (LOS)(OR1.173,95%CI:1.144-1.257, p<0.001),surgeries (OR10.80,95%CI:1.310-88.5, p=0.008),needformechanicalventilation(OR8.10,95%CI:3.31-19.8, p<0.001)antibioticandglucocorticoidstherapydays(OR1.166,95%CI: 1.112-1.122, p=0.017andOR3.20,95%CI:1.325-7.287, p=0.010,respectively),andtocilizumabuse(OR9.33,95% CI:1.115-77.125, p=0.017).Non-significanthighernumber ofchronicrenalfailurecaseswerepresentamongnBSIepisodes(p=0.1).Multivariateregressionanalysesshowed mechanicalventilation(aOR4.892,95%CI:1.206-19.845, p=0.026)andLOS(aOR1.231,95%CI:1.104-1.371, p<0.001)asindependentriskfactorsfornBSIwhencorrected forthepresenceofsurgeries,centralvenouscatheter,tocilizumab,chronicrenalfailureandthedaysofantibioticandglucocorticoidtreatment.

ConclusionandRelevance ThisstudyfoundnBSIindependentlyassociatedwithmechanicalventilationandLOSand didnotfindanassociationbetweennBSIandthepharmacologicalinterventionsassessed.However,giventhebivariateassociationbetweenthesepharmacologicalinterventions andnBSI,andpreviousinconclusiveliteratureonthe effectsofthesetreatmentsonbacterialandfungalinfectionsoccurrence,furtherinvestigationwithalargersample isrequired.

REFERENCE

1.Codina-JiménezC., etal.Riskfactorsfornosocomialbloodstreaminfectionsin COVID-19affectedpatients:protocolforacase-controlstudy. EurJHosp Pharm.2022

ConflictofInterest Noconflictofinterest

4CPS-125 PREEXPOSUREPROPHYLAXISINMENATHIGHRISK FORHIV-1INFECTION

1EMBarreiroFernandez*, 2CMDominguezSantana, 2ERiosSanchez, 3MABlancoCastaño, 4FJSalmeronNavas. 1HospitalUniversitarioPuertoReal,ServiciodeFarmacia,Cadiz,Spain; 2HospitalUniversitarioPuertoReal,FarmaciaHospitalaria,Cadiz,Spain; 3Hospital UniversitarioFarmacia,FarmaciaHospitalaria,Cadiz,Spain; 4HospitalPozoblanco,Farmacia Hospitalaria,Cordoba,Spain

10.1136/ejhpharm-2023-eahp.135

BackgroundandImportance ThePreexposureProphylaxis (PrEP)forHIVinfectionwiththedrugstenofovirandemtricitabine(FTC/TDF)isrecommendedbyWorldHealthOrganizationaspartofHIVpreventiontopeopleatsubstantialrisk HIVinfection.Manycountrieshaveincludeditintheir healthypolice.However,thereisalackofinformationonits implementationinrealpractice.

AimandObjectives Toevaluateadherence,theeffectiveness andsafetytotreatmentforPrEP.

MaterialandMethods Aretrospectiveanddescriptivestudyof alladultpatientswhousedFTC/TDFforPrEPfromSeptember2020toSeptember2022.Clinicaldatawereobtained fromdigitalclinicalhistoryandtheprescriptionsoftware Dominion®:sex,age,durationoftreatment,high-riskforHIV andadherencetotreatment.

Theadherencetotreatmentwasmeasuredusingthedispensingregistry.Effectivenesswasdeterminedbyrelative reductionofHIVincidence;HIVtestingwasperformedevery threemonthsduringthisstudy.Intermsofsafety,adverse events(AE)wererecorded.

Results Fortypatients,100%men,wereincluded,withan averageagedof35(20-57)years.Allpatientswerereceived (FTC/TDF),oncedaily.Theaveragedurationoftreatment was6months(1-30),8patientsreceivedonlytwomonths. AllpatientswereathighriskforHIV,definedas:sexualrisk behaviour(tenormoresexualpartnersandanybacterialsexuallytransmittedinfections(STIs)lastyear).25%patientshad discontinuedtherapyduetolackofadherence.

NoneofthesepatientswerediagnosedHIVduringstudy. 100%relativereductionofHIVincidence.

Notreatment-associatedadverseeffectswereobserved, although75%ofpatientshadPrPE-associatedbacterialSTIs. ConclusionandRelevance

. Aquarterofpatientswerenon-adherenttotreatment,a possiblealternativewouldbeon-demandregimeninthese cases.

. Intermsofefficacy,agreatertherapeuticresultwasobserved, becomingagoodtoolprevention.

. PrEPusedwasassociatedhighincreasedbacterialSTIs, probablyduetonotusingacondom.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-127

PHARMACOKINETICMONITORINGOFVANCOMYCIN, GENTAMICINANDAMIKACININPAEDIATRIC POPULATION

10.1136/ejhpharm-2023-eahp.136

BackgroundandImportance Theaimofpharmacokineticmonitoringistoimproveclinicaloutcomes.Aprotocolwasagreed betweenthepaediatricandthepharmacyservicestoestablish aninitialdosageinthispopulationtoreachatherapeutic benefit.

AimandObjectives Toevaluatetheinitialdosageoftheseantibioticsbycarryingoutpharmacokineticmonitoring.

MaterialandMethods Retrospectiveobservationalstudyfrom May2020toMay2022,includingpatientstreatedwithvancomycin,gentamicin,oramikacinfromthepaediatricsservice aged<1year.ThefollowingvariableswerecollectedatOrion Clinic®:dataonage(postnatal,gestational),weight,anddosage.Thepharmacokineticresults,creatinine,andpharmaceuticalrecommendationwerecollectedfromGestlab®.Theoptimal troughintervalsestablishedintheprotocolforvancomycin, gentamicin,andamikacinwere10-15mcg/mL,0.5-1.5mcg/ mL,2-5mcg/mL,andthedosageaccordingtopostnataland gestationalagewere10-12mg/kg/8h,2.5-4mg/kg/24h,15mg/kg/ 24-48h,respectively.

Results 231patientswereanalysed,50treatedwithvancomycin,169withgentamicinand12withamikacin.Themean weightwas2.58kg,2.52kg,and1.79kgforvancomycin,gentamicin,andamikacin,respectively.Regardinggestationalage (GA),inthevancomycingroup22patients<29weeks,23 between30-36,and5>37weeks.Forgentamicin,theGA was<29weeksin25patientsand>29weeksin144.The GAintheamikacingroupwas<30weeksin7patients, between30-34weeksin4,and>35weeksin1patient.For vancomycin,58%ofpatientsweretreatedforsuspectedsepsis,whilegentamicinandamikacinwerestartedempiricallyin 100%ofcases.Theinitialdosingregimenwasinlinewith theprotocolin86%,94%and67%patientsforvancomycin, gentamicinandamikacin,respectively.Afterthefirstmonitoring,30%patientstreatedwithvancomycinwerewithinthe targetrange,63%inthecaseofgentamicin,and33%for amikacin.Asecondmonitoringwasperformed,afterdosage individualisation,in35,19and6patients,ofvancomycin,gentamicinandamikacin,reachingtheobjectivein49%,68% and67%,respectively.

ConclusionandRelevance Inmostpatients,theinitialdosage ofthethreeantibioticswasadjustedtothehospitalprotocol.

Ahighnumberofpatientstreatedwithvancomycinrequired doseadjustment,incontrastwithgentamicinandamikacin. Theroleofthepharmacist,togetherwithpharmacokinetic monitoring,isappreciatedtoachieveoptimalconcentrations.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-128 CLINICALPRACTICE:ANTI-VEGFTHERAPYFOR RESISTANTMACULAROEDEMA

1EMBarreiroFernandez*, 2FJSalmeronNavas, 3CMDominguezSantana, 3MABlanco Castaño, 3ERiosSanchez. 1HospitalUniversitarioPuertoReal,ServiciodeFarmacia,Cadiz, Spain; 2HospitalPozoblanco,FarmaciaHospitalaria,Cordoba,Spain; 3HospitalUniversitario PuertoReal,FarmaciaHospitalaria,Cadiz,Spain

10.1136/ejhpharm-2023-eahp.137

BackgroundandImportance Therapyapprovedfordiabetic macularoedema(DME)areintravitrealranibizumab(IR), intravitrealaflibercept(IA)anddexamethasoneintravitreal (ID).Currentlythereisagapofinformationonitsusein unresponsivetoprevioustreatment.

AimandObjectives Toevaluateclinicaleffectivenessandsafety ofafliberceptorranibizumab(Anti-VEGF)therapyforresistant macularoedema.

MaterialandMethods Anobservationalretrospectivestudyof allpatientswithDMEunresponsivetopreviousanti-VEGF therapyfromSeptember2021toSeptember2022.Clinical datawereobtainedfromdigitalclinicalhistoryandtheprescriptionsoftware:sex,aged,pathology,previoustherapy,type treatment,numberinjectionsduringstudy,responseand adverseevents(AE).

Effectivenesswasdeterminedbycompleteorpartial response.Completeresponsewasdefinedasmaintenanceof visualacuity(VA)reductionofsubretinalfluidandinflammatoryactivity.Secondly,partialresponsewasconsideredifonly oneoftheseparameterswasobserved.Intermsofsafety, adverseevents(AE)wererecorded.

Results Thirty-fourpatients,53%women(n=18),were included,withanaverageagedof69(35-90)years.The populationwaspatientsdiagnosedwithresistantmacular oedema.Almostallpatientsreceivedtreatmentwithone-line anti-VEGFtherapy(80%aflibercept,20%ranibizumab),only onepatientreceivedtreatmentwithtwolinesanti-VEGF (bevacizumabandranibizumab).Duringthestudy,261injectionsofIR(median9,range3-12)wereadministeredinto 32eyescorrespondingto27patientsand35injectionsofIA (median5,2-7)wereadministeredinto9eyescorresponding to7patients.12%(n=4)forpatientswhoreceivedcombinedtherapywithID.Completeresponsewasobservedin 27%patients(n=9),partialresponsein26%(n=8)and non-response47%(n=17).

Notreatment-associatedadverseeffectswereobserved.

ConclusionandRelevance

. Theeffectivenesswasrelativelylowinunresponsiveto previoustreatment.Futurecontrolledtrialsareneededto confirmtheuseofthistypeoftreatmentsinunresponsive patients.

. Thesafetyprofileforuseofthetherapyshoweditwas tolerated.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

MJLucasMayol,MRodriguezMorote,SGutierrezPalomo,LSorianoIrigaray,MMorante, ANavarroRuiz*. HospitalGeneralUniversitariodeElche,ServiciodeFarmacia,ElcheAlicante,Spain

4CPS-131 SOCIALFUNCTIONOFTHETELEPHARMACY:A SOCIOECONOMICANALYSIS

LDomínguezSenín,GDomínguezBerraquero,MRodriguezJorge*,MDSantos-Rubio. HospitalJuanRamónJiménez,HospitalPharmacy,Huelva,Spain

10.1136/ejhpharm-2023-eahp.138

BackgroundandImportanceremotemedicationdeliverysystems(telepharmacy)areincreasinglyusedbyhospitalsnowadays.Inourhospitalaninclusionandinterruptionprotocolis used,inordertoensurecorrectpharmaceuticalcare,safeand traceabledistributionanddispensingofmedications.Sinceits implementation,aprogressiveincreaseinthenumberoftelepharmacyrequestshasbeenobserved.Despitethis,itisstill unknownwhichkindofpatientswouldbenefitthemostwith thissystem.

AimandObjectivestoconductasocioeconomicanalysisof medicationdeliveryrequeststooutpatientsinatelepharmacy programme.

MaterialandMethodsretrospectiveobservationalstudy fromFebruary1toMay31,2022.Weanalysedwhetherthe averageincomeorthedistancetothehospitalineachlocality ofthepatientsinfluencedthenumberoftelepharmacy requestsbyperformingtwodispersionmapsofrequests:a mapoftheprovincewiththenumberoftelepharmacy requestsofeachlocalitypertotalinhabitantsandasecond mapoftheprovincewiththeaveragepercapitaincomeof eachlocality.

Results 2,842patientswereincludedwith14,833total requests.Accordingtothemapofrequestsfrequencydispersion,therewasnorelationshipbetweenthevolumeof requestsfortelepharmacyandthedistancetothehospital. Someofthemostdistantareasshowedfewerapplications, whileareasclosetothehospital,wereamongthelocations withmostapplicationsperinhabitant.Asshowninthemap ofaverageincomepercapita,wefoundarelationship betweenthenumberofrequestsfromeachlocalityandits averageincome.Theeasternzoneoftheprovince,which highestincomes,hadfewerapplicationsperinhabitant,while moreapplicationstendedtobeassociatedwiththewestern zone,whichhaslowerincomes.Thisrelationshipwasnot absoluteinalllocalities,althoughtherewasageneraltrend. ExceptionswereareassuchasBellavistaandSanlúcarde Guadiana,withhighincomesbutmanyapplications.

ConclusionandRelevancetelepharmacyperformsasocial functionbyfacilitatingaccesstomedicationforthepopulation withfewereconomicresources.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

amongdifferentlevelsofHealthcareSystemsandthatincrease patientmorbidityandmortality.

AimandObjectives ToanalysetheMRactivityonadmission bythePharmacyServiceofasecondlevelhospitaltodetermineitsusefulnessasamethodforpreventingmedication errors.

MaterialandMethods Retrospectivedescriptiveobservational study(January2022-July2022)ofthepharmaceuticalinterventions(PI)reviewedinrelationtoMR.Thevariables studiedwere:clinicalservice,pharmacotherapeuticgroup,type oferrorandacceptance.Weusedtheprogrammeofelectronic medicalrecordMambrinoXXI® forreviewingchronictreatmentsandthepharmaceuticalvalidationprogramme Farmatools®

Results Inthisperiodoftime,12.946admissionswerevalidatedand658PIaboutMRwereperformedonatotalof 516patients.TheclinicalserviceswithmorePIwere:Internal Medicine(N=287,43.62%),GeneralandDigestiveSurgery (N=78,11.85%),Digestive(N=57,8.66%)andNeurology (N=40,6.08%).Themostfrequenttypeofreconciliation errorwas:omission(N=523,79.48%),followedbychangeof dosageregimen(N=114,17.33%).Thepharmacotherapeutic groupswithmostPIwere:lipid-loweringagents(N=75, 11.40%),antihypertensives(N=69,10.49%),antidepressants (N=66,10.03%),urologicaldrugs(N=53,8.06%)and inhaledantiasthmatics(N=30,4.56%).Theacceptancerate was:43.92%(N=289),24.31%non-accepted(N=160)and 31.76%non-evaluable(N=209).Excludingnon-evaluable results,theacceptanceratewas64.37%.

ConclusionandRelevance AlthoughlessthanhalfofthePI wereaccepted,theroleofthepharmacistinMRisuseful. Thisactivitycouldbeoptimisedbythepresenceofthepharmacistbothintheemergencydepartmentandonthehospitalationunit,aswellasbyimplementingactionssuchaspatient interviews.Thedetectionofthemainclinicalservicesand pharmacologicalgroupsrequiringthistypeofintervention wouldmakeitpossibletoprioritiseMRcriteriaandcreate protocolsinordertoimprovethepatientsafetyandreduce theproportionofnon-evaluableresults.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-132 ANALYSISOFPHARMACEUTICALINTERVENTIONS REGARDINGADMISSIONRECONCILIATION

EGarcíaLópez*,SCanalesUgarte,JFernández-BravoRodrigo,LRubioAlonso,GPicazo Sanchiz,DBarredaHernández. VirgendelaLuzHospital,PharmacyDepartment,Cuenca, Spain

10.1136/ejhpharm-2023-eahp.139

BackgroundandImportance Medicationreconciliation(MR)is apharmaceuticalactivitythataimstoresolveerrorsthatoccur inthecontinuationofchronictreatmentatthetransition

4CPS-133 SAFETYANDEFFECTIVENESSOFGUSELKUMABON MODERATETOSEVEREPLAQUEPSORIASIS

1ETejedorTejada, 2MRodriguezGoicoechea*, 2AMorenoLopez, 2NGarciaGomez, 2MJBarberoHernandez, 2FHornoUreña. 1ClinicHospitalofBarcelona,HospitalPharmacy, Barcelona,Spain; 2HospitalaryComplexofJaén,HospitalPharmacy,Jaén,Spain

10.1136/ejhpharm-2023-eahp.140

BackgroundandImportance Psoriasisisachronicinflammatory diseaseassociatedwithvariouscomorbidities,whichrequires multidisciplinarytreatment.Inrecentyears,anti-IL-23drugs haveemergedasanewtherapeuticoptionforplaque psoriasis.

AimandObjectives

Toevaluatesafetyandeffectivenessof guselkumabinmoderatetosevereplaquepsoriasis.

MaterialandMethods

Multicentric,observationalandretrospectivestudyofpatientsdiagnosedwithmoderatetosevere plaquepsoriasis.StudyperiodofdatacollectionwasJune 2021-June2022,activepatientsintreatmentandpatients startingtreatment.Theanthropometricdatawereage,sex,

andpreviousbiologicaltreatments.Theeffectivenessvariables areaffectedbodysurfacearea(BSA)andpsoriasisarea severityindex(PASI)AND90%PASIclearance(PASI90)collectedatbaseline,andnextvisitswithdermatologist.The maintoolsused:Diraya©fortheclinicalhistory,Modulab© forlaboratoryvaluesandExcel©foranonymiseddatarecording.Theinformationwascollectedaccordingtodataminimisationpolicy,article5.1ofdataprotection.

Results 49patients(29men)includedwithameanageof 50.9years.Themainbiologicpre-treatmentswereetanercept (31),adalimumab(11),secukinumab(9)andustekinumab(9).

Averagedpre-treatmentBSA(13,6±10.27SD)andPASI(9.7 ±6.68SD).Nextdermatologist’scontrolat5months43 patientsaveragedBSA(3.9±9.27SD)andPASI(2.9±4.17 SD).PASI90wasreachedby48.8%ofpatients.Therewere fourtreatmentdiscontinuitiesduringthisperiod(1dueto lackofadherence,1duetoprimaryfailure,1duetosecondaryfailureand1duetotoxicity).At10months25patients averagedBSA(1.8±3.28SD),PASI(1.8±3.30SD),and PASI90wasreachedby72%.3treatmentdiscontinuitiesin thisperiod(1duetogestationaldesireand2duetosecondaryfailure).At18months15patientsaveragedBSA(0.9± 1.55SD)andPASI(0.5±0.91SD).PASI90wasreachedby 73%.Patientsnotcountedhadnotgonetodermatologycontrolyetwhenouranalysisweremade.

Safety: Onepatienthadtostoptreatmentduetostrongdiarrhoeasaftereachdose.

ConclusionandRelevance Accordingtotheresultsobtained,it ispossibletoevaluateguselkumabasaneffectiveandsafe alternativeinthetreatmentofmoderatetoseverepsoriasis resistanttoconventionaltreatments.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Results 55CPNwerepreparedand32(58.2%)wereadministered.31newbornrequiredPNand100%receivedthe standardfirstdayoflifeCPN,18(58.1%)patientswere female,themeangestationalagewas28.5weeks,themean weightwas1138.2gand12(38.7%)weremultiplepregnancies.TheindicationofPNwas:23(74.2%)preterminfants born<32.0weekswithbirthweight<1500g,4(12.9%) pretermbabiesborn>32.0weekswith<1500gand4 (12.9%)patientsborn<32.0weekswithbirthweight >1500g.ThemeantimetostartCPNwas6:01h(range 1:13-22:54h),26(83.9%)babiesinitiatedwithin8hatthe latestand5(16.1%)patientsafter8hoflife(3duetoa lackofcentralline,1lackof2readytouseCPNfortwins and1delayedprescription).30patients(96.8%)startedtrophicfeedingwithbreastmilk(maternalorbank)withinthe first24hoflife.

ConclusionandRelevance StandardfirstdayoflifeCPNready tousehasconsiderablyreducedthetimetostartPNinnewbornpatients.However,CPNwasinitiatedafter8hoflifein 5patients(mostlyduetoalackofcentralline).Standardfirst dayoflifeCPNmetthenutritionalrequirementsofallnewbornrequiringPN,notneedingtoproduceindividuallytailoredCPNinanycase.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.2018ESPGHAN/ESPEN/ESPR/CSPENguidelines

2.Neonatalparenteralnutrition.NICEguideline2020

ConflictofInterest Noconflictofinterest

4CPS-136 STANDARDFIRSTDAYOFLIFECENTRALPARENTERAL NUTRITION,EXPERIENCEINREALCLINICALPRACTICE

1MBoschPeligero, 2GGinovartGaliana, 1AAriasMartinez, 1ASilesBaena, 2MOcañaRico, 2RPortaRibera, 1AMartínVal, 1LLagunaMarmol, 1ETerricabrasMas, 1CCodina Jiménez*, 1CQuiñonesRibas. 1HospitalGermansTriasIPujol,PharmacyDepartment, Badalona,Spain; 2HospitalGermansTriasIPujol,NeonatalUnit – PaediatricDepartment, Badalona,Spain

10.1136/ejhpharm-2023-eahp.141

BackgroundandImportance Standardparenteralnutrition(PN) solutionsshouldgenerallybeusedoverindividualisedPNsolutionsinthemajorityofpaediatricandnewbornpatients, includingvery-low-birth-weightprematureinfants,1 startingas soonaspossibleandwithin8hatthelatest.2 In2021our PaediatricandPharmacyDepartmentsdesignedastandardcentralPN(CPN)tohavereadytouse,inordertomeetthe nutritionalneedsofmostnewbornpatientsintheirfirstday oflife.

AimandObjectives Evaluatetheuseofthestandardfirstday oflifeCPNanddescribeclinicaldataofpatientsandthetime frameforitsstart.

MaterialandMethods Observational,retrospectiveandlongitudinalstudyconductedbetweenMarch2022andSeptember 2022inatertiaryhospital.Adatabasewasdesignedtorecord allpreparedCPN,theiruseanddataofpatientswhoreceived them.

4CPS-137 EVALUATINGTHEPOTENTIALCLINICALAND ECONOMICIMPACTOFCHEMOTHERAPY

PRESCRIBINGBYPHARMACISTSATAUNIVERSITY TEACHINGHOSPITAL

1SNally*, 2KDalton. 1UniversityHospitalLimerick,Pharmacy,Limerick,IrelandRep; 2UniversityCollegeCork,SchoolofPharmacy,Cork,IrelandRep

10.1136/ejhpharm-2023-eahp.142

BackgroundandImportance Chemotherapyprescribingerrors representapotentiallyseriousriskofcausingpatientharm. Whilstpharmacistprescribinghasawell-establishedrolein manyclinicalsettingsworldwideandhasbeenshowntobe effective,thereisapaucityofresearchonpharmacistprescribingchemotherapy.

AimandObjectives Assessthepotentialclinicalandeconomic impactofpharmacistprescribingversusmedicalprescribingof chemotherapy(includingsupportivemedicines)atauniversity teachinghospital.

Quantifytheerrorrateinpharmacist-anddoctor-prescribedchemotherapyprescriptions.

ClassifyprescribingerrorsaccordingtothePharmaceutical CareNetworkEurope(PCNE)classificationframeworkfor drug-relatedproblems(DRPs).

Assessthepotentialseverityofprescribingerrorsmadeby thepharmacistsanddoctorsusingavalidatedtoolandpeer reviewpanel.

Evaluatethetimetakenforthechemotherapyprescribing processbydoctorsandpharmacistsandassigncoststothese times.Estimatethecostoftheprovisionofapharmacistprescribingserviceincomparisontothedoctorprescribing practice.

MaterialandMethods

Thiswasacomparative,prospective studythatexaminedthesamesetof155prescriptionspreparedbybothdoctorsandpharmacistsforthesamesetof patients.Thepotentialseverityandadversedrugevent(ADE) probabilityassociatedwiththeprescribingerrorswasassessed usingavalidatedtoolandpeerreviewpanel.Thecostavoidanceassociatedwiththeprovisionofpharmacistprescribing wasalsodetermined.

Results Inthecomparativesampleof155prescriptions,doctorsmadesignificantlymoreerrors(105in40.6%ofprescriptions)thanpharmacists(23in14.8%ofprescriptions); p<0.05.Noneofthepharmacists’ errorswereclassifiedas 'severe',whilst16.7%ofdoctors’ errorswere'severe'(n=17). Regardingcostavoidance,apotentialyearlynetcostbenefit ofC ¼ 1,254,347.72andacost-benefitratioofC ¼ 41.82wascalculatedfortheprovisionofapharmacistchemotherapyprescribingservice.

ConclusionandRelevance Thisstudyhasshownthathaving pharmacistsprescribing – andbetterusingtheirexpertskillset

resultsinfewerchemotherapyprescribingerrors.Whilethis minimiseshealthcareprofessionals’ workloadaswellasany potentialdelaysforpatientstoreceivechemotherapy,pharmacistprescribingmostimportantlyimprovespatientsafety,and thereforethisisultimatelywhythisinitiativeshouldbeconsideredforimplementationincancercareservicesonamuch widerscaleinfuture.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-138

USEOFSODIUMZIRCONIUMCYCLOSILICATEIN HYPERKALAEMICEMERGENCIES

RFusterTalens*,ABasCastillo,MIGilGómez,ROlivesCasasnovas,MDMBetoretVilar, PBlascoSegura. ConsorcioHospitalGeneralUniversitario,ServiciodeFarmacia,Valencia, Spain

10.1136/ejhpharm-2023-eahp.143

BackgroundandImportance Hyperkalaemia(K>5.5mEq/L)is anelectrolytealterationthatcandeterminefatalclinicalcomplications,themostseriousbeingcardiovascularandmuscular. Sodiumzirconiumcyclosilicatebindspotassiumthroughoutthe gastrointestinaltractreducingserumpotassiumlevelsand increasingfaecalexcretiontoresolvehyperkalaemia.

AimandObjectives Analysisoftheeffectivenessofsodiumzirconiumcyclosilicate(SZC,Lokelma®)forthetreatmentof hyperkalaemiainpatientstreatedinhospitalemergencyorin differenthospitalisationunitsinthefirst48hours.

patients(92.0%)and<30ml/min/1.73m2in41(62.0%). Thecausesofhyperkalaemiawere:chronickidneydisease (CKD)(47.0%,N=31),acutekidneydisease(AKD)(39.4%, N=26),iatrogenic(7.6%,N=5)andothercauses(6.0%, N=4).Thedrugscontributingtohyperkalaemiawereangiotensin-receptorblockers(41.0%,N=27),aldosteroneantagonists(28.8%,N=19),non-steroidalanti-inflammatorydrug (24.2%,N=16),andangiotensin-convertingenzymeinhibitors (16.7%,N=11).

Initialserumpotassiumconcentrationmeanwas6.4mEq/L (5.5-8.2),being>7.5mEq/Lin21patients(32.0%).Mean reductioninpotassiumconcentrationsat24hourswas14.1% (N=22)and22.5%(N=21)at48hours.24hoursafterstartingtreatmentwithSZC,potassiumconcentrationswerenormalisedin33.3%(N=22)ofpatientsandin31.8%(N=21) after48hours.

ConclusionandRelevance HyperkalaemicemergenciesarefundamentallyassociatedwithpatientswithAKD,CKDandin concomitanttreatmentwithdrugsinducinghyperkalaemia. SZCtreatmentisanalternativetobeconsideredinpatients withhyperkalaemicemergencies,contributingtothenormalisationofserumpotassiumlevelsinfirst24-48hoursafterstartingtreatment.

WAmmor*,CAuriault,MHorellou,SPetitgas. CentreHospitalierLoireVendéeOcéan, InternalUsePharmacy,Challans,France

10.1136/ejhpharm-2023-eahp.144

BackgroundandImportance SinceJuly2007,pharmaceutical teamwritesamonthlypharmaceuticalnewsletter(PN)tohospitalstaff(HS).Itcontainsinformationaboutdrugsormedicaldevices(pharmaceuticalnews,remindersofappropriate use,etc.).ItiscurrentlysenttohealthmanagersandHSby e-mailandisaccessibleonthehospitalwebportal.However, sinceitsimplementation,nostudyhasbeencarriedoutconcerningtheadherenceofHStothistool.

AimandObjectives TheaimistoassesstheadherenceofHS tothePNandtoproposeareasofimprovement.

MaterialandMethods

One-yearretrospectiveandobservationalstudywascarried,includingpatientstreatedinhospital emergencyoradmittedwithinitialpotassiumlevels 5.5 mEq/LwhoreceivedSZC.TheSZCregimenwas10gevery 8horally.Serumpotassiumconcentrationswereconsidered normalwithvaluesbetween3.3-5.1mEq/L.Thevariables collectedwereage,sex,diagnosisofheartfailure,serum potassiumconcentrations(at0,24,and48hoursafterstartingtreatmentwithSZC),thereasonforhyperkalaemia,glomerularfiltrationrate(GFR,estimatedwithCKD-EPI formula),concomitantdrugsthatcouldinfluencethe hyperkalaemia.

Results 66patients(63%men)withamedianageof79years (41-97)wereincluded.Heartfailurewasdiagnosedin27 patients(41.0%).TheGFRwas<60ml/min/1.73m2in61

MaterialandMethods Wedevelopedtwosurveysindigital andpaperformat:oneforthehealthmanagersandtheother forthereadersofthePN.Thesurveyforthemanagerswas firstsenttothemtofindouthowtheycirculatedthePNto thestaffintheirunits.Unitsforwhichmanagerialresponses hadnotbeencollectedwereexcluded.ThesurveywasconductinSeptember2022bytwopharmacyinterns.

Results 16healthmanagersrespondedtothesurvey:100% readthePN,81%distributedit(85%posteditinthedepartmentand15%bye-mail).

123readers(including40%ofnurses,20%ofnursing assistants,15%ofdoctors)from20departmentsrespondedto thesurvey.68%ofHSreadthePN:20%consulteditbyemail,30%readitonthehospitalwebportal,34%readit displayedintheunitand5%readitatthepharmacy.75% findituseful,83%aresatisfiedwithitscontent,83%withits presentationand63%withthedistributionchannel.Finally, 48%ofreaderswouldlikethePNtobedisplayedintheir

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-139 THEPHARMACEUTICALNEWSLETTERASAN INFORMATIONTOOL:USEFULORFUTILE?

units,40%wouldlikeittobesentbyemailand15%would likeadedicatedwebsite.

ConclusionandRelevance ThemajorityofHSsupportthe PN,finditusefulandappreciateitscontentandpresentation. PartoftheHSdidnotknowthePN,whichshowsthatthe distributionmethodneededtobeimproved.Wehavethereforeupdatedthemailinglist.Thissurveyhasenabledusto highlightthesatisfactionwiththeHNandimproveits distribution.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-142 EVALUATIONOFPREMEDICATIONUSEINADVERSE DRUGREACTIONSOCCURRENCEINPATIENTSWHO RECEIVEDINFLIXIMABTOTREATINFLAMMATORY BOWELDISEASE

1XLarreaUrtaran*, 1QLópezNoguera, 2GEspinMartí, 2LDVTorrealbaMediana-, 1CDíez Vallejo, 1ÀCastellóNòria, 1MBrugeraTeixidor, 1ENoguéPujadas, 2DBusquetsCasal, 1RSacrestGüell. 1HospitalDr.JosepTrueta,PharmacyDepartment,Girona,Spain; 2Hospital Dr.JosepTrueta,DigestiveDepartment,Girona,Spain

10.1136/ejhpharm-2023-eahp.146

4CPS-141 PHARMACEUTICALINTERVENTIONSINAMEDICAL EMERGENCYDEPARTMENT:6-MONTHSEXPERIENCE

1,2OElQabissi*, 1,2FZLasri, 1,2HDaoudi, 1,2AChaibi, 2,3MAitelCadi. 1FacultyofMedicine andPharmacyofRabat-MohamedVSouissiUniversity-Rabat-Morocco,Pharmacy,Rabat, Morocco; 2IBNSinaHospital,Pharmacy,Rabat,Morocco; 3FacultyofMedicineand PharmacyofRabat-MohamedVSouissiUniversity-Rabat-Morocco,Toxicologyand Pharmacology,Rabat,Morocco

10.1136/ejhpharm-2023-eahp.145

BackgroundandImportance Medicationerrorsareamajor globalpublichealthproblemthatrequiresaveryimportant approachandcollaborativeworkbetweenphysicians,pharmacistsandnurses.Pharmaceuticalinterventions(PI)areaneffectivewaytofightdrugiatrogeny.

AimandObjectives Theobjectiveofthestudywastoanalyse pharmaceuticalinterventionsandtheirimpactonpatientshospitalisedinamedicalemergencydepartment

MaterialandMethods Thisisaretrospectivestudyconducted inamedicalemergencydepartmentoftheIbnSinaHospital inRabatoveraperiodof6months.Prescriptionswereanalysedandvalidatedaccordingtothemethodologyofthe FrenchSocietyofClinicalPharmacy(SFPC).Therelevanceof thePIswasassessedbytheiracceptanceratebytheprescribersandtheirclinicalimpactwasevaluatedaccordingtothe Hatoumscale.

Results Atotalof158Pharmaceuticalinterventionswere recordedoversixmonths.Ofthese,98%wereacceptedby theprescriber.Thesexratio(male/female)was1.35.The averageageofourpatientswas56.06±15.81years.86PIs (55%)concernedanantibiotic.Themainprescriptionproblemswereoverdose(29%).Ourinterventionsconcerneddosageadjustment(32.27%),optimisationofadministration modalities(22.15%).

ConclusionandRelevance Thisstudyhighlightstheimportance oftheclinicalpharmacistinthefightagainstdrugiatrogeny.

REFERENCES

1.Hedira etal.Évaluationdel'activitédepharmaciecliniquedansuncentrehospitaliermère-enfantenTunisie – 53-LePharmacienHospitalieretClinicien.2018

2.A.Clementz etal.Miseenplaceetévaluationdesvalidationsd'ordonnanceset d'interventionspharmaceutiquesdansunserviced'urgencesadultes. LePharmacien HospitalieretClinicien,Juin2017; 52:e47–e53

3.AbdelazizH etal.Impactdesservicesdepharmaciecliniquedansuneunitéde courtséjourd'unserviced'urgencehospitalierauQatar. IntJClinPharm 2016;38:776

9

4.NielsenT etal.Servicedepharmaciencliniciendansleserviceaigu. IntJClin Pharm 2013;35:1137

51.

BackgroundandImportance Infliximabcancauseinfusionrelatedreactionslikedelayedhypersensitivityoranaphylactic shock.Usingcorticosteroidsorantihistaminesaspremedication canreduceadversedrugreactions(ADRs)frequency.

AimandObjectives Toevaluatepremedicationimpacton ADRsoccurrenceinpatientswithinflammatoryboweldisease (IBD)whoreceivedinfliximab.

MaterialandMethods Retrospectiveobservationalstudyin patientswithIBDwhoreceivedintravenousinfliximabfrom January2016toDecember2020.Thevariablescollected were:demographic(age,sex),clinical(typeofinflammatory boweldisease,HarveyindexBradshawinCrohn'sdisease, Mayoindexinulcerativecolitis),premedicationused(typeof drugandnumberofadministrations),numberofinfliximab administrationsandtheADRscharacteristics.Forthestatistical analysis,mean,standarddeviationandabsoluteriskwere used.

Results 119patientswereincludedwithanaverageageof46 ±17yearsand42%women.42patientshadulcerativecolitis,74patientshadCrohn'sdisease,and3patientshadindeterminatecolitis.Inthebaselinestudy,patientswithCrohn's diseasehadHarveyscoremeanof7.1±3.7andpatients withulcerativecolitishadpartialMayoscoremeanof3.7± 2.3.Atotalof1909infliximabinfusionswereadministrated andpremedicationwasusedin1185administrationin80 patients.Premedicationwasadministratedin21.2%(n=17) duringinductionphase,in32.5%(n=26)duringmaintenance phase,andin46.3%(n=37)duringbothphases.Glucocorticoidswereusedasapremedicationin97.5%ofcases.

25ADRswererecordedin21patients.Thepatients (n=17)whoreceivedpremedicationhad21ADRsandan absoluteriskof10.3%(CI95,0.7%-19.8%).Intheother group,thepatientswhodidnotreceivepremedicationhad4 ADRs(n=4)andanabsoluteriskof21.3%(CI95,12.3%30.2%).44%ofADRsoccurredininductionphaseand56% inmaintenancephase.ThemainsymptomsofADRSregisteredwereskinmanifestations(n=16),cardiovascular(n=6) andrespiratorysymptoms(n=3).

ConclusionandRelevance NolowerabsoluteADRriskwere observedinpatientswhoreceivedpremedicationcomparedto patientswhodidnotreceivepremedication.Morestudiesare neededinordertoevaluatetheimpactofpremedicationon ADRsoccurrence.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-144

EXPERIENCEOFUSINGREMDESIVIRINTHE TREATMENTOFPATIENTSWITHSARS-COV2 INFECTION

10.1136/ejhpharm-2023-eahp.147

BackgroundandImportance Remdesivirwasthefirstantiviral authorisedbytheEuropeanMedicinesAgencyforthetreatmentofCoVID-19disease.

AimandObjectives Theaimistodescribetheeffectiveness andsafetyofremdesivirinpatientswithSARS-CoV-2infectioninrealclinicalpractice.

MaterialandMethods Observational,descriptive,retrospective studyinalevel-IIhospital.

HospitalisedpatientswithSARS-CoV-2infectionandprescriptionofremdesivirfromApril21-March22wereincluded. DatawereobtainedfromtheUnidosisFarmatools® module andMambrinoXXI®

Variables: sex,age,recommendationsofremdesivirdatasheet (timefromsymptomonsettoadministration £7-days,dosing regimen,durationoftreatmentandglomerularfiltrationrate (GFR)(contraindicatedif<30mL/min).

Effectivenessassessment: hospitalstay,IntensiveCareUnit(ICU) admission,clinicalrecoveryinpatientswith5-daytreatment.

Safetyassessment: elevatedtransaminases(pre-and-post-remdesivirlevels;contraindicatedif 5timesupperlimitofnormalLSN)

Results 59patientswereincluded,64%male,medianage67 (30-101)years.100%startedwithin7-daysofsymptomatology onset(median:3-days)andcompliedwiththerecommended dosingregimen.In93.2%thedurationwas5-days,one patientremainedontreatmentfor7-daysand3discontinued earlierduetoclinicalworsening.MeanGFR:79ml/min and96.6%compliedwiththerecommendation(GFR>30ml/ min).Themedianhospitalstaywas8-days(3-133).Twelve patientsrequiredadmissiontotheICU,twoofwhomdied. Clinicalrecoverywasachievedin91.1%ofpatientswhocompletedthe5-dayregimen.Duringthehospitalstay,7patients diedwithamedianageof85years(59-95).Priortoadministration,22.2%patientsshowedtransaminaselevelsabovethe LSN,includingonepatientwith5LSN.Afteradministration, transaminasesincreasedin31.1%,including5patientswith 5LSN,2ofwhomhadinitiallynormalvalues.

ConclusionandRelevance Allpatientsreceivedremdesiviras earlyasrecommendedandaccordingtotheconclusionsofthe pivotalclinicaltrial,wherethissubgroupwaspostulatedto havethegreatestclinicalbenefit.Althoughonethirdof patientshadelevatedtransaminasemia,nonerequiredtreatmentdiscontinuation.However,otherparameterswouldneed tobecollectedtoassesssafetymorecomprehensively.Despite thelimitationsofthestudy,inourexperience,remdesivir appearstohaveagoodeffectivenessandsafetyprofileand maybeatherapeuticalternativeinthetreatmentofCOVID19disease.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-145 CONSENSUSVALIDATIONOFASCREENINGTOOLFOR CARDIOVASCULARPHARMACOTHERAPYIN GERIATRICPATIENTS:THERASP_CARDIOLIST

1HdeSchutter, 1JHias*, 1LHellemans, 1KWalgraeve, 2JTournoy, 1LVanDerLinden. 1UniversityHospitalsLeuven-Belgium,HospitalPharmacyDepartment,Leuven,Belgium; 2UniversityHospitalsLeuven-Belgium,DepartmentofGeriatricMedicine,Leuven,Belgium 10.1136/ejhpharm-2023-eahp.148

BackgroundandImportance Cardiovasculartherapieshave beenidentifiedasmajorculpritsforadversedrugevents. Theirinappropriate(under)useputsgeriatricpatientsat increasedriskforavoidableharm.Thesetherapiesare usedfrequently,accountingforapproximatelyhalfofall prescribeddrugsingeriatricpatients.Paradoxically,most studiesonmedicationreviewsingeriatricpatientshave notspecificallytargetedcardiovasculartherapies.This mightbeowingtoalackofresources,trainingorexplicit supporttoperformtargetedmedicationreviews.Consequently,thereisaclearneedforanupdatedscreening tool,specificallytargeting cardiovasculartherapiesingeriatricpatients.

AimandObjectives Weaimedtoupdateandvalidatethecardiovascularsegmentofapreviouslydevelopedscreeningtool, theRASPlist.TheupdatedRASP_CARDIOlistwasintended foruseingeriatricpatientsbytrainedhealthcare professionals.

MaterialandMethods Athree-stepstudywasconductedbya collaborationofthepharmacy,geriatricmedicineandcardiologydepartmentsofalarge,academichospital.First,the cardiovascularsegmentoftheRASPlist(version2014)was updatedtakingintoaccountpublishedresearch,otheravailablescreeningtoolsandtheinputofend-users.Secondly, thisdraftwasreviewedduringthreepaneldiscussionswith fiveexpertcardiologistsandthreeclinicalpharmacists,all ofwhomhadrelevantexpertiseingeriatricpharmacotherapy.Thirdly,thecontentwasvalidatedusingamodified DelphiTechniquebyapanelofEuropeanhospitalpharmacists,cardiologists,geriatriciansandaninternalmedicine physician.Consensuswasachievedincaseof 80%agreementamongexperts.Thefinal constructwascomparedto thecardiovascularsegmentoftheSTOPP/STARTcriteria version2.

Results SeventeenexpertsfromfourEuropeancountries participatedintwovalidationrounds.Consensuswas achievedforallstatementsoftheRASP_CARDIOlist.One newstatementwasadded.Thefinalconstructcompriseda listof95statementsrelatedtopotentiallyinappropriate prescribingofcardiovascularagents.Approximately90% (29/32)ofthecardiovascu larstatementsofthesecondversionoftheSTOPP/STARTcriteriawereincludedinthe RASP_CARDIOlistandtheRASP_CARDIOlisthad66 additionalstatements.

ConclusionandRelevance TheRASP_CARDIOlistisan updatedandvalidatedexplicitscreeningtooltooptimisecardiovascularpharmacotherapyingeriatricpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

PHernandoMartínez*,GMarcosPérez,VLafargaLapieza,IMartínNiño,APortelaSotelo, BRealAragón,DBarredaHernández. HospitalVirgendelaLuz,PharmacyDepartment, Cuenca,Spain

4CPS-146 ‘REALWORLD’ EXPERIENCEOFELEXACAFTOR/ TEZACAFTOR/IVACAFTORINTHETREATMENTOF CYSTICFIBROSIS:EFFECTIVENESSANDSAFETY EVALUATION

CFernandezCuerva*,JDParadasPalomo,TChinchillaAlarcon,IMuñozCastillo. Hospital RegionalUniversitariodeMálaga,ServiciodeFarmacia,Málaga,Spain

10.1136/ejhpharm-2023-eahp.149

BackgroundandImportance Cysticfibrosis(CF)isalife-limitingrecessivegeneticdisordercausedbypathogenicvariantsin theCFTR(cysticfibrosistransmembraneconductanceregulator)gene,resultinginincreasedviscosityanddifficultmucus clearance.Introductionofelexacaftor(ELX)/tezacaftor(TEZ)/ ivacaftor(IVA)toclinicalpracticehasbroughtachangeinthe clinicalapproachsincetheymodulateCFTR.

4CPS-147 REALWORLDDATA(RWD)ANALYSISONUSEOF IMMUNECHECKPOINTINHIBITORS(ICI)FORNONSMALL-CELLLUNGCANCER(NSCLC)

1SMasucci*, 2FSalerno, 3LRicci, 1MBellero, 1ABianco, 1GFFazzina, 1OSorrenti, 2GLacidogna, 2MDiMaio, 1AGasco. 1A.OOrdineMauriziano-UmbertoI,Hospital Pharmacy,Turin,Italy; 2A.OOrdineMauriziano-UmbertoI,OncologyDepartment,Turin, Italy; 3UniversityofTurin,Pharmacy,Turin,Italy

10.1136/ejhpharm-2023-eahp.150

AimandObjectives

Toassesseffectivenessandsecurityof ELX/TEZ/IVAinpatientsonatertiaryhospital.

MaterialandMethods

Observational,retrospectivestudycarriedoutbetweenMarch2020andSeptember2022,including alladultpatientstreatedwithELX/TEZ/IVA+IVAinour hospital.

Variablesincluded: age,sex,ageofdiagnose,pulmonaryfunction:measuredwith%pFEV1(medianpercentpredicted forcedexpiratoryvolumein1second)andpulmonaryexacerbations;treatmentadjustment,adverseeventsandtreatment suspension.

Datawerecollectedfromelectronicmedicalrecordsand pharmacydispensingprograms.

Results

Thirty-onepatientswereincluded: male45%(n=14),median of31yearsold(rank17-45),medianageofdiagnosisof4 months(0-38).BeforetakingELE/TEZ/IVA+IVA,45%(n=14) patientsreceivedTEZ/IVA+IVAasCFTRmodulator;55% (n=17)didnotreceiveanyCFTRmodulator.Medianlength ofELX/TEZ/IVA+IVAtreatmentatthemomentoftheanalysiswas9.43months(4.5-31.4).

%pFEV1duringtreatmentaugmentedin83%patients (n=26),slightlydecreasedin13%(n=3)anddidnotvaryin 1patient.Twopatients(6.5%)presentedpulmonaryexacerbationsthatrequiredantibiotictreatmentbutnothospital admission.

Twopatients(6.5%)requiredELX/TEZ/IVA+IVAadjustment:oneduetointeractionswithpotentCYP3A4inhibitors andotherbecauseofhepaticinsufficiency(Child–PughB). Nine(29%)patientspresentedanincreaseoftransaminase and/orbilirubininclinicalanalysis:onepatienttemporarily discontinuedtherapyandonesuspendedtreatmentdefinitely.

ConclusionandRelevance TheintroductionofELEX/TEZ/IVA toCFtreatmenthasbeenahopefuladvancethathasshown inourpopulationtohaveagoodsafetyprofile-whichcanbe managedwithregularcheck-ups-andwithagoodefficacy profile,achievinganincreaseof%pFVE1inashorttime.

REFERENCESAND/ORACKNOWLEDGEMENTS Noconflictofinterest.

ConflictofInterest Noconflictofinterest

BackgroundandImportance InItaly,monoclonalantibodies actingonprogrammedcelldeathprotein(PD-1),nivolumab(N)andpembrolizumab(P),oronthePD-L1ligand, atezolizumabordurvalumab, areauthorisedforthetreatmentofNSCLC.RegistrationRCTsmaynotgivedefinitiveanswersregardingtheoptimalICI'sdurationof treatment(DOT).Thereisevidencethattreatmentmay beinterruptedbeforeprogression,orbeforescheduled cyclesarecompletedfordifferentreasonsandthatpotentiallyaffectsefficacy.Arethecausesforpatientdiscontinuationtreatment(TDC)inRCTsandintherealworld comparable?

AimandObjectivesAim: evaluatetheappropriatenessoftreatmentchoicesbyanalysingDOTwithICIinacohortof patientswithNSCLC

MaterialandMethods For27monthsdatawererecordedon patientstreatedinI-linewithPorcombinationsofP+pemeetrexed+platinumchemotherapy(PPC),orinII-linewithN. ThepercentageofPD-L1expression(PD-L1el)wasobserved; medianDOTwasmeasured,andthedatawerestratified accordingtotreatmentdiscontinuationcauses.

Results Atotalof73patientsweretreated,62%men,38% women,29%smokers,3%non-smokers,40%ex-smokers, and28%n.a.Atthepresentdate5%ofthe73patientsare undergoingtreatmentand4%completedallcyclesoftherapy.Patientsweretreatedwith:33%N,49%P,and18% PPC.ThePD-L1elinthepopulationtreatedwasfor:N4% >50%,63%<1%,33%n.a.versusRTC77%>5%and 33%>50%(3);forP:<5%8%and>50%92%versus RTC100%>50%(4);forPPC:67%<5%and33%< 50%versusRCT-data<=50%63%and32%>50%. MedianDOTforP(8vs7.9months),N(5vs2.8months), andPPC(2vs9.8months)inRWDandRCTsrespectively. RWDTDC:96%7%(4%N,3%P17%C),progression 67%(79%N,53%Pand67%PPC)toxicity22%(13%N, 28%Pand17%PPC).FromRCTdata:death/progression (67%N,47%P,30.8%PC)andtoxicity(3%N,13.6%P, 13.8%PPC)

ConclusionandRelevance RCTandRWDdataareconflicting.MedianDOTforPandtheNdeath/progressionrate arecomparable.Thetreatmentchoicesmadewereappropriate,maximisingtreatmentefficacy,whilerespectingtherisk/ benefitprofileinapopulationdifferentfromthatofthe RCTs

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-149 PAINMANAGEMENTINMENTALHEALTH

AChachulski*,CNiot,LSoubelet,LReal. CentreHospitalierD'arras,PasdeCalais,Arras, France

10.1136/ejhpharm-2023-eahp.151

BackgroundandImportance Inhealthinstitutions,painmanagementisanobligationfromdiagnosistotreatment.However,inmentalhealth,itisdifficulttotreatitbecause psychiatricdiseasesmayaltertheperceptionofthepainand therearedruginteractions(DI)betweenpsychotropicdrugs andanalgesics.

AimandObjectives Theaimofthestudyistofindguidelines onpainmanagementinpsychiatryandreviewthecurrent stateofanalgesicprescriptionsinourpsychiatricunits.

MaterialandMethods Abibliographicsearchonpainmanagementinpsychiatrywascarriedoutandanobservationalaudit ofanalgesicprescriptionswasdone,atagivenday,inthefive psychiatricunitsofourestablishment.

Dataareexpressedasaverage+/-standarddeviationand resultsaspercent.

Results Thebibliographicsearchofferspainassessmentscales inpsychiatryeveniftheyarenotspecifictothispopulation. Nevertheless,thereisnotanyconsensusonthetherapeutic painmanagementinmentalhealth,neitheratnationalnor internationallevel.

Thedayoftheaudit,on88patients,47(53%)were treatedwithanalgesics.Thesepatientswere50+/-17years oldandthesex-ratiowas1.04.

Fiftyprescriptionlinesforanalgesicswereidentified.The mainmoleculesfoundwere:paracetamol,prescribedalone on42prescriptions(90%),andtramadol,aloneon2prescriptions(4%)orco-prescribedwithparacetamolon2prescriptions(4%).Oneprescription(2%)includedparacetamol/opium +ibuprofen.

Ofallthepainkillers,90%wereprescribedconditionally, including79% ‘ifneeded/pain’;14% ‘ifAnalogVisualScale> 3,temperature>38°C ’;7% ‘ifAnalogVisualScale>3’

ADIanalysishasbeenperformedbetweenanalgesics/psychotropicsandasingleprescriptionwithanassociationnot recommended(tramadol/paroxetinewithriskofinefficiencyof tramadolduetometabolicinhibition)wasfound.Theabsence ofcontraindicationcanbeexplainedbythepharmaceutical analysisoftheprescriptions.

ConclusionandRelevance Followingthisaudit,across-referencedtableofexistingDIbetweenanalgesics/psychotropicswas madeandalternativetreatmentincaseofDIwasproposed. Theseworks,andalsoremindersofthescalesthatcanbeused inpsychiatrytoassesspainandthepossibilitiesoftreatment accordingtothementaldisorder,werepresentedtopsychiatristsduringasessiontofacilitatetheirpainmanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-150 THEROLEOFCLINICALPHARMACISTINEMERGENCY DEPARTMENT

1LLópez-Vinardell*, 1RMerino-Mendez, 2JRuiz, 2AJuanes, 2CSocias-Cañellas, 1MBitlloch, 3MPuig-Campmany, 1LCampins. 1HospitaldeMataróConsorciSanitariDelMaresme, Pharmacy,Mataró,Spain; 2HospitaldelaSantaCreuISantPau,Pharmacy,Barcelona, Spain; 3HospitaldelaSantaCreuISantPau,EmergencyDepartment,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.152

BackgroundandImportance Pharmacistroleintheemergency department(ED)hasexpandedoverthelastdecades.However,thereislimitedpublishedliteraturerelatedtotheinterventionscarriedoutintheseunits.

AimandObjectives Toperformadescriptiveanalysisofpharmaceuticalinterventions(PI)inED,theiracceptancerate,the mainprescribingerrors(PE)detectedandthemainAnatomicalTherapeuticChemical(ATC)groupsinvolved.

MaterialandMethods Aretrospectivemulticentricstudywas performedintheEDofasecondaryandatertiaryhospital thatserveabout685.000totalinhabitantswithanoverallof 228.550emergencyattendancesperyear.PIandPEwere documentedfromMondaytoFridayovera4-hourperiod betweenJune-September2022.Dosageandfrequencyadjustment,formularyanddrugmodification,medicationinitiation anddiscontinuation,andpharmacokineticmonitoringwerethe PIincluded.PEweredividedintothreegroups:lackofefficacy,potentialsafetyproblemornecessary/unnecessary treatment.

Results Outof857interventionsregistered,40.4%were relatedtodosageadjustment;32.0%medicationinitiation; 16.0%medicationdiscontinuation;5.6%drugmodification; 3.5%pharmacokineticmonitoring;1.5%frequencyadjustment and1.1%formularyinterchange.RegardingPI,71.9%were accepted,21.9%wererejectedand6.2%werenotevaluated becausepatientsweredischargedordead.AsforPE,37.8% wererelatedtonecessary/unnecessarytreatment,32.6%potentialsafetyproblemand29.6%toalackofefficacy.ThePE detectedwerereconciliationdiscrepancies(39.7%),underdose (21.4%),overdose(19.0%),duplicities(4.9%),contraindications(3.3%),adversedrugevents(1.5%)andinteractions (0.9%).ThemainATCGroupsinvolvedwerebloodand bloodformingorgans(B)(21.7%),anti-infectiveforsystemic use(J)(21.7%),cardiovascularsystem(C)(20.9%)andnervoussystem(N)(18.1%).

ConclusionandRelevance Dosageadjustmentsanddrugtherapyinitiationwerethemostcommondocumentedinterventions.MorethanhalfofPIwereaccepted.Themostfrequent PEwererelatedtonecessary/unnecessarytreatment.The majorityobservedPEwerereconciliationdiscrepancies.The mainATCgroupsinvolvedwereB,JandC.Thegreatnumberofinterventionsandthehighrateofacceptanceseemsto showthatEDpharmacist,asamemberofamultidisciplinary patientcareteam,isabletodecreasethenumberofmedicine errorsandtoimprovethequalityandsafetyofmedicalcare.

REFERENCESAND/ORACKNOWLEDGEMENTS

Thankyouall.

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4CPS-151 ACETYLSALICYLICACIDDESENSITISATIONIN PATIENTSWITHCORONARYARTERYSYNDROME: LITERATUREREVIEW,RETROSPECTIVEANALYSISAND PATIENTFOLLOW-UPPROCEDUREINANIIALIAN CARDIOLOGICALCENTRE

10.1136/ejhpharm-2023-eahp.153

BackgroundandImportance Desensitisationprotocolsforthe treatmentofhypersensitivityto acetylsalicylicacid (ASA)

1AIezzi*, 1VTeso, 2DPinalli, 1SZitelli, 1GBallardini, 1BTebaldini, 1EOmodeoSalè. 1Centro CardiologicoMonzino,ServizioDiFarmaciaOspedaliera,Milano,Italy; 2UniversitàDegli StudiDiPavia,CorsoDiLaureaInFarmacia,Pavia,Italy

consistintheadministrationofincreasingdosesofASAata settimeinordertosensitisethepatienttotheactivesubstanceandinitiateachronictreatment. Hypersensitivity to thedrugoccursinawiderangeofthepopulation,bothin healthysubjectsandpatientswithcoronaryheartdisease. Thisconditionmayaffectpatientcompliancetotherapyand increasetheriskofischemiceventsespeciallyinsecondary prevention.

AimandObjectives Theaimoftheworkisobtainingasystematicreviewoftheliteratureconcerningtheexisting desensitisationprotocols.Thepurposeistoconductadescriptive analysisofthepopulationandevaluatetheeffectivenessand safetyoftheprotocolovertheshortandlongterm.

MaterialandMethods Aretrospectiveanalysiswasconducted onagroupofpatientstreatedwith Rossini’sprotocol, 1 an increasingoraladministrationofASAto100mginfiveanda halfhours.

Results Theliterature'sreviewhasshowntheRossini’sprotocolhasthegreatestnumberofsampleandthebestefficacy andsafetydata.Theretrospectiveanalysisallowedtheevaluationofthegroupcomposedof30patientsaged>18 years,admittedtothecentrebetweenJanuary2020and April2022,diagnosedwithcoronaryarterysyndrome. 83.33%reportedahistoryofhypersensitivitytoASA,especiallywithskinmanife stations(n=8).Themostsensitive patientsrecei vedpre-medicationbeforeundergoingtheprocedure;despitetreatment,20%developedmildadversereactions.Atdischarge73.33%ofpatientsweretreatedwithan antiplatelettherapyofwhich77.27%withASA.50%ofthe patientsunderwentafollow-up,whichtookplaceonaverage after6months;uponre-evaluation60%wereontreatment withASA.

ConclusionandRelevance TheevidencesuggeststhattheRossini’sprotocoliseffectiveforawidespectrumofpatients. Thehospitalpharmacistinagreementwiththecardiologist willevaluatethepossibilitytoimplementasolution-basedformulationtotreatmorefragilepatients,whopresenthistoryof allergytoASA,dysphagiaorrequiringinterventional procedures.

REFERENCES

1.R.Rossini, etal,Aspirindesensitizationinpatientswithcoronaryarterydisease: resultsofthemulticenterADAPTEDregistry, CircCardiovascInterv, 2017;10

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appropriatenessandgivetreatmentsdataof2021andthefirst eightmonthsof2022inourhospital.

MaterialandMethods Theauthorspresenttheirroleinthe authorisationprocessforoff-labeluse,incompliancewith currentlegislation,andmonitoringdatawhicharecollectedfromspecialists ’ assessments/re-evaluations.Psychiatristscollectthepatient'sinformedconsent,filloutthe authorisationformanddeliverittopharmacists.Pharmacistsassesswhetherexistthec onditionsunderwhichthe ketamineinfusionissustainableintermsofbothappropriatenessandcosts.Oncethetreatmenthasbeenauthorised,thecollecteddataareenteredinadatabase periodicallyupdatedwitha uthorisationanddispensing information.

Results 37patientsweretreatedfrom01/01/21to31/08/22, 17in2021and20in2022.

In2021,4patientshadalreadyreceived1+treatmentsthe previousyear,whilst13patientsreceivedtheinductiondose. Ofthesepatients,10switchedtoastandardmaintenancedosageasrapidtherapeuticbenefitwasobserved;only3discontinuedtreatmentorhadadifferentdosageforclinicalreasons.

Between01/01/22and31/08/22,12patientsreceivedthe inductiondosewhile8hadalreadyreceived1+treatments thepreviousyear;ofthe12patients,10switchedtoastandarddoseasarapidtherapeuticbenefitwasobservedwhereas only2discontinuedtreatment.

ConclusionandRelevance Anintravenousslowinfusionofketamineissafeandeffectiveinthesymptoms ’ stabilisation.

Theroleofthepharmacywill betocontinuemonitoring andimproveadatabasetobeusedtoproposeketamine ’ s administrationindepressionfor inclusioninthelistof medicinessuppliedbytheNationalHealthServicetobe usedforatherapeuticindicationotherthantheauthorised ones.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-153 OFF-LABELUSEOFKETAMINEFORRESISTANT DEPRESSION:ROLEOFTHEHOSPITALPHARMACIST

1AMichielon*, 1ACorzani, 2MTBianco. 1UniversitàDiSiena,ScuolaDiSpecializzazioneIn FarmaciaOspedaliera,Siena,Italy; 2AziendaOspedaliero-UniversitariaSenese,UocFarmacia Ospedaliera,Siena,Italy

10.1136/ejhpharm-2023-eahp.154

BackgroundandImportance Anintravenousslowinfusionof ketamine,glutamatereceptorantagonist,hasemergedasan effective,safeandrapidlyactingantidepressantindifferent studies.Itsefficacyisreportedintreatmentofresistantrecurrentmajordepressionandbipolardepression.

Inourcountry,ketamineisnotcurrentlyauthorisedfor theseindicationsthereforeitisusedoff-label.

AimandObjectives Thepurposeistopresenttheroleof pharmacistsmonitoringketamine’soff-labelprescriptive

4CPS-155 CREATIONANDVALIDATIONOFAMEDICATION REVIEWSUPPORTTOOLFORPOTASSIUMCHLORIDE INJECTION(KCL-INJ)PRESCRIPTIONS

MBabin*,CDebanne,ACDesbuquois,MBoisgontier. CentreHospitalierCompiegne Noyon,60321,Compiègne,France

10.1136/ejhpharm-2023-eahp.155

BackgroundandImportance KCl-injisariskydrug,itsadministrationerrorisaNeverEvents.Limitingitsusetojustified situationscontributestoitssecurity.MedicationReview(MR) contributestothislimitation.Despiteawarenesscampaigns, non-compliantprescriptionspersist.DuringtheMR,thePharmaceuticalIntervention(PI)includesaPrescriptionProposal (PP):forKCl-injtheclinicalcontexthasastrongimpactand complicatestheMR.

AimandObjectives Creationandvalidationofasupporttool fortheMRofKCl-injprescriptionsallowingtakinginto accounttheentireclinicalcontextofthepatient.

MaterialandMethods Bibliographicresearchassociatedwith brainstormingonthevariousclinicalandbiologicalcriteriaof thepatientandtheirconsequencesallowedsettingupofa flowchart.

Forvalidation: experimentationofthetoolinaprescriptions prospectivestudy(foreachprescriptiontheproblemrelatedto

therapeutics,theproposedPPanditsacceptancearecollated inanExcelfile);thendiscussionandvalidationoftheresults inMedicinesandSterileMedicalDevicesCommission (MSMDC),inparticularforthenotacceptedPIs.

Results Theflowchartcriteriaarekalemia,oralintake,KCl-inj concentration,KCl-injinpreventionduringhigh-dosehypokalemictreatments,initiationoftreatment.Eachofthesituations identifiedislinkedtoaPIortheabsenceofPI.6axesofPP havebeenidentifiedincludingoralco-prescription,switchby electrolytesolution,andadaptationofthevolumeofsolvent.

Thestudyoveronemonthgives172lineswithaMR accordingtoourtool.85prescriptionswerecompliant.87PI formulatedincluding6withoutPP.ThePIacceptancerateis 43.2%,withamaximumof52%fortheoralrelayanda minimumof0%foradaptationofthevolumeofsolventor electrolytesolutionswitch.AttheendoftheMSMDC,our toolisvalidatedafteranagreementontheimportanceofpromotingtheuseofelectrolytesolution.

ConclusionandRelevance TheacceptancerateandtheconclusionsoftheMSMDCallowustovalidatetheflowchart.Its useimprovestherelevanceofPIs,theiracceptanceand reducestheuseofKCl-inj.Tofacilitatetheuseofthetool, anExcelfilethatidentifiesthePPsaccordingtothecriteriais beingdeveloped.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-157 COMPARISONOFTHEEFFECTIVENESSBETWEEN INTERLEUKIN-23INHIBITORSFORTREATMENTOF PSORIASISINATHIRDLEVELHOSPITAL

AMerchán,SCLucía,FMRaquel,GOMaríadeLosReyes,PMMaría,ABMaríaÁngeles*, PJMaríaDelPuerto,VMIsabel,AMMercedes,CPLucía,VHJoséManuel. HospitalClínico UniversitarioLozanoBlesa,Pharmacy,Zaragoza,Spain

10.1136/ejhpharm-2023-eahp.156

BackgroundandImportance Interleukin-23(IL-23)isacytokineinvolvedininflammatoryandimmuneresponsesinpsoriasis.Noveltherapiessuchastildrakizumab,guselkumab,and risankizumabinhibittheIL-23-receptorinteraction.

AimandObjectives TocomparetheeffectivenessbetweenIL23inhibitorsinpatientswithpsoriasisinathirdlevel hospital.

MaterialandMethods Anobservational,retrospective,descriptivestudywasconductedinpatientswithpsoriasistreated withtildrakizumab,guselkumaborrisankizumabbetween August-20andAugust-22.Demographic,clinical,andtreatmentspecificvariableswerecollected.Effectivenesswasdeterminedthroughthecomparisonofpsoriasisareaseverityindex (PASI)priorstartingIL-23inhibitorandafterthefirstvisit (betweenweeks4and16afterstart).

Results Thestudyincluded58patients[62.1%men,median age51(23-83)years]outofwhom8(13.8%)hadpsoriatic arthritiscomorbidity,11(18.9%)weretreatedwithtildrakizumab,20(34.4%)withguselkumaband27(46.5%)withrisankizumab.Medianoftreatmentlinewas3(2-5)with tildrakizumabandguselkumab,and2(1-12)withrisankizumab.Adalimumabwasthemostcommonprevioustherapy (54.5%,n=6fortildrakizumab;40.0%,n=8forguselkumab; 38.5%,n=10forrisankizumab)andthemediantimeoftreatmentwithpreviousdrugwas58.4(9.8-665.0),64.5(1.5921.0)and46.6(0.0-299.0)weeks,respectively.Reasonsfor

switchingtoIL-23inhibitorsweretreatmentfailure(100.0%, n=11fortildrakizumab;85.0%,n=17forguselkumab; 84.6%,n=22forrisankizumab),adverseevents(15.0%,n=3 forguselkumab;11.5%,n=3forrisankizumab)ordruginteraction(3.8%,n=1forrisankizumab).MediantimeoftreatmentwithIL-23inhibitorwas41.9(16.9-68.0),44.1(9.2168.0)and26.3(14.9-96.1)weeksfortildrakizumab,guselkumabandrisankizumab,respectively.MedianPASIbefore switchingtoIL-23inhibitortreatmentsvsafterfirstvisitwere 7.7(3.3-10.8)vs1.4(0.0-5.2)fortildrakizumab,8.9(1.029.1)vs0.9(0.0-6.8)forguselkumaband7.8(2.8-21.8)vs 1.2(0.0-10.4)forrisankizumab.7patients(35.0%)and10 patients(37.0%)intreatmentwithguselkumabandrisankizumabrespectivelyachievedPASI0,whileonly3patients (27.3%)intreatmentwithtildrakizumabdid.

ConclusionandRelevance Thedurationoftheprevioustreatmentwasprolonged.Treatmentfailurewasthemainreason toinitiateanIL-23inhibitortreatment.Datasuggestthat guselkumabandrisankizumabcouldbemoreeffectivetreatmentsbetween4and16weekscomparedtotildrakizumab.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-158 IMPROVEMENTINPATIENTCAREBYPHARMACIST PHONECALLAFTERSTARTINGTREATMENT

JUrdaRomacho,IBretonesPedrinaci,AJofrePeralta,MACastroVida*. Hospital UniversitarioPoniente,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.157

BackgroundandImportance OutpatientPharmacyUnit(OPU) isthelastplacethatpatientgoeswithinthehospitalcircuit. Usually,patientarrivesoverloadedwithinformationandworriedabouthisnewdisease,notbeingabletoassimilateallthe informationthatisofferedtohimaboutthenewtreatment thathehastostart.

AimandObjectives Todevelopacommunicationproject betweenpatientsandOPUprofessionalstohelppatients understand,rememberandimproveadherencetotreatment prescribed,detectpossiblemedication-relatedproblems(MRP) andincreasethedegreeofsatisfactionwiththecarereceived attheOPU.

MaterialandMethods ProjectstartedinApril2019,inthe OPUofaregionalhospital.Threeprofilesofpatientswere included;Profile1:patientswho,afterarecentdiagnosis, mayhaveagreaterpsychologicalimpact;Profile2:those whostarttreatmentwithdevicesthatrequirespecific manipulationandProfile3:th osewho,duetotheirspecial conditions(language,age...)areconsideredtoneedreinforcementoftheinformationreceivedinthefirstvisitto thePharmacy(FVP).WhenthepatientcomestotheOPU forthefirsttime,heisofferedalltheinformationnecessary tostarthistreatmentandisincludedinafollow-upprogramme,doingaphonecall3to5daysafterbeginthe newmedication.OnthesecondvisittotheOPU,asatisfactionsurveyisgiven.

Results DatacollectedbetweenApril2019-December2021. Patientsincluded:142.Callsmadeto100%ofpatients,118 patients(83.1%)answeredthecall.52.1%ofthepatients wereclassifiedasProfile1;37.3%Profile2,and10.6%Profile3.49patients(34.5%)reportedadverseeffects,ofwhich 41(85.4%)evolvedfavorablyand8(14.6%)changed

treatmentduetopoortolerance.Regardingthesatisfaction survey,92.4%ofthepatientsreportedcallwasusefultothem 95.8%weresatisfiedorverysatisfiedwithcarereceivedat theFVPandatthephonecall.

ConclusionandRelevance Phonecallafterstartingtreatment reinforcestheinformationgiveninOPUduringtheFVP andallowsearlyinterventionindetectionandresolutionof MRP.Ahighpercentageofpatientsconsidertheproject useful,showingahighdegreeofsatisfactionwiththecare received.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-160 REAL-WORLDPERSISTENCEWITHDOLUTEGRAVIR/ LAMIVUDINEVERSUSBICTEGRAVIR/EMTRICITABINA/ TENOFOVIRALAFENAMIDEAMONGHUMAN IMMUNODEFICIENCYVIRUSPATIENTS

1LMartínZaragoza*, 1JSánchez-RubioFerrandez, 1AOntenienteGonzález, 1MGómez Bermejo, 1AAlcántaraPrado, 1LCarmonaJuárez, 2SJRodriguezÁlvarez, 2AMonereo Alonso, 1TMolinaGarcia. 1HospitalUniversitariodeGetafe,PharmacyService,Madrid, Spain; 2HospitalUniversitariodeGetafe,InternalMedicineService,Madrid,Spain

10.1136/ejhpharm-2023-eahp.158

BackgroundandImportance Persistencycanprovideinformationonthecomparativeeffectiveness,durabilityandtolerabilityinreal-worldpatientpopulations.

Littleisknownaboutcomparativepersistenceofdolutegravir/lamivudine(DTG/3TC)andbictegravir/emtricitabine/tenofovir-alafenamide(BIC/FTC/TAF),twopreferredantiretroviral treatmentsinourcountry.

AimandObjectives Tocomparepersistencebetweentwopreferredantiretroviraltherapiesandanalysereasonsfor discontinuation.

MaterialandMethods Weconductedaretrospective,non-interventional,longitudinalstudy.AllHIVpatientsover18years treatedwithDTG/3TCorBIC/FTC/TAFinourcentrewere included.

Persistencewasdefinedasthedurationoftimefrominitiationtodiscontinuationoftherapy(lastdispensingorendof thestudyinMarch2022).Persistencewasalsocalculatedasa dichotomousvariableattheconclusionofthefirstyearof therapy.Permissiblegap(daysbetweentwoprescriptionfills exceedingtheallowablerefillperiod)was90days.

Covariatescollectedfrommedicalrecordwere:age,gender, viralload(VL),CD4count,numberofpreviousantiretroviral medications,CharlsoncomorbidityindexandMedicationPossessionRatio(MPR).

Persistenceafterfirstyearwascomparedusingthe c²test. Kaplan-Meiersurvivalanalysiswasperformedanddifferences wereevaluatedusingthelog-ranktest.AdjustedriskofdiscontinuationwasassessedwithCoxProportionalHazardmodels.Significancelevelwas0.05.

Results Threehundredandsixty-twopatientswereincluded, 79.2%weremale.5.2%werenaive.Age(mean±SD)was 47±12years.91.2%hadVL<200copiesand10.1% CD4<200/ml.Numberofprevioustreatmentswas3.5±2.6. MPRwas95.4±11.1Charlsoncomorbidityindexwas1± 1.66.49.2%weretreatedwithBIC/FTC/TAF.

97.8%vs89.7%ofpatientswerepersistentafterthefirst forDTG/3TCandBIC/FTC/TAFrespectively[OR=5.1 (CI95%1.7-15.6);p=0.002].

Overall,meanpersistencedurationwas1.189days(CI 95%1.163-1.215).PersistencewithDGT/3TCwas1.231days (CI95%1.206-1.255)andpersistencewithBIC/FTC/TAFwas 980days(CI95%944-1.016);p=0.001.HoweverCox-model adjustedHRwas2.5(IC95%0.5-12;p=0.26).

ThemainreasonsfordiscontinuationforBIC/FTC/TAF weretolerability/toxicity(n=9)anddeath(n=3).Onlytwo patientswithdrawedDTG/3TC,duetotoxicity(n=1)and death(n=1).

ConclusionandRelevance Inourstudy,morepatientson DTG/3TCwerepersistentafterthefirstyearcomparedto BIC/FTC/TAF.However,therewerenodifferencesinoverall persistenceincovariate-adjustedanalysis.MainreasonforBIC/ FTC/TAFdiscontinuationwastolerability/toxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-162 TRIPLEWHAMMYDRUG-DRUGINTERACTION: CLINICALRELEVANCEANDRESULTSOF PHARMACEUTICALINTERVENTION

ÁGonzálezGómez*,JAHernándezRamos,ACastroFrontiñán,JMCaroTeller, MDCanalesSiguero,JMFerrariPiquero. HospitalUniversitario12deOctubre,Pharmacy, Madrid,Spain

10.1136/ejhpharm-2023-eahp.159

BackgroundandImportance Acutekidneyinjury(AKI)isa highlyprevalentconditionamonginpatients,usuallyattributed topharmacologicalcauses.Oneofthemostclinicallyrelevant drug-druginteractions(DDI)inthiscontextisthetriple whammyinteraction(TWI),causedbytheadditionofthree potentialnephrotoxicgroupsofdrugs:Non-steroidalantiinflammatorydrugs(NSAIDs),diureticsandACEinhibitors/ angiotensinreceptorblockers(ARB).

AimandObjectives Toevaluateclinicalsignificanceofthe TWI,aswellastheroleofpharmaceuticalintervention(PI) inpreventingpossibleadverseeventsduetothisDDI.

MaterialandMethods Observationalretrospectivestudythat includedpatientswhowereprescribedtheTWIoveraperiod of4years(2018to2022).Datawerecollectedusingcomputerisedmedicalrecords,nurseadministrationregistryandPI database.ICUpatientswereexcludedfromthisstudy.Recommendationofmonitoringserumcreatinineandpotassium, aswellasdiscontinuingthetripletherapywascarriedoutin allpatients.IncidenceofAKIwascalculatedaccordingto AKINcriteria.ImpactofPIwasestimatedbasedonaverage numberofdayspatientsreceivedthecombinationandamount oftimeuntilcompleteresolutionofAKI.

Results 34patientswereincludedandstratifiedaccordingto theirriskfactorsfordevelopingAKI.87,5%patientswere consideredathighrisk.Thefirstcauseofadmissionwassurgeryin62%ofcases.MeanbasalSCrwas0,99(CI95% 0,82–1,15).AcceptanceofPIratewasestimatedin65,62%. IncidenceofAKIwas29,4%(10/34),8ofwhichwereclassifiedasAKIN1.Meandurationofthetripletherapywas 6,81days(CI95%=3,47-10,15)innon-acceptedPIgroup vs3,17days(CI95%=2,23-4,11)intheacceptedPIgroup. AKIwasdetectedmorefrequentlyinacceptedPIpatients(7/ 10).However,thesepatientsrecoverednormalrenalfunction fasterthanpatientswithnoapprovedPI:10days(CI95%= 5,41-14,58)vs14,33days(CI95%=8,52

20,14), respectively.

ConclusionandRelevance TheTWIcanparticipateinacute kidneyinjury,particularlyinhighriskpatients.Clinicalpharmacistsplayanimportantroledetectingpatientsatincreased riskofAKI,preventingadverseeventsduetoTWinteraction, monitoringAKIbiomarkersandrecommendingdeprescription ofpossiblenephrotoxicdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-163 CYTOCHROMEP4502C19GENOTYPINGFOR PERSONALISATIONOFPROTONPUMPINHIBITOR THERAPY

1,2JLDebattista*, 3JSchembri, 2CBarbara, 2GZahra, 1FWirth, 1LMAzzopardi. 1University ofMalta,DepartmentofPharmacy-FacultyofMedicineandSurgery,Msida,Malta; 2Mater DeiHospital,MolecularDiagnosticsUnit-DepartmentofPathology,Msida,Malta; 3Mater DeiHospital,Gastroenterology-DepartmentofMedicine,Msida,Malta

10.1136/ejhpharm-2023-eahp.160

BackgroundandImportance Protonpumpinhibitors(PPIs)are hepaticallymetabolisedprimarilybythecytochromeP450 2C19enzyme.PPIsaregenerallyconsideredeffective,however CYP2C19geneticpolymorphismsmayresultinpatientsnot respondingappropriatelytotreatment.CYP2C19genotyping andinterpretationofresultsmaybeacontributionbypharmaciststowardspersonalisationofPPItherapy.

AimandObjectives Theaimwastodeterminetheprevalence ofCYP2C19geneticpolymorphismsinacohortofpatients showingPPItherapyresistance.

doseincreaseandmonitoringforefficacyinthesepatients.In patientsatriskofside-effects(29%IMs,PMs),theguideline suggestsreductionindoseandcontinuedmonitoringforefficacy.Pharmacist-ledCYP2C19pharmacogenetictestingcanbe usedatooltoguidedosingandmonitoringinpatientstaking PPIs.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-164 ADEQUACYREVIEWINTHEUSEOFDAPAGLIFLOZIN FORTHETREATMENTOFHEARTFAILURE

MRodríguezMorote,MJLucasMayol,AGonzálezFernández,CMatosesChirivella,LPeral Ballester,ANavarroRuiz*. HospitalGeneralUniversiariodeElche,ServiciodeFarmacia, Elche,Spain

10.1136/ejhpharm-2023-eahp.161

BackgroundandImportance Protocolforuseofdapagliflozin wasapprovedfortheadulttreatmentofsymptomaticchronic heartfailurewithreducedleftventricularejectionfraction (LVEF)inpatientsuncontrolledwithfirst-linetherapies,angiotensin-convertingenzymeinhibitors(ACEI)orangiotensin receptorblockers(ARB)withbetablockers,andsecond-line therapies,aldosteroneantagonists.

AimandObjectives Toevaluatetheuseofdapagliflozininthe treatmentofheartfailureinhospitalisedpatients,assessingthe degreeofprescriptioncompliancewiththeprotocolagreed uponbythePharmacyandTherapeuticsCommittee.

MaterialandMethods

Patientsdiagnosedwithgastro-oesophagealrefluxdiseaseorpepticulcerdiseaseandwithdocumentedPPItherapyresistancewereidentifiedusing ambulatoryrefluxmonitoringandendoscopydatabases.An EDTAbloodsamplewascollectedfromeachpatient,followedbygenomicDNAextractionwiththeQIAcube(Qiagen).CYP2C19genotypingwasperformedwithreal-time polymerasechainreactionontheGeneAmpPCRSystem

9700thermalcyclerandreversehybridisationusingthe TwinCubatorwiththePGX-CYP2C19StripAssay® (ViennaLab).Genotypes(phenotypes)wereclassifiedas:*1*1(normalmetabolisers,NMs),*1*17(rapidmetabolisers,RMs), *1*2or*2*17(intermediatemetabolisers,IMs),or*2*2 (poormetabolisers,PMs).The2021ClinicalPharmacogeneticsImplementationConsortium(CPIC)guidelinewasused forgenotype-baseddosingrecommendations,whichsuggests thatNMsmaybeatincreasedriskoftherapeuticfailure comparedtoIMs/PMs,RMsareatincreasedriskoftherapeuticfailure,whileIMs/PMshaveincreasedchanceofefficacybutriskpotentialtoxicity.

Results Thirty-eightpatientswererecruited;allCaucasian;20 female,mode50-59years(n=11).Mostpatients(n=17) experiencedrefluxhypersensitivity,followedbypersistent oesophagitisdespitePPItreatment(n=10).PPItherapy includedesomeprazole(n=20),omeprazole(n=16)orlansoprazole(n=2).Themajorityofpatients(n=20)weregenotypedas*1*1(NM),followedby*1/*17(n=7,RM),*2*17 (n=6,IM),*1*2(n=4,IM)and*2/*2(n=1,PM).

ConclusionandRelevance Themajorityofpatientsinthis studymaybe(53%NMs)orare(18%RMs)atriskoftherapeuticfailure,andtheguidelinerecommendsconsideringa

MaterialandMethods Retrospectiveobservationalstudy betweenDecember2021andApril2022ofhospitalised patientswhostartedtreatmentwithdapagliflozin.Thestudy variableswere:sex,age,reasonforadmission,presenceof heartfailurewithLVEF<40%,concomitanttreatmentwith ACEI,ARB,betablockers,aldosteroneantagonists,positive inotropics,sacubitril/valsartanordiuretics,andpresenceofdiabeteswithorwithoutantidiabetictreatment.Clinicaldata wereobtainedfromtheOrion-Clinic® electronicmedical recordprogram.

Results Intheperiodevaluated,61patientsinitiateddapagliflozin10mgperday,42men(69%),withamedianageof 76years(IQR84-66).Atotalof46patients(75%)presented heartfailureonadmissionandtherestwereadmittedfor othercardiacpathology.Only38patients(62%)hadanLVEF registry,ofwhich22patients(36%)hadanLVEF<40% withamedianLVEFof32%(IQR35-25).Forty-fourpatients (72%)werediabeticand6patients(17%)weretreatedwith dapagliflozinincombinationwithmetformin.Forthestudyof concomitanttreatments:22patients(36%)wereprescribed ACEI/ARB,38patients(62%)betablockers,8patients(13%) positiveinotropics,21patients(34%)aldosteroneantagonist diuretics,41patients(67%)loop/thiazidediureticsand9 patients(14.8%)sacubitril/valsartan.Tohighlight,11patients (18%)werebeingtreatedwiththecombinationACEI/ARA-II +betablockers+aldosteroneantagonist.Finally,only35 patients(57%)continuedwithdapagliflozinasdischarge treatment.

ConclusionandRelevance Thedegreeofadequacyofdapagliflozinprescriptiontotheapprovedprotocolforusewashigh butanappreciablepercentageofpatientsdonotadhereto theinclusioncriteria,indicatingthattheprotocol

recommendationsshouldberevisedtoensureeffectiveuseof dapagliflozin.Onlyhalfofthepatientswhoinitiatedtreatment continuedafterdischarge.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-166 IMPLEMENTATIONOFALINEZOLID PHARMACOKINETICMONITORINGPROGRAMME

1DRoblesTorres*, 1ECampeloSánchez, 1NLagoRivero, 2MSuárezSantamaria, 1MAlfonsínLara, 1PPradoMontes, 1MCouñagoFernández, 1IAgraBlanco, 1NMartínez LópezdeCastro. 1ALVAROCunqueiroHospital,HospitalPharmacy,Vigo,Spain; 2ALVARO CunqueiroHospital,ClinicalAnalysis,Vigo,Spain

10.1136/ejhpharm-2023-eahp.162

BackgroundandImportance Linezolidisanantibioticthat presentshighinter-andintra-individualvariabilityandthereforemaycompromiseitsclinicalefficacyorincreasetherisk ofassociatedtoxicity.

AimandObjectives Toestablishaprogrammeformonitoring linezolidplasmalevelsthatwillallowustoproactivelyidentifypatientswhocanbenefitmostfromitsuseandtoevaluateitsresultsinourcentre.

MaterialandMethods Aliteraturereviewwasperformedto definethecriteriathatallowedustoidentifypatientswho werecandidatesforpharmacokineticmonitoringoflinezolid.

Weestablishedthedeterminationofplasmaconcentrations beforetheadministrationofthe5thdoseandthenperiodicallyevery3-4daysuntiltheendoftreatment.Theefficacy andsafetycriterionwastomaintainthetroughplasmaconcentration(Cmin)inthetherapeuticrange(between2and8 mg/L).

Results Thecriteriaselectedfortheidentificationofpatients whowerecandidatestobepartofthemonitoringprogramme were:criticalpatients,transplantedpatients,severeburnsor cysticfibrosis,obesepatients(BMI>30),kidneyfailure(creatinineclearance<30ml/min)andliverfailure(ChildPugh C),renalreplacementtherapies,prolongedtreatments(>3 weeks)andtreatmentwithGlycoprotein-Pinducers.

FromJanuarytoApril2022,atotalof20patientsthat metatleastoneoftheaforementionedcriteriawereincluded intheprogramme.Allpatientsstartedtreatmentincritical careunitsandthechosenrouteofadministrationwasintravenous.Eighty-fivepercentofthepatientsweremen,the medianagewas69yearsandthemeandurationoftreatment was11.6days.

Atotalof50sampleswereanalysed(2.5samplesper patient).ThemeanCminwas5.3mg/L.Thirtysamples(60%) wereoutoftherapeuticrange. Fiftypharmacokineticreportswereperformed. In60%ofthe cases,modificationsofthedosingregimenweremade:17 weredoseincreasesand13weredosedecreases.

ConclusionandRelevance Incorporatingthisprogrammeinto clinicalpracticeallowsustoproactivelyidentifythepatients whocouldbenefitmostfromlinezolidmonitoring.

Theresultsdemonstratethehighvariabilityoflinezolid plasmalevelsandtheusefulnessofdosingrecommendations issuedbythePharmacyservicetoensurethattheCmin remainswithinthetherapeuticrange.

4CPS-167 CURRENTTRENDSINTHEUSEOFCHECK-POINT INHIBITORSFORNON-SMALL-CELLLUNGCANCER

AAlvarez-Yuste*,MPerez-Abanades,TGallego-Aranda,ELopez-Aspiroz,AIbañezZurriaga,AGarcia-Peralo,GEscudero-Sanchez,PDuque-Tebar,AMorell-Baladron. La PrincesaUniversityHospital,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.163

BackgroundandImportance Overthelastyears,immunotherapyhaschangedthetreatmentparadigmofnon-small-cell lungcancer(NSCLC).Thenumberofpatientstreatedwith immunecheck-pointinhibitors(ICI):atezolizumab,durvalumab,pembrolizumabandnivolumabhasdramatically increased.

AimandObjectives Toevaluatethecurrenttrendsintheuse ofICIforNSCLCinathirdlevelhospital.

MaterialandMethods Aretrospectiveobservationalstudy wasconducted,includingpatientswithNSCLCwhohad receivedtreatmentbetween2016and2021withchemotherapyorICI(atezolizumab,durvalumab,nivolumaborpembrolizumab).Thedatacollectedwasdrug,dateandnumberof administrations,daysbetweeneachadministrationandclinical response.

Results Duringthestudyperiod,therewere606patientsbeing treatedforNSCLC,and254ofthemreceivedICI(41.91%). ConclusionandRelevance Thetotalnumberofpatientstreated withICIforNSCLChasincreasedconstantlyduringthis periodoftime(49.15%increasebetween2016and2021). Moreover,immunotherapyentailthetreatmentofnearlyhalf oftheNSCLCpatients.

Duringthetimeperiodstudied,theuseofnivolumabhas decreased,favouringpembrolizumab,probablybecauseofthe riseofitsnewapprovedindications.Secondly,thenumberof patientswhohavereceivedatezolizumabanddurvalumabhas keptcomparable.

Abstract4CPS-167Figure1

Numberofpatients,administrations anddaysbetweeneachadministrationofICI

Abstract4CPS-167Table1

Wecanseeasignificatedecreaseonthenumberof patientstreatedwithanICIbetweenMay2020andAugust 2020,possiblyinfluencedbythedecreaseinthenumberof patientsdiagnosedwithNSCLCduringtheCOVID-19 pandemic.

ThemeandaysbetweeneachICIadministrationwas slightlyabovetheapprovedposology,possiblyduetodelays becauseofadverseeffects.

REFERENCESAND/ORACKNOWLEDGEMENTS

Age50(43-58)years

Gender(woman)77%

Galcanezumabduration6(6-9)months

MDMmonth015(14-17)

MDMmonth35(3-6)

ORR>50%84%

HIT6month072(68-76)

HIT6month349(48-57)

-9%(5)ofthepatientscontinuewithactivetreatment, 100%maintaineffectiveness,medianMDM:3(2-6).

-91%(51)discontinuedtreatment:

Reasonfor suspension 67%

4CPS-168 RESULTSOFTHEUSEOFGALCANEZUMABIN ROUTINECLINICALPRACTICE

PTardáguilaMolina*,CDeanBarahona,MBlancoCrespo,EMartinezRuiz,AMirandaDel Cerro,GICasarrubiosLázaro,ACodonalDemetrio,FJProJimenez. GuadalajaraUniversity Hospital,Pharmacy,Guadalajara,Spain

10.1136/ejhpharm-2023-eahp.164

BackgroundandImportance Migraineisahighlydisabling neurovasculardisordercharacterisedbyasevereheadacheand trigeminovascularsystemactivation,involvingthereleaseof calcitonin-generelatedpeptide(CGRP).Galcanezumabisa humanisedmonoclonalantibodyblockingtheCGRP.

AimandObjectives

Analyze:

. Theeffectivenessofgalcanezumabintheprophylaxisof chronicmigraine

. Responsetootheranti-CGRPmonoclonalantibodiesafter galcanezumabfailure

MaterialandMethods Observational-retrospectivestudyfrom January2020toSeptember2022.Patientsinwhomatleast oneyearhadpassedsincethestartofgalcanezumabtreatment wereincluded.

Variablesanalysed:demographics,baselinemigrainedays/ month(MDM),threemonthslater,objectiveresponserate (ORR)>50%,duration,reasonforsuspension,andaction. Theheadacheimpacttest(HIT-6)wasperformedatbaseline vsafterthreemonthsoftreatment.Thisscorepresentsa rangebetween36and78(<49=littleornoimpact,50-55= certainimpact,56-59=importantimpact,>60=verysevere impact).

Quantitativevariableswereexpressedasmedian(interquartilerange).

Results 56patientswereincluded.

NªPatients191547

MDMmonth 0 15(12-16)15(15-17)15(15-20)

MDMmonth 3 4(3-5)15(12-17)15(7-20)

ORR>50%89%25%43%

HIT-6month 0 73(68-76)73(68-78)66(59-70)

HIT-6month 3 57(50-68)72(64-78)57(55-67)

*Medianmonthswithouttreatmentaftersuspension:7(5-11).

ConclusionandRelevance Ahighpercentageofpatientspresentedagoodresponsetogalcanezumab,withanimprovementintheHIT-6score.

Alargenumberofpatientswhoreceivedtemporaryprophylaxiswithgalcanezumabdidnotrequireanothervisitto theneurologist.MostofthepatientswhorequiredreintroductionofgalcanezumabreachedanORR>50%.

Lessthanhalfofthepatientswhorestartedtherapywitha differentanti-CGRPaftergalcanezumabfailure,achievedan ORR>50%.

Allpatientswhocontinuedwithgalcanezumabfromthe start,maintainedeffectivenessofthetreatment

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-171 METHADONEDRUG-DRUGINTERACTIONS

POTENTIALLYRELATEDTOCARDIOVASCULAREVENTS INCLINICALPRACTICE

10.1136/ejhpharm-2023-eahp.165

MRodríguezMarín,HMartinez-Barros,BEsteban-Cartelle,PMartin-Sanz,EGomezBayona,AMAlvarezDiaz*. HospitalRamónYCajal,Pharmacy,Madrid,Spain

BackgroundandImportance Methadonecontinuestobethe drugofchoiceinmanagingopioidwithdrawal.However,itis knownthatitsuseisrelatedtoQTprolongation,torsadesde pointesandevensuddencardiacdeath.Theinteractionwith otherdrugscouldworsenthiseffect.

AimandObjectives Toquantifytheprevalenceofmethadone drug-druginteractionswithriskofQTintervalprolongation andtheincidenceofcardiovasculareventsduringadmission.

MaterialandMethods Weconductedaretrospective,descriptivestudythatincludedallpatientsreceivingmethadoneina tertiaryhospitalbetweenJanuary2021andSeptember2022.

Thevariablescollectedwere: age,sex,opioidabuse,treatment withmethadonepriortoadmission,methadonedose,cardiovascularhistory,numberofdrugsprescribed-inadditionto methadone-likelytoprolongQTduringadmission,anddevelopmentofcardiovascularcomplications.InteractionswereconsultedinLexicomp

Results Atotalof109patientswerecollected,themedianage of56(interquartilerange(IQR)50-60),and74.3%were male.82.6%ofpatientshadahistoryofsubstanceabuse recordedintheelectronicmedicalrecord,withprevious opioiduseexplicitin61.5%andwereonmethadonetreatment.Remainingpercentagewereonmethadonefor:respiratoryweaning(9.3%),analgesia(3.5%)andnewmanaging opioidwithdrawal(4.6%).Themedianmethadonedosewas 50mg(IQR35-80mg).Atotalof9.2%hadahistoryofcardiovasculardiseasepriortoadmission.

Patientsreceivedameanof1.8QT-prolongingdrugsin additiontomethadoneduringadmission.Inthiscohort, 93.6%ofpatientsreceivedanyQT-prolongingdrug,48.6% and21.1%twoorthreeQT-prolongingdrugs,respectively. ThemostfrequentlyprescribedQT-prolongingdrugswere quetiapine(24.8%),mirtazapine(19.3%)andondansetron (12.9%).Duringadmission,11.0%ofpatientssufferedacardiovasculareventwitharrhythmiasbeingthemostfrequent event(54.6%).Ahigherproportionofpatientswithprevious cardiovascularhistorysufferedanewcardiovascularevent (19.3%vs7.2%).

ConclusionandRelevance Ourresultsshowahighprevalence ofpatientsusingmethadoneconcomitantwithotherdrugs likelytoprolongQTduringadmission.

Amoresignificantproportionofpatientswithaprevious historyofcardiovasculareventssufferedaneweventduring hospitalisation.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-172 BRODALUMAB'SEFFECTIVENESSONMODERATETO SEVEREPLAQUEPSORIASISINREALPRACTISE

1MRodriguezGoicoechea*, 2ETejedorTejada, 3SCanoDominguez, 1AMorenoLopez, 1NGarciaGomez, 1MJBarberoHernández, 1FHornoUreña. 1HospitalaryComplexofJaén, HospitalPharmacy,Jaen,Spain; 2BarcelonaClinicHospital,HospitalPharmacy,Barcelona, Spain; 3UniversitaryHospitalVirgendeLasNieves,HospitalPharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.166

BackgroundandImportance Plaquepsoriasisisachronicpathologywithanimportantimpactonpatients’ qualityoflife andemotionalhealth.Brodalumabwasthelastanti-interleukin17(IL-17)arrivingtopatients.

AimandObjectives

Toevaluatebrodalumabeffectivenessin realpractise

MaterialandMethods

Multicentric,retrospectiveandobservationalstudyperformedtoevaluatebrodalumabin patientswithmoderate – severeplaquepsoriasisbetween June2021andJune2022.Dataextractedfromclinical recordsapplicationandprescribingprogramme,demographicdata(age,sex),andclinical(previousbiologic treatmentlines,bodysurfacearea(BSA)andpsoriasisarea severityindex(PASI)before treatmentandineachdermatologiccontrol).Effectivenesswasmeasuredcomparing AMAGINEclinicaltrialsPASI75results(efficacycalculated withweightedaverage).

Results 41patientswithbrodalumabasactivetreatment,1 wasexcludedduetolackoffollowupandotherduetolate startoftreatment.39patientsincluded,52.4yearsaveraged, 66.7%weremen.Otherlinesoftreatmentsapprovedfor moderate-to-severeplaquepsoriasiswereusedasfirstlinein 19patients,as2ndlinein5,as3rdlinein3andas4thline in5patients.

AverageBSAandPASIatbaselinewere14.32and11.55 respectively.Afteramedianof23weeks,ourpatientsreached PASI75in56%,PASI90in51%andPASI100in49%of cases.Nopatientstoppedtreatment.

After40weeks,3patientshadchangedtheirtreatmentand 4hadnotreachedthenextvisittoDermatology.PASI90and PASI100keptin9of23patients(39%),asPASI75stillwas keptby11patients(48%).

Afteroneyearoftreatment,only15patientswereactive withtreatment,andPASI90andPASI100werekeptby5 patientsof10withrecordeddata.

Accordingtoclinicaltrials,brodalumabachievesaPASI75 in85%ofpatientsat12thweekandkeptaPASI75in68% ofpatientsat52ndweek.

Limitations: severalpatientsdidnothaverecordedintheir clinicalhistoryBSAandPASIafter12thweekvisit.

ConclusionandRelevance Ourfindingsshowthatbrodalumab islesseffectiveinrealpracticebutitcanbeconsideredasa potentantipsoriaticagentinclinicalpractise.Furtherandlongerstudiesshouldbemade.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-173 EVALUATIONOFINCLUSIONCRITERIAOF OUTPATIENTSINCLUDEDATHOSPITALMEDICATION DISPENSINGPROGRAMMETHROUGHCOMMUNITY PHARMACIES

CSubiranaBatlle,IGómezIbáñez,XLarreaUrtaran*,ADordàBenito,ÀCastellóNòria, COrtíJuan,MBrugueraTeixidor,QLópezNoguera,YOrtuñoRuiz,LViñasSagué, RSacrestGüell. HospitalDrJosepTruetadeGirona,PharmacyDepartment,Girona,Spain 10.1136/ejhpharm-2023-eahp.167

BackgroundandImportance Duringthecontextofthe COVID-19pandemic,inordertoavoidthepossibletransmissionofSARS-COV2,somehospitalsdevelopedanoutpatient hospitalmedicationdispensingprogrammethroughdeliveryto communitypharmacies.Toaccesstheprogramme,outpatients hadtomeetallthecriteriaestablishedbyHealthAuthorities: adherencetotreatment,livemorethan30kmfromthehospitalandpresentsomevulnerabilitycondition(age>65years, reducedmobilityorrespiratorypathology).Thisprogramme hasbeenmaintainedovertimeduetotheexcellentacceptance bypatients.

AimandObjectives

Toevaluatethecomplianceofourhospital withtheinclusioncriteriaandanalysepossibledeviations, assessingwhetheritisnecessarytomodifythembasedonthe currenthealthcontext.

MaterialandMethods Cross-sectionalobservationalstudyin whichallactiveoutpatientsintheprogrammebetweenJuly andSeptember2022wereincluded.

Thefollowingvariableswerecollected: demographic,distance betweenhomeandhospital,vulnerabilityconditionsand adherencetotreatment.

Results 95patientswereevaluated,94(98.9%)ofthemwere adherenttochronictreatment,81(85.3%)livedmorethan 30kmfromthehospital.Regardingthevulnerabilityconditions:68(71.6%)wereolderthan65yearsand14(14.7%) hadavulnerabilityconditionotherthanageover65years.

Ofalltheevaluatedpatients,75(78.9%)metalltheinclusioncriteria.20(21.1%)patientswereintheprogramme, butdidnotmeetsomecriteria:6(30.0%)patientslivedless than30kmaway,8(40.0%)didnothaveavulnerableconditionand6(30.0%)didnotmeetmorethanoneinclusion criteria.

ConclusionandRelevance Themedicationdispensingprogrammethroughcommunitypharmaciesoffersanoptionfor vulnerablepatientsand/orthosewithdifficultygoingtothe hospitaltocollecttheirchronicmedication,thusfacilitating therapeuticcomplianceoftreatment.

Althoughahighpercentageofpatientsmettheestablished criteria,deviationsweredetected.Thatmakeusconsiderthe needtomodifythesecriteriainordertoaccessintheprogrammeaccordingtocurrentneedsofoutpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-175 SEPSISCODE:IMPROVINGOUTCOMESFORPATIENTS WITHSEPSIS

1MEMartinezNuñez*, 1NHerranzMuñoz, 2JBCachoCalvo, 3FJEstebanFernandez, 3FFerrereGonzalez, 2AGonzalezTorralba, 2DMolinaArana, 3GPerezCaballero, 3AMRodriguezBenavente, 1TMolinaGarcia. 1HospitalUniversitariodeGetafe,Pharmacy, Madrid,Spain; 2HospitalUniversitariodeGetafe,ClinicalMicrobiology,Madrid,Spain; 3HospitalUniversitariodeGetafe,InternalMedicine,Madrid,Spain

10.1136/ejhpharm-2023-eahp.168

BackgroundandImportance Sepsisisacommonandpotentiallylife-threateningconditiontriggeredbyaninfection.

CodeSepsis(CS)includesstandardisedSurviving-SepsisCampaignmanagementbundlesmeanttoguideearlyrecognitionandpromptgoal-directedtherapy,inordertoimprove clinicaloutcomes.

MultidisciplinaryCS-teamdailyevaluatesallpatientswith ‘CS-alert’ inordertoguaranteecompliancewithsepsisbundlesandpromotingappropriateantimicrobial-use.

AimandObjectives ToassesstheimpactofCSimplementation onclinicaloutcomesandantibiotictherapy.

MaterialandMethods ExperimentalstudyfromNovember2020toSeptember-2022.Allpatientswithconfirmedsepsis/ septicshockwereincluded.

Meanoutcome: overallandtrendofin-hospitalmortalityrate (MR).

Secondaryvariables:

. Medianlengthofhospital-stay(LOS)andIntensiveCareUnit stay(ICU-LOS).

. Severitycriteria:ICU-admission(%).

. Meanlengthofantibiotictherapy(LAT):overall, antipseudomonal-carbapenemsandantibioticsagainst resistant-gram-positivebacteria(daptomycin,vancomycinand linezolid).

Variableswereanalisedbytrimesters.Medianandinterquartile range(IQR)wereusedtodescribeallthequantitativevariables.Lineal-regressionwasperformedfortrendanalysis.

AllstatisticalanalyseswereassessedwithSPSS®V25.0.Significancelevelwas0.05.

Results Atotalof422CSalertwasactivatedin402patients. Medianage=79years(RIQ16),61.1%males.

Admissionward=12.8%surgical,81.5%medicaland5,7% ICU.

GlobalMRwas20.6%withasignificantlydownwardtrend (slope=-2.2;CI95%-3.4to-1.0).TheoverallMRwas reducedin53.8%(38.9%vs20.9%).

MedianLOSwas8days(RIQ12)andshowedanegative trend(slope=-0.4;CI95%-0.7to1.02).ThemedianICULOSstaywas6days(RIQ8.7)witha9.0%ofICU-admissions,whichalsodecreasedduringthestudy(slope=-0.2; CI95%-0.6to0.2).

TheoverallLATwas9.3days,withtrendtowardshorter courses(slope=-3.2;CI95%-0.9to0.2).Meandurationof antipseudomonal-carbapenemswas4.2days(slope=-2.2; CI95%-0.5to0.1),whereasanti-gram-positivewas5.4days (slope=-0.1;CI95%-0.8to0.6).

ConclusionandRelevance TheCSimplementationwasassociatedwithadecreasemortality,withanoverallreduce byupto50%.ThedownwardtrendinLOSandICUadmissionssuggeststhatanearlyrecognitionofsepsis andoptimised-treatmentarecrucialinpreventing complications.

Dailypatientsurveillanceandfollow-upbyamultidisciplinaryteampromotingantimicrobialde-escalation/discontinuationwasassociatedwithshortercoursesofantibioticswithout worseningclinicaloutcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-176 EVALUATIONOFNIRMATRELVIR/RITONAVIRUSEAND EFFECTIVENESS

ABPousadaFonseca*,ISotoBaselga,NGarridoPeño,ISollanoSancho,IMorona Mínguez,JSolísOlivares,YMateosMateos,MRMengualBarroso,AGonzalezFuentes, BRubioCebrián,CMorielSánchez. HospitalUniversitariodeMóstoles,HospitalPharmacy, Móstoles,Spain

10.1136/ejhpharm-2023-eahp.169

BackgroundandImportance Nirmatrelvir/ritonavir(PAXLOVID)isarecentlyapproveddrugtopreventprogressionin high-riskCOVID-19-infectedpatients.

AimandObjectives Toevaluateprescribinganddispensingof PAXLOVIDandtheproportionofpatientswithhospitalisation ordeathfromanycauseat28day.

MaterialandMethods Descriptive,retrospective,observational studycarriedoutbetweenMayandAugust2022inasecondlevelhospital.AllpatientswithPAXLOVIDprescriptionwere selected.Sourcesofinformationwere:electronicmedical recordsandtheprescriptionprogramme.TheVariablesanalysedwere:sex,age,riskfactors,indications,interactions,

dispensation(yes/no)andfinaltreatmentreceived.Riskfactors wereevaluatedwithourcountry'sdrugregulatoryagency (DRA)recommendationstoassesedtheindication.Efficacy wasassessedbytheproportionofpatientsadmittedtohospitaland28-daymortality.

Results PAXLOVIDwasprescribedto34patients,14(41.2%) werewomen.Themedianagewas76.3yearsold[RIQ25.4].

MainindicationsforPAXLOVIDwere:tobeundergoing treatmentwithmyelotoxicchemotherapy(32.3%),corticosteroidsorotherimmunosuppressants(29.4%);beingover80 yearsofageandpresentingspecificRiskfactors(14.7%)and primaryimmunodeficiency(5.8%).21patients(61.8%)had somerelevantinteractionwiththeirusualmedication.The mostfrequentinteractionswerewithstatins(23.5%),analgesics(20.6%),oralanticoagulants(12%),antiarrhythmics (8.8%),antiplateletdrugs(5.8%),antidepressants(5.8%)and antidiarrhoeals(5.8%).

AfterValidatiónbythePharmacyService,11patients (32.4%)didnotreceivePAXLOVID,5becausetheydidnot meetDRAcriteria,2becausetheirglomerularfiltrationrate waslessthan30ml/minand4becausetheyhadincompatible interactions.4patientsfinallyreceived3days-remdesivir.

AmongpatientswhoreceivedPAXLOVID,82.26%received fulldoses,with4patients(11.76%)requiringadjustmentfor renalimpairment.3patients(13%)werehospitalisedinthe firstmonth,nonedied.

ConclusionandRelevance Themainindicationsforwhich PAXLOVIDwasprescribedwerepatientsundergoingchemotherapyand/orimmunosuppressivetreatments.Interactions withPAXLOVIDwerefrequentandinsomecaseslimited treatment.ValidationbyPharmacyServicepreventedaconsiderablenumberofpatientsfromreceivingPAXLOVIDwhenit wasno-indicatedorwhentheyhadinsurmountableinteractions,alsoallowedpatientstoreceivethedoseadjustedfor renalimpairment.PAXLOVIDwaseffectiveinavoidinghospitaladmissionandmortalityinthemajorityofpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-177 OPTIMISATIONOFTHETHERAPEUTICMANAGEMENT OFPATIENTSONECMOINTHEPAEDIATRIC INTENSIVECAREUNIT

; 2CHAubagne,Pharmacie,Aubagne, France; 3AIXMarseilleUniversité,PharmacieClinique,Marseille,France

10.1136/ejhpharm-2023-eahp.170

BackgroundandImportance ExtracorporealMembraneOxygenation(ECMO)isalast-resortrescuetechniquethatallows thereplacementofcirculatoryand/orrespiratoryfunctions. Thepharmacokineticmodificationsgeneratedbythiscirculatoryassistancerequiretheadaptationofthedosageofcertain drugs

AimandObjectives Theobjectivewastocomparethedrug prescriptionofpatientsunderECMOwithdataavailablein theliteraturetoproposeappropriatedosages

thetypeandindicationofECMO,complicationsand adequacyofdosagescomparedtotheliteraturefor relevance

Results 14patientsunderECMOwereincluded:meanage 18months[0to168months],sexratio=1.Renalfunction wasimpairedin8patients(57%).Theaverageduration ofECMOwas15days[3-24days].6patientswere weaned,4ofwhomwerestillhospitalisedontheward (43%)and8patientsdied(57%).13patients(93%)were onveno-arterialECMO,followingacuterespiratorydistresssyndrome(8casesor61%),refractorycardiacarrest (3cases23%),cardiogenicshock(8%)orsepticshock (8%).1patient(7%)wasonveno-venousECMOfollowinganacuterespiratorydistresssyndrome(ARDS).11 patients(79%)developedcomplicationsrelatedtoECMO (9haemorrhages,8hemolysis,6oxygenationdifficulties,5 PAO,4stroke).Concerningthedrugmanagementofthese patients,wecounted16overdosesand2underdosesnot justifiedeitherbytheliteratureorbytherapeuticdrug monitioring(TDM)i.e.18nonconformitiesoutof73 linesanalysed(Vancomycin,Gentamicin,Fluconazole,Caspofungin,Voriconazole,Ganciclovir,Heparin,Morphine, Sufentanil,Midazolam,Cisatracurium,Hydrocortisone Hemisuccinate,Methadone)

ConclusionandRelevance Thepopulationsstudiedintheliteratureremaindifferentfromours,makingitdifficulttodiscuss ourclinicalresults.However,followingthenon-conformities ofdosagenoted,weproposeatableofdosageadaptation underECMOsynthesisingtheliteratureforthestudiedmoleculeswhichissystematicallyaccompaniedbyinstructionsto makeaTDM

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-180 VANCOMYCIN:CONCORDANCEOFDOSAGE ADJUSTMENTACCORDINGTOMINIMUMPLASMA CONCENTRATIONANDAREAUNDERTHECURVE/ MINIMUMINHIBITORYCONCENTRATION

APérezFácila*,TEdeSalinasMuñoz,JJSaizMolina,CNotarioDongil,RLópezAlvárez, MCCondeGarcía. HospitalGenerallaManchaCentro,FarmaciaHospitalaria,Alcázarde SanJuanCiudadReal,Spain

10.1136/ejhpharm-2023-eahp.171

BackgroundandImportance Thepharmacokinetic/pharmacodynamic(PK/PD)targetforvancomycinhasrecentlybeen definedasanareaunderthecurve(AUC)over24hours/minimuminhibitoryconcentration(MIC)of400-600.

AimandObjectives Toevaluatethedegreeofconcordanceof recommendationsafterdoseadjustmentofvancomycinaccordingtominimumplasmaconcentration(Cmin)andAUC/MIC ratio.

MaterialandMethods Retrospectivestudyinadultpatients whoweretreatedwithvancomycinadministeredbyintermittentperfusionandmonitoredbythePharmacyServiceata generalhospitalduringthemonthofAugust2022.

MaterialandMethods

Our6-monthprospectiveobservationalmonocentricstudyfocusesonpatientsinthepaediatricintensivecareunitreceivingECMO.Clinico-biological datawerecollectedfromthecomputerisedpatientrecord andbyourdailypresenceinthedepartment.Wenoted

Variablescollected: sex,age,weight,height,glomerularfiltrationrate(accordingtoCockcroft-Gault),totaldailydoseand recommendationissuedbasedonthedeterminationofCmin andAUC/MIC.

AppropriateCminwereconsidered15-20mg/mLincomplicatedinfection(endocarditis,nosocomialpneumonia,

1OHanafia*, 2HCapelle, 1JLeonelli, 3SHonore, 1PBertault-Peres. 1HôpitauxUniversitaires deMarseille,PharmacieTimone,Marseille,France

meningitis,osteomyelitis/osteoarticularinfectionandwound infection/abscess)and10-15mg/mLinallotherinfections.For thecalculationofAUC/MIC,MIC=1mg/mLwasassumed. Interpretationofplasmalevelandindividualisedvancomycin adjustmentwasperformedusingMediWarePharm++® softwareusingabicompartmentalmodelandasinglevancomycin level(Cmin).

Results Vancomycintreatmentwasinitiatedandmonitoredin 42patients(52.4%female;72.3±12.3).Anthropometric parameters(weight:81.8±17.9kg;height:163.8±7.9cm; glomerularfiltrationrate:61.5±27.0ml/min/1.73m2);total dailydose:1,878.5mg±524.8mg.Therecommendation issuedwasconcordantviaCminandAUC/MICin35.7%.In thecaseofdiscordance,overexposurewasobservedin66.6% ofcases.

ConclusionandRelevance Approximately2outof3recommendationswerediscordantaccordingtothemethodused, withahighnumberofoverexposuresobservedinthecaseof recommendationsbasedonCmin.Therefore,despitethesmall samplesize,theimplementationofvancomycintherapeutic monitoringaccordingtoAUCisconsiderednecessaryforthe optimisationoftherapeuticmanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-181 FOLLOW-UPOFEXPOSEDNEWBORNSTOHIVIN PREGNANCYINATERTIARYHOSPITAL

RAguilarSalmeron,ENoguéPujadas,MVilaCurrius,COrtíJuan*,XLarreaUrtaran, MBrugueraTeixidor,CSubiranaBatlle,YOrtuñoRuíz,IGómezIbañez,RSacrestGüell. HospitalUniversitariDrJosepTrueta,PharmacyDepartment,Girona,Spain

10.1136/ejhpharm-2023-eahp.172

BackgroundandImportance TherateofnewHIVdiagnoses duetoverticaltransmission(VT)inSpainisverylowandthe newcasesarerelatedtofailuresintheimplementationofpreventionmeasures.

discrepanciesregardingtheregimenreceived.Allchildren couldbeanalyticallyconfirmedtheabsenceofVT,insome casesafter18months.

ConclusionandRelevance Noneofthenewbornsbecame infectedwithHIV.Althoughthemajorityofmotherscarried outcontrolsduringpregnancy,theabsenceofARTbefore/duringpregnancystandsout,togetherwithdetectableCVsasthe mainRFdetected.Informationcampaignsarenecessaryfor thepreventionofVTviewingduringpregnancy,aswellas, trainingforprofessionalsandconstantupdatingofprotocols toguaranteethecorrectmanagementofchildrenexposedto HIV.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-182 EXPERIENCEOFDISCONTINUATIONTYROSINEKINASE INHIBITORSTHERAPYINPATIENTSWITHCHRONIC MYELOIDLEUKAEMIAINCLINICALPRACTICE

CMDominguezSantana*,MDominguez-Cantero,MMoraCortes,MBlancoCastaño, GCanoMartinez. HospitalUniversitarioPuertoReal,PharmacyDepartment,PuertoReal, Spain

10.1136/ejhpharm-2023-eahp.173

BackgroundandImportance Thetreatmentofchronicmyeloidleukaemia(CML)withtyrosinekinaseinhibitors(TKI) resultsinoptimalcytogeneticandmolecularreponses, improvinglifeexpectancy.Neverthelessasalifelongpharmacologicaltreatment,canleadtoadverseevents(AEs)that cansubstantiallyimpactthequalityoflife,adherenceand thereforethesuccesoftreatment.Nowadays,discontinuing treatmentinpatientswhoachievedasustaineddeepmolecularresponse(DMR)isthemaingoalinCMLtherapy,in ordertoachieveaTreatement-FreeRemision(TFR),leading toloweroccurrenceofdrug-relatedAEs,costreductionand feelingofcure.

AimandObjectives

Theaimsofstudyaretoidentifyand quantifyriskfactors(RF)forVTintheprenatal,intrapartum andpostnatalperiodsandtoevaluatetheadequacyofantiretroviral(ART)prophylaxis,theappearanceofadverseevents andfollow-upduringthefirstyearoflife.

MaterialandMethods Adescriptive,retrospectiveandobservationalstudywasdesignedwhichincludedallthechildrenwho werefollowedupinthehospitalduringthe2010-2020 period.ThemainRFsthatcouldcontributetoVTwere definedinthethreeperiodsanddemographicandclinicalvariablesofmothersandchildrenwerecollected.Thefollow-up wasrecordedduringthefirstyear.

Results Atotalof30children,of22HIV+mothers,were included.Theywereyoungwomen,mostlyfromimmigrant communitiesandwithouttoxichabits.17%ofthepregnant womenwerediagnosedduringthepregnancycontrolsandof theremaining,20%didnottakeARTtreatmentatthe beginningofpregnancy.Atthetimeofbirth,34.5%had detectableviralloads(CV).Regardingchildren,57%were bornbycesareansectionand13%werepremature.TheRF detectedcorrespondmainlytotheprenatalperiod(62.5%), followedbytheintrapartum(26.8%)andthepostnatal period.ThemostfrequentRFsweredetectableCVsfollowed byprematureruptureofmembranes.Allthechildren receivedprophylaxisthatwaswelltolerated,observing

AimandObjectives TodescribetheclinicalexperienceofdiscontinuingthetherapywithTKIinpatientsdiagnosedwith CML.

MaterialandMethods Retrospective,descriptive,singlecentre (350-beduniversityhospital)studyofpatientswithPhiladelphiachromosome(Ph)positiveCMLinchronicalphase, treatedwithTKItillaugust2022.Criteriafordiscontinuing thetreatment: 5yearswithTKItreatmentandDMR achieved(molecularresponse(MR) 4.0during 36 months).Outcomeswerecollectedfrommedicalrecords: gender,age,TKItreatment,follow-uptime,candidatesto discontinuation,timeelapsedtoreachMR,timebetween treatmentstartanddiscontinuation,TFRduration,percentage ofpatientswholostreponseandwerereintroductedtotherapy,timetolostofresponse,withdrawalsymptomsanddiseaseprogression.

Results Therewere48patients,70,83%male.Population presentedameanageof61(25-81)years.Allreceivedfirstlineimatinib,exceptonepatientwhoreceiveddasatinib.Follow-uptimemedianwas60months(3-243).25%werecandidatestodiscontinuation,mediantimetoreachMRwas15 months(3-50).Timebetweentreatmentstartanddiscontinuationshowedamedianof9years(3-16).TFRmedianwas 10months(3-108).Percentageofpatientswholostresponse andwerereintroductedtotherapywas25%.Mediantimeto lostofresponsewasthreemonthssincediscontinuation.Just

onepatientshowsawithdrawalsymptom(severeanemic) andnoneofthemshowsaprogressiontoadvanceddisease stages.

ConclusionandRelevance Highpercentageofcandidateswere safelydiscontinuedandcurrentlyremainuntreated.Reduction oftoxicitiesassociatedwithTKItherapycoulddrivetoaclinicalbenefitforCMLpatients,improvinglivingconditions.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-184 WHATISTHEADDITIONNALVALUEOF PHARMACEUTICALINTERVENTIONSON[123I]METAIODOBENZYLGUANIDINESCINTIGRAPHY?

1SChaïb*, 2AFlaus, 1MMeguennani, 1ELevigoureux, 1CBolot, 2MJanier, 3VBreant. 1Radiopharmacy,GroupeHospitalierEst-HospicesCivilsdeLyon,Lyon,France; 2Nuclear Medicine,HospicesCivilsdeLyon,Lyon,France; 3Pharmacy,GroupementHospitalierEstHospicesCivilsdeLyon,Lyon,France

10.1136/ejhpharm-2023-eahp.175

4CPS-183 EFFECTIVENESSANDSAFETYOFNIRMATRELVIR/ RITONAVIRINREALLIFESETTING

MAAllendeBandres*,MArenereMendoza,PGomezRivas,MAAlcaceraLopez,IVarela Martinez,RFresquetMolina,AFrutosPerez-Surio,LCazorlaPoderoso,TSalvadorGomez, JMVinuesaHernando,MDLRGarciaOsuna. HospitalClinicoUniversitarioLozanoBlesa, Pharmacy,Zaragoza,Spain

10.1136/ejhpharm-2023-eahp.174

BackgroundandImportance OnMarch28th 2022,nirmatrelvir/ritonavirwasmarketedinSpain.TheSpanishAgencyfor MedicinesandMedicalDevices(AEMPS)establishedcriteria toprioritiseitsadministrationinpatientsathighriskofprogressiontosevereCOVID.Dataregardingtheeffectiveness andsafetyofnirmatrelvirinpreventingseverecoronavirusdiseaseoutcomesarelimited.

AimandObjectives Toassesstheeffectivenessandsafetyof nirmatrelvir/ritonavirinpatientsathighriskforsevere COVID-19.

MaterialandMethods ProspectivedescriptivestudyfromApril toAugust2022ofpatientstreatedwithnirmatrelvir/ritonavir. Sociodemographicvariables,vaccinationstatus,hospitaladmission,highriskfactorsforprogressionandconcomitanttreatmentwererecorded.Readmissionswererecordedwithin30 daysoftheendofantiviraltreatment.

Results 53patientswereincludedwithameanageof64 years,51%womenand49%men.57%werevaccinatedwith 3doses,17%with2doses,9%with4doses,6%with1 doseand11%werenotvaccinated.34%(18/53)werehospitalisedatthetimeofinitiationoftreatment.

Themostprevalenthigh-riskcriteriawere:24%active treatmentwithmyelotoxicchemotherapy,21%treatmentin theprevious6monthswithanti-CD20drugs,14%over80 yearsvaccinatedwithsomeriskfactorforprogression,7% patientswithonco-haematologicaltreatmentand7%intreatmentintheprevious3monthswithinhibitorsoftheproteinkinase.3treatmentswereperformedoff-labelforpersistent covid.

Themeannumberofdaysfromtheonsetofsymptomsto thestartoftreatmentwas1.6days.23%ofpatientsrequired doseadjustmentduetorenalimpairment.

53%requiredadjustmentofchronictreatmentforinteractions,mainlywithmetamizole,statins,fentanylanddiazepam.

2patientsreceivedremdesivirandsotrovimab,2remdesivir andanothertwosotrovimab.

4(7%)patientswerereadmittedwithin30daysafterthe endoftreatmentwithnirmatrelvirritonavir,1ofthemwith persistentcovid.Onepatientstoppedtreatmentforhives.

ConclusionandRelevance Nirmatrelvirritonavirhasbeen showntobeasafeandeffectivedruginhigh-riskpatientsof progressiontoseverecovid.

BackgroundandImportance [123I]-metaiodobenzylguanidine (mIBG)scintigraphyisatooltoassesscardiacsympathetic innervation.Itisusedtodiscriminateparkinsoniansyndromes. However,manydrugsareknowntointerferewiththisradiopharmaceuticalthatcanleadtofalseresults1

AimandObjectives Theaimofthisstudywastotrytoassess theimpactofstoppinginterferingdrugswith[123I]-mIBGina retrospectivestudybeforetherecentintroductionofpharmaceuticalinterviewsinanuclearmedicinedepartment.

MaterialandMethods Aretrospectivestudyfrom01/01/2010 to31/03/2022wasconductedtofindoutifadruginteraction couldexplaindiagnosticmismatchesbetweena[123I]-Ioflupane and[123I]-mIBGscintigraphies,focusingontheneurological indicationi.e.thedifferentialdiagnosisofParkinson'sdisease. Onthenuclearmedicinesoftware,asearchofallthepatients whohadbotha[123I]-Ioflupaneanda[123I]mIBGscan2010 andJune2022wasperformed.Eachpatient’schartisanalysedandthediagnosisiscollected.

Results 81patientsunderwent[123I]-mIBGimagingforthedifferentialdiagnosisofneurodegenerativediseaseandamong them42hadnon-contributory[123I]-Ioflupaneimaging (51.9%).Adivergentdiagnosisbetween[123I]-mIBGand [123I]-Ioflupanewasfoundin31%ofcases,representing13 patients.Adruginteractioncouldexplainthismedicalinterpretationmismatchin2patients(15.4%).Concerningthelatter,drugsinvolvedwerecalciumchannelblockers.No abnormalityofthesympatheticinnervationwasfoundwhereas the[123I]-Ioflupanescintigraphyfoundanabnormalityofthe dopaminergictransmission.Theseresultsmaycomplement existingdatasuggestingthatcalciumchannelblockersinterferedincardiac[123I]-mIBGimagingthroughincreasedsympatheticactivity2

ConclusionandRelevance Thereisagreatmedicalinterestin continuingpharmaceuticalinterviewsbecausedruginteractions canleadtonon-contributoryorunconclusiveexaminations.In addition,settingupaclinicaltrialbyre-examiningthesetwo patientsbuttemporarilystoppingthedrugspotentially involvedcouldbeveryinteresting.Indeed,thisworkdemonstratesthecomplexityofassessingtheimpactofpharmaceuticalinterventions.Moreover,thisprocessshouldbeevaluated forothercategoriesofradiopharmaceuticals.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.EmilioB,FrancescoG,CumaliA., etal.131I/123I-metaiodobenzylguanidine(mIBG) scintigraphy:procedureguidelinesfortumourimaging. EurJNuclMedMolImaging.2010Dec;37(12):2436–46.

2.AStefanelli,GTreglia,IBruno, etal. Pharmacologicalinterferencewith123I-metaiodobenzylguanidine:Alimitationtodevelopingcardiacinnervationimaginginclinicalpractice? EuropeanReviewforMedicalandPharmacologicalSciences.2013 May; 17(10):1326–33

4CPS-185 COMPOUNDEDINSULINEYEDROPS:POPULATION CHARACTERISTICS,USEINCLINICALPRACTICEAND SAFETY

ALuaces-Rodríguez*,PFeijoo-Vilanova,AMartínez-Pradeda,SRotea-Salvo,VGiménezArufe,LCaiero-Martínez,MMateos-Salvador,TVillalta-Andújar,BFeal-Cortizas,IMartínHerranz. ACoruñaUniversityHospitalComplex,Pharmacy,ACoruña,Spain

10.1136/ejhpharm-2023-eahp.176

BackgroundandImportance Persistentcornealepithelialdefects whichdonotimprovewithstandardsupportivetreatmentare challenging.Recently,insulineyedropshaveemergedasan alternativetreatmentastheyhaveshowntoimprovecorneal epithelialhealing.

AimandObjectives Todescribethecharacteristicsofthepopulationtreatedwithinsulineyedrops,itsuseinclinicalpracticeandsafety.

MaterialandMethods Retrospectiveobservationalstudyof patientstreatedwithcompoundingtopical1UI/mLinsulineye dropspreparedatthePharmacyDepartmentinatertiaryhospitalsinceDecember2020toJuly2022.

Thevariablescollectedwerepatientdemographics,ocular pathology,treatmentdurationandadversereactionsofinsulin eyedropsandconcomitantophthalmologicaltreatment.

Results 59patientstreatedwithinsulineyedropswere included(meanage68.7±17.1yearsold,49.2%women).

Pathologiestreatedwithinsulineyedropsinclude:keratitis(81.4%),ofwhich25.4%wereneurotrophickeratitis, 11.9%superficialpunctatekeratitis,10.2%herpetickeratitis,8.5%bacterialkeratitisandothers;cornealepithelial defectssecondarytokeratoplasty(8.5%),cornealopacity (5.1%)andothers.10.2%ofthepatientshaveaffected botheyes.

Insulineyedropswereprescribedfourtimesadayinall thepatientswhenfirstoptionswereineffective.40.7%ofthe patientscontinuewiththem,presentingamediandurationof treatmentof27.7weeks(min.5.1;max.79.1).Discontinuationwasobservedin59.3%ofthepatientsmostlybecauseof reepithelisationandsomebecausetheywereusedastransition treatmentuntilinitiationofautologousserumeyedrops. Noneofthepatientspresentedadversedrugreactions.

Regardingconcomitantoculartreatment,themeannumber ofeyedropsusedwere4.6±2.3perpatient.40.7%ofthe patientswerealsotreatedwithautologousserumeyedrops. Artificialtearsandlubricanteyedropswereusedin40.7% and88.1%ofthepatients.Otherprescribedeyedropsinclude drugssuchasanti-inflammatory(67.8%ofpatients),antibiotics(100%),antivirals(15.3%)andcycloplegicagents(35.6%).

ConclusionandRelevance Insulineyedropsaremainlyusedas secondarytreatmentforcornealdefects.Theyhaveprovento presentgoodtoleranceandbenefitsforthepatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

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BackgroundandImportance Cilgavimab/tixagevimabaretwo recombinanthumanIgG1ĸ monoclonalantibodiesindicated forthepre-exposureprophylaxisofCOVID-19inadultsand adolescents 12yearsoldweighing 40kg.InSpain,potentialcandidatesarepeoplewithhighdegreeofimmunosuppression(duetopathologyortreatment),whodonotrespond adequatelytovaccination(anti-anati-Santibodies<260BAU/ ml).

AimandObjectives Toanalysetheeffectivenessandsafetyof cilgavimab/tixagevimabinatertiarycarehospital.

MaterialandMethods Descriptive,observational,retrospective study.Patientswhoreceivedcilgavimab/tixagevimabfromMay2022toAugust-2022wereincluded.Variablescollected:age, sex,riskconditionandCOVID-19infection.Theriskconditions,accordingtocriteriaoftheSpanishAgencyofMedicinesandHealthProductswere:1)haematopoieticprogenitor transplantrecipientorCART-T,inimmunosuppressivetreatmentorwithgraft-versus-hostdisease;2)solidorgantransplantrecipients;3)primarycombinedandB-cell immunodeficiencieswithabsenceofresponsetovaccinationCOVID-19;4)immunosuppressivetreatmentwithbiologic immunomodulators(anti-CD20,abatacept,belimumabor mycophenolate,mainly);5)solidorgancancerundertreatment withcytotoxicchemotherapyortreatmentsthatcarryahigh riskofsevereCOVID-19progression;6)peopleatvery-highriskofsevereCOVID-19whoarecontraindicatedfor COVID-19-vaccination.TheprimaryendpointwasCOVID-19infectionaftercilgavimab/tixagevimabadministration.Safety wasanalysedbyincidenceofadversereactions.

Results 43patientswereincluded.23men(53.5%),median age=64yearsold(27-77).36patients(83.7%)wereinrisk group4(26patientstreatedwithrituximab,6patientswith ocrelizumab,1patientwithadalimumaband1patientwith interferonbeta-1A)and7patientswereinriskgroup2(all kidneytransplant).4patients(9.3%)hadCOVID-19infection aftertreatmentwithcilgavimab/tixagevimab(3wereingroup 4and1wasingroup2).Themediannumberofdaysto COVID-19-infectionoccurrenceinthesepatientswas25days. 1patienthadadversereactionsaftertreatment(tachycardia, generalmalaise,hematoma,headache,nauseaanddiffuse abdominalpain).

ConclusionandRelevance Thetreatmentwaseffectiveinthe majorityofpatientsinourhospital.Thissupportstheuseof thedrugasprophylaxistopreventCOVID-19inpeoplewho donotrespondsufficientlytovaccination.Thetreatmentwas welltolerated,presentinglowincidenceofadversereactions. Longertermstudiesshouldbeperformed.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-187 PATIENTSWHOARECANDIDATESFORTREATMENT WITHMONOCLONALANTIBODIESFORPRE-EXPOSURE PROPHYLAXISOFCOVID-19

4CPS-186 EFFECTIVENESSANDSAFETYOFCILGAVIMAB/ TIXAGEVIMABINPRE-EXPOSUREPROPHYLAXISOF COVID-19

10.1136/ejhpharm-2023-eahp.177

RGazquezPerez,DGámezTorres,MSánchezVarela,BSánchezRodríguez,MTGómez Sánchez,TMorenoDiaz*. HospitalUniversitarioTorrecardenas,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.178

BackgroundandImportance Cilgavimab/tixagevimabare recombinanthumanIgG1ĸ monoclonalantibodies,whichare indicatedforCOVID-19pre-exposureprophylaxisinadults andadolescents 12yearsofageweighing 40kg.

RGazquezPerez,BSánchezRodríguez,MTGómezSánchez,DGamezTorres,MSánchez Varela,TMorenoDiaz*. HospitalUniversitarioTorrecardenas,Pharmacy,Almeria,Spain

AimandObjectives

Toassesspatientswhoarepotentialcandidatesfortreatmentwithcilgavimab/tixagevimabinatertiary carehospitalandtodescribethesearchstrategy.

2.1wasdevelopedtoaddressphysicalandemotional limitations.

MaterialandMethods

InSpain,potentialcandidatesfortreatmentwithcilgavimab/tixagevimabarepeoplewithahigh degreeofimmunosuppression(duetopathologyortreatment) whodonotrespondadequatelytovaccination.TheSpanish AgencyofMedicinesandHealthProductsestablishestheconditionsforpatientswhoarecandidatesfortreatmentwithcilgavimab/tixagevimab1 .Asearchforpatientswascarriedout, prioritisingthefollowingcriteria:haematologicalpatientson treatmentwithrituximabduringthelast9months,patients withsolidorgantransplant,patientswithmultiplesclerosison treatmentwithocrelizumab/rituximab,andpatientswithrecent infectionbyCOVID-19whobelongtoanyriskgroup.Allof themunderwentserology,includinginthestudythosewith negativeserology(anti-anati-Santibodies<260BAU/ml). Thosepatientswerescheduledforcilgavimab/tixagevimab administration.

Results 112patients(38=haematologicalpatientsonrituximabtreatment,50=multiplesclerosispatientsonrituximab/ ocrelizumabtreatmentand24=kidneytransplantation)were enrolled.72patientswereincluded,38women(52.8%), medianage59.5yearsold(27-77).Thecauseofexclusion waspositiveserologyinallcases.64patients(88.9%)were ontreatmentwithbiologicimmunomodulators(35haematologicpatientstreatedwithrituximab<9months,27patients withmultiplesclerosisontreatmentwithrituximab/ocrelizumab/interferonbeta-1Aand1patientontreatmentwithadalimumab)andtherestwerekidneytransplantpatients. Cilgavimab/tixagevimabwasadministeredto62patients (86.1%),7patientswithunknownreasons,2patientshad COVID-19infectionand1patienthadtobeexcludedfor deepveinthrombosisduetothedevelopmentofsymptomsat thetimeoftheappointment.

ConclusionandRelevance Morethanhalfofthepatients enrolleddidnothaveanadequateresponsetoCOVID-19 vaccination.Thesearchstrategywasagoodtoolforadministeringpre-exposureprophylaxisofCOVID-19tothesemore vulnerablepatients.Furtherstudiesareneededtoevaluatethe effectivenessofthetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.aemps.gob.es/la-aemps/ultima-informacion-de-la-aemps-acerca-delcovid%E2%80%9119/prevencion-frente-a-la-covid-19/personas-candidatas-arecibir-evusheld-en-espana/#:~:text=En%20Espa%C3%B1a%2C%20son% 20potenciales%20candidatas,responden%20adecuadamente%20a%20la% 20vacunaci%C3%B3n.

ConflictofInterest Noconflictofinterest

AimandObjectives ToassesschangesinlongtermQoLin patientstreatedwithGalcanezumab.

MaterialandMethods Descriptivestudyofpatientswho receivedGalcanezumab(February2020toAugust2022).QoL datawerecollectedfrompatientsatweeks0,4,12and48 andfromtheelectronicclinicalhistory:sex,age,typeof migraine,numberofmonthlymigraineheadachedays(MHD) priortotreatmentanddurationoftreatment.ToassesseffectivenesswasusedMSQv2.1(14-itemquestionnairethatmeasuresQoLimpactsin3domains:RoleFunction-Restrictive (RFR),measureslimitationsinsocialandworkactivities;Role Function-Preventive(RFP),measuretheimpactthroughpreventionoftheseactivities;andEmotional-Function(EF),assess theemotionalimpact.HigherscoresindicatebetterQoL).The mainvariablewastherateofrespondersaccordingtoRFR definedaspatientswhoseaveragechangefrombaselinewas 25overweek48.Secondaryoutcomeswereresponders accordingRFRoverweek4and12,andmeanchangesfrom baselineinRFR,RFP,EFandMSQ-totalatweeks4,12and 48.

Results 34patientswereincluded,33woman,meanage45 years(29-69).Typeofmigraine:70,5%chronicmigraineand 29,5%highfrequencyepisodicmigraine.Meanmonthly MHDpriortotreatmentwere18days(8-30)andmeandurationoftreatmentof15(3-27)months.8patientsdidnot reach48weeks,treatmentwasdiscontinuedforineffectiveness.Mainoutcome:therateofresponderswas38,2%at week48.Secondaryoutcomes:34,2%and45,7%responders atweek4and12respectively.Thetableshowsaverage changefrombaselinescoreinMSQ-domainsandMSQ-total:

4CPS-188 QUALITYOFLIFEINPATIENTSONGALCANEZUMAB LONG-TERMTREATMENT

1CMDominguez-Santana, 2ERios-Sanchez*, 1EMBarreiro-Fernandez, 1MABlanco-Castaño, 1JMBorrero-Rubio. 1HospitalUniversitarioPuertoReal,Farmacia,PuertoReal,Spain; 2HospitalUniversitarioPuertoReal,Farmacia,PuertoRealCádiz,Spain

10.1136/ejhpharm-2023-eahp.179

BackgroundandImportance Galcanezumabisadrugindicated formigraineprophylaxis.Peoplewithmigraineexperiencesignificantfunctionalandqualityoflife(QoL)impairment.

Migraine-SpecificQuality-of-LifeQuestionnaire(MSQ)version

ConclusionandRelevance Inthisstudy,long-termgalcanezumabtreatmenthadamoderateeffectivenessinimprovingthe RFR-domainofQoL.Thenumberofrespondersdecreased overtime.Alldomainsimprovedfrombaselineoverthe weeksstudied.However,atweek48,qualityoflifeworsened comparedtoweeks4and12.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-189 ANALYSISOFMEDICATIONPERSISTENCEIN MIGRAINEPATIENTSTREATEDWITHANTI-CGRP MONOCLONALANTIBODIES

1MMirCros*, 1FITorresBondia, 1SMCanoMarrón, 1PTabernerBonastre, 1CSantos Rodriguez, 1AMoralesPortillo, 2RCandeasAgusti, 3CGonzalezMingot, 3JSanahuja Montesinos, 1JASchoenenbergerArnaiz. 1HospitalUniversitariArnaudeVilanova,Hospital Pharmacy,Lleida,Spain; 2HospitalUniversitariArnaudeVilanova,PharmacyTechnician, Lleida,Spain; 3HospitalUniversitariArnaudeVilanova,Neurology,Lleida,Spain

10.1136/ejhpharm-2023-eahp.180

BackgroundandImportance Monoclonalantibodiestargeting thecalcitoningene-relatedpeptide(anti-CGRP)arerecently availableformigrainetreatment.Real-worlddataontheutilisationofthesedrugsinclinicalpracticeisscarce,butthis informationcouldhelphospitalpharmacistsaffordabetter selectionoftheavailabledrugs.

AimandObjectives Thestudyaimedtoexploredifferencesin medicationpersistenceinpatientswithmigrainetreatedwith erenenumab,ahumanmonoclonalantibodythatbindstothe receptorforCGRP,orfremanezumabandgalcanezumab, humanisedmonoclonalantibodiesthatbindCGRP.

MaterialandMethods RPTisadrugregistryofpatientswith migraineinitiatingbiologictreatmentinpublicuniversityhospitalsinCatalonia.Forthisstudy,weretrievedfromthe registrydataofpatientsinitiatingtreatmentafter01/02/2020 witherenumab,fremanezumaborgalcanezumab.Theprimary outcomesassessedwere:gender,age,discontinuationrate, timetodiscontinuation,andthecausesofit.Wealsocollecteddatatomeasurethetreatmentresponse,suchas migrainedayspermonthandthevalidatedqualityoflife scales(MigraineDisabilityAssessmentScaleandHeadache ImpactTest-6).

Retrieveddatawasdissociatedbeforeanyanalysis.Chisquarewasusedtocompareproportionsandt-Studentfor continuousvariables.

Results Datafrom131patientswasretrieved:55/131were treatedwitherenumaband76/131withgalcanezumab/fremanezumab.85%ofpatientswerewomen,withamedianageof 51.Medicationpersistencethreemonthsafterinitiatingtreatmentwas36/55witherenumaband57/76withfremanezumab/galcanezumab.Therewerenosignificantdifferences betweenthetwomechanismsofaction.

Themeantimetodiscontinuationinpatientstreatedwith erenumabwas8,9monthsandinpatientstreatedwithfremanezumaborgalcanezumab,6,8months,withoutsignificant differences.

2/19and3/19patientsdiscontinuedtreatmentduetotoxicitywitherenumabandfremanezumab/galcanezumab, respectively.

30/131patients’ treatmentwereswitchedtoadifferent mechanismofaction.Athree-monthfollow-upafterthetreatmentchangerevealedsignificantimprovementin15/30 patients.

ConclusionandRelevance Medicationpersistenceinmigraine treatmentwithanti-CGRPmonoclonalantibodiesseemssimilar forbothmechanismsofaction.

Moreextensivestudiesareneededtoclarifythedifference inresponsetodifferentanti-CGRPmonoclonalantibodies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-190 ANALYSISOFIBRUTINIBDOSEREDUCTIONIN PATIENTSDIAGNOSEDWITHCHRONICLYMPHOCYTIC LEUKAEMIA:AREWEDOINGITRIGHT?

JBooRodríguez*,ARosOlaso,IBeristainAramendi,AEceizaDíez,ALatasaBerasategui, CSaizMartínez,MJGarciadeAndoinBarandiaran,JLandaAlberdi,DGarcíaEcheverría, GLizeagaCundin. HospitalDonostia,Farmacia,Donostia,Spain

10.1136/ejhpharm-2023-eahp.181

BackgroundandImportance Theusualoraldosageofibrutinib inchroniclymphaticleukaemia(CLL)is420mgevery24h.

However,comorbidities,adverseeffectsanddruginteractions requireadosereduction(DR),andtheefficacyoftreatment maybecompromised.

AimandObjectives Toanalysethereasonsofibrutinibdose reductionanditsconsequencesondiseaseprogression/ death.

MaterialandMethods Retrospectiveobservationalstudythat includespatients(n=60)diagnosedwithCLLtreatedwith ibrutinibbetween09/16/2020-09/16/2022andnotinvolvedin aclinicaltrial.Thedemographiccharacteristicsofpatients werethefollowing:43males(72%),meanage72.9years (53-89).

DatacollectionincludeDRrequirements,DRreasons,treatmentsuspensions,diseaseprogressionanddeathwiththeir respectivedaterecording.

ThepercentageofpatientsrequiringDRandthereason thereofwerecalculated.Percentageofdiseaseprogressionand deathalso.Inaddition,mediantreatmentdurationswerecalculatedinmonthsandexpressedinpercentages;overall medianduration(OMD)andafterDRrequirement(DRMD).

Thedatawasobtainedfromtheelectronicmedicalrecord (OsabideGlobal)andtheelectronicprescriptionprogram (Onkobide).

Results 35%ofpatients(n=21)requiredDRduringthestudy period.ThemainreasonsforDRweretoxicity76,1% (n=16),pharmacologicalinteractions9,5%(n=2),efficacy 4,8%(n=1),aging4,8%(n=1)andpatientdecision4,8% (n=1).10%ofDRpatients(n=2)sufferedCCLprogression and29%(n=6)died.5%(n=2)ofpatientsnon-requiringDR sufferedCCLprogressionand13%(n=5)died.TheOMDof thetreatmentwas17months(0-73)andtheDRMDwas12 months(0-70).

ConclusionandRelevance TheibrutinibDRdoesnotinfluence thediseaseprogressionormortality,althoughthesamplesize isnotenoughforaformalstatisticalanalysis.Toxicitywas identifiedasthemostcommonreasonforDR.TheOMD andDAMDdatapresentedinthisworkarelowerthanthose commonlypublishedintheliterature(1)duetothetechnical limitationsonthesoftwaresystems.

REFERENCE

1.Hardy-AbeloosC,PinottiandR,GabriloveJ,Ibrutinibdosemodificationsinthe managementofCLL. JournalofHematologyandOncology 2020;13:66Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275592/pdf/ 13045_2020_Article_870.pdf

ConflictofInterest Noconflictofinterest

4CPS-191 IMPACTOFTHECOVID-19PANDEMICONTHE ADHERENCEOFHIVPATIENTS

AVélezBlanco*,XCasasFernández,LOrtegaValín,IÁlvarezFernández,JCSáez Hortelano,SLlamasLorenzana,RVarelaFernández,EGutiérrezGutiérrez,JJOrtizde UrbinaGonzález. HospitaldeLeón,HospitalPharmacy,León,Spain

BackgroundandImportance In2020Spainwasinvolvedin theSARS-CoV-2pandemic.Thissituationentailedinthedispensingofdrugsfrompharmacyservicestopatients'homes. Thiswayofreachingthepatientfacilitatedtheaccesstoantiretroviraltreatment(ART)inthisdifficultsituation.However, duetothesocialstigmas,certainpatientsdidnotconsentto accessthisdispensingsystem.

10.1136/ejhpharm-2023-eahp.182

AimandObjectives

Theobjectiveistostudyhowadherence toantiretroviraltreatmentwasaffectedinHIV-positive patientsduringthemonthsofthefirstalarmstateinSpain (March14toJune212020);becauseduringthoseperiod ARTwashomedispensation.

AimandObjectives Toanalysetheadherenceofpatientswith MSthatwereprescribedwithdisease-modifyingtreatment (DMT)andtoidentifyriskfactors.

MaterialandMethods

Observationalretrospectivestudy, includedpatientsHIV-positivewhoreceivedARTduringthe firstalarmstateinSpainduringCOVID-19pandemicandin thesameperiodof2019.

Collecteddatawere: sex,ageandvariablesrelatedtopharmacologicaltreatment(ARTintheselectedperiods,numberof dispensationsmade,galenicunitsdispensed).

Tomeasureadherence,anindirectmethodwasused,comparingthedispensationsmadeinthehospitalpharmacyofthe hospitalofLeónduringthestudiedperiodandthesamedates ofthepreviousyear.

%adherence=[dispensedgalenicunits/plannedgalenic units]x100

Results Weanalyse444patientswithamedianageof54 years(45-59)being77.93%(n=346)men.

Duringthestudyperiod83patients(18.69%)changed theirART.38.55%(n=32)carriedoutasimplificationof ARTin2020(fromatreatmentbasedonseveralpharmaceuticalformstoatreatmentbasedonasingleone).

Themeanadherenceintheperiodsstudiedin2019and 2020was91.89%(CI90.44-92.90)and90.25%(CI87.6192.90),respectively.In2019,67.12%(n=298)ofpatientshad adherencegreaterthan95%,comparedto86.71%(n=385)in 2020.

For38patientstherearenomedicationdispensations duringthe2020period.Of themajority(n=27)thereason fortheabsenceisunknown;6werenotdisposedoffrom thehospitalofLeónforspend ingtheconfinementoutside thecity;4havediedand1didnotaccepthome dispensation.

ConclusionandRelevance TheimplementationofhomedispensingcouldhavepositivelyinfluencedadherenceinHIVpositivepatients.Itisnecessarytoevaluateinthefuturethat theimplementationofnewtelepharmacyprogrammescan haveapositiveinfluenceonadherence.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1699-714X2020000300193

2.https://iris.paho.org/bitstream/handle/10665.2/51947/2020-cde-coronavirus-diseasehiv.pdf?sequence=1&isAllowed=y

ConflictofInterest Noconflictofinterest

MaterialandMethods Aretrospectiveobservationalstudywas conductedincludingMSoutpatientsunderactiveDMTin 2021.Variablescollected:gender,age,drugtype(subcutaneous interferonbeta1b,intramuscularinterferonbeta1a,subcutaneousinterferonbeta1a,teriflunomide,dimethylfumarate, fingolimod),routeofadministration(oralvsparenteral),polypharmacy(>5drugs/day),adverseeffects(AEs),typeofMS (relapsingremittingMS-RRMS-,secondaryprogressiveMSSPMS-,primaryprogressiveMS-PPMS-),timecourse, ExpandedDisabilityStatusScale(EDSS)scoreatonsetof DMT,numberofpreviousflaresandhospitalisations,and comorbidities.

AdherencewascalculatedthroughtheMedicationPossessionRatio(MPR)usingpharmacydispensationrecorddatabase.GoodadherencewasconsideredMPR 80%.A statisticalanalysiswasperformedwithIBMSPSSStatistics v21.0.

Results Atotalof214patientswereincluded[(62.1%female), meanage43.9(SD9.7)years].

Themostprescribeddrugwasteriflunomide(26.6%),followedbydimethylfumarate(20.6%),subcutaneousinterferon beta1b(14.5%),glatirameracetate(12.6%),fingolimod (12.1%),intramuscularinterferonbeta1a(7.0%),andsubcutaneousinterferonbeta1a(6.5%).Themostfrequentrouteof administrationwasoral(59.3%)vsparenteral(40.7%).38.3% ofpatientswerepolymedicatedand53.7%sufferedAEs.

95.3%ofpatientshadRRMSand4.7%hadSPMS. MediantimewithMSwas11(0.2 – 45)yearsandmedian EDSSwas1.5(0 – 8).Previousflare-upswere51.4%,hospitalisations39.3%andcomorbidities79.4%.

Goodadherence(MPR 80)wasdeterminedfor89.7%of thepatients.MedianMPRwas100(19 – 100).

Adherencewasinfluencedbyrouteofadministration (p=0.024)andcomorbidities(p=0.014)withstatisticallysignificantdifferences.Astatisticallysignificantdifferencewas notobservedfortheanyothervariable.

ConclusionandRelevance Adherencewassatisfactoryinmost patients.Determiningmodifyingfactorsofadherenceisimportanttoidentifypatientsatriskofnon-adherencewhoshall receivepersonalisedpharmaceuticalcareandoptimised treatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-192 ANALYSISOFADHERENCEANDASSOCIATEDRISK FACTORSINMULTIPLESCLEROSISPATIENTSUNDER DISEASE-MODIFYINGTHERAPY

1LSopena, 1AMagallon, 1AFrutos, 2MGarcés, 2CIñiguez, 1RFresquet, 1PGomez, 1JMVinuesa, 1AMerchan, 1TSalvador, 1ABMaríaÁngeles*. 1HospitalClínicoUniversitario LozanoBlesa,Pharmacy,Zaragoza,Spain; 2HospitalClínicoUniversitarioLozanoBlesa, Neurology,Zaragoza,Spain

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BackgroundandImportance Multiplesclerosis(MS)isoneof themostfrequentcausesofdisabilityamongyoungpeople. Understandingpatients’ adherencetotreatmentsisofgreat importancetoassesstheeffectivenessandsafetyoftheprescribedtreatments.

4CPS-193 SUITABILITYOFTHEDUALANTIPLATELETTHERAPY TOTHEGUIDELINESOFEUROPEANSOCIETYOF CARDIOLOGYINACUTECORONARYSYNDROME

HSuñer*,CJCortésSánchez,DPascualCarbonell,ASanjuánBelda,ISacanellaAnglès, AGarciaMolina,LCanadellVilarrasa. HospitalUniversitariJoanXxiii,Pharmacy,Tarragona, Spain

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BackgroundandImportance Thedualantiplatelettherapy (DAPT)consistingofacetylsalicylicacidplusoneP2Y12plateletreceptorinhibitorrepresentsthefirstlinetotreatpatients withdiagnosisofacutecoronarysyndrome(ACS).

AimandObjectives ToreviewtheDAPTprescribedtopatients withACSadmittedinathirdlevelhospitalandtoassesstheir

adequacygradetotheEuropeanguidelinesofcardiology (ESC).

MaterialandMethods

Observationalandretrospectivestudy donebetweenJanuary-June2022wheredataforpatientswith ACSdiagnosis:unstableangina(UA)ormyocardialacuteinfarctionwithandwithoutSTelevation(STEMI,NSTEMI)have beencollected.Studiedvariablesweredemographicandclinicalinformation(diagnostic,treatment,cardiovascularriskfactors(CVRF)).Foreachpatientischemicandhaemorrhagicrisk havebeencalculated(usingGRACEandCRUSADEscore). Patientswith3ormoreoftheCVRFdescribedhavebeen consideredfragilepatients.ESCguidelinesestablishedthe appropriateDAPTforeachpatientaccordingtotheACS's typeandpatient’sischemic-haemorrhagicrisk.Adequacywas assessedintermsofcomplianceornon-compliancewiththese recommendations.

DatawereexportedfrommedicalhistorythankstoSAP® informatics’ toolandSilicon® electronicprescriptionprogram. StatisticanalysiswasmadebyStata.v.15.0®.Qualitativevariableswereexpressedinpercentagesandabsolutefrequencies. Quantitativeoneslikeaverage±standarddeviation.

Results Atotalof95patientswerediagnosedwithACS

74,74%(71)ofwhichweremenwithanaverageageof 64,38±12,77years,the7,37%(7)withUA,44,21%(42) NSTEMIand48,42%(46)STEMI.Allwereundertreatment withDAPTandmoreoverthe21,05%(20)wereanticoagulatedafterpercutaneouscoronaryintervention.The51,58% (49)werelow,33,68%(32)mediumand14,74%(14)high ischemicriskypatients.Regardingthebleedingriskthe 53,86%(51)werelow,23,16%(22)mediumand23,16% (22)high.

The37,89%(36)oftheprescribedtreatmentsweren’tcomplyingwiththerecommendedDAPTinESCguidelines accordingtoACS'stypeandpatient’sriskfactors.Bydiagnosis,in42,85%(3/7)ofUApatients,42,85%(18/42)of NSTEMIand30,43%(14/46)ofSTEMItheprescriptionsdid notconformtoguidelines.

ConclusionandRelevance Percentageofnon-adequacyofprescribedDAPTtorecentpublishedESCguidelinesisconsiderable,leadingtodisparityofcriteriawithguidelinesand betweenprofessionalsandpossibletreatment'sinequity betweenpatients.Futurestudiescouldexploretheimportance ofpharmacistintegrationandvalidationtoavoidreported discrepancies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-194 BASELINEAUDITOFPOTENTIALTOOPTIMISE

THERAPYTHROUGHUSEOFSGLT2IINACOHORTOF PATIENTADMITTEDWITHANACUTEMYOCARDIAL INFARCTION

NBenHajmessaoud*,PWright,SFhadil,SAntoniou. StBartholomew'sHospitalBarts HealthNHSTrust,Cardiology,London,UnitedKingdom

10.1136/ejhpharm-2023-eahp.185

BackgroundandImportance Therearearound100,000hospitaladmissionseachyearintheUKduetoacutemyocardial infarctions(AMI).Co-morbiditiesinthosewithischaemic heartdiseasearecommonandincludeheartfailure,diabetes andchronickidneydisease(CKD),theinterplaybetweenthese conditionsbeingrecentlytermedcardiometabolicsyndrome.

RecentupdatesinUKNICEguidancesupporttheuseof SGLT2iforthosewithtypeIIdiabetes(T2DM)andcardiovascular(CV)risk,fortreatmentinthosewithheartfailurewith reducedejectionfractionandmostrecentlyforCKD.

AimandObjectives AssesspatientsatalargeLondonbased cardiovascularcentre,beingpreviouslydischargedwithadiagnosisofAMItoidentifytheopportunitytooptimisetherapy throughprescribingSGLT2i.

MaterialandMethods RetrospectiveanalysisofpatientsadmittedwithanAMIbetweenJanuaryandOctober2021ata largeLondonbasedcardiovascularcentretocomparetheoptimisationofSGLT2iatdischarge(DC)andat12monthsin thosewithcardiometabolicriskfactors(i.eT2DM,HFand CKD).

Results 450patientswithAMIwerefollowedduring1year, averageagedof57.3yearsoldwith84%male,T2DM (25.7%),HF(23.5%),CKD(10%),43%smokersand3% withAF.

Atdischarge,SGLT2iwereprescribedin4.6%ofallAMI patients.InpatientswithT2DM,HFandCKD,therespective ratesofSGLT2iatdischargewere18%,3.7%and2.2%.

At12monthspost-discharge,T2DMincreasedto28%(11 newlydiagnosed),23.5%ofpatientswithHFand16%with CKD(26patientsnewlydiagnosed).SGLT2iwereprescribed in10.4%ofpatientswithrespectiveratesof30%,16%and 11.1%.

ConclusionandRelevance Thisdatasupportsanopportunity toimproveSGLT2iprescribinginourpost-MIcohortwith additionalcardiometabolicriskfactors.Therewasasmall increaseinprescribingnotedafter12monthsbutrecent updatesinUKpolicywouldsupportawideradoptionof SGLT2iuse,inparticularnotingthehighratesofT2DMand HFseeninthepost-AMIgroup.Strategiestofacilitateoptimisationincludeprotocolisationofinitiation,communicationfor 1rycarephysicianstostartshortlyafterdischargeandconsiderationofearlierinitiationpriortodischargeinthosewith cardiometabolicriskfactors.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-195 E-LUNGING:EVALUATIONOFANE-LEARNING PROGRAMINTENDEDFORHEALTHCARE PROFESSIONALSREGARDINGTHEMEDICATIONOF LUNGTRANSPLANTPATIENTS

1RSchofield*, 1OJouhet, 1DBoden, 1ACrou, 2GDauriat, 1VChevalet, 1LGutermann. 1HôpitalMarieLannelongue,Pharmacy,LePlessis-Robinson,France; 2HôpitalMarie Lannelongue,Pneumology,LePlessis-Robinson,France

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BackgroundandImportance Ourinstitutionisspecialisedin lungtransplantation(LT).Thedrugsassociatedwiththisprocedurearenumerousandofcomplexmanagement.However, thelong-termsuccessofLTisdirectlylinkedtopatientadherence.Inourinstitution,nursingstaffturnoverisfrequent,and thereplacementstaffisnotalwaysspecialisedinLT.This observationledtothedevelopment,incollaborationwiththe medicalandnursingteams,ofanonlinetrainingprogram(elearning)forhealthcarestaff,intendingtoreinforcethe appropriateuseoftransplantdrugsandbetterrespondto patients'queries.

AimandObjectives

Toevaluatetheimpactofourtrainingon theacquisitionofknowledgebynursingandpharmaceutical staff.

comprehensivemedicationreviewwasconductedbyahospital pharmacist.PIMsandPPOswereidentifiedusingtheSTOPPSTARTcriteria.

MaterialandMethods

Thecontentandformatofthee-learningweredecidedduringmultidisciplinarymeetings,andthe trainingwascreatedusingspecificsoftware(ArticulateStoryline®).Itisdividedinto5partsandcontainsanassessment questionnairetobecompletedbeforeandafterthetraining. Thee-learningwasdistributedtothenursingstaffofthe thoracicsurgeryandintensivecareunits,aswellastothe pharmaceuticalstaffofourhospitalgroup.Therateofcorrect answersobtainedbeforeandafterthetrainingwascollected andcompared.

Results 34peoplecompletedthetraining.Theaveragerateof correctanswersobtainedbeforeandaftercompletingthe trainingincreasedsignificantly,from75%to86%(p< 0.001).Themostrepresentedprofessionalcategorieswere pharmacystudents(15/34),pharmacyresidents(7/34),and nurses(7/34).

100%ofpeoplesaidtheywere ‘satisfied’ or ‘verysatisfied’ withthetrainingand97%wouldrecommendit.

ConclusionandRelevance Theincreaseintherateofcorrect answersbeforeandafterthetrainingshowsthatthenursing andpharmaceuticalstaffhasacquiredknowledge.Amainlimitationoftheprojectwasthedifficultyfornursestofinddedicatedtimetocompletethetraining.Theimpactondaily practicesinourinstitutionstillremainstobeevaluated.The distributionofthetrainingtocommunitypharmaciesthat treatlungtransplantpatientscouldprovevaluableto strengthenourcommunityrelations.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-196 POTENTIALLYINAPPROPIATEMEDICATIONSAND POTENTIALLYPRESCRIBINGOMISSIONSINOLDER PEOPLELIVINGWITHHIV

1JFernándezFradejas, 1MVélez-Díaz-Pallarés, 1EDelgado-Silveira, 1PGuijarro-Martínez, 1SRodríguez-Tierno, 2CRodríguez-González, 3FMartínez-DelaTorre, 4CMartínez-Nieto, 5EGonzález-Burgos, 1AMAlvarezDiaz*. 1HospitalUniversitarioRamónYCajal,Pharmacy, Madrid,Spain; 2HospitalGeneralUniversitarioGregorioMarañón,Pharmacy,Madrid,Spain; 3HospitalUniversitario12deOctubre,Pharmacy,Madrid,Spain; 4HospitalUniversitario InfantaSofía,Pharmacy,SanSebastiándeLosReyes,Spain; 5UniversidadComplutensede Madrid,PharmacologyDepartment,Madrid,Spain

10.1136/ejhpharm-2023-eahp.187

BackgroundandImportance DuetoahigherburdenofnonHIVcomorbiditiesandtheuseofmultiplemedicinesincomparisontonon-infectedpopulation,olderpeoplelivingwith HIV(PLWH)aremorelikelytobeatriskofdrug-related problems,includingpotentiallyinappropriatemedications (PIMs)andpotentiallyomittedprescriptions(PPOs).

AimandObjectives TodeterminetheprevalenceofPIMsand PPOsinolderPLWH.ToidentifythemaingroupsofmedicationsinvolvedinPIMsandPPOsaccordingtotheSTOPPSTARTcriteria.

MaterialandMethods Across-sectional,observational,multicentrestudywasconducted.OlderPLWH(aged65orolder) whowereonactiveantiretroviraltreatmentatfourdifferent hospitalsbetween1September2021and31December2021 wereincluded.Demographicandclinical-pharmacotherapeutic datawereobtainedfromelectronicmedicalrecords.A

Results Onehundredpatientswereincluded,83%male,mean age73.1years(SD6),meanVACSindex40.8(SD11),96% weremultipathological(meannumberofnon-HIVcomorbidities4.3,SD2).Meannumberofchronicdrugsperpatient (excludingantiretroviraltreatment),8.5(SD3.4),92%presentedpolypharmacy.Forthepatientsincluded,atotalof124 PIMsand119PPOswereidentified.Theglobalprevalenceof PIMsandPPOswas75%.TheprevalenceofPIMsandPPOs separatelywas53%and68%respectively.Seventeendifferent STOPPcriteriawereidentified.ThemostfrequentSTOPPcriteriawereA1(drugwithoutevidence-basedclinicalindication, n=51,41.1%),D5(benzodiazepinesfor4ormoreweeks, n=20,16.1%)andK1-K4(benzodiazepinesandZ-drugprescriptions,n=20,16.1%).TwentydifferentSTARTcriteria wereidentified.ThemostfrequentSTARTcriteriawereI1-I2 (influenzaandpneumococcalvaccine,n=56,47%),E4(bone antiresorptiveoranabolictherapyinosteoporosis,n=10, 8.4%)andG8(5-alphareductaseinhibitorwithsymptomatic prostatism,n=8,6.7%).

ConclusionandRelevance Threequartersofthepatients includedinourcohortofolderPLWHpresentPIMsor PPOs.ThemaingroupofdrugsinvolvedinPIMsandPPOs arebenzodiazepinesandvaccines.Medicationreviewisessentialtooptimisepharmacotherapyandpreventdrugrelated problemsinthispopulation.

REFERENCESAND/ORACKNOWLEDGEMENTS

STOPP-STARTcriteria(O’Mahonyetal.,2015).PMID25324330

ConflictofInterest Noconflictofinterest

4CPS-198 ANALYSISOFANTIPSYCHOTICDRUGSUSEATA SPANISHTERTIARYHOSPITAL

1RCastillejo*, 1LDLRuedaBermudez, 1GRamirezSoto, 1NRebolloDiaz, 2ÁLópezDíaz. 1ClinicalPharmacist,HospitalUniversitarioVirgenMacarena,Seville,Spain; 2Clinical Psychiatrist,HospitalUniversitarioVirgenMacarena,Seville,Spain

10.1136/ejhpharm-2023-eahp.188

BackgroundandImportance Theeffectivenessofsecondgenerationantipsychotics(SGA)hasbeenshowntobeequivalentto thefirst-generationantipsychotics(FGA),withdifferentside effectprofiles.

AimandObjectives Theaimofthisstudywastodetermine thepatternsofantipsychoticsprescriptionandrelatedcostsat auniversityhospital.

MaterialandMethods Oneyearretrospectiveobservational studyataSpanishuniversitygeneralhospital.Identificationof outpatientsundertreatmentwithantipsychoticsduring2021, whichhadbeenprescribedathospital.FGAandSGAdata consumptionwasobtainedfromMicrostrategy ® database. Comparativeanalysisinrelationtotheeuropeanpatternsof prescriptionandcostanalysiswereperformed.Mainoutcome measures:percentageofpatientswithSGA,FGAandlong-actingantipsychotics(LAI)andcostsperpatient.

Results Atotalof16.967patientsundertreatmentwithantipsychoticsduring2021wereidentified:9.01%FGAand 90.9%SGA.ThemostfrequentFGAwere:oralhaloperidol (44.4%),oralclotiapine(26.6%)andorallevomepromazine (17.9%).AmongtheSGA,themostusedwere:oral

quetiapine(37.3%),oralolanzapine(20.2%),oralaripripazole (15.7%)andoralrisperidone(11.4%).Regardingthetotal prescriptions,thepercentageofuseofLAIwas6.66%(3.43% and6.98%amongFGAandSGA,respectively).The95.31% totalLAIprescriptionswereSGA.TheuseofLAIathospital wasfoundtobelowerthaninotherEuropeancountries (15%accordingtoArangoC.etal2019).However,theproportionofsecondgenerationLAIwashigherthantheEuropeanaverage(34%).Themeancostperpatientwashigher forSGAthanforFGA(353.5C ¼ vs27.0C ¼ ).Likewise,incomparisontoconventionalinjectableantipsychotics,costsper patientwerehigherforLAI:155.1C ¼ vs15.8C ¼ forFGAand 2887.5C ¼ vs72C ¼ forSGA,respectively.

ConclusionandRelevance IncomparisonwithotherEuropean countries,apredominanceoftheuseofsecondgeneration LAIhasbeendetected.However,theuseofLAIislower. Cost-effectivenessstudiesregardingtheuseofSGAversus FGAandconventionalversusLAIantipsychoticsareneededin ordertooptimisethebenefitstothepatientandminimisethe economicburdenforthehealthsystem.

REFERENCES

1.ArangoC etal.Long-actinginjectableantipsychoticsforthetreatmentofschizophreniainSpain. RevPsiquiatrSaludMent(EnglEd).2019; 12(2):92–105.

ConflictofInterest Noconflictofinterest

4CPS-199 PHARMACO-ECONOMICIMPACTOFDRUG INTOXICATIONSINCHILDREN

1SMousannif*, 2HMefetah, 3IZhim, 1MBouatia. 1MohammedVUniversity-Facultyof MedicineandPharmacy-PaediatricHospital,PharmacyDepartment,Rabat,Morocco; 2PaediatricHospitalRabat,PharmacyDepartment,Rabat,Morocco; 3MohamedVMilitary Hospital,PharmacyDepartment,Rabat,Morocco

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BackgroundandImportance DrugIntoxicationsinchildren,by itssocial-economicimplications,representamajorproblemof PublicHealth.Theyconstitutethemaincauseofemergency admissionsandalsooneoftheprincipalcausesofdeathin childrenandadolescents.

AimandObjectives Theaimofthisstudyistoevaluatethe pharmaco-economicimpactofdrugintoxicationsregistredin thepaediatricemergencydepartment.

MaterialandMethods Thisisastudyspreadoveraperiodof 12monthsfromJanuary1,toDecember31,2021,inthe paediatricemergencydepartment.Itisbasedontheanalysis ofcoststomanagealldrugintoxicationsrecordedinchildren foronedayofhospitalisationwhichincludethecostof:drugs andantidotesadministered,laboratoryandradiologicalanalysis,hospitalisationfees.

Thereferenceoftheidentifycostsisgivenbythebilling departmentofourhospital.

Results Duringthisperiod69casesofdrugintoxications wereadmitted.AccordingtoATCCSclassification,theclass N(NervousSystem)wasthemostcommonclassinvolvedin drugintoxications(50%)followedbyMusculo-SkeletalSystem(15%)thenGenito-UrinarySystemandSexHormones (11%),RespiratorySystem(8%)and16%forotherclasses.

Tomanagethesedrugintoxications,asymptomatictreatment andantidotesadministrationisregistredin32.5%ofcases (500C ¼ ),in35.5%ofcaseslaboratoryandradiologyanalysis weredone(1400C ¼ ).Thedistributionofthecostsforone

dayofhospitalisationrelatedtoeachinterventionandforall recordeddrugintoxicationsissummarisedinthetable below:

Onaverage,intoxicatedchildrenstayinthehospitalforat least48hoursundermedicalsupervision,thetotalcostof treatmentfordrugintoxicationbecomes6000C ¼ anditcan increasedependingontheseverityofintoxication.

ConclusionandRelevance Inourstudywehaveincludedonly thedrugintoxicationsandwehavefoundthattheirmanagementrepresentsaconsiderablepharmaco-economicimpact alsotheresearchhasallowedustoconcludethathalfofthe drugsusedbychildrenbelongtotheclassofthenervoussystemwhichconstitutesasignificantdanger.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-200 SUSTAININGAPHARMACEUTICALDECISIONSUPPORT SYSTEMBYDETERMININGTHECLINICALRISK’S LEVELOFDETECTEDDRUG-RELATEDPROBLEMS

1JBouet*, 1APotier, 2CMongaret, 3BMichel, 4MCillis, 5ADony, 1MAde, 5EDivoux, 1CViaud, 5EDufay. 1ChruNancy,Pharmacy,Vandœuvre-Lès-Nancy,France; 2ChuReims, Pharmacy,Reims,France; 3HuStrasbourg,Pharmacy,Strasbourg,France; 4ChuUclouvain, Pharmacy,Namur,Belgium; 5ChLunéville,Pharmacy,Lunéville,France

10.1136/ejhpharm-2023-eahp.190

BackgroundandImportance Pharmaceuticaldecisionsupport system(PDSS)isapositivetriangulationbetweenpatients’ data,modelledsituationsstandingfordrug-relatedproblems andareasoningsoftwaresendingalerts.Sothepharmaceutical interventionsbetterpreventadversedrugeventsandbetter reducehealthcarecosts.ButtobeoptimalthePDSShasalso tolinkthemodelledsituationstoaclinicalwell-definedrisk. Asconsequenceseachpharmaceuticalintervention’simpact willbedocumentedandthePDSS’sinterestinpatients’ safety sustained.

AimandObjectives Topresenttheresultsofane-Delphistudy duringwhichhealthprofessionalexpertsevaluatetheclinical risk’slevelof52modelledsituationsstandingfordrug-related problemsoradversedrugevents.

MaterialandMethods Twentyexpertsacross4francophone countrieswereinvolvedbecauseoftheirclinicalskills. Basedontheirexperience,physicians(5)orpharmacists (15)scoredthelikelihoodofoccurrenceofclinicalconsequencesanditsseverityforeachofthe52modelled patients ’ situationsusingafive-pointLikertscale.Thesesituationswerechosenamongapanelof199one,according totheirhighfrequencyinthehealthfacilities.Thedegree ofconsensusbetweenparticipantswasdefinedastheproportionthatgaveariskscoreinthesamecategoryasthe median.Consensuswasobtainedifthescorewas75%or more.Thenthe2mediansc ores-occurrenceandseverity-

werecombinedtoproducetherisklevelforeachsituation. Only2Delphiroundswerenecessary.

Results Afterthefirstroundaconsensuswasreachedfor8 situations.Expertsagreedonthelevelofriskassociatedwith 48outof52modelledsituations.Ahighorextremeconsensusrisklevelisdeterminedfor45modelledsituations.These situationsrepresentavarietyofdrug-relatedproblems.Overdosingwasthemostfrequentsituation[12(22%)].Cardiovascular,PsychiatricandEndocrinologicaldrugclassesarethe mostcommoninvolvedinrespectively[25(45%)],[7(13%)] and[5(9%)]situations.

ConclusionandRelevance Thesymbolicartificialintelligenceto detectdrug-relatedproblemsinpatients’ medicationswillbe muchmoresharedifpharmaceuticalalgorithmsincludingthe clinicalriskaredefinedthroughconsensus.

REFERENCESAND/ORACKNOWLEDGEMENTS

HealthRegionalAgency,InnovationDepartment,RégionGrandEst,France

ConflictofInterest Noconflictofinterest

4CPS-201 PHARMACEUTICALCARETOOPTIMISETREATMENT FORASTHMAANDCHRONICOBSTRUCTIVE PULMONARYDISEASEINAPRISON

QLopezNoguera,SGarciaRodicio,NRamonRigau,COrtíJuan*,ADordàBenito, RSacrestGüell. HospitalUniversitariDrJosepTruetadeGirona,PharmacyDepartment, Girona,Spain

10.1136/ejhpharm-2023-eahp.191

BackgroundandImportance Lungdiseaseprevalenceinthe prisonpopulationishigherthaninthegeneralpopulationof thesameage.Pharmaceuticalcaredetectsandreducesdrugrelatedproblemsbyhelpingintherapyoptimisationand improvingtreatmentadherence.

withoutexacerbationsoverthelastyear).28/36patients requiredpharmaceuticalcaretoimprovepatient’sinhalation technique(23non-adherentand5treatmentoveruse).

ConclusionandRelevance Pharmacistsplayakeyroletooptimisecomplextherapies.Thisstudyshowsusthatalmosthalf ofbronchodilatortreatmentsinprisoncanbeoptimised,and morethanthreequartersofthepopulationhavepooradherence.Aspecificpharmaceuticalcareprogrammeinprison shouldbecarriedouttoidentifydrug-relatedproblems.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-202 THEUSEFULNESSOFAPHARMACYRESIDENTSTAGE INTHECRITICALCAREUNIT

AMoralesPortillo*,MMirCros,MBardollCucala,MCuyBueno,BMartínezCatro, MMartínezSogues,MNevotBlanc,CSantosRodríguez,MGilabertSotoca, JASchoenenbergerArnaiz. HospitalUniversitarioArnaudeVilanova,Pharmacy,Lleida, Spain

10.1136/ejhpharm-2023-eahp.192

BackgroundandImportance Thepresenceofpharmacistsas membersofthemulti-professionalcriticalcareteamisincreasinglyacceptedandwelcome.However,theimpactofthis presenceisnotalwayseasytomeasuresincetheofferedserviceportfoliovarieswidelyfromhospitaltohospital.

AimandObjectives Thisstudymeasurestheintervention impactoftherotationofapharmacyresidentinthecritical careunitofahospitalafterassessingtheunit'scomplexity level.

MaterialandMethods Criticalcarecomplexitywasmeasured asthemeanMedicationRegimenComplexity-ICU(MRC-ICU) throughoutthestudyperiodandcomparedtoprevious studies.1

AimandObjectives

1/Toimprovethebronchodilatortreatmentofpatientswithasthmaorchronicobstructivepulmonarydisease(COPD)inprison.

2/Toidentifypatientswithlowadherenceinorderto checkthepatient’sinhalationtechniqueandensureproper administration.

MaterialandMethods Observational,descriptiveandretrospectivestudyofpatientswithasthmaand/orCOPDdiagnosisin August2022.Demographicdata(age,sex),clinicaldata(body massindex,smokinghabit,presenceofexacerbations)and typeoftreatmentwerecollected.Adherencewascalculated throughdispensingrecords(packagescollected/packagesprescribed)betweenAugust2021andAugust2022.Adherent patientwasdefinediftheyhad100-80%ofdispensations, non-adherentiftheyhad<80%,andpoorlycontrolleddueto bronchodilatortreatmentabuseiftheyhad>100%.

Results 46(6.7%)patientsunderbronchodilatortreatment wereidentifiedoutof686prisoners.10patientswere excludedbecausetheywerenotchronictreatment.The36 selectedpatientshadameanageof40±9yearsand8.3% werewomen.28patientshadasthmadiagnosis,6COPD diagnosisand2hadmixedpattern.33patientsweresmokers and24wereoverweightorobese.

Bronchodilatortreatmentcouldbeoptimisedin16/36 (44.4%)ofpatients:10patientswithasthma(5without inhaledshort-actingbronchodilator(SABA)and5usedinhaled corticosteroids),and6patientswithCOPD(3usedSABAas maintenancetreatmentand3usedinhaledcorticosteroids

Pharmacistinterventionsinthecriticalcareunitover7 weekswereprospectivelyrecorded.

Therewerethreetypesofinterventions:clinical(affecting thepharmacotherapyofanadmittedpatient),informative (regardinggeneralinformationofmedicines),andlogistical (regardingthecriticalunitorganisationandmedicines distribution).

Interventionswerealsoclassifiedbytheaddressee(medical, nurserystaff,orboth)andbyintensity(low,medium,or high),measuredaspreviouslydescribed.2

Acceptanceoftheinterventionswasalsorecorded.

Interventionsregardingparenteralnutritionandtherapeutic drugmonitoringwereexcludedfromthisstudysincethey werealreadystandardcareinourhospital.Results

ThemeanMRC-ICUscorewas10.46(standarddeviation 5.4).

Amongthe108interventionsrecorded,for83patients,75 (70%)wereclinical,22(20%)informativeand11(10%) logistical.In85cases(79%),theaddresseeoftheintervention wasthemedicalstaff,18(17%)thenurses,and5(4%)both. Regardingtheintensity,11/108(10%)wereclassifiedaslow, 37/108(35%)mediumand58(55%)ashigh.Theacceptance ofinterventionswashigh:106/108(98%).

ConclusionandRelevance Criticalcarecomplexityinthisstudy wasaboveaveragecomparedtopreviousstudies.1

Aclinicalpharmacist,evenatraineepharmacyresident,can improvecriticalhealthcareandclinicaldecision-makingbythe criticalcareteam.

Ahighinterventionacceptancerateshowshowvaluablethe restoftheprofessionalsintheintensivecareteamconsider theclinicalpharmacist.

REFERENCESAND/ORACKNOWLEDGEMENTS

1. CritCareMed 2022Sep1;50(9):1318–1328.doi:10.1097/ CCM.0000000000005585.

2. CritCareMed 2022Sep1;50(9):1318–1328.doi:10.1097/ CCM.0000000000005585.SupplementalDigitalContent – Table3.(http://links. lww.com/CCM/H141).

ConflictofInterest Noconflictofinterest

4CPS-204 NATIONALSURVEYONCLONIDINEPRESCRIBING PRACTICESINCOMPLEXTRAUMAINCHILD PSYCHIATRY

PCarlier, 1CNiot*,AVisticot,LRéal. CentreHospitalierD'arras,Pas-De-Calais,Arras, France

10.1136/ejhpharm-2023-eahp.193

BackgroundandImportance Themanagementofcomplex traumainchildrenandadolescentsisdifficultbecauseof hismultidimensionalnature.Researchintothisareaisparticularlychallengingandveryfewclinicalstudiesareavailable.Clonidineisusedoff-labelinourcountryforthis indication.

AimandObjectives Theaimofthisworkistostudytheprescribingpracticesofclonidineinchildrenandadolescentswith complextrauma:thepre-therapeuticassessment,thetargeted symptoms,thegalenicformulationandthetolerance.

MaterialandMethods Nationaldistributionofaquestionnaire viathemailingofthePsychiatryInformationCommunication networkandtheFederativeAssociationofPsychiatricStudents ofourcountrytofindoutaboutthepracticesofprescribing clonidineinotherhealthestablishments.Questionnairevalidatedupstreambythereferentchildpsychiatristthenextractionoftheanswersanddescriptiveanalysisofthedata collected.

Results 88responseswereobtained,58%frompsychiatrists and38%fromresidentsinpsychiatrywithatleastone responseperregion.TheanalysisshowstheuseofClonidine, especiallyintabletform,asalastresortandveryoftenin combinationmedication.Amongthe25peoplewhoanswered theentirequestionnaire,goodtolerancewasobservedin84% ofcases,theremaining12%reportedepisodesofhypotension orheadaches.Apre-therapeuticassessmentwithelectrocardiogram,bloodpressureandpulsearecarriedoutin72%of casesandclinicalefficacyisobservedin76%ofcases,inparticularonnightmares,insomniaandanxiety.

ConclusionandRelevance Preliminarydataseemtoindicate thatclonidinecouldhaveapositiveclinicalimpactoncertain symptomsofcomplextrauma.Amulticentre,double-blind clinicalstudy,Clonidineversusplacebo,onalargersample andtakingintoaccounttheenvironmentalcontextofthe child,couldmakeitpossibletoconfirmornotthis hypothesis.

REFERENCES

1.BriereJ,ScottC.ComplexTraumainAdolescentsandAdults:EffectsandTreatment. PsychiatrClinNorthAm.sept2015;38(3):515–27.

2.LustigSL,BotelhoC,LynchL,NelsonSV,EichelbergerWJ,VaughanBL.Implementingarandomisedclinicaltrialonapaediatricpsychiatricinpatientunitata

children’shospital:thecaseofclonidineforpost-traumaticstress. GenHospPsychiatry.déc2002;24(6):422–9.

ConflictofInterest Noconflictofinterest

4CPS-206 EVALUATIONOFIRONCARBOXYMALTOSEVSIRON SUCROSEADMINISTRATIONFORTHECONTROLOF ANAEMIAINHOSPITALISEDPATIENTS

CCáceres-Velasco*,MÁAmor-García,AMelgarejo-Ortuño,RMoreno-Diaz,EMatillaGarcía,BRodriguez-Vargas,CAApezteguiaFernandez,MPBautistaSanz. Hospital UniversitarioInfantaCristina,PharmacyDepartment,Madrid,Spain

10.1136/ejhpharm-2023-eahp.194

BackgroundandImportance Ironcarboxymaltose(ICM)and ironsucrose(IS)aretwotypesofintravenousironusedfor thetreatmentofiron-deficiencyanaemia.Differencesbetween thedosingregimenandhospitallengthhaveledmanycentres toperformcost-effectivenessstudieswithvariableresults.

AimandObjectives Tocomparetheeffectivenessandcostof intravenousICMvsISforthecontrolofanaemiainhospitalisedpatients.

MaterialandMethods Retrospectivecohortstudyinanaemic patients(Hb£12g/dL)whoreceivedICM(500-1,000mg,single-dose)orIS( 3X100mg)betweenApril2021andApril 2022wasperformed.Demographicvariables(age,gender), totaldoseadministered,Hbpreandpost-treatment(>6days), patientswithincreasedHb 1g/dl,previoustreatmentwith oraliron,hospitaladmissionlengthanddirectcostwere collected.

Cohortswerematchedforbaselinecharacteristics(age,genderandhospitalservice)andinitialHbvalues.Selectedvariableswerecompiledfromtheelectronicmedicalhistoryand prescriptionandcomparedusingstudent'sttestwithSPSS v.22.0.

Results Atotalof98patients(63.3%women)wereincluded: 49receivedICMand40IS.Meanagewas75.5±13.8and 75.9±13.6yearsfortheICMandISgroupsrespectively.In theICMcohort,patientsreceivedameandoseof867.35± 223.0mgand36.7%hadpreviouslyreceivedoraliron. PatientsintheIScohortreceivedameandoseof438.8± 199.8mgand22.4%hadpreviouslyreceivedoraliron.

ThemeanpreviousHbwas:9.5±1.4g/dlintheICM groupand9.4±1.3g/dlintheISgroup.IntheICMgroup, 38.7%patientsshowedanincreaseHb 1g/dl,while24.5% didsointheISgroup.StatisticallysignificantvariationsinHb levelswereobservedinbothgroups(+0.71g/dlinICMvs +0.31g/dlinIS;p<0.05).However,theanalysisshowedno significantdifferencesbetweenbothcohorts(p=0.06).

HospitaldurationlengthmeanwasshorterintheISgroup (15.3±21.9vs19.9±22,9days)withoutsignificantdifferencesbetweencohorts(p=0.307).Ameancostof144.2± 37.1C ¼ /patientand5.0±2.3C ¼ /patientwasestimatedforthe ICMandISgroupsrespectively.

ConclusionandRelevance ICMandISadministrationproduced animprovementofHblevelsinbothcohortswithoutshowing asignificantdifferenceinthehospitaladmissionlength.ICM treatmententailedanincreaseofdirectcosts.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-208 TELEPHARMACYINTERVENTIONSINPATIENTSWITH CHRONICDISEASES

MABlancoCastano*,MDominguezCantero,ERíosSánchez. UniversityHospitalofPuerto Real,Pharmacy,PuertoReal,Spain

10.1136/ejhpharm-2023-eahp.195

BackgroundandImportance Theemergenceofinformation andcommunicationtechnologieshasenabledthedevelopment oftelepharmacyprogrammes(TPP)asacomplementarytool topersonalcare,throughwhichpharmaceuticalcarecanbe providedwithouttheneedtovisitthehospital.TPPbeganin December2019withdeliveryofmedicationtoprimary healthcarecentrespreviouspharmaceuticalcarebytelephone fromthehospitalpharmacy.

AimandObjectives Describingthepharmaceuticalinterventions (PI)ofpatientsincludedinaTPP

MaterialandMethods Prospective,descriptivestudy,from december2019-september2022.Pharmacotherapyfollowupconsistedofstructuredtelephoneinterviewsscheduled every3months.Inclusioncriteria:durationoftreatment greaterthan3months,stablechronicdisease,adherence greaterthan90%,goodtolerancetomedicationand/or mobilityordependencyproblems.Exclusioncriteria:oncohaematologicaltreatment,andpatientswithcognitiveproblems,ortechnologicalbarr ierstotelephonepharmacotherapeuticfollowup.

PIwereclassifiedas:drug-druginteractions(DDI),clinical monitoring(CM),adversedrugreactions(ADR)and/orlack ofefficacy(LOF).Inaddition,theresultsofeachPIwere recordedas:temporary/permanentdiscontinuation(TPD), changeoftreatment(ChOT),changeofdosingregimen (ChDR)orcontinuationoftreatment(COT).Thedegreeof acceptanceofthePiwascalculated.

Results Atotalof4.497telephoneinterviewswereconducted with410patientsincludedintheTPP.Fifty-sevenpercentof treatmentswerebiologics,27%antiretrovirals,6%multiple sclerosis/amyotrophiclateralsclerosistreatment,3%lipid-loweringdrugs,3%somatropins,2%pulmonaryantihypertensives and2%otherdrugs.

88Piwereregistered,58%ofwhichwereacceptedbythe prescribingphysician.

Thepharmacist´sactivityinaTPPcancontributetoabetteruseofmedicines,aswellaspreventandsolvemedicationrelatedproblems.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-209 EXPERIENCEOFTHENOCEBOEFFECTINPATIENTS WITHSWITCHTOBIOSIMILARSINRHEUMATOID ARTHRITIS

1RFresquet, 2ABMaríaÁngeles*, 1OPascual, 1RGracia, 1LSopena, 1IVarela, 1PGomez, 1AMerchan, 1BBonaga. 1HospitalClínicoUniversitarioLozanoBlesa,ServiciodeFarmacia, Zaragoza,Spain; 2HospitalClinicoUniversitarioLozanoBlesa,ServiciodeFarmcia,Zaragoza, Spain

10.1136/ejhpharm-2023-eahp.196

BackgroundandImportance Thenoceboeffectisdescribedas theworseningofassociatedsymptomsoranincreasein adverseeffectsduetoanegativeattitudetowardsaparticular drugorpharmacologicaltherapy,inthiscasebiosimilartreatment.Lackofpatientknowledgeanddiscrepanciesinthe informationprovidedarethemaincausesofnegativeexpectationswithbiosimilarsandtheirexchangewiththeoriginaldrug. AimandObjectives Studyofthenoceboeffectinpatients withspondyloarthropathyandpsoriaticarthritisafterswitching fromtheoriginaldrugtothebiosimilarofadalimumabina tertiaryhospital.

MaterialandMethods Retrospectiveandobservationalstudy fromJanuary2020toOctober2021.Clinicalinformationwas obtainedfromtheelectronicmedicalrecord.Thefollowing clinicalanddemographicvariableswererecorded:age,sex, medication,typeofadversereaction,adherence,andfollow-up afterthechange.

Results Duringthestudyperiod,66switchesweremadefrom Humira® (originaldrug)toHyrimoz® (biosimilar),with72% biosimilaruseinthisclinicalcontext.In4%(3patients)of theswitches,aclinicalworseningwasobservedat6months, themeanagewas46years,male.Adherencetotreatment (Hyrimoz)wasover90%.Themostfrequentsymptomswere: skinsymptomswithpruritus,axialclinicalworsening,morning arthralgias.Inallcases,andafterdiscussionwiththeprescribingphysician,itwasdecidedtoswitchtotheoriginalbrand. Afterreturningtothereferencebrand,thepatientspresented animprovementofthesymptomatologyassociatedwiththe changetothebiosimilardrug.

ConclusionandRelevance Thenoceboeffectisanuncommon effect,butitcausesanincreaseinpharmaceuticalexpenditure, aswellasinmedicalvisitsandcomplementarytests.Dueto thesmallsamplesize,clinicalworseningcannotbeassociated withthenoceboeffectinthisstudy.Therefore,further researchonthistopicisrequired.Itmayalsoleadtothe administrationofnewdrugstocounteractthesymptoms causedbythenoceboeffect.Bettereducationofbothhealthcareprofessionalsandpatientsontheknowledgeofbiosimilarscanhelpreducethelikelihoodoftriggeringanocebo effect.

ConclusionandRelevance Pharmacotherapeuticmonitoringof patientsincludedintheTPPmainlyallowedforthedetection ofADRsandensuredadequateclinicalsupervisionofinpatientmedication.

TheoutcomeoftheinterventionswasmostlyCOTfollowedbymodificationoftheprescribedregimen.

REFERENCES

1.Horta-BaasG.Patient-reportedoutcomesinrheumatoidarthritis:akeyconsiderationforevaluatingbiosimilaruptake? PatientRelatOutcomeMeas.2022Mar 30;13:79–95.doi:10.2147/PROM.S256715.

ConflictofInterest

4CPS-210 EFFECTOFMONOCLONALANTIBODIESTOPREVENT PROGRESSIONTOSEVERECOVID-19DISEASE:REALLIFEDATAOFAUNIVERSITYHOSPITAL

1VRosafio*, 1ACorzani, 1VSDiVico, 1AMichielon, 2MTBianco. 1UniversitàDiSiena, ScuolaDiSpecializzazioneInFarmaciaOspedaliera,Siena,Italy; 2AziendaOspedalieroUniversitariaSenese,UocFarmaciaOspedaliera,Siena,Italy

10.1136/ejhpharm-2023-eahp.197

BackgroundandImportance SinceFebruary2021,our NationalMedicinesAgencyhastemporarilyauthorisedfor emergencyusethemonoclonalantibodiestotreatCOVID-19 disease.

Furthermore,firstauthorisedandmostusedonesinour Hospitalwerebamlanivimab-etesevimabmonoclonalantibody combination,casirivimab-imdevimabcombinationand sotrovimab.

MonoclonalantibodytherapyforCoronavirusdisease2019 (COVID-19)isrecommendedinmildtomoderatedisease patientswhoareatriskofprogressingtoseveredisease,with atleastoneriskfactor,includingageover65.

AimandObjectives Aimofthestudyistoevaluatetheeffect ofmonoclonalantibodytherapyforCOVID-19topreventdisease ’sprogression,hospitaladmissionsanddeaths.

MaterialandMethods Datarelatedtotreatedpatientsfrom 29/03/2021to02/05/2022werecollectedfromourNational MedicinesAgencydatabase.Thesedatawere:sex,age,outcomesofthetreatmentandantibodyadministered.

Results 336patientsweretreatedinourHospitalfrom29/03/ 2021to02/05/2022.

Patientstreatedwithbamlanivimab-etesevimab(700mg +1400mg)combinationwere117:48females(F);69males (M);64patientsagedover65.Thesepatientsweretreated withthiscombinationfrom29/03/2021to29/12/2021.The outcomeswere:112healings,3hospitalisationsoremergency departmentvisits,1death,1notavailable.

Patientstreatedwithcasirivimab-imdevimabcombination (1200mg+1200mg)were121:59Fand62M;72 patientsagedover65.Thesepatientsweretreatedwith thiscombinationfrom16/07/2021to31/12/2021.Theoutcomeswere:110healings,9hospitaldischarges(2 patients,treatedwithhighdosage(4000mg+4000mg), werehospitalisedforCOVID-19while7werehospitalised forotherreasons),2hospitalisationsoremergencydepartmentvisits.

Patientstreatedwithsotrovimab(500mg)were98:42F and56M;38agedover65.Thesepatientsweretreated withthisantibodyfrom29December2021to2May2022. Theoutcomeswere:96healings,1hospitaldischarge(hospitalisedforotherreasons)and1notavailable.

ConclusionandRelevance Theadministrationofmonoclonal antibodiesinpatientswithCOVID-19,withcomorbilities, whoareatriskofseveredisease’sprogressionreporteda reducedriskofhospitalisationordeath(only5hospitalisations oremergencydepartmentvisitsand1deathon336treated patients).

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-212 SPECIALISTPHARMACIST-LEDMULTIDISCIPLINARY CAREPATHWAYFOROPTIMISINGLIPIDTHERAPY –SIXMONTHSINTERIMANALYSIS

1NHamedi*, 2SAli, 3JRobson, 4RPatel, 5HAlbert, 6IKhan, 5MKearney, 6BKrishek, 1SFhadil, 1PWright, 1SAntoniou. 1BartsHealthNHSTrust,Pharmacy,London,United Kingdom; 2SouthdeneSurgery,GpPractice,London,UnitedKingdom; 3ClinicalEffectiveness Group,QueenMaryUniversityofLondon,London,UnitedKingdom; 4BartsHealthNHS Trust,Cardiology,London,UnitedKingdom; 5Uclpartners,CardiovascularHealth,London, UnitedKingdom; 6RedbridgeClinicalCommissioningGroup,Pharmacy,London,United Kingdom

10.1136/ejhpharm-2023-eahp.198

BackgroundandImportance Cardiovasculardisease(CVD)isa leadingcauseofmortalityworldwideandaccountsforapproximately27%ofalldeathsinUnitedKingdom.TherelationshipofhypercholesterolemiatoCVDiswellestablishedand understoodintermsofatherogenesis.Reductionofatherogeniclipoproteins,inparticular,low-densitylipoproteinwith lipidmodificationtreatmentshasbeenshowntoreducethe riskofCVDeventsandmortality.

AimandObjectives Design,testanddevelopanintegrated carepathwaythatutilisesspecialistcardiovascularpharmacists workingwithprimarycareteams.Thisinvolvesoptimising secondarypreventionwithlipidmodificationtherapyinpeople withestablishedCVDacross42GeneralPractitionerpractices overone-yearpilotprogramme.

MaterialandMethods Specialistcardiovascularpharmacists werecommissionedtoworkwithprimarycarecliniciansto identify,reviewandoptimisesecondarypreventioninhigh-risk patientsnotreceivinglipidmodificationtherapy.

Eligiblepatients’ clinicalnoteswerereviewedtoconfirm CVDdiagnosis,historyoftreatment,bloodtestresultsand CVDriskfactors.Complexcaseswerereviewedbyavirtual lipidspecialistmultidisciplinaryteamtoagreeatreatment plan.Patientswerecontactedforavirtualconsultationtodiscussandinitiatetailoredlipidmodificationtherapy.

Results ApreliminaryreviewofpracticesCVDlistshowed 20%(2200/11233)ofpatientshadaCVDdiagnosisandwere notreceivinglipidmodificationtherapy.Asix-monthinterim analysisof1100outofthe2200clinicalreviewsconducted byspecialistpharmacists,identifiedthat60%(660/1100)were eligibleforstatintherapywithonly4%(44/1100)ofpatients havingatruestatinintolerance.

Theremaining36%(396/1100)werenotforlipidmodificationtherapy.Ofthesepatients:6%(66/1100)declinedtreatment,9%(96/1100)werepalliativeortheriskoftreatment outweighedthebenefits,8%(90/1100)hadnon-atherosclerotic CVD,9%(100/1100)hadincorrectCVDdiagnosisandthe remaining4%(44/1100)werenolongerpartofthepractice list.

ConclusionandRelevance Anintegratedcarepathwayusing specialistcardiovascularpharmacistssupportingamultidisciplinaryworkforcewithinprimarycarehasshownasignificant improvementinlipidmodificationtherapyprescribingto reducetheriskofmyocardialinfarction(MI)andstroke. Extrapolatingtheseresultsnationallywouldavert17,000MIs and5,000strokesovera5-yearperiod.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-213 CHARACTERISTICSOFMULTISYSTEMINFLAMMATORY

SYNDROMEINCHILDRENVERSUSKAWASAKION

CLINICALASPECTS,SPECIFICITIESANDTREATMENT

1OHanafia*,

10.1136/ejhpharm-2023-eahp.199

BackgroundandImportance SincetheCoronavirus(COVID19)pandemic,therehasbeenahighnumberofchildrenhospitalisedinthepaediatricintensivecareunit(PICU)forPaediatricMultisystemicInflammatorySyndrome(MIS-C) resemblingKawasakiDisease(KD)

AimandObjectives Theobjectivesofthisstudywereto describetheclinicandthetherapeuticsthatweusedinPIMS, comparedtothoseofKD.Todescribetheimpactofthe treatmentsusedanddiscusstheclinicalevolutionofour patients

MaterialandMethods Thisisaretrospectiveobservational studyinthepaediatricintensivecareunit,overa9-month periodfromApriltoDecember2020.Theclinical,biological andmedicationdatawascollectedviathecomputerised patientrecord,ourpresenceinthedepartmentandthanksto theprescriptionsoftwareforPIMSpatientsandcomparedto theKDdataofthescientificliterature

Results Weincluded12children,medianage8years[2-16 years]andsexratio=2,diagnosedwithMIS-C.Negative PCRtestsonadmissionandpresenceofanti-SRAS-CoV-2antibodiesinallpatients.Allpresentedfever,withameandurationof5days.5patientspresented2clinicalcriteria characteristicofKDinsufficienttodiagnosecompleteKD. Gastrointestinalsymptoms(10patients),rarelyseeninKD.All hadinflammatoryandcardiacmarkershigherthanthosein KD.Cardiacdamagewasobservedin10patients:50%had persistentsystemichypotensionand5hadECGabnormalities. Drugtherapywastoreduceinflammation.9patientsreceived intravenousimmunoglobulin(IVIG),5patientsreceiveda2nd doseofIVIGand2a3rddose.Corticosteroidtherapyfor4 dayswasadministeredto10patientsand9requiredantiinflammatorytreatmentwithacetylsalicylicacid.Thesetreatments,combinedwithvasopressorordiureticandanticoagulantsupport,werenecessary.Therewerenodeathsinour cohort,theaveragetimeofmanagementinthedepartment was6days[2-13days].

ConclusionandRelevance OurpatientsdescribedaclinicalpicturesuggestingKD,withabroadersymptomatologyand severity,muchmoremarkedinflammatoryandcardiac markers,ashorterfever,alowerplateletcount,morefrequent gastrointestinalinvolvement,themedianageofourcohort washigher.Thetherapeuticstrategy:IGIVandcorticosteroid therapyappearedtobeeffectiveinourstudy

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-215 DESCRIPTIONOFTHEPRE-EXPOSUREPROPHYLAXIS COVERAGEAGAINSTTHEHUMAN IMMUNODEFICIENCYVIRUS

XLarreaUrtaran*,ADordàBenito,ENoguéPujadas,ÀCastellóNòria,LViñasSagué, CSubiranaBatlle,COrtíJuan,MBrugueraTeixidor,IGómezIbáñez,YOrtuñoRuiz, RSacrestGüell. HospitalDrJosepTrueta,PharmacyDepartment,Girona,Spain

10.1136/ejhpharm-2023-eahp.200

BackgroundandImportance Pre-exposureprophylaxis(PrEP) againsthumanimmunodeficiencyvirus(HIV)infectionaimsto preventHIVtransmissioninpeopleatriskofacquiringthe infection,consistingofdailytenofovirdisoproxilfumarate withemtricitabine(TDF/FTC).

AimandObjectives TheaimofthestudyistodescribePrEP coverageandpatients’ baselinecharacteristicstakingPrEP.

MaterialandMethods Retrospective,descriptivestudy.Patients thatstartedwithPrEPfromOctober2020toApril2022 wereincluded.PatientswhotookPrEPlessthan6months wereexcluded.Demographicvariables(ageandsex),indicationcriteria,sexuallytransmittedinfections(STIs)(beforeand during),creatininevalues,seroconversiontoHIVandwithdrawalreasonswerecollected.Forthestatisticalanalysis,the mean,standarddeviation(SD)and t-student testwereused. Results 52patientsreceivedPrEPduringthestudyperiod.10 patientswereexcluded.Ofthepatientsincluded(n=42), 97.4%(n=41)weremenwithameanage±SDof35.8± 8.4years.

Theindicationsfortreatmentwere: 97.6%hadmorethan10 differentsexualpartnersinthelastyear;90.2%hadanalsex withoutacondominthelastyear;29.3%haddruguse relatedtohavingsexwithoutacondominthelastyear; 14.6%hadreceivedpost-exposureprophylaxisonseveral occasionsinthelastyearand36.6%hadatleastonebacterial STIinthelastyear.

66.7%(n=28)ofthepatientshadoneormoreprevious STIs.ThemostfrequentSTIwas Treponemapallidum (n=21) followedby Neisseriagonorrhoeae (n=12).Whilepatients weretakingPrEP,40.5%(n=17)ofthempresentedSTIs: 19.0%(n=8)had chlamydiatrachomatis;14.3%(n=6)had Neisseriagonorrhoeae and9.5%(n=4)had Mycoplasmagenitalium.Baselinemean±SDcreatininewas0.86±0.11mg/ dlandattheendofthestudywas0.90±0.11mg/dl (p=0.024).26.8%(n=11)ofthepatientsdiscontinuedPrEP (n=5duetostablecouple;n=2bytheirowndecision;n=2 duetolackoffollow-up;n=1duetochangeofcentreand n=1duetoproteinuria).Therewasnoseroconversionto HIVinanypatients.

ConclusionandRelevance ThemajorityofPrEPpatientsare youngmenwithriskysexualpractices.Duringtheuseof PrEP,STIswerefrequent.Therewasnoseroconversionto HIVduringthestudyperiod.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-217

REGULATORMODULATORSINPATIENTSWITHRARE MUTATION

1NMontiGuarnieri*, 2BFabrizzi, 1EAndresciani, 1AMFGarzone, 1SBagagiolo, 1IBartolucci, 1SGuglielmi, 1CCapone, 3CPolidori, 1APompilio. 1AouDelleMarche,Sod Farmacia,Ancona,Italy; 2AouDelleMarche,SosFibrosiCistica,Ancona,Italy; 3Università DegliStudiDiCamerino,ScuolaDiScienzeDelFarmacoEDeiProdottiDellaSalute, Camerino,Italy

10.1136/ejhpharm-2023-eahp.201

BackgroundandImportance CysticFibrosis(CF)isamonogenicandmulti-organdisease.Thisconditionisrelatedto mutationsinCysticFibrosisTransmembraneRegulator (CFTR),thegeneencodingtheepithelialionchannelthat normallytransportschlorideandbicarbonate.Therapeutic

1AGhandour, 2SHonoré, 1PBertault-Peres. 1HôpitauxUniversitairesde Marseille,PharmacieTimone,Marseille,France; 2AixMarseilleUniversité,Facultéde Pharmacie,Marseille,France

THEUSEOFCYSTICFIBROSISCONDUCTANCE

strategiesdeeplychangedwhenIvacaftor(2015)andthe combinationtherapyIvacaftor/Tezacaftor/Elexacaftor(ETI) (2021)weremarketed.AtthismomentETItherapyis licensedtotreatCF’spatients>6yearswithatleastone F508delmutation,themostcommonone;however,patients withrarerCFTR’smutationsdon’ thaveaccesstothis therapy.

AimandObjectives Withthisworkwewouldliketoreport theuseofthecombinationtherapyIvacaftor-ETIintwo youngpatientswithrareCFTR’smutations:theN1303K/ 2183AA>GandtheW1282X/N1303K.

MaterialandMethods Startingfromtheoff-labelauthorisationsfromJanuary-2015toJune-2022byourHospitalCommittee(composedwithaClinician,aPharmacologistanda HospitalPharmacyst)inaccordtoLaw94/98,weidentified patientsthatrequiredoff-labelCFTRmodulators’ combinationtherapyduetotheirCFTR’ sraremutationsandinvitro responsetoETItherapy.Fortheseweanalysed:ageatthe beginningofthetherapy,gender,typeofmutation,clinical manifestations,periodoftherapy,AdverseDrugReactions (ADRs)notified.

Results Onlyin2022twopatientswereauthorisedtouseofflabelCFTRmodulators’ combinationtherapyduetotheirrare CFTR’smutations.Thefirstpatient(P1)wasafemale,20 years,W1282X/N1303Kmutations;herclinicalhistory showedmeconiumileus,seriouspneumopatyandsheoften requiredantibiotictherapyduetoherlungsinfections.The secondpatient(P2)wasafemale,19years,N1303K/ 2183AA>Gmutations;herclinicalhistoryshowedpancreatic andlungsinsufficiency,BMI<14,infectionsinducedbymultidrugresistantPseudomonasandMycobacteriumAbscessus,D hypovitaminosis.Atfirst,HospitalCommitteeauthorised3 cyclesoftherapyforP1and4cycles(28daysforeachcycle) forP2;bothofthemwereauthorisedtoprolongetheirtherapyduetoclinicalevidentefficacy.NosignificantADRs relatedtotreatmentwerenotified.

ConclusionandRelevance CFTRmodulatorsaresmallmoleculesthatdirectlyimpactandachievethefunctionofCFTR channel.Theygivelong-termimprovementsinclinicaloutcomesandwehopemoreresearchontheirefficacyin patientswithrarerCFTR’smutations.

REFERENCESAND/ORACKNOWLEDGEMENTS

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AimandObjectives TodeterminetheutilityofSingleNucleotidePolymorphismsofHLA-BandTNF-238,TNF857,TNF308,TNF-1031,TNFRSF1Basprognosticandpredictive markersinpatientsdiagnosedwithmoderate-severepsoriasis treatedwithadalimumab,etanerceptorinfliximab.Aswellas, toevaluatetheefficacyofanti-TNFtreatmentintheinduction phase.

MaterialandMethods Aprospectivecohortstudywasperformed.DataandDNAwereobtainedfromsalivasamplesof 103patientsresidingintheprovinceofGranadawithmoderateandseverepsoriasiswhohadbeentreatedwithanti-TNF. ThegenotypesweredeterminedbyTaqmanPCRRealTime. Results Patients'meanagewas54.19±13.65years;54male (54/103);100hadplaquepsoriasis(100/103),90locatedin trunkandextremities,and89onscalpandface,42with psoriaticarthritis(42/103),33smokers(33/103),36drinkers (36/103),62hadpsoriasisfamilyhistory(62/103).These103 patientshavebeentreatedwith135anti-TNF(adalimumab, ADA=80;etanercept,ETN=39;infliximab,INF=16).Also20 receivedoraladministrationoftheconcomitantmethotrexate (20/135).

Inreferencetoefficacy,74patientshadaresponsetoantiTNF(74/135),and61donotshowtheexpectedresponsein theinductionphase(61/135).ConcerningPASI75values,55 patientstreatedwithADAachievedPASI75at3-6months (55/80),12patientstreatedwithETN(12/39),and7patients treatedwithINF(7/16).

Furthermore,patientscarryingTNFRSF1B-rs1061622-G alleleanassociationwithADAresponseat3months (p=0.0026)andpatientscarryingTNFa-1031-rs1799964-Tan associationwithETNresponseat6months(p=0.0047),also patientscarryingTNFa-238-rs361525-GtreatedwithINF havearesponseat6months(p=0.045).

ConclusionandRelevance Inconclusion,responsetoanti-TNF drugswasassociatedwithdifferentsinglenucleotideallelic polymorphismsoftheTNFgene.Nonetheless,furtherstudies withlargecohortsofpatientshavetobeperformedtoconfirmthesedatainordertoapplyforthispersonalisedmedicineinroutineclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-218 TNFGENEPOLYMORPHISMSPREDICTORSOF RESPONSETOANTI-TNFDRUGSINPATIENTS DIAGNOSEDWITHMODERATE-SEVEREPSORIASIS

1CMembrive-Jimenez, 2CZuñiga, 3CPérez-Ramirez, 4SArias-Santiago, 5AJimenez-Morales, 5CMontero-Vilchez*. 1PharmacogeneticsUnitPharmacyService,UniversityHospitalVirgen deLasNieves,Granada,Spain; 2UniversityofGranada,PharmaceuticalCare,Granada, Spain; 3UniversityofGranada,BiochemistryandMolecularBiology,Granada,Spain; 4UniversityHospitalVirgendeLasNieves,Dermatology,Granada,Spain; 5University HospitalVirgendeLasNieves,Pharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.202

BackgroundandImportance Psoriasisisachronicinflammatory skindisease.Biologicaltreatmentsagainsttumournecrosisfactor(anti-TNF)areeffectiveintreatingthisdisease,however, notallpatientsrespondtothistreatment,anditcancause serioussideeffects.BiomarkersinvolvedintheTNFcytokine maybeimplicatedintheresponsetotheanti-TNFdrug.

4CPS-219 AGAMENON-SEOMMODELFORTHEPREDICTIONOF SURVIVALINPATIENTSWITHHER2-POSITIVE ADVANCEDOESOPHAGOGASTRICADENOCARCINOMA RECEIVINGTRASTUZUMAB-BASEDFIRST-LINE TREATMENT

1LMacía-Rivas*, 2CLFernández-Laguna, 2FJÁlvarez-Manceñido, 3AArias-Martínez, 4AMartínez-Torrón, 5IMacías-Declara, 6JMCano-Cano, 7MDiez, 8ACustodio, 9JLópezRobles, 2ALozano-Blázquez. 1UniversidaddeSantiagodeCompostela/Hospital UniversitarioCentraldeAsturias,DoctoralProgrammeInMedicineClinicalResearch/ HospitalPharmacy,SantiagodeCompostela,Spain; 2HospitalUniversitarioCentralde Asturias,HospitalPharmacy,Oviedo,Spain; 3UniversityofGranada/HospitalUniversitario GermansTriasIPujol,DoctoralProgrammeInPharmacy-FacultyofPharmacy/Pharmacy Department,Granada,Spain; 4UniversityofGranada/HospitalUniversitarioCentralde Asturias,DoctoralProgrammeInPharmacy-FacultyofPharmacy/HospitalPharmacy, Granada,Spain; 5HospitalUniversitarioParcTauli,MedicalOncology,Sabadell,Spain; 6HospitalGeneralUniversitariodeCiudadReal,MedicalOncology,CiudadReal,Spain; 7HospitalUniversitarioVallD’hebron,MedicalOncology,Barcelona,Spain; 8Hospital UniversitariolaPaz,MedicalOncologyDepartment/CiberoncCb16/12/00398,Madrid, Spain; 9HospitalUniversitarioMoralesMeseguer,MedicalOncology,Murcia,Spain

10.1136/ejhpharm-2023-eahp.203

BackgroundandImportance Trastuzumabassociatedwithchemotherapy(platinumandfluoropyrimidine)isthestandard first-linetreatmentinHER2-positiveadvancedoesophagogastricadenocarcinoma(AGA);however,itsbenefitsare heterogeneous.

AimandObjectives Todevelopandvalidateapredictivemodel foroverallsurvival(OS)andprogression-freesurvival(PFS)in patientswithAGAtreatedwithtrastuzumab.

MaterialandMethods PatientsfromtheSpanishSocietyof MedicalOncology(SEOM)-AGAMENONregistrywithHER2positiveAGAtreatedinfirst-linewithchemotherapyandtrastuzumabbetween2008and2021wereselectedforthisstudy. Anacceleratedtime-to-eventmodelwasdevelopedtopredict survivalandrepresentedasanomogramandanonlinecalculator.ThenomogramwasexternallyvalidatedinanindependentseriesfromTheChristieNHSFoundationTrusthospital inManchester,England.

Results 737patientswererecruited(AGAMENON-SEOM,n= 654;Manchester,n=83).Inthereferralcohortthemedian PFSandOSwere7.76(95%CI,7.13-8.25)and14.0months (95%CI,13.0-14.9),respectively.Patientsreceivedamedian ofsixcyclesofplatinum,eightcyclesoffluoropyrimidineand trastuzumabforamedianof7.6months(95%CI,7.10-8.30).

Inthevalidationcohort,themedianPFSandOSwere8.1 (95%CI,7.1-11.3)and12.8months(95%CI,10.3-20.4), respectively.Patientsreceivedchemotherapyforamedianof fivecyclesandtrastuzumabforamedianof6.3months.

SixcovariatesweresignificantlyassociatedwithOSand wereusedtoconstructthenomogram:neutrophil-lymphocyte ratio(timeratio(TR):0.73;95%CI:0.63-0.83),ECOGstatus (TR:0.59;95%CI0.48-0.73),Laurenhistologicsubtype (TR:0.73;95%CI0.57-0.94),HER2expression(TR:0.85; 95%CI0.73-1),histologicgrade(TR:0.87;95%CI0.721.07),andtumourburden(TR:1.69;95%CI1.34-2.13).The AGAMENON-HER2modeldemonstratedadequatecalibration andfairdiscriminatoryabilitywithac-indexforPFSandOS of0.606(95%CI0.58-0.64)and0.623(95%CI0.59-0.66), respectively.IntheManchestervalidationcohort,themodelis wellcalibrated,withac-indexof0.65and0.68forPFSand OS,respectively.

ConclusionandRelevance HER2-positiveAGApatientsreceivingtrastuzumabandchemotherapycanbestratifiedaccording totheirestimatedsurvivalendpointsusingtheAGAMENONHER2prognostictool.Thisnomogramcouldbeavaluable toolformakingtreatmentdecisionsindailyclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-222 HAPLOIDENTICALHAEMATOPOIETICCELL TRANSPLANTATIONINPATIENTSAGED>55YEARS WITHACUTEMYELOIDLEUKAEMIA

COrtegadelaCruz*,RTamayoBermejo,JCDelRioValencia,IMMuñozCastillo. Hospital RegionalUniversitariodeMalaga,Pharmacy,Malaga,Spain

10.1136/ejhpharm-2023-eahp.204

BackgroundandImportance IntheelderlypatientswithAML, boththedevelopmentofreduced-intensityconditioning(RIC) regimensandtheuseofhaploidenticaldonorshaveimproved theiraccessibilitytoallo-HCT.

AimandObjectives Toanalysetheclinicalcharacteristicsand resultsofhaploidenticalfamilydonorallo-HCT,performedin

ourhospitalduringtheyears2014to2021,inpatientswith AML>55years.

MaterialandMethods

Retrospectiveobservationalstudy. Datacollected:age,sex, HCTstatus,timefromdiagnosistotransplant,ECOGPerformanceStatus,comorbidityindexes(HCT-CI,EBMTs,DRindex),haematopoieticprogenitorsource(HPS),CMV-mismatch, conditioningregimen,graft-versus-hostdisease(GVHD)prophylaxis,andpost-HCTcomplications.Overallsurvival(OS) andprogressionfreesurvival(PFS)wereanalysedusing Kaplan-Meier.

Results Thirtypatientswereincluded.Median(range):64 (56 – 71)years,57%women.70.3%infirstcompleteremission.Median(range)timefromdiagnosiswas6.5(3.4752.37)months.74%ECOG0.33%DRindexhighandvery high15%patients.TheEBMTs>4in26%andtheHCTCI 3in56%patients.HPSwasp eripheralbloodin52% andbonemarrowin48%.56%CMV-mismatch(donor-/ patient+).AllpatientsreceivedaRICregimenandpostHCTcyclophosphamideand 89%tacrolimusastheonly immunosuppressant.

Majornon-haematologicaltoxicitiesincludedmucositis, gastrointestinalandlivertoxicityin26%,19%and7%of patients,respectively.19%patientsdevelopedhaemorrhagic cystitis,onepatientunderwentthromboticmicroangiopathy,41%developedacuteGVHDand37%patientspresentedchronicGVHDcmvinfectionoccurredin78%of patients.

Median(range)follow-upwas21.55(1.67-89.80)months, OSat1yearwas65%(95%CI,46-83%),at2years56% (95%CI,36-75%).PFSat1yearwas61%(95%CI,4280%),at2years48%(95%CI,28-68%).48%arestillalive andallincompleteremission.

ConclusionandRelevance Thesmallsamplepreventsnumerous affirmationsfrombeingemphaticallyextracted,buttheresults obtained,whichareverycomparabletothepublishedexperiences,supporttheuseofthistypeofdonorinthispatient population.Currently,weshouldnotdelaytransplantationin elderlypatientswithAMLtryingtofindanHLA-identical donor.IftheexperienceoftheCentreisextensive,performingatransplantfromahaploidenticaldonorshouldbeconsideredinthealgorithmoftheAllo-HSCTprocedure.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-223 BOTULINUMTOXINTYPEA:THENON-INVASIVE SUCCESSFOROVERACTIVEBLADDERS

1ZImane*, 2SMousannif, 3LHamedoun, 4YBoukhlifi, 4MAlami, 5YTadlaoui, 6YBousliman. 1PharmacyUnit,DrugDepartment,Rabat,Morocco; 2Children'sHospital, PharmacyDepartment,Rabat,Morocco; 3MilitaryHospitalofInstructionMohamedV, UrologyDepartment,Rabat,Morocco; 4MilitaryHospitalofInstructionMohamedV,Urology Depatment,Rabat,Morocco; 5MilitaryHospitalofInstructionMohamedV,Drug Department,Rabat,Morocco; 6FacultyofMedicineandPharmacyRabat,Toxicology Laboratory,Rabat,Morocco

10.1136/ejhpharm-2023-eahp.205

BackgroundandImportance IntradetrusorinjectionsofbotulinumtoxintypeA(TBA)havesignificantlychangedthemanagementofoveractivebladder(OAB),allowingtheacquisition ofurinarycontinenceandcontrolofrenalrisks.Thistechniquemakesitpossibletoavoidbladderreplacementsurgeryby

enterocystoplasty.HAVincursdirectandindirectcoststo society.

AimandObjectives Assessdiseaseimpactinpatientsaffected withIBDsusingPROMs.

AimandObjectives

Ourstudyhastwomainobjectives:to evaluatetheimprovementofthehandicapofpatientswith urinaryincontinencebybladderhyperactivity,afterinjectionof botulinumtoxinAthentoevaluatethecosteffectiveness ratio.

MaterialandMethods

Aretrospectiveobservationalstudyof 74patients,whoreceivededucationonself-catheterisationand treatedwithTBAattheUrologyDepartmentofbetweenJanuary2018andAugust2022.AmodelwasdevelopedtoestimatecostsbycomparingthecostofTBAversusastandard protocol(involvingbehaviouraltherapy,incontinencepads, anti-cholinergictreatmentand,catheters)excludinglossof productivity.Aqualityoflifequestionnairewasalsoadministeredtopatientsatthefollow-upvisits.

Results ProfilesofTBAuse:Primo-injectionin83.78%.Forthe indication,AVHwithoutleakagein32.43%,urinaryincontinencebyAVHin35.14%,multiplesclerosisin13,51%and spinalcordinjuryin18.92%.Theinjectionswereperformed intheoperatingroom.Amedianparamedicaltimeof30min topreparethepatientandtheproduct.Injectionconducted endoscopicallylastedamedianof8minwithamedianhospital stayof2days.Clinicalimprovementin81%withamedian durationofefficacyof98days.Foradverseevents:hypoora contractilebladderrequiringself-catheterisation(n=81%),generalisedfatigue(n=40%)andmuscleweakness(n=35%).Calculatedcosts:Thecostofaninjectionis7000MAD(price producedwiththehospitalpackage).Thecostofstandard treatmentwithoutself-catheterisationis2340MAD(foranticholinergictreatmentassociatedwithbehaviouraltherapy).If useofcathetersthecostoftheinjectionis8340MAD.Ifurinaryretentionoccurs,thecostis13000MAD.Ourstudy showsthatthehospitalcostishigherthanthestandardtreatmentwithoutself-catheterisationandlessexpensiveifcatheterisationwaspreviouslyused,butwithasignificant improvementinthequalityoflifeaccordingtothequestionnaireresults.

ConclusionandRelevance Forourcentre,since2014,TBA representsanewtherapeuticoptioninsecond-linetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

Theauthorsthankallthosewhocontributedtotherealisationofthiswork.

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4CPS-225 HEALTHIMPACTOFTREATMENTFOR INFLAMMATORYBOWELDISEASEWITHBIOLOGICAL AGENTSFROMTHEPATIENT’SPERSPECTIVE:A CROSS-SECTIONALSTUDYUSINGPATIENTREPORTED OUTCOMEMEASURES(PROMS)

LEstrada*,SMarin,GCardona,LCarabias-Ané,AMorales,ETerricabras,ABocos-Baelo, CGarcía-Castiñeira,CCodina-Jiménez,EValls,CQuiñones. HospitalUniversitariGermans TriasIPujol,PharmacyDepartment,Badalona,Spain

10.1136/ejhpharm-2023-eahp.206

BackgroundandImportance Theclinicalmanifestationsof inflammatoryboweldisease(IBD)compromisepatient'sdaily life.Inthisregard,theuseofPatientReportedOutcome Measures(PROMs)todeterminehealthstatus,qualityoflife andtreatmenteffectivenessfromthepatient’sperspectivecan addsignificantvalueinclinicalpractice.

MaterialandMethods Cross-sectionalstudyincludingoutpatientstreatedwithbiologicalagentsforulcerativecolitis (UC)andCrohn'sdisease(CD) 18years.Socio-demographicandclinicalcharacteristicswerecollectedfromclinicalrecords:age,gender,typeofIBD,diagnosisyear, biologicaltreatment,startingdateofbiologicaltreatment, previousbiologicaltreatment,conco mitantimmunosuppressivetreatment,previoussurgeriesduetoIBDandsmoking habits.Weused2questionnairestoevaluatePROMs:IBDControl(IBD-Control-8sub -scoreplusvisualanalogscale (VAS),thatrangefrom0-16and0-100,respectively,higher scoresrepresentingbetterdiseasecontrol)andIBD-Disk (thatrangesfrom0-100,higher scorerepresentinghigher IBDdaily-lifeburden).

Results 42patientswithCDand21withUCwereincluded (meanage44.25±14.67,54%men).44patientswere treatedwithinfliximab(69.84%),9withustekinumab (14.29%),7withvedolizumab(11.11%),2withgolimumab (3.17%)and1withadalimumab(1.59%).22(34.92%)were previouslytreatedwithbiologicalagents.4werediagnosed duringthelast18monthswhileotherswerediagnosedbefore. 44patients(69.84%)tookoralimmunosuppressant.60were treated>6monthswiththeircurrentbiologicalagent,the other3casesfor3-5months.

MeanIBD-Control-8scorewas12.41±3.87.Mean VASscorewas87.19±18.17.MeanIBD-Diskscorewas 33.22±25.95(69.84%ofpatientsbeingbelow50 points).4outof63caseshadworseoverallmeasurements (IBD-Control-8score £7,VASscore £60andIBD-Disk score 63).3werewomenwithCDandsmokinghabits (2currentsmokersand1ex-smoker).3ofthemwere treatedwithinfliximaband1withvedolizumab(3requiringconcomitantimmunosuppressants).2requiredprevious surgery.

ConclusionandRelevance Thisstudyaddsnovelliteratureon healthstatusofthesepatientsusingPROMs.Measurements weregenerallyfavorablebut4patientsoutof63hadworse overallmeasurements.Literatureonthistopicisscarce. PROMsareusefultoolsthatcouldbeincorporatedinpharmaceuticalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-227 REALWORLDEVIDENCEOFTHEUSEOFDEFIBROTIDE FORPROPHYLAXISOFVENO-OCCLUSIVEDISEASE AFTERPOST-HAEMATOPOIETICSTEM-CELL TRANSPLANTATIONINCHILDREN

1MBettio, 1DMengato*, 2AFrancavilla, 1FVenturini. 1PadovaUniversityHospital, PharmacyUnit,Padova,Italy; 2UniversityofPadova,UnitofBiostatistics-Epidemiology-And PublicHealth-DepartmentofCardiac-Thoracic-AndVascularSciences,Padova,Italy

10.1136/ejhpharm-2023-eahp.207

BackgroundandImportance Hepaticveno-occlusivedisease (VOD)isalife-threateningconditioncausedbytheobstructionofliversinusoids.

Since2014,inItalythestandardofcareforthemanagementofVODisrepresentedbydefibrotide.Recentevidence suggestedthatdefibrotidecouldhelppreventingtheonsetof hepaticVODwhenallogeneichaematopoieticstemcell

transplantationisneeded.OnJune2022,however,a ‘direct healthprofessionalcommunication’ issuedbytheEuropean MedicinesAgency(EMA)invokednottousedefibrotideanymoreforVODprophylaxisduetolackofeffectiveness.

AimandObjectives Theaimofthisworkistoexplorethe differenceintheincidenceofVODsat30daysin2groups ofchildren,withandwithoutprophylaxistherapywithdefibrotidebeforeundergoinghaematopoieticstemcell transplantation.

MaterialandMethods Asingle-centre,retrospectivestudywas conductedataUniversityHospital.Alldatawerecollected fromelectronichealthrecords.Thesedatawerecross-checked withdatafromanintegratedanalyticsapplication(Qlikview®, QlikTechInternationalAB,KingofPrussia,USA).

Allpaediatricpatients(age<18years)undergoinghaematopoieticstemcelltransplantationforonco-haematologicaldiseasesandconsideredathigh-riskfordevelopingVODwere enrolled.Weobservedaninitialgroup,calledthe ‘intervention’ group,consistingofpatientswhohadreceivedthedrug, comparedwitha ‘historical’ controlgroupofpatientswith similarbaselinecharacteristicsbutwhodidnothaveaccessto defibrotide.

Results Between2020and2022,datawerecollectedfrom27 patients.Thebaselinecharacteristicsofthetwogroupwere similarregardingofage(9yearsoldforbothgroups),gender andonco-haematologicaldisease,allshowingnostatistically significantdifferences.Intermsofoutcome,wewitnessed onlyoneepisodeofVOD,inthetreatmentgroup(1of11 patients,9%),at30daysaftertransplantation.Noepisodes weredocumentedinthecontrols.

ConclusionandRelevance Accordingtotherecentstatement madebyEMA,ourdata – althoughnotdefinitive – show thatproportionofVODinchildrenundergoingbloodstem transplantationinpatientswhoreceivedaprophylaxistreatmentwithdefibrotidewascomparablewiththeoneinchildrenwherenoprophylaxisstrategyhasbeenadopted.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-228

HIGHDOSEPHENOBARBITALCOMAINPAEDIATRIC REFRACTORYSTATUSEPILEPTICUS

ACasaldàliga,AFont, 1CJMoreno,EWilhelmi*,APieras,MVillaronga,FBossacoma, RFarré. HospitalSantJoandeDéu,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.208

BackgroundandImportance Statusepilepticus(SE)isassociated withhighmorbimortality.Earlytreatmenthasbeendemonstratedtodecreasetheriskofdeathandsequelae.WhenfirstlinedrugscannotsolveSE,therapeuticcomashouldbeinitiatedwithmidazolam(mostused),propofol,thiobarbitalor phenobarbital(bettertherapeuticprofilewithlowevidence, especiallyinpaediatrics)areusedforthispractice.

AimandObjectives Describinghigh-dosephenobarbital(HDPHB)usedintherapeuticcomainpaediatricrefractorySEand theirsideeffects.Exposingthepharmacokineticmonitoringto achievebarbituratecoma(BC).

MaterialandMethods Observationalretrospectivestudyofa third-levelpaediatrichospitalconductedbetween2012-2022. 51paediatricintensivecareunit(PICU)’spatientswho receivedintravenousphenobarbitaltreatmentwereincluded,6 ofthemunderwentBC.Variablescollectedwereage,weight,

numberofpreviousantiepileptictreatments,loadingandmaintenancedosesofphenobarbital,phenobarbitalplasmaticlevels duringcoma,BCdaysuntilresolutionofSE,exitusand adverseeffectsofHD-PHB.Alldatawereobtainedfromthe clinicalhistoryprogramme.

Results 51patientswereincluded,ofthem6(median9years [0.2-14.5]and20.2kg)weretreatedwithHD-PHBtoachieve BCduetothepresenceofseizuresrefractorytopropofolor midazolam:5hadaprevioushistoryofepilepsy,treatedwith amedianof3antiepilepticsathome.Theresolutionwasevaluatedbyencephalogram.Theinitialphenobarbitaldosesused toachieveBCwere60mg/kg/day[50-125].ReportedphenobarbitalplasmalevelsachievedintheBCphasewere 943mmol/L[743-1883].Patientswereincomaforamedian of4.5days[1-6]andinallofthemasuppressionburstwas observedintheencephalogram.GlasgowScalebeforecoma was9[7-13]andduringcomawas3[2-5].Afterresolutionof thestatus,taperingregimenwascarriedoutuntilphenobarbitalplasmalevelswerebelow350mmol/Landamaintenance dose(10mg/kg/12h[2-20])wascontinued.Theadverseeffects reportedwerehaematologicalin5patients(decreaseinhaemoglobinandhaematocritlevels)andhepaticin2patients(elevationoftransaminaseslevels).Onepatientdiedbefore6 monthspost-coma.

ConclusionandRelevance HD-PHBseemstobeaneffective therapeuticprocedureinpaediatricrefractorySE.Pharmacokineticsisimportanttoensurethemaintenanceofcomaand avoidtoxicity.Morepharmacokineticstudiesareneededto establishapopulationmodelandclearprotocolsforBC management.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-229 THEADDEDVALUEOFANATIONALELECTRONIC HEALTHRECORDFORTHEBESTPOSSIBLE MEDICATIONHISTORYOBTAINEDBYACLINICAL PHARMACIST

1ASzilvay*, 2ECzakó, 1PPázmány, 1KRichter. 1SzentBorbálaHospital,HospitalPharmacy Department,Tatabánya,Hungary; 2SzentBorbálaHospital,HospitalPharmacyDepartment, Tatabánya,Hungary

10.1136/ejhpharm-2023-eahp.209

BackgroundandImportance ObtainingtheBestPossibleMedicationHistory(BPMH)isanessentialstepinthemedication reconciliationprocess,thatshouldideallybebasedonthe mostappropriatesourcesofinformation,suchaspatient healthrecords,towhichaccessisoftenlimited.ImplementationofaNationalElectronicHealthRecord(NEHR)system aimsatstreamliningthisprocessbyconvergingrelevantdata intoasingulardatabase.

AimandObjectives Thisresearchaimedtoassesstheadded valueofNEHRtoBPMH.Inaddition,thequalityofNEHRbasedBPMHwascomparedtotheformerphysician/nurse-led StandardofCare(SoC),inordertoexploretheaddedvalue ofclinicalpharmacyservicesinobtainingBPMHs.

MaterialandMethods Thestudytookplacebetween05.202208.2022inthegeneralsurgerydepartmentofacountyhospital,enrollingpatientsover18yearsofage,admittedfrom theirhomes,withatleastoneregularlytakenprescribedmedicationandwithoutmajorcommunicationdifficulties.Medicationreconciliationwasinitiatedbyclinicalpharmacists,based

onthedocumentationavailableatthepoint-of-care(‘Hospital list’),whichinturngotvalidatedviaNEHRdata(‘NEHR list’),withthefinalstepbeingapatientinterview,formulating thefinalmedicationlist(‘BPMHlist’).Primaryoutcomemetricswerethefrequencyandtypesofmedicationdiscrepancies derivedfromthecomparisonoftheaforementionedlists, includingtheformerSoC.

Results Thestudyincluded100patients(52%female,average age=62years).231discrepancieswerefoundbetweenthe NEHRlistandtheHospitallist(median=2;IQR=4),64%of thepatientsbeingaffected.Themostcommondiscrepancy wasdrugomission(65%)andincorrectdailydose(26%). TherewasaninconsistencybetweentheBPMHlistandthe SoCin90%ofthepatients(median=3;IQR=3),themost commonerrorsbeingdrugomission(41%)andincorrectdaily dose(31%).

ConclusionandRelevance Basedontheseresults,theNEHR cancontributetothecompilationofamoreprudentBPMH duetoitsmorecomprehensivedatacontent.Thismethodologymay,inturn,facilitatethepreventionofmultiplemedication-relatederrors.Theseoutcomesalsounderlinethe legitimacyofpharmacists'accesstosuchnationalsystems.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-230 ALLOGENEICHAEMATOPOIETICCELL TRANSPLANTATIONINPATIENTSAGED<60YEARS WITHACUTEMYELOIDLEUKEMIA

RTamayoBermejo*,COrtegadelaCruz,JCDelRíoValencia,IMMuñozCastillo. Regional UniversityHospitalofMalaga,PharmacyDepartment,Málaga,Spain

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BackgroundandImportance Allogeneichaematopoieticcell transplantation(allo-HCT)isapotentiallycurativetherapeutic modalityforacutemyeloidleukaemia(AML),butitstillcarrieshighmorbidityandmortality;therearelimiteddata regardingoutcomes,soitisimportanttoresearchitsresults, andthefactorsthatinfluencethem.

21.6%haploidentical),35.1%unrelateddonor(21.6%HLAidentical,10.8%HLA9/10,and2.7%HLA8/10).70.3% allogeneicperipheralbloodstemcelltransplantation.64.9% reduced-intensityconditioning.16.2%retransplantation.Most donorsweremen>30years.37.8%receivedpost-transplantationtreatmentwithcyclophosphamide,tacrolimus,andmycophenolatemofetil.18.9%CMV-mismatch(patientpos/donor neg),56.8%ABO-compatible,54.1%developmentchronic GVHDand40.5%acuteGVHD.43.2%didnotrequire relatedhospitalisation.

PFSat12monthswas72%(95%CI,55-84%),and51% (95%CI,34-66%)at24months.OSat12monthswas78% (95%CI,61-89%)and62%(95%CI,45-76%)at24 months.MedianPFSandOSwerenotreached.Themedian follow-upforPFSwas33months[1-69]and34months[169]forOS.

PFSwassignificantlyhigherinpatientsin1stCR,EBMTscore £4,andlower-risk.

ConclusionandRelevance Patientsundergoingallo-HCTshow encouragingsurvival,althoughmoreextendedfollow-upis requiredtodefinemoreaccuratelytheirprognosis.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-232 COMPARATIVEEFFICACYOFRISANKIZUMABAND GUSELKUMABINMODERATETOSEVEREPLAQUE PSORIASIS

1MRodriguezGoicoechea*, 1BMoralesRivero, 2ETejedorTejada, 1NGarciaGomez, 1MJBarberoHernández, 1FHornoUreña. 1HospitalaryComplexofJaén,Pharmacy,Jaén, Spain; 2BarcelonaClinicHospital,HospitalPharmacy,Barcelon,Spain

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BackgroundandImportance Anti-interleukin23drugswere approvedinthelast5years.Theabsenceofcomparison betweenalternativessuchasrisankizumab(RIS)orguselkumab (GUS)needstobefulfilled.

AimandObjectives

Toassessthesurvivalofallo-HCTin AMLpatientsage<60years,describeitscharacteristics,and identifyfactorsthatarerelatedtothebestoutcomes.

MaterialandMethods

Retrospectiveobservationalstudy. Weincludedallpatientswith AML,aged<60years,whounderwentallo-HCTperformed atourcentrebetween2016-2019.

Weanalysedtheirage,sex,cytogeneticriskgroup,disease statusatthetimeoftransplantation,Karnofskyperformance status(KPS)score,comorbidityindexes(HCT-CIandEBMTscore),donortype,source,conditioningregimens,graft-versushostdisease(GVHD)prophylaxis,retransplantation,donor age,donorsex,CMV-mismatch,ABO-mismatch,development ofGVHD,relatedhospitalisations,progression,anddeath.

Overallsurvival(OS)andprogression-freesurvival(PFS) wereanalysedusingKaplan-MeierandLog-Ranktest.

Results

Thirty-sevenpatientswereincluded. Meanagewas44.81± 12.26[18-59]years.64.9%werewomen.51.4%intermediateriskand43.2%high-risk.70.3%infirstcompleteremission (CR).91.9%patientshadaKPSscoreover90%atthetime oftransplantation.54.1%HCT-CIbetween0-2,81.1%EBMT score £4.64.8%relateddonor(43.2%HLA-identicaland

AimandObjectives Toevaluatetheeffectivenessthroughindirectcomparisonsofrisankizumabandguselkumabinplaque psoriasis.

MaterialandMethods Multicentric,retrospectiveandobservationalstudy.Comparisonmadewithplaquepsoriasispatients withactivetreatmentwithrisankizumaborguselkumabfrom June2021andJune2022.Demographic(sex,age)andclinical(bodysurfacearea(BSA),psoriasisareaseverityindex (PASI)atbaselineandinsubsequentdermatologycontrols, PASIclearance(PASI100))datacollected.Comparisonmade throughPASI100andBSAandPASIreduction.

Results 59patientstreatedwithRIS,64%men,52,4±15,3 SDyearsoldaveraged,andBSAandPASIof11,4±8,2SD and8,7±4,2SDrespectivelyatbaseline.49patientstreated withGUS,59,2%men,50,9±12,1SDyearsoldaveraged, andBSAandPASIof10,25±10,27SDand8±6,69SD respectivelyatbaseline.

RISachievedatmean21,6±15,7SDweeksaBSAand PASIof2,24±6SDand1,81±3,7SDrespectively,with PASI100reachedby46%ofpatients.GUSachievedatmean 22,9±13,1SDweeksaBSAandPASIof3,87±9,28SD and2,89±4,26SDrespectively,withPASI100reachedby 45%.

At39,5±10,8SDweeks,RISobtainedBSA0,66±1,27 SDandPASI0,64±1,01SD,withPASI100in64%of

patients,whileGUSobtainedBSA1,82±3,28SDandPASI 1,89±3,3SD,withPASI100in50%ofpatientsin44,6± 17,5SDweeks.

After63,6±14,5SDweeks,RISachievedBSA0,68± 0,94SDandPASI0,9±1,14SD,andPASI100maintained by57%patients.GUSachievedBSA0,95±1,55SDand PASI0,53±0,92SD,andPASI100maintainedby67% patients.

ConclusionandRelevance RISandGUSareeffectivealternativesforplaquepsoriasistreatment,althoughitseemsthat afterayear,theactivityofRISstartstodecrease.Further studiesshouldbeperformedtodeterminethishypothesis.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-233 PD-L1EXPRESSIONANDHISTOLOGICALTYPEAS PREDICTORSOFRESPONSEINMETASTASICNONSMALL-CELLLUNGCANCER(NSCLC)PATIENTS TREATEDWITHPEMBROLIZUMABINFIRST-LINE

MTouris-Lores,MBusto-Iglesias*,LGarcía-Quintanilla,ACastro-Balado,ELopez-Montero, AMosquera-Torre,BBernardez-Ferran,SSantana-Martinez,SVazquez-Troche,HJMozoPeñalver,IZarra-Ferro. HospitalClínicodeSantiagodeCompostela,Pharmacy,Santiagode Compostela,Spain

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BackgroundandImportance InpatientswithNSCLCandprogrammeddeathligand-1(PD-L1)expression 50%,pembrolizumabasfirst-linetreatmenthasshownanincreaseinsurvival overplatinum-basedchemotherapy.Todate,itisnotknown whetherhigherPD-L1expressionisassociatedwithlonger survival.

ConclusionandRelevance Statisticallysignificantdifferencesin PFSbutnotOSwerefoundinpatientswithNSCLCandPDL1 80%expression.AdenocarcinomawithPD-L1 80% seemtobenefitthemostfrompembrolizumabtreatmentthan otherNSCLChistologies.ThesefindingscouldhaveimplicationsfortreatmentselectionbasedinNSCLChistology.Future researchisneeded.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AguilarEJetal.,Outcomestofirst-linepembrolizumabinpatientswithnon-smallcelllungcancerandveryhighPD-L1expression.AnnOncol.2019oct1;30(10):16531659.

ConflictofInterest Noconflictofinterest

4CPS-236 LOSSTOFOLLOW-UPFACTORSOFPEOPLELIVING WITHHIV

1MVélez-Díaz-Pallarés, 2BMonteroLlorente, 2MÁParroMartín, 2MDMolinaMendoza, 2EGemenoLopez*, 3DHernándezHuerta, 4MJVivancosGallego, 5LDelCampoAlbendea, 5AMurielGarcía, 2AMÁlvarezDíaz. 1HospitalRamonYCajal,Pharmacy,Madrid,Spain; 2HospitalRamónYCajal,Pharmacy,Madrid,Spain; 3HospitalRamónYCajal,Psiquiatry, Madrid,Spain; 4HospitalRamónYCajal,InfectiousDisease,Madrid,Spain; 5Hospital RamónYCajal,ClinicalBiostatistics,Madrid,Spain

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BackgroundandImportance Lossofadherencetoantiretroviral treatment(ART)isoneoftheleadingcausesofvirological failureinpeoplelivingwithHIV(PLWHIV).Lackofadherenceisassociatedwithalossoffollow-upbythehealthsystem,particularlyinthePharmacyDepartment.

AimandObjectives ToidentifyfactorsinPLWHIVwhich causetheirfollow-uptofailbythePharmacyDepartment.

AimandObjectives

Theaimofthisstudyistoevaluatethe impactofPD-L1expressionlevelsonprogressionfreesurvival (PFS)andoverallsurvival(OS),inpatientsreceivingfirst-line pembrolizumabtreatmentforNSCLCanditsassociationto histologictype.

MaterialandMethods

Aretrospectiveanalysisofpatientswith metastaticNSCLCandPD-L1expressionlevelof 50%,who weretreatedwithpembrolizumabmonotherapyasfirst-line therapyinourcentrefromJanuary2020toJanuary2022 wascarriedout.ThedifferenceinresponsebetweenthehistologictypeofNSCLC(adenocarcinomaandnon-adenocarcinoma),andefficacyofpembrolizumabbylevelofPD-L1 expressionwasstudied.ROCcurvewasusedtoevaluatethe optimalPD-L1cut-offpointtoidentifyagreaterpossibilityof response.Event-timedistributionswereestimatedusing Kaplan–Meiermethodology.Log-ranktestswereusedtotest fordifferencesinevent-timedistributions.Allp-valuesare2sidedandCIsareatthe95%level,withsignificancepredefinedtobeatthe0.05level.

Results 49patientswereincludedinthestudy.36patients (73.5%)hadadenocarcinomahistology,10(20.4%)epidermoid,and3(6.1%)other.Acut-offof80%forPD-L1 expressionwasestablished.40(81.6%)hadPD-L1expression <80%and9(18.4%) 80%.MedianPFSwas14.7months (95%CI:7.0-15.1)inpatientswithPD-L1<80%and25.8 months(95%CI:notreached)inpatientswithPD-L1 80% (p=0.017).NodifferenceswerefoundinOS.Patientswith adenocarcinomaandPD-L1expression 80%obtainedbetter resultsinintermsofPFS:19.3months(95%CI:not reached,p=0.031).

MaterialandMethods Case-controlstudyconductedinatertiaryhospitalwhichattends3,000PLWHIV.Patientswhohad runoutofmedicationformorethanonemonth,accordingto pharmacyregistrationsbetweenSeptember2020andSeptember2021,wereidentifiedandnamedaftercasesifthereason tonotcometothePharmacywerenotjustified(death,hospitaltransfer,inclusioninaclinicaltrial,etc.).Weconducteda case-controlstudy(1:4),andcaseswerematchedaccordingto age(5years)anddateofthelastdispensation.

StatisticalanalysiswasperformedusingtheSTATA17.0 program(StataCorpLLC).Allmodelswereperformedunivariately,anda p<0.05wasconsideredsignificant.

Variablesstudiedwere: gender,age,regionofbirth,studies, stablehousing,routeofHIVtransmission,CD4nadir,years afterdiagnostic,typeofART,yearsonART,stage,adverse effectstoART,numberoflinesoftreatment,pharmacyregistrationsofadherence,alcoholuse,druguse,andpsychiatric problems.Datawereobtainedfromtheclinicaldatabase Results Sixty-onecaseswereidentifiedandmatchedwith244 controls.Statisticaldifferenceswerefoundingender,where cis-manhaveanOR=4.5(CI95%1.0 19.6,p=0.047)and trans-manhaveanOR=23.9(CI95%2.9 195.8,p=0.003)in comparisonwithwomen,andregionwhereLatin-American haveanOR=2.7(CI95%1.3 5.6,p=0.008).Patientswho failtoadheretotreatmentaccordingtotherecordsinPharmacyhaveanOR=0.04(CI95%0.01 0.11,p=0.000)and patientswhoarealcoholicsordrugabusers,havean OR=3.24(CI95%1.30 8.04,p=0.011)andanOR=2.01 (CI95%1.03-3.93,p=0.039),respectively.

ConclusionandRelevance Cliniciansshouldpayspecialattentiontocisortrans-men,LatinAmericans,historicbad

adherenceregistrationsbypharmacistsandalcoholicordrug abuserswhoaremorepronetolosingfollow-upintheirtreatments.Thisenhancestheimportanceofmultidisciplinaryteam approachtothesepatients.Clinical,pharmacistandnurse interventionsandinformationregistrationarecrucialtoidentifythesepatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

ConclusionandRelevance Hyperkalaemiaismorefrequentin menandpatientswithKI.Thereisanassociationbetween PIDco-prescriptionandhyperkalaemiaepisodes.

Thedevelopmentofpharmaceuticalvalidationsupporttools suchasEAlocatorsprovidesthescreeningandmonitoringof disordersthatmighttriggerhealthconsequences.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-237 HYPERKALAEMIAANDRISKFACTORS:SCREENING ANDASSESSMENTINHOSPITALPATIENTS

1SSolisCuñado*, 1LRubio-Ruiz, 1RVázquez-Sánchez, 1NIbáñez-Heras, 1MHijazi-Vega, 2VBarroso-Torrejón, 2JSánchez-Valero, 1TMolina-García. 1GetafeUniversityHospital, HospitalPharmacy,Getafe-Madrid,Spain; 2AlcaladeHenaresUniversity,PharmacyDegree, AlcaládeHenares-Madrid,Spain

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BackgroundandImportance Hyperkalaemiaisafrequentelectrolytealteration(EA)inhospitalpatients(HP).Thus,close monitoringofplasmapotassiumlevels(PKL)andappropriately managementisnecessary.Highlevelsofpotassiummaylead toheartandmuscledisorders.

4CPS-240 FINGOLIMOD:ANALYSISOFUSEANDSAFETYIN PATIENTSWITHRELAPSING-REMITTINGMULTIPLE SCLEROSIS

1POrtizFernandez, 2MGilCandel, 2AMartinezSoto, 2AHerreroFernandez, 2PFernandezVillacañasFernandez, 3ISalarValverde, 2MGarciaCoronel, 2CPastorMondéjar, 2CCaballeroRequejo, 2EUrbietaSanz*. 1HospitalGeneralUniversitarioReinaSofia, Pharmacy,Murcia,Spain; 2HospitalGeneralReinaSofia,Pharmacy,Murcia,Spain; 3Hospital DoctorMoliner,Pharmacy,Serravalencia,Spain

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AimandObjectives

MainobjectivesaretoevaluateandmonitorhyperkalaemiainHP,tostudyriskfactorsandpotentially implicateddrugs(PIDs)andtoanalysethedegreeofacceptance(DA)ofthepharmaceuticalinterventionsonPKL normalisation.

BackgroundandImportance Fingolimodisusedwhenthediseaseremainsactivedespitetreatmentwithatleastoneother disease-modifyingtherapy,orissevereandgettingworserapidly.Ithadthebenefitofbeingtakenbymouthwhilemost otherdrugsaregivenbyinjection.

AimandObjectives Toanalysetheuseoffingolimodtreatment andanalysethecausesoffingolimod´streatment discontinuation.

MaterialandMethods

Observational,descriptiveandprospectivestudyfromOctober2021toJanuary2022.

Patientswithhyperkalaemia(K+>5.3mEq/L)inthefirst 24hourswereevaluatedwiththeassistanceofanEAlocator includedinthehealthrecordsystem.

PKLwereclassifiedasminor(5.3-5.9mEq/L),moderate(66.5mEq/L)orsevere(>6.5mEq/L).

Age,sex,basalPKLandmeasuredPKLfourdaysafter, prescribedPIDs,comorbiditiessuchaskidneyimpairment (KI),previoustherapeuticapproachordietarypotassium restrictions(DKR)werecollected.

DependingonthePKLandthepatientcharacteristics,differentrecommendationsweremade:discontinuationofpotassium-containingserums;PKLmonitoringandDKR considerationinminorhyperkalaemiacases;ion-exchangeresin (IER)evaluationwhenpatientswithmoderate-severehyperkalaemiatoleratedoralintake.Iftherewereanyprescribed PIDs,pharmacistsrecommendedanalternative.

PKLwereevaluatedafterinterventionsandDAwas determined.

Results Weanalysed87patients.64,4%weremenandthe averageagewas77.Themostacceptedrecommendations were:discontinuationofpotassium-containingserums(DA 100%),PKLmonitoringandDKR(DA64.2%)andIERprescription(DA46.15%).TheproposedalternativestoPIDshad notahighDA.ThePIDsprescribedwereheparin58.6%, renin-angiotensinsysteminhibitors39%,anti-inflammatory drugs27.9%andK-sparingdiuretics3.4%.66.7%ofthe patientsweretreatedwithmorethanonePID,41%ofthem hadKI.

Wemadeaninterventionin40,2%ofthecases.TheDA was65,7%witha60.8%ofPKLnormalisationversusa25% ofrecoveryinthosepatientswithnon-acceptedintervention.

MaterialandMethods Retrospectivedescriptivestudywasperformedinanareareferencehospital.Allpatientstreatedwith fingolimodfromitsinclusioninthehospital'spharmacotherapeuticguideinAugust2012tothepresentwereincluded. Datacollected:age,sex,previoustreatmentreceived,reason forprescription,dateofstartandendoftreatment,thereasonforsuspensionandclinicaldata(basal,finalorcurrent EDSS).WeusedExceltoanalysethedata.

Results Atotalof61patientswereincluded,onepersonwas excludedforreceivingonlyonedose,39(65%)werewomen, withamediaageof42±11years.Allpatientsweretheir heartactivitycloselymonitoredafterthefirstdose.7(10%)of patientsusedfingolimodasfirstline,whoseprescriptionreasonwas:fourforrapidandaggressiveevolutionandthree duetopositiveJCantibody.53(90%)ofpatientshadused otherdisease-modifyingtherapiesbefore,23(43.4%)glatiramer acetate,14(26.4)interferonbeta-1a,4(6.5%)dimethylfumarate,4(6.5%)teriflunomide,1(1.8%)interferónbeta-1band7 (13.2%)startedfingolimodafterfailuretonatalizumab. MedianEDSSwas1innaïvepatientsand1.5inpretreated patients.

Mediantimetodiscontinuationwas42.3[49.8]months.32 patients(53.3%)discontinuedtreatmentfordifferentreasons. Sideeffectswasthemaincause17(53.1%),followedbyinefficacy10(31.2%),forbothreasons2(6.2%)and2(6.2%) unknow.Lymphopeniarepresentedthemostprevalentofthe adverseevents(47.3%),followedbycefalea(21%),liver enzymelevels(21%)andotherlikearterialhypertension,atrioventricularblockandinfections.MedianEDSSincreasedone pointbothinthosewhodiscontinuedtreatmentduetoinefficacyandadverseeffects.

ConclusionandRelevance Therapeuticsuccessisnotassured, asitisadrugwithahighprevalenceofadverseeffects, whichmakesitnecessarytowithdrawtreatment.Isessential

detectingthesymptomsandsignsoftoxicityforavoid unwantedeffects,itispossiblebyfrequentvisitstothehospitalpharmacy.

2.MehtaRandOnatadeR.Contentvalidityofatoolforratingthesignificanceof pharmacists’ cliniccontributionsinhospitalsettings. UKCPASymposiumProceedings; 2016.

ConflictofInterest Noconflictofinterest.

4CPS-241 FINALVALIDITYOFATOOLFORRATING SIGNIFICANCEOFPHARMACISTS’ CLINICAL CONTRIBUTIONSINHOSPITAL

1PGWright, 2MReena, 1RSloss, 3ROnatade*. 1BartsHealthNHSTrust,Pharmacy,London, UnitedKingdom; 2KingsCollegeHosptal,Pharmacy,London,UnitedKingdom; 3Barts HealthNHSTrust,Pharmacy,Lonodn,UnitedKingdom

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BackgroundandImportance Todatethereisnogoldstandard forratingclinicalsignificanceofpharmacycontributionsto care.

IMPACCTS(InstruMentforPhArmacyClinicalContributionsTocareSignificance)isbasedontheHatoumscale1 and consistsoffiveorderedcategoriesorlevels,eachunderpinned bydescriptivestatements(totalof45statements).

Arobustprocesstoensuresimplicityandclarityofthe instrumenthasbeenpreviouslyreported.2

AimandObjectivesAim:Tocompletethevalidationof IMPACCTS.

Objectives wereto:

. demonstratecomprehensivenessofIMPACCTS

. quantifyinterraterreliabilityofIMPACCTS

MaterialandMethods ThisstudywascompletedFebruary 2022.Thestudydidnotrequireethicsapproval.

Toassesscomprehensiveness,20seniorpharmacistswith priorexperienceofusingIMPACCTSwerepairedtoreview 45scenarios(450differentscenariosintotal)andaskedto findacorrespondingstatement,orfailingthat,asuitablesignificancelevel.

Forinterraterreliability,all20pharmacistsweregiventhe same15detailedscenariostorateclinicalsignificance.Intraclasscorrelationstatistics(two-way,randomeffects,absolute agreement,individual)werecalculatedusingStatav14.

Alldatawerecollectedviaawebsurveyplatform.

Results Comprehensiveness – forallscenarios,atleastone personfoundastatement.For441/450(98%)scenarios,both respondentsinapairfoundacorrespondingstatement.Out oftheninescenarioswhereonepersonfromthepairdidnot findastatement,alevelcouldbeassignedforeightofthese. Therefore,astatementand/orlevelcouldbeassignedfor449/ 450(99.8%)ofthescenariosbyallrespondentpairs.

Intraclasscorrelationwas0.71(95%CI=0.55,0.86) whichdemonstratesmoderatetogoodpharmacistinterrater agreement.

ConclusionandRelevance Thisstudydemonstratesexcellent comprehensivenessandmoderatetogoodinterraterreliability ofIMPACCTS.Thesedatasupportreadinessofthetoolfor useinresearchandpracticetoassessclinicalseverityofpharmacycontributionsinhospital.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.HatoumHT etal. Evaluationofthecontributionofclinicalpharmacists:inpatient careandcostreduction. DrugIntelligenceClinicalPharmacy 1988; 22(3):252

9.

4CPS-242 ISAVUCONAZOLETREATMENTINTWOPAEDIATRIC PATIENTSDURINGEXTRACORPOREALMEMBRANE OXYGENATIONSUPPORT:THEROLEOFTHERAPEUTIC DRUGMONITORING

1APauParra*, 2MPujolJover, 3SMelendoPérez, 1AFernández-Polo, 1MMiarons, 2JIzquierdoBlasco, 1SGarcía-García, 3BFernándezLedesma, 1MJCabañas-Poy, 2JBalcells, 1SClemente-Baustista. 1VallD'hebronUniversityHospital,PharmacyDepartment, Barcelona,Spain; 2VallD'hebronUniversityHospital,PaediatricCriticalCareDepartment, Barcelona,Spain; 3VallD'hebronUniversityHospital,PaediatricInfectiousDiseasesand ImmunodeficienciesUnit,Barcelona,Spain

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BackgroundandImportance Extracorporealmembraneoxygenation(ECMO)mayleadtopharmacokineticalterationsof antimicrobials.Isavuconazoleisnotapprovedinpaediatric patients(PedP)(off-labeluse)anddataonpaediatricECMO arenon-existent.

AimandObjectives Todescribetwocasereportsusingtherapeuticdrugmonitoring(TDM)tooptimiseisavuconazoledosageinPedPduringECMO.

MaterialandMethods ProspectivestudyincriticallyillPedP treatedwithintravenousisavuconazolereceivingECMO(January2021toAugust2022).Biodemographic,clinicalandpharmacokineticdatawerecollected.Initialproposeddoseof isavuconazolebasewas5.4mg/kg(first48hq8h,followedby q24h;maximum200mg/dose).Isavuconazoletroughserum concentration(IsaCmin)of2.5-5 mg/mLwasconsideredas therapeuticrange(internalprotocol).Continuousvariables wereexpressedasmedian(range).

Results 1)A2-year-oldboy(11.5kg,90cm)lungtransplant recipient(pulmonarycapillaryhemangiomatosis)diagnosed withtracheobronchitiscausedby Aspergillusflavus (9months aftertransplant).Isavuconazolewasstartedataproposeddose andIsaCminremainedintherapeuticrange:5.1(2.5-5.5) mg/ mL.Secondaryprophylaxiswithisavuconazolewasmaintained (samedose),requiringECMOduetosevereacuterespiratory failure(multifactorial).DuringECMO(165days),itwasnecessarytoincreasethedoseto16.5(8.7-19.1)mg/kg/24hto achievetargetconcentrationofmedianIsaCmin2.82(1.3-6.5) mg/mL(24bloodsamples).Nonewfungalinfectionswere observedbutsadlythepatientdiedduetointracranial haemorrhage.

2)A11-year-oldgirl(70kg,158cm)admittedforinfluenza Ainfectionandnecrotisingpneumonia(Staphylococcusaureus),requiringECMO.Invasivefungalinfectionwasprobable (EORTCcriteria;positivegalactomannanandtrachealaspirate for Aspergillusniger)andisavuconazolewasstarted:loading doseof300mg/6h(suspectedinteractionwithpentobarbital duringfirst48h)andTDM-guidedmaintenancetherapy.DuringECMO(30days)medianmaintenancedosewas900mg (12.9mg/kg)/24h(variedwidelyrangingfrom200mg/12hto 250mg/4h)andmedianIsaCminremainedinthetherapeutic range:4.0(1.1-8.4) mg/mL(9bloodsamples).AfterECMO decannulation,isavuconazoledosewasreducedto200mg/1224handmedianIsaCminremainedinrange:3.9(2.8-11.4)

mg/mL.Shecontinuesisavuconazolemaintenancetreatment withapartialresponse.

ConclusionandRelevance

. PedPonECMOmayrequirehigherdosesofisavuconazoleto achievetherapeuticconcentrations,suggestingthatTDMmay beclinicallyuseful.

. FurtherstudiesincriticallyillPedP,especiallythoseon ECMO,arenecessarytoconfirmtheoptimalisavuconazole dosage.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2022,thedelaywasreducedby20days(95%CI13.66to 27.26;p<0,001).

ConclusionandRelevance ThedelaytoARTinitiationhas beensignificantlyreducedinrecentyears.Factorsrelatedto thedecreaseindelayarelowerCD4c,startingtreatmentwith INSTIorPI/bvsNNRTIandbeingwithin2019-2022vs 2012-2018.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-246 TREATMENTANDNURSINGCAREOF

MUCORMYCOSISINPAEDIATRICS:ACASEREPORT

4CPS-243 DELAYEDHIVTREATMENTANDFACTORS

ASSOCIATED

1GICasarrubios*, 1AMiranda, 1EMartínez, 1CDean, 1ACodonal, 1PTardáguila, 1ALázaro, 2ADelgado, 2MTorralba. 1HospitalUniversitariodeGuadalajara,HospitalPharmacy, Guadalajara,Spain; 2HospitalUniversitariodeGuadalajara,InternalMedicine,Guadalajara, Spain

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BackgroundandImportance Clinicalpracticeguidelines(EACS, DHHS,Gesida)recommendstartingantiretroviraltherapy (ART)assoonaspossibleafterHIVdiagnosis,irrespectiveof CD4cellcount(CD4c).PostponingARTstartuntilcomplementaryassessmentsdependsonthesetting,medicalindicationsandriskoflossfromcare.

AimandObjectives Toanalysedelayintreatmentinitiation overthepasttenyearsandtounderstandfactorsassociated withdelayedARTinitiation.

MaterialandMethods Retrospectiveobservationalstudyin patientsdiagnosedwithHIVinfectioninanintegratedhealth areafromJanuary-2012toJune-2022.Variablescollected:age, sex,routeofinfection,healthcaresettingofdiagnosis,time fromdiagnosistoARTinitiation(delaytime),ART,AIDS stage,baselineVLandCD4c.

Datawerecollectedfromelectronicmedicalrecordsand outpatientdispensationprogram.StatisticalanalysiswasperformedusingStudent´st-testandlinearregressionmethod (dependentvariable:delaytime)bySPSS®v.15.0.

Results 108patientswereincluded,medianagewas34years (IQR29.2-42.7)and76.9%weremen.41.7%werediagnosed inprimarycareand58.4%inthehospitalsetting.38.9% wereinAIDSstageatdiagnosis.Thepredominantrouteof infectionwasmenwhohavesexwithmen(MSM)50.9%.

ARTwasinitiatedwithnucleosidereverse-transcriptase inhibitors(NRTI)combinedwithintegrase-strand-transfer inhibitors(INSTI)66.7%,non-nucleosidereverse-transcriptase inhibitors(NNRTI)13%andboostedproteaseinhibitors(PI/b) 20.4%.

ThemedianbaselinelogVLwas4.63(4.13-5.14)andCD4c was325(95-500).

Themediandelaywas21days(IQR9-55).Factorsassociatedwithdelay:baselineCD4c(forevery100CD4increase thedelaytimewasextendedby2.29days(95%CI0.56to 4.02;p=0.01);baselinelogVL(-3.25days95%CI1.57-8.08; p=0.18);AIDSatdiagnosis(-5.40days;95%CI3.30-14.10; p=0.2);useofINSTIorPI/bcomparedtoNNRTI(-31.28 days;95%CI7.85-54.71;p=0.016).Foreachyearofevolution,thetimetoARTinitiationwasreducedby3.05days (95%CI1.59-4.50;p<0.001).Comparing2012-2018vs2019-

1GPerez, 2EWilhelmi*, 2AFont, 2ACasaldàliga, 2CJMoreno, 2MVillaronga, 3JETorra, 2RFarré. 1HospitalSantJoandeDeu,P-Icu,Barcelona,Spain; 2HospitalSantJoandeDeu, Pharmacy,Barcelona,Spain; 3UniversitatdeLleida,NursingCollege,Lleida,Spain

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BackgroundandImportance Mucormycosisisaseriousfungal infectionthatcausesfastinvasion,especiallyinimmunocompromisedpeople.

Rhino-orbitalcerebralinvolvementmanifestswithoedema, sinusitis,periorbitalcellulitisandothers.

Treatmentoftenrequirescombinedendovenousandtopical therapy,anddependingontheinvolvement,surgery.

AimandObjectives Explainingthetherapeuticapproachand evolutionofaveryseverelesionwithdeepnecrosisinthe rightnostril,withrapidprogressionandinfectedbyAcinetobacterBaumaniiextremelymultidrug-resistant(ABXDR), AspergillusnigerandRhizopusarizus.

MaterialandMethods A13-year-oldpatient(45kg)withAtypicalHaemolyticUremicSyndrome,admittedinanothercentre whereshestartedtreatmentwitheculizumabandreceivecorticotherapy,wastransferredtoourcentreduetoclinical worsening.

Presentedarapidlyprogressionlesionwithdeepnecrosisin therightnostril.

WoundcultureisolatedAcinetobacterBaumaniiextremely multidrug-resistant(ABXDR)andAspergillusNiger.Subsequently,Rhizopusarizuswasisolatedinthebiopsyandadiagnosisofrhino-orbitalmucormycosiswasmade.Furthermore, ABXDRisisolatedinconjunctivalswabandtrachealaspirate.

Systemictreatmentwasstartedwithisavuconazole(loading dose:200mg/8hfor2daysandmaintenancewith200mg/24h, plasmaticlevels3.85mg/mL),liposomalamphotericin-B(225 mg/24h),meropenem2g/8hgivenasa4-hourextendedinfusionandnebulisedcolistin2MUIevery8h.

Locally,thewoundwasfirstsurgicallydebridedintwo stepsandtargetedtherapywasinitiated.Duetothelackof commerciallyavailableformulations,sterilegelsofamphotericinBdeoxycholate0.15%andcolistin0.5%wereprepared bythepharmacyservice;bothwerepreparedonawater-solublebasis.Theywereappliedevery4hoursalternately.

Duringadmission,topicaldressingswithsodiumhypochloritefomentation(MicrodacynR)plusbacteriostaticgel-based mesh(CutimedSorbactR)wereperformedevery24h.

Apharmacy-preparedcolistin0.2%/6hophthalmicgelwas appliedtotheeyes.

Throughoutthehospitalisation,thewoundwasclosely monitoredperformingsmearstodetectthemicrobialgrowth. Results ClinicalOutcomeswerearapidwoundreductionwith 80%granulationandnegativemicrobialculturesafter28days

ofcontinuoustreatment.Afteramonth,thepatientwasdischargedfromtheunit.

telepharmacy;pharmacokineticmonitoringandtelemedicine; carecoordination;patienthealtheducation;research,educationandtraining.Subsequently,theinitiativeswereprioritised basedontheirimpactonimprovingpatientcareandonthe feasibilityoftheirimplementation(scaleof1-5).

Results Twenty-eightinitiativeswereidentifiedandgroupedin sevenworkareas.Aftertheprioritisationoftheinitiatives,the expertsidentifiedfivepriorityinitiativesforHospital Pharmacy:

-Evaluationandselectionofmedicines:

. Incorporatethepatient'sperspectiveandopinioninHAE treatmentdecision-makingprocessesusingPROs(Patient ReportedOutcomes)andPREMs(PatientReported ExperienceMeasures).

. Participateinmultidisciplinarymeetingsfortheevaluation andselectionofdrugsforHAE.

-Carecoordination:

. Developaguidelineofrecommendationsforthecoordination ofthehealthcareprofessionalsresponsibleforthe managementofpatientswithHAE.

-Patienthealtheducation:

. Promotetheuseoftelepharmacytoolsforpatienteducation andinformationasacomplementtoface-to-facecare.

ConclusionandRelevance Rhino-orbitalmucormycosisisa veryseriousconditionthatrequiresspecifictargetedtreatment andthenursingcare,surgeryandpharmacyinvolvementasa teamisessential.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

4CPS-247 INITIATIVESTOIMPROVETHEMANAGEMENTOF PATIENTSWITHHEREDITARYANGIOEDEMABY HOSPITALPHARMACY

1JBMontoroRonsano*, 2JMMartínezSesmero, 3RLleonartBellfill. 1VallD’hebron UniversityHospital,HospitalPharmacyService,Barcelona,Spain; 2ClínicoSanCarlos Hospital,HospitalPharmacyService,Madrid,Spain; 3BellvitgeUniversityHospital, AllergologyService,HospitaletdeLlobregat-Barcelona,Spain

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BackgroundandImportance Hereditaryangioedema(HAE)is arare,hereditarydiseasewithanegativeimpactonthequalityoflifeofpatients.TheincreaseintheknowledgeofHAE andtheappearanceofnewtreatmentsinrecentyearshave contributedtomodifyingthecourseofthisdisease.Inthis scenario,hospitalpharmacistshaveacquiredamoresignificant role.

AimandObjectives Identifyandpromoteinitiativestoimprove themanagementofpatientswithHAEbyHospitalPharmacy andevaluatetheimportanceofcarecoordinationforamultidisciplinaryapproachtopatientswithHAE.

MaterialandMethods Initiativestoimprovethecareof patientswithHAEwereidentified,evaluatedandprioritised byamultidisciplinarypanelofexperts(agroupofhospital pharmacists,oneallergistandonenurse/HAEpatient).The initiativesweregroupedintosevenkeyareasofactivity:evaluationandselectionofmedicines;dispensationand

ConclusionandRelevance Fivepriorityinitiativesareproposed forthemanagementofpatientswithHAE,highlightingthe importanceofcarecoordinationtoimprovethemultidisciplinaryapproachofthesepatients.Fromthisstudy,specific actionshavebeenidentifiedthatcouldimprovetheapproach topatientswithHEAbyhospitalpharmacists.Thus,these professionalswillbeabletopromotepotentiallyimplementableinitiativesthatcouldhavearealimpactonpatients’ lives.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-249 RELATIONSHIPBETWEENRENALFUNCTIONAND ERTAPENEMPLASMACONCENTRATIONINADULT PATIENTS

1APauParra*, 1BMontoroRonsano, 1PGonzálezMoreno, 1DAnguitaDomingo, 2JVima Bofarull, 1MQGorgasTorner, 1DCampanyHerrero. 1VallD'hebronUniversityHospital, DepartmentofPharmacy,Barcelona,Spain; 2VallD'hebronUniversityHospital,Clinics LaboratoriesService,Barcelona,Spain

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BackgroundandImportance Ertapenemisaparenteral b-lactamantibioticwithpredominantlyrenalexcretion.Itpresents atime-dependentbactericidalactivityandusualdoseis1g every24h,butinpatientswithestimatedglomerularfiltration rate(eGFR)<30ml/minisrecommended0.5gevery24h.

AimandObjectives Ouraimistoevaluatetherelationship betweenrenalfunction(eGFR)andertapenemplasmatrough concentration(Cert).

MaterialandMethods Retrospectivecohortstudyconductedat atertiaryuniversityhospitalfromOctober2019toFebruary 2021.Adultpatientstreatedwithertapenemforatleast72 hoursandwhohadaCertdeterminationwereincluded.Biodemographic,analyticalandtreatment-relateddatawerecollected.Continuousvariableswereexpressedasmean± standarddeviation(SD)andcategoricalvariablesas

Abstract4CPS-246Figure1

percentages(cases).High-performanceliquidchromatographyultraviolet(HPLC-UV)wasusedtomeasureCert.

Certwasmeasuredafteratleasttwodosesofertapenem (>48h)andbeforethenextdoseadministration(trough). RenalfunctionwasmeasuredaseGFRaccordingtoCKD-EPI (ChronicKidneyDiseaseEpidemiologyCollaboration).

Pearsoncorrelationcoefficient(R)wascalculatedtostudy thecorrelationbetweeneGFR(independentvariable)andCert (dependentvariable).Todeterminethestatisticalsignificance ofR,theanalysisofvariance(ANOVA)wasperformedandp valuewasobtained(IBMSPSSStatisticsV21.0).

Results 102patientswithCertdeterminationwereincluded, 53%malesex,with73.0±12.2yearsold.MeaneGFRwas 57.5±27.86mL/min/1,73m2.Certwasmeasured6.4± 4.04daysafterstartingertapenemandthemeandurationof treatmentwas15.5±11.4days.

Rvalorwas-0.436(R2=0.190)whichexplainsaninverse linearcorrelationbetweeneGFRandCertwithstatisticalsignificance(p=0.001).Influenceofothercovariates(albumin, platelets,ertapenemdose,samplingtime)ontherelationship betweenCertandeGFRwasstudied,withnosignificant impactobserved.

MeanCertforthedifferenteGFRrangesweresummarised inthetable:

eGFRcategory(mL/min/1,73m2)Cert(mcg/mL)

eGFR>90(n=24)7.3±12.1

eGFR60-90(n=24)14.1±10.1

eGFR30-60(n=29)19.4±19.5

eGFR<30(n=25)29.7±28.0

Total(n=102)17.8±20.3

ConclusionandRelevance

. DecreaseineGFRiscorrelatedwithanincreasedinCert, withapossibleoverexposureinpatientswithrenal dysfunction.

. Adoseadjustmentcouldbeconsideredinpatientswith compromisedrenalfunction,eveniftheeGFR>30mL/min/ 1,73m2

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

AimandObjectives UnderstandthepatientwithHAEpathway byidentifyingandassessingtheelementsthatcomprisethe burdenofthediseaseofpatients.

MaterialandMethods Descriptivestudy basedonabibliographicreviewandtheexpertiseofamultidisciplinarypanel of18professionalswithkn owledgeandexperienceinHAE (Allergology,Immunology,MedicalEmergency,Hospital Pharmacy,NursingandPatientAssociations).Thepatient pathwaywaselaboratedbyidentifyingtheelementsthat comprisetheburdenofthedisease.Thoseelementswere evaluatedfromthepatient ’ sandthehealthcaresystem ’ s perspectives.

Results ApatientwithHAEsuffersanaverageof5.8attacks peryear,althoughthereisgreatvariabilityamongpatients.It hasbeenestimatedthat35%ofpatientstakelong-termprophylaxis(LTP).

TheestimatedaveragecostofapatientwithHAEis C¼ 47,825/year,includingpharmacologicalcosts,admissions, medicalappointmentsandproceduresandindirectcosts(transportandlossofproductivity).Pharmacologicaltreatmentof LTPrepresents79%ofthetotalcosts;however,itdecreases thenumberofattacksby76%,andthereforereducingthe burdenofdisease.

Intermsoflostproductivity,itisestimatedthatapatient withHAElosses2.5daysofworkperyear,althoughthis variesdependingonthetreatmentandsituation.Thelossof productivityassociatedwiththelossofeducationalandprofessionalopportunitiesandtheemotionalimpactofHAEare importantcomponentsoftheburdenofthedisease.

TheprescriptionofLTPinpatientswithahighnumberof attacksandtheimplementationoftelepharmacy/telemedicine programsimprovesthequalityoflife,reducesvisitstohealth carefacilitiesanddecreasessickleaves.Thepossibilityofhavingthemedicationavailableathomeforself-administrationis animportantbenefitforpatientsandthehealthcaresystem. ConclusionandRelevance HAEhasahighimpactonpatients andthehealthcaresystem.Identifyingthekeyelementsat eachstageofthepatientpathwayisessentialtoimprovetheir qualityoflifewhileensuringthesustainabilityofthehealthcaresystem.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-251 HEREDITARYANGIOEDEMA:IMPACTOFTHEBURDEN OFDISEASEINSPAIN

1EMonteBoquet*, 2CBJosé, 3MNavarroBrugueras, 4ADEscobarOblitas, 5MTCaballero Molina, 6SSmithFlotz. 1HospitalUniversitarioYPolitécnicodelaFe,HospitalPharmacy Service,Valencia,Spain; 2HospitalUniversitarioClínicoSanCecilio,HospitalPharmacy Service,Granada,Spain; 3HospitalUniversitarioSantaMaría,HospitalPharmacyService, Lleida,Spain; 4HospitalUniversitarioSonEspases,ImmunologyService,PalmadeMallorca, Spain; 5HospitalUniversitariolaPaz,AllergologyService,Madrid,Spain; 6Asociación EspañoladeAngioedemaFamiliarAedaf,President,Madrid,Spain

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BackgroundandImportance Hereditaryangioedema(HAE)is ararediseasewithanegativeimpactonpatients'qualityof life.Understandingthepatientpathwaywouldcontributeto reducingtheburdenofthedisease.

4CPS-254 DAPAGLIFOZINPRESCRIPTIONPRACTICEINPATIENTS WITHCHRONICHEARTFAILURE

MGarcíaHervalejo*,AmLópez-González,RAparicioPeñacoba,ICondeGonzález, JCGarcíaCasanueva,MJOtero. HospitalofSalamanca,HospitalPharmacy-SalamancaSpain,Salamanca,Spain

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BackgroundandImportance Dapagliflozinisasodium-glucose cotransporter2(SGLT2)inhibitorauthorisedbytheSpanish MedicationandHealthcareProductsAgencyforchronicsymptomaticheartfailure(HF)withreducedleftventricularejectionfraction(LVEF).InthepivotalstudyDAPA-HF,therisk ofcardiovasculardeathorworseningoftheHFwasreduced withdapaglifozincomparedwithplacebo.

AimandObjectives Theobjectiveofthestudywastoevaluate theuseofdapagliflozininalevelfouruniversityhospitalfor HFindicationaccordingtotheDAPA-HFstudyinclusion

criteria,emergencyroomvisits,andhospitalreadmissionsdue toHFdecompensation,ordeathfromanycause.

MaterialandMethods ThiswasaretrospectivestudyJanuaryJuly2021thatincludedHFpatientswithatleastonedose ofdapagliflozin.Thevariablesrecordedwere:gender,age, LVEF,N-terminalB-typenatriureticpeptide(NT-proBNP), standardtreatment,HFclassificationaccordingtotheNew YorkHeartAssociation(NYHA),readmissions/emergency roomvisitsforHF,anddeath.Thefollow-upperiodlasted 14months.

Weevaluatedwhethertheprescriptionofdapaglifozinmet theinclusioncriteriaoftheDAPA-HFstudywhichwere: LVEF £40%,NT-proBNP 600pg/mL,NYHAclassII-IVand standardtherapy(angiotensin-converting-enzymeinhibitors, angiotensinIIreceptorblockersorsacurbitril/valsartan,plus betablockersandmineralocorticoidantagonists).

Results Wehad51patients(20%female)withanaverageage of71(49-88).Prescriptoradherencetoallofthecriteriawas achievedin30/51patients(59%).Adherenceforeachcriterionwas:LVEF £ 40%in46patients(90%),NT-proBNP 600pg/mLin44(86%),NYHAII-IVin38(74.5%)and adequatetreatmentwithstandardtherapyin45(88%) patients.

Seventy-sixpercent(39/51)ofpatientscontinuedwith dapagliflozinat14months.Duringthefollow-upperiod10/ 51visitedanemergencyroomand10/51werereadmittedfor HFdecompensation.Thecauseofdeathofthreeofthefour patientswhodiedwascardiovascular.

ConclusionandRelevance Morethanhalfoftheprescriptions fordapagliflozinmetthecriteriaforinclusioninthestudy. ThepercentageofHFdecompensationordeathfromcardiovascularcauseswasgreaterinourcohortthanintheclinical trialsample.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-255 ANTIPARKINSONIANMEDICATIONRECONCILIATION: HOWPREVENTINGMEDICATIONERRORSPROMOTES THERAPEUTICQUALITYANDSAFETY

AViudez-Martinez,AMRamirezLopez*,JLopez-Nieto,ECliment-Grana,GRiera. Hospital GeneralUniversitarioDrBalmisdeAlicante,Pharmacy,Alicante,Spain

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BackgroundandImportance Pharmacotherapyistheprimary treatmentforParkinsonDisease(PD).Theadministrationof PDmedicationneedstobecarriedoutataparticulartimeto avoidmissingdosesorinaccuratedosageschemesthatmay resultinmotorandnon-motorconsequences.One-thirdofall patientswithPDvisitanemergencydepartmentorhospital eachyear,yetabout70%ofneurologistsreportthatPD patientsdonotgettheirmedicationproperlywhenhospitalised.Besides,1in3patientswithPDisprescribedcontraindicateddrugsduringhospitalisationandseriouscomplications, mostlyneuropsychiatric,occurinmorethanhalfofthese patients.

AimandObjectives

Todesignandimplementamedication reconciliationprotocolledbyclinicalpharmaciststhatallowed toidentify,characteriseand,eventually,preventantiparkinsonianmedicationerrorstopromotetherapeuticqualityand safetyindailypractice.

MaterialandMethods

Thiswasaninterventional,singlecentre,one-year,prospectivestudyanalysingtheimpactof developinganantiparkinsonianmedicationreconciliation programme.Allthepatientswhowerehospitalisedand had,atleast,oneactiveprescriptioncontaininganantiparkinsoniandrugathospitalad missionwereincluded.The medicationreconciliationwasperformedbyfollowinga three-phasedcheck:inpatientelectronicprescriptionvalidationafterassessingtheoutpatientmedicationschedule, reviewofthelatestclinicalreportemittedbytheNeurology Department,andpharmacist-driveninterviewofthepatient and/orcaregivertoconfirmtheinformationregardingmedicationgathered.

Results 171admissionepisodesfrom132patientswereregisteredbetweenFebruary1,2021,andJanuary31,2022.Of 224prescriptionlinesinvolvingantiparkinsoniandrugs,179 contained,atleast,onemedicationerror(59.8%).Commission errors(91.62%)weremorefrequentthanomitteddrugs (8.38%).Themostcommonmedicationerrorswererelatedto timing(41.90%),frequency(21.23%),anddosing(19.55%). Theimplementationofthemedicationreconciliationprogrammepreventedtheerroneousadministrationof2716antiparkinsoniandoses,60%ofthetotalnumberofdoses prescribedduringthisperiod.Interestingly,asignificantrelationshipbetweenthenumberofmedicationerrorsandhaving levodopaprescribedwasevidenced(p<0.05).Acontraindicateddrugwasprescribedinalmostone-thirdoftheepisodes (29.82%).

ConclusionandRelevance Clinicalpharmacists'implementation ofanantiparkinsonianmedicationreconciliationprogramme sharplyreducedmedicationerrors,andcontraindicateddrugs prescription,thusimprovingtherapeuticsanddrugsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-257 PREOPERATIVEINTRAVENOUSIRONTOTREAT ANAEMIABEFOREMAJORORTHOPEDICSURGERY

SAsenjoSegovia*,MSarobeCarricas,MNocedaUrarte. HospitalUniversitariodeNavarra, Pharmacy,Pamplona,Spain

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BackgroundandImportance Preoperativeanaemia,isarisk factorforpooroutcomeinpatientsundergoingsurgery.Sufficientdataexisttosupportintravenousironasefficacious andsafeifsurgeryisplannedfor<2-3weeksafterthe diagnosisofirondeficiency.Treatmentofpreoperativeiron deficiencyanaemiashouldbeimplementedasearlyasposible beforethescheduledsurgicalprocedure,mostmajorsurgeryis elective.

AimandObjectives Thepurposeofthisstudyistoreviewthe clinicaleffectivenessofIVIadministeredpreoperativelyfor irondeficientinadultpatientsundergoingelectiveorthopedic surgery

MaterialandMethods RetrospectiveObservationalstudyconductedbetweenJanuary2021andDecember2021

Eligibleparticipants,identifiedinpreoperativehospitalvisit wereolderthan18yearsofageandhadhaemoglobinless than13g/dLformenand12g/dLporwomen.

Preoperativeassessmentvisitscheduled1-2weeksbefore surgery,abletoreceiveinfusionatleast7daysbeforethe plannedoperationdate.

Intervention: Intravenousironwasadministeredasasingle 500-1000mgdoseofferriccarboxymaltose(FCM)

Endpointsincluded: demograficcharacteristics,clinicaleffectiveness(hemoglobinlevelbeforesurgery>13g/dL),time spanbetweenfirstFCMadministrationandsurgery,safety (rateofadverseevents).

Limitations: noevidencewithrespecttooutcomessuchas qualityoflife,post-operativecomplications,morbidityand mortalitywereidentified.

Results Werecruited165adultspatients(86,6%femaleand 13,3%male).Themedianagewas71,1years.Thetypeof orthopedicsurgerywas:hip66(40%),knee77(46,7%)and spine18(10,9%).Treatmentwithintravenousironwere administrateden79patients(48%)between7-15daysbefore surgery.

Intravenousironwasadministratedasasingle500mg dosein44patients(26,6%)andasingle1000mgin121 pacientes(73,3%)

Thedayofthesurgery,7,27%ofthepatientsreachedhaemoglobinconcentrationlevels 13g/dL

Patientsweremonitoredforadverseeventsorsignsof hypersensitivityduringandforatleast30minaftertreatment andnosevereadverseeventsrelatedtoFMCocurred

ConclusionandRelevance Theprimaryresultsofourstudy shownoevidenceofclinicalbenefitingivingintravenousiron preoperativelytopatientsundergoingmajorsurgery

Thestudysuggeststhatcurrentprotocolonpreoperative irontherapyshouldberevisedtoimprovetheresults.

REFERENCESAND/ORACKNOWLEDGEMENTS

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4CPS-259 MANAGEMENTOFVORICONAZOLE-INDUCEDLIVER TOXICITYINAPAEDIATRICPATIENT

1AMartínez*, 2LMoñinoDomingez, 2JCorderoRamos, 2VMerinoBohorquez. 1Clinical Pharmacist,HospitalPharmacy,Sevilla,Spain; 2HospitalUniversitarioVirgenMacarena, HospitalPharmacy,Sevilla,Spain

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BackgroundandImportance Invasivefungalinfectionsarean importantcauseofmorbidityandmortalityinimmunocompromisedpatients.Voriconazolehasvariablepharmacokinetics andchildrenusuallyrequirehigherdosestohavevoriconazole concentrationswithinthetherapeuticrange(TR)anddueto variability,closemonitoringofplasmaconcentrations(Cpvor) isrecommended.

AimandObjectives Todescribepharmacokinetic/pharmacokinetic(PK/PD)management,efficacyandsafetyofvoriconazole-inducedlivertoxicityinapaediatricpatient.

MaterialandMethods PK/PDmanagementwasperformedby clinicalpharmacistsandthegoalwastohaveplasmaCpvor withintheTR(1.5-5.5mg/L).Voriconazolehasvariable pharmacokineticslinkedtoage, cytochromeCYP2C19,hepaticdysfunctionanddruginteractions.Efficacyisdefinedas analytical,clinicalandradiographicimprovementandsafety astheabsenceofadversereactions.Cpvorweremeasured byavalidatedhigh-performanceliquidchromatography method.

Results An8-year-oldpaediatricpatientundergoingactive chemotherapyforacutemyeloidleukemia.Duringthe2nd consolidation(probableinvasiveaspergillosis)andafterthe 3rd(proveninvasiveaspergillosis)thepatientwas

hospitalisedandtreatedwithvoriconazole,reachingthe therapeutictargetwithvoriconazol20mg/kg/12horal/IV.In bothadmissions,separatedby8months,thepatientsufferedhepatictoxicity(incr easedtransaminases).Onboth occasionsthefollowingplanwasdeveloped:1)closemonitoringofCpvorand2)closemonitoringofliverfunction. Duringthefirsthospitalisation(Cpvor=1.23mg/L; ALT=90U/L;AST=58U/L;GGT=430U/L)itwasrecommendedtomaintainthedoseof20mg/kg/12horaland monitorliverfunction.At10daysCpvor=3.52mg/Land transaminasesdecreased.Duringthe2ndhospitalisation (Cpvor=9.7mg/L;ALT=35U/L;AST=72U/L;GGT=569U/ L)itwasrecommendedtodecreasethedosefrom20mg/ kg/12hIVto15mg/kg/12hIVandmonitorliverfunction. At10daysCpvor=1.58mg/Landtransaminasesdecreased. Thepatientwastreatedwi thoralandIVvoriconazole, oralbioavailabilitywasestimatedtovarybetween70100%.Treatmentwithvoriconazolewaseffective,the patientpresentedclinical,analyticalandradiographic improvement.

ConclusionandRelevance Voriconazolewaseffectiveinthe treatmentofprobableandprovenaspergillosis.Although voriconazole-inducedlivertoxicity isnotdose-dependent, onthesecondadmissionthe patienthadCpvorabovethe TR.Thepatientpresentedvori conazole-inducedhepatotoxicity,whichwasresolvedwithPK/PDmanagementonboth occasions.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-261 ANALYSISOFDRUGINTERACTIONSBETWEENORAL ONCOLOGICALTREATMENTOFPROSTATECANCER ANDCHRONICMEDICATION

1POrtizFernandez, 2EUrbietaSanz*, 2MGarciaCoronel, 2PFernandez-Villacañas Fernandez, 2AMartinezSoto. 1HospitalGeneralUniversitarioReinaSofia,Pharmacy, Murcia,Spain; 2HospitalGeneralReinaSofia,Pharmacy,Murcia,Spain

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BackgroundandImportance Potentialinteractionsaredetected withneworaltreatmentsforprostatecancer.Interactionswith thesedrugsneedtobereviewedinelderlypeoplearefragile, polypathologicalandpolymedicated

AimandObjectives Todetectandanalysetheinteractions betweentheselectiveinhibitoroftheenzyme17a-hydroxylase (abiraterone)andtheandrogenreceptorinhibitors(apalutamideandenzalutamide)withthechronicmedicationof patientswhocometotheoutpatientclinic.

MaterialandMethods ObservationalandtransversalstudycarriedoutintheOutpatientUnit(UPE)fortwomonths(JulyAugust2022)inanareareferencehospital.

Thepharmacistconductedaclinicalinterviewwithall patientsreceivingtreatmentwithabiraterone,apalutamide,and enzalutamidewhocametopickuptheirmedicationatthe outpatientclinic.Innecessarycases,werelyonthecomputerisedelectronicprescription.Inaddition,age,diseaseclassificationandtreatmentstartdatewerecollected.

ThedatacollectedwasanalysedusingtheLexicompdatabase,whichclassifiesinteractionsinto5categoriesaccording totherecommendation:CategoryAandB(Nofollow-upnecessary),C(Monitorthepatient),D(Considermodificationof therapy)andX.(Avoidcombination).Theinteractionsof

categoriesC,DandXhavebeenconsidered.Thedegreeof rigorandthereliabilityratingwerealsocollected.

Results Atotalof69menwereinterviewed.Themeanage was77years,allolderthan60years.31patientswere receivingtreatmentwithapalutamide,26withabiraterone and12withenzalutamide.Thepatientshadameanof12.6 ±15.1monthsoftreatment.88.5%took5ormore medications.

Atotalof709linesoftreatmentwereanalysed,finding that66.6%ofthepatientspresentedaninteractionintheir treatments,1.9interactionsperpatient.

Accordingtotheseverityoftheinteractions,76.2%(91) wereC,10.1%(12)Dand12.7%(15)categoryX.63.5%of theinteractionswerewithapalutamide,26.2%withenzalutamideand10.1%withabiraterone.4pharmacologicalgroups areresponsibleforcategoryDinteractionsand1isresponsibleforcategoryXinteractions(protonpumpinhibitors).

ConclusionandRelevance

. Thestudyhasallowedustodetectahighnumberof interactions,althoughtheproportionofpatientswith clinicallyrelevantinteractionsislow.

. Thepharmacistplaysaveryimportantroleintheprevention, detectionandmonitoringofinteractionsinthisgroupof patients.

Results Atotalof110responseswerereceivedfromdifferent countriesandpractitioners’ groups.Themajorityoftheparticipants(86.11%)statedtheywoulduseatoolforAchBassessmentifavailableandwhentheywereaskedtoratetheIACT againstothertools,amongst34responders,20.59%ratedit betterand8.82%rateditsignificantlybetter,44.12%ratedit neitherbetter,norworse,14.71%rateditworseand11.76% somewhatworse.

ConclusionandRelevance Thereisaneedforananticholinergicburdencalculatortoassesstheanticholinergicityofmedications.ToolssuchastheIACTpotentiallycouldmeetthis demanddueitsabilitytoassignscorestocurrentandnew medicationsappearingonthemarketbasedbothontheir chemicalstructureandreportedadversepharmacological effects.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

4CPS-262 ANOVELARTIFICIALINTELLIGENCE-BASEDTOOLTO ASSESSANTICHOLINERGICBURDEN:ASURVEY

1ASecchi*, 2CFox, 3HMamayusupova, 4SSami, 5IMaidment, 6SCoulton, 7PKMyint, 8CFox. 1KentandMedwayNHSPartnershipTrust,Pharmacy,Maidstone,UnitedKingdom; 2UniversityofExeter-CollegeofMedicineandHealth,UniversityofExeter,Norwich,United Kingdom; 3UniversityofEssex-Co43sq-UK,EssexUniversity,Essex,UnitedKingdom; 4UniversityofEastAnglia-Norwich-NR47TJ-UK,UniversityofEastAnglia,Norwich, UnitedKingdom; 5AstonUniversity,Pharmacy,Birmingham,UnitedKingdom; 6Universityof Kent,UniversityofKent,Kent,UnitedKingdom; 7AgeingClinical&ExperimentalResearch Team-InstituteofAppliedHealthSciences-UniversityofAberdeen-Aberdeen-ScotlandUK,InstituteofAppliedHealthSciences,Aberdeen,UnitedKingdom; 8UniversityofExeterCollegeofMedicineandHealth,CollegeofMedicineandHealth,Norwich,UnitedKingdom

10.1136/ejhpharm-2023-eahp.228

1AFésüs*, 2RBenkő, 2MMatuz, 2ZEngi, 2RRuzsa, 2HHambalek, 3ÁMFésüs, 4TBazsó, 4ZCsernátony, 5IBácskay, 6GKardos. 1UniversityofDebrecen,FacultyofPharmacy DepartmentofPharmaceuticalTechnology,Debrecen,Hungary; 2UniversityofSzeged, InstituteofClinicalPharmacy-FacultyofPharmacy,Szeged,Hungary; 3Universityof Debrecen,DepartmentofTraumatologyandHandSurgery-FacultyofMedicine,Debrecen, Hungary; 4UniversityofDebrecen,DepartmentofOrthopedicSurgery-FacultyofMedicine, Debrecen,Hungary; 5UniversityofDebrecen,FacultyofPharmacy-Departmentof PharmaceuticalTechnology,Debrecen,Hungary; 6UniversityofDebrecen,Departmentof Metagenomics,Debrecen,Hungary

10.1136/ejhpharm-2023-eahp.229

BackgroundandImportance Surgicalantibioticprophylaxisin orthopaedicjointarthroplastiesiscommonreasonforunnecessary,excessiveandirresponsibleuseofantibiotics.

AimandObjectives Thepurposeofthisstudywastoanalyse whetherthecontinuouspresenceofclinicalpharmacistonthe wardmayimproveSAPguidelinesadherenceandclinical outcomes.

BackgroundandImportance

Manymedicationspossessanticholinergicactivity.Theiruseisassociatedwithanumberof seriousadverseeffectsincludingcognitiveeffects.Thecumulativeanticholinergiceffect ofmedicationsasassessedby toolssuchastheanticholinergicburdenscale(AchB)can identifypeopleparticularlyatriskofanticholinergicsideeffects.Currently,morethan20toolsareavailableforclinicianstouse,butthereisnoconsensusonthemostappropriatetool.

AimandObjectives Toassesstheoverallneedforanassessmenttoolaswellastheusabilityofanewlycreatedtool,the InternationalAnticholinergicCognitiveBurdenTool(IACT),to assessanticholinergicburdenofmedications.

MaterialandMethods Anewlycreatedonlinetool,InternationalAnticholinergicCognitiveBurdenTool(IACT),basedon naturallanguageprocessingandchemicalstructureanalysis, wasdevelopedandmadeavailableforclinicianstotestits functions.Wecarriedoutasurvey(between8Februaryto31 March,2021)toassesstheoverallneedforanassessment toolaswellastheusabilityoftheIACT.

MaterialandMethods ThestudywasconductedatanOrthopaedicsDepartmentofatertiarycaremedicalcentre.Overallguidelineadherence(agent,dose,frequency,duration), clinicaloutcomes(lengthofstay-LOS,numberofsurgical siteinfections-SSIs),antibioticex posureanddirectantibiotic costswerecomparedbetweenpre-intervention(retrospective observational)andintervention(prospective)periods.The clinicalpharmacist ’ sinterventionsconsistedofproactively controllingantibioticprophylaxiseverydayonanindividual leveltoensurecompliancewithSAP(agentselection,dosage,andduration)guidelines,attendingsurgicalwardvisits, participatinginantibioticrelateddecisions,andproviding continuouscounsellingservice.SAPguidelineadherence, antibioticexposure,andcostsinthetwoperiodswerecomparedusingChi-square,Fisherexact,andMann-Whitney tests.

Results SignificantimprovementinoverallSAPguideline adherence(by56.2%,from2%to58.2%,p<0.001)was observed.SignificantreductioninSAPduration(by42.9%, 4.1±2.1vs2.1±1.9days,p<0.001),inSAPantibiotic exposure(by41%,from6.1±0.05to3.6±4.3DDD/ patient,p<0.001),andaverageprophylacticantibioticcost(by 54.8%,9278.8±6094.3vs3598.2±3354.6HUF/patient)

4CPS-263 THEPHARMACIST’SROLEINOPTIMISINGSURGICAL ANTIBACTERIALPROPHYLAXIS(SAP)

wereobserved.Moreover,prolongedprophylaxishasnobenefitonclinicaloutcomes(LOS:decreasedby37.2%,11.2±7 to7.62±3days,p<0.001;confirmedSSIs:deceasedby 1.8%,from3%to1.2%,p=0.21).

ConclusionandRelevance Continuouspresenceoftheclinical pharmacistiscrucialinoptimisingantibioticuse.Pharmacist ’ sinterventionledtoasignificantimprovementinSAP guidelineadherence,thatentailedalsothesignificantreductionofantibioticexposure,lengthofstay,andcosts.Additionalresearch,focusingonempiricalandtargetedantibiotic therapyandimplementationofoptimisingantibioticuse,is needed.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Fesus,A., etal.TheEffectofPharmacist-LedInterventiononSurgicalAntibacterial Prophylaxis(SAP)atanOrthopedicUnit.Antibiotics(Basel),2021: 10(12)doi.org/ 10.3390/antibiotics10121509

ConflictofInterest Noconflictofinterest

Section5:Patientsafetyandquality

assurance

5PSQ-002 PHARMACISTINSECURINGDRUGCIRCUIT:FROM PRESCRIPTIONTOADMINISTRATION(ANALYSISAND ACTIONS)

1CMuziotti*, 1JFodimbi, 1CUnia, 2FSantin, 1LDol. 1CentreHospitalierD'hyeres,Service Pharmacie,Hyeres,France; 2CentreHospitalierD'hyeres,QualityService,Hyeres,France

10.1136/ejhpharm-2023-eahp.230

BackgroundandImportance Inamultidisciplinaryhospital with426beds,rolesofhospitalpharmacistarevariedand drugcircuitpresentsmanyrisksofmedicationerror.AccordingtotheWHO,therolesofpharmacistsare ‘theSevenstar Pharmacist’:caregiver,decisionmaker,communicator,leader, manager,lifelonglearnerandteacher.

AimandObjectives Objectiveofthisstudyistomeasureeffectivenessofactionstakenbypharmaciststoreducemedication errors:fromprescriptiontoadministration.

MaterialandMethods Between2019and2022,acompilation ofauditshavebeenmade.Variousstagesofdrugcircuitwere auditedusingpreviouslyvalidatedauditgrids.Eachaudithave beenmadeduring15daysforallnewprescriptions.Astatisticalanalysisofproportioncomparingtheerrorratebeforeand aftertheimplementationofimprovementactionswascarried out.Prescriptionofallinjectabledrugshasbeenformalised, newdoctorsarrivingatthehospitalaremadeaware.Concerningmedicationreconciliation:intheeventofadiscrepancy observed,doctorissystematicallyinformed,apharmacystudenthasbeenassignedtothesurgeryunit.Errorsnot detectedduringpharmaceuticalvalidationwerepresentedto allpharmacists.Measurestoreduceriskoftaskinterruption wereimplementedduringdispensing(dedicatedemergencytelephoneline,redefiningtasks).Concerningadministrationof medication:trainingworkshopdaysfornurseshavebeencreatedbypharmacists.

Results Resultsshowedastatisticallysignificantimprovement incertaincriteria(statisticalanalysisofproportion:comparingerrorratebeforeandafteractions;alpha=5%):medicationreconciliationrateincreasedfrom64%in2019to73% in2021(64%VS73%);errorsnotdetectedduring

pharmaceuticalvalidation(2%VS1%);dispensingerror(3% VS2%);lackofknowledgeoftheestablishment'sdrugadministrationprocedure(58%in2019VS33%in2022).Onthe otherhand,certaincriteriahavedeteriorated:prescription compliantin70%in2019and65%in2022.

ConclusionandRelevance Thisstudyhasmadeitpossibleto objectifythatactionsofpharmacistshavebeenbeneficialin managementofpatients.However,wefindthatactionstaken toimproveprescriptionofdrugshavenotbeeneffective.It wouldbeinterestingtosetupcontinuoustrainingfordoctorsontheuseoftheprescriptionsoftwareinour establishment.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-003 PERFORMANCEOFACOLDMAINTENANCEDEVICE DURINGTHEIMPLEMENTATIONOFAPNEUMATIC CIRCUIT

CFerrari*,HModeste,PBesnier,RBaveux,CECollet,GSaint-Lorant. CaenUniversity Hospital,Pharmacy,Caen,France

10.1136/ejhpharm-2023-eahp.231

BackgroundandImportance Fewinformationareavailable abouttheperformanceofcoldmaintenancedevice.

Withintheframeworkoftheimplementationofapneumaticsysteminanewuniversityhospital,thefeasibilityof sendingdifferenttypesofmedicines,includingcoldproducts withapneumaticsystemwasstudied.

AimandObjectives Theobjectiveofthisstudyistoevaluate thecomplianceofacoldmaintenancedevicewithina pneumatic.

MaterialandMethods ThestudywasledinaFrenchUniversityHospitalwith1495bedsandmorethan80careunits betweenMayandSeptember2022.Theanalysiswasmade withkitsprovidedforthecartridgesdedicatedtocold transportandwithqualifiedelectronictemperaturerecordersLog-tags ® (C.M.IFrance,Neung-sur-Beuvon).Different conditionsweretested,oneconditionpertest,reproduced atleast3times:kitsplacedatroomtemperature,inthe fridge(2/8 °C)orinthefreezer,presenceornotofasecondarypackaging,eutecticplateorputtingthekitinthecartridge.Thesupplierhadcertifiedonhiscommercialleaflet adurationof50minbetween2and8 °Cunderthefollowingconditions:500mlinfusionbagstoredat5 °C,with thermalrecorderinsidethebag,placedinthekitthenin thecartridge.

Results Alltheresultsofthe9differenttests(onecondition pertest,reproducedatleast3times)donotmeetthe50 mindataindicatedbythesupplier.Themethodappliedby thesuppliershowsameandurationbetween2and8 °Cof 4.20min[4;5]Usingthesame startingconditions:freezing thekit,gaveanaverageof8.20min[7;9],usingasecondarypackaging,theaveragewas6.40min[6;7],outsidethe cartridge,theaveragewas4.40min[4;6],andaddingan eutecticplate,theaveragewas29.24min[11;60]butwith atemperaturebelow0 °C.Theaverageforalltestsis8.46 min.

ConclusionandRelevance Thisstudyshowedthatthesupplier ’sdeviceanddatadidnotcomplythegoodpracticesconcerningmanagementofhealthproductssubjecttocoldchain andthepatientsafety.

Variousstudieshavebeenundertakenatthelevelofthe Hospitalpharmacyandthecoldsuppliertoimprovethesuppliedisothermalenclosure.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-004 EPCLUSARELATEDSLEEPINESS:ACASEREPORT

RPlaPasán*,ISánchezLobón,MCorralesPaz,JTudelaTomás,MJHuertasFernández,

10.1136/ejhpharm-2023-eahp.232

BackgroundandImportance Epclusaisatwo-drugcombination administeredasasingledailypillcontainingVelpatasvirand SofosbuvirusedtotreatdeHepatitisC.Thetreatmentdurationis12weeksandthecureratesarefrom97%to100% inthosepatientswithoutcirrhosisorwithcompensated cirrhosis.

Basedondataobtainedfromphase3clinicalstudies,the percentageofpatientsexperiencinganyseriousadverseevent was3.2%.Themostcommonadversereactionsobservedare headacheandfatigue.

Pharmacovigilancecollectsinformation,andanalysesand notifiescaseofsuspectedadversedrugreactions(ADRs)to preventthemoccurringinthefuture

AimandObjectives Todescribeacaseofsleepinessina patienttreatedwithEpclusaandestablishitspossible association.

MaterialandMethods Wedescribeacaseofan72-year-old womandiagnosedwithhepatitisCwithcompensatedcirrhosis andtreatedwithEpclusa.InMay2022,beforestartingthe treatmentwithEpclusa,herhomemedicationwascheckedat thePharmacyDepartment,whichincludeatorvastatin,enalaprilandomperazole;pointingouttoseparatetheintakeof omeprazoleandEpclusa4hoursandprovingtherenowere anydruginteractions.After16daysreceivingthetreatment withEplcusa,shewasreferredtotheemergencydepartment presentingsleepinessandgeneraldeterioration.Asaresult, shewasdiagnosedwithcommoncoldandtreatedwithamoxicilin.Italsocoincidedwithconstipation,whichspontaneously resolvedwithintwodays.FinallyEpclusatreatmentwas stopped.

Results 4daysafter,shereportedimprovementinsleepiness afterdiscontinuationoftreatment,althoughtheiatrogenicorigincannotbeguaranteedsinceithasalsocoincidedwith catarrhalsymptomsandconstipation,bothsituationsinresolution.Naranjo’salgorithmsestablishthecausalityrelationship aspossible(scoreof2).TheSpanishpharmacovigilancecentre wasnotified.

ConclusionandRelevance TheEuropeanMedicinesAgency ’ s technicalsheetforEpclusadoesnotdescribesleepinessasan ADR.Patientcouldconfusefatiguewithsleepinessindealing withsubjectivesymptoms.TheRPCreportedthiscaseasthe onlyEpclusaADRnotifiedinourcountry.Thereportingof ADRsinhospitalsisveryimportantbecauseinnovativenew drugsareusuallyused,severeADRsaremostlikelytobe seeninhospitalsanditcanbedetectedearlyhelpingothers howtoact.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-005 ANALYSISOFANTI-ANGIOGENESIS-RELATED ADVERSEEVENTSASSOCIATEDWITHVASCULAR ENDOTHELIALGROWTHFACTORRECEPTOR-TYROSINE KINASEINHIBITORS(VEGFR-TKIS)INPATIENTSWITH METASTATICRENALCELLCARCINOMA

1,2NLee*, 3JLLee, 2JYLee. 1AsanMedicalCenter,DepartmentofPharmacy,Seoul,KoreaSouth; 2SeoulNationalUniversity,CollegeofPharmacyandResearchInstituteof PharmaceuticalSciences,Seoul,Korea-South; 3AsanMedicalCenter-UniversityofUlsan CollegeofMedicine,DepartmentofOncology,Seoul,Korea-South

10.1136/ejhpharm-2023-eahp.233

BackgroundandImportance Oralvascularendothelialgrowth factorreceptor – tyrosinekinaseinhibitors(VEGFR-TKIs) arestandardtreatmentsformetastaticrenalcellcarcinoma. TheVEGFpathwayplaysanimportantroleinthephysiologicalfunctionandhomeostasisofthecardiovascularand kidneysystems,resultinginanti-angiogenesis-relatedadverse events(AEs).Limitedstudieshaveevaluatedanti-angiogenesis-relatedAEsinvolvingVEGFR-TKIsusingreal-worlddata, whichmayprovideimportant evidencefordrugchoiceand monitoringinthetreatmentofmetastaticrenalcell carcinoma.

AimandObjectives Thisstudyaimedtoinvestigatetheincidenceandpatternsofanti-angiogenesis-relatedAEsassociated withtheuseofVEGFR-TKIsinpatientswithametastatic renalcellcarcinomausingreal-worlddata.

MaterialandMethods Thiscross-sectionalstudyincluded patientswithadiagnosisofmetastaticrenalcellcarcinoma whoreceivedaxitinib,cabozantinib,pazopanib,sorafenib,and sunitinibatthethirdlevelhospitalinSouthKoreabetween January2007andDecember2019.Anti-angiogenesis-related AEswererated ‘possible’ orhigherontheWHO-Uppsala MonitoringCentre(WHO-UMC)causalityassessmentscale. TheseverityofAEswasgradedusingtheCTCAEv.5.0.To comparetheincidenceofAEsassociatedwithdifferent VEGFR-TKIs,wedividedtheenrolledpatientsintothosewho hadnotpreviouslyreceivedaVEGFR-TKI(VEGFR-TKI-naïve) andthosewhohadpreviouslyreceivedaVEGFR-TKI (VEGFR-TKI-experienced).

Results Atotalof988patientswereincluded(75%men, median61years).644patientswereVEGFR-TKI-naïveand 314patientswereVEGFR-TKI-experienced.Anti-angiogenesisrelatedAEsofanygradeoccurredin65.1%ofVEGFR-TKInaïvepatientsand54.8%ofVEGFR-TKI-experiencedpatients. Inaddition,severeAEsoccurredin34.6%ofVEGFR-TKInaïvepatientsand36.0%ofVEGFR-TKI-experiencedpatients. Regardlessoftreatmenthistory,themostcommonAEwas hypertension,witha48.6%ofVEGFR-TKI-naïveand35.0% ofVEGFR-TKI-experienced.ForVEGFR-TKI-experienced patients,theoverallrateofanti-angiogenesis-relatedAEsfor sorafenib(24.3%)waslowerthanthatforotherVEGFR-TKIs (p<0.05).Femalegender(adjustedhazardratio[aHR]1.23, 95%confidenceinterval[CI]1.02-1.48)andhighbloodpressure(aHR1.47,95%CI1.23-1.76)wereriskfactorsfor VEGFR-TKI-associatedAEs.

ConclusionandRelevance Morethanhalfofpatientswith renalcellcarcinomareceivingVEGFR-TKIexperiencedantiangiogenesis-relatedAEs.AnygradeofAEsoccurredmorefrequentlyinVEGFR-TKI-naïvepatients,whilesevereAEs occurredmorefrequentlyinVEGFR-TKI-experiencedpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

MVManzanoMartin. HospitalPuertaDelMar,Farmacia,Cadiz,Spain

5PSQ-006 IMPACTOF PUIZZLE,APLAYFULEDUCATIONALTOOL ONHIGH-ALERTMEDICATIONSONHEALTHCARE

PROFESSIONALS'KNOWLEDGE:A7-MONTHS ANALYSIS

1EChen*, 1VLamand, 1LCatala, 2WCaré, 2HNielly, 1CBroncard, 1BReynaud, 1ALAntoine. 1InternalUsePharmacy-BéginMilitaryTeachingHospital,Val-De-Marne, Saint-Mandé,France; 2DepartmentofInternalMedicine-BéginMilitaryTeachingHospital, Val-De-Marne,Saint-Mandé,France

10.1136/ejhpharm-2023-eahp.234

BackgroundandImportance High-alertmedications(HAMs) canleadtoseriousadverseeventswhenerrorsoccurduringthedrugmanagement.Toraiseawarenessamong healthcareprofessionals(HCPs),ourhospitalpharmacy hasdevelopedafuneducationaltoolinpuzzleform: PUIzzle(PUIistheFrenchacronymforinternaluse pharmacy).

AimandObjectives ToevaluatePUIzzle’simpactonHCPs’ knowledgeonHAMs,aswellasparticipants’ satisfaction.

MaterialandMethods Ourmonocentricstudytookplaceina 300-bedhospitalinParisregion(France)betweenJanuary andAugust2022.Noethicalapprovalforthestudywas requestedasparticipationwasvoluntaryandanonymous. PUIzzleconsistsof12piecescontaininggeneralinformation onHAMsandadescriptionoftheirmanagement,monitoringandantidotes.Aquestion-cardisassociatedwitheach puzzlepiece.Toassesstheirknowledge,participantscompletedapre-andpost-trainingquestionnaireconsistingof fivemultiple-choicequestions,withatotalscoreranging from0to5.Theyalsocompletedasatisfactionquestionnaire consistingoffouritemsratedfrom1 ‘ dissatisfied ’ to4 ‘ very satisfied’

Results Atotalof147participantsweretrainedduring39 sessions:92nurses,17pharmacytechnicians,17paramedicalstudents,12caregivers,7healthcarestudents,1pharmacistand1physician.Sessionmediandurationwas60 minutes[min=55;max=110].Theaverageknowledge scoresbeforeandaftertraining(AFT)wererespectively1.1/ 5and3.1/5(+40%).Beforetraining,54(37%)HCPshad ascoreof0,versus4(3%)AFT,43(29%)ascoreof1, versus20(14%)AFT,34(23%)ascoreof2,versus21 (14%)AFT,13(9%)ascoreof3versus42(29%)AFT,3 (2%)ascoreof4,versus35(24%)AFT.Twenty-fiveHCPs (17%)achievedthehighestscoreof5,onlyAFT.Asignificantimprovement(p<0.001)withanaverageincreaseof +2points( s=0.104)wasobserved.Regardingsatisfaction ofthetraining,participantsattributedanaveragescoreof 3.8/4( s=0.096).

ConclusionandRelevance PUIzzleisafuneducationaltool thatsignificantlyimprovesHCP'sknowledgeonHAMs.SuitabletoallHCPs,thistrainingwillgraduallybeextendedto morephysicians.Therefore,PUIzzlewillbepartofacontinuingeducationprogrammeondrug-inducedadverseevents implementedatourinstitution.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-007 IMPACTOF PUIZZLE,APLAYFULEDUCATIONALTOOL ONHIGH-ALERTMEDICATIONSONHEALTHCARE PROFESSIONALS'KNOWLEDGE:WHAT'SNEWAND WHAT'SLEFT?

1EChen*, 1VLamand, 1LCatala, 2WCaré, 2HNielly, 1CBroncard, 1BReynaud, 1ALAntoine. 1InternalUsePharmacy-BéginMilitaryTeachingHospital,Val-De-Marne, Saint-Mandé,France; 2DepartmentofInternalMedicine-BéginMilitaryTeachingHospital, Val-De-Marne,Saint-Mandé,France

10.1136/ejhpharm-2023-eahp.235

BackgroundandImportance High-alertmedications(HAMs) havehigherrisksofcausingharmtopatients.Topreventthis, ourhospitalpharmacytrained147healthcareprofessionals (HCPs)onthistopicusingafuneducationaltoolinpuzzle form:PUIzzle(PUIistheFrenchacronymforinternaluse pharmacy),whichhassignificantlyimprovedshort-termknowledgeonHAMs.However,itsimpactonlong-termknowledge retentionisnotknown.1

AimandObjectives ToevaluatePUIzzle’simpactonHCPs’ knowledgeretentionanditscontributiontoprofessional practices.

MaterialandMethods Ourmonocentricstudytookplaceina 300-bedhospitalinParisregion(France)betweenJanuaryand August2022.Noethicalapprovalforthestudywas requested.HCPs’ knowledgewasassessedwithaself-questionnaireadministered3weeksafterthetraining(3WAT).The firstpartfocusedonprofessionalpractices.Thesecondpart wasidenticaltothepre-andpost-trainingknowledgequestionnaire,tocomparethescoresofthepre-training(PrT), post-training(PoT)and3WATquestionnaires.Thethirdpart hadfiveotherquestionsonHAMs.

Results Ofthe141eligibleHCPs,60completedthe3WAT (31nurses,13pharmacytechnicians,5paramedicalstudents, 4caregivers,6healthcarestudentsand1pharmacist)ina meantimeof3.6months(s=1.37),48werelosttofollowupand33didnotrespond.Fifty-two(87%)HCPscouldsituateoneofthetwoHAMs’ locationlist,and44(75%)could identifyHAMsontheprescriptionsoftware.Mostchangesin practicewereobservedattheprescribinglevel(n=31;52%). HCPsdeclaredbeingmoreattentivetoHAMs’ labelling.The meanscoreofPrT,PoTand3WAT’ secondpartwererespectively1.1/5(s=0.04),3.1/5(s=0.14)and2.5/5(s=0.33).A significantimprovementbetweenPrTand3WAT(p<0.03)and anon-statisticaldecreasebetweenPoTand3WAT(p<0.17) wereobserved.The3WAT’sthirdpartmeanscorewasidenticaltothesecondone(s=0.27).

ConclusionandRelevance PUIzzle’simpactispositiveon HCPs’ practicesandoverallknowledgeretentiononHAMs. Therefore,ourhospitalwillorganiseregulartrainingsessions, andthistrainingwillbetransposedintocontinuingprofessionaleducation.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.E.CHEN,2022, Designofafuneducationaltoolfortrainingonhigh-alertmedicationsandevaluationofitsimpactonhealthcareprofessionals’ knowledge,pharmacythesis,Paris-CitéUniversity,France.

ConflictofInterest Noconflictofinterest

5PSQ-008 ADIGITALASSISTANTTOSUPPORTPATIENTSIN PREPARINGMEDICATIONRECONCILIATION:PATIENT EXPERIENCES

10.1136/ejhpharm-2023-eahp.236

BackgroundandImportance Medicationreconciliationhas becomestandardcaretoobtainacompleteoverviewofthe currentmedicationofapatient.However,itistime-consumingandlabour-intensive.Studieshaveshownpromisingresults foronlinemedicationreconciliationpreparationdoneby patients.Nonetheless,thereisaneedforenhancedpatient supporttomakethisprocessassimpleandeffectiveas possible.

AimandObjectives Toascertaintheexperiencesofpatients usingadigitalassistantforpre-visitonlinemedication reconciliation.

MaterialandMethods Thisstudyfollowedaqualitative, descriptivedesign.InMay2022,rheumatologyandneurology outpatientswereapproachedface-to-facebyarheumatologist/ neurologistduringtheirvisit,ifconsideredcapabletoparticipate.Theyreceivedaninformationletterexplainingthestudy. Participationwasvoluntary.Afterwrittenconsent,patients wereinstructedtouseadigitalassistantforverifyingand complementingtheirhomemedicationonline,afterwhich semi-structuredindividualinterviewswereconducted,audio recordedwiththeparticipant’spermission.Interviewdata wereanonymisedandevaluatedusinginductivethematicanalysisaccordingtothemethodofBraunandClarke.Awaiver wasobtainedfromtheregionalMedicalEthicsReview Committee.

Results Elevenpatientswereincluded.Thestudypopulation comprised2menand9womenwithamedianageof64.0 years(interquartilerange[IQR]50.0-70.0).Themainthemes identifiedamongstpatientexperienceswererelatedtousability,methodofinput,layout,safety,communication,perception andnecessity.Advantagespatientsmentionedwereplaceand timeindependence,efficiencyandincreasedawarenessoftheir medicationuse.Limitedinformationtechnology(IT)skills amongelderlywasthemostfrequentlymentionedbarrierfor usingthedigitalassistant.Suggestionsforimprovementwere relatedtousabilityofthedigitalassistant(e.g.largerfontstyle andascertainthattextsfitthedevice),layout(e.g.provide overviewofgivenanswers)andsafety(e.g.integratedigital assistantinonlinehospitalenvironmentandexplicitlystate thatpatientdataaresavedinasecureenvironment),amongst others.Themajorityofthepatientspreferredthedigitalassistantoveramedicationreconciliationconversationwithapharmacytechnician.

ConclusionandRelevance Overallexperiencesofpatientsusing adigitalassistantformedicationreconciliationwerepositive, demonstratingthereispotentialfortheuseofadigitalassistantinclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-010 DIGOXINADJUSTMENT:COMPARATIVEANALYSISOF THREEPHARMACOKINETICSOFTWARE

1ARodríguezEsquíroz*, 2CLeraltaGonzález, 3MJiménezMeseguer, 3ÁLSalcedo Mingorranz, 3BGarcíaDíaz, 1MSarobeCarricas, 2MFHurtadoGómez. 1Hospital UniversitariodeNavarra,Pharmacy,Pamplona,Spain; 2HospitalSanPedro,Pharmacy, Logroño,Spain; 3HospitalUniversitarioSeveroOchoa,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.237

BackgroundandImportance Digoxinisadrugwithanarrow therapeuticindex(0.8-1.2ng/mL).Therapeuticdrugmonitoringisanimportanttooltoimprovetherapeuticsafetyand efficacy,especiallyinelderlypatients.

AimandObjectives Toestimatetheaccuracyandprecisionof threepharmacokineticsoftwaretoanalyseserumdigoxinconcentrations(SDC).

MaterialandMethods Retrospectiveobservationalstudyin elderlypatientsadmittedtoatertiaryhospitalandtreated withdigoxinin2020.Weexcludedpatientsover80yearsold.Variablesrecorded:sex,age,bodymassindex(BMI), SDC,creatinineclearanceevaluatedbytheCockcroft-Gault equation(CrCl),andconcomitanttreatment:protonpump inhibitors(PPIs)andnon-steroidalanti-inflammatorydrugs (NSAIDs).

SDCwereestimatedwiththreepharmacokineticsoftware: Mediware,PKSandNONMEM.

AccuracyandprecisionwereassessedusingSheinerand Beal'spredictionerrortheory.Accuracywiththemeanpredictionerror(MPE)andprecisionwiththemeanabsolutepredictionerror(MPAE)andthesquarerootoftherootmean squarepredictionerror(RMSE).

Twosubgroupswereanalysed: renalimpairmentpatients (CrCl<60mL/min)andpatientswithtwoormoreSDC.

Results 53patientswith130SDC,31women(58.5%), medianage75.5years-old(66.5-80.7).64%onconcomitant treatmentwithPPIsand41.5%withNSAIDs.

Accuracy: MPE0.002,-0.011,-0.081,forMediware,PKS andNONMEMrespectively.

Precision: MPAE0.193,0.201,0.243;RMSE0.331,0.345, 0.328forMediware,PKSandNONMEM.

Renalimpairment: 32patientswith64levels.

Accuracy: MPE-0.052,-0.028,-0.106forMediware,PKS andNONMEM.

Precision: MPAE0.192,0.246,0.275;RMSE0.330,0.416, 0.363forMediware,PKSandNONMEM.

2levels:36patients

Accuracy: MPE0.003,-0.010,-0.080forMediware,PKSand NONMEM.

Precision: MPAE0.205,0.211,0.235;RMSE0.347,0.360, 0.312forMediware,PKSandNONMEM.

ConclusionandRelevance Thethreesoftwareshowedsimilar accuracyandprecisionforanalysingSDC.

Mediwareisthebesttoolfordailyclinicalpracticein termsofeaseofuse.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

1BMaat, 2ADijkmans*, 3KTenfelde, 3CVanDerLee, 1MKicken, 3JdeWit. 1ElisabethTweestedenHospital,ClinicalPharmacy,Tilburg,TheNetherlands; 2UtrechtUniversity, DepartmentofPharmacoepidemiologyandClinicalPharmacology,Utrecht,TheNetherlands; 3TilburgUniversity,DepartmentCommunicationandCognition-TilburgSchoolof HumanitiesandDigitalSciences,Tilburg,TheNetherlands

5PSQ-011 PHARMACOKINETICEVALUATIONOFDRUGSWITHA NARROWTHERAPEUTICRANGEANDTHEIR INFLUENCEONCLINICALDECISION

1ISollano-Sancho*, 2SGarcíaMartínez, 2ALSalcedoMingoarranz, 2APovedaEscolar, 2IOrozcoCifuentes, 1CMorielSánchez, 2BGarcíaDíaz. 1MostolesUniversitaryHospital, HospitalPharmacy,Madrid,Spain; 2SeveroOchoaHospital,HospitalPharmacy,Madrid, Spain

10.1136/ejhpharm-2023-eahp.238

BackgroundandImportance Thereisaneedtocarefullyprescribedrugswithanarrowtherapeuticrangeandpharmacokineticreportsontheirserumconcentrationsarethenecessary toolforthiscommitment.

AimandObjectives Evaluatetheimpactofpharmacokinetic reportsonclinicaldecision.

MaterialandMethods Aprospectiveanalysiswasconductedin asecondarycarehospitalbetweenMarchandAugust2020 includingadultpatientswithatleastoneserumconcentration ofvalproicacid,amikacin,carbamazepine,cyclosporine, digoxin,phenytoin,phenobarbital,lithium,gentamicin,theophylline,vancomycinandvoriconazole.

Dialyzedandnon-admittedpatientswereexcluded.Data wasobtainedfrommedicalrecordsandpharmacokineticsoftware.Thevariablescollectedwere:age,sex,prescribeddrug, clinicaldepartment,pharmacokineticreportandmedical decision.

Results 166patientswith613pharmaceuticalinterventions wererecorded.Ninety-five(57.2%)werewomenwithamean ageof73years(28-100),meanweight66kg(40.5-139.2) andmeanserumcreatinine1mg/dL(0.3-12.5).

Thenumberofpharmacokineticreportsweredigoxin:265 (43.2%);vancomycin:139(22.7%);valproicacid:79 (12.9%);lithium:69(11.3%);amikacin:17(2.8%);carbamazepine:10(1.6%);theophylline:9(1.5%);phenytoin:8 (1.3%);gentamicin:8(1.3%);cyclosporine:4(0.7%);phenobarbital:3(0.5%);voriconazole:2(0.3%).

Pharmacokineticreportsaccordingtotheprescribingclinical department:internalmedicine:223(36.4%),psychiatry:100 (16.3%);andcardiology:71(11.6%)werethemainones.

Thephysician'sacceptanceofthepharmacokineticreports accordingtothedrugweredigoxin:112(37.6%);vancomycin:74(24.8%);valproicacid:43(14.4%);lithium:38 (12.8%);amikacin:13(4.4%);phenytoin:4(1.3%);theophylline:4(1.3%);gentamicin:3(1.0%);carbamazepine:2 (0.7%);cyclosporine:2(0.7%);phenobarbital:2(0.7%);voriconazole:1(0.3%).

Acceptanceofpharmaceuticalrecommendationsbymajor clinicalserviceswereinternalmedicine:110(36.9%);psychiatry:54(18.1%);andgeriatrics:32(10.7%).

Acceptedrecommendationsweredosemaintenance: 202 (75.4%);dosesuspension:26(72.2%);dosereduction:41 (68.3%);doseincrease:26(66.7%).

Thepharmacokineticreportsaccepted295(73.2%).8% werenotacceptedduetopatientdischargeordeath.

ConclusionandRelevance Apharmacokineticareasupports cliniciansinordertoestablishthesafestandmosteffective dosingregimens.

Ahighpercentageofpharmacokineticreportswere accepted,however,itisnecessarytoincreasethispercentage bytalkingtophysiciansandremarkingtheimportanceofthis activity.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-012 CASEREPORT:INHALEDGRANULOCYTEMACROPHAGECOLONY-STIMULATINGFACTORFOR MILD-TO-MODERATEAUTOIMMUNEPULMONARY ALVEOLARPROTEINOSIS – 24MONTHSOFFOLLOWUP

1IOterino*, 2MJLinares-Asensio, 3IMorona-Minguez, 1SSanz-Márquez, 1MPérez-Encinas. 1AlcorconFoundationUniversityHospital,PharmacyDepartment,Alcorcón,Spain; 2Alcorcon FoundationUniversityHospital,PulmonologyDepartment,Alcorcón,Spain; 3Mostoles UniversityHospital,PharmacyDepartment,Mostoles,Spain

10.1136/ejhpharm-2023-eahp.239

BackgroundandImportance Autoimmunepulmonaryalveolar proteinosis(aPAP)isadiseasecausedbyIgGantibodies againstgranulocyte-macrophagecolony-stimulatingfactor(GMCSF).Thetreatmentofchoiceisbronchoalveolarlavage (BAL).

AimandObjectives TopresentaPAPevolutionduring24 monthsoftreatmentwithinhaledGM-CSF.

MaterialandMethods A37-year-oldmalediagnosedwith aPAPinApril2014hasrequired3BAL(October2014,February2016andMarch2019).InthelastBAL,hedeveloped majorcomplicationsthatrequiredadmissiontotheintensive careunit.InOctober2019,hepresentedanewworsening,so off-labeltreatmentwithsargramostim(250mginhaledevery12 hoursfor7dayseveryotherweek)waschosen.

Thepharmacyservicepreparedafavorablereportonofflabeltreatmentandrequesteddrugfromregulatoryagency.In thepharmaceuticalcareconsultation,theadministrationtechnique,stability,dosageregimen,storage(2-8°C)wereexplained anddoubtswereresolved.

Results Theclinicalandfunctionalevolutionoftheventilatory parametersandthesix-minutewalktestareshowninthe table1.

Thefigure1showstheradiologicalevolution(chestX-ray) fromthesituationbeforethirdBAL(1),furtherworsening after7monthsafterthirdBAL(2),improvementafter3 monthsoftreatmentwithinhaledGM-CSF(3)andstability after18monthsoftreatment(4).

growthfactorreceptor2-negative(HR+/HER2 )locally advancedormetastaticbreastcancer(LA/MBC).Neutropenia isthemostcommonadverseevent.Incontrasttoneutropenia inducedbychemotherapyagents,neutropeniaresultingfrom CDK4/6inhibitorsisreversibleanddosereductionsandmodificationsarerecommended.

AimandObjectives Theaimofthisstudywastoevaluatethe neutropeniaduetopalbociclibandtoanalysehowmodificationsintreatmentsaremadeinclinicalpractice.

MaterialandMethods Weconductedadescriptive,observationalandretrospectivestudy(April2016-July2022)ofpatients treatedwithPalbociclibinathirdlevelhospital.Thedata wereobtainedfromtheelectronicmedicalrecordsofthe patientsandtheFarmatoolsManagementprogramme.The parametersanalysedwere:demographicinformation,menopausalstatus,priorlinesoftherapytopalbociclib,frequency andgradesofneutropenia,timefromfirstdosetofirstepisodeonset,dosesreductions,cyclesdelays,useofhuman granulocytecolonystimulatingfactor(G-CSF),changesto otherCDK4/6inhibitoranddiscontinuationtreatment.Data wereprocessedbyMicrosoftExcelsoftware

Results 50womenwithHR+/HER2 MBCweretreatedwith palbociclib.Medianagewas62years.92%(46/50)waspostmenopausal.80%(40/50)receivedpriortherapytopalbociclib and58%(23/40)wasinthecontextofMBC.54%(27/50) receivedPalbociclibasfirst-linetreatment.Startingdosewere: 82%(41/50)125mg;12%(6/50)100mg;6%(3/50)75mg.

Abstract5PSQ-012Figure1

After24monthsoftreatment,thepatienthasnotpresentedanyadverseeventsandmaintainsanexcellentresponse withsignificantimprovementingasexchange,whichhas allowedhomeoxygentherapytobewithdrawn.

ConclusionandRelevance Inconclusion,ourcasesupports thatinhaledGM-CSFhasbeensafeandeffectiveinthetreatmentofaPAPandrepresentsatherapeuticoptionafterresistanceorcontraindicationtoBAL.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-013 PALBOCICLIBINMETASTATICBREASTCANCER TREATMENT:NEUTROPENIAMANAGEMENTIN CLINICALPRACTICE

1ARojasAlbarrán*, 2MDRivasRodriguez, 2AGilGarcia, 2MGrageraGómez, 2MDZambranoCroche, 2HVelazquezVazquez. 1UniversityHospitalComplexofBadajoz, HospitalPharmacy,Badajoz,Spain; 2UniversityHospitalComplexofBadajoz,Pharmacy, Badajoz,Spain

10.1136/ejhpharm-2023-eahp.240

BackgroundandImportance Palbociclibisaselectivecyclindependentkinase4/6(CDK4/6)inhibitorapprovedforthe treatmentofhormonereceptor-positive,humanepidermal

Thefrequencyofneutropenia(all-grade)was74%(37/50); 27%(10/37)wasgrade1-2;73%(27/37)wasgrade3-4.Time fromfirstdosetofirstepisodeonset(cycles)wasreportedin: 8,1%(3/37)first-cycle;56,7%(21/37)second-cycle;13,5%(5/ 37)three-cylcle;21,6%(8/37) fourth-cycle.Neutropenialed todosereductionin54%(20/37)ofpatients;32%(12/37) requiredadosereduction;21,6%(8/37)requiredtwodoses reductions.Cyclesdelaysoccurredin78%(29/37)ofpatients. 19%(7/37)wastreatedwithG-CSFassupportivetherapy. 5,4%(2/37)neededtochangetoanotherCDK4/6inhibitor. 10,8%(4/37)discontinuedtreatment.

ConclusionandRelevance Thefrequencyofneutropeniain ourpopulationwassimilartoclinicaltrials.¹Inclinicalpracticethistoxicitycanbemanagedwithdosereductionand cyclesdelayswithoutleadtodiscontinuationtreatment(only fourpatients)asitisdescribedinguidelines.²

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PivotalstudyPALOMA-3

2.https://cima.aemps.es/cima/dochtml/ft/1161147003/FT_1161147003.html

ConflictofInterest Noconflictofinterest

5PSQ-014 IMPACTOFHISTAMINE-2ANTAGONISTSHORTAGE ONTHEINCIDENCEOFHYPERSENSITIVITY REACTIONSTOPACLITAXEL – TOWARDSCRISIS MANAGEMENTANDAPREMEDICATION RECONSIDERATIONINFRANCE(PACLIREACTSTUDY)

1GStrobbe*, 2LGaboriau, 1MAbele, 1AVillain, 3CAelbrecht-Meurisse, 3ACarnot, 4MCLe Deley, 4CLéguillette, 1ISakji, 1FFeutry, 1GMarliot. 1CentreOscarLambret,Servicede Pharmacie,Lille,France; 2ChuLille – CentreRégionaldePharmacovigilance,Servicede Pharmacologie,Lille,France; 3CentreOscarLambret,PoleD'oncologieMédicale,Lille, France; 4CentreOscarLambret,UnitédeMéthodologieEtdeBiostatistique,Lille,France

10.1136/ejhpharm-2023-eahp.241

BackgroundandImportance AtthebeginningofOctober 2019,aninternationalshortageofranitidineforcedusto adjustpaclitaxel-basedchemotherapypremedicationregimens.

Afterseveralmodifications,weimplementedananti-allergic premedicationprotocolbasedonDexchlorpheniramineashistamine-1antagonist(H1A),Methylprednisoloneascorticosteroid(Doubledoseatfirstinjection)andwithdrawalof histamine-2antagonists(H2A).

AimandObjectives Thisstudyaimedtodeterminetheefficacy ofthismodifiedregimenandassessthehypersensitivityreactions(HSRs)associatedwithit.

MaterialandMethods Weconductedasingle-centreobservationalretrospectivestudyofpaclitaxeladministrations(n=831 patients).Allincidentscharacterisedasdrugallergiesinthe prescribingsoftwarewereexhaustivelyrecordedoveratwoyearperiodfromJanuary2019toDecember2020(before andafterranitidineshortage,includingtheperiodwithoral Famotidineasatransitionalalternative).Tomodeltheriskof allergyateachinjectionaccordingtothetypeofinjectionand possibleconfoundingfactors,amixedlogisticregressionmodel wasimplementedtoaccountforrepeatedadministrationper patient.

Results Amongthe7146paclitaxeladministrations,therewere atotalof27HSRsoccurringin24patients,amongwhom threepatientshadtwoconsecutiveevents.Noprotectiveeffect wasobservedforH2Apremedicationregimens,neitherwhen comparingthetwotypesofH2A(famotidineorranitidine) separately(p=0.94)norwhencomparinginjectionswith H2ApremedicationversusinjectionswithoutH2A(OR:1.12, 95%CI,0.36-3.50,p=0.84).However,theriskofHSRs wassignificantlylowerforpaclitaxelinjectionswithcorticosteroidsthanforthosewithoutcorticosteroids(OR:0.08,95% CI:0.008-0.78,p=0.03).Inaddition,theriskofHSRwas significantlyhigherforthefirst,second,orthirdpaclitaxel injectionsthanforthesubsequentinjections(OR:10.1,95% CI:3.23-31.4,p<0.001).

ConclusionandRelevance Wedidnotfindevidenceofan increasedriskofHSRduetotheabsenceofH2AinthepremedicationprotocolsofPaclitaxel.Ourfindingssupportthe choiceofapremedicationprotocolwithoutH2A,despite whatishistoricallystatedinPaclitaxelmonographs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-016 HUMANFACTORSROLEINMEDICATIONERRORS:

DILUTINGINTRAVENOUSMEDICATIONSATHOSPITAL WARDS – ASTUDYBASEDONINCIDENTREPORTS

1AMulac*, 2EHagesæther, 1,3AGGranås. 1UniversityofOslo,DepartmentofPharmacyThe FacultyofMathematicsandNaturalSciences,Oslo,Norway; 2OsloMetropolitanUniversity, DepartmentofLifeSciencesandHealth-FacultyofHealthSciences,Oslo,Norway; 3UniversityHospitalofNorthNorway,NorwegianCentreForE-HealthResearch,Tromsø, Norway

10.1136/ejhpharm-2023-eahp.242

BackgroundandImportance Humansmakemistakes,inadvertentlywhenmakingpoordecisions,beingdistractedor whennotperceivingriskwhilstmanagingmedications. Healthprofessionalsdonotmakemistakesonpurpose, yetmedicationerrorsremainthemostcommontypeof medicalerrors.Ahumanfactorsapproachcanbeapplied toaddressthecausationofmedicationerrorsfroma

processpointofviewwhileadd ressingourerror-prone humannature.Intravenousmedicationsarecomplexto prepareandadminister.Specifictasks,suchasdiluting intravenousmedicationsareatahigherriskofmedication errors.

AimandObjectives Thisstudyaimstoaddresshumanfactors inmedicationcalculationerrorsinvolvingdilutionofintravenousmedications.

MaterialandMethods Fromthemedicationerrorsreported in2016and2017totheN orwegianIncidentReporting System,wespecificallyscrutinisedmedicationcalculation errorsthatrequireddilution duringmedicationpreparation, dispensingandadministration.Weincludedrealeventsthat hadreachedthepatients,andwhichcontainedsufficient incidentdescriptiontoallowforcausalanalysis.Fromthe incidentdescriptions,weco nductedacontentanalysisof humanfactors.

Results Intotal,14incidentsmettheinclusioncriteriaand involvedthedilutionofmorphine,oxycodone,adrenalin, andnoradrenalin.Severalhumanfactorsexposedtheintravenouspreparationprocesstorisks.Forexample,performingtaskswithcognitiveloads,suchasdilution,followed bybedsidedosecalculationwhilstprovidingpatientcare. Somedilutionerrorswerecausedbynotknowingthe exactconcentrationafterdilution,whichresultedinone infantreceiving7mgofmorphineinsteadof0.7mg. Administeringfromasyringethatcontainsmorethanthe prescribeddosewasfoundasahigh-riskpractice.Most dilutionerrorsledtooverdosagesandresultedinpatient harm.

ConclusionandRelevance Thisstudydiscusseshowcognitive processingisrelatedtomedicationerrors.Addressinghuman factorsthatcontributedtomedicationerrorsshouldinvolve systemicmeasureswhichtakeinaccounthowhumansthink andprocessinformationtoavoidpatientharmfromdilution errors.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-019 ANALYSISOFTHEUSEOFIDARUCIZUMABINA

TERTIARYHOSPITAL

CRodriguez-TenreiroRodriguez*,MMuñozVillasur,VGarcíaJiménez,CLFernández Laguna,LMacíaRivas,IdelaFuenteVillaverde,SFernándezLastras,MEiroaOsoro, LOyagueLópez,ALozanoBlázquez. CentralUniversityHospitalofAsturias,Hospital Pharmacy,Oviedo,Spain

10.1136/ejhpharm-2023-eahp.243

BackgroundandImportance Theevaluationofanticoagulation reversalpracticesofdirect-actingoralanticoagulantsallows theiroptimisationbyimprovingtheirsafetyandefficiency.

AimandObjectives Toreviewtheuseofidarucizumabinthe reversaloftheeffectofdabigatranandtoevaluateitseffectivenessinthenormalisationofcoagulationparametersand clinicalevolutionofthepatient.

MaterialandMethods Descriptive,observational,retrospective studyofallpatientswhoreceivedidarucizumabintheperiod fromDecember2015toJune2022,inclusive,inatertiary hospital.Datawerecollectedfromtheelectronicmedical record.Variablesassessedwere:demographics(age,sex);coagulationparameters[activatedpartialthromboplastintime (aPTT)];indicationanddoseofdabigatran;reasonfor

prescriptionanddoseofidarucizumab;responsetotreatment (normalisationofaPTTandclinicalevolution).

Results Fifty-fourpatientsprescribedidarucizumabwereidentified.Onepatientwasexcludedbecauseactivetreatmentwas declined(n=53).Medianagewas82years(RIQ:75-88.5), 58.5%maleand41.5%female.Theindicationfordabigatran wasstrokepreventionandsystemicembolismduetonon-valvularatrialfibrillationin52patientsandstrokein1patient.

Thedosesofdabigatranreportedinthemedicalrecordswere: 150mg/12hin16patients,110mg/12in34patientsand 75mg/12in1patient(nodatain2patients).Thirty-six patientsreceivedidarucizumabformajorbleeding,12for urgentsurgery,3forurgentinvasiveprocedureand2for supratherapeuticlevelsofdabigatran.Inallcasestheindicationwasestablishedbythehaematologydepartment.Median aPTTbeforeantidoteadministrationwas46.95seconds(RIQ: 35.2-52.5)(n=52);1patienthadsupratherapeuticlevelsof dabigatran,showingincoagulable.MedianaPTTafteridarucizumabadministrationwas27.4seconds(RIQ:25-29.8)(no post-administrationaPTTvaluesin6patients).Thedoseof idarucizumabwas5ginallcases.Fourpatientsdied.In49 patientstreatmentwaseffectivewithnoepisodesofrebleeding orthromboembolism.

ConclusionandRelevance Idarucizumabwasmostlyusedin majorbleeding.Treatmentwaseffectivein92%ofthestudy population.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-020 ANALYSISOFAPHARMACEUTICALINTERVENTIONIN POLYMEDICATEDPATIENTSTOINCREASETHE SAFETYANDADEQUACYOFTHEIRTREATMENT

BNucete,LGonzalez,AMarchena,MAGarciaLirola*. DistritoSanitarioGranada Metropolitano,Pharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.244

BackgroundandImportance Polymedicationhaspotential healthrisksforpatientssuchasinteractionsandincreasedrisk ofadverseeffectsthatcanbefatal.

AimandObjectives Theaimofthisstudywastoanalysea pharmaceuticalinterventioncarriedoutbyagroupofpharmacistsinpatientstaking15ormoredrugsconcomitantlyto improvethesafetyandadequacyoftheirprescriptions.

MaterialandMethods Pre-poststudythatincludedpatientsof anyage,with15ormoredrugprescriptions,prescribedbya generalpractitoners(GPs)intheelectronicprescriptionsystem,fromJanuarytoDecember2021.Theinterventionwas performedby9pharmacistsin35primaryhealth-care centres(PHCC)and673GPs.Theyprovidehealthcareto 677,782inhabitants.First,ageneralsessionwasheldineach PHCC,presentingtheobjectivesandinformativematerial. Subsequently,individualmeetingswerescheduledwitheach physician,inwhichthepharmacistsprovidedtheprescribers withlistsofpolymedicatedpatients(PP)andvariouslocal documents,STOPP/START,Beerscriteriaandclinicalpractice guidelinestohelpreviewtreatments.Eachprescribeddrug wasevaluatedbasedonitsnecessity,effectiveness,appropriatenessandsafety.Inaddition,thepharmacistsalsoissued reviewreportsonpatientswithparticularlycomplexpathologies.ThereviewsperformedwererecordedbytheGPsin thedigitalhealthrecord.TheserecordsandlistsofPPwere

extractedthankstoalocalsoftwareapplicationandanalysed inExcel.

Results Pharmacistsprovided39grouptrainingsessionsand 387individualmeetingstotheGps.Atotalof1468patients metthecriteriaforPP.Meanage73.58years+-11.14(58% women).Prescriptionsof91.7%ofPPwerereviewedatleast oncein2021.Atotalof4,848reviewswereperformed.

In14.41%ofthecases,anewtreatmentwasstarted.In 14.73%oftherevisions,itwasnecessarytochangethedosage ortheprescribedtreatmentregimen.In27.81%ofthecases, theGPscancelledadrugfromthepatient´sprescriptions.In 54.68%ofthereviews,nochangeintreatmentwasmade ConclusionandRelevance Theinterventionhadahighlevelof acceptance.

Despitethehighpercentageofpatientsreviewed,itisstrikingthehighnumberofpatientsinwhom,nochangeintheir treatmentwasmade,whichraisesthequestionofwhetherthe reviewswerecorrect.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-021 AUTOMATIONMEETSTRACEABILITYTOOPTIMISE DRUGSANDMEDICALDEVICESLOGISTICS

GUARANTEEINGPATIENTSAFETYANDHOSPITAL STAFFWELL-BEING

1APiovanelli*, 2DTrojaniello, 3AFusco, 3DBonetti. 1AntaresVisionGroup,Digital Healthcare,TravagliatoBrescia,Italy; 2IrccsOspedaleSanRaffaele,CenterForAdvanced TechnologyInHealthandWellbeing,Milan,Italy; 3AntaresVisionGroup,DigitalHealthcare Department,TravagliatoBrescia,Italy

10.1136/ejhpharm-2023-eahp.245

BackgroundandImportance HospitalSanRaffaelewasseeking asolutiontoimprovethemedicationmanagementprocessand logistics,spanningfromcentralpharmacytothepatient’sbedside,inordertoavoidshortage,improvestaffwell-beingand patientsafetybyensuringthefiverightsofmedicationadministration(patient,drug,dose,timeandroute).

AimandObjectives TheCovidemergency,theshortageofpersonnelandtheneedtocontrolhealthcarespending,arekey driversinseekinginnovativesolutionstoimprovetheefficiencyindrugsandmedicaldeviceslogistics.

Thenewsystemincludesanewgenerationofautomated cartsandcabinets:beforeeachround,thesoftwarepredicts theoverallneedfordrugs/medicaldevices.

Thedrugsareautomaticallyloadedintothecartswithout anyhumanintervention.

Duringtheround,oncethepatientisidentified,theautomatedcartretrievesthedrug(s)tobeadministeredandplaces themdirectlyonthecountertop.

Thesystemtracksalltheoperations:whichdrugwas administered,atwhattimeandbywhom.

Thenewsystemenablesend-to-endtraceabilityensuringthe completevisibilitytothehospitalpharmacists/staffondrug flowsfromthecentralpharmacyuptomedicines’ administrationandbringingmanybenefitssuchas:logisticsoptimisation andinventoryaccuracybyavoidingwasteandshortage,while guaranteeingpreciserecalls/withdrawalsandhavingareal-time visibilityontheentirehospitalstocks.MaterialandMethods

ThestudycomparedthenewAUTOMATEDsolutionversustheTRADITIONALonebymeasuringdifferentmetrics andKPI.

Apanelofnurseswasselectedtoconductthetestwithdifferentprofiles(age,experience,andconfidencewithITapplications).Eachnursewasaskedtocarryonsomecyclesofthe therapydispensingandtoexpressevaluations,inaranking from1to5,onseveralparametersrelatedto:

. Trackingofalloperations

. PatientSafety

. Ergonomics

. Efficiency

Results

Abstract5PSQ-021Figure1

ConclusionandRelevance Theresultsshowthattheautomatic systemisprevailingoveralltargetmetrics,withparticularlya highgaponsafetyandefficiency,thankstothereductionof non-value-addedactivitiessuchasmanualdrugsreplenishment ofthestockswithincabinetsandcarts,enablingwhatreally matters:thePatientCare.

Thisprovidestothehealthcaresystemsanewdisruptive platformthatmakestheworkofhospitalstaffeasier,more efficient,reliablethusensuringpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

priortothebeginningoftreatmentandinthe6monthsafter treatmentof5patients(3womenand2men).DatawerecollectedfromtheclinicaldatabaseoftheAndalusianHealthSystem(Diraya).Allpatientshadahighdegreeofcomorbidity andVUswithuncontrolledpain.

Results Thefollowingfigureshowsthenumberoftimesthat patientsgotohealthservicesforuncontrolledpainassociated withvascularulcers.Thereisadecreaseinemergencycare visitsinallthepatientsstudiedafterthestartoftreatment.It shouldbepointedoutthatpatients2,4and5didnothave togotothehealthemergencyservices.

5PSQ-022 ANALYSISOFHEALTHCAREVISITSTOEMERGENCY SERVICESFROMPATIENTSWITHPAINFULVASCULAR ULCERSTREATEDWITHTOPICALSEVOFLURANE

MTGomezSanchez,FDFernandezGines,BSanchezRodriguez,MSanchezValera, TMorenoDiaz*,DGamezTorres. HospitalTorrecardenas,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.246

BackgroundandImportance Patientswithchronicvascular ulcers(VUs)sufferpainthatisfrequentlymanagedwithsystemicanalgesicssuchasopioids,exposingthepatienttothe secondaryeffectsofthesedrugs.Therefore,thereisadecrease inthepatient'squalityoflifeandanincreaseinemergency healthcare.Recently,sevofluranehasbeenshowntohavea rapidanalgesiceffectwhenappliedtopicallyonVUs,providinganewtherapeuticalternativeinpainmanagement.

AimandObjectives Toevaluatetheanalgesiceffectivenessof topicalsevofluraneinpoorlycontrolledVUsusingacomparativeanalysisofemergencyandscheduledhealthcarebefore andafterthebeginningoftreatment.

Abstract5PSQ-022Figure1

ConclusionandRelevance Thisstudyseemstoshowadecrease inemergencyhealthcareafterapplyingtopicalsevofluranedue toitsroleasananalgesicinpatientsrefractorytoconventionaltherapies.Obviously,relevantclinicaltrialsarerequiered toadequatelyestablishtheroleoftopicalsevofluraneinthe painmanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-023 SEVEREPHOTOTOXICITYREACTIONASSOCIATED WITHVANDETANIB:ACASEREPORT

1MDPBriceñoCasado, 2MDGil-Sierra, 2CMorenoRamos*, 3BdelaCalle-Riaguas, 1CMCuadros-Martinez. 1HospitalUniversitariodeJerezdelaFrontera,HospitalPharmacy, JerezdelaFrontera,Spain; 2HospitalUniversitarioPuertoReal,HospitalPharmacy,Puerto Real,Spain; 3HospitalNuestraSeñoraDelPrado,HospitalPharmacy,TalaveradelaReina, Spain

10.1136/ejhpharm-2023-eahp.247

BackgroundandImportance Vandetanibisatyrosinekinase inhibitorusedforthetreatmentofmetastaticmedullarythyroidcancer(MMTC).Thisdrughasbeenassociatedwith phototoxicity,butrarelysevere.

AimandObjectives Toreportacaseofseverephototoxicity reactionassociatedwithvandetanib.

MaterialandMethods

Theclinicalmanagementofacasewith rarephototoxicityadversereactionwasdescribed.Electronic medicalrecordswereusedtocollectpatientdata:baseline clinicalcontext,adverseevents,treatment,andclinicalevolution.Naranjoalgorithmwasusedbyhospitalpharmacistto stablishthecausalityofphototoxicity.

MaterialandMethods

Aretrospectivestudywasdesignedto quantifyurgentandscheduledcarevisitsinthe12months

Results An82-year-oldmannewlydiagnosedwithMMTC startedtreatmentwithvandetanib.After12days,he

presentedslightrashindorsalregion.Thepatientreceived oneradiotherapysession.Seventeendaysafterstartingvandetanib,hevisitedEmerg encydepartmentforgeneralised erythema(onface,neck,upperandlowerlimbs),flushing andpruritus,relatedtobriefsunexposure.Thepatientwas treatedwithsingledoseintramuscularmethylprednisolone andoraldexchlorpheniramine. Vandetanibandradiotherapy werediscontinued.Fivedayslater,thepatientpresented severedeterioration,progressi onoferythemaandintense oedemainhands,feetandface.Deflazacortwasprescribed. AfterdiagnosisbyDermatologydepartmentofacutephototoxiceruption,treatmentwasstartedwithprednisone45 mg/dayfor7dayswithprogressivedecrease,emollientsand topicalmethylprednisolone .Betweendays26-40,gradual improvementofoedemaanderythemawasobservedwithoutappearanceofnewtoxicity.Prednisonedosewas reduced.Progressively,des quamationandscabswere observedonbothhands,withimprovementoflegandfoot ulcers.Poorpaincontrol requiredtapentadol25mg/12 hours.Onday62,therewasaworseningwithincreased erythemasinceoralprednisonewasreduced.Treatmentwith Polypodiumleucotomos ,vitaminD,CandEwasinitiated. Onday68,therewasasignificantimprovementwithno itchiness.Threemonthsaftersymptomonset,itchingand erythemahadalmostdisappeared.Remaininghyperpigmentationoftheskinwasobserved.Naranjo'salgorithmdeterminedaprobablerelationsh ip(score5)andreintroduction ofvandetanibwasdiscouraged.

ConclusionandRelevance Hospitalpharmacistdetermineda probablerelationshipbetweenvandetanibandseverephototoxicityreactioninapatientwithMMTC.Theroleofhospital pharmacistsisessentialinpharmacovigilanceandininforming patientsaboutpossibleadverseeventsofdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-024 HAZARDVULNERABILITYANALYSIS(HVA): EVALUATIONOFRISKINEXPERIMENTAL ONCOLOGICALDRUGSCOMPOUNDING

1GCancellieri*, 1MSantonocito, 1EdeLuca, 1CBotto, 2RGiammona, 2PPolidori. 1UniversitàDegliStudiDiPalermo,Ssfo – ScuolaDiSpecializzazioneInFarmacia Ospedaliera,Palermo,Italy; 2OspedaliRiunitiVillaSofia – Cervello,UocFarmacia,Palermo, Italy

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BackgroundandImportance Variousclinicaltrials,especiallyin oncologyandhaematology,involvechemiotherapicdrugscompounding.Thesepreparationsrequirestandardworkingproceduresforwhichhospitalpharmacistisresponsible.Oncological drugsusedinclinicaltrialsarecharacterisedby:lowtherapeuticindex;unknowntoxicity;dosagetobepersonalisedon patient;assignmentofnumberkit/placebotospecificpatient; associationswithotherdrugsnotknowninconsolidatedclinicalpractice.Alltheseelementscancontributetotheoccurrenceofpotentialerrors.

AimandObjectives TheaimofthisstudyistousedHazard VulnerabilityAnalysisinordertoclassify,intohigh,medium, lowrisk,experimentalprotocolsthatprovideforchemiotherapicdrugscompoundingandwhicharecurrentlyactiveour hospital.Forprotocolsclassifiedashighrisk,standardprocedureswillbeoutlinedtominimiserisks.

MaterialandMethods Inordertodeterminethepercentage risk(R%),iscalculated:probability(P)thatanerrorwilloccur, bycalculatingthenumberofpreparation-phases;magnitude (MA)bycalculatingcarcinogenicity,storagetimeofpreparationandchemicalincompatibilitybetweendrugsandmedical devices;mitigation(MI)bycalculatingdrugdosage,chemicalphysicalpreparationstability,possibleuseofsafety-devices.By applyingtheformulaR%=(P/3)*[(MA+MI)/18]*100,protocols aredefinedlow-riskifR%<30%,moderate-riskif30%£R%£ 60%,High-riskifR%>60%.

Results Among35activeclinical-trialsanalysed,18require chemiotherapicdrugscompounding.For33%(6/18)ofprotocolstheprobabilityislow;50%(9/18)ismoderate;17%(3/18) ishigh.For44%(8/18)ofprotocolsthemagnitudeislow; 50%(9/18)ismoderate;6%(1/18)ishigh.Finally,for6%(1/ 18)ofprotocolsthemitigationislow;88%(16/18)ismoderate;6%(1/18)ishigh.Byapplyingtheformulatocalculate percentageriskitwasfoundthat5/18protocolsarelowrisk, 10/18moderaterisk,3/18highrisk.

ConclusionandRelevance HVAprovidesasystematic approachtoanalysinghazardsthatmayaffecthospital service.Clinicalprotocolsclassifiedas ‘ highrisk ’ have beenmonitored,andstandardprocedureshavebeenoutlinedtominimisetherisks(e.g.proceduresformanaging vialaccidentalbrea king,coldchaincontrolforprepared drugs,useofsoftwaretocalculatedrugdosagebasedon bodysurface).Theseproceduresareaimedatallpersonnel involvedinpreparationphase,includingthehospitalpharmacist.Hospitalpharmacistiscoordinateswholeprocess, dealswithriskmanagementandensurespersonnel/patients safety.

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5PSQ-025 IMPACTANDEVALUATIONOFPHARMACOKINETIC MONITORINGINPRIMARYCARE

1GSJuanAntonio, 2ICJavier*, 2FGLydia, 2TBPaula, 2HSMaria, 2CSMiguelAngel, 2PLPilar, 2GDMaria, 2MOAdrian, 2MRNoemi. 1HospitalUniversitarioMoralesMeseguer, PharmacyService,Murcia,Spain; 2HospitalMoralesMeseguer,PharmacyService,Murcia, Spain

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BackgroundandImportance Monitoringofnarrow-margin drugsinprimarycareisimportanttooptimisetheefficacy andsafetyoftreatment.

AimandObjectives Toanalysetheimpactoftheactivityand repercussionsofmonitoringplasmalevelsofantiepileptics, lithiumanddigoxininprimarycarepatientscarriedoutby thePharmacokineticsArea-HospitalPharmacyService(PAHPS).

MaterialandMethods Two-monthretrospectiveobservational studyofthepharmacokineticreportsofallpatientswho requiredmonitoringoftheirplasmalevels.Thecircuitstarts witharequestfromtheprimarycarephysicianaskingforthe determinationoftheplasmalevel,thebloodsampleisanalysedbythelaboratoryandthePA-HPSinterpretsallthedata fromtheclinicalhistory,finallyproducingapharmacokinetic reportintegratedintheclinicalhistorytogetherwiththe analytical.

Thevariablesrecordedfromtheanalysesandclinicalhistorywere:age,sex,renalclearance,liverenzymes(GOT,GPT

REFERENCESAND/ORACKNOWLEDGEMENTS

andgamma),monitoreddrugandplasmalevel,pharmacokineticreportsandtheirdegreeofacceptance.

Results Atotalof202pharmacokineticreportswereperformedtargeting191ambulatorypatients.Themeanageof thetotalwas42.33±16.46years(range:6-106)and51% werefemale.Only5patientshadestablishedrenalinsufficiencywithrenalclearance<60ml/minand3patientswith hepaticinsufficiency(liverenzymesgreaterthan3timesthe upperlimitofnormal).

Thepharmacokineticreportsproducedwerevalproic (43.56%),lithium(37.62%),carbamazepine(8.91%),digoxin (5.94%),phenytoin(2.47%)andphenobarbital(1.48%).Of thepatients,82.68%hadplasmalevelsintherapeuticrange, 14.85%weresubtherapeuticand2.47%weresupratherapeutic.Wehighlightadegreeofinterventionin17.32%ofthe pharmacokineticreportsmade,and10.93%ofthesereports requiredachangeinthedosingregimenordosinginterval togetherwithanewmonitoring.Thedegreeofacceptanceby thephysicianwas67%.

ConclusionandRelevance Itisimportanttoperforman adequatefollow-upofpatientswithactivetreatmentofdrugs withanarrowtherapeuticmarginforaconstantoptimisation ofthetreatment

Thedatareflecttheimportanceofthehospitalpharmacist aspartofthemultidisciplinaryteamandtheneedfordirect communicationwiththeprimarycarephysician.

Thehighdegreeofacceptanceofpharmacokineticreports showsthatthecircuitiswellreceived.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-026 MEDICATION-RELATEDOSTEONECROSISOFTHEJAWS AND CDK4/6INHIBITORS

1LDomínguezSenín, 2DMoralesPancorbo, 2MYRodríguezGarcés, 1MRodriguezJorge*, 1MDSantos-Rubio, 2JBayoCalero. 1HospitalJuanRamónJiménez,HospitalPharmacy, Huelva,Spain; 2HospitalJuanRamónJiménez,MedicalOncology,Huelva,Spain

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BackgroundandImportance Medication-relatedosteonecrosis ofthejaw(MRONJ)isarelativelyuncommonbutserious complicationofosteoclastinhibitorstherapywithintravenousbisphosphonatesandden osumab.Dose, schedule,and durationofinhibitionareassociatedwithMRONJrisk. Marcianòetal. 1 launchedanalertaboutapossibleassociationbetweenMRONJandcyclin-dependentkinase(CDK)4/ 6inhibitorsinbreastcancerpatientswithosteoclastinhibitorstherapy.

AimandObjectives EvaluatetheuseofCDK4/6inhibitorsas ariskfactorforMRONJinourcohortofpatientswithmetastaticcanceranddenosumab.

MaterialandMethods

Retrospectiveobservationalstudy. Allpatientswithdenosumab (January2011toFebruary2022)wereincluded.Casesof MRONJfoundweredescribed.RelationshipbetweenCDK4/6 inhibitorsandMRONJwasanalysedwithaChi-square analysis.

Results 363patientswithdenosumabwereincluded.21cases ofMRONJweredetected:62.5%women,57.1%(12/21) withbreastcancer,19%(4/21)prostatecancer,and9.5%(2/ 21)lungcancer.42.9%withextraosseousmetastases.Median treatmentdurationfordenosumabwas19months(1-52).7

withCDK4/6inhibitors(3palbociclib,2abemacicliband2 ribociclib).MediantreatmentdurationwithCDK4/6inhibitors was27months(10-35).Themeantimefromthestartof denosumabtotheappearanceoftheeventwas23months (16-29).

Incidenceofthiscomplicationinpatientstreatedwith denosumabbutwithoutCDK4/6inhibitorswas5.24%(14/ 267)and7.29%(7/96)inpatientswithdenosumabanda CDK4/6inhibitor.AlthoughthegroupwithCDK4/6inhibitors hadahigherincidenceofMRONJcases,thedifferencewas notsignificant(0.461).

ConclusionandRelevance TheincidenceofMRONJinour cohortofpatientswithmetastaticcanceranddenosumabwas higherinthegroupofpatientswithCDK4/6inhibitors.However,thisdifferencewasnotsignificant.Ourdataaresomewhathigherthanthosereportedintheliteratureaccordingto whichtheriskofMRONJwithdenosumabis1.1%during thefirstyear,3.7%thesecondyearand4.6%peryearthereafter.StudieswithmorepatientswouldbenecessarytoconfirmtherelationshipbetweentheuseofCDK4/6inhibitors andMRONJ.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Marcianò,A.;Guzzo,G.M.;Peditto,M.;Picone,A.;Oteri,G.Medication-Related OsteonecrosisoftheJawsandCDK4/6Inhibitors:ARecentAssociation.Int.J.Environ.Res.PublicHealth2020,17,9509.

ConflictofInterest Noconflictofinterest.

5PSQ-027 APPROPRIATENESSOFPRESCRIPTIONOFTRICYCLIC ANTIDEPRESSANTSACCORDINGTO STOPP CRITERIA: SYSTEMATICREVIEWOFTHECRITERIAREFERREDTO THEUSEOFTRICYCLICANTIDEPRESSIVESIN DEMENTIA

DGuerraEstévez*,MRomeroAlonso,CPalomoPalomo,MReyesMalia,EContreras Macías,AGanforninaAndrades,JEstaireGutiérrez. HospitalInfantaElena,Hospital PharmacyDepartment,Huelva,Spain

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BackgroundandImportance TheSTOPP-STARTcriteriaarea usefultooltodetectpotentiallyinappropriateprescriptions (PPIs).Fortricyclicantidepressants(TCAs),thereare6STOPP criteria.

AimandObjectives Toanalysetheadequacyaccordingtothe STOPPcriteriaoftheprescriptionofTCAsinpatientsolder than64yearsandtosystematicallyreviewtheliterature relatedtotheuseofTCAsinpatientswithdementia,analysingthesuitabilityoftheSTOPPcriteria.

MaterialandMethods Descriptivecross-sectionalstudythat includedallpatientsover65yearsofagereceivingTCAs. ThesystematicreviewwasconductedfollowingthePRISMA Declaration.

Results 63patients(50women)withamedianageof70 years(65-88)werereviewed.In21patients(33.3%),the prescriptionofTCAsaccordingtotheSTOPPcriteriawas notappropriate(9patientsreceivedconcomitanttreatment withopiates,4patientsdementiamedication,3hadprescribedcalciumantagonists,another3medicationforbenign prostatichyperplasiaand,finally,2forconstipation).Nosignificantdifferenceswerefoundintherelationshipbetween thenumberofprescribeddrugsandtheadequacyofthe TCAsprescription(p=0.74).Inthesystematicreview,

7articleswereincluded.Onestudyshowedthatinclinical practice,TCAsdispensationsweremaintainedafterthediagnosisofdementia.TwostudiesconcludedthatTCAsarethe antidepressantsleastassociatedwiththeonsetofdementia. Inanotherstudy,thelong-termuseofTCAswasassociated withadecreaseintheincidenceofdementia.Areviewby theCochraneGroupstatedthattheevidenceonthesafety ofantidepressantsinpatientswithdementiaisofmoderate quality,withlittledatafromtheantidepressantsubgroups. Thelasttwoarticlesassociatedtheuseofantidepressants withdementiawithoutdifferentiatingtheantidepressant groups.

ConclusionandRelevance Basedonthedatafromourpopulation,thehighinappropriatenessofTCAsprescriptionaccordingtotheSTOPPcriteriasuggeststhatthisisafieldwith ampleroomforimprovement.PPIscouldbereducedif STOPPcriteriawerecomputerisedinelectronicprescription programs.Sincetheresultsofthereviewarenotconsistent, webelievethattheSTOPPcriteriaregardingtheuseofTCAs inpatientswithdementiashouldbemoreflexible,assessing thebenefit-riskoftreatmentonanindividualbasisandclosely monitoringadverseeffects.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

Results 35patientswereincluded(100%male),medianage 53years(31-72),97.6%tookonetabletdaily,mediandisease evolution17years(0.5-33).

4telematicconsultationswerecarriedoutwitheach patient.

GlobalIEXPAC: 27patientshadabetterexperience,8 remainedthesame.ConditionalIEXPAC:30patientshada betterexperienceand5remainedthesame.TheWilcoxon testcomparedtheresultsofIEXPACbeforeandafterimplementingatelepharmacyprogramme(p<0.01).

ConclusionandRelevance Theimplementationoftelepharmacy programmesimprovestheexperienceperceivedbyHIV patientsofpharmaceuticalcare.

Telepharmacycouldbeausefultoolforthecontroland pharmacotherapeuticfollow-upofHIVpatientsandother pathologies,avoidingunnecessarytripsbyvulnerablepatients whohavedifficultyingoingtothehospital.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-030 SAFETYANDSECURITYOFCICLOSPORINEYEDROPS INPATIENTSWITHXEROPHTHALMIA

MHerreraExpósito*,JIBretonesPedrinaci,JUrdaRomacho,MACastroVida. Hospitalde Poniente,HospitalPharmacy,ElEjido-Almería,Spain

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5PSQ-029 PERCEIVEDEXPERIENCEOFPATIENTSWITHHUMAN IMMUNODEFICIENCYVIRUS(HIV)AFTER IMPLEMENTINGATELEPHARMACYPROGRAMME

XCasas*,AVélezBlanco,LOrtegaValín,EGutiérrezGutiérrez,MSáezVillafañe,SLlamas Lorenzana,ZRodríguezFernández,RVarelaFernández,JCSáezHortelano,JOrtizde Urbina. ComplejoAsistencialUniversitariodeLeón,Farmacia,Leon,Spain

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BackgroundandImportance Telepharmacypromotescontinuous andqualityhealthcarebasedontheuseofnewtechnologies.

Usefulinpatientswithchronicdiseasesthatrequireapharmacovigilanceprogramme,suchasHIVpatients.

AimandObjectives Todetermineifatelepharmacymodel, improvestheperceivedHIVpatientexperiencecomparedtoa traditional(face-to-face)modelofhealthcare.

MaterialandMethods Prospectiveobservationalinterventional study(JanuarytoAugust2022).Included35HIVpatients withantiretroviraltreatment(ART)oflegalageunderfollowupbythepharmacist,withaccesstotechnologiestoreceive telepharmacyassistanceandwhogavetheirconsent.

Thestudywasdividedinto2stages:T-4pre-implementationoftelepharmacy(JanuarytoApril2022),T+4post-telepharmacy(MaytoAugust2022).

PatientswererecruitedduringtheT-4periodinthepharmaceuticalcareoffice,wheretheyweregiventhequestionnaire:InstrumentfortheEvaluationofChronicPatient eXperience(IEXPAC),a15-itemquestionnairewith11global questionsand4conditionalquestions,whichmakesitpossible toassessthepatient’sperceivedexperienceofhealthcare.

TheSPSS®programandWilcoxontestassessedwhether therearedifferencesintheIEXPAC(globalandconditional) inthesamepopulationbeforeandafterimplementingatelepharmacyprogramme.

Otherstratificationdatawere: sex,age,timesincediagnosis andnumberoftabletsperday.

BackgroundandImportance Ciclosporin1mg/mleyedropsis indicatedfortheuseofxerophthalmiainpatientswithsevere keratitisunresponsivetoartificialtears.Oculardrynessisa refractorysymptomofmanysystemicpathologies.Itisdifficulttomanageclinicallyandtherapeuticoptionsarelimited.

AimandObjectives Toreviewthetoleranceofpatientsto cyclosporine1mg/mleyedrops,aswellastherateofassociatedeyeinfectionsandthefeelingofimprovementevaluated bythepatienthimself.

MaterialandMethods Retrospectivestudycarriedoutina 350-bedgeneralhospital.Patientswhohadstartedtreatment withcyclosporine1mg/mleyedropsfrom2018to2022 andwhohadbeendiagnosedwithkeratoconjunctivitissicca (KS),Sjögren ’ ssyndrome(SS),Graves-Basedowsyndrome (GBS)withxerophthalmiawerestudied.Datacollected:sex, medianage[range],pathology,positiveSchirmertest(<5 mm),associatedeyeinfectionsduringtreatment,treatment oftheseinfections,discon tinuationofcyclosporinedueto infections,tolerancetotreatment,discontinuationdueto poortoleranceandclinicalimprovementperceivedbythe patient.Dataobtainedfromthedigitalmedicalrecord,the assistedelectronicprescriptionprogram(Dominion ® )and theclinicalinterviewwiththepatientinthepharmacy consultation Results 37patients.25women(67.57%).Medianage46[475].PatientswithSS14(37.84%),KS19(51.5%),GBS4 (10.81%).All(100%)ofthemwithpositiveSchirmertest(< 5mm).Associatedeyeinfectionsduringtreatment11 (29.73%),needforantibiotictreatment9(24.32%).Patients wholeftthetreatmentforanycircumstance20(54.05%),due topoortolerance14(37.84%).Patientsthatperceivedclinical improvement21(56.77%).

ConclusionandRelevance Xerophthalmiaisahardtocontrol symptominsystemicpathologies.Treatmentwithcyclosporine eyedropsisanalternativeforthosepatients.Somedonot

toleratethedrugcorrectlyanditisnecessarytoresortto othertreatmentstrategies.Associatedinfectionscouldbea riskfactorfordiscontinuingcyclosporineeyedrops,buteach patientmustbeevaluatedindividuallyandcloselymonitored forpossiblecomplicationsthatmayarisefromtreatment.The responsetociclosporintreatmentimprovedpatient’slife quality.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-032 PHARMACISTINTEGRATIONINTHE MULTIDISCIPLINARYEMERGENCYTEAM

1EMartinez*, 2ICorredor, 1PTardaguila, 1CDean, 1GICasarrubios, 1AMiranda, 1ACodonal, 1AMHorta. 1HospitalUniversitariodeGuadalajara,HospitalPharmacy, Guadalajara,Spain; 2HospitalUniversitariodeGuadalajara,HospitalEmergency Department,Guadalajara,Spain

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BackgroundandImportance Hospitalpharmacists’ activityis turningtowardsthedirectcareonclinicalunits.InEmergency Department(ED),medicationerrors(ME)mayoccurdueto multiplefactors:lackofcoordinationbetweenservicesorpressureinmedicalcare.Numerousstudies,highlightthebenefit ofpharmacistinterventioninthemultidisciplinaryhealth team.

AimandObjectives Theaimofthisstudywastoanalysepharmaceuticalinterventions(PIs)carriedoutinED,studiedthe ATCgroupofdrugsinvolvedandevaluatemedical acceptance.

MaterialandMethods Thistwomonth(April-May2022)prospectivestudywascarriedoutintheHalf-StayUnit(HSU)of theEDinasecondlevelhospital.

Inclusioncriteria: age 65yearsandpolypharmacy( 5 drugsinchronictreatment).

Variablescollected: demographic,PIs,causeofPIs,medical acceptanceandATCgroupofdrugsinvolved.

Dailylistofpatientswasobtainedthroughtheelectronic prescriptionprogramandPIswerenotifiedon-siteorusing thisprogram.

PIswereclassifiedaccordingtothesystemoftheConsensusofGranadamodifiedindrugdiscontinuation (unnecessary/duplicity/contraindication/interaction),drug change(contraindication/interaction),changeofdose,frequencyorschedule,initiationoftreatment(usualtreatment notprescribed/needadditionaltreatment),monitoring(determinationofplasmadruglevels andfollow-up)andprescriptionerrors.

PIswereconsideredacceptedwhendoctormodifiedtreatmentinmedicalorderordischargereport.

Results Finalanalysesincluded52patients.Medianagewas 82years(IQR:68-88),58%men.Duringthestudyperiod, 120PIswereperformedandthe77%wereaccepted.

46%ofPIscorrespondedtoinitiationoftreatment(usual treatmentnotprescribed),15%todiscontinuation(unnecessary drug),15%tochangeindosage,frequencyorschedule,14% toprescriptionerrorsand10%others.

ATCgroupsmostfrequentlyinvolvedwereCgroup(cardiovascularsystem)(35%)Bgroup(bloodandbloodforming organs)(25%)andNgroup(nervoussystem)(20%).

ConclusionandRelevance MostofPIscorrespondedtoinitiationofusualnon-prescribedtreatmentfollowedbydiscontinuationofunnecessarydrugs.

Medicalacceptancewashigh. HighlightPIscarriedoutaround groupC(lipid-loweringandantihypertensivedrugs).

Multidisciplinaryteamhelpsimprovepharmacotherapeutic profileandpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-033 ANTIVIRALTREATMENTDISCONTINUATIONIN PATIENTSWITHHEPATITISB

EMartinez*,SCorrales,CDean,ACodonal,PTardaguila,GICasarrubios,AMiranda, ALazaro. HospitalUniversitariodeGuadalajara,HospitalPharmacy,Guadalajara,Spain 10.1136/ejhpharm-2023-eahp.255

BackgroundandImportance Studiessuggestthesafeststrategy oftreatmentdiscontinuationwithnucleos(t)ideanalogues (NAs)againsthepatitisBvirus(HBV),isproposedafterloss surfaceantigen(HBsAg).Evidencesupportsthepossibilityof discontinuingNAsinthefollowingsituations:

. Patientswithpositiveeantigen(HBeAg)withoutcirrhosis: afternegativisationofHBV-DNAandHBeAgseroconversion, confirmedin2determinationsseparatedby3-6monthsand afterNAsatleast12months.

. PatientswithnegativeHBeAg,withoutadvancedfibrosisearly intreatment:afternegativisationofHBV-DNAforatleast3 yearsandHBsAgclearance(qHBsAg) £1000IU/mL.

AimandObjectives TheobjectivewastocharacterisethepopulationintreatmentwithNAsandanalysepatientswhomet requirementsfortreatmentdiscontinuation

MaterialandMethods Cross-sectional,descriptive,retrospective studyofpatientsunderactivetreatmentwithNAsbetween August2020-August2021.

Variablescollected: demographic,NAsused,treatmentdurationandclinical(positiveornegativeHBeAg,HBeAgseroconversion,HBV-DNA,qHBsAg,degreeofhepaticfibrosis, HBsAgloss,virologicalrelapse(RV)(HBV-DNA>2000IU/ml aftertreatmentdiscontinuation).

Results Weincluded50patients(70%men).Medianagewas 56years(IQR:48-66)andmedianoftreatmentdurationwas 66months(IQR:27-108).62%weretreatedwithtenofovir disoproxilfumaratoand38%withentecavir.

8%ofpatientshadpositiveHBeAgwithoutseroconversion andwithoutnegativeHBV-DNA.92%hadnegativeHBeAg withseroconversionandnegativeDNA-HBV.

32%ofpatientshadqHBsAg £1000IU/ml,28% 1000 IU/mland40%notdetermined.30%ofpatientshad advancedfibrosis.

In12%ofpatientswithpositiveHBsAg,treatmentdiscontinuationcouldbeconsidered.AllofthemhadHBeAgnegative,fibrosisF0-F1atthebeginningoftreatment,negative HBV-DNAmaintainedatleast3yearsandqHBsAg£1000IU/ ml.

HBsAglossoccurredin6%ofpatientswhohadnotdiscontinuedtreatmentand16%ofpatientshadtorestarttreatmentforRV.

ConclusionandRelevance

. Studypopulationincludespatientswhomeetcriteriafor treatmentdiscontinuation.

. Treatmentdiscontinuationrequiresclosefollow-uptodetect RV.

. InpatientswithHBsAgloss,treatmentwasnotdiscontinued duetoadvancedfibrosis.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

wouldreceive100mgdose,whichmeanshalfpriceofthe fixeddose)(Moniruletal,2020).

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-036 MEDICATIONERRORSRELATEDTOHIGH-ALERT MEDICATIONSINATERTIARYCAREPAEDIATRIC HOSPITAL – ANANALYSISOFREGISTER-BASEDDATA

1SKuitunen*, 2MSaksa, 2JTuomisto, 2ARHolmström. 1HelsinkiUniversityHospitalHus, HusPharmacy,Helsinki,Finland; 2UniversityofHelsinki,FacultyofPharmacy,Helsinki, Finland

5PSQ-034 FIXEDVSWEIGHT-BASEDDOSINGOF PEMBROLIZUMABFORPATIENTSUNDER80KG, BASEDONOBSERVEDADRSINONECANCER SETTING

MFortuna*,MKovačevič InstituteofOncology-Ljubljana-Slovenia,Pharmacy,Ljubljana, Slovenia

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BackgroundandImportance Monoclonalantibodiesareusually dosedbythekilogrammeofthepatient’ sweight,duetoperceivedcontributionofbodysizeinpharmacokineticvariability.Lately,especiallyduringtheCOVIDpandemic,alotof monoclonalantibodies,includingpembrolizumab,were switchedtofixeddosing.Pembrolizumabwasinitiallydosed at2mg/kg,fixeddosingincludes200mgeverythreeweeks or400mgeverysixweeks(Freshwater,2017).Thefixed dosingismoreconvenient,eliminatesthewaste,might improvepatient ’scomplianceandreducesdosingerrors. However,forthepatientsthatweightlessthan80kg,fixed doseisassociatedwithalmostmaximumexposure,whichis alsoassociatedwithgreateroccurrenceoftoxicity(CADTH, 2020).

AimandObjectives Theaimofthisretrospectivestudywasto determinewhetheritisbettertousefixedorweight-based dosingofpembrolizumabforpatientsunder80kginorderto avoidseriousADRs.

MaterialandMethods WeobservedADRsthatoccurredwith 391patientsreceivingpembrolizumabin2021,regardlessthe diagnosis.Wecollectedthedata,byreviewingpatients’ documentation.Thepatientsweredistributedacrossoncologyindications,includingNSCLC,melanoma,breastcancer,urothelial carcinoma,cervicalcancer,Hodgkin’slymphoma,headand necksquamouscellcarcinoma,oesophagealcancerandrenal cellcarcinoma.

Results Thepatientsweresplitintotwosubgroups,underand over80kginweight(group1and2).For29patients,data aboutweightwasnotavailable.198patientswereingroup1, whereasingroup2therewere164patients.TheADRs occurredin69patients(34,8%)fromgroup1and46patients fromgroup2(26%).ThemostcommonADRsoccurredwere skintoxicities,hypothyreosis,muscleandjointpain,diarrhoea andfatigue.Therewerenosignificantdifferencesinthe occurredADRsbetweengroup1and2.

ConclusionandRelevance Theresultsindicatedthatfor patientsunder80kg,weight-baseddosewouldnotonlybe betterintermsoflesstoxicity,butitwouldalsobemorecost effective.Theadaptationoffixeddosingregimenswouldlead totheestimated26%ofadditionalcost(e.g.50kgpatient

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BackgroundandImportance Paediatricpatientsareproneto adversedrugevents,includingmedicationerrors(MEs). Althoughhigh-alertmedicationsareoftenassociatedwithseriousMEs(1),fewerstudieshavefocusedondescribingthese errorswithinpaediatricpopulations(2–3).

AimandObjectives Theaimofthisstudywastoinvestigate theprevalenceandcharacteristicsofself-reportedMEsrelated tohigh-alertmedicationsinapaediatricuniversityhospital setting.

MaterialandMethods Thiswasacross-sectionalstudyofselfreportedMEs(n=2,404)inatertiarycarepaediatrichospital during2018–2020;743(31%)oftheMEsinvolvedhigh-alert medications(3).Aquantitativedescriptiveanalysis(frequencies andpercentages)wasperformedusingMicrosoftExcel®.The prevalenceofdifferenthigh-alertmedications,Anatomical TherapeuticChemical(ATC)groups,drugformulationsand administrationroutesappearinginthestudysamplewere defined.Finally,themostsevereMEswereidentifiedand summarised.

Results AmongthestudiedsampleofMEreports(n=743),71 differenthigh-alertmedicationswereidentified.Themost commonATCsubgroupswerebloodsubstitutesandperfusion solutions(B05;n=345,40%)antineoplasticagents(L01; n=139,16%),andanalgesics(N02;n=98,11%).Themost commonmedicationscomprisedparenteralnutrition(n=130, 15%),hypertonicsodiumchloride(n=93,11%),potassium chlorideconcentrate(n=66,8%),morphine(n=47,5%),and heparin(n=43,5%).Mosthigh-alertmedicationswereadministeredintravenously(n=636,73%).Moreover,IVpreparationswereadministeredviaoff-labelroutes(n=52,6%),such asoral,inhalationandintranasalroutes.MostseriousMEs (n=16,2%)wereassociatedwithanalgesics(N02)(n=8),antineoplasticagents(L01)(n=3),andantithromboticagents (B01)(n=3).

ConclusionandRelevance Accordingtothepresentandpreviousstudies,MEsonconcentratedelectrolytesandparenteral nutritionrepresentacentralrisktopaediatricmedication safety(1–2).WhilesevereMEsinthesegroupsremainedlow inthisstudy,ahighproportionofsevereMEsassociatedwith analgesicsandantineoplasticagentsrepresentedakeyfinding. Preventiveriskmanagementactionsshouldbetargetedon thesehigh-alertmedicationsaswellastosecuresafetyin intravenousadministrationandoff-labeldruguseinpaediatric patients.

2.Stavroudis, etal.JPerinatol2010;30(7):459–68

3.InstituteforSafeMedicationPractices.ISMPlistofHigh-AlertMedicationsinAcute

ConflictofInterest Noconflictofinterest.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-037 IMPORTANCEANDIMPACTOFPHARMACEUTICAL RECONCILIATIONATDISCHARGEINTHEELDERLY PATIENTWITHPOLYMEDICATION

1MVaraUrruchua*, 2CVilaGallego, 2MInclanConde, 2BBelioAguera, 2NGomez Echevarria, 2ZPerezEspaña, 2NMPardoSantos, 2AVAguirrezabalaArredondo. 1Basurto Hospital,Pharmacy,Bilbao,Spain; 2HospitalBasurto,Farmacia,Bilbao,Spain

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BackgroundandImportance Medicationreconciliationisakey tooltoincreasepatientsafetyandcanbeveryusefulinthe polymedicatedelderly.

AimandObjectives Theaimofthestudyistoassessthe impactofreconciliationandtoidentifyandpreventreconciliationerrors(CE)inpolymedicatedelderly.

MaterialandMethods Aprospectivestudywasconductedconsistinginamedicationreconciliationprojectatdischarge,with apharmacistincharge,inpatientsadmittedtothecareof MDIduringtheperiodOctobertoDecember2021.Patients over65yearsofageandpolymedicated(>5prescribed drugs)wereincluded.

Thepharmacistinchargewasresponsibleforcomparing themedicationprescribedintheupdatede-prescriptionwith thehospitale-prescriptionandthedischargemedicalreport. Herecorded,evaluatedandclassifiedthe ‘reconciliation errors ’,thosethatweremodifiedbytheprescriberafterthe pharmacist'swarningaccordingtotheSEFHConsensusDocumentonterminologyandclassificationinmedication reconciliation.

WeclassifiedtheCEsintoseven:dosagediscrepancy,omissionintheprescription,commission,prescriptionofadrug notindicatedorcontraindicatedduetothepatient'sclinical situation,incompleteprescriptionandduplicity.

Results Dischargereconciliationwasperformedin113 patients,51%ofwhomwerewomen.Themeanagewas82.4 years(62-100).Themeannumberofdrugsprescribedper patientwas11(5-22).Sixty-nine(61%)unjustifieddiscrepanciesweredetectedofwhich57(50%)werereportedtothe responsiblephysicianand50wereaccepted,88%ofthe reporteddiscrepanciesand72%ofthetotal,i.e.CEoccurred in72%ofthereconciledpatients.

Regardingtheclassificationofdiscrepanciesdetected,the majoritywereposologicaldiscrepanciesconstituting39.1% (27);followedby27.5%(19)maintainingadrugnotindicatedorcontraindicatedforthecurrentclinicalsituation; omissionofdrugsin18.8%(13);commission8.7%(6), incompleteprescription4.3%(3)andduplicity1.4%(1).

ConclusionandRelevance Pharmacotherapeuticreconciliation resultedinasignificantreductionintheincidenceofCDand itsimpact,constitutingastrategytoimprovesafetyinpolymedicatedelderlypatients.Thepresenceofapharmacistonthe hospitalwardisveryusefultocarryoutthistask,improving communicationbetweenprofessionalsandcontributingtoa moreeffectivereconciliation.

5PSQ-038 DRUGRELATEDVISITSTOTHEEMERGENCY DEPARTMENTINNURSINGHOMEPATIENTS

1JAna*, 1MPedemonte, 1CSocias, 1MSantos, 2MPuig, 1MAMangues, 1JRuiz. 1Hospital delaSantaCreuISantPau,Pharmacy,Barcelona,Spain; 2HospitaldelaSantaCreuISant Pau,Emergency,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.259

BackgroundandImportance Drugrelatedproblems(DRPs) areoneofthemaincausesrequiringassistancetotheEmergencyDepartment(ED)infrailtypeople.Manyofthese patientsliveinnursinghomes(NH).IdentifyingthedifferentialcharacteristicsofpatientsandDRPsthatcauseconsultationinthissubgroup,canhelptoimprovethe pharmaceuticalcareprogramsimplementedinourenvironmentinNH.

AimandObjectives Toidentifydrugsthatareassociatedwith DRPsthatcausesconsultationofEDinpatientscomingfrom NHandcomparethedrugsinvolved,andthecharacteristics andcomorbiditiesofthesepatientswithnon-NHpatients.

MaterialandMethods Retrospective,descriptiveobservational studywasconductedbetweenFebruary21-May2022inthe EDofauniversityhospital.Weincludedadultpatientswho attendedEDforDRPs.

Thefollowingvariableswerecollectedandcompared betweenNHpatientsandnoNHpatients:age,sex,chronic pathologiesatadmission,numberofdrugsprescribedinthe electronicprescription,druginvolvedintheDRPsanddiagnosisrelatedtotheDRPs.

QualitativevariableshavebeencomparedbetweentheNH patientsvsnoNHpatientsusingtheChi-Squaretestand quantitativevariablesusingtheindependentdatat-test. Results 1029patientswereincluded.98ofthem(9.53%) werereferredfromNHnhpatientswereolder(84,6(8.9) yearsoldvs77,1(15.7)P<0.001*),mostlywomen[64 (65.3%)vs511(54.8%)P=0 ,046*],withahigherpercentageofcognitiveimpairment[59(60.2%)vs189(20.0%) P<0.001*],severefunctionaldep endence[68(69.3)vs216 (23.2)P<0.001*]and severepolypharmacy(>=10home medications)[53(54.0%)v s276(29.6%)P<0.001]than therestofthepatientswhoconsultedtheEDforDRPs. DRPsrelatedtotheATCgroupC(cardiovascularsystem) weremoreprevalentinNHpatients[21(21.4%)vs310 (33.2%)P=0.017*]aswellasdiagnosticsgastrointestinal motilitydisorders[23(23.4%)vs129(13.8%)P=0.011*] andconfusionalsyndromes[5(5.1%)vs17(1.8) P=0.031*]

ConclusionandRelevance NHpatientsthatconsultEDfor DRPswereolder,mostlywomenwithahighdegreeofsociofunctional,cognitivedependenceandextremepolypharmacy thannoNHpatients.DRPrelatedwithCATCgroupand diagnosisofconfusionalsyndromeandgastrointestinalmotility disordersarealsomoreprevalent.

CareSettings,2018.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-040 ANALYSISOFTHEIMPACTOFTHECOVID-19 PANDEMICONPSYCHOTROPICDRUGUSE

1BNucete, 2AMarchena, 2LGonzalez, 2MAGarciaLirola*. 1DistritoSanitarioGranadaMetropolitano,Pharmacy,Granada,Spain; 2DistritoSanitarioGranadaMetropolitano, Pharmacy,Granada,Spain

10.1136/ejhpharm-2023-eahp.260

BackgroundandImportance TheCOVID-19disease,declared apandemicinMarch2020,radicallychangedpeople’swayof life.Thehealthrisk,themeasuresofthestateofalarmand itsimpactatsocialandeconomiclevelhaveexposedthepopulationtoathreattotheirpsychologicalwell-being.

AimandObjectives Toanalysetherelationshipbetween COVID-19andchangesinthetrendofpsychotropicdrug consumption.

MaterialandMethods Descriptivedrugutilisationstudywhich included665,222inhabitants.Thispopulationisdistributedin anurban(UA)(275,990inhabitants)andrural,peri-urban (RA)(389,232inhabitants)area.ThestudyperiodwasJanuary 2018toDecember2021.Datawereobtainedfromthedatabaseofdispensedandbilledprescriptions.Theunitusedwas theDefinedDailyDose(DDD)andthemainvariablewasthe DDDper1000inhabitantsandday(DHD).Thetherapeutic groupsstudiedwerebenzodiazepines(N05BA,N05CA, N05CF)andantidepressants(N06AB,N06AX),accordingto theAnatomicalTherapeuticChemicalClassificationSystem (ATC).Mann–Whitneytestwasusedforstatisticalanalysis.

Results Thegroupofdrugswiththegreatestincreaseinconsumptionwasbenzodiazepines,followedbyantidepressants, thelatterbeinghigherinthe2ndand4thquarterof2020, coincidingwiththefirstandsecondwaveandhigherinrural areas.Inantipsychoticdispensations,aslightincreasewasonly observedinthemetropolitanarea(p<0,05).Duringtheyear 2021,theratesofbenzodiazepinesweredecreasing,ending theyearatvaluessimilartopre-pandemicrates.Incontrast, theincreaseinantidepressantusewassustainedduring2021.

-DHD2ndQuarter:

BENZODIAZEPINES

UA:2018:86.71;2019:83.58;2020:86.16;2021:81.71

RA:2018:88.97;2019:88.95;2020:97.63;2021:87.85

ANTIDEPRESSANTS

UA:2018:38,79;2019:39,73;2020:40,16;202141,38

RA:2018:44.76;2019:45.58;2020:48.49;2021:47.85

-DHD4thQuarter

BENZODIAZEPINES

UA:2018:84.67;2019:83.15;2020:87.60;2021:82.00

RA:2018:88.42;2019:89.97;2020:97.38;2021:87.84

ANTIDEPRESSANTS

UA:2018:38.73;2019:39.72;2020:40.99;2021:43.14

RA:2018:45.12;2019:46.24;2020:48.91;2021:49.19

Itwasonlystatisticallysignificanttheincreaseintheconsumptionofantidepressants(P=0.019)intheperiods20202021vs2018-2019.

ConclusionandRelevance Theuncertaintyinthefirstmonths ofthepandemic,bereavement,isolationandtheeffectsofthe economiccrisismayhavefavouredanincreaseintheconsumptionofantidepressantsandbenzodiazepines.Itwouldbe necessarytoreorientclinicalpracticestrategies,promotingthe appropriateandsafeuseofthesedrugsintheprimaryand hospitalcaresetting.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-041 STERILEINTRAOCULARINFLAMMATIONAFTER INTRAVITREALAFLIBERCEPT

1MHernandoVerdugo*, 1AFijóPrieto, 1BÁlvarezGrande, 1MTSánchezSánchez, 2MILópezGálvez. 1HospitalClinicoUniversitariodeValladolid,PharmacyDepartment, Valladolid,Spain; 2HospitalClinicoUniversitariodeValladolid,OphtalmologyDepartment, Valladolid,Spain

10.1136/ejhpharm-2023-eahp.261

BackgroundandImportance Sterileintraocularinflammation (SII)isaknowncomplicationoftherapeuticintravitrealinjections,particularlywithallanti-vascularendothelialgrowthfactordrugs.Theseeventsusuallyoccurresporadicallybutthere hasbeenanincreaseinthenumberofreportedcasesdueto aflibercept 1 .

AimandObjectives ToanalysetheappearanceofSIIin patientswithintravitrealaflibercept.

MaterialandMethods Descriptiveobservationalstudyof patientswithSIIafterintravitrealafliberceptreportedfrom AugusttoNovember2021.Datacollected:sex,age,eye, pathology,pre-treatment,dosesandbatchofaflibercept,time topresentationanddescriptionofsymptoms,best-corrected visualacuity(BCVA)priortolastdose,aftertheonsetof symptomsandatsixmonthsoffollow-up.Patientstreated bilaterallywerecountedastwotreatments.

Results SIIwasobservedin14ofthe110patientstreated (12.7%);57%women;meanage:78.9±8.3years.

17eyesweretreated:right28.6%,left50.0%,bilateral21.4%. Pathology: neovascularage-relatedmaculardegeneration 85.8%,diabeticmacularoedema7.1%,branchretinalvein occlusion7.1%.

Patientspreviouslyreceivedranibizumab,bevacizumaband anaverageof11dosesofaflibercept.Alldoseswerefrom batchKT09625.

Meantimetopresentationsymptomswas22days,which includedmyodeopsis,precipitationinthevitreouswithcrystals ofaspectof ‘starrysky ’,vitreousinflammationanddecrease oftheBCVA.Nopatientpresentedinfectiousendophthalmitis andonerequiredvitrectomy.MeanBCVApriortolastdose andaftertheonsetofsymptomswas0.57±0.42logMAR and0.56±0.27logMAR,respectively,andtothesixmonths was0.66±0.39logMAR.

AlladverseeffectswerereportedtotheSpanishPharmacovigilanceSystem,manufacturerlaboratoryofafliberceptand DrugInspectionandControlDepartmentoftheSpanish AgencyforMedicinesandMedicalDevices.

ConclusionandRelevance

. SIIisassociatedwithintravitrealantiangiogenicdrugs, especiallywithaflibercept.1 However,thesuddenonsetof symptomsalertedtheOphthalmologyDepartment.

. Itwasinitiallysuspectedtoberelatedtothebatchof aflibercept,buttheresultsareinconclusive.

. Theclinicwasimportant,withoutshowingasharpdecrease inBCVA.

. Long-termmonitoringofthesepatientsisnecessarytoassess theresolutionoftheinflammation.

. Multidisciplinarypharmacovigilancecoordinationiscrucial forthedetectionofknownorunexpectedadverseeffects.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1.GreenbergJPetal.Aflibercept-RelatedSterileIntraocularInflammationOutcomes. OphthalmolRetina.2019Sep;3(9):753-759.

5PSQ-042

PREVALENCEOFMEDICATIONPRESCRIPTIONWITHA

POTENTIALNEGATIVEEFFECTONSWALLOWINGIN

OUTPATIENTSWITHCOGNITIVEIMPAIRMENTANDA DIAGNOSISOFDYSPHAGIA

PPradoMontes,MCouñagoFernández*,IAgraBlanco,MAlfonsínLara,DRoblesTorres, NLagoRivero,EYRomeroVentosa,ICastroNúñez,NMartínezLópezdeCastro. Hospital ÁlvaroCunqueiro,Pharmacy,Vigo,Spain

10.1136/ejhpharm-2023-eahp.262

BackgroundandImportance Dysphagiaisahighlyprevalent syndromeintheelderlypopulation,andespeciallyinthose withcognitiveimpairment.Inadditiontoage-relatedfactors andcomorbidities,drugswithapotentialnegativeeffecton swallowingfunctionhavebeenidentified,manyofwhichare commonlyusedinpathologiesthatarealsoprevalentinthe elderly.Knowingandraisingawarenessaboutthedimension ofthisproblemcanhelpincreasethesafetyofpharmacologicaltreatmentinthesepatients.

AimandObjectives Todeterminetheprevalenceofmedication prescriptionwithapotentialnegativeeffectonswallowingin elderlyoutpatientswithcognitiveimpairmentanddiagnosisof dysphagia.

MaterialandMethods Observational,descriptiveandcross-sectionalstudyinwhichweanalysedthepharmacologicaltreatmentofpatientswithcognitiveimpairmentandadiagnosisof dysphagiaattendingthenutritionhospitalpharmacyclinicofa tertiaryhospital.Werecordedsociodemographic,prescribed medications,potentialeffectonswallowingfunctionandits mechanismdata.Medicationswithapotentialeffectonswallowingwereselectedfromtheexistingliteratureandthe informationcontainedinsummariesofproducts characteristics.

Results Weanalysed594prescriptionscorrespondingto68 patientswhosemeanagewas85,5.Weidentified170drugs belongingto12therapeuticgroups.66patients(97%)had beenprescribedsomemedicationwithapotentialnegative effectonswallowingfunction,andthemeannumberofthese medicationsprescribedperpatientwas3.6.246prescriptions (41,6%)correspondedtomedicationswithnegativepotential ontheswallowingfunction,mainlyduetotheirsedativeeffect (n=118,48%),followedbyproductionofxerostomia(n=44, 18%),neuromuscularaction(n=33,13.4%),directirritants (n=18,7.3%),andunknownmechanisms(n=4%).23prescriptions(9,3%)shareddifferentmechanisms.

ConclusionandRelevance Weobservedahighprevalenceof drugprescriptionswithapotentialnegativeeffectonswallowinginthissubgroupofpatients.Theseresultshighlight theimportanceofre-evaluatingtheclinicalneedforthese medicalprescriptionsinpatientswithdysphagia.Hospital pharmacyhasanimportantroleindetectingthesemedical prescriptionsandpromotingthesearchforalternativesto ensurethebestbenefit-riskratio.Theneedtoextendthe studytoothersubpopulationsofpatientswithdysphagia shouldbeconsidered.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-044 REAL-LIFESAFETYANDSATISFACTIONOFCFTR PROTEINMODULATORSINCYSTICFIBROSIS

1AIbáñezZurriaga*, 1ERamírezHerraíz, 2EPradillaBascuas, 2MRoderoNevado, 3RMGirónMoreno, 3VSanzCobeña, 1AGarciaPeralo, 1AÁlvarezYuste, 1GEscudero Sanchez, 1AMorellBaladrón. 1HospitalUniversitariodelaPrincesa,Farmacia,Madrid, Spain; 2UniversidaddeAlcala,Farmacia,AlcaladeHenaresMadrid,Spain; 3Hospital UniversitariodelaPrincesa,Neumologia,Madrid,Spain

10.1136/ejhpharm-2023-eahp.263

BackgroundandImportance Thenewtransmembraneconductanceregulator(CFTR)modulatordrugs(ivacaftor/tezacaftor/ elexacaftor)arebringingaboutamajorchangeinthetreatmentandqualityoflifeofcysticfibrosis(CF)patients.There isaneedtocollectinformationonpatientperceptionofbenefitandsafety.

AimandObjectives Toassessthesatisfactionandadverseeffect (AE)profilereportedbypatientsonivacaftor/tezacaftor/elexacaftortreatment.

MaterialandMethods Observational,prospective,single-centre studyfromMarchtoJune2022.CFpatientswithatleast onep.Phe508delmutationintreatmentwithCFTRmodulators.Variables:sociodemographic(ageandsex)andbiochemical(GOT-ASAT,GPT-ALAT,bilirubinandCPK)collectedfrom patients'medicalrecords.TreatmentSatisfactionQuestionnaire forMedication(TSQM1.4)with14itemsinfourscales assessingefficacy,sideeffects,convenienceandoverallsatisfactionfromthepatient'sownperspective,thehigherthescore, thehigherthesatisfaction.AdverseEffectsQuestionnaire(ad hoc),PatientInformedConsent.

Results Outof58patientsontreatment,43answeredthe questionnaires,17(40%)female,medianage30(26-37).For TSQMthemedianscoreforeachitemwas21(20-21)over 21;19(16-20)over21;21(18-21)over21and17(16-17) over17respectively.RegardingAEs:39.47%reported increasedappetite,31.58%rash,23.68%headache,13.16% runnynose,increasedbloodpressure,diarrhoeaanditchy skin,10.53%abdominalpainordiscomfort,commoncold anditchyorstingingeyesand £ 2%flatulence,memoryloss, yellowingofskinandeyes,musclepain,fluidretention, insomnia,acne,nauseaandvomiting.Onepatientpresented withsevererashrequiringdiscontinuationoftreatment.Three monthsafterstartingtreatment,onlythreepatientshadGPTASAT>3LSNandonlyonepatient>5LSN,onepatient hadincreasedCPK>5LSNandnopatienthadbilirubin>2 LSN.

ConclusionandRelevance Althoughahighpercentageof patientshaveexperiencedAEs,CFTRmodulatorsarewidely accepteddrugswithafavourableAEprofile.ThemostfrequentAEsreportedbypatientswereincreasedappetite,rash andheadache.TheAEsdescribedbypatientsaredescribedin thedatasheet.Morereal-lifestudiesareneededtoconfirm ourstudyandtoprovidefurtherevidence.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-045 IMPACTOFPHARMACEUTICALINTERVENTIONSIN CRITICALPATIENTS

1CGastalver-Martín,OSerna-Romero*,SBuendia-Bravo,AIglesias-Bolaños,CCapillaMontes,IEscribano-Valenciano,TCruz-Cruz. HospitalUniversitarioDelSureste,Pharmacy Department,ArgandaDelRey,Spain

10.1136/ejhpharm-2023-eahp.264

analysis,itreachesidentificationofpossibleinconveniences (failuremode)andeffectsonanentiresystem.

AimandObjectives OurpurposewasdetectingthemostcriticalphasesofParenteralNutritionbags(PNB)compounding processthroughanauditconsistingofhospitalpharmacists, doctors,nutritionistsandnurses.

BackgroundandImportance

Thehighhealthcareburdeninthe IntensiveCareUnit(ICU)duetotheSARS-CoV2Coronavirus pandemichascreatedaworkenvironmentthatincreasedmedicationerrors.Itisknownthatpharmaceuticalinterventions reducedmedicantionerrors.

AimandObjectives

Theobjectiveofthisstudyistoknowthe impactofpharmaceuticalinterventionincriticallyillpatients.

MaterialandMethods Retrospectiveobservationalstudycarried outinageneralhospital.Allthepharmaceuticalinterventions performedintheIntensiveCareUnit(ICU)betweenthe monthsofOctober2020andApril2021wereanalysed.It wasregisteredinadatabase:PositivediagnosisofCOVID-19 (SARS-CoV2coronavirusdisease),numberofinterventions, typeofinterventionandacceptanceoftheintervention.

Results Atotalof51interventionswereobtainedin169 patientsadmittedduringthe7monthsofthestudy(0.3interventions/patient).42.6%ofthepatientshadadiagnosisof COVID-19.17%ofthepatientsadmittedtotheICUhadat leastoneintervention,ofwhich38%hadmorethan1(mean 1.76interventionsperintervenedpatient).Themostfrequent reasonsforinterventionweredosemodificationduetoinappropriatedose(35.3%)andinappropriatechoiceofpresentationduetotherouteofadministration(21.5%).84%ofthe interventionswerecarriedoutinCOVID-19patients,withthe meannumberofinterventionsperformedinthesepatients higherthaninnon-COVID-19patients(1.87vs1.33).92% oftheinterventionsconductedbythepharmacistwere accepted.

ConclusionandRelevance Pharmaceuticalvalidationinthe IntensiveCareUnit(ICU)isessentialtooptimisethetreatmentofcriticalpatients,increasingsafetyandefficacyofmedicationstheyreceiveandreducingmedicationerrors.Patients diagnosedwithCOVID-19areespeciallylikelytobenefit frompharmaceuticalinterventions,whicharehighlyaccepted byphysicians.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-046 FMEA(FAILUREMODEANDEFFECTANALYSIS)

APPLICATIONTOPARENTERALNUTRITIONBAGS

MANUFACTURINGPROCESS:ROLEOFHOSPITAL

PHARMACIST

1EdeLuca*, 1GCancellieri, 1MSantonocito, 1CBotto, 2RGiammona, 2DLeonardiVinci, 2PPolidori. 1UniversitàDegliStudiDiPalermo,Ssfo

ScuolaDiSpecializzazioneInFarmacia Ospedaliera,PalermoPa,Italy; 2OspedaliRiuniti ‘VillaSofia-Cervello’,UocFarmacia, Palermopa,Italy

10.1136/ejhpharm-2023-eahp.265

BackgroundandImportance Correctidentificationofunexpected/unwantedprocessesvariabilityallowsusstudyingsolutionsforincreasinganysystemreliability.FMEA(Failure ModeandEffectAnalysis)isaninductivemethodthatprovidesa ‘bottomup’ approach;startingfromactivitiesprocess

MaterialandMethods FMEAwasappliedtoPNBcompoundingprocessinahospitalwith639beds.Theprocesswasdividedintofourphases(prescription,formulation,compounding, quality-control).Bymakinganestimateofseverity,probability anddetectability,wehavedefinedappropriateactionstobe takenforeliminatingpotentialproblems’ occurrence.The productbetweenpreviouslyidentifiedvalues(onscalefrom1 to10)providesRiskPriorityIndex(IPR),anoverallcriticality measure.

Results ThehighestIPRvalue(384)wasfoundinformulation phasewherebag’sosmolaritywashigherthanvenousaccess typechosen.AnIPR=168wasfoundinprescriptivephase concerningpatientincorrectselectionfromsoftware(homonymycases),followedbydataincompleteness,relatingto microelementsaddition(withanIPR=150).AnIPR=140was foundduringSiframixmachinesettingupregardingmicroelements’ housingsexchange(dangerduetoPotassiumreplacementwithmicroelementrequiredingreaterquantities). Finally,IPR=144wasfound,duringcompoundingphase,due toconfusionabout ‘lookalikesoundalike’ constituents(inframin/siframinreplacement);thisallowedPNBcompounding withaqualitative-quantitativecompositiondifferentfromthat requested.

ConclusionandRelevance Jointauditproposedsolutionsfor eachphase.Forprescriptiveone,itwouldbedesirabletotake advantageofasoftwarethatgivesaccesstomedicalrecords inordertocheckthatbagsuitedpatient'sneeds.Duringformulationphase,itisnecessarythatahospitalpharmacist(HP) performsadoublecheckbetweenworksheetdraftingand label,verifyingcorrespondence,completenessandoverlapping withdataindicatedinprescription.HPshavetocontrolprescriptionfeasibilityandthatvolumeissuitableforaccessprovidedforpatient.Forset-upphase,adoublecheckshouldbe carriedouttomakesurethateachhousingcontainscorrespondingnutrient;inaddition,atleasttwotechniciansshould bepresenttocarryouttheoperationsinduplicate.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-047 PRECAUTIONARYCANCELLATION:TOOLTOIMPROVE PATIENTSAFETY

1ERodriguezMolins, 1APelaezBejarano, 1CJimenezDe-Juan, 1LGomezSayago*, 1LJimenez-Pichardo, 2JRodriguezCastilla. 1RiotintoHospital,HospitalPharmacy,RiotintoHuelva,Spain; 2PrimaryCarePharmacy,PrimaryCarePharmacy,Riotinto-Huelva,Spain

10.1136/ejhpharm-2023-eahp.266

BackgroundandImportance Precautionarycancellationisa newtoolforprimarycareandhospitalpharmacistthatallows themtocancelprescriptionsandavoiddispensingmedicinesat pharmacies.

AimandObjectives Analysetheprecautionaryannulments madeinahospitalandquantifythedegreeofacceptanceof thedoctor.

MaterialandMethods Prospectivestudylastingfivemonthsin acountryhospital.Allpatientsoutpatientswithonco-

haematologicalprescriptionsandhometreatmentwere included.Theprecautionaryannulmentswerecodifiedas safety:interactionbetweendrug(INT):categoryX(avoid combination)andcategoryD(modifytherapy),unnecesassary medication(UM),overdose(OD)andtherapeuticduplicity (TDUP).Thevariablescollectedwere:age,sex,prescribing service,typeofprecautionaryannulmentsanddegreeof acceptanceofthedoctor.Sourcesused:digitalclinicalhistory Diraya,corporatedispensingmodule,Uptodateinteractions andelectronicprescriptionprogramFarmisOncofarm v4.0.11.164.

Results Weanalysed35precautionaryannulments.Population ofmeanage52years(range46-87).71%werewomen.The prescribingserviceswereOncology(97.14%)andHematology (2.86%).Theprecautionaryannulmentswereofsafety:INT 80%(categoryX85.72%andcategoryD14.28%),UM 14.28%,OD2.86%andDUPL2.86%.Thedegreeofacceptanceofthedoctorwas88.57%andmodifiedthetreatment 11.43%.

ConclusionandRelevance Theresultsoftheseriesstudied showahighdegreeofacceptancebythedoctoroftheprecautionarycancellationsmadebythehospitalpharmacist.Itis ausefulsafetytool,emphasisingseriousinteractions.

REFERENCESAND/ORACKNOWLEDGEMENTS

AcknowledgementstotheCongress

ConflictofInterest Noconflictofinterest.

5PSQ-048 WHATDOONCOLOGISTSANDPHARMACISTSTHINK ANDWANTFROMA CAHMS-DRUGINTERACTION CHECKER?ABROADSCALESURVEYTOASSESS EXPECTATIONS

1ALammens, 2JNeefs, 2ESimons, 2,3ISpriet*, 4MDelforge, 4AJanssens, 2TVan Nieuwenhuyse. 1DepartmentofPharmacy-UniversityHospitalsLeuven-Belgium, DepartmentofPharmacy,Leuven,Belgium; 2UniversityHospitalsLeuven,Departmentof Pharmacy,Leuven,Belgium; 3KuLeuven,DepartmentofPharmaceuticaland PharmacologicalSciences,Leuven,Belgium; 4UniversityHospitalsLeuven,Departmentof Hematology,Leuven,Belgium

10.1136/ejhpharm-2023-eahp.267

BackgroundandImportance Theuseofcomplementaryand alternativeherbalmedicines(CAHMs)iswidespreadandpopularamongcancerpatientsfordifferentreasons.Unfortunately,CAHMscaninterferewithanticancertreatments leadingtobothtoxicityordecreasedefficacywiththerapeutic failure.Theavailabilityofatoolforthemanagementof potentialCAHM-druginteractions(CAHMDI)couldprovide healthcareprofessionals(HCP)withscientificevidence-based information.Itmayfacilitateopencommunicationabout potentialadverseeffectswithoutneglectingpatient’sbeliefs andpreferences.Suchatooldoesnotyetexistinour hospital.

AimandObjectives Theaimofthissurveywastoassess futureuser ’sexpectationsofapracticaltooltomanage CAHMDI.

MaterialandMethods Twoe-surveys,carriedoutinGoogle Forms,weresentto1)healthcareproviders(HCPs)ofall oncologicaldisciplinesinourhospitalandresearchdepartmentsand2)allhospitalpharmacistsofUHL.

Results Thesurveywascompletedby37HCPand27hospital pharmacists(HP).Theresultsclearlydemonstratedaninterest

inaCAHMDI,asconfirmedby94.6%and100.0%ofthe HCPandHP,respectively.Allrespondentsindicatedapreferenceforawebsiteratherthanatoolintegratedintheclinical decisionsupportsystem(51.0%HCPand46.4%HP,respectively).Intheircurrentdailypractice,themostcommonly consultedresourcesforcheckingCAHMDIbyHCPwereconsultingaclinicalpharmacist(33.9%)andLexicompDrug Interactions ® (21.4%).HPmentionedStockley ’sHerbalDrug Interactions ® (21.3%)andLexicompDrugInteractions® (21.3%).Keyrequirementsforthedevelopmentofatool weremanagementoptions,potentialclinicalconsequences, severitylevel,mechanismandlevelofevidence.

ConclusionandRelevance Developingauser-friendlyCAHMDI checkerwouldbehelpfulforHCPandHP.Alertingabout HDIcouldenhanceprescribers’ knowledgeandawareness aboutthistopicandenablethemtoinformpatientsaboutthe potentialadverseeffectsoftheseeasilyaccessibleCAHMs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1SBlondelle*, 2LLejeune, 1,2APardo. 1ChrHauteSenne,Pharmacy,Soignies,Belgium; 2UniversityofMons,FacultyofMedicineandPharmacyFaculty,Mons,Belgium 10.1136/ejhpharm-2023-eahp.268

BackgroundandImportance HighRiskMedicines(HRMs)are medicineswithanincreasedriskofsignificantharmtothe patientiftheyaremisused.

RegardingthestorageofHRMs,ourhospitalguidelinesare basedonthereferencesystemofouraccreditation organisation.

Compliancewithguidelinesisessentialtoensurethequality ofcare.

AimandObjectives

. Todeterminetherateofadversedrugeventsrelatedto HRMs.

. Toevaluatetheimpactoftheintroductionoflowconcentrationelectrolytes(KCl)ontheconsumptionof concentratedelectrolytes(KCl).

. Totesttheimpactofpharmaceuticalinterventionsonfour qualityindicatorslinkedtoHRMsstorageincareunits.

MaterialandMethods

. Amongalltheadversedrugeventsencodedduringtheyear 2021,weidentifiedthoserelatedtoHRMs.

. AconsumptionanalysisofinjectablePotassiumChloride (KCl)concentratedandlow-concentratedsolutionswas performedduringtheyears2018-2022.

. AuditstargetingHRMswasconductedin6careunitsovera periodof3weeksinDecember2021.Theseauditsfocused onthefollowingitems:storage,quantity,labellingand expirydateofeachHRMstoredincareunit.Duringeach audit,apharmaceuticalinterventiontookplaceasfollows: tidying,relabelling,withdrawalofexpiredHRMs,feedback ofaudit,educationandawareness.Theimpactofthe pharmaceuticalinterventionswasfurtherevaluated.For comparisonbetweenthegroups(pre-testandintervention groups),datawereanalysedusingChiSquaretestforal HRMs.

5PSQ-049 ASSESSMENTANDOPTIMISATIONOFTHE MANAGEMENTOFHIGH-RISKMEDICINESINA GENERALHOSPITAL

. TheLEANMethodologywasusedtodraftouractionplanto improveHRMspractices.

Results

. Weidentifiedthat14%ofadversedrugeventswererelated toHRMs.

. Ourconsumptionanalysisindicatedthattheintroductionof low-concentratedKClsolutionsincareunitswasnot followedbytheexpecteddecreaseintheprescriptionsof injectableKClconcentratedsolutions.

. Atotalof171HRMswereauditedincareunits.Theimpact ofthepharmaceuticalinterventionsperformedduringthese qualityauditswasevaluated,whichallowedtodemonstratea statisticallysignificantimprovement(p<0,05)intermsof storageandexpiryofHRMs.

ConclusionandRelevance Thisworkhighlightstheimportance ofthehospitalpharmacistasakeycontributorinthecontinuousqualityimprovementapproachtooptimisethemanagementofHRMsinahospital.

REFERENCESAND/ORACKNOWLEDGEMENTS

https://www.eahp.eu/24-5PSQ-161

ConflictofInterest Noconflictofinterest.

5PSQ-051 PARKINSONISMINDUCEDBYTAKINGTRAZODONEAS AHYPNOTIC:ACASEREPORT

1MCalvoArbeloa*, 1AEgüesLugea, 2MPAnguianoBaquero, 1MMNocedaUrarte, 1MSarobeCarricas. 1HospitalUniversitariodeNavarra,PharmacyService,Pamplona,Spain; 2HospitalUniversitariodeNavarra,CriticalCareUnit,Pamplona,Spain

10.1136/ejhpharm-2023-eahp.269

BackgroundandImportance Sleepdisturbanceisveryprevalent incriticallyillpatients.Treatmentapproachestoimprovesleep havefocusedonbothnon-pharmacologicandpharmacologic strategies.Trazodoneisanatypicalantidepressantusedwith highlyfrequencyashypnotic.

Themainsideeffectsdescribedfortrazodoneareself-injuriousthoughts,anaemia,seizures,paraesthesia,confusionor dyspnoea.Itcaninhibitdopaminergicneurotransmissioninthe midbrainandasresult,causeextrapyramidaleffects.

AimandObjectives Todescribeacaseofparkinsonism inducedbytakingtrazodoneashypnoticinapatientadmitted inaCriticalCareUnit(CCU).

MaterialandMethods A57-yearoldmanwithnorelevant medicalhistorywasadmittedtoCCUinMay2021with pneumoniacausedbyCOVID-19disease.Thepatientsuffered frominsomnia.Thephysicianprescribedtrazodonestarting withadoseof50mgandthen100mg.

Results Thatafternoon,aftertakingtrazodone,thenurse describedslighttremorintensifiedwithmovementinupper extremities.Thephysicianondutywasnotifiedbuthedid notfindanyexplanation.Nextday,theofficialphysician checkedthemedicationwiththecriticalcarepharmacist.

Thesyndromewasnotexplainedbyanalyticsorother tests.Thepharmacistcheckedallpatient`smedicationssearchinginformationindifferentdatabases:theofficiallabelsand theclinicaltrials,PubMed® andUpToDate®.Inaddition,she checkedpossibleinteractionsinLexicomp® databasebutshe didnotfindnothing.Trazodonewastheuniquedrugassociatedwiththesyndrome.

Thephysicianandthepharmacistagreedtodiscontinuethe medicationtocheckifthesyndromedisappeared.

Thefollowingdays,thepatientcontinuedwithtrembleon movement.Thepatternofthemovementwassimilareach day.Itstartedatafternoonsanddisappearduringnights.The intensityofthemovementwasreducedeachday.Thesyndromedisappearedcompletelyoneweeklater.

Basedoncausalityassessmentofadversedrugreactionsby Naranjoetal.,weclassifythiseventasprobable/likely.The pharmacistnotifiedthisadverseeffecttopharmacovigilance. ConclusionandRelevance Trazodoneisconsideredsafeand usedfrequentlyinourmedicalsystem,sotheknowledgeof effectslikethatisimportant.Nevertheless,theparkinsonism inducedwasreverseanddisappearoneweeklateroncethe treatmentwasstopped.

REFERENCESAND/ORACKNOWLEDGEMENTS

Naranjoetal,ClinPharmacolTher1981.30:239-4.

ConflictofInterest Noconflictofinterest.

5PSQ-053 DESIGNOFAPRIORISATIONSYSTEMBYCOMPLEXITY OFTHEREVIEWINPOLYMEDICATEDPATIENTS: POTENTIALINADECUACYINDEX

AAlcalaSoto,MVázquezReal,DSRuizPérez,CMCuadrosMartínez*,JFSierraSánchez. HospitalUniversitarioJerezdelaFrontera,PharmacyService,JerezdelaFrontera-Cádiz, Spain

10.1136/ejhpharm-2023-eahp.270

BackgroundandImportance Inourhealtharea,whichserves 450,000patients,wehave>2,000polymedicatedpatients (PP)with>15drugs/month.Foranefficientapproachto thesePPitisnecessarytoestablishsomeprioritisationcriteria fortheirreview.

AimandObjectives Todesignanindexofprioritisationto reviewPPbasedontheinadequacyoftheirpolypharmacy, namedPotentialInadequacyIndex(PII).

StratifyallPP(>15drugs/month)accordingtothescoreof thePIIthroughanautomatedanalysisoftheirprescriptions. MaterialandMethods PIIismadeupofdifferentsituations thatcanoccurinthepharmacologicaltreatmentofPP:duplicities,prescribingcascades,drugswithlowtherapeuticvalue, drugsthatprolongtheQT-intervalanddrugscontributingto anticholinergicburdenwerechosenascomponentsofthePII, givingthemascoreincaseofappearance:

PotentialInadequacyIndex(PII)

Duplicity1point

Lowtherapeuticvalue1point Prescribingcascades0,5points QTintervalprolongation0,5points Anticholinergicburden0,5points

AllPPwerestratifiedaccordingtothePIIscore,review ’ s complexitydegreeofthepolymedicatedpatientandestimated timeforreviewareshown:

Review’scomplexity

DegreeofcomplexityPIIpunctuationEstimatedrevisiontime

Verylowcomplexity<110min

Lowcomplexity1to<215min

Moderatecomplexity2to<430min

Highcomplexity4to<890min

Veryhighcomplexity 8160min

Results 2,258PPwereincluded,withameannumberofmedicationsperpatientof16.78(95%CI14.65-18.79),andthe meanPIIscorewas2.01(95%CI1.96-2.06).Patients’ distributionbyreview ’scomplexityisshowninthefollowingtable:

Verylowcomplexity<13881717

Lowcomplexity1to<27293250

Moderatecomplexity2to<48803989

Highcomplexity4to<82281099

Veryhigh complexity >=82218100

All0a17,52247100100

ConclusionandRelevance Theautomatedanalysisoftheprescriptionsofpolymedicatedpatients,insearchofpotentialcriteriaofinadequacy,canfacilitateprioritisationinthereview ofpatients.

ThePIIcanhelpguidetheidentificationofthosepatients withthegreatestcareneeds.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

averageageof80.1years.84.8%(n=28)ofthevalveswere placedtransfemorally,6.1%(n=2)transapicallyand9.1% (n=3)transcarotidly.28patientshadsymptomaticsevere aorticstenosis(ASN),1patienthadasymptomaticASN,and4 patientshadcardiacdecompensationonASN.Contraindicationstosurgeryweredocumentedinthepatientrecordin 84.8%(n=28)ofcases.TheSocietyofThoracicSurgeons (STS)databasescorewasspecifiedin42.4%(n=14)ofthe casesandtheEuroscorewasnotspecifiedforanypatient. Multidisciplinaryconsultationswerecarriedoutin100%of cases,aswellaspre-andpost-TAVIassessments.Atotalof24 non-compliances(NC)wereobserved,including16patients with1NCand4patientswith2NC.Thefundingcriteria werenotrespectedin27.3%(n=9)ofcases.

ConclusionandRelevance Althoughmostofthepatientfiles stipulatecomorbiditiesconsistentwiththeplacementofa TAVI,thereisstillalackofformalisationoftheindications: theSTSscoreismentionedinonly42.4%ofthecases,even thoughitispartoftheFC.Areportwaspresentedtothe recruitingphysiciansandtheimportanceoftranscribingthe STSscoreinthepatientfilewasexplained.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-055 SAFETYTESTINGASSESSMENTFORTHEADHERENCE OFDOSEREDUCTIONINONCOLOGYTREATMENT FOLLOWINGCLINICALGUIDELINES

RECOMMENDATIONSINPATIENTSPRIORRECEIVING FLUOROPYRIMIDINES(5-FLUOROURACIL, CAPECITABINEANDTEGAFUR)

VChorro-Mari,ROnatade*,DChauhan. NorthThamesGenomicMedicinesServiceAlliance NHS,Pharmacogenomic,London,UnitedKingdom

10.1136/ejhpharm-2023-eahp.272

5PSQ-054 ASSESSEMENTOFOCCUPATIONALPRACTICES: ANALYSISOFTHEPRESCRIPTIONSOF TRANSCATHETERAORTICVALVEIMPLANTATION (TAVI)

JFouillet*,NPrisque,CFaure,JPerrey. ChudeMontpellier,PharmacieEuromédecine, Montpellier,France

10.1136/ejhpharm-2023-eahp.271

BackgroundandImportance Transcatheterimplantationofan aorticbioprosthesis(TAVI)allowsthereplacementofthe aorticvalvebyaprosthesiswithoutopensurgery.Likeany medicaldevice,theimplantationoftheseprosthesesmust complywiththeCEmark.AsthefundingofTAVIsisunder specificscriteria,thosemustalsoberespected.

AimandObjectives TocarryoutanoverviewofthecomplianceoftheTAVIprescriptionswiththefundingcriteria(FC).

MaterialandMethods 33patientswererandomlyselected fromthe300TAVIsimplantedin2021.Valvemodels,implantationroutes,andpatientdatawereextractedfromtheinternaltraceabilitysoftware(GILDAS)attheuniversityhospital andfromcomputerisedmedicalrecords(DxCare).Thesedata wereanalysedwithagriddevelopedfromtheFC.

Results Amongthe33patientsselected,15weremenet18 werewomen,ranginginagefrom68to94years,withan

BackgroundandImportance Fluoropyrimidinesinsolid tumoursaremetabolisedbydihydropyrimidinedehydrogenase (DPD)enzyme,encodedbyDPYDgene.Upto3-6%ofthe populationhaveaDPYDvariant,which,withoutappropriate dosereduction,willleadtoseveretoxicity/death[i].

Since2020theregulatoryagenciesinEuropeandtheUK recommendallpatientstobetestedforDPDdeficiencybefore initiationtominimisetheriskofthesereactions[ii],[iii]

FiveLondoncancerprovidingtrusts(CPT)assuredtesting wasbeingperformed[iv].

TheNorthThamesGenomicMedicinesServiceAlliance (NTGMSA)isoneofthesevenintheUKworkingona nationalprojecttoensureequitableimplementationofDPYD pharmacogenomictesting.

AimandObjectives ToestablishthatallCPTwithinNTGMSA aresafelyimplementingDPYDtesting.

MaterialandMethods Fivequestionsanalysedfromnational survey:

WhoisinvolvedincheckingtheresultoftheDPYD genetictest?;

Whomakesdoseadjustments?; Protocol?;

Ischemotherapyprescribedpriorthetestreport?;

Ischemotherapydelayedwhenresultsarepending?

Results WithinNTGMSAall14CPTresponded.Everyone providesDPYDtestingforallcancerindicationswhichinclude fluoropyrimidinetreatment.Multiplehealthcareprofessionals

checkandactionthetestresults,followingdosereductions, followingguidance.Chemotherapyisprescribedpriorreceiving thegeneticreportin10CPT.6hospitalswoulddelayadministrationwhenresultismissing.

ConclusionandRelevance Thereisarichmultidisciplinary involvementincheckingtheresultsofthetest,includingmakingthecorrectdoseadjustments.TheuseofDPYDteststo preventchemotherapytoxicityfollowsasafeandrobustpathwaywithinourregion.

REFERENCESAND/ORACKNOWLEDGEMENTS

[i]UKChemotherapyBoard, ‘PersonalisedMedicineApproachForFluoropyrimidinebasedTherapies,’ 2020.[Online].Available:https://www.theacp.org.uk/userfiles/file/ resources/dpd-testing-ukcb-july-2020-updated.pdf

[ii]EMArecommendationsonDPDtestingpriortotreatmentwithfluorouracil,capecitabine,tegafurandflucytosine|EuropeanMedicinesAgency(europa.eu)

[iii]5-fluorouracil(intravenous),capecitabine,tegafur:DPDtestingrecommended beforeinitiationtoidentifypatientsatincreasedriskofsevereandfataltoxicity

GOV.UK(www.gov.uk)

[iv]NijjarR,ShaunakN,MahmoudS,ThwaitesB,DesaiM,AjeditiC,BrownA,Yeoh I,PatelT,MasentoS.'AcollaborativeauditonDPYDtestingofallpatientsinitiatedonfluoropyrimidines(5-fluorouracil,capecitabineandoralprodrugtegafur) across5Londonteachinghospitals'Abstract;JournalofOncologyPharmacyPractice,2021Suppl&OralPosterPresentation

ConflictofInterest Noconflictofinterest

5PSQ-056 HETEROGENEITYOFDEXMEDETOMIDINETREATMENT EFFECTONMORTALITYACCORDINGTOAGE

MTGomezSanchez,RGazquezPerez,MSanchezValera,DGamezTorres,TMoreno Diaz*,BSanchezRodriguez. HospitalTorrecardenas,Pharmacy,Almeria,Spain

10.1136/ejhpharm-2023-eahp.273

BackgroundandImportance Dexmedetomidineisanalpha-2 agonistwithsedativeeffects.Itisusedforthesedationof patientsintheIntensiveCareUnit(ICU)andsedationofsurgicalprocedures.InJune-2022,theSpanishAgencyforMedicinesandMedicalDevices(AEMPS)publishedasafetyletter reportinganincreasedriskofmortalityinpatients£65years ofagecomparedtostandardsedativeagents1

AimandObjectives Toanalysetheuseofdexmedetomidinein ourhospitalandtocomparetheheterogeneityoftheeffect onmortalityaccordingtoageinreallife.

MaterialandMethods Observational,descriptiveandretrospectivestudy.Patientstreatedwithdexmedetomidineorpropofol duringtheyear2021wereincluded.Variablescollected:age, sex,numberofdaysontreatmentwithdexmedetomidine/propofol,admissiondiagnosistotheICU,surgicalintervention duringICUstayand90-daymortalityfromanycause.Variableswerecollectedthroughthedigitalmedicalrecordandthe hospital'selectronicprescriptionprogram.Datawereanalysed usingExcel.

Results 403patientswereincluded(169=dexmedetomidine vs234=propofol).75.7% weremen(125=dexmedetomimidinevs180=propofol).Baseline patientcharacteristicsare showninthefollowingtable.Therewere74deathsat90daysinthecontrolgroupvs31deathsat90-daysinthe dexmedetomidinegroup,oddsratio(OR)=0,49[95%CI: 0,30 – 0,78].Inthe>65yearsgrouptherewere35vs13 deathsat90days(propofol vsdexmedetomidine,respectively),OR=0,39[95%CI:0,18 – 0,86].Deathsat90days inthegroupaged £65yearswere39vs18(propofolvs dexmedetomidine,respectively),OR=0,55[95%CI:0,30 –1,02].

Abstract5PSQ-056Figure1

ConclusionandRelevance Thedataobtaineddonotreproduce thoseobtainedinthestudyonwhichthealertreceivedwas based.Thismaybeduetolimitationsofourstudy.Evenso, theuseofdexmedetomidineinyoungpatientsshouldbecarriedoutwithcaution.Thepharmacyservicehascommunicatedthealerttothehospitalservices.

REFERENCESAND/ORACKNOWLEDGEMENTS

1https://sinaem.aemps.es/CartasFarmacovigilanciaDoc/2022/DHPC-dexmedetomidine. pdf

ConflictofInterest Noconflictofinterest

5PSQ-057 EFFICACYANDSAFETYOFADALIMUMABINTHE TREATMENTOFINFLAMMATORYFACIAL GRANULOMASECONDARYTOSILICONE

MLCasanovasMoreno-Torres*,PYanesSánchez,LMajuelosAicart,MJRevertAlarcon, VQuesadaMarques,MVMoralesLeon. ChuDoctorNegrin,HospitalaryPharmacist,Las PalmasdeGranCanaria,Spain

10.1136/ejhpharm-2023-eahp.274

BackgroundandImportance Theadministrationofsiliconeas afillermaterialisassociatedwiththedevelopmentofinflammatorygranulomaduetoanincreaseintheproinflammatory cytokinetumournecrosisfactor(TNF-a).Basedonthepathophysiologyofgranulomas,anti-TNF- a drugsarepostulatedas possibletherapeuticalternativeforpatientsnotrespondingto initialtreatments.

AimandObjectives Todescribetheefficacyandsafetyofthe useofadalimumabinpatientsdiagnosedwithinflammatory facialgranulomaduetofillermaterial(silicone).

MaterialandMethods A3-monthretrospectivedescriptive observationalstudyofapatientundertreatmentwithadalimumabforinflammatoryfacialgranulomaduetosilicone.

Studyvariablesincludednumberandsizeofgranulomas andadverseevents(AE)occurrencesassociatedwith adalimumab.

Results 62-year-oldwomanfollow-upbydermatologydepartmentduetoinflammationcompatiblewithsiliconeshowed threelesions,oneontheglabellaandtwoonthecheeks.She receivedasfirstlinetreatmentsystemiccorticosteroids(partial controloftheprocess),methotrexate(noclinicalresponseand evenworseningafter3weeks),doxycycline(noclinical responseafter6weeks)andfinallyhydroxychloroquinein associationwithdoxycycline(noclinicalresponse).Shestarts adalimumab40mg/2weeks.

-Response:After6doses ofadalimumabwereadministered(12weeksoftreatment)combinedwithdoxycycline 100mg/24handhydroxychloroquine400mg/24h.Since treatmentstartedpatientexperiencedadecreaseinthe

numberoflesionsandareductioninthesizeofthemasses: fromthreeinitiallesionsonlylesionattheglabellalevel remainsvisibleandpalpable.Afterobjectiveclinical improvementitwasdecidedto withdrawdoxycyclineand infiltrationofdexamethasoneatthepersistentlesion.Treatmentwithadalimumabtogetherwithhydroxychloroquine wasmaintained.

ThepatientdidnotreportanyAEassociatedwiththeuse ofadalimumab.

ConclusionandRelevance Theuseofadalimumabinthis patientshowedobjectiveclinicalbenefitsoverpreviouslyused alternativetreatmentsbyachievingasignificantreductionin thenumberandsizeoflesionsinareducedtreatmenttime withoutexperiencingAE.Togetherwiththeevidencecollected previouslytheuseofTNF-a inhibitors

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-059 REAL-WORLDCLINICALDATAOFPALBOCICLIBAND RIBOCICLIBINBREASTCANCERPATIENT

MDelVecchio*,CLauriaPantano,FZelante,BRe,VLadisa. FondazioneIrccsIstituto NazionaleDeiTumoriDiMilano,FarmaciaOspedaliera,Milano,Italy

10.1136/ejhpharm-2023-eahp.275

BackgroundandImportance Cyclin-dependentkinase(CDK)4/ 6inhibitors,blockthetransitionfromtheG1toSphaseof thecellcyclebyinterferingwithRbphosphorylationandE2F release,showingpotentantitumouractivityandmanageable toxicityinHR+/HER2 breastcancerpatients.

AimandObjectives Themainobjectiveofthisworkisto compareRealworlddata(RWD)betweenpalbocicliband ribociclibinordertoinvestigatethecontinuityintreatment andthefrequecyofheamatologicadverseevents(AEs)before andafterCDKinihibitorsdosereduction(DR).

statisticalmodeltoconfirmresults..Forclinicianusingribociclibismuchmorecomfortablethanpalboclib,duetothepossibilityofDMwithoutinterruptingtreatment

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-060 GLUTENINMEDICINES.APRESCRIPTIONHELPING TOOL

1PDuqueTebar*, 1SRuizGarcía, 1ERamírezHerraiz, 1AGarcíaPeralo, 1AAlvarezYuste, 1GEscuderoSánchez, 2ÁMorellMuñoz, 1AIbáñezZurriaga, 1MPérezAbánades, 3JCElvira Gómez, 1AMorellBaladrón. 1HospitalUniversitariodelaPrincesa,PharmacyDepartment, Madrid,Spain; 2UniversidadSanPabloCeu,FacultaddeFarmacia,Madrid,Spain; 3Hospital UniversitariodelaPrincesa,TechnologyDepartment,Madrid,Spain

10.1136/ejhpharm-2023-eahp.276

BackgroundandImportance Theuseofexcipientscontaining gluteninmedicinescanbeaproblemforceliacpatients,especiallyforthosewithchronicpathologies.Basedonthis,currentspanishlegislationrequirespharmaceuticallaboratoriesto declareexcipientscontainingglutenandthosethatmaycontaingluten.

AimandObjectives Toevaluatethepresenceofunsafeexcipientsforceliacspatientsinmedicinesandthequalityofthe informationregardingglutencontentforpatientsandprescriptors;aswellastocreateanapplicationthatfacilitatesprescriptionbyprofessionals.

MaterialandMethods

Acourtof128ptshasbeenanalyse frommedicalandpharmacyrecords,ofthese101treated withpalbocicliband27withribociclib.Patients(PTS)has beenobservedfrom2019to2021andtheresultswerecomparedwiththoseofpivottrials.TheDRwasdefinedas reducingpalbociclibdosefrom125mgto100mgor75mg ( 20%DR),whileinribociclibfrom600mgto400mgor 200mg.Inbothcases,DRiseffectiveinthemanagementof AE

Results RWDshowsthattimetofirstDRissimilarinboth cases:11and10monthsrespectivelyforpalbocicliband ribociclib.IfasecondDRisnecessary,itoccurrsbyth16,5 monthsforpalbocicliband16.6forribociclib.Of101pts treatedwithpalbociclib,50(49.5%)discontinuedforprogressiondisease(PD)andoneofthemformetastaticmelanoma.6/27ofpts(22.22%)intheribociclibsettingstopped forPD.Inbothcases,neutropeniaisthepriorAEtodose reductionasshowninreallifeandclinicaltrials.Itsfrequencydecreasesduringthefirstcyclefollowingthedose reduction,withareductionintheseverity.OtherAEs observedwere:haematologicdisorder,hepaticcytolysis,drug intolerance,anaemia,leukocytosis,febrileneutropeniaand fever.

ConclusionandRelevance Asshownbythepivottrials,both thetreatmentsareequalintermoftoxicityandduration.The proportionofptswithPDappearstobesuperiorinPalbociclibsetting,eventhoughneedadeeperstudywithagood

MaterialandMethods Adatabaseinatableformatwascreatedtodeterminethepercentageofpharmaceuticalpresentationswithexcipientsthatmaycontaingluten.Datacollected was:activeingredients,therapeuticgroup,typeofexcipient, andmarketingstatus.ThisdatawasobtainedfromtheprescriptionNomenclatortables(source:AgenciaEspañoladel MedicamentoyProductosSanitarios).Withthisdatabase,an applicationwascreatedtofindoutwhichpresentationsmay containtheseexcipientsandwhatalternativesareavailableon themarket.

Results 41319presentationswererecorded,ofwhich 19957werecommercialised.Thedatabaserevealedthat 8%ofthepresentationscommercialisedincludedexcipientsthatmaycontaingluten.Ofthese,93.05%correspondedtocarboxymethylstarchandsodium carboxymethylstarch,ofwhichitisdifficulttoknowthe sourceofthestarchanditspossibleglutencontent. Moreover,1.836%containedwheatstarch,whichcan havevariableamountofgluten.Theinformationfoundin thedatasheetswasvariableand,insomecases,insufficienttoacknowledgetherealrisk.

Withthisdata,anapplicationhasbeencreatedinwhichit ispossibletosearchbyactiveingredientortherapeuticgroup, providingspecialtiesthatcontainexcipientswithglutenorits derivatives,aswellastherapeuticalternativessuitableforceliacpatients.Inaddition,thisapplicationwarnsofthepresence oflactose.

ConclusionandRelevance Carboxymethylstarchandsodium carboxymethylstarcharethemostusedexcipientsthatmay containglutenandthereisagreatdifficultyinfindingreliable informationabouttheirorigin.Thissituationmakesprescriptiondifficultandshowstheneedfortoolsthatallowquick andeasyaccesstodata,guidingtowardsasaferprescription forceliacpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-062 REVIEWANDDEPRESCRIPTIONOFMEDICATIONIN POLYMEDICATEDPATIENTSWITHPSYCHOACTIVE DRUGS

RDíazPerales*,YDominguezRivas,ALunaHiguera,IMMuñozCastillo. HospitalRegional UniversitariodeMálaga,UnidaddeGestiónClínicadeFarmacia,Málaga,Spain

10.1136/ejhpharm-2023-eahp.277

BackgroundandImportance Approximately38%ofEuropean populationhasamentalhealthdisorderthatrequireschronic andcomplextreatment,whichhaveahighriskoflong-term toxicity.Moreover,inthetherapeuticgroupsused,itisadvisabletocarryoutaprogressivedecreaseinthedoseuntilthe drugiswithdrawn.

AimandObjectives Toevaluateamedicationreviewand deprescriptionprogrammeinpatientswhohaveprescribed threeormoredrugsforpathologiesundermentalhealthfollow-up.

MaterialandMethods Descriptiveandprospectivestudy,carriedoutwiththreecohortsineachofwhichpatientshadto havethreeormoreconcomitantprescriptionsof:antidepressants(A),neuroleptics(B)andbenzodiazepines(C);followed bythementalhealthunitofatertiaryhospital.

PharmacyserviceobtainedthelistsinMay2022through InformationProcessingModuletoknowtheconsumethrough electronicprescription,andpostedonacorporateapplication, sothateachdoctorcouldaccesstheindividualisedreviewduringthecurrentyear.Fourmonthslater,asectionwasmade tostudythedegreeofstrategy'simplementation.

Demographicdata(age;sex)andreview'spercentageswere collected,analysingdeprescription(one/twodrugs),treatment maintenance(byreasonofseverity/prescriptionondemand/deescalationphase/otherreasons),dosechangesandnewdrug's prescription(substitution/addition).

Results Studypopulationobtainedof338patients(meanage: 51years;men:55.3%):34(10.1%)(A),81(53.5%)(B)and123 (36.4%)(C).Theresultsobtained:53.9%reviewed[(A): 44.1%;(B):58%;(C):50.4%],34%pendingreview[(A):26.5%; (B):31.5%;(C):39.9%]and12.1%excluded(reviewnotapplicable).Somedrugswasdeprescribedin17.6%[(A):20%; (B):17.1%;(C):17.7%]:14.8%(one)and2.8%(two).Sameprescriptions'numberwasmaintainedin82.4%[(A):80%;(B): 82.9%;(C):82.3%]:75.3%severity,15.3%scheduleddemand, 8.7%de-escalationand0.7%other.Dosechangeswere reportedin12.1%[(A):6.7%;(B):15.2%;(C):8.1%]:allof themdecreased.Finally,1.7%ofnewprescriptionswere obtained[(A):6.7%;(B):1%;(C):1.6%]:allofsubstitution.Inno casewastheprescriptionsnumberincreased.

ConclusionandRelevance Thistoolprovidedhasallowedprescriberstoaccessandreviewthepopulationsusceptibleto deprescription.Thedegreeofacceptancehasbeengood.In themajorityofpatientstheprescriptionsweremaintained,but in1/5thepatient’smedicationdeprescriptionwasperformed. Thestudyshouldbeextendeduntilthereviewoftheentire selectedpopulation.

Periodicreviewscanmakeahighimpactonthesepatients' healthaswellasapositiveeconomicimpact.Furthermore,it wouldbeusefultocreateourowndrugreview/deprescription algorithmsandtoimplementthisstrategyinotherunits.

5PSQ-063 ACROSS-SECTIONALSTUDYONTHEPOTENTIALLY INAPPROPRIATEPRESCRIBEDAND CONTRAINDICATEDHIGH-RISKMEDICATIONIN HOSPITALISEDCHRONICCOMPLEXPATIENTS

ABocosBaelo*,CGarcía-Castiñeira,AVilariño,AMartin,AArias,CCodina–Jiménez, LEstrada,ETerricabras,EValls,SMarin,CQuiñones. HospitalGermansTriasIPujol, Pharmacy,Badalona,Spain

10.1136/ejhpharm-2023-eahp.278

BackgroundandImportance Increasedlifeexpectancyhas supposedahigherpresenceofcomorbiditiesleadingto polypharmacyrisingtheprevalenceofpotentiallyinappropriateprescriptions(PIPs)andhigh-riskmedication(HRM) burden.PIPscanbeacauseofharmornolongerprovide healthbenefitswhichiswhypharmacists-ledinterventions aimedatdetectingandred ucingithaveemergedduring recentyears.

AimandObjectives AssesstheprevalenceofPIPs,HRMand contraindicatedmedicationsinchroniccomplexpatients(CCP) towhompharmacist-ledin-hospitalreconciliationhavebeen performedandtodeterminedeHRMburdenconsequenceof PIPs.

MaterialandMethods Cross-sectionalstudyonhospitalised CCPbetweenMarchandApril2022.Pharmacist-ledmedicationreconciliation,PIPsidentification(usingtheListofEvidence-baseddeprescribingforchronicpatients(LESS-CHRON) criteria)andcontraindicated(usingtheSpanishdatasheet)and HRM(usingtheHigh-AlertMedicationsinchronicpatients InstituteforSafeMedicationPractices(ISMP)list)identificationwasperformed.

DemographicdatatogetherwithPfeifferandBarthelindex werecollectedfrompatients’ medicalrecords.Chi-squaretest wasutilisedtodeterminedifferencesintheproportionofPIPs betweenHRMandnon-HRM.

Results 60patientswereincluded,(43.3%women,meanage was76.8±9.8years).Pfeifferindexwas0-2(normalcognitivelevel)in35(58.3%)andBarthelindexwas60-99(low dependencelevelin26(43.4%)ofpatients.Meannumberof prescribedmedicationswas12.8±4.7.AtleastonePIPwas detectedin100%ofpatients(meannumberof4.7±4.1 PIPs).In11patients(18.3%)thedetectedHMRalsowas PIPs.Mostlyinvolveddrugswerebenzodiazepines(72.7%of cases),spironolactone(9.1%),vildagliptine(9.1%)andquetiapine(9.1%).In13cases(21.7%)HRMwasalsocontraindicated(23%oralanticoagulants,23%digoxineand15% eplerenone).Therewerenon-significantdifferencesintheproportionofPIPsbetweenHRMandnon-HRM(3.9%vs3%, p 0.05).

ConclusionandRelevance Consideringthesefindings,ahigh prevalenceofPIPswasfoundthroughpharmacist-ledassessmentinhospitalisedCCPaccordingtoLESS-CHRON criteria.

MoreoverfromHRMassessedbyIRMP,ahighnumber ofPIPSandcontraindicatedmedi cationwereidentified,of whichbenzodiazepinesandanticoagulantswerethemost detectedaccordingtothelit eratureandtheresults obtained.

Thisfacthighlightstheneedforpharmacists-ledtreatmentassessmentandoptimisationprogramsinthispopulation.

5PSQ-064 CONCOMITANTTREATMENTWITHATEZOLIZUMAB ANDENZALUTAMIDEFORMETASTASTICNON-SMALLCELLLUNGCANCERANDMETASTASTICPROSTATE

CANCER:ACASEREPORT

1AMelgarejo-Ortuño*, 1MPBautista-Sanz, 2ASánchez-de-Torre, 2EBernal-Hertfelder, 1CAApezteguia-Fernández, 1Cde-Cáceres-Velasco, 1MÁAmor-García, 1EMatilla-Garcia, 1BRodríguez-Vargas, 1RMoreno-Diaz. 1HospitalUniversitarioInfantaCristina,Pharmacy, Madrid,Spain; 2HospitalUniversitarioInfantaCristina,Oncology,Madrid,Spain

10.1136/ejhpharm-2023-eahp.279

BackgroundandImportance OnlyonephaseIIItrialofenzalutamidewithorwithoutatezolizumabinmenwithmetastatic prostatecancerwhoprogressedonabirateronehasbeen reportedintheliterature.Nocaseshavebeenreportedin clinicalpracticewithexperienceinthemanagementof patientswithlungandprostatecancerunderconcomitant treatmentwithatezolizumabandenzalutamide.

AimandObjectives Todescribetheefficacy,safetyandadherenceofconcomitanttreatmentwithenzalutamideformetastaticcastration-resistantprostatecancerandatezolizumabfor metastaticlungadenocarcinomainapatientcase.

MaterialandMethods Thiswasadescriptive,retrospective clinicalcase.Thedata(diagnostictests,therapyandclinical course)wereobtainedbyreviewofelectronicmedicalrecords. Adherencewasevaluateusingmedicationpossessionratio (MPR).

Results A72-year-oldmalepatientwithstageIVnon-smallcelllungcancer,negativeeGFR,ALKandPD-L1,diagnosedinJanuary2019,receivedafirstlinestandardchemotherapy.InSeptember2019,therewasevidenceof tumourprogressionandtreatmentwithatezolizumabwas started.InDecember2019,patientwasdiagnosisofprostateadenocarcinomawithpossibleganglionicinvolvement, surgerywasperformedandanti-androgentreatmentwas started.Thepatientcontinuesmaintenancetreatmentwith atezolizumabandinDecember2021,bonemetastasesof prostateoriginweredetected.Enzalutamidetreatmentis proposedforprostatecancerandmaintenanceatezolizumab forlungcancer.Nocaseshavebeenreportedintheliterature,butthereisonephaseIIItrial,Imbassador250,which atleastreportsconcomitantadministrationofthetwo drugsforprostatecancer.Giventhefavourablesafetydata fromthestudy,andtheefficacydatareportedforboth treatmentsfortheircorrespondingindications,enzalutamideisinitiatedwhiletreatmentwithatezolizumabis maintained.Notoxicityfrom thetreatmentshasbeen reported.Thepatienthasmaintainedbothtreatmentsto thepresentday,maintainingclinicalresponseforboth tumours.Thepatienthasshown100%adherencetooral andintravenoustreatment.

ConclusionandRelevance Thisisthefirstcasereportwithevidenceofefficacyofconcomitanttreatmentwithatezolizumab forlungcancerandenzalutamideforprostatecancer,withno additionaltoxicity.Itisimportanttoreportthesecasesinreal clinicalpracticebecausetheseconditionswillnotbepresent inclinicaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-065 BEAHUMAN,NOTACASEREPORT:HOSPITAL PHARMACISTSMAKETHEDIFFERENCE

1,2ABrescia*, 3MDNaturale, 1,2GMMarrazzo, 1DCasuscelli, 1BSpinoso, 1SEsposito, 1CMonopoli, 1MZito, 3AdeFrancesco. 1AouMaterDomini,Pharmacy,Catanzaro,Italy; 2MagnaGraeciaUniversity,HospitalPharmacySchool,Catanzaro,Italy; 3AouMaterDomini, HospitalPharmacy,Catanzaro,Italy

10.1136/ejhpharm-2023-eahp.280

BackgroundandImportance Thehospitalpharmacyofour HealthInstituteiseligibletocarryoutphase1studytill 2017.InJuly2021amultidisciplinaryteam,whichincludes pharmacists,approvethechoicetoenlista61yearoldman of70kgaffectedbycoloncancerfourthstage,inoperable, withfailureofalldrugtherapiesandwithouttherapeutic treatment.

AimandObjectives Theaimofourworkwastocreateapersonalisedpharmacologicaltherapyinordertoimprove patient’slifeexpectancy,minimisingsideeffects.

MaterialandMethods Evaluationandc reationofacustom pharmacologicalprotcol,withcontinuousmonitoring patient ’ svitalparameters,before,duringandafterdrug administration.Thecalculateddosewas5mg/kg.Pharmacistswereinvolvedalsoinmonitoringofadversedrug reactionsschedulingperiodicalpatientinterviewandparticipatinginthereviewoftherapy withclinicians .Specifically 24hfromthefirstinjecton;7and15daysafterdrug administration.

Results Reductioninthevolumeofmorphologicallesionsafter amonthfromfirstinfusion,observedbycomputedtomography,accordingtoresponseevaluationcriteriainsolidtumours (RECIST1.1):supraclavicularlesionontheleft(cm1.6vs cm2.7);paratrachealformation(cm1.6vs1.4);formationof theaorta-pulmonarywindow(cm1.6vs1.8);decreasedhepaticformation(cm4.6vscm5.1).Afterninemonthsfrom firstadministration,weobservedthatreductionofmorphologicalvolumelesionsremainsconstant.Noadversereactions werepresentedinthewholeobservationalperiod.inaddition, thepatientinterviewedreportslessfatigueandincreased mobility.

ConclusionandRelevance Phase1study(eudract2017002615-33)involvestheuseofLNA-i-miR-221,anewmoleculesynthesisedtoinhibitmir-221,whichmayberesponsibleforcellulardysfunctionattributabletoincreased proliferationandinhibitionofapoptosis,whichhasalways beenallmarkersofcancer.Singledrugvialcontains35mg. TheForcalculateddosewas350mg,reconstitutedwith20 mlNaCl,infusedintotalvolumeof100mlfor30minutes. Therapypersonalisationandinterdisciplinarycollaboration provedtobeasuccessinensuringhelpandlimitingadverse effects.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.DiMartinoMT,et.alDose-FindingStudyandPharmacokineticsProfileoftheNovel 13-MerAntisensemiR-221InhibitorinSprague-DawleyRats.MolTherNucleic Acids.2020Jun5;20:73-85.

ConflictofInterest Noconflictofinterest

5PSQ-066

ADEQUACYTOPROTOCOLOFUSEOFTOCILIZUMAB FORMANAGEMENTOFCOVD-19DISEASE

TESalinasMuñoz*,CNotarioDongil,APerezFacila,MDCGonzalezEscribano,AMarcos delaTorre,MLMorenoPerulero. HospitallaManchaCentro,Pharmacy,AlcazardeSan Juan,Spain

10.1136/ejhpharm-2023-eahp.281

BackgroundandImportance Thesevereaffectationbythe COVID-19virusiscausedbyaninflammatoryresponse triggeredintheindividual.Theuseofimmunosuppressive agentssuchastocilizumabmaybeeffectiveduetocytokinestormblockade.Sinceitisaboutoff-labeluse,experts recommenddevelopingmanagementprotocolsfrom hospitals.

AimandObjectives Todeterminetheefficacyoftocilizumab insevereCOVID-19diseaseandtheadequacytoaprotocol ofuse.

MaterialandMethods Aretrospective,observationaland descriptivestudyovera12-monthperiodwasconducted. AllCOVID-19patientswhoreceivedtocilizumabwere included.

Fortheprotocoldevelopment,followingcriteriawere included:1)Interstitialpneumoniawithrespiratoryinsufficiency andhigh-flowoxygen;2)Absenceofresponseto3bolusesof corticosteroids;3)Interleukin-6>40UI/L.Intheabsenceof interleukin-6,patientshadtomeetatleast3criteria:C-reactiveprotein(CRP)>10mg/dl;D-Dimer>1mg/ml;Ferritine>1000ng/ml;cytopeniaofatleast1series.Toevaluate response,CRPwasmonitored.

Collecteddatawereage,gender,administrationdate,vaccinationagainstCOVID-19,administereddose,CRP,exitus.

DatawerecollectedfromanelectronicprescriptionprogrammeFarmatools® andthecomputerisedmedicalhistory, MambrinoXXI®

Results Atotalof32patientswereanalysed,ofwhich90.6% adheredtotheprotocolforuse.Ofthosewhowerenot adhered9,4%duetoseverityofsuddenillness.

ThemeanvalueoftheinitialCRPwas5.96mg/dlreducing to1.14mg/dlafterthetocilizumabadministration.In81.3% ofpatientstherewasareduction.

Referingtodosebasedonweigh,60%ofthepatients receivedthe600mgdose,theremaining40%receivethedose of400mg.

Ofthetotalofpatients,43.75%hadnotbeenvaccinated againstCOVID-19,37.5%ofpatientstreatedthefinalresult wasexitus,allofthemvaccinated.

ConclusionandRelevance Ahighpercentageofpatientsmeet theprotocolcriteria.ThereasonwhyPatientsaccomplished theprotocolwasarapidevolutionofthedisease.

Ahighpercentageoftreatedpatientswerenotvaccinated. Ingeneral,thevaccineprotectsfromseveredisease.

Theroleofthehospitalpharmacistisimportantinthe developmentofprotocols,especiallyinthesecasesofoff-label usesforacorrecttreatmentapproachavoidingindiscriminate use.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-067 TRACKINGTHEOVERALINUSEANDSTRESS STABILITYOFROMIPLISTIM(N-PLATE®)BYTHE EVALUATIONOFASELECTEDSETOFCRITICAL QUALITYATTRIBUTES

1RPérez-Robles*, 2JRuiz-Travé, 2MMartinez, 3JHermosilla, 3ATorrente-López, 4ASalmerón-García, 4JCabeza, 3NNavas. 1Universityofgranada-fibao-ibsgranada, analyticalchemistry,granada,spain; 2UniversityofGranada,AnalyticalChemistry,Granada, Spain; 3Universityofgranada-ibsgranada,analyticalchemistry,granada,spain; 4Sancecilio universityhospital-ibsgranada,departmentofclinicalpharmacy,granada,spain 10.1136/ejhpharm-2023-eahp.282

BackgroundandImportance Romiplostim(N-Plate ® )isaFcfusionproteininwhichaTPOagonistpeptideisassociated withtheFcdomainofahumanantibody.Itcontainsof twoidenticalsubunitseachconsistingofanFcdomainof humanimmunoglobulinIgG1linkedtoapeptidecontaining twohumanTPOreceptorbindingdomains.Thisdrugis indicatedinthetreatmentofimmunethrombocytopenic purpura(ITP).Asproteinaceo usbased-medicine,romiplostimisindicatedtohavelowstability,thusthestudieson theeffectsofpossiblein-usem ishandlingandinstressconditionsarewelcomedtogetknowledgeuponitsstability anddegradation.

AimandObjectives ToevaluatetheimpactofinusemishandlingandforceddegradationonromiplostimchemicalstructurebyevaluationofseveralCriticalQualityAttributes (CQAs).

MaterialandMethods Vialsofromiplostim(N-plate,0.5mg/ mL)werereconstitutedasitisindicatedbythemanufacturer andsubmittedtoseveralstressstimuli:expositionat80 °C (2h),smoothshaking(12h),roomlightandtemperature (excursionaprox.20-24 °C)exposition(24h),acceleratedlight exposition(24h)and1freeze/thawcycle.TheCQAsevaluated were:(A)primarystructure,bypeptidemapping-RP/UHPLC(Orbitrap)MS/MS;(B)tertiarystructurebyIntrinsictryptophan fluorescencespectroscopy;(C)aggregationbySE-HPLC/DAD; andfunctionalactivity(asthecapacitytobindtoitstherapeutictarget)byELISA.

Results Changesintheprimaryandtertiarystructureandthe formationofaggregatesweredetectedafterromiplostimsamplesweresubmittedtohightemperatureandtoroomconditions.Thesechangesdetectedwereaccompaniedbyalossof functionality.Similareffectswerecausedwhenstressedby acceleratedlightexposition.Thesmoothshakeandfreeze/ thawcyclestimulididnotaffecttheCQAsstudied.

ConclusionandRelevance Thisstudyprovesthatromiplostimmustbereconstitutedandadministratedavoidinglongtimelightexposureandelevatedtemperaturesastheycan inducetheactivationofse veraldegradat ionpathways whichcauselossoffunctionali tyandaggregation,and thus,losingtheoriginalsafety,qualityandefficacyofthe drug.

REFERENCESAND/ORACKNOWLEDGEMENTS

ThisstudywasentirelyfundedbyProjectFIS:PI-17/00547(InstitutoCarlosIII,MinisteriodeEconomíayCompetitividad,Spain),whichmeansthatitwasalsopartially supportedbyEuropeanRegionalDevelopmentFunds(ERDF).

ConflictofInterest Noconflictofinterest

5PSQ-068

DIARRHEAOCCURRENCEANALYSISINIDIOPATHIC PULMONARYFIBROSISPATIENTS

1ADordàBenito, 1XLarreaUrtaran*, 1ENoguéPujadas, 1ÀCastellóNòria, 1MVilaCurrius, 2FArtimeRodríguez-Hermida, 1CSubiranaBatlle, 1LViñasSagué, 1RSacrestGuell. 1Hospitaldrjoseptruetadegirona,pharmacydepartment,girona,spain; 2HospitalSanta Caterina,PharmacyDepartment,Girona,Spain

10.1136/ejhpharm-2023-eahp.283

BackgroundandImportance Nintedanibandpirfenidoneare theonlydrugsindicatedforthetreatmentofc(IPF).Both drugshavediarrhoeain62.4%and18.8%,respectively, describedintheSummaryofProductCharacteristics(SmPC)as afrequentadverseeffect(AE).

Incaseofdiarrhea,itisrecommendedtoreducethedose orstoptreatment.

AimandObjectives Toanalysethefrequencyofappearanceof diarrhoeaofthetreatmentwithpirfenidoneandnintedanib describedinSmPCwiththatofthepatientsinthestudyand todescribetheactioncarriedout.

MaterialandMethods Retrospectiveobservationalstudy betweenJanuary2017andAugust2022inwhichIPFpatients treatedwithnintedaniborpirfenidonewereincluded.

Thefollowingvariableswerecollected:age,sex,drug, durationoftreatment,withdrawalreason,existenceofdiarrhoeaandseverityaccordingtomedicalevaluationand,if necessary,thecorrectiveactiontaken(dosereduction,treatmentdiscontinuationorcontroloftheAEwithanother drug).

Forstatisticalanalysis,mean,medianandstandarddeviation(SD)wereperformed.Theoddsratio(OR)wascalculated withthedataobtainedandthosedescribedintheSmPCof eachmedication.

Results Thirtypatientswereincludedwithamean±SDage of72±8years,ofwhich23.3%(7)werewomen.80.0%(24) receivedtreatmentwithnintedanib(durationrange:37and 1953days),and20.0%(6)weretreatedwithpirfenidone (durationrange:124and1073days).

Ofthepatientstreatedwithpirfenidone,83.0%(5)discontinuedtreatment(noneduetoEA).17%(1)hadmilddiarrhoeathatwascontrolledwithloperamide.

66.7%(16)ofnintedanibpatientspresenteddiarrhoea(7 severe,7moderate,and2mild).Ofthese,37.5%(6)were treatedwithloperamidemaintainingthedose,18.7%(3)discontinuedtreatment,and43.8%(7)underwentadosereduction.Thisadjustmentallowedtreatmenttocontinuein71.4% (5/7)ofthepatients.TheORofdiarrhoeainstudypatients, comparedtodescribedinSmPC,withnintedanibwas1.21 CI95(0.51-2.86)andwithpirfenidonewas0.86CI95(0.107.47).

ConclusionandRelevance Theappearanceofdiarrhoeain bothdrugsisveryfrequent.Nostatisticallysignificantdifferenceswereobservedinthefrequencyofonsetofdiarrhoeain patientsatourhospitalcomparedtothosedescribedinthe SmPC.

Inmostcasesdiarrhoeawascontrolledbydosereduction orloperamideadministration.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-070 PHARMACEUTICALCAREINANONCOHAEMATOLOGICALCLINICALTRIALSUNIT

1LGarcíaBasas*, 2CVaron-Galcera, 2PGarciaOrtega, 1ESerramontmanyMorante, 1SGimenezGiner, 1MCarreresPrieto, 1PRoviraTorres, 1ICidonchaMuñoz, 3MQGorgas Torner. 1HospitalUniversitarioVallD’hebron,Pharmacy – VallD’hebronInstitutode OncologíaVhio,Barcelona,Spain; 2HospitalUniversitarioVallD`Hebron,Pharmacy – Vall D’hebronInstitutodeOncologíaVhio,Barcelona,Spain; 3HospitalUniversitarioVall D’hebron,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.284

BackgroundandImportance Thepharmacist’sroleinthe healthcareforpatientsparticipatinginclinicaltrials(CTs) goesbeyondtellingthemhowtotakethemedicationatthe startoftreatment.CTprotocolsareverycomplexandcompliancewithalltheirrequirementsisessential.

Patientsalwayshaveavailableapharmacydirectphoneand emailinordertomakeiteasiertosolveanyqueriesthey mayhaveaboutdrug-druginteractions,sideeffectsordietary anddailylivingrecommendations.

AimandObjectives Toevaluateallpharmaceuticalcarequeries addressedtothepharmacistteaminaCTsunit.

MaterialandMethods Retrospectivestudycarriedoutina tertiaryuniversityhospitalovera7-monthsperiod(January – July2022).Allthecon sultationswereevaluatedandclassifiedaccordingtothephaseoftheCTinwhichthe patientwasincluded,sex,pathology,personwhoasked (patient,oncologist,etc.),communicationmediaandreason ofconsulting.

Results Atotalof596querieswerereceived,mostlyabout patientsincludedinphaseItrials(58,6%).Thenumberof consultationsincreasedsteadilyfromJanuary(37)toJuly (115).

Accordingtosexandpathology,559queriescouldbeevaluated.Morethanhalfwereaboutwomen(58,9%).Mostfrequentconsultationswereaboutpatientswithbreast(17,4%), lung(14,1%)andgenitourinary(13,8%)cancer.

Ofthefullyevaluablequeries(494),40,7%weredoneby patients,followedbystudycoordinators(32,8%)andphysicians(25,9%).Mostoftheconsultations(57,7%)were receivedbyemail.Relatedtothetopic,almostallofthe querieswererelatedtointeractionswithconcomitanttherapies (92,5%),followedbyinstructionsonhowtotakethedrug (3.8%).

ConclusionandRelevance Pharmacistsreceiveahugenumber ofconsultationsaboutdrug-druginteractions.Bothpatients andhealthcareprofessionalsneedtohaveaquickwayto havetheirconsultationssolved.

Continuouspharmaceuticalattentionisvitaltoensurethe efficacy,safetyandcontrolleduseoftheinvestigationaldrug andtofacilitatecompliancewithCTprotocols.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-071 ANALYSISOFMEDICATIONPROVIDEDBYPATIENTS

1ISoto, 2IGonzález, 1MRMengualBarroso, 1BRubioCebrian, 1PSanMiguelTorvisco, 1ISollano-Sancho*, 1IMoronaMinguez, 1APousadaFonseca, 1JSolisOlivares, 1YMateos Mateos, 1CMorielSanchez. 1HospitalUniversitariodeMóstoles,FarmaciaHospitalaria, Móstoles,Spain; 2HospitalUniversitariodeMóstoles,FarmaciaHospitalaria,Móstoles,Spain

10.1136/ejhpharm-2023-eahp.285

BackgroundandImportance Manypatientsbringmedication withthemduringtheiradmissiontohospital,whichisa sourceoferror.

AimandObjectives Analysetheprescriptionofmedicinesprovidedbythepatientandevaluatetheircorrectuse.

BackgroundandImportance Tofacitinib,baricitinib,upadacitinibandfilgotinibareJanuskinaseinhibitors(IJAKs)indicated inrheumatoidarthritis(RA).TheEMAnotifiedthatin patientswithRAwhowere 50yearswithatleastonecardiovascularriskfactorhadanincreasedriskofmajoradverse cardiovascularevents(MACE),andmalignancieswithuseof tofacitinibrelativetoTNF-alphainhibitor:https://www.ema. europa.eu/en/documents/dhpc/direct-healthcare-professional-communication-dhpc-xeljanz-tofacitinib-increased-risk-major-adverse_en.pdf Althoughitisbeingevaluated,itisstillunknownifthis riskissharedbyotherIJAKs.

MaterialandMethods

Cross-sectionaldescriptivestudyof patientsadmittedtoasecondlevelhospitalon11-11-2021 whichhadtreatmentsprescribedas ‘medicationprovidedby thepatient’ (MPP).Thesourcesofinformationusedwere:the electronicmedicalrecordandtheprescriptionprogramme. Thevariablescollectedwere:age,sex,prescribingservice, whetherornotthemedicationwasprovided,patientknowledgeofthedosageofthemedicationprovided,numberof totalactiveingredientsprescribedperpatient,andmedications provided,numberoftherapeuticduplicationsinthecomplete treatment.

Results Atotalof96patientshadaprescriptionforaMPP, representing28.92%ofthepatientsadmittedtothehospital atthattime.Ofthistotal,afterexcludingthosewhocould notbeinterviewedduetotheirclinicalsituation(Intensive Care,Resuscitation,Psychiatry,Emergency,HomeHospitalisationUnitandisolatedpatients),42patientswereanalysed, withamedianageof74.5years[RIQ70-80.75],59.52% beingmale.Themainprescribingservicewasinternalmedicine(59.52%)followedbysurgery(16.67%)andtraumatology (16.67%).Ofthetotalnumberofpatientswithprescribed MPP,85.71%actuallyprovideditand97.22%wereawareof itsdosage.Themediannumberofactiveingredientsprescribedperpatientwas13[RIQ11-17],withthemediannumberofMAPsbeing2[RIQ1-2.75].Therapeuticduplication wasfoundbetweenthemedicationprovidedandthatofthe admissionin2patients.

ConclusionandRelevance Aconsiderablepercentageof patientsadmittedtothehospitalprovidemedication,withthe majorityofpatientsbelongingtotheInternalMedicine Department.Aftertheinterview,itwasobservedthatmostof themcontrolledtheirmedication;however,asignificantpercentage,despitehavingmedicationprescribedasprovided,did nothaveitduringtheiradmission.Forthisreason,weconsiderthatthepatientshouldnotprovidemedicationasfaras possible,inordertotrytopreventmedicationerrorsduring thehospitalstayandtoadjusthistreatmenttothehospital pharmacotherapeuticguide.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

AimandObjectives Todescribeandcomparethesafetyof tofacitinib,baricitinib,upadacitinibandfilgotinibinpatients withRAinareal-world-setting.

Secondaryobjective toanalyseifthereisarelationship betweenMACEandmalignancieswithapatientprofilewitha higherriskofdevelopingthemasestablishedinthealert.

MaterialandMethods Retrospective/prospectiveobservational studyofRApatientsundertreatmentwithtofacitinib,baricitinib,upadacitinibandfilgotinibuntilSeptember2022.

Safetywasdeterminedbasedontheadverseevents(AEs) reported.

Variables sex,ageatstart,time-of-treatment,reasonfordiscontinuation,riskfactor´sMACE,riskfactorsformalignancies, andAEs.

Statisticalanalysis adescriptionofcharacteristicsandevents thatoccurredinthecohortwascarriedout.Associationswere laterexplored.

Results 124patients(80.6%women)wereenrolled.Mean age:55.8(SD11.8)years.

Treatmentsreceived tofacitinib(n=60),upadacitinib(n=49), baricitinib(n=21)andfilgotinib(n=14),because19patients (15.3%)weretreatedwithmorethanoneIJAKsequentially.

Medianoftreatment;tofacitinib:399(171-884)days,baricitinib:308(210-632),upadacitinib:287(130-477)and93 (60-171)forfilgotinib.

Weidentified110patienttreatmentswithanincreasedrisk ofMACEormalignances.

AEswerereportedin39(31,5%)treatments(21,9,7,and 2caseswithtofacitinib,upadacitinib,baricitinibandfilgotinib) beingthemostcommonherpeszoster.Only2patientssufferedaMACEinthetotalcohort(bothwithtofacitinib).

Therewere79end-of-treatmentbecauseofinefficacy (n=46),AE(n=22),both(n=7)orforbeingconsidereda riskpatient(n=4).

Noassociationcouldbeestablishedbetweenriskpatientand thedevelopmentofadverseevents,neitherminorormajor. ConclusionandRelevance Therefore,itisstillunknownifthe exchangestrategybetweenthemisadequatetoreducethe risk.Limitation:alargersamplesizeandlongerfollow-up timearerequiredtodetectmajorAEsandtheirassociation withpatientsatrisk.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-073 ISTHEREASAFETYDIFFERENCE?JANUSKINASE INHIBITORSINREALCLINICALPRACTICE

1MTGómezLluch*, 1PGarcíaLloret, 2MGonzálezBoronat, 3CVAlmeidaGonzález. 1HospitalUniversitarioVirgendeValme,ServiciodeFarmacia,Sevilla,Spain; 2Universidad deSevilla,Farmacia,Sevilla,Spain; 3HospitalUniversitarioVirgendeValme,Bioestadística deInvestigación,Sevilla,Spain

10.1136/ejhpharm-2023-eahp.286

5PSQ-074 INTERACTIONSDETECTEDWITHTHEUSEOF NIRMATRELVIR/RITONAVIRINATERTIARYHOSPITAL

RManzanoLorenzo*,JCTallonMartinez,NSanchez-OcañaMartin,PPastorVara, JCorazonVillanueva,AFernandezRuiz-Moron,LYbañezGarcia,JMMartinezSesmero. HospitalClinicoSanCarlos,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.287

BackgroundandImportance

Theincorporationofnirmatrelvir/ ritonavirintothetherapeuticarsenalforthetreatmentof SARS-CoV2infectionhasmadeitnecessaryforPharmacy departmentstoactivatecircuitsandtoolsthatallowusto adequatelyreviewthepotentialmultipleinteractionsthatritonavircanproduce.

AimandObjectives Todescribetheinteractionsdetectedsince thebeginningoftheuseofnirmatrelvir/ritonavirinatertiary hospital.

MaterialandMethods Allpatientswhoreceivednirmatrelvir/ ritonavirfromApriltotheendofAugust2022were included.Thepatient‘susualtreatmentwasconsultedinthe electronicprescriptionsystemoftheregionofMadrid,aswell asaninterviewwiththepatient,andthemedicalhistorywas consultedwhendeemednecessary.Forthedetectionofinteractions,the ‘COVID-19DrugInteractions’ platformofthe UniversityofLiverpoolwasusedandFarmaweb,anapplicationoftheMadridHealthService,wasusedtovalidatethe dispensingofmedication.Ifthereareanyinteraccionesthe pharmacistnotifiestheprescribingphysician,aswellasthe necessaryadjustments,thesetreatmentmodificationsarealso explainedtothepatientwhenthemedicationisgivento them.AnExceltablewasusedtorecordwhetherthepatient hadanyinteractionand,iftherewereany,thedrugswere recorded.

Results Duringthestudyperiod,thesedrugsweredispensed toatotalof81patients,andinteractionswiththepatient‘ s usualmedicationweredetectedin61.73%(50patients).18 patientshadoneinteraction,21patientshad2interactions,6 patientshad3,4patientshad4andonepatienthad5potentialinteractions.Themostcommonlydetectedinteractionwas withatorvastatin(19)followedbymetamizole(11),simvastatin (7),amlodipine(6)andtramadol(4).

ConclusionandRelevance Thepercentageofpatientswith interactionsisveryhigh,anditisveryimportanttoreview theusualtreatmentaswellasaninterviewwiththepatientto identifywhetherthepatientistakingotherunregisteredmedicationthatcouldinteract.

Thishashighlightedtheimportanceofinterdisciplinarycollaborationbetweenthemedicalteam(mainlyintheemergency department,wheremostofthesedrugshavebeenprescribed) andthepharmacyteamtoensurethecorrectuseofthis drug.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-075 PROPOSALFORTHEADJUSTMENTAND OPTIMISATIONOFTHEMEDICATIONPROVIDEDBY THEPATIENT

1IGonzález, 2ISotoBaselga, 2MRMengualBarroso, 2PSanMiguelTorvisco, 2BRubio Cebrian, 2ISollano-Sancho*, 2IMoronaMinguez, 2APousadaFonseca, 2YMateosMateos, 2CMorielSanchez, 2JSolisOlivares. 1HospitalUniversitariodeMóstoles,Farmacia Hospitalaria,Móstoles,Spain; 2HospitalUniversitariodeMóstoles,FarmaciaHospitalaria, Móstoles,Spain

10.1136/ejhpharm-2023-eahp.288

BackgroundandImportance Manypatientsbringmedication withthemduringtheiradmissiontohospital,whichisa sourceoferror

AimandObjectives ToadaptthePharmacotherapeuticGuide (PTG)tohometreatmentandpatientconformitytotherapeuticexchangeduringadmission.

MaterialandMethods

Cross-sectionaldescriptivestudyof patientsadmittedtoasecondlevelhospitalon11-11-2021 withtreatmentsprescribedasMedicationProvidedbythe patient(MPP).Thesourcesofinformationusedwere:the electronicmedicalrecordandtheprescriptionprogramme. Thevariablescollectedwere:age,sex,therapeuticgroupof thePPMaccordingtotheATCclassification,inclusionstatus inthePTGand/orinthetherapeuticexchangeprotocol,and patientagreementwiththeexchangeforanotheravailable.

Results Atotalof96patientshadaprescriptionforMPP,representing28.92%ofthepatientsadmitted.42wereanalysed afterexcludingthosewhocouldnotbeintervieweddueto theirclinicalsituation,withamedianageof74.5years (IQR70-80.75),59.52%beingmale.OftheMPPs,themost frequenttherapeuticgroupwasC(38.82%)followedbyN (20%)andR(15.29%)amongothers.AnalysinggroupC,the mostfrequentsubgroupwas:agentsactingontheReninAngiotensinSystem(RAS)(33.33%),lipid-modifyingagents (21.21%).47.06%oftheMAPswereincludedinthePT. Amongthosenotincludedintheguidelines,84.78%were includedinthetherapeuticexchangeprotocolwhile15.22% werenot,whichwererecommendedtobemaintainedduring admission.80.56%ofthepatientsshowedcompliancewith thechangeforanothermedicationavailableinthehospital ConclusionandRelevance Astrikingpercentageofpatients admittedtothehospitalbringmedication,themostfrequent therapeuticgroupandsubgroupwerethoserelatedtothecardiovascularsystemandtheRAS,respectively.AhighpercentageoftheMPPwerefoundinthePTG,andcouldhavebeen dispensedbythePharmacyService.Thosemedicinesnotavailableinthehospitalwereincludedinthetherapeuticexchange protocol;Fornon-interchangeabledrugs,wasrecommendedto maintainduringadmission.Mostpatientswouldhaveno objectiontotheirmedicationbeingexchangedduringadmission.Weconsiderthatthebestapproachwouldbetoavoid thesupplyofmedicationbypatients,withallmedication beingdispensedbythePharmacyService.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-076 PATIENTS’ SATISFACTIONAFTERCHANGINGFROM 150MGTO300MGSECUKINUMABPEN PRESENTATION

PCastroSalinas*,VCharques,ARetamero,SMendiola,AFigueras,JSerrais,JMartínez, DFerrandez. HospitalUniversitariodeIgualada,Pharmacy,Igualada,Spain

10.1136/ejhpharm-2023-eahp.289

BackgroundandImportance Secukinumabisananti-interleukin-17drugusedforpsoriasis,psoriaticarthritisorspondyloarthritis.Recently,ourhospitalchangedfrom150mgto 300mgsecukinumabpenpresentationinordertosimplify treatmentandfacilitateadministration.However,aspatients oftenhaveotherexpectations,desiresandprioritiesevaluating thedegreeofsatisfactionallowsustoidentifydeficienciesand causesofdissatisfaction.

AimandObjectives Todeterminepatients’ satisfactionafter changingfrom150mgto300mgsecukinumabpen presentation.

MaterialandMethods Retrospectivestudycarriedoutina regionalhospital.Patientsontreatmentwithsecukinumab 2x150mg/monthwhochangedpresentationto300mg/month

duringNovember-December2021wereincluded.Patientswho hadn´ttakenbothpresentationsforatleast4monthsand patientsimpossibletolocatewereexcluded.Thosewhogave theirverbalconsentunderwentatelephonesurvey.Variables collected:sex,age,drugindication,treatmentduration,selfadministration,painmeasuredwithVAS(VisualAnalogueScale) withbothpresentations,presenceofadministrationsitereactionswithbothpresentations,satisfactionwithpenchange measuredfrom0to10(0minimum-10maximum),300mg pendiscontinuationandreason.Qualitativevariableswere expressedasfrequencyandpercentageandquantitativeones asmeanandstandarddeviation.StatisticalanalysiswasperformedwithExcel(v.12.0).

Results Totalnumberofpatientswith300mgpenpresentation:33.Included:24(72.2%).Women:9(42.9%).Age:49 (13.9).Patientswithpsoriasis:19(79.2%),psoriaticarthritis4 (16.7%)andspondyloarthritis1(4.2%).Treatmentduration (months)38.7(22.6).Patientswhoself-administeredmedication:23(95.8%).VASwith150mgpresentation1.8(1.2)and with300mgpresentation2.2(1.9).Regardingthe150mgpresentation,2(8.3%)patientsreportedhavingbruisesatthe injectionsiteandregardingthe300mgpresentation,3(12.5%) reportedhavingsufferedswellingthatrevertedspontaneously. Two(8.3%)hadtodiscontinuethe300mgpresentationdueto severepainduringadministration.Regardingchangesatisfaction,1(4.1%)referredtothechangeasindifferent,2(8.3%)as notsatisfactoryand21(87.5%)assatisfactory,withtheaverage satisfactionbeing8.0(2.2).

ConclusionandRelevance

. Changingfrom150mgto300mgsecukinumabpen presentationwasconsideredsatisfactoryfor87.5%of patients.

. Twopatientssufferedgreaterpainduringadministration, leadingtoareturntothepreviouspresentation.

. Itwouldbeadvisabletocarryoutadditionalfollow-upin ordertodetectpossiblereactionsattheadministrationsiteor greaterpainafterthechangeofpresentation.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-078 ANALYSISOFCASIRIVIMABANDIMDEVIMABUSEIN OUTPATIENTSWITHCOVID-19

1,2PRozsívalová*, 2JMinaříková, 1MMikešová, 1LBeková, 3Ľ Slimáková, 4A Štricová, 2EZimčíková, 1MHeislerová, 5P Šmahel, 2JMaly, 6VKoblížek. 1UniversityHospitalHradec Králové,HospitalPharmacy,HradecKralove,CzechRepublic; 2FacultyofPharmacyIn HradecKrálové-CharlesUniversity,DepartmentofSocialandClinicalPharmacy,Hradec Králové,CzechRepublic; 3UniversityHospitalBratislava,HospitalPharmacy,Bratislava, Slovakia; 4UniversityHospitalBanskáBystrica,HospitalPharmacy,BanskáBystrica,Slovakia; 5UniversityHospitalHradecKrálové,DepartmentofInfectiousDiseases,HradecKralove, CzechRepublic; 6UniversityHospitalHradecKrálové,DepartmentofPulmonaryMedicine, HradecKralove,CzechRepublic

10.1136/ejhpharm-2023-eahp.290

BackgroundandImportance AtheightofCOVID-19pandemic surgeofdeltavariant,monoclonalantibodiesbecameavital treatmentoptionforSARS-COV-2positiveoutpatientsathigh riskofseverediseaseprogression.Casirivimabandimdevimab (C/I)wereusedunderEMAemergencyuseauthorisation (EUA)andtherewaspaucityofreal-worlddataonsafetyand effectiveness.

AimandObjectives

Thestudyaimedtodescribedrugsafety, self-reportedsymptomburdenandvaccinationstatusinSARSCOV-2positiveoutpatientswithin90dayspost-C/Iinfusion.

MaterialandMethods

Prospectivemulticentricsurveyof SARS-CoV-2positiveoutpatientswithmildsymptomsathighriskofsevereCOVID-19progression(definedcriteriaunder EUAauthorisationforC/Iambulatoryadministration)wasconductedfromSeptember2021tillJanuary2022inthreeteachinghospitals.Thedatacollectedusingelectronicmedical recordscomprised:patientdetails,vaccinationstatus,dateof SARS-COV-2positivetest,indication,adversedrugreactionto infusion,hospitalisation.Structuredtelephonequestionnaire withsymptomscoringadaptedfromBLAZE-1trialwasused onD(day)0,D+7,D+29andD+90post-C/Iinfusion. DatawereanalysedusingMSExcel.Ethicscommitteeapprovalwasobtained.

Results Withinstudiedperiod404outof471patientswere included(medianage66years;57.4%females).Excluded patientsincludedprophylacticC/I,notconsentedordropped out.396patientshadthefirstCOVID-19episode.Themost frequentindicationsincludedageover65years(55.5%), hypertension(56.8%),diabetesmellitusII(19.4%).C/Iinfusionwasadministeredwithameanof2.3days(range0–11 days)sinceviruspositivity.62.4%patientshadcompletevaccination(2or3dosesComirnaty,1doseJanssenvaccine)prior C/Iinfusion.Adverseeventswerereportedby11.6%of patients,mostcommonlychills,fever,diarrhea.SubjectiveworseningofsymptomsafterC/Iinfusionwasreportedby3.4% subjectsbyD+7.11.6%patientsobservednodifferencein symptomscorebetweenD0andD+7.Altogether85%;92% and93.6%patientsreportedimprovementinsymptomburden scorebyD+7,D+29andD+90respectively.

ConclusionandRelevance Wedescribereal-lifeoutpatientutilisationofC/Iintermsofpatientcharacteristics,self-reported symptomburdenandadverseevents.TherapeuticvalueofC/I timelyadministrationisevidentinhigh-riskpatientswithcompletedvaccination.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.NEnglJMed.2021Jan21;384(3):229-237

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5PSQ-079 FONDAPARINUXINANINFANTWITHSUSPECTED HEPARIN-INDUCEDTHROMBOCYTOPENIA.ACASE REPORT

1EWilhelmi*, 2SFerro, 1AFont, 1ACasaldáliga, 1CJMoreno, 1ÁPieras, 1MVillaronga, 1RFarré, 3RBerrueco. 1HospitalSantJoandeDeu,Pharmacy,Barcelona,Spain; 2Hospital UniversitarioLucusAugusti,Pharmacy,Lugo,Spain; 3HospitalSantJoandeDeu, Hematology,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.291

BackgroundandImportance A3-month-oldinfant(3kg)was admittedinthepaediatricintensivecareunitforextracorporealmembraneoxygenation(ECMO)afterapulmonary lobectomy.

Anticoagulanttreatmentwasperformedwithunfractionated heparin(UFH).

DuringtreatmentwithUFH,thepatienthadasustained decreaseinplateletcount(>50%ofbasal)andinferiorcava deepvenousthrombosis(DVT).OnceECMOwasfinished, anticoagulanttreatmentwasmodifiedtoenoxaparin.

DuetopersistentthrombocytopeniaandDVT,heparininducedthrombocytopeniawassuspected.Anticoagulantwas replacedtofondaparinux,whoserecommendeddoseinpaediatricsis0.1mg/kg/day.

AimandObjectives Toshowtheneedtoredosefondaparinux inpaediatrics,asregisteredpresentationsdon’tallowfractionation:theyaresingle-dosepre-filledsyringesbasedontwoconcentrations:5mg/mland12.5mg/ml.

Toverifythestabilityofthepreparationthroughthestudy ofthepharmacotherapeuticeffect,indirectlymeasuredby plasmalevelsofanti-Xafactor(antiXa).

MaterialandMethods Subcutaneousfondaparinuxwasstarted atadoseof0.3mg/day(0.06mL).Tofacilitateadministration, thepreparationwasinitiallydiluted1mg/mLinnormalsaline understerileconditions.Thedosewaspackagedin1mldead spacefreesyringewithapurgedneedle.Accordingtothe datasheet,thepreparationisstablefor24hatroom temperature.

AntiXawasmonitored3hoursafteradministrations.The dosewasadjustedaccordingtoTable1untilthetargetlevel (0.5mg/l)wasreached.

Subsequently,asthedoseincreaseallowed,theundiluted dose(0.4mg/0.08ml)wasfractionatedfromcommercialpresentation.Stabilityof7daysintherefrigeratorwasdefined accordingtotheriskmatrix(lowrisk)oftheGoodPharmaceuticalPracticesforthepreparationofsteriledrugs.

Results ThedosewasadjustedaccordingtoantiXa(Table2). ThemonitoringofantiX,necessaryfortheclinicalfollow-up, allowedustoobtainindirectdataonthestabilityofthefractionateddrug,maintainingcorrectlevelsthroughouttreatment, asshowningraph.

Afterfondaparinuxinitiation,theplateletcountincreased tonormalvalues.Anticoagulationtherapywasdiscontinued afterthreemonths,uponconfirmationofDVTresolution.

Abstract5PSQ-079Table1

ConclusionandRelevance IndividualiseddosingoffondaparinuxbydilutionorfractionationhasallowedDVTtreatment, usingacommercialpresentationunsuitableforpaediatrics.

Weverifystabilityofthefractionateddosewiththetherapeuticeffect.

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5PSQ-083 FOURYEARSOFAPHARMACEUTICALCARE PROGRAMMEINPATIENTSUNDERGOINGCARDIAC SURGERY

ICavadaCarranza*,XGarcía-González,SIbáñez-García,DGómez-Costas,AHerranzAlonso,MSanjurjo-Saez. HospitalGeneralUniversitarioGregorioMarañón,Pharmacy Department,Madrid,Spain

10.1136/ejhpharm-2023-eahp.292

BackgroundandImportance Thepreoperativesettingisan areawithhighriskformedicationerrorswithpotentially severeconsequences.Pharmaceuticalcareprogrammes(PCP) canhelptoachieveanadequatepreoperativepharmacological management,toensurepatientsreachsurgeryinoptimalpharmacologicalconditions.Adequatecoordinationwithotherspecialistssuchassurgeonsandanaesthetistsisparamountto guaranteepatientsafety.

AimandObjectives ToevaluatetheimpactofaPCPin patientsundergoingcardiacsurgeryinpreventingmedication errorsafter4yearsofimplementation.

MaterialandMethods Retrospective,observational,descriptive study.Timeofstudy:July2018-July2022.Allpatientsscheduledforcardiacsurgerywereinterviewedbyaclinicalpharmacist24-72hbeforethesurgery.Interviewswereconducted byphone.Duringtheinterview,patients’ completemedication list,includingoverthecountermedicinesandherbalproducts, wascollectedandinstructionsforadequatepreoperativemedicationmanagementaccordingtocurrentguidelinesandanaesthetistinstructionswerereinforced.

Avoidedmedicationerrorswerecategorisedaccordingto Overhage-classificationandtheirseveritywasanalysedaccordingtoNCC-MERP.

Savingswerecalculatedbymultiplyingtheprobabilityof adverseeventoccurrencewiththeerror(NCC-MERP F:high riskofadmissionorprolongedhospitalstay)byavoidedcost (6.745C ¼ accordingtoMinistryofHealth,Consumerand SocialWelfare).

Results Duringthetimeofstudy,1020pharmacistpreoperativeinterviewswereperformed.Meanagewas66.8(sd:12.6) yearsand65.8%oftheinterviewedpatientsweremales.

41.8%ofpatientsweretakingatleastonedrugthat neededtobediscontinuedbeforesurgery.Themostfrequent wereangiotensin-convertingenzymeinhibitors,angiotensin-II receptorsblockersanddiuretics(23.6%),anticoagulantsand antiplatelettreatment(22.2%)andhypoglycaemictreatment (11.4%).43.5%ofpatientsneededheparinbridgetherapy.

Atotalof807pharmacyinterventionswereconducted with94.2%ofacceptancerate:533requirementstodiscontinuedrugsbeforesurgery(70.1%),81doseerror(10.7%),49 drugomission(6.4%),32associatedwithduration,frequency orindication(4.2%).

673seriouserrorswereavoided,236(31.1%)ofthese errorscouldhaveresultedinpermanentharm(G/H),277 (36.4%)intemporaryharm(E/F)and160(21.1%)monitoring patientstoconfirmnoharm(D).

Potentialmedicationerrorsavoidedanestimatedcostof 992.130C ¼ .

ConclusionandRelevance APCPinpatientsundergoingcardiacsurgerywassuccessfullyimplemented,ensuringacorrect preoperativedrugmanagement,with0.8severemedication errorsavoidedperpatientthatwasinterviewedandpotential savingsof992.130C ¼ .

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-084 ASSESSINGQUALITYOFLIFEOFPATIENTSWITH SEVEREASTHMAMEASUREDBYPATIENTREPORTED OUTCOMES

1MMuñozGarcía:, 1HMartínez-Barros, 1PGuijarro-Martínez, 2ASantamaria-Gadea, 3AdeAndrés-Martín, 1DGonzález-de-Olano, 4AMorales-Tirado, 5DAntolín-Amérigo, 6SSánchezCuéllar, 1AMAlvarezDiaz*. 1HospitalUniversitarioRamonYCajal,Pharmacy,Madrid, Spain; 2HospitalUniversitarioRamonYCajal,Otorhinolaringology,Madrid,Spain; 3Hospital UniversitarioRamonYCajal,Inmunology,Madrid,Spain; 4HospitalUniversitarioRamonY Cajal,PediatricsService,Madrid,Spain; 5HospitalUniversitarioRamonYCajal,Allergy, Madrid,Spain; 6HospitalUniversitarioRamonYCajal,Neumology,Madrid,Spain

10.1136/ejhpharm-2023-eahp.293

BackgroundandImportance Severeasthma,whichaffects approximately5-10%ofpeoplewithasthma,isaheterogenous,chronicandcomplexdisease.Itusuallyhasanegative physical,mental,emotionalandsocialimpact.

AimandObjectives Toanalysequalityoflifeofpatientswith severeasthmacurrentlytreatedwithbiologicaldrugsusing PatientReportedOutcomesMeasures(PROM).

Toidentifythedomainsandspecificquestionsmostfrequentlyaltered,byusingmini-AQLQ.MaterialandMethods

Adescriptivecross-sectionalstudybetweenApril-May2022 inatertiaryhospitalwascarriedout.Adultpatientswith severeasthmaonactivetreatmentwithabiologicaldrugfor atleastoneyearwhoprovidedinformedconsentwere included.

Electronicmedicalrecordswerereviewedtoobtain:

. Age,sex

. Numberofasthma-associatedcomorbidities

. FEV1andFEV/FVC

Atelephoneinterviewwasalsoconductedtorecordthe PROMs:

. Mini-AQLQ(maximumscore:7)

. EQ5D-5L(maximumscore:1)(withVisualanaloguescale, score0-100(VAS))

Results Fifty-fivepatientswhomettheinclusioncriteriawere identified.38whoagreedtoparticipatewerelocated.Median agewas65years(56-71.5)and60.5%(23)werefemale. Mediannumberofasthma-relatedcomorbiditieswas2.5(1-4). FEV1andFEV/CVFwere76.3%(SD=3.2)and69% (SD=1.3)respectively.

ThemeanscorefortheEQ5D-5Lwas0.924(0.818-1), whilethemedianVASwas70(60-85).

Theaveragescoreforthemini-AQLQwas6.1.By domains,environmentalhadtheworstmean(5(4.3-6.3)),followedbylimitationofactivities(6.1(5.5-6.7)),symptoms(6.2 (5.8-7))andemotional(7(5.3-7)).

Three(0.8%)patientsdidnothaveanydisturbancesinthe responses,buta81.6%(31)hadalteredlimitationofactivities,79.3%(29)environmental,73.7%(28)symptomsand 55.3%(21)emotional.

Specifically,thequestionthatmostfrequentlyreceivea scorebelow7was ‘didyoufeelthattobaccosmokebothered youordidyouhavetoavoidaplacebecauseoftobacco smoke?’ in76.3%(29)patients.

ConclusionandRelevance Thequalityoflifeofpatientswith severeasthmatreatedwithbiologicaldrugsisgood,according tospecificasthmaquestionnairesusedasPROM,althoughfew patientsdonothaveanyalteredsphere.

Themostalteredspherewasenvironmental.Tobaccois consideredamajorthreat.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-086 ANALYSISOFPOTENCIALLYINAPPROPRIATE PRESCRIPTIONINANURSINGHOME

MRodriguezJorge*,RSánchezdelMoral,IGarcíaGiménez. HospitalJuanRamónJiménez, Pharmacy,Huelva,Spain

10.1136/ejhpharm-2023-eahp.294

BackgroundandImportance Potenciallyinappropriatemedicationprescriptioncanincreasetheriskofadversedrugreactions(ADRs).Therefore,multipletoolshavebeendeveloped todetectinappropriateprescriptions.STOPP(ScreeningTool ofOlderPerson’sPrescriptions)/START(ScreeningToolto AlerttoRightTreatment)criteriaisoneofthem.

AimandObjectives Toanalyseinappropriateprescriptions(IP) ortheneedofpotencialprescriptionsinpolymedicatedinstitutionalisedpatientsinordertoimprovepatientssafety.

MaterialandMethods Adescriptive,transversalstudywasperformedinSeptember2022.Weincludedallpolymedicated residents(>6drugs)ofanursinghomeattachedtoaPharmacyDepartment.Datacollectwereage,sex,numberofmedications/residentanddrugsprescribed.STOPP/STARTcriteria v.2.wasappliedtodetectinappropriateprescriptionsorthe needofpotencialtreatment.DatawerecollectedfromelectronicprescriptionprogrammeATHOS-PrismaandcomputerisedmedicalrecordDiraya.

Results Atotalof50patientswereincluded,66%men.The medianagewas73years(range:69-83).Averagedrugsprescribedbyresidentswas10(6-21).

Seventy-twopercentoftheresidents(36)presentedatleast oneSTOPPcriteria.TotalIPswere142,withanaverageof5 IPsperresident(0-7).Mostprevalentweretreatmentduration longerthandefined(72%),prolongeduse(>4weeks)of benzodiazepines(72%),drugsthatadverselyaffectfallers (mostrelatedtobenzodiazepines)(72%)andprescriptionof twodrugswithinthesameclass(22%).

RegardingSTARTcriteria,23residents(42%)presented anyprescriptioninitiationcriteria.Thetotalpotencialprescribingomissionwere26,withanaverageof1perresident(02).Themostcommonwere:useoflaxativesinpatientswith opioidtreatments(47,8%)andvitaminDsupplementsin olderpatients(34,8%).

ConclusionandRelevance STOPPcriteriawasthemostfrequentlyfound.Themajorityrelationedwithinappropriate durationorduplicityofbenzodiazepintreatment.

ForSTARTcriteria,theindicationoflaxativesforpatients receivingopioidsonaregularbasiswasthemostfrequent potencialprescribingomission.

TheuseofSTOPP/STARTcriteriacouldimprovepatients safety,whichareabletodetecttheinappropriateprescription

ofsomedrugsinadditiontotheomissionofpotencialindicatedmedication.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-087 EVALUATIONOFTHEEFFECTIVENESSOFLAMIVUDINE INTHEPROPHYLAXISOFHEPATITISBVIRUS REACTIVATIONINPATIENTSWITHHAEMATOLOGICAL DISEASES

BMoñinoBlazquez*,MLigrosTorres,JBarrosoCastro,MDuqueRodriguez,ACalleja Bueno,XAntonMendez,AFernandezPeña,MLopezGillete,BSanJoseRuiz. Cruces UniversityHospital,PharmacyService,Barakaldo,Spain

10.1136/ejhpharm-2023-eahp.295

5PSQ-091 TRIFECTA™ BIOPROSTHESES:EVALUATIONOFTHE SAFETYBASEDONTHESTUDYOFDEGENERATIONS ACCORDINGTOTHEVARC-3CLASSIFICATION

1ORichez*, 2YHun-Chabry, 3DMalaquin, 3JHudelo, 2TCaus, 1APetit. 1Amiens-Picardie TeachingHospital,Pharmacy,Amiens,France; 2Amiens-PicardieTeachingHospital,Cardiac Surgery,Amiens,France; 3Amiens-PicardieTeachingHospital,Cardiology,Amiens,France 10.1136/ejhpharm-2023-eahp.296

BackgroundandImportance

TheuseoflamivudineasprophylactictreatmentinpatientswithpasthepatitisBvirus(HBV) infectionandontreatmentwithdrugsconsideredathighrisk ofreactivationhasbeenassociatedwithahigherlikelihoodof reactivationcomparedtotheuseofotherantivirals.

BackgroundandImportance In2021,cardiologistsreportedto themedical-devices-vigilancesectorseriousincidentsinfour patientswithafirst-generationTrifecta ™ bioprosthesisthat resultedinthreeaorticvalvereplacement(AVR)andone death.Thequestionofdegenerationoftheirbioprosthesis arose.

AimandObjectives Theaimwastoevaluatetheintrinsic imputabilityofTrifecta™ fordysfunctioninpatientsimplanted andtoreassesstheirreferencinginourcentre.

AimandObjectives

Toevaluatetheeffectivenessoflamivudine intheprophylaxisofHBVreactivationinpatientswithhaematologicaldisease,undergoingimmunosuppressiveorchemotherapytreatmentandpresentingpositiveserologyforHBV.

MaterialandMethods

Observationalandretrospectivestudy includingallhaematologicalpatientsover18yearsofagewho startedHBVprophylaxisbetweenJanuary2018andDecember 2020inatertiaryhospital.Follow-upwasperformedfrom thestartoftreatmentuntilDecember2021toobserve whetherHBVreactivationoccurred.

Electronicmedicalrecordswerereviewedandthefollowingvariableswerecollected:demographicdata(ageandsex), haematologicaldiagnosis,immunosuppressiveorchemotherapytreatmentreceived,analyticaldata(HBsAg,HBcAc, HBeAc,HBVDNA,transaminases)andHBVprophylactic treatment.

Results Inthestudyperiod,65patientsstartedHBVprophylaxis,ofwhich3patientswereexcludedduetofalsepositive. Sixty-twopatients(33women)werereviewed,withamedian age(range)of70years(20-91).Diagnoseswerelymphomas (26patients),monoclonalgammopathies(13),chroniclymphoproliferativesyndromes(7),autoimmunediseases(6),acute leukemias(5),chronicmyeloproliferativesyndromes(4)and bonemarrowaplasia(1).

Outofthe62patients,60patientswereHBsAgnegative andanti-HBcpositiveattheinitialserologicalcontrol.Allof whichreceivedlamivudineprophylaxis.Theother2patients hadchronicHBVinfectionatthestartofprophylaxis,with positiveHBsAg,positiveanti-HBeandundetectableHBV DNA.Oneofthemstartedprophylaxiswithtenofovir,and theotherreceivedlamivudineasprophylaxis.

Ofthepatientswhostartedlamivudineprophylaxis,60.7% werebeingtreatedwithdrugsconsideredathighriskofreactivation(rituximab,doxorubicinoridarubicin).

Nopatienthadeitherclinicalreactivationordetectable HBVviralloadduringthestudyperiod.Fourteenpatients diedduringfollow-upduetonon-HBVcauses.

ConclusionandRelevance Inourpatients,60.7%ofwhom receivedhigh-riskdrugs,noreactivationeventoccurred.LamivudinehasproventobeeffectiveintheprophylaxisofHBV reactivationinourstudypopulation.

MaterialandMethods Aretrospective,single-centreandobservationalstudyofcomputerisedpatientrecords(CPR)wasconductedbetween02/04/2011,dateofourcentre’sfirst implantation,and12/31/2016tohave5yearsoffollow-up perpatient.

Trifecta ™ valvesanddatarelatedtotheimplantationwere extractedfromthetraceabilitysoftware.Thecollectionof echographicandclinicalfollow-updatawasbasedontheCPR withanextendedfollow-upperioduntil03/31/2022.

DysfunctionswereclassifiedaccordingtotheVARC-3classificationcriteria:structuralvalvedeterioration(SVD),nonstructuralvalvedysfonction(NSVD),thrombosisand endocarditis.

Thestudywasapprovedbyourlocalresearchdepartment. Results Atotalof382bioprostheseswasimplantedin378 patients,meanage73.0yearsand60.7%male.Datawere missingfor253bioprosthesesand15patientsdiedperioperatively.Amongthe114bioprostheseswithconclusivedata,50 functionnedproperly(meanfollow-uptimeof6.6years)and 64presenteddysfunctions:34SVD,10NSVD(8paravalvularregurgitation,2prosthesis-patientmismatches)and20 endocarditis.AVRoccurredfor20patientsfollowingSVDand for11patientsfollowingendocarditis(4ofwhomhadasecondTrifecta™)withinameantimeof6.7yearsand3.4years, respectively.

ConclusionandRelevance TheclassificationoffailuresaccordingtoVARC-3allowedustoconfirmtheintrinsicimputabilityoftheTrifecta™ bioprosthesesregardingtothenumberof SVD-typedysfunctions.Althoughthisstudyhaslimitations,it showstheunderstatementofmedical-devices-vigilancecasesby themedicalstaff.The64fileswithdysfunstionswillbetransmittedtothenatonalhealthautority.Thepatientswillbe reviewedtocompletethedataandperformanechographic follow-up.Accordingtothemanufacturer,degenerationscould berelatedtotheexpansionsystemthatwasimprovedinthe second-generationTrifecta™ marketedin2016.Sincethis study,theTrifecta ™ hasbeenremovedfromthehospital formulary.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-093

PHARMACEUTICALINTERVENTIONAFTER INAPPROPRIATEPRESCRIPTIONOFZOLPIDEM

1ISánchezLobón*, 2MDCJiménezde-Juan, 1JTudelaTomás, 1VManzanoMartín, 1RPla Pasán. 1PuertaDelMarUniversityHospital,Pharmacy,Cádiz,Spain; 2RiotintoHospital, Pharmacy,Huelva,Spain

10.1136/ejhpharm-2023-eahp.297

BackgroundandImportance Zolpidemisabenzodiazepine-like hypnoticthatactsonGABA-omegareceptorsinthecentral nervoussystem.Itisindicatedfortheshort-termtreatmentof insomniainadults.

In2014,aninformativenotewaspublishedbyTheSpanish MedicinesandMedicalDevicesAgency(AEMPS)recommendingadoseof5mg/dayinelderlypatients(over65yearsold), insteadof10mg(usualdose),inordertoreducethenumber ofcasesofalterationsinattentionandconcentrationcapacity, includingparasomnias.

AimandObjectives Evaluatetheimpactofhospitalpharmaceuticalintervention(PI)ontheprescriptionofzolpidemafter thepublicationoftheAEMPSinformativenote.

MaterialandMethods Multicentreandprospectiveintervention studywhichincludesallpatientsadmittedtotreatmentwith zolpidem.ThestudyintervalwasfromSeptember2021to September2022.Thevariablescollectedwerethefollowing: age,sex,dosageandprescriptionofzolpidemashometreatment.Clinicalrecords(Diraya®)andtheelectronicprescriptionprogram(Prisma®)werereviewed.TheIFconsistedof sendinganinformativenotetothedoctorresponsibleforthe patientswhodidnotcomplywiththeAEMPSrecommendation.

Results Atotalof62patientswereincluded(meanage:72± 15years;sex:37men).PIwasperformedin59.7%(37/62) becausetheprescriptionwasnotadjustedtotheAEMPSalert. Regardingthe37patientswithinappropriateprescription,the dosewasreducedto5mg/dayin37.8%(14/37)ofthecases. Thedoseoftherestofpatients,62,2%(23/37),wasnot change,ofwhich87%(20/23)hadtheoriginoftheprescriptionattheprimarycarelevel.

ConclusionandRelevance TheacceptanceofthePIwasperformedinalownumberofcasesduetothefactthattheoriginofzolpidemprescriptionsisprimarycare.Thiscreatesthe needtoestablishchannelsofcommunicationbetweentheprimarycarephysicianandthehospitalpharmacisttoreportpossibleerrorsdetectedintheirprescriptions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

AimandObjectives 1)Toevaluatethehaematologicaltoxicity ofvenetoclaxduringdoseescalationand;2)TodescribeAE associatedwithvenetoclaxduringtreatment.

MaterialandMethods Multicentre,observational,retrospective studyinpatientswhoinitiatedvenetoclaxuntil01/06/2022 withatreatmentperiod 3months.Variablescollected:sex, age,diagnosis,treatmentschedule,hemoglobin,neutrophiland plateletlevelsatbaselineandafterdoseescalationand;AE developedduringtreatmentappearanceaswellasitsgravity accordingtoCommonTerminologyCriteriaforAdverse Events(CTCAE)version5.0.

Hematologictoxicityduringescalationwasanalysedusing Student’st-test(SPSSStatistics25.0).

Results 41patientsinitiatedvenetoclax,ofwhom33maintainedtreatment 3months(63.6%male,mean68.7±9.7 years).Diagnosis(CLL:20,AML:10,myelodysplasticsyndrome:3),treatmentschedule[monotherapy:2;bitherapy (rituximab:16,azacitidine:13,decitabine:1,obinutuzumab: 1)].5patientsrequireddoseadjustmentduetoconcomitant useofazoles(posaconazole:2,voriconazole:2,fluconazole: 1).

Meanhemoglobinatbaselineandafterdoseescalation (10.6±1.9vs10.8±2.1g/dL;p=0.282),meanneutrophils atbaselineandafterdoseescalation(1,667.6±1,064.9vs 1,237.3±1,011.5/mL;p=0.001),meanplateletsatbaseline andafterdoseescalation(120,060.0±77,662.3vs116,121 ±77,012.0/mm3;p=0.697).AEdevelopedduringtreatment: anaemia(G2:3,G3:4),neutropenia(G1:1,G2:6;G3:6,G4:4), thrombocytopenia(G2:1,G3:4),asthenia(G1:2,G3:1),bradycardia(G2:1),diarrhoea(G1:1),fever(G1:1),hypertransaminemia(G2:1),mucositis(G1:1),pneumonia(G2:2,G3:3), tumourlysissyndrome(G3:2).Duringtreatment,15patients requireddiscontinuationoftreatment(restarts:7)and5 requireddosereduction.

ConclusionandRelevance Duringdoseescalation,themain haematologicaltoxicityofvenetoclaxwasneutropenia.This adverseeffectalsooccurredmorefrequentlyduringmaintenancetreatment.Weconsideritrelevanttocarryoutserial haematologicalcontrolsinpatientstreatedwithvenetoclax.

Limitationsofthestudy:retrospectivestudywithasmall samplesize;therefore,itisconsiderednecessarytoperform morestudiestoconfirmtheresultspresented.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.CommonTerminologyCriteriaforAdverseEvents(CTCAE)Version5.0.27 November2017.

ConflictofInterest Noconflictofinterest

5PSQ-094 TOXICITYINPATIENTSTREATEDWITHVENETOCLAX. ASAFETYSTUDYINREAL-WORLDPRACTICE

1APérezFácila*, 2PCiudadGutiérrez, 2MFalcónCubillo, 1CNotarioDongil, 1JJSaiz Molina, 1NAndrésNavarro. 1HospitalGenerallaManchaCentro,FarmaciaHospitalaria, AlcázardeSanJuanCiudadReal,Spain; 2HospitalUniversitarioVirgenDelRocío,Farmacia Hospitalaria,Sevilla,Spain

10.1136/ejhpharm-2023-eahp.298

BackgroundandImportance Venetoclaxactsasaninhibitorof theanti-apoptoticproteinBcl-2,whichisincreasedin ChronicLymphocyticLeukemia(CLL)andAcuteMyeloid Leukemia(AML).Itisdescribedonitslabelthefrequent occurrenceofhaematologicaltoxicity,amongotheradverse events(AE).

5PSQ-095 CARDIACCONDUCTIONDISORDERSASSOCIATED WITHTHEUSEOFTRICYCLICANTIDEPRESSANTSIN THEELDERLY

DGuerraEstévez*,MReyesMalia,CPalomoPalomo,MRomeroAlonso,EContreras Macías,AGanforninaAndrades,JEstaireGutiérrez. HospitalInfantaElena,Hospital PharmacyDepartment,Huelva,Spain

10.1136/ejhpharm-2023-eahp.299

BackgroundandImportance Tricyclicantidepressants(TCAs) blocksodiumchannelsintheheart,whichcanprolongthe QTintervalandcausearrhythmias.Patientsover64yearsof ageareatincreasedriskofthesesideeffects.

AimandObjectives ToconductasystematicreviewofthecardiaceffectsofTCAsinpatientsolderthan64years.Asasecondaryobjective,thefrequencyofTCAsprescriptionsin patientsolderthan64yearswithcardiacconductiondisorders (CCD)wasanalysed,reviewingconcomitanttreatments.

MaterialandMethods Asystematicreviewofthepublished scientificliteraturewasconductedfollowingPRISMADeclaration.Inaddition,adescriptivecross-sectionalstudywas carriedout,includingallpatientsover64yearsofage receivingTCAstreatment.Ananonymiseddatabasecontainingthevariablesage,sex,andprescribedmedicationswas used.

Results Afterthesearch,5articleswereincludedinthequalitativesynthesis.AstudyconcludesthatTCAscauseCCD, butwithoutclinicalcompromise.ThesecondshowsanassociationbetweentheuseofTCAsandsuddendeathin patientswithpreviousheartdisease(HD).Anotherstudy concludesthatnormaldosesofTCAsinpatientswithsevere HDareequivalenttotoxicdosesinpatientswithoutHD. Thefourthshowsnocorrelationbetweenserumsodiumlevels,electrocardiogramchanges,andseverityofTCAstoxicity.

ThelateststudyshowsthatprolongedexposuretoTCAsis alsorelatedtotheoccurrenceofcoronarydiseaseeventsin patientswithoutknownHD.Theprescriptionsof63patients receivingTCAswithamedianageof70(65-88)yearswere reviewed.Nopatienthad prescribedtreatmentsforCCD, however,49,2%ofpatientshadprescribed³1drugthatprolongstheQTinterval.

ConclusionandRelevance Theliteraturereviewedreveals CCDcausedbyTCAs.InthedatasheetofTCAs,theiruse iscontraindicatedinpatientswithpreviousHD.Inoursample,theprescriptionofTCAsisappropriate;however,we recommendthatinpatientsover64yearsofagewithout CCD,electrocardiogramsbeperformedbeforestartingtreatmentwithTCAsandperiodically.Inaddition,afterverifying thehighfrequencyofprescriptionofdrugsthatprolongthe QTinterval,webelievethatitisessentialtoreviewtheconcomitantmedication,lookingfortherapeuticalternativesfor thesedrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-096 APROSPECTIVEOBSERVATIONALSTUDYOF MEDICATIONPRESCRIBINGERRORSINAN EMERGENCYDEPARTMENT

1COrtíJuan*, 1CToroBlanch, 2MAGispertAmetller, 1APérezPlasencia, 2CLechaOchoa, 1QLópezNoguera, 1RSacrestGüell. 1Hospitaluniversitaridrjoseptrueta,pharmacy department,girona,spain; 2Hospitaluniversitaridrjoseptrueta,emergencydepartment, girona,spain

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BackgroundandImportance Prescribingerrors(PE)arean importantcauseofmedication-relatedadverseeventsinthe EmergencyDepartments(ED)butlimiteddataareavailablein EDwith electronic prescribingand administration(ePA)systems.KnowingthefrequencyandtypesofPEcanhelp healthcareprofessionalstopreventandreducetheriskof themoccurring.

AimandObjectives TodeterminetherateofPEintheED,to classifyincidenttypesandtoidentifycriticalpointswhere measuresshouldbeimplementedtoimprovepatientsafety.

MaterialandMethods Prospective,observationalandcross-sectionalstudyinanEDwithePAsystemduring6workingdays (May-June2021).Theinclusioncriteriawerepatientsstayed morethan8hoursintheEDandallpatientsawaitinghospitalisation.Prescriptionswereanalysedbyamultidisciplinary teammadeupoftwopharmacists,anemergencyphysician andthepersoninchargeofthehospital’smedicationerrors committee.PEwerereportedtothehospital’spatientsafetyrelatedincidentnotificationsystem.

Results Ofthe65prescriptionsrevisedduringthestudy period,PEwerereportedin84casesand15situationswith thecapacitytocauseerrorsweredetected.Theaverageageof patientswas67±(SD=17,9)yearsandeachprescriptionhad anaverageof8.4medications.TherateofPEwas1.52 errorsperpatient,beinghigherinlessseverepatientsthan monitoredpatients(1.09vs2.0PEperpatient,respectively). ThemostcommontypesofEPwereomissionoftheusual medication(60.7%),wrongdose(15.5%),wrongfrequency (7.1%)anddrugisnotindicated(7.1%).Noadversereactions relatedtoEPweredetected.AccordingtotheSpanishconsensusabout MedicationReconciliationinEmergencyUnits, 47.1%ofomissionsofusualmedicationweredrugsthat shouldbereconciledduringthefirst4hoursintheED.The resultsofthestudyandtheimportanceofmedicationreconciliationarehighlightedinasessionintheED.

ConclusionandRelevance ThePErateintheEDwas1.52 perpatientandthemaintypewasomissionoftheusualmedication.Acrosssectionalstudywillbemadeinthefutureand comparedtothecurrentonetoestablishtheimpactofthe implementedmeasuresonthePErate.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-097 HEALTHALERTOFTOFACITINIBAND

PHARMACEUTICALINTERVENTION

ISánchezLobón*,RPlaPasán,AGanforninaAndrades,VManzanoMartin,MSaldaña Valderas,MJHuertasFernández. PuertaDelMarUniversityHospital,Pharmacy,Cádiz, Spain

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BackgroundandImportance Tofacitinibisaselectiveinhibitor ofthejanuskinasefamilyindicatedforthetreatmentofvariousrheumatologicalpathologiessuchasrheumatoidarthritis (RA)andpsoriaticarthritis(PsA)andused,offlabel,inpathologiessuchasalopeciaareata(AA).

TheSpanishMedicinesandMedicalDevicesAgency (AEMPS)releasedinJuly2021asafetyalertstatingthat patientsover65yearsofage,smokersorex-smokersand withcardiovascularriskfactorsorwithapredispositiontothe developmentofneoplasms,shouldnotreceivetreatmentwith tofacitinibunlessnootheravailabletherapeuticalternativecan beused,basedintheresultsfromtheORALSurveillanceclinicaltrial.HealthpolicyinAndalucíaestablishestheneedto follow-upontheapplicationofthesafetynotesissuedbythe AEMPSregardingprescriptionsofdrugs.

AimandObjectives Evaluatethepharmaceuticalintervention onthereviewoftofacitinibprescriptionstoensuretheiradaptationtothecriteriaestablishedbytheAEMPS,accordingto theAndalusianregionalregulations.

MaterialandMethods Retrospectivereviewoftofacitinibprescriptioninatertiaryhospital.Allpatientsontreatmentwith

tofacitinibfromJuly2021toFebruary2022wereincluded. Variablescollectedwereage,sex,riskfactorsincludedinthe healthalertandcontinuationordiscontinuationoftreatment.

Results Atotalof71patientsreceivingtofacitinibtreatment wereincluded(meanage:41±16;sex:74.6%women).The treatmentwasdiscontinuedin25.4%(18/71)ofthepatients duetoinefficacy,adversereactionsorpresentingatleastone riskfactor.However,74.6%(53/71)ofthepatientscontinued treatment,with43.4%(23/53)havingatleastoneriskfactor. ResultswereshowntothePharmacyCommission,wherethe pharmacistdevelopedaprotocolregardingtofacitinibsafety issues.

ConclusionandRelevance Thisisthefirstexperienceinour hospitalregardingtheglobalmonitoringofsafetynotes releasedbytheAEMPS,endorsedbyautonomicregulation. Despitethepresenceofriskfactors,tofacitinibwasnotwithdrawnnorjustifiedinahighpercentageofpatients.Thisfindingunderlinestherelevanceofsystematicpatientsfollow-up andtheneedtodevelopprotocolsagreedbythepharmacists andinvolvedphysicians.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-099 ADEQUACYOFSOTROVIMABPRESCRIPTIONINSARSCOV-2INFECTIONINAUNIVERSITYHOSPITAL

TBlancoEspeso,MFloridoFrancisco,RSerranoGiménez,MRodriguezJorge*. Hospital JuanRamónJiménez,HospitalPharmacy,Huelva,Spain

10.1136/ejhpharm-2023-eahp.302

BackgroundandImportance TheSpanishMedicinesand HealthProductsAgency(AEMPS)hasdevelopedcriteriato adapttheprescriptionofsotrovimab1,duetothepandemic situationandthelimiteddrugstock.

AimandObjectives Todescribethepatients´populationon treatmentwithsotrovimabandtoassesstheadequacyofthis prescriptionaccordingtothecriteriaestablishedbythe AEMPS.

MaterialandMethods RetrospectiveobservationalstudyanalysingallsotrovimabprescriptionsinpatientswithSARS-CoV-2 infectionfrom01/25/2022to08/31/2022.

DemographicvariablesanddatarequiredbytheAEMPS forsotrovimabprescriptionwerecollected:Omicronvariant infection,SARS-CoV-2vaccinationstatus,serology[anti-Santibody<260BAU(bindingantibodyunits)/mL].Also,patients hadtobelongtooneofthefollowinggroups:

. Group1:Immunocompromised,regardlessofvaccination status.

. Group2:>80yearsunvaccinated.

. Group3:>65years(regardlessofvaccinationstatus)and 1 riskfactorforprogression.

Prescriptionsforsotrovimabwerecollectedandanalysedto determinewhethertheymetthecriteriaandwhetherthey wereaccepted.Datacollectedfromelectronicmedicalrecords andprocessedusingExcel2019®.

Results Fiftypatientswereincluded,62%male;medianage 69years(IQR=60-76).100%hadtheOmicronvariant.Vaccinationstatus:84%complete,6%incompleteand10%unvaccinated.Serology:96%(<260BAU/mL)and4%(>260BAU/ ml).92%belongedtogroup1(39%solidorgantransplantation,29%activemyelotoxicchemotherapy,13%non-cytotoxic

onco-haematologicaltreatmentswithneutropenia/lymphopenia, 13%treatmentwithbiologicalimmunomodulators,2% Down’ssyndrome,2%haematopoieticstemcelltransplantationorCAR-T,2%HIVinfection(with £200cells/mL).Two percentbelongedtogroup2.Theremainingpatients(6%) didnotbelongtoanygroup.Tenpercentoftheapplications didnotmeetthecriteria:fourofthemwerenotaccepted (patientsdidnotbelongtoanyriskgroup);onewasaccepted, althoughitwasawell-controlledHIV.

ConclusionandRelevance Themainprofileofpatientstreated withsotrovimabismenwithsolidorgantransplantation,vaccinatedandwithnegativeimmunitytoSARS-CoV-2.Although theappropriatenessoftheprescriptionishigh,itisnecessary tocontinueprotocolisingtheuseofthisdrugtoensureits rationaluse.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.1.https://www.aemps.gob.es/medicamentos-de-uso-humano/acceso-a-medicamentos-en-situaciones-especiales/criterios-para-valorar-la-administracion-de-las-nuevasalternativas-terapeuticas-antivirales-frente-a-la-infeccion-por-sars-cov-2/

ConflictofInterest Noconflictofinterest

5PSQ-100 UTILITYOFSOCIALMEDIAASASOURCEOF

PAEDIATRICDRUGSAFETY,ASYSTEMATICREVIEW 1IVilimelis*, 2,3APérez-Ricart, 1,2MBoschPeligero, 4ACalvo, 2EVallsSánchez, 2CCodinaJiménez, 2SMarin, 1JMSuñéNegre, 2CQuiñonesRibas, 5JCGiménez-Juárez. 1Universitat deBarcelona.,PharmacyFacultyCampusDiagonal.,Barcelona,Spain; 2HospitalUniversitari GermansTriasIPujol-.,PharmacyDepartment,Badalona,Spain; 3ServeiCatalàdelaSalutÀreaMetropolitanaNord-RegióSanitàriadeBarcelona,PharmacyUnit,SantCugatDel Vallès,Spain; 4UniversitatPolitècnicadeCatalunya,ComputerScience,Barcelona,Spain; 5Centred’informaciódelmedicamenthospitaluniversitarivalld’hebron,pharmacyservice, barcelona,spain

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BackgroundandImportance Paediatricpopulationarepredisposedtohavemoreadversedrugreactions(ADR)andother drugrelatedproblems(DRP).Socialmedia(SM)couldbean innocuoussourceofpharmacovigilance.

AimandObjectives AssessADRandDRPevidencereportedin SM.

MaterialandMethods AsystematicreviewaccordingPRISMA recommendationswasconductedinMEDLINE,Embaseand LILACS.ArticlesinEnglish,SpanishandCatalanlanguages frominceptionuptoSeptember2021werereviewedusing searchtermsrelatedtopaediatricage,SMandDRP.Inthe screeningphase,articlesnotmentioningpaediatricsandSM wereexcludedincludinggreyliterature.Intheeligibility phase,articlesrelatedtonon-pharmacologicaltreatments/substances,surveys,recruitmentprotocols,sociologicalstudies, professionaluseofSMandtechnologicalimplementationwere excluded.Articlesincludinginformationaboutcommonlyused drugsinpaediatricswereevaluated.Demographicvariables,SM platforms,medicinesandtypeofinformation(ADR,DRPor experiencesandopinions(EO))wereanalysed.

Results 6079articleswereassessedand28(0,4%)metthe inclusioncriteria.16(57%)studieswerequalitative,6(21%) quantitativeandqualitativeandquantitative6(21%).When mentioned,mostarticlesanalyseddatafromparents/caregivers (10;36%)andadolescents(2;7%).GenderofSMuserwasnot systematicallyreportedbutfemaleswerereportedin7(25%) articlesinarangeinof22-77%,inanarticle245females comparedto74malesandonereferredthatpostswere

mostlyfrommothersofyoungchildren.Mostarticlesincluded datafromforums(13;46%),Twitter(5;18%)andFacebook (6;21%).17(61%)reportedinformationaboutvaccines,3 (11%)asthmamedicationsand8(28%)othermedicines.8 articles(28%)reportedanADRincludingtremor,auto-injector woundsandvaccineADR.Onlyinonearticletheseverity wasreported.EOwerereportedin25(89%)studiesand10 (36%)articlesmentionedaDRP.Studiesreportedlackof adherence(4;14%),difficulties(3;11%)ordoubts(2;7%) aboutdrugadministrationofasthmainhalers(2;7%),epinephrineauto-injector(1;4%),antibiotics(1;4%),oraldrugs (1;4%),ophthalmicdrugs(1;4%)andtopicaldrugs(1;4%).

ConclusionandRelevance Articlesevaluatingpharmacological drugsinpaediatricsfocusedmostlyonEOandscarcedata aboutADRandDRPwerementionedinSM.Consequently, morestudiesarerequiredtotakeadvantagefromSMasa potentialtoolinpaediatricpharmacovigilance.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-101 ANALYSISOFHIPPROSTHESESOVERAYEAR

WGuibane*,ZSaoudi,NHagui,MGargouri. HospitalPharmacyDepartment-CenterFor TraumatologyandMajorBurns-Tunisia,BenArous,2013,Tunisia

10.1136/ejhpharm-2023-eahp.304

BackgroundandImportance Oneofthemostcommonorthopedicoperationsistheprostheticreplacementofthehipjoint. Tojudgethechoiceofaprosthesis,weoftenlackfactual data.

AimandObjectives OurobjectiveistoassesswhethertherecommendationsoftheHighHealthSecurityarerespectedand toanalysetheiraveragecoststooptimisepharmaceuticalvalidationbycreatingaprescriptionsheetfororthopedic implants.

MaterialandMethods Censusofthevariousinterventionswas carriedoutduringtheyear2019bytypeofact:TotalHip Prostheses(THP);IntermediateProsthesis(IHP);Repeats (REP);Rebuilds(REB).

Analysisofthedifferentfrictioncouples(head/insert): Ceramic/polyethylene(C/PE);Metal/PE(M/PE);Ceramic/ Ceramic(C/C).

ThesoftwareusedfordatacollectionisACCESSandfor statisticalanalysisisSPSS.

Results 140hipinterventionsin2019including:34HIP;88 THP;16REP;2REB.Agesaccordingtothetypeofoperationscarriedout:25.71%(£50years);12.85%(50-70years); 61.44%( 70);withthedistributionaccordingtothetypeof prosthesis:THP(meanage75years);PIH(82years);REP (47years).Clinicalindicationswerecoxarthrosis39.23% (THP);Femurfracture14.28%(HIP,THP);Osteonecrosis 7.14%(THP);Rheumatoidarthritis10.71%(IHP);Dislocation 17.81%(REP).FrictioncouplesusedwereC/PE3.57%;M/M 13.71%;C/C82.72%distributedaccordingtoCLASrating: competition(100%C/C),activity(78.7%C/C),leisure(80.8% M/PE),sedentary(100%M/PE).Breakdownoftheaverage costaccordingtotheallocatedbudgetwas62.85%THP, 24.28%HIP,8.57%REP,1.42%REB.

ConclusionandRelevance Thestudyshowedthatthemost frequentinterventionsareIHPandTHP,IHPareplacedin veryelderlypatientsinwhomosteosynthesisisnotpossible,theC/Ccoupleisreservedforpeopleundertheageof

50,withalevelofactivityandalifeexpectancy.Finally, wenoticedthatthemostcostlyinterventionisTHP. Resultsareinaccordancewiththerecommendationsofthe HAS.Thisstudyallowedustocreateaprescriptionsheet fromtheanalysisofthesedata indicating:identificationof thepatientspecifyingageandactivity;clinicalindication andtypeofprosthesisandfriction.Thisprocedureoptimisesthepharmaceuticalvalidati onbydirectingthecliniciantowardstherightmedicalandpharmacoeconomic choiceoftheprosthesis.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-102 SAFETYEVALUATIONOFMIDLINECATHETERSUSED FORANTIBIOTICTHERAPY

1AEgüésLugea, 1ARodríguezEsquíroz*, 2BFernandinoZubieta, 3BGalarragaIñarra, 4MTimonedaCompany, 5REscobedoRomero, 1MSarobeCarricas. 1HospitalUniversitario deNavarra,Pharmacy,Pamplona,Spain; 2HospitalUniversitariodeNavarra,Home-Care Unit,Pamplona,Spain; 3HospitalUniversitariodeNavarra,Digestive,Pamplona,Spain; 4HospitalUniversitariodeNavarra,InternalMedicine,Pamplona,Spain; 5Hospital UniversitariodeNavarra,IntensiveCare,Pamplona,Spain

10.1136/ejhpharm-2023-eahp.305

BackgroundandImportance Inpatientswithdifficultintravenousaccessorthosewhorequireshort-termintravenousdrug administration,midlinecatheters(MLC)canbeasafealternativetoperipherallyinsertedcentralcatheters(PICCs).

AimandObjectives Theobjectiveofthisstudyistodescribe outcomesinpatientswhohadamidlineplacedfortheindicationofantibiotictherapy.

MaterialandMethods Thiscohortstudyanalyseddatafrom hospitalregistryincludingpatientswhohadamidlineplacementforintravenousantibiotictherapy.Patientdemographics andclinicaldata(diagnoses,comorbidities,medications,laboratoryvalues,antibioticuseanddurationofinfusiontherapy), anddevicevariable(placementarmandveinofinsertion, cathetergauge,andnumberofcatheterlumens)were abstracteddirectlyfrommedicalrecords.Datawereanalysed fromJune2021toSeptember2022.

Results Sixty-ninepatientswithMLCwereincludedforanalysis,68%weremaleandmeanagewas70years(range28–96).Themostcommondiagnoseswerebloodstreaminfection (46.4%),respiratorytractinfections(17.4%)andurinarytract infections(14.5%).Themostprescribedantimicrobialswere piperacillin-tazobactam(52.2%),ertapenem(19%)andmeropenem(11.6%).

Intotal69MLCwereplaced,totaling952catheter-days, withandaveragemidlinedwell-timeof14days(range=243days;median=12days).Totalcomplicationswere31.9%, includingfour(5.8%) ‘leak’,fourteen(20.3%)catheter obstructions,two(2.9%)phlebitisandone(1.45%)thrombosis.Inaddition,onepatientpresentedagradeIinfiltrations (INSInfiltrationScale).Therewerenoconfirmedorsuspected bloodstreaminfection.

ConclusionandRelevance Inthisstudy,theMLCcomplication ratewas31.9%.Thecomplicationsweremostlymechanical (81.8%)anddidnotrequirethesuspensionoftheantibiotic therapyorthewithdrawalofthecatheter.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-103

PARENTALUNMETNEEDSONPAEDIATRICDRUGS EXPRESSEDINFORUMS

1IVilimelis*, 2,3APérez-Ricart, 1,3MBoschPeligero, 4ACalvo, 3CCodina-Jiménez, 3EValls Sánchez, 1JMSuñéNegre, 3CQuiñonesRibas, 5JCGiménez-Juárez. 1Universitatde barcelona.,pharmacyfacultycampusdiagonal.,barcelona,spain; 2ServeiCatalàdelaSalutÀreaMetropolitanaNord-RegióSanitàriadeBarcelona,PharmacyService,SantCugatDel Vallès,Spain; 3HospitalUniversitariGermansTriasIPujol,PharmacyDepartment,Badalona, Spain; 4UniversitatPolitècnicadeCatalunya,ComputerScience,Barcelona,Spain; 5Centre d’informaciódelmedicamenthospitaluniversitarivalld’hebron,pharmacyservice, barcelona,spain

10.1136/ejhpharm-2023-eahp.306

BackgroundandImportance SocialMedia(SM)couldbea sourceofunmetneedsofparentsaboutdruguseinpaediatrics.Knowingsubjectiveinformation(SI)canleadtoimprove pharmaceuticalcare.

AimandObjectives Analysecontentofpostsfromparent forums(PF).

MaterialandMethods Observational,ambispectivestudyonPF relatedtoprimarycaremedicinesinpaediatrics.PFwere selectedifincludedchild-healthsectionsinCatalan,Spanish orEnglishandpermissionwasobtained.Dataminingsoftware wasdevelopedusingontologiesfromSpanishAgencyofMedicinesandMedicalDevicesandMedicalDictionaryforRegulatoryActivities.Postswereexcludedifwrittenbyprofessionals, referredtonon-pharmacologicaltreatments,adults,pregnancy, hospitaldrugs,non-originalentriesorduplicates.SIwasclassifiedintopositive,negativeordoubtsaccordingtoneand adjectivesexpressed.

Results 3572postsfromtwoPFweredownloaded,821 (26%)analysed.Excludedentries(94;11%):non-pharmacologicaltreatments(42;5%),hospitaldrugs(12;1%),adults (12;1%),non-originalentries(9;1%),pregnancy(2;0,02%)or duplicates(2;0,02%).444(72%)usersmentionedSIin591 posts(1,3SI/post).Notifierweremainlyparents(177;40%) andcaregivers(233;52%).SIpostscontainedneutral (223;38%),doubts(259;44%),negative(63;10%),positive (47;8%)SI.Postsreferredto453children,infants(28days23months)(156;26%)andchildren(3-11years)(107;18%) andnotclassified(190;56%).Reporteddrugs:antibiotics (214;36%),respiratory(99;17%)andnervoussystem (78;13%)medications,other(200,34%).Routes:oral (330;56%),parenteral(123;21%),other(138,23%).Topics reportedwere:

Positive(47)Negative(63)Doubts(256)

Effectiveness37(79%)10(16%)12(5%)

Accessibility(24;4%)

Vaccines0(0%)0(0%)7(3%)

Other0(0%)5(8%)12(5%)

ConclusionandRelevance Doubts,negativeattitudestowardsa futuremedicineandpositiveopinionsaboutdrugeffectiveness werethemostSIexpressedbyPFusers.Pharmacistscanhave amainroleprovidingmoreinformationandknowledgeto parentsaboutdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-106 SAFETYPERCEIVEDBYPROFESSIONALSAFTERTHE INNOVATIONOFTHEMEDICATIONUSECIRCUITINA

NEONATALINTENSIVECAREUNIT

1DCanales*, 1CGarcía-Muñoz, 1JMCaro, 1FMartinez, 1AGonzález, 1ACastro, 2MTMoral, 2INúñez, 1JMFerrari, 2CRPallás. 1Hospital12deOctubre,ServiciodeFarmacia,Madrid, Spain; 2Hospital12deOctubre,ServiciodeNeonatología,Madrid,Spain

10.1136/ejhpharm-2023-eahp.307

BackgroundandImportance Recently,aredesignhasbeentakingplaceinçcircuitofprescription,dispensing,preparation andadministrationofmedicationsinNeonatalIntensiveCare Unit(NICU).Thesechangesareaimedatimprovingthesafety ofthemedicationuseprocess.

AimandObjectives Toevaluatethesafetyrelatedtotheuse ofmedicationsperceivedbyprofessionalsaftertheimplementationofimprovementmeasuresinthecircuit.

MaterialandMethods Aquestionnairewasdevelopedfornursingstafftoassesstheperceivedsafetyin:prescriptionby assistedelectronicprescription(AEP),dispensingthroughan automatedmedicationdispensingsystemintegratedwithAEP, anddrugadministrationthroughsmartpumps.Secondly,a questionnairewasdevelopedformedicalstafftoassessthe perceivedsafetyofEAPandpharmaceuticalvalidation.In both,questionswereincludedaboutmeasurestobeimplementedtoimprovecircuitsafety.

Thequestionnairesconsistof17(nursingstaff)and14(medicalstaff)questionswithanaveragecompletiontimeof2 minutes.BothweredesignedinGoogleForms® togivemaximumdiffusion.

Attitudes(32;5%)

Futuremedicine2(4%)20(32%)0(0%)

Currentmedicine5(11%)5(8%)0(0%)

Druginformation(270;46%)

Pharmacokinetics0(0%)1(2%)7(3%)

Posology0(0%)0(0%)16(6%)

Avoided/delayed/discontinuedmedicine0(0%)3(5%)23(9%)

PeerAdvice0(0%)0(0%)97(39%)

Vaccinationschedule0(0%)0(0%)34(13%)

Alternativetherapies0(0%)9(14%)20(8%)

Routeofadministration3(6%)1(2%)8(3%)

Reconstitution0(0%)0(0%)2(1%)

Conservation0(0%)0(0%)1(0%)

AdverseEvents0(0%)9(14%)15(6%)

Contraindications0(0%)0(0%)1(0%)

Interactions0(0%)0(0%)1(0%)

Results Responseratewasof60%(42peoplefilledoutthe questionnaire,26fromnursingstaffand16ofmedicalstaff). RegardingAEP,nursingstaffagreedthatitprovidesgreater safetythanmanualprescription,although7.7%(n=2)consideredthattheinformationisnotalwaysclearandcomplete. Regardingmedicalpersonnel,88%considerthattheAEPprovidesgreatersecurity.

Regardingpharmaceuticalvalidation,100%ofmedicalstaff believethatitisanimprovementinthequalityofcareand thatitprovidessecuritytotheprocess.

Regardingdispensing,96%considerthatmedicinesare moreeasilyfoundwithrespecttotheplantmedicinecabinet systemand85%considerthattheintegrationwithAEPallows unequivocallyobtainingtheprescribedmedication.

Intheadministration,85%ofnursingstaffconsiderthat smartmedicationinfusionpumpspreventexceedingtherapeuticdoses.

Finally,intermsofareasforimprovement,themajorityof nursingstaffconsidersthatthemeasuresshouldfocuson preparation(57.7%)andthemedicalstaffconsidersthatthey shouldfocusonadministration(75%).Administrationbybarcodeisthemeasuremostvotedforbothgroupstoworkon incomingyears.

ConclusionandRelevance TheperceptionofsafetybyNICU staffofmeasuresimplementedishigh.Therearestillareas forimprovementsuchaspreparationoradministration.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-107 SAFETYASSESSMENTOFERENUMABAND

GALCANEZUMABINCLINICALPRACTICE

MDCGonzalezEscribano*,APerezFacila,JJSaizMolina,TdeSalinasMuñoz, MDMAlañonPardo,PAraqueArroyo. HospitallaManchaCentro,Pharmacy,Alcazarde SanJuan,Spain

10.1136/ejhpharm-2023-eahp.308

BackgroundandImportance Erenumabandgalcanezumabare twomonoclonalantibodies(mAbs)administratedsubcutaneouslyindicatedformigraineprophylaxisinadults.Asthese arenewlyapproveddrugs,itisimportanttoknowtheirsafety profile.

AimandObjectives Toanalysetheadverseeffects(AE)of thesemAbsinreallifeinatertiaryhospital.

MaterialandMethods Observational,retrospective,30-month study(March2020

September2022).Thestudyincluded allpatientsdiagnosedwithchronicmigraine(CM)orepisodic migraine(EM)andwhoreceivedtreatmentwithgalcanezumab orerenumabrespectively.

Thefollowingvariableswerecollected sex,age,typeof migraine,durationoftreatmentandAE.

Datawerecollectedthroughtheoutpatientmoduleofthe Farmatools® softwareandtheelectronichealthrecord,MambrinoXXI®

Results Ninety-fivepatients(92%female,8%male)witha medianageof50years(18-73)wereincluded.Ofthese,72% hadCMand28%hadEM.45%and55%ofpatients receivederenumabandgalcanezumabrespectively.

48patients(44%erenumab,56%galcanezumab)experiencedsometypeofAEduringtreatment,consideredmildmoderateinseverity.Fourpatients(75%erenumab,25%galcanezumab)hadtodiscontinuetreatmentduetopoortolerabilitydespiteprophylactictreatment.17(41%erenumab, 59%galcanezumab)hadinjectionsitereactionorpain,27 (48%erenumab,52%galcanezumab)constipationand4(25% erenumab,75%galcanezumab)nauseaandvomiting.AEswere morefrequentamongpatientswithCM(65%)vsEM(35%).

Comparingthedataobtainedwiththosedescribedinother clinicaltrials,itwasobservedthattheproportionofAEswas verydifferentfromthatreportedinthetrials.Inaddition, therewerenocasesofnasopharyngitisorrespiratorytract infectiondescribedascommoninthetrials.Nocardiovascular AEswereobserved.

ConclusionandRelevance Basedontheresultsofourstudy,it wasobservedthatgalcanezumabanderenumabAEswerecategorisedasmild-moderate.TheincidenceofAEswashigher forthegroupofpatientsreceivinggalcanezumab.Inaddition, asmallnumberofpatientsdiscontinuedtreatmentdueto AEs.Itisessentialtoknowthesafetyprofileofnewly

approveddrugsinclinicalpracticesoastocomparethem withthosedescribedinclinicaltrialsandtoseepossibledifferencesbetweenthemthatcontributetogeneratenew evidence.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-108 COMPUTERISEDPHYSICIANORDERENTRYWITH CLINICALDECISIONSUPPORTINPREVENTING WRONGDOSEERRORSINPAEDIATRICMEDICATION ORDERS:ASYSTEMATICREVIEW

1HRuutiainen*, 2EKunnola, 2ARHolmström, 1SKuitunen. 1HelsinkiUniversityHospitalHus, HusPharmacy,Helsinki,Finland; 2UniversityofHelsinki,FacultyofPharmacy,Helsinki, Finland

10.1136/ejhpharm-2023-eahp.309

BackgroundandImportance Prescribingisaspecifichigh-risk taskwithinthepaediatricmedication-useprocess,whichis whydefensesareneededtopreventorstoperrors.Suchsystem-centricbarriersincludeelectronichealthrecord(EHR) systemswithcomputerisedphysicianorderentry(CPOE). Clinicaldecisionsupport(CDS)toolscanbeintegratedinto theCPOEsystemstoassistsafeprescribing.

AimandObjectives Theobjectiveofthissystematicreview wastoexaminetheeffectsofCPOEsystemswithCDSfunctionsonpreventingwrongdoseerrorsinpaediatricmedicationorders.

MaterialandMethods ThisstudyfollowedthePreferred ReportingItemsforSystematicReviewsandMeta-Analyses (PRISMA)2020criteriaandSynthesisWithoutMeta-analysis (SWiM)items.ThestudyprotocolwasregisteredinPROSPERO.TheliteraturesearchwasconductedinMEDLINE Ovid,Scopus,WebofScienceandEMBReviewsinJanuary 2022.Studyselectionanddataextractionwerecarriedoutby twoindependentreviewers.Afterthis,thequalityofevidence oftheincludedstudieswereassessed.Finally,votecounting methodwasusedtoevaluatetheeffectivenessofCPOE-CDS systemstoreducewrongdoseerrors.

Results Atotalof18studiespublishedin2007–2021metthe inclusioncriteria.ThemostcommonCDStoolsappearingin thestudiesweredoserangecheck(n=14/18),dosecalculator (n=8/18)anddosingfrequencycheck(n=8/18).Inninestudies,aspecificalertfunctionwasaddedtotheCDStool, whereasalertswererecordedin15studies.Astatisticallysignificantreductioninwrongdoseerrorswasfoundineight studies.Noneofthestudiesrepostedanoverallincreaseof wrongdoseerrors.

ConclusionandRelevance CPOE-CDSsystemshaveagreat potentialtopromotepaediatricmedicationsafety.Systemcustomisationforpaediatricpopulations,implementingCDS alerts,andtheuseofdoserangecheckseemtobemostusefulinterventionstoreducewrongdoseerrors.However, CPOE-CDSsystemscannotpreventallwrongdoseerrorsas humanerrorscontinuetooccur.Implementationofnewtechnologycanalsoposenewmedicationsafetyrisks,suchasalert fatigue.Therefore,furtherstudiesandsystematicdevelopment activitiesareneededtooptimisethesafeuseofCPOE-CDS systemsinpaediatriccaresettings.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-109 RANSOMWAREATTACKONACYTOTOXIC PREPARATIONUNIT(CPU):WHATNOW?

MLourenço,CCanário,GCosta,HDuarte,AAlcobia*. HospitalGarciadeOrta,Pharmacy, Almada,Portugal

10.1136/ejhpharm-2023-eahp.310

BackgroundandImportance Theinformatisationofprocesses hasincreasedthesusceptibilityofthehealthcaresectorto computerattacksthroughransomware.Thesecanmanifestby theimpossibilityofaccessingtheinternet,andcomputersystems,withconsequentinterruptionofelectronicprescription, registrationinpatientdiary,consultationofpreviousclinical data,requestformeansdiagnostictools,amongothers.PharmaceuticalServicesareparticularlyvulnerabletotheseattacks.

AimandObjectives Theaimofthisworkwastosystematise thestrategiesadoptedduringthecyberattack,minimisingthe errorandallowingtheworktobecarryoutattheCPU,with theelaborationofaguidelinetobeadoptedinafuture cyberattack.

MaterialandMethods RetrospectivestudybetweenApril26 andMay10,2022.

Results CPUwasrestructuredinordertoguaranteeitsfunctionality.ThroughtheinformationonpaperfromtheproductionmapsofApril2022,chemotherapyprotocols,chartswith reconstitution/dilutionofuseddrugs,literatureandcoordinationofinformationwiththenursingandmedicalteam,itwas possiblepreventthecollapseoftheunit.Itwasperformeda dailysurveyofpatientsmarkedinagenda,andrespective informationaboutthecycle.

Inthefirst15daysofattack,28.8%(n=132)ofscheduled patients(n=458)wereuncheckedduetolackofaccessto complementarymeansofdiagnosisandhistoryofchemotherapyprotocols.Thepreparationofcytotoxicswaspossible throughtheelaborationofmanuallabels(n=615),usingthe validationofpaperprescriptions.Inthefirstweek(April26 to29)41.9%(n=67)ofthepatients(n=160)wereunchecked andinthesecondweek(May2to6)25%(n=54)ofpatients (n=216).Intheinitialdaysofcyberattacknonewpatients werescheduled.

ConclusionandRelevance Facedwiththerealityofacomputer attack,theCPUprioritywastoensureasafetypreparationof chemotherapy.Ontheotherhand,thisattackshowedthatit iscrucialtohavemechanismsofreplacementofinformation suchasthechemotherapyprescriptionsfile.Anticipatingfuture cyberattacks,aguidelinehasbeendevelopedtoensurecircuit safetyincaseofcomputerfailure.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Notapplicable.

ConflictofInterest Noconflictofinterest

5PSQ-111 MEDICATIONERRORS,THEIRPERCEPTION,ANALYSIS,

1HKomjathy*, 2VGogolova, 1KTóthová, 1DTárnoková, 1KHajtmanová, 1AHorváthova, 1CGálova, 3LMasaryková. 1HospitalAgelKomárno,HospitalPharmacy,Komárno,Slovakia; 2Expiro,Pharmacy,NovéZámky,Slovakia; 3FacultyofPharmacyComeniusUniversity Bratislava,DepartmentofOrganisationandManagementofPharmacy,Bratislava,Slovakia

10.1136/ejhpharm-2023-eahp.311

BackgroundandImportance Amedicationerrorisamistake intheuseofamedicinethatcanresultinharmtothe patient.Medicationerrorscanincreasehospitalisationcosts andprolonghospitalstays.Whereasthemedicationerrorsare preventable,itisimportanttoidentifythemostvulnerable steps.

AimandObjectives Theaimofourworkwastoanalysethe perceptionofmedicationerrorsbyhealthcareprofessionalsin ourhospitalconcerningparenteralmedicines.Subsequentlyto findtheroleofhospitalpharmacistsintheprocessofeliminatingmedicationerrors.Furthermore,toidentifythemedicinesinwhichamedicationerrorcanoccurmostoften.

MaterialandMethods Retrospective,observationalstudyina publichospitalfromAugust2021toDecember2021.The studywasconductedusingquestionnairesadministeredbyhospitalpharmacistsfilledbyhealthcareprofessionals(doctors andnurses).Thequestionsfocusedonmedicationerrors,their causes,andtheirfuturesolutions.Severalquestionswere focusedonspecificdrugsregardingthepreparationand administrationofspecificparenteraldrugs.

Results 47doctorsand72nursesfromthedifferentdepartmentsparticipatedinthesurvey.72%doctorsand46%nurses encounteredmedicationerrors.Increasedworkload(87%doctors,79%nurses)andnegligence(61%doctors,47%nurses) wereidentifiedasthemostcommoncauses.Themostfrequentlyobservedmedicationerrorsofparenteraldrugs occurredduringtheprocessofprescription(75%doctors, 54%nurses)andadministration(68%doctors,50%nurses). Whiledoctorsmostoftenconsultedtheircolleagues(78%)or lookfortheliterature(55%),nursesconsulteddoctors(81%) whensolvingissuesconcerningparenteraldrugspreparation andadministration.Ontheotherhand,upto49%ofdoctors alsoapproachedthehospitalpharmacist,inthecaseofnurses itwasonly22%.Morethan87%ofdoctorsand76%of nurseswouldwelcomelecturesandtrainingfrompharmacists focusedonthecorrectadministrationandprescriptionof parenteraldrugs.

ConclusionandRelevance Ourresultsconfirmtheliterature data,whichsaythatthemostcommonmedicationerrors occurduringprescribingandadministeringdrugs.Hospital pharmacistswiththeirknowledgecansignificantlycontribute totheeliminationofmedicationerrorsandincreasethesafety ofhospitalisedpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-113 REAL-LIFEEFFECTIVENESS,SAFETYANDADHERENCE OFDUPILUMABINPATIENTSWITHATOPIC DERMATITIS

1CSociasCañellas*, 1PRiera, 1MMasip, 2ESerra-Baldrich, 2JSpertino, 2ERoé-Crespo, 1NPagès-Puigdemont. 1HospitaldelaSantaCreuISantPau,PharmacyDepartment, Barcelona,Spain; 2HospitaldelaSantaCreuISantPau,DermatologyDepartment, Barcelona,Spain

10.1136/ejhpharm-2023-eahp.312

BackgroundandImportance Dupilumab,ananti-IL-4/13,isa monoclonalantibodyapprovedforthetreatmentofmoderateto-severeatopicdermatitis(AD).Sofar,fewstudieshaveevaluateddupilumabeffectivenessandsafetyinrealclinical practice.

ANDPROPOSALOFSOLUTIONSINAPUBLIC HOSPITAL

AimandObjectives

Toevaluatetheeffectiveness,safetyand treatmentadherenceofdupilumabinpatientswithADinclinicalpractice.

MaterialandMethods Weconductedaretrospectivestudycarriedoutinatertiaryhospital.WeincludedallADpatients treatedwithdupilumabwithaminimumfollow-upof52 weeks.

Wecollectedthefollowingdatafromelectronicmedical records:age,gender,previoustreatments,eczemaareaand severityindex(EASI)anddermatologylifequalityindex (DLQI)atbaselineandat52weeksoffollow-up,adverse effectsandtreatmentadherence(calculatedbymedicationpossessionratio[MPR]).

EffectivenesswasdeterminedbythechangeintheEASI andDLQIvaluesat52weekscomparedtobaseline.Safety endpointswerethenumberandtypeofadverseeffects(AE) duringthefollow-upperiod.

Results Intotal,61patientswereincludedinthestudy.The meanage(±SD)was40(±18)years.Thirty-fivepatients (57%)weremen.

Asprevioustopicaltreatments,100%ofpatientshad receivedcorticosteroids;whereas49%,tacrolimus.Besides, 70%hadunderwentphototherapy.Regardingsystemictreatment,79%hadreceivedcorticosteroids;70%,cyclosporine; 25%,mycophenolatemofetil;25%,azathioprine;and28%, methotrexate.

Mean(±SD)EASIandDLQIbaselinevalueswere33± 11and19±5,respectively.At52weeksfollow-up,these indexeswere2±3and4±5,respectively.Thereduction inEASIandDLQIwasstatisticallysignificant(p<0.001).Duringthisperiod,AEwerereportedin22patients(36%):conjunctivitis(20%),arthralgia(5%),herpesvirusinfection(5%) andparadoxicalpsoriasis(3%)werethemostcommonones. Threetreatmentswerediscontinuedduetoineffectiveness,4 duetoAEand2becauseofclinicalremission.

ThemeanMPR(±SD)was100±14%,whichdemonstratesgoodratesoftherapeuticadherence.NopatientpresentedaMPR<75%,sowecouldnotdeterminetheimpact ofthisvariableontreatmenteffectiveness.

ConclusionandRelevance Ourstudyshowsthatdupilumabis aneffectiveandsafedrugformoderate-to-severeDA.Our cohortexperiencedastatisticallysignificantimprovementin EASIandDLQIat52weeksoftreatment.Additionally,therapeuticadherencewasveryhigh.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-115 DEPRESCRIBINGLONG-TERMTREATMENTSWITH BIPHOSPHONATES:PHARMACEUTICALINTERVENTION BRINGSVALUE

10.1136/ejhpharm-2023-eahp.313

BackgroundandImportance Bisphosphonatetreatmentlasting morethan5years(BP5y)inpatientswithoutpreviousfractures and/orlowriskoffracturedoesnotconferadditionalbenefits. Theantiresorptveeffectismaintainedforatimeafterdrug discontinuationandtheside-effectsriskisminimised.The increasedriskofrareandlong-termside-effectassociatedwith theprolongeduseofbisphosphonateshasbeenreasonof

safetynotesissuedbytheSpanishAgencyforMedicinesand HealthProductsandotherregulatoryagencies.So,are-evaluationofthetreatmentisnecessaryconsideringthebenefits andrisksforthepatientindividually,especiallyafter5years ofuse.

AimandObjectives TheaimofthepresentstudywastoidentifypatientsintreatmentwithBP5yandtoevaluatethe acceptanceofpharmaceuticalintervention(PI)overdeprescribinginprimaryprevention.

MaterialandMethods Bymeansoftheprimarycaredata exploitationplatform(Digitalis®)andafterreviewingtheelectronicprescription,patientsontreatmentwithBP5ywere identifieduntilDecember-2021.Patients>85-years-oldwere selectedduetotheirincreasedfrailty,comorbiditiesandpolypharmacy.Thephysicianswereinformedviatheinformative sheetsoftheprimarycareinformationsystem(Turriano®) aboutthesusceptibleconditiontodeprescribingaftermore than5yearsofcontinuoustreatmentinprimaryprevention. Sevenmonthslater,acceptancedegreeofPIwasassessed.

Results Atthestartofthestudy,186patientswereidentified intreatmentwithBP5y,51ofwhomwere>85years-old. Finally,PIwasperformedon43patientsbelongingtothe selectedhealthcentres.Sevenmonthslater,bisphosphonate withdrawalwasobservedin10patients,withaprescribing doctorsacceptancerateof23%(10/43).Currently,33patients continuewithsuchtreatmenteitheroutofnecessityordueto lackofknowledgeofPI.Onlyoneofthe8patientswithout PI(12.5%)hadbisphosphonatediscontinuation.

ConclusionandRelevance Themonitoring,analysisoftreatmentswithBF5yandthecorrespondingPIhavepromoted thedeprescriptioninalmostaquarterofthecases,creating theneedtoextendthestudytotherestofthepatients.The importanceofthepharmacistinthereviewoftreatmentsis highlighted,aswellastheinterdisciplinarycollaborationwith physicianstoachieveasafeuseofthedrug.

REFERENCESAND/ORACKNOWLEDGEMENTS

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5PSQ-116 PERSISTENCEOFINHIBITORSOFINTERLEUKIN-23 (ANTI-IL-23)FORTHETREATMENTOFMODERATE-TOSEVEREPSORIASIS(MSPS)INTHEROUTINECLINICAL PRACTICECONDITIONS

1LDomínguezSenín, 2SCamachoParreño, 2ESánchezGómez, 2MRodriguezJorge*, 2MDSantos-Rubio. 1HospitalJuanRamónJimenez,HospitalPharmacy,Huelva,Spain; 2HospitalJuanRamónJiménez,HospitalPharmacy,Huelva,Spain

10.1136/ejhpharm-2023-eahp.314

BackgroundandImportance Anti-IL-23haveemergedassafe andeffectiveoptionsforthetreatmentofmsPs.

AimandObjectives Weaimedtoevaluatethepersistenceof anti-IL-23(guselkumabandrisankizumab)inpatientswith msPs.Secondarily,thesepatients’ clinicaloutcomesandhealthrelatedqualityoflife(HRQL)andthesafetyprofilewerealso assessed.

MaterialandMethods Retrospectiveobservationalstudyfrom January2019toSeptember2022.PatientswithmsPsreceiving anti-IL-23wereincluded.Demographic(sex,age)andclinical data(previousbiologicaltreatments,therapydurationand baselinePsoriasisAreaandSeverityIndex(PASI))werecollectedfromthedigitalmedicalrecord.Non-persistencewas definedastreatmentdiscontinuationoratreatmentgap>90

VLafargaLapieza*,PHernandoMartinez,CMartiGil,DCaniegoRodrigo,EGarciaLopez, DBarredaHernandez. HospitalVirgendelaLuz,Farmacia,Cuenca,Spain

days.Thecumulativeprobabilityoftreatmentpersistencewas analysedbyKaplan-Meiermethod.Secondaryendpoint: PASI90responseat1year,changeinHRQLthroughdermatologylifequalityindex(DLQI)at1year,andsafetyprofile. Results 44patientswereincluded(26women),30received guselkumaband14risankizumab.Meanagewas53.5years. 93.2%receivedbiologictherapiesbefore,and86.3%conventionalsystemictreatment.Atdatacut-offtime,73.3%and 92.8%patientsremainedonguselkumabandrisankizumab respectively.Themaincauseofdiscontinuationwasprimary failure.In13.3%ofguselkumabpatients,doseintervalwas extended>8weeksandin7.1%ofrisankizumabpatientswas extended>12weeks.Thecumulativeprobabilityofguselkumabtreatmentpersistencewas79.7%at1yearandforrisankizumab92.6%.ThemedianPASIscorewas8and9at guselkumabandrisankizumabtreatmentinitiationrespectively. 50%ofguselkumabpatientsand64.3%ofrisankizumab patientsachievedPASI90improvementat1year.44.8%of guselkumaband71.4%ofrisankizumabpatientsachieveda minimalclinicallysignificantdifference(>4-pointreduction)in DLQIscoreat1year.Onepatientexperiencedoneadverse reaction(ARs)relatedtoguselkumab:headacheandtworisankizumabpatientsexperiencedincreaseintransaminases.

ConclusionandRelevance OurcohortshowsamoderatepersistencerateandPASIimprovementat1yearwithguselkumabandamoderatebenefitinimprovingHRQL.High persistencerateandmoderatePASIimprovementwasreached withRisankizumabandasubstantialimprovementinHQRL. Noimportantadversereactionswerefound,withouttreatment withdrawals.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-118 PATIENTS’ EXPERIENCEWITHSUBCUTANEOUS INJECTIONSELF-ADMINISTRATIONANDTHEROLEOF VIRTUALREALITY

MGómezBermejo*,RVázquezSanchez,AOntenienteGonzalez,JCCiezarRodriguez, MGarciaParaje,ADomingoBuzon,GMDelgadoLopez,TMolinaGarcia. Hospital UniversitariodeGetafe,HospitalPharmacist,Getafe,Spain

10.1136/ejhpharm-2023-eahp.315

BackgroundandImportance Thenumberofpatientstreating themselvesviathesubcutaneous(SC)administrationroutehas widelyincreasedinrecentyears.Althoughself-medicationcan reducewaitingtimesandsavemoney,isapublichealthconcernthatitmaycarrysomepotentialrisksassociatedwith inappropriatemanagement.Gettingthecorrectmethodof administrationisessentialtoensurethedrug’seffectiveness andminimisetheriskofcomplications.

Weproposetotakeadvantageofthebenefitsthatnew technology,suchasvirtualreality(VR),couldprovidefor patients’ performance.

AimandObjectives Thisinvestigationaimedtoexplore patients’ perceptionsoftheirexperienceswithSCinjection self-administrationandtheirwillingnesstoimplementVRto improvetheirlearningprocessofthemethodof administration.

MaterialandMethods Anobservationalandtransversalstudy wasperformed.Theadultswhoattendedforsubcutaneous medicinedispensingwereincluded.Ayes/nosurveywasconductedregardingtomedicationfirstself-administration

knowledge,handlingskills,administrationerrors,riskperception,clarityofinformationreceivedandwhetheraVRenvironmentwouldhelptheirlearning.

Results

Forty-fivepatientswereincluded Mean±SDagewas51± 12years.Mostofthepatientsinterviewedwereintreatment withdrugsforimmune-mediatedinflammatorydisorders.The firstadministrationwasdonebyahealthprofessionalin 53.3%ofthecases,44.4%weredonebythemselvesand 2.2%weredonebyafamilymember.Although95.6%ofthe participantsconsideredthattheinformationgivenbythepharmacistwasclearenough,15.6%ofthemdiscardedtheinjectionsduetohandlingfailuresand66.7%reportedinjection sitereactions.Finally,75.6%ofparticipantsbelievedthatVR mayhelptolearntheadministrationprocess.

ConclusionandRelevance Althoughtheinformationandtrainingprovidedbythepharmacistwereclearenough,some patientsdonotfeelconfidentwiththeirfirstself-administrationhavingtodiscardthemedicationduetosomehandling failures.

TheVRrepresentsapotentialalternativeforpromotinga safeenvironmenttoimprovetheknowledge,skillsandattitudesinSCinjectionself-administrationthroughreproducing environmentsclosetotherealone.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-119 ANEWPHARMACEUTICALCAREPROGRAMMEFOR COVID-19PATIENTSTREATEDWITHPAXLOVID®: IMPLEMENTATIONANDSAFETYOUTCOMES REPORTED

1MFerrisVillanueva*, 2EChamorrodeVega, 2CGGonzalezRodriguez, 2BTorrobaSanz, 2JVicenteValor, 2AHerranzAlonso, 2MSanjurjoSáez. 1GregorioMarañónUniversity GeneralHospital,HospitalPharmacy,Madrid,Spain; 2GregorioMarañónGeneralUniversity Hospital,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.316

BackgroundandImportance TheCOVID-19pandemichas highlightedtheimportantrolethathospitalpharmacistsplay inimprovingpharmacotherapyoutcomes.Paxlovid® (Nirmatrelvir/ritonavir)wasrecentlygrantedanEmergencyUse AuthorisationforthetreatmentofmildtomoderateCOVID19.However,theuseofPaxlovid® withcertainotherdrugsin high-riskpatientsmayresultinpotentiallysignificantdrugdruginteractions(DDI)andadversedrugevents(ADE).

AimandObjectives Toassesstheimpactofacomprehensive pharmaceuticalcareprogram(CPCP)focusingonthepreventionofDDIandADE,initiatedinahospitalpharmacyfor patientswithmildtomoderateCOVID-19treatedwith Paxlovid®.

MaterialandMethods Design:Quasi-experimentalstudyperformedbetween1Mayand31July2022.Pharmacistswere responsibleforproposingCOVID-19localguidelinestophysicians,monitoringadherencetoguidelines,managingDDIand ADE,providingpatienteducation,andevaluatinghealthoutcomes.Atelephoneconsultationwascarriedout10daysafter theendofPaxlovid® treatment.

PotentialDDIweredetectedaccordingtoLexi-Comp ® and LiverpoolCOVID-19databases.Paxlovid-relatedADEreported weregradedaccordingtoCommonTerminologyCriteriafor AdverseEvents,version4.

Results 140patients(60.7%outpatients)initiatedPaxlovid® andwereenrolledintheCPCP.Adherencetolocalguidelines fortheuseofPaxlovid® was100%.

Overall,232DDIweredetectedin111(79.3%)patients, 142(61.2%)ofwhichrequiredspecificmanagement(34.5% discontinuationoftheconcomitantdrugand65.5%dose adjustment).

Pharmacistsmade267interventionsthatledtothepreventionof177ADE(1.3/patient),96(54.2%)ofwhichwere gradeG-H(NCCMERPclassification).

Atday10,96ADEswerereportedin42patients(26.1% ofwhichweregrade 3),beingdysgeusiaanddiarrhoeathe mostcommon.PrematurediscontinuationofPaxlovid® dueto ADEswasnecessaryin4(2.8%)patients.

ConclusionandRelevance TheimplementationofaCPCP developedbyhospitalpharmacistsforpatientstreatedwith Paxlovid® wasaneffectiveapproachformonitoringadherence toguidelines,managingDDI,providingpatienteducation,and evaluatingsafetyoutcomes.Paxlovid® showedanacceptable safetyprofile.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-120 ANALYSISOFTHEPHARMACEUTICALINTERVENTIONS PERFORMEDONONCO-HAEMATOLOGICALPATIENTS THROUGHANONCO-HAEMATOLOGYPHARMACY CONSULTATION

CAlarcon-Payer*,AMartínRoldan,MDMSánchezSuárez,CMonteroVílchez,AJiménez Morales. HospitalUniversitarioVirgendeLasNieves,ServiciodeFarmacia,Granada,Spain

10.1136/ejhpharm-2023-eahp.317

BackgroundandImportance Intheareaofonco-haematology, medicationerrorsareofgreatimportancebecauseoralantineoplasticdrugshaveanarrowtherapeuticmargin,complex dosingregimens,possibleinteractionswithotherdrugsand foods,andlowsupervisionoftheirself-administrationby healthcareprofessionals,increasingtheriskofmedication errors.

drugs,25%relevantdruginteractions,18%omissionofthe drug,10%incorrectfrequencyofadministrationand2% detectedadversereactions.Themostfrequentdoseerrors werepooradjustmentforrenalfunction(40%),failureto writethedoseinthepatient‘sclinicalcourse(30%),failureto adjustforliverfailure(20%),pooradjustmentforbodysurfacearea(10%).100%oftheerrorsweredetectedinthe pharmaceuticalvalidationprocessduringthedispensingoforal cytostatics.100%ofthepharmaceuticalinterventionswere enteredinthepatient‘sclinicalhistoryasaclinicalreport. 97%wereacceptedandprevented97%ofmedicationerrors inpatients.

ConclusionandRelevance Pharmaceuticalinterventionshave proventobeaneffectivetooltocontributetotheachievementofthepatient‘stherapeuticgoals.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.JOncolPract2011;7(1):7–12.

ConflictofInterest Noconflictofinterest.

5PSQ-122 COVID-19VACCINEVIGILANCE:COMPARATIVESTUDY BETWEENHOSPITAL,REGIONALANDNATIONAL DATA

Camerino,Italy

10.1136/ejhpharm-2023-eahp.318

BackgroundandImportance FollowingAIFA’ sauthorisationof firstmRNAvaccineon27/12/2020,C OVID-19vaccination campaignstartedinItalytogetherwithvaccinevigilancein ordertoindividuateexpectedandunexpectedAdverseEvents-Following-Immunisation(AEFIs)andthebenefit/risk balance.

AimandObjectives Theaimofthisworkiscomparingreports ofvaccinevigilanceinourHospitalfromDecember2020to June2022tonationalandregionaldata.

AimandObjectives

Toanalysethepharmaceuticalinterventions performedononco-haematologypatientsseeninanOnco-haematologyPharmacyconsultation.

MaterialandMethods Prospectiveobservationalstudyof onco-haematologypatientsinatertiaryhospitalforaperiod ofoneyear.Toidentifythetypeofinterventionperformed, adatabasewascreatedusinganExcel ® spreadsheettorecord andcategoriseit.Onceidentified,itwasenteredasanepisodeinthepatient ‘sclinicalhistoryintheDirayaClinica ® programmesothatthecliniciancouldconsultitinthe patient ‘sevolution.Finally,errors,interactionsandadverse reactionsavoidedbyperformingtheseinterventionswere recorded.

Results Atotalof35onco-haematologypatientsunderwent pharmaceuticalinterventions.55%menand45%women.The medianagewas64years.Thepatientsbelongedtotwoclinicalservices,40.8%toHaematologyand59.2%toOncology. Theonco-haematologicalpathologieswheremostinterventions wereperformedwere:ProstateCancer(30%),ColonCancer (25%),ChronicLymphaticLeukaemia(16%),MultipleMyeloma(10%),OvarianCancer(7%),BrainTumours(5%),Lung Cancer(4%),BreastCancer(3%).45%ofthepharmaceutical interventionsperformedwereincorrectdosesofantineoplastic

MaterialandMethods StartingfromdataoftheNationalSystemofPharmacovigilance(RNFV),weanalysedreportsby age,sex,severityofreaction,reporterandSystem-Organ-Class (SOC)involved(Meddraclassificationsystem).Finally,we comparedresultswithtwelfthvaccinesurveillancereportpublishedonJune2022bytheItalianAgencyofDrugs(AIFA) andto2021annualregionalreport.

Results IntheperiodourHospitaladministeredabout111000 doses(99%Comirnaty,0.3%Vaxzevria,0.6%Spikevax).176 reportswerecollected:69(39%)concernedCovidvaccination (reporting-rateRR0,06%).52(75,4%)ofCovid-reportswere notsevereand17(24,6%)weresevere;amongthosesevere,2 casesofineffectivevaccination(Comirnaty),1caseofheart attack(Spikevax),1caseofadrenalhematoma(Vaxzevria)and 1episodeofdeepveinthrombosis(Comirnaty).59(85,5%) involvedwomenand10(14,5%)men.65(94,4%)involved Comirnaty(23%severe,andfurther9%ofseverereaction aregivenbyassociationwithotherdrugs,RR0,06%),2 (2,9%)Spikevax(50%severe,RR0,6%),2(2,9%)Vaxzevria, (50%severe,RR0,3%).216AEFIswerecollected;83(38%) generaldiseasesandconditionsrelatedtositeofinjection(13 fever,9asthenia);37(17%)nervoussystemdiseases(26headache);30(14%)generalisedmuscularpains(8myalgia).Little

1IBartolucci, 1NMontiGuarnieri, 1AMFGarzone, 1EAndresciani, 1SBagagiolo, 1ECocci, 2CPolidori, 1APompilio*. 1AouDelleMarche,SodFarmacia,Ancona,Italy; 2Università DegliStudiDiCamerino,ScuolaDiScienzeDelFarmacoEDeiProdottiDellaSalute,

percentageinvolvedalsovision,skinandrespiratorysystem. 49%ofreportswerefromdoctors,30%frompharmacists, 15%fromotherhealthworkerandlast6%patients.35(51%) AEFIswerefromfirstdose,32(46%)fromsecondand2 (3%)formthird.Almostallreportsinvolvedagerange18-64.

ConclusionandRelevance ResultsonComirnatyareinline withAIFA’sandregionalones;SpikevaxandVaxzevriashow alteredpercentagebecauseoflittlenumberofreports.Reportingratesarecomparable.Mostofreportsconcernednot severereactions,mainlyrelatedtositeofinjection.Itis importanttounderlinetheessentialroleofvaccinevigilance toidentifyredflagsforpublichealthinordertocontain mainseverereactions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

prescribedinthesecasesafterTURwasbemiparinataprophylacticdoseof3500IUevery24hours.

59.5%ofpatientswereattendedatEmergencyDepartment (ED)afterTURwithhaematuriadiagnostic.

ConclusionandRelevance Althoughanticoagulationwasnot reintroducedastheprotocolestablished,morethan50%of patientswerereadmittedintheEDforhaematuria.Therefore, ourstudyconfirmsthatappropriateinterruptionofanticoagulationintheperioperativeperiodisadelicatebalancingact betweencomplicationsofbleedingandthrombosis.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-127 PHARMACOLOGICALRISKFACTORSFORDRUG-DRUG INTERACTIONSINPEOPLELIVINGWITHHIV:A SYSTEMATICREVIEW

5PSQ-125 BRIDGINGANTICOAGULATIONINPATIENTSWITH ATRIALFIBRILLATIONAFTERATRANSURETHRAL RESECTION:PATIENTMANAGEMENTISDONE APPROPRIATELY?

10.1136/ejhpharm-2023-eahp.319

EValls*,SMarin,CCodina-Jiménez,ETerricabras,LEstrada,ABocos-Baelo,CGarcíaCastiñeira,GCardona,ÀAndreu,CQuiñones. HospitalUniversitariGermansTriasIPujol, PharmacyDepartment,Badalona,Spain

10.1136/ejhpharm-2023-eahp.320

BackgroundandImportance

Themanagementofanticoagulationinpatientsundergoingsurgicalproceduresliketransurethralresection(TUR)ischallenging.Abalancebetween reducingthromboembolismriskandpreventingexcessive bleedingmustbereached.Thisriskisaggravatedinpatients treatedwithanticoagulants.

BackgroundandImportance Improvedsurvivalofpeopleliving withHIV(PLWH)increasescomorbiditiesburdenleadingto polypharmacyanddrug-druginteractions(DDIs).DDIssuppose ahigherconcerninPLWHduetoantiretroviraltherapy(ART). Presencesoriskfactors(RF)fordevelopingDDIsareofinteresttodetectcasesneedingforpharmaceuticalassessment.

AimandObjectives Assessliteratureonthepharmacological RFfordevelopingDDIsinPLWH.

AimandObjectives

Theaimofthestudywastoassessthe adequacybridginganticoagulationafterTURinpatients treatedwithdirect-actingoralanticoagulants(DOACs)orVitaminKantagonists(VKAs)topreventstrokeinatrialfibrillation(AF).

MaterialandMethods

Retrospectiveobservationalstudycarried outinanareareferencehospitalservingapopulationof 200,000inhabitants,fromJanuary2021toJune2022. PatientswhounderwentTURwithdiagnosticofAFwere included.DatawereobtainedfromMinimumBasicDataSet (CMBD).Wereviewedwhetherpatientswereanticoagulated, thetypeofanticoagulantdrugprescribed(VKA,DOAC)and theprescribeddrug(acenocoumarol,warfarin,dabigatran, rivaroxaban,apixaban,edoxaban).Weverifiedwhetherthe reintroductionofanticoagulanttreatmentafterTURwas appropriatetohospitalprotocolandtherateofsubsequent readmissionsduetobleeding.

BecauseofthemoderatebleedingriskofTUR,theprotocolforreintroducinganticoagulantmedicationafterTURin thecaseofpatientstreatedwithVKAsconsistsofadministeringbemiparinorenoxaparinatanticoagulantdoses24hours afterTURtogetherwiththeusualdoseofacenocoumarolor warfarin.InthecaseofpatientstreatedwithDOAC,theprotocolconsistsofreintroducingtheirmedicationattheusual dose24hoursafterTUR.

Results Themeanageofthe37includedpatientswas81±6 years.94.6%weremale.89.19%ofthepatientswereanticoagulated(60%AVK,40%DOAC).

Theprotocolforreintroducinganticoagulanttreatmentwas notfollowedin100%ofanticoagulatedpatients.Thedrug

MaterialandMethods FollowingthePRISMArecommendations,asearchcombiningtermsassociatedwith ‘ART’ , ‘DDIs’ and ‘RF’ wasconductedinMEDLINEdatabaseforrelevant English-andSpanish-languagearticlesfrom2006throughJanuary2022.Longitudinalandcross-sectionalstudieswere included.ArticlesnotmentioningdataonDDIsbetweenART andnon-ARTwereexcludedinafirstscreeningphase.Ina subsequentselectionphase,articleswereexcludediftheydid notcontaininformationonRFforDDIs.Theoutcomeof interestwasthepharmacologicalRFforDDIs(orgroupedby severity)betweenARTandnon-ARTinPLWH 18years. Datawassynthesisednarratively.

Results 349articleswereidentifiedand10included(4longitudinaland6cross-sectional).Kunimoto-et-al, foundanassociationbetweentheoccurrenceofpotentialDDIsandnumber ofcomedications(OR=1.52[1.16–1.99]),similarcorrelationwas reportedbyOkoli-et-al(OR=1.3[1.2–1.3]),Pontelo-et-al (OR=1.13[1.11–1.15])andBastida-et-al(OR=1.18[1.14-1.22]).

ElMoussaoui-et-al foundthatthenumberofcomedications independentlyassociatedwithorange-(OR=1.8[1.6–2.0])and red-flag(OR=1.4[1.3–1.6])DDIs.Relatedtocomedication, Kunimoto-et-al foundpolypharmacyasasevereRFforDDIs (OR=11.69[3.01–45.40]),thisalsoreportedbyLópez-Centeno-et-al forred-(OR=2.65[1.98–3.54])andorange-flag (OR=2.17[1.90–2.47])DDIs.Halloran-et-al reportedthat ART-regimenscontainingproteaseinhibitors(PIs)weremore likelytohaveDDIscomparedwiththosecontainingnonnucleosidereversetranscriptaseinhibitors(NNRTI)-andintegraseinhibitors(II).ThisincreasedriskofIP-regimenswasalso notifiedbyChen-et-al(OR=2.54[1.25-5.16])andBastida-et-al (OR=1.18[1.14-1.22]),insteadFernándezCañabate-et-al found itinPI-regimens(OR=8.82[4.07–19.14])asalsoNNRTI-

AHerrerosFernández,EUrbietaSanz*,PFernandez-VillacañasFernandez,POrtiz Fernandez,AMMartinezSoto. ReinaSofiaHospital,Pharmacy,Murcia,Spain

regimens(OR=2.65[1.25–5.16]).Moreover,ElMoussaoui-et-al foundPIsasanindependentRFforred-(OR=7.9[3.2-19.5]) andorange-flag(OR=7.5[4.5-12.5])DDIswhileNNRTI (OR=2.4[1.5-4.0])andtheII(OR=1.6[1.0-2.6])onlyitwere fororange-flag.ThisriskofPIsofweremoreinvolvedin red-flag/contraindicatedwasalsoreportedbyLópez-Centenoet-alandHoltzman-et-al.

ConclusionandRelevance Thisisthefirstsystematicreview summarisingliteratureinthisfieldandishelpfultostratify patientsatneedforspecialisedmanagementtoreduceDDIs andpolypharmacyburden.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

Constipation(38.7%)anditchiness(3.2%)werethemost frequentadverseeventsduringthestudyperiod.

ConclusionandRelevance Ourfindingsin20treatment-resistantpatientsindicatedthatswitchingbetweenCGRPmAbs couldbebeneficialtosomenon-responderstoainitialmAb.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-129 SWITCHINGBETWEENANTI-CALCITONINGENE RELATEDPEPTIDEMONOCLONALANTIBODIESIN

MIGRAINE

1CRiberaPuig, 1PCleriesRovira*, 1NMasBauza, 1SGamarraCalvo, 2JCRojasAlvero, 2JCampdelacreuFumado, 1MComasSugranes, 1MAlonsoMoreno, 1MMuñozBolaño, 3NPadullésZamora. 1BellvitgeUniversityHospital,Pharmacy,Barcelona,Spain; 2Bellvitge UniversityHospital,Neurology,Barcelona,Spain; 3BellvitgeUniversityHospital,PharmacyBellvitgeBiomedicalResearchInstituteIdibell,Barcelona,Spain

10.1136/ejhpharm-2023-eahp.321

BackgroundandImportance Monoclonalantibodies(mAb) againstcalcitoningenerelatedpeptide(anti-CGRP)andits receptor(anti-CGRP-receptor)areeffectiveintheprophylaxis ofmigraine.However,studiestodetermineeffectivenessand safetyonswitchingbetweentheminnon-respondersare scarce.

5PSQ-132 PHARMACOGENETIC-GUIDEDTREATMENTIN PATIENTSWITHDYHYDROPIRYMIDINE

DEHYDROGENASEDEFICIENCY

1JFernándezFradejas, 2MMorín-Rodríguez, 1EGemeno-López, 1EDelgado-Silveira, 2MÁMoreno-Pelayo, 1AMAlvarezDiaz*. 1HospitalUniversitarioRamónYCajal,Pharmacy, Madrid,Spain; 2HospitalUniversitarioRamónYCajal,Genetics,Madrid,Spain

10.1136/ejhpharm-2023-eahp.322

BackgroundandImportance Certainpolymorphismsin DPYD geneareassociatedwithpartialorcompletedeficiencyof dyhydropyrimidinedehydrogenase(DPD)enzymeandare linkedtoagreaterriskofseveretoxicitiesafterfluoropyrimidines-basedtreatment.In2020,theEuropeanMedicines Agencyrecommendedthatpatientsshouldbetestedforthe deficiencyofDPDpriortotreatmentwithfluorouracil,capecitabineortegafur.

AimandObjectives Toassesstheprevalenceof DPYD variants linkedtoDPDdeficiencyincancerpatientswhoarecandidatestotreatmentwithfluoropyrimidinesandtoevaluatethe safetyofpharmacogeneticguidedtreatmentinpatientswith DPDdeficiency.

AimandObjectives

Toevaluatethereal-worldclinicaleffectivenessandsafetyofmAbswitchinmigrainepatients.

MaterialandMethods

Retrospectivecohortstudyofadult patientswhoswitchedbetweenmAbinatertiaryhospital fromDecember2019untilSeptember2022.Sociodemographic andclinicaldatawererecorded.Outcomemeasures:the reductionofHeadacheImpactTest(HIT-6)scalepunctuation andthereductionofmonthlymigrainedays.

Results Weanalysed147patientstreatedwithanti-CGRPor anti-CGRP-receptor.Amongthese,20patients(13.6%) switchedbetweenmAbandhadatleastonefollow-upvisit afterswitching.16patients(80%)sufferedfromchronic migraine(CM)withabaselinemediandaysofmigrainea monthof15[13-24],medianRegicorscaleof2%[1-3%]and medianHIT-6of67[62.5-72.3].19(95%)werefemale.

Outofthese20patients,15(75%)startedwithErenumab and5(25%)withGalcanezumab.FirstmAbswitchingwas performedafteramedianof7.4monthstreatment[5.9-11.8] (12fromErenumabtoGalcanezumab;3fromErenumabto Fremanezumab;2fromGalcanezumabtoErenumaband3 fromGalcanezumabtoFremanezumab).5patientsrequireda secondswitch,andonereceivedathirdmAb.Reasonsfor firstswitching:12(60%)non-response,7(35%)lossof responseand1(5%)adverseevent.1patient(5%)discontinuedmAbtreatingduringthestudyperiodduetolackof effectiveness.

MedianreductioninHIT-6afterfirstandsecondswitching was-2[-11.5-0],and-3.5[-11.8-0],respectively.Medianreductionofmonthlymigrainedaysafterfirst,andsecondswitchingwas-4.15[-7-0]and-4.8[-6.5to-0.6],respectively.

MaterialandMethods Prospective,observationalstudyata thirdlevelhospital.CancerpatientswhounderwentgenotypingtestforDPDdeficiencybetween1November2021and 15September2022wereincluded.Demographicandclinical datawerecollectedfromelectronicmedicalrecords.Thepolymorphismsstudiedwerers3918290,rs55886062,rs67376798 andrs75017182.DNAwasobtainedfromperipheralblood samplesandapharmacogeneticanalysiswasperformedusing areal-timepolymerasechainreactiontechnique.Patientswere classifiedasnormal,intermediate,andpoormetabolisers accordingtotheresultofthetest.Severetoxicities(grade3-4 CTCAE5.0)inintermediateandpoormetaboliserswere screenedduringthefirsttwocyclesoftreatment.

Results Atotalof345patientswereincluded,52.6%male, meanage68.3years(SD11.7).Themostfrequentdiagnoses werecoloncancer(43.8%),rectalcancer(18.9%),pancreatic cancer(9.8%),breastcancer(8.0%)andgastriccancer(7.1%).

Overall,14patientswereclassifiedasintermediatemetabolisers:8patientswereheterozygousforrs75017182,3 patientswereheterozygousforrs67376798,2patientswere heterozygousforrs3918290andonepatientwashomozygous forrs75017182.

Elevenoftheintermediatemetabolisersweretreatedwith fluoropyrimidine-basedchemotherapy(threepatientsdidnot starttreatment)withaninitial50%dosereductionandfurtheradjustmentbasedoninitialtolerancetotreatment.During followup,thesepatientsunderwenttreatmentwithoutsufferinganygrade3-4adverseevent.Nofurtherdosereductions ortreatmentdelayswererequiredinthisgroupofpatients.

ConclusionandRelevance Overall,4.1%ofthepatientsofour cohorthadpartialDPDdeficiency.Treatmentindividualisation

basedon DPYD genotypingcanhelptoavoidsevereadverse eventsinpatientstreatedwithfluoropyrimidines.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest

5PSQ-134 UNITDOSEINACYBERATTACKSCENARIO

AMSoares*,AMSimões,PSantos,PAlmeida,MRodrigues,AGusmão,AAlcobia. HospitalGarciadeOrta,PharmacyDepartment,Almada,Portugal

5PSQ-133 PHARMACISTS – GENERALPRACTIONERS(GPS) COLLABORATIONTOIDENTIFYDRUG-RELATED PROBLEMS(DRPS)INPATIENTSINPOLYTHERAPY

1FMortillaro*, 1AListro, 2SDominici, 2MPastorello. 1UniversityofPalermo,Graduate SchoolInHospitalPharmacy,Palermo,Italy; 2ProvincialHealthCompanyofPalermo, IntercompanyPharmaceuticalDepartment,Palermo,Italy

10.1136/ejhpharm-2023-eahp.323

BackgroundandImportance Medicationreconciliationand medicationreviewareindispensableinstrumentsinthepreventionofclinicalrisk.Inclinicalpractice,suchmethodsarenot alwaysused.Thisexposesthepatient,intreatmenttransitions, toDRPs,includingAdverseDrugReactions(ADRs),which couldcausehisrehospitalisation.Howmanyclinicalsymptoms arerelatedtodiseaseorhiddenADRs?TheClinicalpharmacist,throughremotemonitoringprovides,cansupporttothe GPbyaperiodicanalysisofthetherapytakenbytheindividualpatient.

AimandObjectives Theobjectiveofthestudywastooutline apharmaceuticalcareanddrugmonitoringmethodologybased onPharmacist-GPcollaborationtoidentifyDRPsthatcould generatepredisposingclinicalconditionsthatcanbeidentified assignsofhiddenADRs.

MaterialandMethods FromApriltoSeptember2022,we establishedateamworkbetweenPharmacistsandGPsina LocalHealthAuthority,selectingpatients>65yearsofage receiving>4drugs.Patient-relateddrugprescriptionsonthe healthcardwereanalysed,excludingherbalproducts,homeopathicproducts,andsupplements.Treatmentduplications, ATCtherapyswitchesanddruginteractionswereexamined, simultaneouslyverifyingdosingschedules.Appointmentshave beensetupwithGPstocomplementtheinformation.Final reportswerepreparedforindividualpatienttobedeliveredto theGPontheclinicalalertstobemonitored.

Results N.24/1304(%1,84)GPswereinvolved,n.149patients wereidentified(average72years)andn.1348drugsanddosingscheduleswereanalysed.Duplicationsidentified:13/1348 (%0,96).Unmotivateddrugswitches23/72(%31,94),drug alertsforinteractions:n.2357.Ex.fluoroquinolone-quetiapine, statin-clopidogrel,ASA-omega-3.Weidentifiedn.10hidden ADRs,subsequentlyregisteredonthePharmacovigilance NationalNetwork.

ConclusionandRelevance TheidentificationofhiddenADRs inpolytreatedpatientsavoidedtheinclusionofanewdrugto treattheclinicalsymptomnotrelatedtoanewdisease.The nextgoalistointegratethepatientintothepath,avaluable sourceofinformationcurrentlyunavailable,thusimplementing territorialhealthcarethroughnarrativepharmacovigilancethat willallowacompletepictureoftheindividualpatient.The aimistoanenhancedcaremodelwiththetopthepatient betweenGPandpharmacist.

10.1136/ejhpharm-2023-eahp.324

BackgroundandImportance Atdawnonthe26thofApril 2022,ourhospitalsufferedacyberattack.Allhospital´scomputersystemsandapplicationswereinaccessible,andthenetworkandmostworkstationsinoperable.Theonlyfew computersthatremainedoperationalwerestandalone,thatis, notconnectedtoanetwork.Theinstitutionalemailwasonly availableonmobilephones.Atthattime,wewereconsideredapaper-freehospital,totallycomputerised,withelectronicpatientrecordsandonlineprescriptiontotally implemented,andpharmaceuticalprocedureshighlydependentontechnologyandautomationso,itwasparticularly challengingtocontinuetoprovidepharmaceuticalcarein thisscenario.

AimandObjectives Descriptionofproceduresimplementedin ascenarioofcyberattackbythepharmacydepartmentand establishmentofpreventivemeasuresforthefuture.

MaterialandMethods Thisstudyisadescriptionofacase.

Results Duetolackofaccesstoclinicalandpharmacotherapeuticprofileofpatients,itwasnecessarytoreversethe prescriptionforpapersupport, ininpatientwards.TheKardexSystemremainedoperational,havingbeendisconnected fromthenetworkinatimelymanner,allowingthereconstitutionofthehistorytreatmentofpatientsthroughthepreviousdaytherapeuticmapfiles.MicrosoftExcelfileswere createdforallpatientsadmittedtoserviceswithunitdose distribution,usinglaptops stand-alone.Thecommunication withthenursingteamwasmadedaily,bytelephone,with conferenceofallthepatients.TheExcelfileswiththetranscriptionoftheprescriptions,perpatient,weremanually codedbyservice,patientanddrug,and,attheendofthe day,transformedintotheapp ropriateformattobecorrectly readbyKardexsystem,transferredtoitbypen-drive, allowingtheUnitDosepreparation.Contactwasstrengthenedwiththemedicalandnursingstafftoavoidduplication ofdrugsorinadequateposologyerrors.Paperfilefolders werecreatedbyserviceforallprescriptionsmade,and updateddaily.AllExcelfileswereposteriorlyaccountedfor regularisationofconsumption.

ConclusionandRelevance Inthiscyberattackcontext,itwas evidentthedifficultyinreversingtheprescriptionsforpaper support,especiallybyyoungdoctors.Itwillbenecessaryto implementvalidatedprocedureswithperiodicmeasures, includingtrainingincontingencyprotocolsandcloudbackup informationmaintenance.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.CanadianMedicalAssociationJournal2020;192(4):E101-2.

ConflictofInterest Noconflictofinterest

5PSQ-135

HASANANTIMICROBIALSTEWARDSHIPPROGRAMME HADANIMPACTONTHEANTIBIOTIC CONSUMPTION?

1,2OUrbina*, 2,3JCGainzarain, 2,4ACanut, 2,3JPortu, 2,3ZOrtizdeZárate, 2,3ESáezde Adana, 5MCampos, 1JJGarcía, 1EGómez, 1MDMartinez, 1CMartinez. 1ArabaUniversity Hospital,PharmacyDepartment,Vitoria-Gasteiz,Spain; 2Bioaraba,InfectiousDiseases ResearchGroup,Vitoria-Gasteiz,Spain; 3ArabaUniversityHospital,InfectiousDiseases Department,Vitoria-Gasteiz,Spain; 4ArabaUniversityHospital,MicrobiologyDepartment, Vitoria-Gasteiz,Spain; 5UniversityofMurcia,FacultyofComputerScience,Murcia,Spain

10.1136/ejhpharm-2023-eahp.325

BackgroundandImportance Theincreasinguseofantimicrobialsandtheglobalsurgeofantimicrobialresistanceisa majorpublichealthconcern.

AntimicrobialStewardshipProgrammes(AMSP)arean importantsecuritystrategyinhospitalsbecausetheirimplementationpromotesanoptimaluseofantimicrobials,improvingpatientoutcomeswhiledecreasingtheriskofadverse eventsaswellasantimicrobialresistance.

AimandObjectives ToevaluateifanAMSPhadanimpactin theoverallconsumptionofantibiotics,measuredasnumberof defineddailydosesper100stays(DDD/100s),inanacute carehospitalduringthefirstyearofimplementation.

MaterialandMethods AMSPstartedinArabaUniversityHospitalinOctober2020.

TheAMSPwasconducted3daysperweekbyahospital pharmacistandaninfectiousdiseasespecialistwiththepossibilityofconsultingamicrobiologistbytelephone.

AnAntimicrobialStewardshipProgrammeSupportSystem (AMSPSS)wasusedtoalertofantibioticprescriptionsthat needarevision.Thesealertswerepreviouslydesignedbythe AMSPteam.

Antibioticrecommendationsweremadeinthehealthelectronicrecordorbytelephonetothepatientresponsibledoctor.TheywereregisteredintheAMSPSSaswell.

Weretrospectivelyanalisedinterventionsandmeasuredthe globalantibioticconsumptionasDDD/100susingthepharmacydispensationregistersfromJanuarytoDecember2021. Results 1206alertsoftheASPSSwerereviewedbytheAMSP teamand434ofthem(36%)generatedprescriptionrecommendations(oneormore).

Atotalof820antibioticrecommendationswereperformed withaglobalacceptanceof78,3%.

Areductionof10,6DDD/100swasfoundin2021comparedto2020(58,42DDD/100svs69,02DDD/100s).

ConclusionandRelevance AftertheimplantationoftheAMSP, therewasadecreaseintheantibioticusein2021.Although otherfactorsmayhavealsocontributedtothisreduction,we confirmthatadailyAMSPisausefultooltooptimiseantimicrobialconsumption.

Itisnecessarytocontinuewiththeimplementationofthe AMSPtoguaranteetheproperuseofantimicrobials.

REFERENCESAND/ORACKNOWLEDGEMENTS

None

ConflictofInterest Noconflictofinterest

5PSQ-136 ANALYSISOFANTIRETROVIRALTHERAPYPOTENCYIN HIV-NAÏVEPATIENTS

1AMiranda*, 1CLGemaIsabel, 1EMartínezRuiz, 1ACodonalDemetrio, 1PTardáguila Molina, 1CDeanBarahona, 1ALázaroLopez, 2MTorralbaGonzalezdeSuso. 1Farmacist, HospitalPharmacist,Guadalajara,Spain; 2MedicalDoctor,InternalMedicin,Guadalajara, Spain

10.1136/ejhpharm-2023-eahp.326

BackgroundandImportance Clinicalpracticeguidelinesrecommendinitiationofantiretroviraltherapy(ART)assoonaspossibleafterdiagnosisofHIVinfectionwithacombinationof nucleosidereversetranscriptaseinhibitors(NRTI)withintegraseinhibitors(INSTI),non-nucleosideNNRTIorprotease inhibitorspharmacologicallyboosted(PI/b).

AimandObjectives ComparethepotencyofdifferentcombinationsofNRTIwithNNRTIs,INSTIsorPI/bs.

MaterialandMethods Retrospectiveobservationalstudyof naivepatientsdiagnosedbetweenJanuary-2012andJune2022.Variablesanalysedwereage,sex,routeofinfection, ART,AIDS,viralload(VL)andtimetoreachundetectable VL(<50copies/ml).

Datawerecollectedfromtheelectronicmedicalrecords (MambrinoXXI®)andoutpatientdispensingsoftwareDPE Farmatools®.

Statisticalanalysiswasperformedusingalinearregression method(dependentvariable:potencyofthecombinationcharacterisedasthereductioninVLcorrectedforthetime (months)inwhichundetectableVLisachievedandananalysis ofvariance(ANOVA)usingSPSS® v.15.

Results Ninety-sixpeoplewerediagnosedwithHIVinfection. Medianage:34years(RIC30-43),78%male.AIDSstage waspresentin34%.Themostcommonrouteoftransmission wasmensexmen(MSM)53%.

InitiationofARTNRTIcombinedwithINSTIwas73%, NNRTI7%andIP/b20%.ThemeanlogVLbaselinewas 4.63(SD:0.93).

ThemeanVLreductionpermonthoftreatmentinpatients treatedwithNRTI+INSTIwas2.45copies/ml/month,NRTI +PI/bwas1.72copies/ml/monthandNRTI+NNRTIwas 1.63copies/ml/month.Thesignificanceoftheanalysisofvariancesofthemeansobtainedwas0.112.

ConclusionandRelevance INSTIspotencywashigherthanthe otherTARcombinations,althoughthedifferenceswerenot significant.

Studyheterogeneityinthefollow-uptimesbetweendiagnosisandthedateofVLanalysisaswellasthenumberof patientstreatedwithNNRTIs,andPI/bswaslowerthanthe INSTIsgroupmayexplainthenon-significantresults.

Itwouldbeinterestingtoextendthesamplewithamulticentrestudytovalidatetheresultsobtained.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-137

ANALYSISOFTHEDPYDGENEMUTATIONSIN CANCERPATIENTSWHOARECANDIDATESFOR TREATMENTWITHFLUOROPYRIMIDINES

RTamayoBermejo*,BMoraRodríguez,MEspinosaBosch,IMMuñozCastillo. Regional UniversityHospitalofMalaga,PharmacyDepartment,Málaga,Spain

10.1136/ejhpharm-2023-eahp.327

BackgroundandImportance Dihydropyrimidinedehydrogenase (DPD)encodedbytheDPYDgene,istherate-limitingenzyme offluoropyrimidinescatabolism.

Amongaround450missenseDPYDsingle-nucleotidepolymorphisms,onlyapproximatelytwentyofthemacquirea functionalsignificance.Fourofthesevariantsareconsidered tobeofclinicalrelevanceforrecognisedeffectsontheprotein,theiridentifiedhigherriskofseveretoxicity,andfor theirpopulationfrequency.

AimandObjectives ToanalyseDPYDgenemutationsinall patientswhoarecandidatesforreceivingafluoropyrimidinebasedregimensandtheirinfluenceontheindividualisationof cancertreatment.

MaterialandMethods Retrospectiveobservationalstudyfrom July/2020-July/2022.Allpatientswhounderwentagenotyping testforDYPDwereincluded.Demographicvariableswere recorded.Theloss-of-functionvariantsintheDPYDgene wereanalysed:c.1905+1G>AthatidentifiestheDPYD*2A haplotype,andc.1679T>GthatidentifiestheDPYD*13haplotype.Italsostudiesthevariantsofreducedfunction: c.1129-5923C>GthatidentifiestheHapB3haplotypeand c.2846A>T.Thefrequencyofeachofthesevariantswere determined,andtherecommendationsoftreatmentindividualisationwerecollected.

Results Weanalysed638requestsforDPYDgenedetermination,meanagewas62.65±12.58years,and52.98%were men.Thirty-two(5,0%)hadsomemutationintheDPYD gene.Four(0,6%)patientswereheterozygousfortheloss-offunctionvariantc.1905+1G>Aandone(0,16%)patient washeterozygousforthevariantc.1679T>G.Twenty-three (3,6%)patientswereheterozygousforthedecreasedfunction variantc.1129-5923C>G,andfour(0,6%)patientswereheterozygousforthereducedfunctionvariantc.2846A>T.

Allofthemwereintermediatemetabolisers,whoifthey startedtreatmentwithfluoropyrimidines,theyshouldstart treatmentwithadosereducedtoapproximately50%and thenescalatethedoseinlatercyclesifnotoxicitywas observed.

Therecommendationofindividualisationoftreatmentwas: sixteenpatientsstartedtreatmentat50%ofthedose,inseven patientsthechemotherapyregimenwerechanged,inseven patientsadjuvanttherapyweredismissed,onepatientwasnot treated,andonepatientreceivedradiatiotherapyalone.

ConclusionandRelevance ThedeterminationofDPYDpolymorphismspriortothestartoftreatmentwithfluoropyrimidines,allowstoidentifyDPD-deficientpatients,andavoid mayexperienceserioussideeffectswhentreatedwithfluoropyrimidines;andthusclinicians ’ decisionsareinfluencedby theresultsofDYPDgenotyping.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-138 CHEMOTHERAPYERRORSDETECTEDDURING PHARMACEUTICALVALIDATION

MCSánchezArgaiz*,MJGándaraLadróndeGuevara,MISierraTorres,CMonteroVilchez, AJimenezMorales. HospitalUniversitarioVirgendeLasNieves,HospitalPharmacy, Granada,Spain

10.1136/ejhpharm-2023-eahp.328

BackgroundandImportance Chemotherapyerrorsrepresenta potentiallyseriousriskofpatientharmbecauseofthenarrow therapeuticwindowofantineoplasticandtheirhightoxicity. Pharmaceuticalvalidationaimstooptimisechemotherapytreatmentinordertoobtainthebestresultsforpatients‘ health andtominimisepotentialprescriptionerrors.

AimandObjectives Todescribethechemotherapyprescription errorsofintravenouscytostaticdetectedduringthepharmaceuticalvalidationandtheinterventionsmadetoavoidpotentialharmtothepatient,helpingpreventmistakes.

MaterialandMethods Observational,descriptive,retrospective studyofchemotherapyprescribingerrorsdetectedbypharmaceuticalvalidationthatresultedinaprescriptionchangein intravenouschemotherapy.

TheywererecordedbetweenNovember2020toSeptember 2021andtheprogrammeusedforprescribingandrecording wasOncoFarm.®

Theerrorswereclassifiedinto10groups:1)Upper/lower dose<10%,2)Upperdose>10%,3)lowerdose>10%,4) Inappropriatecyclefrequency,5)Relevantinteractionor adverseeffect,6)Doseadjustmentordelayadministration (renalandhepaticimpairment,haematologictoxicity),7) Incorrectprotocol,8)Missingdrug,9)Excessdrug,10) Others.

Results Duringthestudyperiod,180chemotherapyerrors weredetectedamong53.243dosesofintravenouschemotherapypreparedinahospitalpharmacyfor2.944patients(63% fromoncologyservice,32%haematologyservice,3%urology service;2%others).Theseerrorsdetectedthroughpharmaceuticalprescriptionreviewinducedchangesinchemotherapy prescriptions:88inhaematologyprescriptions,83inoncology prescriptions,6inurologyprescriptionsand3inonco-haematologyprescriptions.

Classification 6Upper/lowerdose<10%,60upperdose >10%,7lowerdose>10%,17inappropriatecyclefrequency, 4relevantinteractionoradverseeffect,14doseadjustmentor delayadministration(renalandhepaticimpairment,haematologictoxicity),20incorrectprotocol,12missingdrug,18 excessdrug,22others

Themostcommonerrorswereattributedtoerrorprescriptionofupperdose>10%,in36%werecarboplatindosemistakes;andalsoerrorsinprescribingandprotocolfrequency.

ConclusionandRelevance Despitethenumberofdetectedchemotherapyerrorsdoesnotrepresentalargevolumeinthe totalnumberofpatientstreatedinalmosttwoyears,theyled toaprobablereductioninadversedrugevents,toxicitiesand patientsoverdose.Thisgivesusanideaofthebenefitandthe importanceofpharmaceuticalvalidationinchemotherapy treatmentoptimisationandpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

5PSQ-139

USINGATEXT-MININGAPPROACHTOIDENTIFYTHE CONTEXTVARIABLESLANGUAGEBARRIER,LIVING ALONE,COGNITIVEFRAILTYANDNON-ADHERENCE

FROMELECTRONICHEALTHRECORDS(EHRS)

1STenHoope, 2KWelvaars, 1MEveraars-Klok, 3SVanSchaik, 1FKarapinar*. 1Olvg Hospital,ClinicalPharmacy,Amsterdam,TheNetherlands; 2OlvgHospital,DataScience, Amsterdam,TheNetherlands; 3OlvgHospital,Neurology,Amsterdam,TheNetherlands

10.1136/ejhpharm-2023-eahp.329

BackgroundandImportance ElectronicHealthRecords (EHRs)containfreetextfieldssuchasclinicalnotes.These textfieldsfrequentlycontainvaluableinformationaboutthe contextofpatients.Nevertheless,thisinformationisoften unusedastextfieldsaretime-consumingtoread.Thecontextvariableslanguagebarrier,livingalone,cognitivefrailty andnon-adherenceareassociatedwithunplannedhospital readmissions.Previousstudieshavenotexploredwhether text-miningcouldhelptoidentifythesevariablesfromfree text.

AimandObjectives Theprimaryaimofthisstudywasto identifythefourcontextvariableslanguagebarrier,living alone,cognitivefrailty,andnon-adherencefromtheEHRs usingtext-mining.

MaterialandMethods Thestudypopulationwasfroma databaseofn=1,120unplannedhospitalreadmissions (30-days)atOLVGhospital.Amanualstandardwascreatedbyextractinginformation fromclinicalnotesandcategorisingeachpatientforeachvariable(induplo).Forthe simpletermslanguagebarrierandlivingalone,arulebasedalgorithmwasused,seefigure1.Forthemorecomplextermscognitivefrailtyandnon-adherence,aNamed EntityRecognition( NER)algorithmwasused,seefigure2. Eachalgorithmwasvalidated againstthemanualstandard untilahighpercentageagree mentwasachievedforamaximumoffiveiterations.Theprimaryoutcomewasthepercentageagreementandkappavaluebetweenthemanual standardandthealgorithm .Descriptivedataanalysiswere used.

Results Therule-basedalgorithmforlanguagebarrierhada percentageagreementof96.8%andaKappaof0.90.Forlivingalonethepercentageagreementwas76.8%andtheKappa 0.53.TheNERmodelforcognitivefrailtyhadapercentage agreementof95.1%andKappaof0.83,andfornon-adherencetheagreementwas91.9%andKappa0.37.Generally, themodelsoverestimatedthenumberofpatientswithacontextvariable(e.g.afamilymemberwithalanguagebarrier ratherthanthepatienthimself).

ConclusionandRelevance Inthisstudy,text-miningwasable toidentifycontextvariablesfromEHRs,withagoodkappa forthevariablelanguagebarrierandcognitivefrailty.Future studiesshouldexplorehowoverestimationintext-mining couldbereduced.Text-miningcouldhelphealthcareprofessionalstoanticipateonpatientcontextinthefuturetooptimise care.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-140 FREQUENCYOFBLEEDINGEVENTSREQUIRING HOSPITALISATIONINPATIENTSUNDERGOINGHOME TREATMENTWITHDIRECT-ACTINGORAL ANTICOAGULANTS(DOACS)

SGutiérrezPalomo,AAndújarMateos,MJLucasMayol,CMatosesChirivella,GMiralles Andreu,ANavarroRuiz*. HospitalGeneralUniversitariodeElche,HospitalPharmacist, Elche,Spain

10.1136/ejhpharm-2023-eahp.330

BackgroundandImportance DOACsweredevelopedtominimisethedrawbacksoforalvitaminKantagonists(VKAs).The goalofthenewdrugswastokeeporimprovetheefficacyas wellasthesafetyinthebleedingmonitoring.Pivotalclinical trialsshowedafavourablebenefit/riskratio.However,these studieshadmethodologicallimitations.

AimandObjectives Todeterminethefrequencyofbleeding eventsthatrequirehospitaladmissioninpatientsreceiving DOACtreatment,analysingthecharacteristicsofthepatients andclassifyingthebleedingeventsaccordingtothetypeof DOACandthesiteofbleeding.

MaterialandMethods Retrospectiveobservationalstudythat includesallpatientstreatedwithDOACswhorequiredhospitaladmissionduetoableedingevent(ICD-10-CM:T45.51). ThestudywasperformedbetweenJanuary2016andMarch 2022.Thevariablescollectedwere:sex,age,DOACandtype ofhaemorrhageresponsibleforhospitaladmission.Datawere collectedfromcomputerisedmedicalrecordsandtheywere analysedwiththestatisticalprogramSPSS®.

Results 53hospitaladmissionswereincluded.Themeanage was79.3±7.1years.37(69.8%)episodescorrespondedto men.Ifbleedingeventwasassociatedwiththetypeof DOAC,itwasfound:20(37.7%)episodesfordabigatran,17 (32.1%)forapixaban,8(15.1%)forrivaroxabanand8 (15.1%)foredoxaban.Regardingtypeofhaemorrhage,23 (43.4%)episodeswererelatedtolowergastrointestinalbleeding(LGIB),11(20.8%)tohaematuria,9(17%)touppergastrointestinalbleeding(UGIB)and7(13.2%)tointracranial haemorrhage(ICH).

ThemostprevalentDOACineachhaemorrhagewas studied.Dabigatranwasthemostfrequentwith10(43.5%) eventsinLGIBandwith5(71.4%)casesinICH.However, apixabanwasthemostfrequentwith4(44.4%)episodesin UGIBandwith4(36.4%)casesofhaematuria.

Regardingtypeofbleedingbysex,LGIB(OR=1.68;CI =0.74-3.83)andICH(OR=2.19;CI=0.98-4.90)weremore frequentinwomen,whilehaematuria(OR=1.41;CI=1.061.90)andUGIB(OR=1.35;CI=0.99-1.85)weremorecommoninmen.

Byagerange,percentagesofUGIB,haematuriaandICH caseswerehigherinpatientsaged80yearsorolder,being 55.6%,54.5%and57.1%respectively.LGIBoccurredin patientsyoungerthan80years(56,5%).

ConclusionandRelevance Patientswhorequiredhospitalisation wereelderly,havingahigherriskofsufferingdifferenthaemorrhageswhenwereover80yearsold.Statisticallysignificantdifferencesbetweenhaematuriaandmenwereobserved. Gastrointestinalhaemorrhagesandhaematuriaswerethemost

frequentdiagnosis.Dabigatranwasthecauseformostofthe hospitaladmissions,beingmainlyinvolvedinLGIBandICH, followedbyapixaban,relatedwithUGIBandhaematuria.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-143 THEROLEOFTHEPHARMACISTININCREASING HEALTHVIGILANCEAMONGHEALTHPROFESSIONALS: ANGIOEDEMAFOLLOWINGTHEADMINISTRATIONOF RITUXIMAB

1,2HDaoudi*, 1,2FZLasri, 1,2OElQabissi, 1,2SElMarnissi, 1,2MAitElCadi. 1IbnSina HospitalUhcIbnSinaRabat,Pharmacy,Rabat,Morocco; 2FacultyofMedicineand PharmacyRabat,PharmacologyandToxicologyLaboratory,Rabat,Morocco 10.1136/ejhpharm-2023-eahp.332

5PSQ-141 FALLSINELDERLYPATIENTSANDCHRONIC CONSUMPTIONOFANXIOLYTICBENZODIAZEPINES

1IMoronaMinguez*, 2CMMeseguerBarros, 2IOterinoMoreira, 2LJamartSanchez, 1ISollano-Sancho, 1CMorielSanchez. 1HospitalUniversitariodeMóstoles,Pharmacy, Móstoles,Spain; 2DirecciónAsistencialOestedeAtenciónPrimaria,Pharmacy,Móstoles, Spain

10.1136/ejhpharm-2023-eahp.331

BackgroundandImportance Fallsintheelderlyhaveamultifactorialcomponent,amongthesefactors,oneofthemain causesischronicconsumptionofbenzodiazepines(BZD).

AimandObjectives TodescribetheprevalenceofchronicconsumptionofanxiolyticBZDinelderlypeoplewhohavesufferedfallswithinhospitaladmissionschemes.

MaterialandMethods Cross-sectionaldescriptiveandobservationalstudyinahealtharea.WeidentifiedthroughtheMinimumBasicDataSet(CMBD)patientsolderthan64years withhospitaladmissionwithcodeW19.XXXA(Unspecified acutefall,initialcontact)accordingtotheInternationalClassificationofDiseasesversion10,between2017and2021.Variablescollected:dateofbirth,sex,comorbiditiesandVan WalravenComorbidityIndex.

Chronicconsumption(morethan4weeks)ofanxiolytic BZD(ATC-WHOcodeN05BA)recordedintheprescription billingsystemwasanalysedinthesepatients.Patientswhohad pickedupBZDatthecommunitypharmacyduringthefall episodeweretheonesselected.

DatawereanalysedusingStata/BEv17statisticalsoftware. Results 1585patients(63.8%female)withacutefallcodehospitaladmissionbetween2017and2021wereidentified. Medianageatadmissionwas82.6[IQR11.5].Andmedian ofVanWalravenComorbidityIndexwas5.0[IQR11.0], mainly:hypertension(49.0%),arrhythmias(29.5%)anddiabetes(22.4%).Patientsthathadmorethanonefallepisoderepresented6.5%oftotal,withamedianof7.0[IQR7.4]days ofhospitalisation.ChronicanxiolyticBZDuseduringthefall episodewasobservedin23.3%(77.3%female)ofpatients. ThemostfrequentlyusedanxiolyticBZDwerelorazepam (48.6%),bromazepam(29.4%)anddiazepam(14.3%),the firsttwobeingofshort/intermediatehalf-lifeanddiazepamof longhalf-life.

ConclusionandRelevance Almostaquarterofthestudypopulationwithunspecifiedacutefallswerechronicanxiolytic BZDusers,mainlywithashort/intermediatehalf-life.Because BZDuseintheelderlyisacausativefactorinfalls,itisnecessarytoadjusttreatment,recommendingde-prescriptionor gradualdosereductionwherepossible.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

BackgroundandImportance Angioedemaisarapidswellingof theskinandmucousmembranesintheheadandneckarea andshouldbetreatedasanemergency.1 Rituximabisachimeric monoclonalantibodyusedinchemotherapyagainsttheCD20 surfacemolecule.2

AimandObjectives Thisworkisaimedtoevaluatetheefficacy andthesafetyofrituximabadministrationbydeterminingthe causalityofsuspectedangioedemainpatientsreceiving chemotherapy.

MaterialandMethods WearereportingtwocasesofangioedemaonRituximab:

. A66yearsoldmanwithDLBCLwhoreceivedfourcourses ofRCHOP(Rituximab,Cyclophosphamide,Doxorubicinand Vincristine).Onthefifthcourseand15minutesafterstarting administrationofrituximab,hedevelopedangioedema,after that,hereceivedhydrocortisoneandadrenalineandwas quicklytransferredtotheintensivecareunit,12hourslater, hewaspronounceddead

. A52yearsoldwomanwithahistoryofpulmonary tuberculosistreated18yearsago,treatedformarginalzone lymphomawithRCHOPprotocol,shepresentedan angioedematwohoursafterthestartoftherituximab infusionduringthe2ndcourseoftheprotocol.Thepatiente receivedhydrocortisoneandadrenalineandsherecovered well.

Thecause/effectassessmentwascarriedoutaccordingto theFrenchmethodafterathoroughinvestigation.3

Results Forbothcases,theresultsshowedthatrituximabwas incriminatedwithanintrinsicimputabilityscoreofI5andan extrinsicimputabilityscoreofB4,causedbyadministrationof ahighrateofrituximab(200mg/h)atthestartofthe infusion.

Toavoidthistypeofadverseevent,thehospitalpharmacist adjustedtherituximabinfusion,startingwithinfusionrateof 50mg/hfor30minutesandthenincreasingby50mg/hevery 30minutestoreachamaximumof400mg/h.

ConclusionandRelevance Thisobservationillustratestherole ofthehospitalpharmacistinmakingnursesanddoctorsaware oftherisksofadministeringdrugsthatcancauseangioedema, inparticularrituximab,topreventtheriskofincidenceand improvevitalprognosis.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PeterJ.Delves,Quincke’sedemaMSDmanuals

2.PloskerGL,FiggittDP,«Rituximab:areviewofitsuseinnon-Hodgkin’slymphomaandchroniclymphocyticleukaemia»Drugs2003;63:803-843

3.MooreN,etal.Adversedrugreactionmonitoring:DoingittheFrenchway

ConflictofInterest Noconflictofinterest

5PSQ-144

ELECTRONICPATIENTREPORTEDOUTCOME(PROM) MEASUREMENTUSINGPRO-CTCAE® QUESTIONNAIRE TOIMPROVEQUALITYOFLIFEASSESSMENTAND HEALTHCARERESOURCESMANAGEMENTIN PATIENTSWITHLYMPHOMARECEIVING INTRAVENOUSCHEMOTHERAPY

1NBarreras*, 2SRamos, 1ECastillo, 2RCórdoba, 1MHernandez, 1JBécares. 1Hospital UniversitarioFundaciónJiménezDíaz,PharmacyService,Madrid,Spain; 2Hospital UniversitarioFundaciónJiménezDíaz,Haematology,Madrid,Spain

10.1136/ejhpharm-2023-eahp.333

BackgroundandImportance PROMSbegintomakeaplacein theworldofclinicalcare,forthisreason,itwasimplemented inourhospital.

AimandObjectives Theprimaryobjectivewastocomparethe adverseevents(AEs)profilereportedintheelectronicmedical record(EMR)andthosereportedbypatientsthroughavalidatedquestionnaire(PRO-CTCAE ®).Secondary,weretoanalysetheimpactinthereductionofvisitstoEmergencyRoom (ER).

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-145 APATIENTSATISFACTIONSURVEYONUNITDOSE DRUGDISTRIBUTIONINHOSPITAL

TSteindl-Schönhuber,GGittler*. KrankenhausBarmherzigeBrüderLinz,HospitalPharmacy, Linz,Austria

10.1136/ejhpharm-2023-eahp.334

BackgroundandImportance Sincethebeginningofthe COVID-19pandemicdrugdistributionintheHospitalSt. JohnofGod,Linz,hasbeenswitchedtoautomatedunitdose packaging.Weintendedtocreateevidenceforpatients’ satisfactionwithpharmacydeliveredblistersachets,asliterature onthistopicislimitedandourserviceissofaruniquein Austrianhospitals.

MaterialandMethods

Patientswithdiagnosisofnon-Hodgkin’slymphomaintheneedofIVtherapybetweenJanuary 2019andDecember2021wereincluded. ‘E-ResSalud’ was launchedinJanuary2020.Patientsincludedin2019werethe controlarm.PRO-CTCAE® waselectronicallysentthroughthe appafter1st,3rd,and6th monthoftherapy.Thosesymptoms oflowintensityweretoreceiverecommendationsautomaticallythroughtheapp.Thosesymptomsofhighintensitywere toreceiveateleconsultationcallbythenurse.ASankeydiagramwasbuilttodepictflowsofseverityofsymptoms.Twosidedtestandp-values<0.05wereconsideredstatistically significant.

Results Amongthe201patientsincludedinthestudy,76 patients(37.8%)reportedoutcomesintheePROMprogram. MostfrequentlyAEsreportedintheEMRwerehaematological(73%),gastrointestinal(62%)andpsychological(38%).In contrast,themostfrequentlypatient-reportedadverseevents werecutaneous(47%),gastrointestinal(44%)andoral(26%), accordingtoPRO-CTCAE® categories(p<0.01).

Afterthefirstcourseofchemotherapy,46%ofpatients reportedsymptomsofhighfrequency,intensityorimpact intheirQoL.Atthirdmonththeproportionwassignificantlyhigher(67%vs46%;p<0.05).Differenceswere alsostatisticallysignificantbetweenfirstandsixthmonth (p<0.01).

ThosewhowereadherenttotheprogramhadfewernumberofvisitstoER(19.2%vs55.2%;p<0.01)andrequired fewerunscheduledhospitaladmissions(15.8%vs37.6%; p<0.01).Whenanalysingoutcomesofpatientswhowere calledbyanursereducedtheproportionofpatientswhovisitedtheERvsthosewhodidnotreportanyorlowintensity symptoms(18.8%vs53.8%;p<0.01).Survivalamongpatients visitingERwassignificantlyshorterthanamongthosewho didnot(hazardratio,2.26;95%[CI],1.11to4.63;p= 0.025).

ConclusionandRelevance BetterunderstandingofpatientreportedsymptomscouldaidpharmacisttodevelopanindividualisedtreatmentdoseadjustmentandreductionofERvisitsshouldbeakeytargetforhaematologistsasitmayimpact insurvival.

AimandObjectives Weperformedapatientsatisfactionsurvey toinvestigatethestatusquoaswellaspotentialneedsfor improvementandtoprovidethebasicdataforfurther analyses.

MaterialandMethods Patientswereinterviewedinhousewith aninternallydevelopedquestionnaire.Itsmixeddesign – 12 multiple-choicequestionsandfieldsforcomments – enabled quantitativeandqualitativefindings.

Patientsnotfamiliarwiththeblistermedication(e.g.no oraldrugs)ornot(mentally)fitenoughwereexcluded. Withinaperiodoftwoweekshospitalpharmacistscarriedout 38face-to-faceinterviews.

Results Patientsatisfactionwiththeblisterswashigh;Transparencyinadministereddrugtherapywasconsideredimportant.Patientsnotorrathernotsatisfiedstateddifficultiesin handlingtheblisters(20%).Poorphysicalconditions,vision deficiencyandhigheragecorrelatedwithutilisationproblems andlowersatisfaction.Onein10patientshadnotbeen capableofopeningtheblistersachetsandtakingthemedicationwithoutassistance.Two-thirdsfoundunitdosedrugdistributionpreferableorequaltotraditionalpilldispensers. Somepatientscommentedontheenvironmentaleffectsof theplasticsachets.

Respondingtothereporteddifficultiesweplacedinfographicsinthepatientroomsillustratingthelabellingand handlingoftheunitdosesachets.Thestaffonthewards weretrainedtogivefurtherinformationtopatientsandassistanceinopeningandemptyingtheblisters.

ConclusionandRelevance Studiesontheeffectsofunitdose supplyusuallyfocusoncost-effectiveness,medication safetyandnursingstafftimeandsatisfaction.Ourresults addinformationonthepatientperspectiveandwere importantforqualityimprovement:Thispilotstudynot onlyallowedforimmediatelyimplementedactions(graphic depictionsforpatientsandstafftraining)butisalsoa guidanceforthedesignofalargerstudy(patientselection, interviewtechnique, reliableandvalidq uestions)toobtain sufficientstatisticalpowerandquantifiableandactionable data.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

Section6:Educationandresearch

6ER-001 THEUSEOFGAMIFICATIONTOEVALUATEPUBLIC UNDERSTANDINGOFADVERSEDRUGREACTIONS

YNLin*. TainanMunicipalHospitalmanagedbyshowChwanMedicalCareCorporation, Pharmacy,Tainan,Taiwan,RepublicofChina

10.1136/ejhpharm-2023-eahp.335

BackgroundandImportance Thepublicwasfarlessawareof adversedrugreactionsthantheefficacyofdrugs.Everyone neededtotakecareoftheirownmedicationsafety.

AimandObjectives Todevelopaninteractivegametoevaluate publicunderstandingofadversedrugreactions.

MaterialandMethods Wedesignedaninteractivegame throughtheuseof ‘Wordwall’ onlinetemplate: ‘Quiz’ for ‘Adversedrugreactions’.Thecorrectanswerofeachquestion couldbeshownautomaticallyattheendofthegame.The outcomeswerecollectedduringJuly2022andevaluatedwith t-testbySPSS(StatisticalProductandServiceSolutions)23.0. Results 46peoplewereincludedinthegameandthetotal correctratewas81.74±18.29%.Thelackofknowledge aboutadversedrugreactionswasfound,forexample,26.08% peoplethoughtthatadversedrugreactionsmustoccurwhen takingmedicine.Besides,41.30%peoplethoughtthatthe medicationmustbediscontinuedifanyadversedrugreaction occur.17.39%peopleagreedthataddingonotherdrugsmay increasetheincidenceofadversedrugreactions.Finally, 6.52%peopledidnotknowtheycouldfeedbacktoprescribingphysiciansandpharmaciststomarktheadversedrugreactioninmedicalrecords.

ConclusionandRelevance ‘Wordwall’ wasaneasy-to-playand user-friendlygame.Ourresultsindicatedthatgamificationwas wellacceptedamongpeopleandhelpedpharmacistsunderstandwhatpeoplereallythinkaboutadversedrugreactions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-004 EFFECTIVENESSANDSAFETYOFCOVID-19 VACCINATIONINPATIENTSWITHIMMUNE-MEDIATED DISEASESONBIOLOGICALTHERAPY

1CBarcaDiez*, 1ICProupinCantelar, 2LGonzalezFreire, 1AMDeusCasas, 1ABVeiga Villaverde, 2CCrespoDiz. 1ComplejoHospitalarioUniversitariodePontevedra,Pharmacy, Pontevedra,Spain; 2Complejohospitalariouniversitariodepontevedrafundaciónbiomedica galiciasur.,pharmacy,pontevedra,spain

10.1136/ejhpharm-2023-eahp.336

BackgroundandImportance Theeffectivenessandsafetyof COVID-19vaccineshasbeendemonstratedinthepivotaltrialsthathaveledtotheirapproval.However,thereisnospecificinformationavailableregardingCOVID-19vaccinationin patientswithimmune-mediateddiseases(IMD).

AimandObjectives Evaluatetheeffectivenessandsafetyof COVID-19vaccinesinpatientswithIMDwhoarebeing treatedwithbiologicaldrugs(BD).

MaterialandMethods Prospectivedescriptiveobservational studyofpatientswithIMDtreatedwithBDwhohave receivedatlistonedoseofanyoftheCOVID-19vaccines commercialised.

Variablescollected:age,sex,IMD,BD,post-vaccination COVID-19infection,adversereactionsobservedaftervaccination.

Demographicandclinicaldatawereobtainedfromthe medicalrecords.

Toassesseffectiveness,wecheckedthenumberofpatients whobecameinfectedwithSARS-CoV-2aftervaccinationand whethertheinfectionwasasymptomatic,withmildsymptoms orrequiredhospitaladmission.

Toassesssafety,astandardisedinterviewofadversereactionsobservedinthefirstsevendaysafterCOVID-19vaccinationwasconductedduringroutinepharmacypractice.

ThisstudywasapprovedbytheEthicsCommitteeof ResearchwithMedicinesundercode:2021/435.

Results 106patients(52.8%female)wereincluded,witha medianageof53years(21-76).ThemostfrequentIMD were:rheumatoidarthritis(33%),psoriaticarthritis(15%), psoriasis(15%)andCrohn’sdisease(11.3%).ThemostcommonlyusedBDswere:adalimumab(33.9%),etanercept (25.5%),abatacept(7.5%),ixekizumab(6.6%),secukinumab (6.6%),golimumab(5.7%)andustekinumab(4.7%).

Twenty-twopatients(20.75%)wereinfectedafterreceiving dosesofCOVID-19vaccines:2afterthefirstdose,6after theseconddoseand14afterthethirddose.Infectedpatients hadmildsymptoms(77.3%)orwereasymptomatic(22.7%). Nopatientrequiredhospitaladmission.

Themostcommonadversereactionswere:painatthe injectionsite(79.2%),fatigue(48%),malaise(42.4%),myalgia (35.8%),headache(33%),arthralgia(25.5%),fever(21.7%), pruritus(11.3%),nauseaorvomiting(9.4%),andlymphadenopathy(9.4%).

ConclusionandRelevance 79.25%ofthepatientsstudiedwere notinfectedwithSARS-CoV-2aftervaccination.Mostofthe infectedpatientshadmildsymptomsandnoneofthem requiredhospitaladmission.

Adversereactionsweresimilartothosedescribedinthe generalpopulation,themostfrequentbeingpainattheinjectionsite,fatigueandmalaise.

COVID-19vaccineswereeffectiveandsafeinpatientswith IMDtreatedwithBDincludedinthestudy.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-005 EFFECTSOFADHERENCETOTHEMEDITERRANEAN DIETINPATIENTSWITHAUTOIMMUNEDISEASES

AMartínRoldán*,MDMSanchezSuarez,CMonteroVilchez,MIArchillaAmat. Virgende LasNievesUniversityHospital,PharmacyDepartment,Granada,Spain

10.1136/ejhpharm-2023-eahp.337

BackgroundandImportance Adherencetoahealthydietary patternhasbeenshowntobeinverselyassociatedwithmetabolicsyndrome.LowadherencetotheMediterraneandietis directlyassociatedwithaworseprofileofplasmaticinflammationmarkers.Somestudieshaveshownthatthisdietmay reducetheriskofautoimmunediseases.

AimandObjectives ToevaluateadherencetotheMediterraneandietinpatientswithautoimmunediseasesaswellas theirqualityoflife.

MaterialandMethods Retrospective,descriptivestudyofthe adherencetotheMediterraneandietinpatientswithautoimmunediseasesduringJanuarytoMarch2021.Variablescollected:demographic(sex,age),diagnosis,bodymassindex (BMI),biologicaltherapy,lifestyle,cholesterol,triglycerides, glucose,ferritin,calprotectinandC-reactiveproteinlevels.

AdherencewasmeasuredbythePREDIMEDquestionnaire. Qualityoflifewasdeterminedby:VisualAnalogScalefor Pain(VAS),ChecklistIndividualStrength(CIS)andTheFunctionalAssessmentofChronicIllnessTherapy–Fatigue(FACITF).Informationsources:electronicprescriptionandcomputerisedmedicalrecord.StatisticalanalysiswithR® software. Results 66patientswereincluded(50%women),medianage 48(IQR38-56).MedianBMI26.3(IQR26-39.1).Mostfrequentdiseases:rheumatoidarthritis(18),Crohn’sdisease(10), ankylosingspondylitis(8)andmultiplesclerosis(7).42%of patientshadnopreviouscomorbidity,28%hadarterialhypertension,13.6%hypercholesterolemiaand6%depression.The mediandiagnosisyearofthediseasewas2012(IQR20022016).37.8%ofpatientshavehadtwolinesoftreatment, 24.2%threelines,4.5%fourlines.Themostfrequentdrugs wereanti-TNFtherapy(19adalimumab,4certolizumab,4etanercept),tocilizumab(5)secukinumab(4)andtofacitinib(4). MedianscaleVASwas4(IQR1-6),CIS83(IQR76-91)and FACIT-F16(11-24).MedianofthePREDIMEDquestionnaire was7(lowdietaryadherence).NostatisticallysignificantdifferenceswerefoundbetweenadherencetotheMediterranean dietandscoresonqualityoflifequestionnaires.Statistically significantdifferenceswerefoundwithcalprotectinlevelsand glomerularsedimentationvolume.78.7%ofpatientsarenot awareoffoodswithpotentialanti-inflammatoryproperties and87.8%wouldliketoreceivedietaryrecommendations fromhealthcareprofessionals.

ConclusionandRelevance Althoughmorestudiesareneeded tolinkdiettoautoimmunediseases,itistruethatanappropriatedietreducestheriskofmultiplepathologies.Patients demandinformationandashealthprofessionalswemustgive ittothemandreinforceadherencetogooddietarypatterns suchastheMediterraneandiet.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-008 CORRELATESOFONE-YEARMORTALITYAMONG PATIENTSLIVINGWITHHIVACCORDINGTOTHE STRATIFICATIONLEVELOFTHEPHARMACEUTICAL CAREMODEL

1EContrerasMacías*, 2FALaoDomínguez, 2PGarcíaLloret, 2RMorilloVerdugo. 1Hospital InfantaElena,HospitalPharmacy,Huelva,Spain; 2HospitalUniversitarioVirgendeValme, HospitalPharmacy,Sevilla,Spain

10.1136/ejhpharm-2023-eahp.338

BackgroundandImportance Thesuccessofhighlyactiveantiretroviral(ARV)therapyhasallowedpeoplelivingwithHIV (PLWH)tohaveanear-normallifeexpectancy.However,the increaseinlifeexpectancyhasgeneratedanewsetofchallengesinthesepatients,whooftenexperienceage-related comorbiditiesand,withit,polypharmacywiththenegative consequencesthatthisentails.

AimandObjectives Toanalysetheeffectthatthelevelof stratificationhasonmortalityresultsatoneyearanddevelop apredictivemodelinPLWHonactiveARV

HIVpatientmodelpublishedbySEFH).Asurvivalanalysis wasperformedtoassesshowthelevelofstratificationpredictedmortalityatoneyear.Thesurvivalratewasestimated usingKaplan-Meieranddifferencesbetweenlevelswereevaluatedusingalog-ranktest.Afterverifyingtheproportional hazardassumption,aCoxregressionwasruntoestimatehazardratios(HR).Toevaluatethediscriminatorypowerofthe model,thecalculationoftheareaundertheROCcurve (AUC-ROC)wascarriedout.Theanalysiswascarriedout usingtheSPSSv.28.0software.

Results Atotalof428PLWHwereincluded.Morethan90% ofthepatientshadadequateimmunovirologicalcontrol.The distributionofpatientsaccordingstratificationmodelwas: level3(83%),followedby12%and5%forlevel2and1, respectively.Attheendoffollow-up,5patientsdied.The resultsoflog-rankanalysisshowedsignificantdifferences regardinglevelofstratificationformortalityatoneyear (p=0.02).Coxregressionidentifiedlevelofstratificationasa riskfactorformortality,wherepatientsstratifiedaslevel1 hada99.7%higherrisk(HR:0.003;95%CI:0.001-0.027). TheAUC-ROCwas0.98(95%CI:0.96-1.00).

ConclusionandRelevance Patientsclassifiedaslevel1inpharmaceuticalcarestratificationmodelhaveahigherriskofmortalityatoneyear.Thepredictivemodeldevelopedhighlights theimportanceofthisconceptandtheneedforbothindividualisedpharmaceuticalcareandcomprehensivemonitoring.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-009 COMPARATIVEEFFICACYOFABEMACICLIBAND PALBOCICLIBASADJUVANTTREATMENTINPATIENTS WITHEARLYBREASTCANCER

1AGanforninaAndrades*, 2ASalgueroOlid, 3EJAlegreDel-Rey, 3SFenixCaballero. 1Puerta DelMarUniversityHospital,Pharmacy,Cádiz,Spain; 2OsunaHospital,Pharmacy,Osuna, Spain; 3PuertoRealUniversityHospital,Pharmacy,PuertoReal,Spain

10.1136/ejhpharm-2023-eahp.339

BackgroundandImportance Abemaciclibincombinationwith endocrinetherapy(ET)hasrecentlybeenauthorisedforadjuvanttreatmentofpatientswithhumanepidermalgrowthfactorreceptor2(HER2)negativeandluminalearlybreast cancer(EBC)athighriskofrecurrence.

AimandObjectives Toassessthecomparativeefficacybetween abemaciclibandpalbociclibinHER2-negative,highriskof recurrenceandluminalEBCpatientsandtoestablishwhether thesedrugscanbeconsideredequivalenttherapeuticalternatives(ETA),throughanadjustedindirecttreatmentcomparison (ITC).

MaterialandMethods

Asingle-centre,cross-sectionalstudy thatincludedPLWHonactiveARVwhoattendedPharmaceuticalCareoutpatientbetween1Januaryand15March 2021andwerefollowedupforaperiodof1year.Demographic,clinical,pharmacotherapeuticvariableswerecollected andpharmaceuticalcare,levelofstratification(accordingto

MaterialandMethods Abibliographicsearchwasconductedto identifyphaseIIIclinicaltrialswithabemacicliborpalbociclib asadjuvanttreatmentinasimilarEBCpopulation(luminal type,HER2-negativeandhighriskofrecurrence),duration andendpoints.Theprimaryendpointwasinvasivedisease-free survival(IDFS)andETwasusedasacommoncomparator. Similarclinicaltrials,consistentresultsandefficacydemonstrationagainstthecommoncomparator(ET)wererequiredfor theadjustedITC.

Results Twotrialswereincluded,oneofeachdrug.Bothof themwerephaseIIItrials,randomised,inpatientswith HER2-negative,highriskandluminalEBC.Differenceswere foundinthetrialdesign(abemaciclibopen-labelvspalbociblib

double-blind),numberofpatientsincluded(abemaciclib N=5637vspalbociclibN=1250),treatmentduration(abemaciclibtwoyearsvspalbocicliboneyear)andpercentageof patientspretreatedwithtaxane,anthracyclineorboth(abemaciclib37%vspalbociclib99%).Clinicaltrialswerenotsimilar duetothesedifferences.

AbemaciclibwaseffectiveinHER2-negative,highriskand luminalEBC.However,palbociclibwasnot.IDFSabemaciclib groupwasstatisticallysignificant(HR=0.70;95%CI:0.590.82;p<0.0001)withamedianfollow-upof27months (90%patientscompletedtreatment).Incontrast,IDFSpalbociclibgroupwasnotstatisticallysignificant(HR=0.93;95%CI: 0.74-1.17;p=0.525)withamedianfollow-upof43months (92%patientscompletedtreatment).

Regardingconsistresults,2-yearIDFSratewasdifferent too:abemaciclib93%vspalpociclib88%.Inshort,relevant methodologicallimitationsweredetectedsoadjustedITCwas notpossible.

ConclusionandRelevance Abemaciclibandpalbociclibcannot beconsideredETAinHER2-negative,highriskandluminal EBC,althoughabemaciclibdemonstratedefficacyasadjuvant treatmentinthesepatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-010 EVOLUTIONOFONCO-HAEMATOLOGICALCLINICAL TRIALSFROM2016TO2021:EXPERIENCEFROMA

TERTIARYHOSPITAL

HMartinezBarros,ÁDíazGago,MRodriguezMarin,EGemenoLopez*,CPueyoLópez, MLavandeiraPerez,APovedaEscolar,AMAlvarezDian. HospitalUniversitarioRamonY Cajal,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.340

BackgroundandImportance Previousworkhasdescribed changesinthetrendsinonco-haematologicalclinicaltrialsin recentyears,describinganincreaseintheuseofsurrogate endpoints,changesintheirfundingoragreaternumberof non-randomisedtrials(1,2).

AimandObjectives Todescribeandcomparethecharacteristics ofonco-haematologicalclinicaltrialsopenedinatertiaryhospitalin2016and2021.

MaterialandMethods Allinterventionalclinicaltrialsinitiated inourhospitalin2016and2021wereincluded.Thefollowingvariableswerecollected:title,funding,tumoursite,blinding,control,randomisationandprimaryendpoint.Datawere comparedusingthePearson c2.Resultsweredeemedstatisticallysignificantatp<0.05.Statisticalanalysiswasperformed usingSTATA(StataCorp,Texas,USA).

Results Wefound89interventionalclinicaltrialsstartedin 2016and71studiesin2021.ThemajoritywereintheMedicalOncologyservice(93.6%and83.1%).Breastcancer accountedforthelargestnumberoftrialsinitiated(22.5% and19.7%).Inbothstudyperiods,mostclinicaltrialswere industry-sponsored,withanincreaseovertime(82.0%vs 94.4%;p=0.019).Morethanhalfofthestudiesinitiated werecontrolled(58.4%vs54.9%;p>0.05),randomised (59.6%vs66.2%;p>0.05)andopen-label(78.7%vs67.6%; p>0.05),withnostatisticallysignificantdifferencesbetween 2016and2021.Anincreaseinthenumberofphase3clinical trialswasobserved(37.0vs54.9%;p=0.017),withapredominanceofopen-labeldesign(54.6%vs51.3%;p>0.05)

andtheuseofsurrogateendpointsasprimaryoutcomes(54.5 vs69.2%;p>0.05).Notrialhadqualityoflifeasaprimary endpoint

ConclusionandRelevance Mostphase3clinicaltrialsusedan open-labeldesignandsurrogateendpointsasprimary outcomes.

Althoughthisisasingle-centreanalysis,sometrends observedbyotherauthors,suchasahighernumberofindustry-sponsoredstudies,wereobserved.

Noneofthe160clinicaltrialsinitiatedhadqualityoflife asaprimaryendpoint.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.DelPaggioJCetal.EvolutionoftheRandomizedClinicalTrialintheEraofPrecisionOncology.JAMAOncol.2021May1;7(5):728-734.

2.WessonWetal.Characteristicsofclinicaltrialsforhaematologicalmalignancies from2015to2020:Asystematicreview.EurJCancer.2022May;167:152-160. ConflictofInterest Noconflictofinterest.

6ER-011 EFFICACYOFTHERAPIESINNON-SMALL-CELLLUNG CANCERWITHEGFREXON20INSERTION MUTATIONS:ASYSTEMATICREVIEW

1MDGil-Sierra, 2MDPBriceñoCasado*, 1CMoreno-Ramos, 1MABlanco-Castaño, 3CMCuadros-Martinez. 1HospitalUniversitariodePuertoReal,Pharmacy,PuertoReal, Spain; 2HospitalUniversitariodeJerezdelaFrontera,HospitalPharmacy,Jerezdela FronteraCádiz,Spain; 3HospitalUniversitariodeJerezdelaFrontera,Pharmacy,Jerezdela Frontera,Spain

10.1136/ejhpharm-2023-eahp.341

BackgroundandImportance Patientswithnon-small-celllung cancer(NSCLC)andepidermalgrowthfactorreceptor (EGFR)exon20insertionmutationshavepoorprognosisand fewtherapeuticalternatives.

AimandObjectives Todevelopasystematicreviewofplatinumpre-treatedNSCLCharbouringeGFRexon20insertions toassessefficacyoftreatmentsandscientificqualityof studies.

MaterialandMethods PreferredReportingItemsforSystematic ReviewandMeta-analysis(PRISMA)guidelineswasappliedin bibliographicreview.SearchwasconductedinPubMed® databaseupto15September2022.Filter ‘clinicaltrial’ ontypes ofarticleswasappliedtothefollowingreviewstrategy:(exon 20insertion)AND(Therapy/broad[filter]).Inclusioncriteria: Randomisedclinicaltrials(RCTs)evaluatingtreatmentsin patientsdiagnosedwithadvancedormetastaticNSCLCharbouringEGFRexon20insertionswhohadpreviously receivedplatinum-basedchemotherapy.Efficacyendpointsconsideredwereobjectiveresponserate(ORR),progression-free survival(PFS)andoverallsurvival(OS).Datarecorded:publicationdate,studydesign,comparatorarm,therapies,sample size,treatmentline,efficacydata.

Results Fortysearchresultswerefoundinreview.Twelve RCTswereincluded.Publicationdatesofstudieswere betweenApril2015andJuly2022.Designofstudies:9 (75%)phaseIIRCT(onewasbaskettrial)and3(25%)phase I/II.Noneofthempresentedacomparatorarm.Therapies assessed:poziotinib,osimertinib(highandlowdoses),pertuzumab-trastuzumabcombination,mobocertinib,amivantamab, erlotinib-onalespibcombination,luminespib,ado-trastuzumab emtansineanddacomitinib.SamplesizeofRCTsrangedfrom 10to114patients.Bothuntreatedandplatinum-pretreated patientswererecruitedin4(25%)RCTsandtherest

comprisedexclusivelyplatinum-pretreatedpopulation.Ado-trastuzumabemtansineshowedthebestnumericalresultsaccordingtoORR(54.5%),buttheworstPFS(2.8months;95% CI1.4-4.4)andOS(8.1months;95%CI3.5-13.2)ofall therapeuticalternatives.Thehighestnumericalefficacyresults wereachievedbyamivantamab[PFS=8.3months(95%CI 6.5-10.9);OS=22.8months(95%CI14.6tonotreached)] andmobocertinib[PFS=7.3months(95%CI5.5-9.2);OS =24.0months(95%CI,14.6-28.8)].

ConclusionandRelevance Resultsofamivantamabandmobocertinibsuggestedahighernumericalefficacyforclinicallyrelevantendpointsinplatinumpre-treatedNSCLCharbouring EGFRexon20insertions.However,comparativeRCTswith largersamplesizesarenecessarytoobtainreliabledata.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

ConclusionandRelevance Theclinicalevaluationsystemfor internshipstudentsinthepharmacyserviceisexpectedtobe veryusefulforpharmacistsinthePharmacyService.Thanks tothisexamtheywillhaveobjectiveinformationabouttheir teachingrolewiththesestudents,thusdetectingpointsfor improvement.Inaddition,thestudentlearnsaboutclinical reasoning,decision-making,problemsolving,andinterpersonalrelationshipskills.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-019 THESTUDENTPHARMACISTEXPERIENCEOF ENHANCEDCLINICALPLACEMENTS

1,2CThompson*, 1,2SWilliams. 1UniversityofBrighton,MedicinesUseResearchGroup, Brighton,UK; 2UniversityofBrighton,SchoolofAppliedSciences,Brighton,UK

10.1136/ejhpharm-2023-eahp.343

6ER-017 STRUCTUREDOBJECTIVECLINICALEVALUATIONFOR PHARMACYSTUDENTSONINTERNSHIPSATTHE HOSPITAL

AMValleDíazdelaGuardia,SSadyrbaevaDolgova,MIArchilla*,CMontero-Vilchez. HospitalUniversitarioVirgendeLasNieves,ServiciodeFarmacia,Granada,Spain

10.1136/ejhpharm-2023-eahp.342

BackgroundandImportance

Structuredassessmentforfinal yearstudentsisateachingtoolbasedontheMiller´sPyramid thathasbeenimplementedinSpainformanyyears.Tocarry outthisevaluationsystemforstudentsdoinginternshipsin thehospital’sPharmacyServiceisveryinnovative.

AimandObjectives Todescribetheprocessofdesigninga structuredevaluationforstudentswhoaredoingtheirinternshipinthehospitalPharmacyService.Thepurposeofthe objectiveassessmentistoverifythatthestudentscandemonstratewhattheyhavelearnedduringtheirhospitalpractice. Todothis,differentclinicalskillsandtechnicalskillswillbe evaluated,simulatingrealsituationsrelatedtotheworkofthe PharmacyService.

MaterialandMethods Sixtestshavebeenestablished:pharmaceuticalcareforoutpatients,validationofmedicalprescriptions,stockmanagement,reconciliationofmedicationon admission,preparationofamasterformulaandoncology pharmacy.Alltestsarerelatedtodailyassistanceactivitiesof thehospitalpharmacy.Ineachtest,thestudenthasalimited timetoperformthetaskthatisindicated.Thequalification methodistotallyobjective,throughapreviouslydefined checklist.Aschedulehasbeenscheduledforeverythingtobe readyinJanuary2023.

Results Theobjectiveclinicalevaluationhasbeenstructuredin 6tests,inwhichatotalof24studentsmaybeexamined. Thepresenceof6evaluatorsand3actorswillbenecessary. Thecostofeachtestwillbeminimalbecausemostofthe materialsaredonationsfrompharmaceuticallaboratoriesand othercompanies.Thequalificationisimmediate,andthedurationofthetestwillbeabout3hours.Thechecklistofeach testwillbereviewedbytwoevaluators,andmustinclude itemsonclinical,technicalandinterprofessionalcommunicationskills.

BackgroundandImportance Theroleofapharmacistiseverexpandingwithanincreasingneedfortheprovisionof enhancedhealthservices.InresponsetotheGeneralPharmaceuticalCouncil’srecentannouncementfor ‘prescribing ready ’ pharmacygraduatesby2025,HealthEducationEnglandhas,thisyear,broadenedthecl inicaltariffforeducation providerstoincludepharmacygivinganopportunityto enhancetheclinicalplacementsofferedtopharmacystudents intheUK.

AimandObjectives Theaimofthisprojectwastoassessthe overallexperiencestudentshadonanEnhancedClinical Placementsoveravarietyofclinicalsettings.

MaterialandMethods Theplacementwaspatient-facing(5days)undertheprimarysupervisionofaprescriber,witha pre-placementinduction(15hoursofblendedlearning)consistingofsimulatedclinicalactivities,andapost-placement conference(1day).Duringtheplacement,studentshadthe opportunitytodevelopanextendedrangeofclinicalskills andobserveanddiscusstheprescribingdecisionsmadeby theirprescribingsupervisorwhicharecurrentlyoutsidethe scopeofthepharmacydegree.

Twofocusgroups(n=10andn=9)wereheldwithstudentsatthepost-placementconference.Studentswereasked abouttheirinductionandplacementexperience.Focusgroups weretranscribedandanalysedusingThematicAnalysis. Results Fourmainthemesemergedfromthedata,whichwere namedVariety,Consolidationofpriorlearning,Professional identity,andLogistics.Studentsexpressedanappreciationfor theECPinprovidingthemwithadditionalclinicalexperience overawidervarietyofsettingsthantheyhadseenbefore. TherewasarecognitionthattheECPhelpedtoconsolidate learningtheyhadgainedonthetaughtcoursesandthatit heightenedtheirprofessionalidentitybutstudentsalsoraised someareasforimprovementintermsofthegenerallogistics oftheplacement.

ConclusionandRelevance Thiswasausefulexercisetoprovidestudentswitharangeofexperiences,helpingthemto promoteanunderstandingoftheirprofessionalvalueandrole withinamulti-disciplinaryteam.Futureimplementationneeds toconsiderthelevelofstandardisationbetweenplacements

andtheimportanceofhavingclearexpectationsforstudents andproviders.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-020 PRESCRIPTIONANDUSEOFLIPOSOMAL AMPHOTERICINBDURINGTHECOVID-19PANDEMIC

10.1136/ejhpharm-2023-eahp.344

BackgroundandImportance TheimpactofCOVID-19andits influenceinthemanagementofhospitalisedpatientshasbeen indisputable.Manypublicationspresentcombinationsofdifferentantimicrobialstotreatthepatientsinfections,andtheliposomalamphotericinb(Amb-L)isanexampleofoneofthe mostprescribed.

AimandObjectives Tocomparetheprescriptionandindication ofAmB-Linatertiaryhospitalbeforeandduringthe COVID-19pandemic.

MaterialandMethods Observational,retrospective,descriptive studyofpatientsprescribedAmB-LfromMarch-2020to March-2021,andthecomparisiontotheyearbeforethe pandemic.

Results 58patientsanalysed:40(69%)men,medianage71 years(IQR54.5-75.2),and18(31%)women,medianage 63.5years(IQR49.5-71.25).Themonthsinwhichmore patientsreceivedAmB-Lwere:July2020(6/56),December 2020(7/56)andFebruary2021(12/56).

-39(69.6%)CRITICALpatients.Outofthese:22witha coviddiagnosis,14non-covidand3onco-haematological.26/ 39patientsreceivedAmB-LasatargetedtreatmentforCandidaGlabrataandAlbicans(16/26),AspergillusFumigatus(6/ 26)andMucor(4/26).Asaconcomitanttherapy,anidulafunginandisavuconazolewerethepreferentones.ThemostprescribeddoseofAmB-Lwas400mg(5mg/kg)withamedian of7daysoftreatment(IQR4-17.5).86.4%outofthetotal experienceddeath.

-17(30.4%)NON-CRITICALpatients:0covidpatients,6 (35.3%)non-covidand11(64.7%)onco-haematological patients.10(58.8%)patientsreceivedAmB-Lasempirical treatmentforfebrileneutropenia,withposaconazoleanditraconazoleasthemostcommonlyusedantifungals.Themost prescribeddosewas200mg(3.3mg/kg)foramedianof9 days(IQR6-16).

Inthepreviousyear(March2019toFebruary2020)we observed:17patientsreceivedtreatmentwithAmB-L,53% (9/17)onco-haematological,12menwithamedianof53years (IQR:38.2-59.1).Mostprescribeddose:180mg(3mg/kg).

ConclusionandRelevance Thedataobservedinthisperiod reflectshowtheprescriptionofAmB-Ltripledcomparedto thepreviousyear.Ittargetsacompletelydifferentprofile: unstablepatients,withinvasivelungdisease,riskfactorsin criticalcareunits,treatedwithhighdosesofAmB-L.Thefact ofbeinganantifungalwithahighcost/dayperpatient,the wayofmonitoringthesituationofthistypeofpatientisa crucialstrategytoguaranteeefficiencyandoptimisepharmaceuticalspending.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

6ER-021 RETROSPECTIVEOFDRUGINNOVATIONDURINGTHE SARS-COV2PANDEMIC:DEVELOPMENTOFAGAMEBASEDTRAINING

STollec*,VTeixeira,ALefrançois. OrléansRegionalHospital,Pharmacy,Orléans,France

10.1136/ejhpharm-2023-eahp.345

BackgroundandImportance Hospitalpharmacieshavecontributedtotheresearchanddevelopmentofremediesagainst coronavirusdisease2019(COVID-19),bymanagingmany drugs,off-label,inclinicaltrial,orinearlyaccessprogram. Withintheframeworkofcontinuingeducationofpharmacy technicians,aretrospectiveofthisdruginnovationprocess, withashortandplayfulformat,wasproposed.

AimandObjectives Todevelopandevaluateagame-based training,forthepharmacytechnicians,inordertounderstand thedruginnovationprocess,duringtheSARS-Cov2pandemic. MaterialandMethods Regardlessoftheirstatus,32medications,usedagainstCOVID-19,inourhospital,fromMarch 2020toMay2022,wereidentified.Foreachmedicine,a playingcardwascreatedwithonthefront:International Non-ProprietaryName(INN)andprinceps,andontheback: INN,princeps,drugstatus,pharmacologicalclassandfamily, dateoffirstdispensing.2teamsof3playerscompetedto aligntheplayingcardsinchronologicalorder,thenthetrainer debriefedthegame.Apresentationsupportofthetraining wasdone,detailingthepedagogicalobjectives,therulesofthe gameandthetheoreticalknowledge.Aself-assessmentanda feedbackformwerecreated.

Results 2one-hour(30minutesofplay,30minutesofdebriefing)sessionswereconducted.34healthcareprofessionals, from14hospitals,participatedintraining.94%ofparticipants completedquestionnaires.Attheendofthesession,100% improvedtheirknowledge,84%couldchronologicallylocate thedrugsusedagainstCOVID-19(against16%atthebeginningofthesession)and97%couldexplainthestagesofdrug innovationduringthepandemic(against3%atthebeginning ofthesession).Regardingthefeedbackform,100%appreciatedthecontentand97%therhythmofthegame.Theoverallsatisfactionratewas97%(goodorverygood).

ConclusionandRelevance Thisgamificationoftrainingwas verymuchappreciated.Theformatcombinesconvivialityand cooperation,whileprovidingseriouscontent.Theexperience couldbereplicated,duringcontinuingeducation,withother themes.

ConflictofInterest Noconflictofinterest.

6ER-022 CLINICALIMPACTOFTHEUSEOFGLUCOCORTICOIDS FORTHETREATMENTOFCOVID-19ININTERMEDIATE RESPIRATORYCAREUNITS

MAyllón*,VLCollada,EVillamañán,MEscario,LGarcía,AHerrero. HospitallaPaz, HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.346

BackgroundandImportance Duringthepandemic,patients admittedtointermediaterespiratorycareunits(IRCU) receivednon-invasiverespiratorysupportandpharmacological treatment,mainlyglucocorticoids(GC).Dexamethasoneisthe onlyonethathasshownreducingmortality;however,there arenocomparativeefficacystudiesbetweenthedifferentGC.

PBlancoGarcia*,MAntonMartinez,AFijóPrieto,MTSánchezSánchez. HospitalClínico UniversitariodeValladolid,HospitalPharmacy,Valladolid,Spain

REFERENCESAND/ORACKNOWLEDGEMENTS

AimandObjectives

Todeterminethepossibleinfluenceofthe typeanddoseofGConthepatients’ evolutionwithSARSCoV-2pneumoniaadmittedtotheIRCUduringthefirstand secondwaveofthepandemic.

MaterialandMethods

Descriptive,observationalandretrospectivestudyofpatientswithSARS-CoV-2infectionadmittedto theIRCUinatertiarycarehospitalsinceMarchuntilDecember2020.Demographicvariables,comorbidities,GCtherapy receivedandfinalresolution(improvement,transfertoICU, ordeath)wereanalysed.Thedatawereobtainedfromthe clinicalhistoryandtheelectronicprescription.

Results 135patients(62.5%men)wereincludedwithamean ageof67.00(SD:13.16)years.69.31%ofthemhadoverweightand29.41%respiratorypathologies.

89.63%ofthepatientsadmittedtotheIRCUreceived treatmentwithGC,withinthem,89receivedtreatmentwith asingleGC,27receivedthecombinationoftwoandonly3 patientsreceivedthreeGC.64GC-treatedpatientsimproved, receivingameanprednisoneequivalentdoseof65.43 (SD:88.77)mgdailyforameanof13.40(SD:7.02)days.

The19patientstransferredtotheICUreceivedamean doseof89.18(SD:71.81)mgdailyfor6,00(SD:5.19)days. The38patientswhodiedinIRCUtreatedwithGCreceived ameandoseof114.18(SD:90.39)mgdailyforameanof 8.92(SD:6.17)days.

ThemostusedGCorcombinationswere:dexamethasone (76patients),dexamethasoneandprednisone(13patients), methylprednisolone(11patients),dexamethasoneandmethylprednisolone(8patients),andmethylprednisoloneandprednisone(5patients).100%ofpatientstreatedwith dexamethasoneandprednisoneimproved,followedbydexamethasoneandmethylprednisolone(62.5%)andmethylprednisoloneandprednisone(60%).27.27%ofthepatientstreated withmethylprednisolonealoneimproved,with63.64%dying.

ConclusionandRelevance Mostofthepatientsadmittedto theIRCUwithcoronavirusreceivedGCandtheresultssuggestsomeimprovementinthosewhoreceivedlowerdosesof GCforlongerperiods.

TheGCcombinationwasassociatedwithahigherrateof improvement,especiallywithdexamethasoneandprednisone. Treatmentwithmethylprednisolonealonehadthehighest deathrate.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-024 COMPARISONOFREDUCTIONSINMONTHLY MIGRAINEDAYSBETWEENNEWSMALLMOLECULE CGRPRECEPTORANTAGONISTS(GEPANTS)AND MONOCLONALANTIBODIESTARGETINGCGRP/CGRP RECEPTOR

MRomero-González*,JCorderoRamos,MValeraRubio,VMerinoBohorquez,LMartin Casado. HospitalUniversitarioVirgenMacarena,HospitalPharmacy,Seville,Spain

10.1136/ejhpharm-2023-eahp.347

BackgroundandImportance Migraineischaracterisedby repeatedheadacheattackslastinghoursordaysandusually accompaniedbyotherassociatedsymptoms.Accordingtothe InternationalHeadacheSociety,itcanbeclassifiedinto

migrainewithaura,withoutauraandchronicmigraine.Atargetpathwaytotreatorpreventmigraineisthecalcitonin gene-relatedpeptide.Availabletreatmentsinourcountrythat actinterferingthatpathwayareerenumab,fremanezumab,galcanezumab,iptenezumabandrimegepant.

AimandObjectives Toanalysewhetherthedifferenttherapeuticoptionsareequivalentalternativesthroughanadjusted indirectcomparison.

MaterialandMethods Thetherapiesincludedwerefound afterasystematicsearchperformedinPubMed.Theanalysis includedrandomised,double-blind,phase2and3,controlled trials,prophylaxistherapiesandnumberofmigrainedays reducedmeasurementafter12weeksoftreatment.TheanalysiswasperformedusingtheR® softwaretoestimateBayesianstatistics,withrimegepanttakenasareferenceforthe comparison.Adeltavalueof1day,asprovidedbytheregulatoryagenciesFDAandEMA,wasusedtodeterminethe margin(maximumacceptabledifferenceasanon-inferiority criteria)andtheaveragenumberofmigrainedaysreduced. Toestablishthetherapeuticpositioning,theNationalEquivalentTherapeuticAlternativesPositioningGuidecriteriawere applied.

Results AsshowninFigure1,thedifferenceinthemean numberofmigrainedaysreducedpermonthversusplacebo wasfavourableinallcases.Eachtreatmentreduced migrainebybetweenonetotwodayspermonth,showing statisticallysignificantdifferences.Themostoutstanding beingfremanezumab(-1,73[-2.33;-1.12]).Basedonthe resultsobtained,asubsequentanalysiswascarriedoutcomparingfremanezumabwiththeotheralternatives.Inthis case,erenumab140mgshowedthemostsimilarefficacy result(0.13[-1.14;1.39]).Nevertheless,itdidnotshowa statisticallysignificantdifferenceagainstanytreatment, exclusivelyagainstplacebo.Nodifferenceswerefoundin termsofsafety.

Abstract6ER-024Figure1 Forest-plotofthedecreaseinaverage numberofmigrainedayspermonth.Comparator:rimegepant75mg/ 48h.SMD:standardmeandifference.95%CI:95%confidenceinterval

ConclusionandRelevance Nostatisticallysignificantdifferences werefoundbetweenrimegepantandmonoclonalantibodies againsttheCGRP/CGRPreceptorexceptforfremanezumab. Fremanezumabpresentedastatisticallysignificantmorepronouncedresponseinthedecreaseofmigrainedayspermonth at12weeksoftreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

6ER-025

EFFECTIVENESSANDSAFETYOF20%AUTOLOGOUS SERUMEYEDROPSINPATIENTSWITHCORNEAL SURFACEPATHOLOGIES

10.1136/ejhpharm-2023-eahp.348

BackgroundandImportance Autologousserumeyedrops (SAED),apharmaceuticalformulationpreparedfrompatient’ s blood,areusedincornealsurfacepathologies.Sincealternativetherapiesarelimited,itsprescriptionhasincreasedin recentyears.

AimandObjectives AnalyseeffectivenessandsafetyofSAED inpatientsdiagnosedwithcornealsurfacepathologies.

MaterialandMethods Observational,retrospectivestudyina secondaryhospitalbetweenJanuary2019andMarch2022 includingpatientstreatedwith20%SAED.

Variables:demographicdata,diagnose,concomitantdiseases, durationoftreatment,ocularaffectation(lefteye(LE),right eye(RE),botheyes(BE)),subjectiveclinicalimprovement (SCI),adverseeffects(AE),concomitanttreatments,visual acuity(VA)atmonths0,3and6oftreatment.

EffectivenesswasevaluatedbySCIandVA,measuredona decimalscale,atthreeandsixmonthsoftreatment.Safety wasevaluatedbyAEdocumentedinmedicalrecords.

Results Thirty-fivepatients(77%women)wereincludedwith meanage61years(20-96).Principalsdiagnoseswere:dryeye syndrome(n=15),superficialpunctuatekeratitis(n=10)and Sjögren’ssyndrome(n=9).Forty-eightpercentofpatientspresentedconcomitantdiseases,highlightingfibromyalgiainsixof them.

Meantreatmentlengthwas500±348days.Tenpatients (28%)discontinuedtreatmentduringthestudy.Thereasons were:reactionto20%SAED(n=4),remission(n=4),death notassociatedwiththetreatment(n=1)andchangeofhospital(n=1).

Twenty-ninepatients(82%)hadaffectationinBE.SCIwas observedin82%ofpatientsatmonthsthreeandsix.PrincipalsAEwere:conjunctivalhyperaemia(n=4),blepharitis (n=2),stinging(n=1)andtearswithexcessmucus(n=1). Artificialtears(51%)andcorticosteroidseyedrops(11%) werethemainconcomitanttreatments.

VAdatawasavailablein14patients(40%).MeanVAin REwas0.80±0.29,0.80±0.31and0.82±0.25at months0,3and6respectively.MeanVAinLEwas0.85± 0.25,0.83±0.23and0.87±0.15respectively.

ConclusionandRelevance AccordingtoSCIandVA’ sprogressiveimprovementoverthemonthsandalowincidenceof AE,20%SAEDareaneffectiveandsafetreatmentforcornealsurfacepathologies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-026 SPECTRUMOFHEARTFAILUREIN16SUB-SAHARAN AFRICANCOUNTRIES:TREATMENTSANDINHOSPITALOUTCOME

1PCavagna*, 2CKouamKouam, 3IBDiop, 4ELimbole, 5LAllawaye, 4JLTakombe, 6AKTraore, 7RN’Guetta, 8MSIkama, 9XJouven, 1MAntignac. 1PitieSalpetriereAphp UniversityHospital,Pharmacy,Paris,France; 2RegionalHospitalofBafoussam,Cardiology, Bafoussam,Cameroon; 3FannUniversitaryHospital,Cardiology,Dakar,Senegal; 4Ngaliema Hospital,Cardiology,Kinshasa,CongoRepublicOf; 5HopitalGeneraldelaReference Nationale,Cardiology,Ndjamena,Chad; 6HospitalofSikasso,Cardiology,Sikasso,Mali; 7AbidjanInstituteofCardiology,Cardiology,Abidjan,CoteD’ivoire; 8NationalUniversity HospitalofBrazzaville,NationalUniversityHospitalofBrazzaville,Brazzaville,Congo Brazzaville; 9EuropeanGeorgesPompidouHospital-Ap-HpCentre-UniversityofParis, Cardiology,Paris,France

10.1136/ejhpharm-2023-eahp.349

BackgroundandImportance Heartfailure(HF)isthemost commonprimarydiagnosisforpatientsadmittedtohospital withheartdiseaseinsub-SaharanAfrica(SSA).However,little isknownaboutthemanagementofHFinhospitalisationin SSA.

AimandObjectives Todescribeinhospitaldrugsstrategiesto manageHFin36cardiovascular(CV)departments.

MaterialandMethods WeconductedatransversalandlongitudinalstudyinCVdepartmentsof36hospital(publicandprivate)in16SSAcountries.TheFebruarystudyisanongoing observatoryincludedallinpatientsinFebruaryfromeachyear since2016.Dataincludingsocio-demographicandclinical characteristics,CVriskfactors,causesofadmission,medicationandlengthofstaywerecollectedduringhospitalisation byphysicians.Patientwealthindexwasassessedbyphysicians aslow,middleandhighaccordingtopatientcapacityto affordhospitalisation.Allanalyseswereperformedwithrandomeffectoncountriesandthroughscriptsdevelopedinthe Rsoftware4.0.3.

Results Overall,2084patientswereadmittedforHFinthe Februarystudy.HFrepresenting47.9%ofallpatients included.Themeanagewas57±17.4yearsand53.8% weremen.ProportionsofpatientsadmittedforHFvaried acrosscountriesfrom21.4%inBurundito66%inCongo (p<0.01).Averagelengthofstayinhospitalswas11daysand mortalityratewas13%.AmongHFpatients,74%ofpatients hadCVriskfactorsandhypertensionwasreportedin55.8% ofpatients.Duringhospitalisation,88.8%ofpatientswere treatedwithdiureticsfollowedbyangiotensin-converting enzymeinhibitors(ACEI)(61.8%),anticoagulant(47.8%)and betablockers(BB)(34.6%)(figure).Monotherapywereused in14%,combinationoftwodrugs,threedrugsandfour drugsstrategieswereusedin35%,33%12%respectively. Diureticsweremostlyprescribedinpatientwithlowwealth indexwhereasACEI,BBandanticoagulantinhighwealth index(p<0.05).

MCanoAlonso*,APlanas-Giner,NAlmendros-Abad,ASosa-Pons,LCardonaRoca, LCoronelCordero,MRoigSoronellas,NRudiSola. HospitalGeneraldeGranollers, PharmacyDepartment,Granollers,Spain

Abstract6ER-026Figure1

ConclusionandRelevance HFtreatmentaccessvariedsignificantlyacrosscountriesandaccordingtopatientwealthindex.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-027 ASSESSMENTOFATTITUDESANDPERCEIVED SKILFULNESSOFPHARMACYSTUDENTSINCARING FORUNDERSERVEDPOPULATIONS

1JEClark*, 1GUlangkaya, 1MWatler, 2JValdesLedsma. 1UniversityofSouthFlorida,Taneja CollegeofPharmacy,Tampa,USA; 2UniversityofSouthFlorida,TanejaCollegeof Pharmacy,Tamp,USA

10.1136/ejhpharm-2023-eahp.350

BackgroundandImportance Studiesindicatethatgapsin knowledgeaboutunderservedpatientcareissuesmaybeassociatedwiththelevelofcomfortandattitudesofpharmacy studentscaringforunderservedpatients.

AimandObjectives Theobjectiveofthisstudywastoassess theattitudes,perceivedknowledge,andskillsofpharmacystudentstodelivercaretounderservedpopulations.

MaterialandMethods 385pharmacystudentswereeligibleto participateinthestudy.StudentscompletedamodifiedversionoftheHealthProfessionals’ AttitudesTowardthe HomelessInventoryadministeredbetweenDecember2020 andJanuary2021.Eachparticipantwasaskedtoratetheir levelofagreementwith8statementsconcerningattitudes towardtheunderservedand8statementsregardingperceived skilfulnessincaringfortheunderservedinprovidingmedicationreconciliationservicesandpatientcounsellingonascale from1to5.

Results Theresponseratewas22%(n=85).Moststudentsfelt comfortableprovidingmedicationtherapymanagement(78%), medicationreconciliation(79%),andpatientcounselling(78%) services.88%felttheyknewhowtocommunicatewith patientsfromdifferentculturalbackgrounds.Theaverageperceivedskilfulnessincompletingmedicationreconciliationactivitiesvariedlongitudinallyacrossclassyears(P1,3.4±1.08; P2,4.27±1.01;P3,4.8±1.01;P4,5.0±0.89).Theaverageperceivedskilfulnessinaddressingpatientsfromdifferent culturalbackgroundswashighestforstudentsintheP1years (4.09±1.12)andlowestforstudentsintheP2classyear (3.91±1.21).

ConclusionandRelevance Theattitudesandcomfortlevelsof studentstowardunderservedpopulationsdidnotdiffersignificantlybetweenclassyears.Theperceivedskilfulnessincreased longitudinallybetweenfirstandfourth-yearstudentsinthe areasofconductingmedicationreconciliationactivities,counsellingandassessingmedicationunderstandinginunderserved patients.StudentsintheP1classyearperceivedskilfulnessin caringfortheunderservedwashigherthanstudentsintheP4 classyear.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.BuckDS,MonteiroFM,KneuperS,etal.DesignandvalidationoftheHealthProfessionals’ AttitudesTowardtheHomelessInventory(HPATHI). BMCMedEduc 2005;5(1):2.(2)LupuAM,ConnorSE,JonkmanL.Pharmacystudents’ actual andperceivedknowledgerelatedtounderservedpopulationsacrosstheprofessionalcurriculum. CurrentsinPharmacyTeachingandLearning 2013;5(6):526540.

ConflictofInterest Noconflictofinterest.

6ER-029 EYEDROPSOFINTERFERONALPHA-2BTOTREAT OCULARPATHOLOGIES

1MSerrano*, 2ELópez-Aspiroz, 1EGarcía-Martín, 1JPBarro-Ordovas, 1AMartínezHernández. 1HospitalUniversitarioInfantaSofía,Pharmacy,SanSebastiandeLosReyes, Spain; 2HospitalUniversitariolaPrincesa,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2023-eahp.351

BackgroundandImportance Interferonalpha-2bisanoption oftreatmentinmalignantocularpathologiessuchasocular squamoussurfaceneoplasia(OSSN)butitsuseisless extendedtobenigndiseaseslikepterygium.Inourcountrywe hadavailableIntrona® tomadeeyedropsuntil2021June, butitsproductionwasdiscontinuedandanotherdrug(Bioferon®)withfewdataofsafetyinocularadministrationwas imported.

AimandObjectives Toevaluatetheefficacyandsafetyoftwo differentdrugs(Introna® andBioferon®)inthetreatmentof ophthalmicpathologies.

MaterialandMethods Allpatientswhounderwenttreatment witheyedropsofinterferonalpha-2binourhospitalfrom Aprilof2009untilAugustof2022wereselected.Weregisteredage,typeofpathology,timeoftreatment,adverse events,recurrencesandresponse(partial,completeorsurgery immediatelyafterorbeforetreatment).

Aliteraturesearchwasdonetomaketheeyedropsfrom Bioferon® andfinallyweusedwaterforinjectiontoreconstitutethevialandbalancedsalinesolutiontocomplete10mL ofvolume(concentrationof10mg/mL).

Results Thirty-sixpatientsreceived38treatments(twopatients hadbotheyesaffected).Bytypeofpathology,24werepterygium,8OSSN,2papilloma,1epidermoidcarcinomaand1 clearcellcarcinoma.Fromthetotalofpatientswithpterygium,54%receivedsurgery,21%hadpartialresponseand 25%hadnoresponse;fourpatientswithmalignantpathology (OSSNandcarcinomas)hadcompleteresponse,2hadpartial responsesand4wereoperated.Allpatientswithpapilloma underwentsurgery.

Ongroupsofmalignantpathologyandpapilloma1patient hadrecurrenceateachone.Evaluationofrecurrencesin pterygiumgroupwashardduetolackoffollowupafter

surgery,butwiththedataavailable70%ofthemhadno recurrences.

Onlyoneofallpatientshadanadverseevent(ocular irritation).

TwopatientsreceivedBioferon®,bothwithOSSN.Onehad completeresponseandtheotherpartialresponsewithno adverseeffects.

ConclusionandRelevance Wecanconcludethateyedropsof interferónalfa-2baresafeandeffectivetotreatmalignant pathologiesandtheformulationwiththenewdrugBioferon seemstomaintainsafetyandefficacy,butweneedmore patientstoconfirmit.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-031 KNOWLEDGEABOUTHUMANIMMUNODEFICIENCY

VIRUS(HIV)TRANSMISSIONINPEOPLELIVINGWITH HIVINANTIRETROVIRALTHERAPY

1ÁLópezGarcía*, 1LMartín-Zaragoza, 1LRubio-Ruiz, 2CMartínez-Nieto, 3MVelez-DiazPallares, 4PSanmartin-Fenollera, 5JAPeña-Pedrosa, 1AOnteniente-González, 6LMBedoyadel-Olmo, 6IIglesias-Peinado, 1JSánchez-Rubio-Ferrández. 1HospitalUniversitariode Getafe,PharmacyService,Getafe,Spain; 2HospitalUniversitariodelaPrincesa,Pharmacy Service,Madrid,Spain; 3HospitalUniversitarioRamonYCajal,PharmacyService,Madrid, Spain; 4HospitalUniversitarioFundaciónAlcorcón,PharmacyService,Alcorcón,Spain; 5HospitalClínicoSanCarlos,PharmacyService,Madrid,Spain; 6UniversidadComplutense deMadrid,PharmacyFaculty,Madrid,Spain

10.1136/ejhpharm-2023-eahp.352

BackgroundandImportance HumanImmunodeficiencyVirus (HIV)infectionisnowadayschronicduetoantiretroviraltherapy(ART).

KnowledgeaboutHIVtransmission(KHIVT)empowers peoplelivingwithHIV(PLWHIV)toengageinART.

AimandObjectives TodescribeKHIVTamongPLWHIVon ARTandtoidentifyfactorsassociatedwithloweraccessto thisinformation.

MaterialandMethods Multicentre(5centres),observational, prospectiveandcross-sectionalstudy.Weincludedadult PLWHIVonARTwith>3monthssincediagnosis.

KHIVTwasevaluatedusingan adhoc questionnaireof20 statements,tobereplied ‘true’ or ‘false’.Resultsarethepercentagesofcorrectanswers,consideringasoptimalknowledge results 80%.

Factorscollectedweresexualorientation,genderidentity, racialisation,religion,socialsupport,educationallevel,relationshipandeconomicstatus,socialvisibility,druguse,and involvementinsexwork.

Associationsbetweenquantitativeandqualitativevariables wereanalysedwithStudent’sTtestorMann-WhittneyUtest basedonnormalitytests.Spearmancorrelationcoefficient(r) wasusedbetweenquantitativevariables.

P-values<5%wereconsideredstatisticallysignificant.

Results Weenrolled169participants,aged20-81yearsold (x=46.6±12.2);147men,19women,and3non-binary people.

KHIVTobtainedanaverageresultof87.2±10.4%. 77.52%ofparticipantshadoptimalknowledge.

Threeofthefourstatementswiththeworstresultswere thatrelatedtoHIVuntransmissibilityinPLHIVwithundetectableviralload(U=U).

Womenachievedworseresultsthanmen(Dx=8.16| CI95%:3.3-13.0|p=0.001).

Heterosexualmenachievedworseresultsthanhomosexual men(Dx=6.1|CI95%:2.7-9.5|p=0.001).Therewerenosignificantdifferencesbetweenbisexualmenandothermen.

PLWHIVwithno/onlyprimaryeducationobtainedworse results(Dx=7.5|CI95%:3.2-11.8|p=0.000).

PLWHIVwithanincome<1,000C ¼ /month(gross)obtained worseresults(Dx=3.7|CI95%:0.5-6.8|p=0.015).

AgewasinverselycorrelatedwithKHIVT(r=-0.367| p=0.000).

ConclusionandRelevance AboutaquarterofPLHIVhavesuboptimalKHIVT.Furthermore,thepremiseU=Uisnotyet sufficientlywidespread.

Women,heterosexualmen,olderpeople,peoplewithlow educationlevelandthosewithalimitedeconomicalincome havegreaterdifficultyaccessingthisinformation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest

6ER-032 HOWCANDUTCHUNIVERSITYHOSPITALS CONTRIBUTETOAFFORDABLEMEDICINESANDCOST CONTAINMENTOFTOTALHOSPITALDRUG EXPENDITURE:ADELPHISTUDY

1ADane*, 2ARamlal, 3MOvergaag-vanHemert, 1PRoos, 4CPost, 5CUyl-deGroot, 1HVan DerKuy. 1ErasmusMc,HospitalPharmacy,Rotterdam,TheNetherlands; 2NoAffiliation,N/ A,DenHaag,TheNetherlands; 3NZA,N/A,Utrecht,TheNetherlands; 4AmsterdamUmcLocatieUniversityofAmsterdam,Oncology,Amsterdam,TheNetherlands; 5Erasmus UniversityRotterdam,ErasmusSchoolofHealthPolicyandManagement,Rotterdam,The Netherlands

10.1136/ejhpharm-2023-eahp.353

BackgroundandImportance IncreasingexpenditureonpharmaceuticalsisofgrowingconcerntotheaffordabilityofhealthcaresystemsacrossEurope.AsstatedintheEuropean Commission(EC)’sPharmaceuticalStrategyforEuropeall stakeholdersshouldbeinvolvedintacklingthisproblem.The EChasindicatedthatsolutionsalongtheentiredruglifecycle (DLC)shouldbeconsideredasitoffersamorecomprehensive andintegratedviewtoaddressthistopic.Beingastakeholder, universityhospitals(UH)areengagedinmultiplephasesof theDLC,consistingof(pre-)clinicalresearch,marketauthorisation,pricingandreimbursement,manufacturing,procurement,prescribing,dispensingandmonitoringreal-world effectiveness.

AimandObjectives

WeaimedtoexplorewhichactivitiesUHs performorshouldperformtocontributetocostcontainment ofmedicines.

MaterialandMethods WeusedaDelphitechniqueand assembledanexpertpanelof31pharmaceuticalexpertsof DutchUHs(i.e.,doctors,researchers,hospitalpharmacists, directors),healthinsurersandgovernmentalauthorities.Inthe firstround,weexploredactivitiesUHscurrentlyperformor shouldperformthroughouttheDLCandwhatbarriersor dilemmastheyencounter.Inthesecondround,weaskedour panelona5-pointLikertpointscaleto(dis)agreewithall mentionedactivitiesandbarriers.Thethirdroundwasused toreachconsensusonactivitiesandbarrierswhichwere(dis) agreeduponlessthan50%.

Results Thepanelagreedthat,considering(pre-)clinical research,UHsshouldincreaseinvolvementindrugrepurposingandmonitoringofreal-worldeffectivenessofmedicines. Furthermore,whileprescribingmedicinesisreservedfor medicalspecialistsUHsshouldraisemoreawarenessoncosteffectiveprescribingbydoctorsviamoreactiveinvolvement ofhospitalpharmacists,adjustmentofnationalprescribing guidelinesandextendingpharmacotherapyeducation.Finally, costcontainmentcouldbeenhancedbyreducingspillage,e. g.,efficientdosing.Controversyamongthepanelremained onthenotionofUHsbuildingmoreknowledgeonregulatoryaffairsformarketingauthorisationandincreasingtheir effortonself-manufacturingofmedicines.AgreeduponbarriersrestrictingUHstoexpand theiractivitieswereinsufficientfinancialresourcesan dlegalandentrepreneurial expertise.

ConclusionandRelevance UHsshouldincreasetheireffortsto reducecostsofmedicinesthroughoutthewholeDLC,but especiallyonactivitiesregardingdrugrepurposing,avoidance ofspillageandcost-effectiveprescribing.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-033 PEMBROLIZUMABANDATEZOLIZUMABASPOSSIBLE EQUIVALENTFIRST-LINETHERAPEUTICALTERNATIVES INPD-L1-EXPRESSINGTRIPLE-NEGATIVEBREAST CANCER

MDRivasRodríguez*,ÁGilGarcía,ARojasAlbarrán,MGrageraGomez,HVázquez Velázquez. BadajozUniversityHospital,Pharmacy,Badajoz,Spain

10.1136/ejhpharm-2023-eahp.354

BackgroundandImportance Recentstudieshaveestablished theinfluenceoftheimmunesystemondiseaseprogressionin triplenegativebreastcancer(TNBC)patients.

AimandObjectives Todetermineifpembrolizumabandatezolizumabcanbeconsideredequivalentfirst-linetherapeutic alternatives(ATE)byusingacommoncomparator,for patientswithlocallyrecurrentunresectableormetastaticunresectableTNBCinadultswhosetumoursexpressPD-L1and whohavenotreceivedpriorchemotherapy.

MaterialandMethods Abibliographicsearchwasconductedto selectphaseIIIrandomisedclinicaltrialsoffirst-linetreatmentsforTNBC.Theindirectcomparisonwasperformed withtheBuchermethod.Thevariableselectedtodetermine clinicalequivalencewasprogression-freesurvival(PFS),dueto thelackofmaturitywithrespecttotheoverallsurvivalvariable.Themaximumacceptabledifferenceasaclinicalnon-

inferioritystandardDelta(D),anditsinverseweresetat0.65 and1.54,respectively.TheywereestablishedbyESMO-MagnitudeofClinicalBenefitScale.

Toestablishthepositioning,weappliedthecriteriaofthe guideontherapeuticalternatives.

Results Accordingtotheclinicalstudiesreviewed,apotentialtherapeuticequivalenttopembrolizumab,atezolizumab combinedwithnab-paclitaxel(IMp assion130)wasidentified forthetreatmentofTNBCwhosetumoursoverexpressPDL1 1%andwhohavenotreceivedp riorchemotherapyfor theirmetastaticdisease.Althoughinourcase(KEYNOTE355),thePD-L1 10subgroupwasconsideredthereference subgroupforthestudy,wehavedatafromthePDL1 1 subgroupinpatientstreatedwithpembrolizumabincombinationwithchemotherapythatallowustomakethe comparison.

AfterapplyingtheBuchermethod,aHR=0.85(95%CI 0.63to1.16)wasobtainedforpembrolizumab+chemoterapyversusatezolizumab+nab-paclitaxel.Consideringthe standarddeltaestablished,thisisaprobableclinicalequivalence.WehavetoresortinthiscasetoShakespeare’scalculatorwhichstatesthatthereisa4.25%probabilitythatthe valueisbelow0.65.Sincethisisaprobabilityoflessthan 17%,wecanconcludethattheseareequivalenttherapeutic alternatives.

ConclusionandRelevance Pembrolizumabandatezolizumab couldbeconsideredATE,however,recentstudiessuchasthe Impassion131bringagreatdealofuncertaintytothis determination.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-034 USEOFCLOSEDSYSTEMTRANSFERDEVICESWITH INVESTIGATIONALDRUGPRODUCTS

1LValdeolmillos, 2CGarciaPastor*, 2MSerranoAlonso, 2CLacasaArregui, 2EMolíns Castiella. 1ClinicaUniversidaddeNavarra,Pharmacy,Pamplona,Spain; 2ClinicaUniversidad deNavarra,PharmacyDepartment,Pamplona,Spain

10.1136/ejhpharm-2023-eahp.355

BackgroundandImportance Investigationaldrugproducts (IDP)shouldbetreatedashazardousdrugs(HD)asitisnot frequenttohavehazardstudiesavailableortheinformation aboutsafetyisusuallyinsufficient.Thisisahandicapfor pharmacists,whomustguaranteethesafetyofprofessionals duringthehandling,preparationandadministrationofIDPas wellasdrugquality.

RecommendationsbyNIOSHandUSPincludetheuseof closedsystemtransferdevices(CSTDs)inthehealthcaresettingtoreduceoccupationalexposuretoHD.

FrequentlythereisalackofinformationaboutthepotentialimpactofusingCSTDsonproductquality.Thismaybea challenge,especiallywhentheyareusedwithIDP,monoclonal antibodies(mAb)anddrug-conjugatedmAb.

AimandObjectives Toreviewthescientificevidencerelatedto theuseofCSTDswhencompoundingandadministering IDPs,inordertodeterminethemainchallengesrelatedtoits useandtoestablishtheusecriteriaindailypractice.

MaterialandMethods AcomprehensivesearchinPubMed databasewasperformed.Thesearchstrategywasbasedona combinationofthefollowingterms:closedsystemtransfer devices,drugdevelopmentandbiologicproducts(meSH

term).WeincludedstudiesevaluatingCSTD,safehandling anddrugquality.

Results Weincluded7articles(onesystematicreview,four reviewsandtwoprospectivestudies)thatshowedthefollowingcriticalissues:

. ThereisawidevarietyofcomponentsinCSTDsthatcan potentiallycauseincompatibilityissues,physicalandchemical instabilitiesaswellasdruglossandpoorqualityproductdue toadsorptionontoCSTDmaterials.

. CSTDsareassociatedwithhigherincidenceofinsolublefine particlesrelatedtosiliconeoildroplets.MAbareknownto formaggregateswhenCSTDsareusedthatcouldbe potentiallydetrimentaltopatientsafety.

. CSTDsholdupvolumerangefrom0,04to1mLwhichhas animpactondeliverabledrugdosewhichisespecially worryinginlowvolume-doseIDP.

ConclusionandRelevance Frequently,thereisinsufficientinformationtoexcludesafetyconcernsforIDPleadingtobroad useofCSTDsaccordingtoguidelines.

Thereisanurgentneedtoincreaseknowledgeaboutthe hazardofnewtherapiesandtoassessCSTDsimpactonproductquality,clinicaltrialoutcomeandpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

Thenumbernexttotheauthorindicatesthepagenumber,nottheabstractnumber.

AbeleM,A115

AbotalebA,A17

AcramelA,A18

AdeM,A90

AdrianMO,A119

Aelbrecht-MeurisseC,A115

AgiusP,A21

AgraBlancoI,A30,A77,A126

AguadoBarrosoP,A27,A53

AguilarSalmeronR,A41,A82

AguirrezabalaArredondoAV,A124

AitElCadiM,A6,A69,A159

AkgölK,A14

AlañonPardoMDM,A148

AlamiM,A97

Alarcón-PayerC,A40

Alarcon-PayerC,A152

AlbanellM,A20,A24,A28,A29,A49

AlbertH,A94

AlcántaraPradoA,A75

AlcaceraLopezMA,A83

AlcalaSotoA,A60,A62,A129

AlcobiaA,A149,A155

Aldea-PeronaA,A54

AlegreDel-ReyEJ,A162

Alegre-DelReyEJ,A8

AlfonsínLaraM,A30,A77,A126

AliS,A94

AlkanjA,A45

AllawayeL,A167

AllemandJ,A48

AllendeBandresMA,A83

AlmeidaGonzálezCV,A137

AlmeidaP,A155

Almendros-AbadN,A167

AlmiñanaM,A49

AlonsoMorenoM,A154

Alonso-GarcíaA,A17

AlvarezDianAM,A163

AlvarezDiazAM,A53,A78,A89,A141,A154

AlvarezManceñídoFJ,A59

AlvarezYusteA,A132

ÁlvarezDíazAM,A101

ÁlvarezFernándezI,A86

ÁlvarezGrandeB,A125

ÁlvarezM,A64

ÁlvarezYusteA,A126

Alvarez-YusteA,A77

Álvarez-DíazAM,A56

Álvarez-ManceñidoFJ,A96

AmmorW,A54,A68

AmorGarcíaMA,A52

AmorGarciaMA,A20

AmorMÁ,A48

Amor-GarcíaMÁ,A92,A134

AnaFP,A9

AnaJ,A124

AnaSoaresArmandoAlcobia,A3

AndújarMateosA,A158

AndrésNavarroN,A143

AndrescianiE,A95,A152

AndreuÀ,A153

AnguianoBaqueroMP,A129

AnguitaDomingoD,A105

AntónX,A62

AntignacM,A167

AntoineAL,A112

Antolín-AmérigoD,A141

AntonM,A49

AntonMartinezM,A165

AntonMendezX,A142

AntoniouS,A88,A94

AparicioC,A39

AparicioPeñacobaR,A106

ApezteguiaFernandezC,A20

ApezteguiaFernandezCA,A92

Apezteguia-FernándezCA,A48,A134

AraújoR,A19

AraqueArroyoP,A148

ArchillaAmatMI,A9,A11,A28,A161

ArchillaMI,A164

ArenasJimenezM,A11

ArenereMendozaM,A83

ArgandoñaMJ,A15

AriasA,A59,A133

AriasMartinezA,A67

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Arias-SantiagoS,A96

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EJHP

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