Abstract book

28th EAHP Congress Bordeaux, France

20-21-22 March 2024

Sustainable healthcare — Opportunities and strategies

EJHP

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Abstracts from the 2024 EAHP Congress

A1 National poster winner abstracts

A6 Section 1: Introductory statements and governance

A18 Section 2: Selection, procurement and distribution

A28 Section 3: Production and compounding

A51 Section 4: Clinical pharmacy services

A163 Section 5: Patient safety and quality assurance

A224 Section 6: Education and research

A245 Author index

Nationalposterwinnerabstracts

NP-001 EXTEMPORANEOUSFLUCYTOSINE15.5% INTRAVAGINALGELTOTREATREFRACTORY CANDIDAGLABRATA VULVOVAGINTIS – CASE REPORT

1RitaRitaBranco, 1AnaParóla, 1LuisaFétal, 3LilianaCarvalho, 1,2HelenaFarinha, 3CristinaChagas, 1,2FátimaFalcão. 1PharmacyDepartment,CentroHospitalardeLisboa OcidentalEPE,Lisbon,Portugal; 2FacultyofPharmacyoftheUniversityofLisbon,Lisbon, Portugal; 3Gastroenterology,CentroHospitalardeLisboaOcidentalEPE,Lisbon,Portugal 10.1136/ejhpharm-2024-eahp.1

BackgroundandImportance Candidaglabrata(C.glabrata) is thesecondleadingcauseofvulvovaginalcandidiasis(8%of cases).1–5

Recommendationstotreatazoleresistance(AR) Candida glabrata (C.glabrata)vulvovaginalcandidiasis(VVC)areintravaginalboricacidcapsules(first-line),intravaginalnystatinsuppositories(second-line)and,asthird-line,flucytosinecream (17%or15.5%)oramphotericinBcream.1–4

Vaginalflucytosineandamphotericinarenotcommercially available,soanextemporaneousformulationhastobe developed.

AimandObjectives Tocompoundflucytosine15.5%intravaginalgelandtoevaluatetheeffectivenessandsafetyinanAR C. glabrata VVCpatient.

MaterialsandMethods Literaturereviewtoinvestigatethe above-mentionedcompoundingmagistralformulations.

Effectivenessandsafetywereassessedbyclinicalmonitoring,analyticalmonitoringandpatientinterview.

Results A47-year-oldwomanwithrecurrentVVCsinceMarch 2020wastreatedwithoralfluconazole,orallactobacillus/lingonberryandmultipleintravaginaldrugs(clotrimazole,nifurantel,nystatin,benzydamine,estriol+lactobacillusandboric acid).InMarch2022,a C.glabrata strainwasisolated,exhibitingantifungalsensitivityonlytocaspofungin,flucytosineand micafungin.

Fourflucytosineformulationsforvaginalapplicationwere identifiedinliterature.5–8 Wecompoundedflucytosine15.5% gelbyreducingfourteen500mgflucytosinetabletstoafine powderinamortar.Thepowderwasthenmoistenedwith5 mLofglycerintoformasmoothpaste,whichwasthen addedto40gofalubricatingvaginalgelbase.Shelf-lifeof wasgivenfor14days,storedatroomtemperature.Vaginal applicatorswereusedtoapplythegelintravaginallyatbedtimefor19days.

Duringthisperiod,threeactivepharmacovigilanceinterviewswerecarriedouttoverifytolerabilityandsideeffects. Thepatientreportedonlyvaginaldischarge,nopain,pruritus orrash.

Analyticalevaluation(bloodcount,renalandhepaticfunction)wasperformed,withoutrevealinganychange.Vaginal culturewasnegativeatweek2,4and6aftertreatment.The patientremainedasymptomaticuntilthelastevaluationin August2022.

ConclusionandRelevance Theflucytosine15.5%intravaginal gelformulationfulfilledanunmetneed,enablingtheeffective resolutionofARC.glabrataVVC.

Theactivemonitoringofitsuseallowedustocollectreal contextdataonsafety,verifyingtheabsenceofadverseeffects andgoodtolerance.

REFERENCES

1.PappasPG, etal.Clinicalpracticeguidelineforthemanagementofcandidiasis: 2016updatebytheinfectiousdiseasessocietyofAmerica. ClinInfectDis. 2016 Feb15;62(4):e1–50.doi:10.1093/cid/civ933.Epub2015Dec16.

2.Centersfordiseasecontrolandprevention(CDC) ‘VulvovaginalcandidiasisSexual TransmittedInfectionsGuidelines2021.’

3.Uptodate ‘Candidavulvovaginitisinadults:Recurrentinfection.’ seenin21/03/ 2022.

4.SobelJD,ChaimW,NagappanV, etal.TreatmentofvaginitiscausedbyCandida glabrata:useoftopicalboricacidandflucytosine. AmJObstetGynecol 2003;189:1297–1300.

5.WhiteDJ,HabibAR,VanthuyneA,LangfordS,SymondsM.CombinedtopicalflucytosineandamphotericinBforrefractoryvaginalCandidaglabratainfections. SexTransInf 2001;77:212–3.

6.RicoteLoberaI, etal.Poster55CongressoSEFH: ‘GeldeAnfotericinaBYFlucitosinaeneltratamientodevulvovaginiterecurrenteporCandidaglabrata:case report.’ 2010.

7.SanJoséB, etal.Hospitalformulationsforthetreatmentofnon-albicansvulvovaginitis. EurJHospPharm 2012-000074.152.

8.Micromedexmonography ‘Flucytosine’ seenin17/3/2022.

NP-002 MEDICATIONSAFETY:STRATEGIESAND OPPORTUNITIESINCLINICALPHARMACYPRACTICE MaltaRichardDespott*.

10.1136/ejhpharm-2024-eahp.2

BackgroundandImportance Medicationerrorsremainthe mostcommonpreventablecauseof adverse eventsindrug therapywithfurtherscopeforreducingpatientharmandthe associatedeconomicburden.

AimandObjectives Thisstudyexploreswaysforimproving medicationsafetyinclinicalpracticebyevaluatingthedrug relatedproblemsandtypeofmedicationerrorsassociated withpreventablepatientharm.

Methods Medicationerrorswereidentifiedfromreportsof adversedrugeventsintheEudraVigilancedatabaseandclassifiedaccordingtotheunderlyingdrugrelatedproblems(DRPs) whichmaybemitigatedthroughpharmaceuticalintervention describedbythePCNEClassificationV9.1.

Evidence-basedstrategiestoreducetheriskofpreventable patientharmwereidentifiedfordifferentstagesofdrugtherapyaccordingtotherootcauseofmedicationerror.

Results Atotalof2294reportsofmedicationerrorwere receivedoveraperiodof3yearsforwhichaspecifictypeof rootcausemedicationerrorcouldbeidentifiedin1300 (57%)cases.Thenumberofcasesassociatedwithpreventable patientharmduetoaspecificDRPwas1190(91.6%)and 48.7%ofthesewereassociatedwithhospitalisationorprolongedtreatment.509(42.8%)caseswererelatedtoprescribingerror;244(20.5%)ofcasestodispensingerrorand437 (36.7%)relatedtotheadministrationanduseofdrugs.

Conclusion Theresultsshowthatclinicaldecisionsupportand electronicprescribingsystemsaremoreeffectivesystems-based approachestopreventplanningerrorsintheprescribingprocess,whilststrategiestomitigateexecutionerrorsshouldfocus onpredisposingfactorsfromunsafemedicationsystems, fatigueanddistractionsattheworkplace.Thisinvolvesin-line safetychecksandaidstosupportandfacilitatethedrug administrationprocesses,suchasstandardisationofmedication labels,cartsandtrays,colour-codingandbar-codingforautomatedidentitycheck, ‘smart’ infusionpumpsanddispensing carts.

Dispensingpracticescanbenefitfromdrasticimprovements inincidentreportingschemesandfurtherresearchtoleverage criticalinformationonadversedrugevents,reducethenumberofmedicationerrorsmoreeffectivelyandavoid hospitalisations.

NP-003 PATIENTMEDICINEGUIDESSUPPORTSAFE MEDICATIONTREATMENTANDDISCHARGEFROM THEHOSPITALINPAEDIATRICSPECIALISEDMEDICAL CARE

ASAnnaSantamäki*,SFSanniFagerroth,VTVenlaTöyräs,SKSiniKuitunen. HUS PharmacyHelsinki,Finland

10.1136/ejhpharm-2024-eahp.3

BackgroundandImportance Childrenaresusceptibletomedicationdeviationsandadversedrugevents.Severalhigh-risk medicinesareusedbothinhospitalsandathomewithpaediatricpatients.Writtenmedicationinstructionsplayakeyrole inensuringmedicationsafetyduringthehospitalperiodand afterdischarge,asmanymedicationsareunlicensedorused off-labelinpaediatrics.

AimandObjectives Thegoalwastoproduceuniformandreliablemedicationguidesforbothclinicalandhomeuse.

MaterialsandMethods Pharmacistpreparedtheguideusing thedepartment’spreviousinstructions,manufacturer ’sproduct summariesandnationaldatabasesasabackground.Thecontentandstructurewerebasedontheneedsandquestions raisedduringthepatientguidanceandwereevaluatedmultiprofessionally.

Results Thepaediatricorgantransplantdrugguidewasdevelopedfirstandcontainsinformationonthepracticalinstructionsformedicationtreatmentathome.Themedicationguide isgiventoeachfamilyandisalsoavailabletootherhospital districtsandpharmaciesthroughthenationaldatabase.Warfarinandenoxaparinpatientinstructionshavelaterbeen developedusingthesameideology.Pictorialinstructionsprovidesupportandcertaintyfortheuseofhigh-alertmedicines athomeby,forexample,reducingerrorsindosecalculations. Themostrecentpaediatriccancermedicationguidealso includespictorialinstructionsonthesafehandlingofchemotherapydrugsathome.Asaresultofthemedicationguides, hazardoussituationsandcontactstothehospitalafterdischargehavedecreased.

ConclusionandRelevance Patientmedicineguidesenablereliabledruginformationforfamiliesandpractitioners.Withthe helpofthematerials,thefamilycanpracticehandlingmedicinessafelyalreadyinthedepartment.Writtenmaterialand medicationcounsellingshouldbegivenwellinadvancebefore discharge,sothatthefamilieshavetimetoadoptgiveninformationandaskfollow-upquestions.

NP-004 PALL-OLU.DE:ANEWDATABASEONTHEOFF-LABEL USEOFDRUGSINPALLIATIVEMEDICINE

SPStefaniePügge*,ADOAleksandraDukic-Ott,SBStephanieBüsel,JBJulianBaumgärtel, CRConstanzeRémi. DepartmentofPalliativeMedicine,UniversityHospital,LMUMunich, Germany

10.1136/ejhpharm-2024-eahp.4

BackgroundandImportance Themainfocusofpalliativecare (PC)isthereliefofdistressingsymptoms.Upto50%of

drugsareusedoff-label(OLU);yetonlyalimitedpartof theseusesissupportedbyofficialrecommendationssuchas guidelines.

Theefficientsearchforevidence-basedinformationisthereforeparticularlyimportantfortreatmentplanning.However, ineverydayclinicalpractice,healthcareprofessionalsoften lackthetimeandresourcesforsuchresearch.

AimandObjectives Theaimistoprovidehealthcareprofessionalswithevidence-basedtherapyrecommendationsforOLUin palliativecarethroughthedatabasepall-olu.de.

MaterialsandMethods RelevantdrugsandtheirOLUinPC areidentifiedusingasystematicapproach.Treatmentrecommendationsaresubsequentlydevelopedbasedonthebest availableevidenceandagreedthroughaweb-based,two-round DelphipanelprocesswithinternationalPCexperts.Thefinal off-labeltreatmentrecommendationsarepresentedindrug monographsandincludeadditionalinformation,e.g.onmonitoringoralternativemedicalandnon-medicaltreatment options.

Results Thefirst38treatmentrecommendationswereagreed uponin2022.70expertsparticipatedineachround (responserate:firstround72.9%/secondround67.9%).Since 2023recommendationsareaccessiblefreeofchargeonpallolu.de.Intotal,theaimistopublisharound400treatment recommendationsforaround80drugs.Asmartphoneappis underdevelopment.

ConclusionandRelevance pall-OLU.deprovideseasyaccessto evidence-basedinformation.Thedatabasefillsaninformation gapandmakesanimportantcontributiontosafeandeffective pharmacotherapyinPC.

FundingGermancanceraid(Fördernr.70113910).

NP-005 UNAUTHORISEDMEDICATIONUSEINESTONIAN HOSPITALS

1,2AnetteNurm, 1,2KerstiTeder, 1,3JanneSepp. 1UniversityofTartu; 2TartuUniversity HospitalPharmacy; 3EstonianStateAgencyofMedicines

10.1136/ejhpharm-2024-eahp.5

BackgroundandImportance Unauthorisedmedicationuseis ofteninevitableinEstoniaowingtothesmalllocalpharmaceuticalmarket,supplydifficultiesetc.Duetotheabsenceof SummaryofProductCharacteristicsinEstonianlanguageand foreignlanguagepackageofunauthorisedmedications,several problemsrelatedtotheuseofthesemedicationsmayarise. However,noresearchonthistopichasbeencarriedoutin Estonia.

AimandObjectives Theaimofthisstudywastofindout howmuchandwhichunauthorisedmedicationswereusedin Estonianhospitalsin2019–2020.Theobjectivewastofind out:1)Howmanypackagesofunauthorisedmedicationswere used;2)WhichwerethemostusedAnatomicalTherapeutic Chemical(ATC)groups;3)Whatwasthemostusedactive ingredient;4)Whatwerethemostusedadministrationroutes anddosageforms.

MaterialsandMethods Dataregardingtheuseofunauthorised medicationsinEstonianhospitalsin2019–2020wereobtained fromtheEstonianStateAgencyofMedicinesandwasanalysedbythenumberofpackagesusingMicrosoftExcel software.

Results 286719and313793packagesofunauthorisedmedicineswereusedin2019and2020,respectively,which

constitutesapproximately12%ofallimportedmedicationsin Estonianhospitalsinbothyears.ThemostusedATC-groups in2019–2020wereanti-infectivesforsystemicuse,nervous systemandalimentarytractandmetabolism.Themostused activepharmaceuticalingredientwasoxacillininbothyears.

Unauthorisedmedicationsinhospitalswereadministered mainlyparentally(approximately75%ofallpackages)andthe mostuseddosageformwassolutionforinjection.

ConclusionandRelevance Theimportanceofthisworkliesin studyingtheuseofunauthorisedmedicationsuseforthefirst timeinEstonia,similarstudiesinothercountrieswerenot found.Asaresultofthisstudy,wehaveinformationon whichunauthorisedmedicationsareusedthemostinEstonian hospitals.Thereforeitispossibletoimprovehandlingofthese medications,forexampleusinglabelsonpackageswiththe mostimportantinformationaboutthespecificmedicationin Estonianlanguage.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

NP-006 DRUGHOST,THEFIRSTDATABASEOFUNAVAILABLE DRUGSINEUROPE – ANITALIANMODEL:DATA1 YEARAFTERTHESTARTOFTHEPLATFORM

1MeryLaFranca*, 2SOliverio, 2SPireddu, 2COrsucci, 2AGarna, 1RPetti, 1DTarantino, 1EPasut, 1FUrso, 1MPani. 1ItalianSocietyofHospitalPharmacyandPharmaceutical Services(SIFO),Milan,Italy; 2TuscanyHealthcareTechnicalAdministrativeSupportAgency (ESTAR),Tuscany,Italy

10.1136/ejhpharm-2024-eahp.6

BackgroundandImportance Drugshortagesareaglobalproblem;alltypesofdrugsareliableforshortageswithmultifactorialcausessuchassupply,demand,andsometimesregulatory issues.Regulatoryagencies,associations,andgovernmentshave developedvariouspolicies,programmes,researchstudies,and guidelinestoaddresstheissue.However,thephenomenonis growing,representingaproblemforaccesstotherapies.Our

teamwasthefirstinEuropetodevelopawebplatformcalled DruGhostformonitoringunavailabledrugs,distinguishedfor thefirsttimefromshortages,provingtobeavalidtoolfor monitoringthephenomenonandrelatedmanagement.

AimandObjectives Theweb-basedplatform,integratedintoa nationalportalforItalianpharmacists(SIFO),collectsall reportsofunavailablemedicinestomaptheirprogressand takeactions.

MaterialsandMethods Allhospitalpharmacistshaveaccessto theplatformtosubmitreports,whicharepublishedifthe necessaryconditionsaremet.Theseconditionsincludethat themedicinecannotbeonthelistofshortages,theorder datecannotbeolderthan15days,andthecompanymust havereceivedoneprompt.Concurrentlywiththevalidation andpublicationofthereport,thecompanyreceivesanalert. Thedataissharedwiththenationalregulatoryagency,Agenziaitalianadelfarmaco(AIFA),withtheaimofproviding timelyinformationforthepossibleadoptionofrapidmeasures,especiallyfororphan,innovative,andlife-savingdrugs. Results Inthefirstyearfollowingtheplatform’sintroduction inItalyin2022,17,563reportswerereceived.Outofthe totalnumberofreports,1,214wereeffectivereportsof unavailabledrugs,theremaining,infact,referredtoshortage ofdrugsalreadypublishedbyAIFA,duplicatereportsand, some,wereconsiderednon-compliant.90reportsofunavailabilityreferredtoorphandrugs,and92otherstodrugswe havewitnessedthetransitionfromunavailabletoshortage. Analysingthedataforfirst-levelofATC,itappearsasfollows:25%nervoussystem(N),15%antineoplasticandimmunomodulators(L),and4%blooddrugsandhaematopoietic organs(L),followedbylowerpercentagesfortheother classes.

Thereportsaregrowingexponentially.Ourteam’saims, amongothers,istoidentifyearlyalertsandadoptpreventive measurestoguaranteeconstantaccesstotreatment.

REFERENCE

1.ShukarS, etal.Drugshortage:causes,impact,andmitigationstrategies. Front Pharmacol. 2021.

AbstractNP-005Figure1 Thenumberofpackagesofunauthorisedmedicationsissuedtohospitalpharmaciesin2019–2020,arrangedbyATCgroups

Abstracts

VALIDATIONOFANTIMICROBIALDEFINEDDAILY DOSEFORTHEPAEDIATRICPOPULATION:FINAL RESULTSOFKIDDDSPROJECT

1EMontecatine-Alonso, 1MMejias-Trueba, 1MVGil-Navarro, 2EChavarri-Gil, 3CMFernandez-Llamazares, 4EDolz-Bubi, 5JMGutierrez-Urbon, 1CAlvarez-Vayo, 1PSuarez-Casillas, 1SLora-Escobar*. 1DepartmentofPharmacy,HospitalUniversitario VirgendelRocio,Seville,Spain; 2DepartmentofPharmacy,HospitalUniversitariodeCruces, Barakaldo,Spain; 3DepartmentofPharmacy,HospitalGregorioMarañón,Madrid,Spain; 4DepartmentofPharmacy,ComplejoHospitalarioUniversitarioInsular-MaternoInfantil,Las PalmasdeGranCanarias,Spain; 5DepartmentofPharmacy,ComplexoHospitalario UniversitarioACoruña,ACoruña,Spain

10.1136/ejhpharm-2024-eahp.7

Background Antimicrobialstewardshipprogrammes(ASPs) optimiseantimicrobialuse,improvepatientoutcomes,and reduceresistance.ToassesstheeffectivenessofASPs,itisnecessarytohaveindicatorsthatcanbewidelyused.Defined dailydose(DDD)wasdesignedbytheWorldHealthOrganizationfortheadultpopulationasaconsumptionindicator.

Objectives ValidatethetooldesignedinphaseIofthe KiDDDsprojecttoestablishthemostappropriateDDDvalues inthepaediatricpopulation.

MaterialandMethods Thisisanobservational,retrospective, multicentrestudyconsistingoftwophases.Thefirstphase wasaimedatthetheoreticalcalculationofpaediatricDDD. Thesecondphaseconstitutesthevalidationofthestudy.

Antimicrobialprescriptionswerecollectedfromthewards ofsevenSpanishhospitalsduring2017and2018.Studiedvariableswereage,gender,weight,antimicrobialdose,frequency androuteofadministration.Thoseantimicrobialsincludedin thefirststagewereconsidered.

Fromthedatacollected,thetotaldoseofantibiotic receivedperpatient(mg/day)wascalculated,subsequently,the medianoftheresultingDDDperantibiotic(g/day)was obtained(DDD-PhaseII)andwerecomparedwiththetheoreticalDDD(DDD-PhaseI).

AbstractNP-007Table1

Theselectioncriteriaofthe optimalDDDvalueareshown intable1. POWERVALUE

>80%

PHASE-DDDISELECTEDPHASE-DDDIISELECTED

Nosignificantdifferences (p>0.01)+Clinical differencemagnitude (<10%)

Statisticallysignificant differences(p<0.01)+Clinical differencemagnitude(>10%)

Statisticallysignificantdifferences(p<0.01)+Clinicaldifferencemagnitude(<10%) Nosignificantdifferences(p>0.01)

+Clinicaldifferencemagnitude(>10%)+Degreeofagreement(>75%)

≤80%

Degreeofagreement (>75%)

Notapply

ABarusseau,LRuesche,LGueneret,YLurton. Pharmacie,CHUdeRennes,2RueHenriLe Guilloux,35000Rennes,France

10.1136/ejhpharm-2024-eahp.8

BackgroundandImportance Single-usecranialdrillsareused inneurosurgerytoperforatecranialbones.FromJune2018

toOctober2020,18adverseevents(AEs)wererecordedin ourhospital,sevenofwhichresultedinamaterialsafety(MS) declarationtothe AgenceNationaledeSécuritéduMédicamentetdesproduitsdesanté (ANSM)forriskofcerebral damage.

AimsandObjectives Weaimedtoanalysethecausesofthese AEsinordertoproposecorrectiveandpreventivemeasures. MaterialsandMethods MSdatawereanalysedchronologically, andthevariouspeopleinvolvedinthecircuitwerecontacted. Otherhealthcareestablishmentswerequestionedinorderto obtainfeedbackonthemanagementofthistypeofAE.At thesametime,asearchofMSdataviatheAmericanMAUDE databasewascarriedoutfortheperiod,targetingthedevices usedinourcentre.Wethenperformedacausalanalysisusing the5MmethodandanIshikawadiagram.

Results Weidentifiedseveralmodesofpossiblefailure:(i)connectionbetweenchuckandmotormaybeloose;(ii)different typesofmaterialfortheconnectiontipmayinfluencethe behaviourofthedevice;(iii)anaddedmanualrotationmovementduringthesurgicalgesture;(iv)non-perpendicularplacementofthedevice;(v)inappropriaterotationspeed,andthe thicknessofthecranialbone.

ResearchviaMAUDEshowed13notificationsofincidents ofnon-disengagementovertheperiod.

ConclusionandRelevance Single-usecranialdrillsrequirecarefulhandlingforoptimumdisengagement.Thematerialcauses havebeenidentified,butthehumancomponentcannotbe ruledout.Correctivemeasureshavebeenimplementedto reducetheriskoftheseAEs,includingachangeofsupplier andtrainingforthemedicalteam.Preventivemeasuresalso needtobedevelopedsuchasrevisedselectioncriteriaforthe nextcallfortenders,orbestpracticesauditsintheoperating room.

Theimpactofthesecorrectiveandpreventivemeasures willbeassessedthoughAEsmonitoring.

NP-009 BARRIERSANDFACILITATORSTOPHARMACY PROFESSIONALS’ SPECIALISTPUBLICHEALTHSKILLS: AMIXEDMETHODSUK-WIDEPHARMACEUTICAL PUBLICHEALTHEVIDENCEREVIEW

1,2DAshiru-Oredope*, 1ROsman, 3CNarh, 4UOkereke, 1EJHarvey, 5CGarland, 6CPyper, 7MBennie, 8AEvans. 1UKHealthSecurityAgency,London,UK; 2SchoolofPharmacy, UniversityofNottingham,UK; 3BartsHealthNHSTrust,London,UK; 4NHSEngland,East Midlands,Birmingham,UK; 5DepartmentofHealth,Belfast,NorthernIreland,UK; 6Public HealthActionSupportTeam(PHAST),London,UK; 7PublicHealthScotland,Edinburgh,UK; 8HealthandSocialServicesGroup,WelshGovernment,Cardiff,UK

10.1136/ejhpharm-2024-eahp.9

BackgroundandImportance IntheUKandgloballypharmacy professionals(PPs)contributetothedeliveryoflocaland nationalpublic/populationhealth(PH)interventions.1 However,thereispaucityofinformationtowhatextentPPshave specialist/advancedskills/roleswithinPHpractice.

Aim Themixedmethodsreview,commissionedbytheUK ChiefPharmaceuticalOfficersin2020,aimedtoexplorePPs’ specialistPHcontributionsincludingbarriersand opportunities.

Methods DatabasesavailablethroughPubMedweresearched toretrievearticlespublishedinEnglish(2011-2021)onseven topicsincluding:emergencypreparednessresilienceand response(EPRR);integratingpharmacytobettersupport

NP-008 CASEREPORT:SINGLE-USECRANIALDRILLS,HIGHRISKDEVICES!

publichealthprotectionandimprovementgoals;publichealth skillsandmitigatinghealthinequalities.

Twoindependentelectronicsurveysweredeveloped,piloted anddeployedforpharmacyandpublichealthspecialistsvia emailcascadeandsocialmedia.Thesurveysexploredthe extenttowhichPPsareinvolvedinPHrolesincludingthe barriersandopportunities.

Descriptivestatisticssummarisedthedata,andopen-ended responseswerethemed.UKHealthResearchAuthoritytool identifiedethicsapprovalwasnotrequired;questionnaire includedconsentrequest.

Results RapidEvidencereviews:Followingassessmentof 2,542articles,448evidencestatementswereextractedfrom 135relevantarticles.TheywerepredominantlyfromtheUSA (39%)andtheUK(29%),withfewerhigh-qualityreviews (17)orguidance(12),thanmoderate/low-qualityreviews(42), singlestudies(33),orquantitativeresearch(33).

PharmacyandPHprofessionalsSurveys:TherewereUKwideresponsesfrom128PPsand37PHspecialists.Respondingpharmacistswerefromprimary-care(34%,43),secondarycare(26%,33),communitypharmacy(13%,16),andPH bodies(13%,16).OpportunitiesidentifiedbyPPsincluded: PHareastheydirectlycontributeto(45%);qualifications, knowledgeandskills(27%);strategicpositioninthecommunity(19%),recentchanginghealthlandscape(4%).Barriers includedlackofdefinedcareerpathway(20%);poorprofessionalrecognition(18%);limitedresources(16%);lackof trainingandsupport(15%)andorganisationalandstructural barriers(10%).MajorityofthePHPsstatedthatitwouldbe beneficialorverybeneficialtohavePPsspecialisinginPH (83%).

ConclusionandRelevance PharmacyprofessionalsmakespecialistcontributionstoPHdespitebarriers.DedicatedPharmaceuticalPHtrainingandsystem-wideleadershiparerequired tofullyrealisepopulation-levelbenefits.Lowresponsestothe surveyspresentastudylimitation,however,therewasconsensusfromthethemesemergingfrombothsurveysandrapid evidencereviewsfindings.Furtherinvestigationisrequiredto identifyhowbesttodeployadvancedPPHresources.Future qualitativestudiesshouldbeconsidered.

Acknowledgements Theauthorsacknowledgeallcontributors tothedevelopmentofthescope,workshops,discussionsand recommendations,contributorsofcasehistoriesandcallfor evidence.

REFERENCE

1.ThomsonK,Hillier-BrownF,WaltonN,BilajM,BambraC,ToddA.Theeffectsof communitypharmacy-deliveredpublichealthinterventionsonpopulationhealth andhealthinequalities:areviewofreviews. PrevMed. 2019Jul;124:98–109.

NP-010 COMPATIBILITYOFLOCALANAESTHETICAND CORTICOSTEROIDMIXTURESINTRANSFORAMINAL EPIDURALSTEROIDINJECTIONS

1VSlezakova, 2MDrobny, 1KSzmicsekova*, 1KLajtmanova. 1NationalInstituteof CardiovascularDisease,Bratislava,Slovakia; 2PosAm,s.r.o. 10.1136/ejhpharm-2024-eahp.10

BackgroundandImportance CT-guidedtransforaminalepidural steroidinjection(TFESI)hasbecomeincreasinglyusedinthe treatmentofradicularpain.Choiceofpharmacologicagents forthisprocedurefacesseveralissues,oneofthemiscompatibilityoflocalanaestheticandcorticosteroidmixture.

AimandObjectives Weaimedtoassessthecompatibilityof localanaestheticandcorticosteroidmixturesthatareusedin TFESI.

MaterialsandMethods First,weconductedaliteraturesearch. Intheexperimentalpartofourstudy,localanaesthetics(lidocaine,bupivacaine,levobupivacaine,trimecaine)andcorticosteroids(particulate:betamethasone,methylprednisoloneacetate; non-particulate:dexamethasone)forinjectionavailableinSlovakiawereused.Eachlocalanaestheticwasmixedwitheach corticosteroidinthesyringeusing1:1and1:3volumeratio atroomtemperature.Formationofcrystalsinthemixture wasobservedvisuallyandwasconfirmedwithamicroscope. Thesizeofthecrystalswasdeterminedusingamicroscope slidewithamicrometrescale.

Results Basedonaliteraturesearchalonewecouldonlyidentifyincompatibilitybetweenbetamethasoneandlevobupivacaineandcompatibilityofmixturesoflidocaineand dexamethasone. Invitro weobservedaturbidityaftermixing lidocainewithdexamethasonein1:1ratio,butitwasonly transient.Precipitationofcrystalswasobservedaftermixing dexamethasonewithbupivacaine,levobupivacaineandtrimecaine.Aftermixingparticulatecorticosteroids(betamethasone andmethylprednisoloneacetate)withlocalanaestheticsuspension,particlesformedbigclusters(>>100 mm).

ConclusionandRelevance Inour invitro experimentweconfirmedcompatibilityofthemixtureoflidocaineanddexamethasoneasdescribedinliterature.Incompatibilitybetween dexamethasoneandbupivacaine,levobupivacaineandtrimecainewasidentified invitro,althoughnotreportedinliterature.Mixturesoflocalanaestheticandcorticosteroidare potentiallyunsafeduetopossibleincompatibilities.Cautionis warrantedduringtheiruseinTFESI.Separateadministration ofthesetwodrugclassesasrecommendedbysomeexperts wouldovercometheissuesofpossibleincompatibilityofthe mixture.

NP-011 LINEZOLIDTHERAPEUTICDRUGMONITORING AMONGCRITICALLYILLADULTPATIENTSAFTER CARDIOVASCULARSURGERY

1LiliHolub*, 1RózsaHümpfnernéHajagos, 2GellértBalázsKarvaly, 1,3BotondLakatos, 1,3BálintGergelySzabó. 1GottsegenNationalCardiovascularCentre,Budapest,Hungary; 2SemmelweisUniversityDepartmentofLaboratoryMedicine,Budapest,Hungary; 3South PestCentralHospital,NationalInstituteofHaematologyandInfectiousDiseases,Budapest, Hungary

10.1136/ejhpharm-2024-eahp.11

BackgroundandImportance Sepsis-inducedpathophysiological changescanresultinseriousalterationsinthepharmacokinetic parametersofantibiotics.Drugexposureisconsequentlydifficulttopredictincriticallyillsepticpatients.Thelatest SurvivingSepsisCampaign guidelinesrecommendroutinetherapeutic drugmonitoring(TDM)tooptimiseantibiotictherapyinthis patientpopulation.Linezolidisanoxazolidinoneantibiotic usedtotreatinfectionscausedbygram-positivebacteria.The prevalenceofitsadverseeffectsisassociatedwithhigher exposure,whilesuboptimalconcentrationscanleadtotreatmentfailureandanincreasedriskofclonalevolutionof resistantstrains.

AimandObjectives Ouraimwastodetermineoptimaldosing strategiesamongcriticallyillsepticpatientsafterhigh-riskcardiovascularsurgerytreatedattheintensivecareunitsofa nationalcardiovascularsurgerycentrebasedonTDMresults.

MaterialsandMethods Weretrospectivelyanalysedthedataof patientstreatedatourcentrefromApril2022toAugust 2023.Atotalof15patients(11men,fourwomen)receiving empiricortargetedlinezolidtherapyguidedbyTDMwere included.Bloodsampleswerecentrifugedimmediatelyafter beingcollected,andserumlinezolidlevelsweremeasured within24hours.Troughlevelswereevaluatedwhenusingan intermittentdosingregimen,whilebloodwastakenatrandom timesafterreachingthesteadystatewhenacontinuousinfusionwasapplied.

Results Doseadjustmentswereperformedin11patientsbased onTDMresults.Optimallinezolidexposurewasonly achievedwhenhigherdoses(1800–2400mg/24h)wereadministeredbycontinuousinfusion.Thisregimen,whichwassubsequentlyintroducedintoroutinecare,ledtolinezolid overexposureinasinglepatient.Dosereductionwithclinical improvementwasaccomplishedinthreepatients.Serumlinezolidlevelsshowednocorrelationwithkidneyfunction,age, orgender.

ConclusionandRelevance Optimallinezolidexposureoften cannotbeachievedwithstandarddosingregimensincritically illpatientsafterhigh-riskcardiovascularsurgery.Higherdoses andcontinuousinfusionregimesmayberequiredinthispopulation.TDMisanimportanttoolforguidingtherapy.

NP-012 IMPROVINGTHECLINICALPHARMACISTHANDOVER PROCESSUSINGANADAPTEDISBAR COMMUNICATIONTOOLWHENTRANSFERRING PATIENTSFROMCORKUNIVERSITYMATERNITY HOSPITAL(CUMH)TOANINTENSIVECAREUNIT(ICU) WITHINCORKUNIVERSITYHOSPITAL(CUH)

MariaMulrooney,AlanaDineen,JoanRyan,DeirdreLynch.

10.1136/ejhpharm-2024-eahp.12

Introduction Clinicalhandoverhasbeenidentified,both nationallyandinternationally,asahigh-riskstepinapatient’ s hospitaljourney.Barrierssuchaspoorcommunicationcan contributetovariationsinpractice.1

Theuseofdifferentelectronichealthcarerecordsbetween CUMHandtheICUinCUHcanleadtotimelyandineffectivehandover.Inordertoensureclinicalhandoverofcritical patientsfromCUMHtoCUHisnotjeopardised,anISBAR toolwasadaptedtostandardisethepatienthandoverprocess betweenclinicalpharmacists.

Aims

. Toimplementacommunicationhandovertoolfor pharmacists,tooptimisepatientsafetyandreduceriskof errorormiscommunicationbetweenelectronichealthcare records,whencriticallyunwellpatientsaretransferredfrom CUMHtotheCUHICU.

. Todeterminethebenefitofthistoolbyassessingpharmacist responses.

Method TheNationalClinicalGuidelineISBARcommunicationtool2 wasadaptedforpharmacistuseinCUMHforsafer transferofobstetricsandgynaecologypatientsandtheiridentifiedrequirements.

Toevaluatethebenefitofthetool,asurveyquestionnaire wasdistributedtoICUpharmacistsforfeedback.

Conclusion Attimeofabstractsubmission,theISBARtool wasnewlyimplemented.Feedbackfromuserswaslimitedbut positive.

SinceimplementationinJanuary2023,theISBARtoolwas completedfor100%ofpatientstransferringtoICU.

Pharmacistfeedbackreportedsatisfactionwiththecommunicationmethod,usabilityofthetool,accuracyandefficiency ofthehandover.

REFERENCES

1.DepartmentofHealth(2014).Communication(ClinicalHandover)inMaternity ServicesNationalClinicalGuidelineNo.5.Dublin:StationaryOffice.

2.DepartmentofHealth(2015).ClinicalhandoverinAcuteandChildren’sHospital ServicesNationalClinicalGuidelineNo.11.Dublin:StationaryOffice.

ConflictofInterest Noconflictofinterest.

1ISG-001 ANALYSISOFTHEUSEOFORALONCOLOGY TARGETEDTHERAPIESINAREGIONOFSPAIN CRosasEspinoza*,VAlonsoCastro,EMarotoGarcía,MDGarcíaCerezuela,BSantos Mena,MNievesSedano,EPGómezCaballero,PJiménezMoreno,DAlioto,BLópez Centeno,MJCalvoAlcántara. ServicioMadrileñodeSalud,SubdirecciónGeneralde FarmaciayProductosSanitarios,Madrid,Spain

10.1136/ejhpharm-2024-eahp.13

BackgroundandImportance Individualisedtreatmentsarethe mostimportantoncologypharmacotherapeuticinnovation nowadays.Thehighcostofsuchtreatmentsmayhindertheir incorporationintoclinicalpractice.

AimandObjectives Toanalysetheimpactoftheincorporation oforaloncologytargetedtherapies(OOTT)intoroutineclinicalpracticeinaregion.

MaterialandMethods Retrospective,descriptivestudyofthe uptakeandeconomicimpactofOOTTbetween2012and 2022.

Analysisofincorporationandeconomicimpactincluded OOTTforsixmoleculartargets,whichweredispensedin HospitalPharmacyServices.ALK/ROS1mutationswereanalysedtogetherbecausetheindicationofOOTTcouldnotbe identified.

Regionalconsumptionregisterswereusedasasourceof data.

Results AvailableOOTToptionsincreasedby500%,with18 authoriseddrugsattheendofthestudy.In2012–2013,only ALK/ROS1andEGFRdrugswereavailable.BRAFandMEK drugswereaddedin2014andBRCAdrugsin2015.

Thepercentageoftreatmentsused(greaterthan10%)by mutationareshownintable1.

Abstract1ISG-001Table1

MutationBeginningofthestudyEndofthestudy

ALK/ROS1Crizotinib(100%)Alectinib(44%),lorlatinib(26%),crizotinib (15%)

EGFRErlotinib(100%)Osimertinib(84%),afatinib(7%),erlotinib (6%)

BRAFVemurafenib(72%),dabrafenib (28%)

Dabrafenib(54%),encorafenib(41%)

MEKTrametinib(100%)Trametinib(60%),binimetinib(38%) BRCAOlaparib(100%)Niraparib(49%),olaparib(47%)

In2012,EGFRdrugshadthegreatestimpactonboth treatedpatients(99.8%)andpharmaceuticalexpenditure

(100%).In2022,BRCAdrugshadthegreatestimpacton treatedpatients(34%),whilethehighestpharmaceutical expenditure(34%)wasstillonEGFRdrugs.

Bytheendofthestudy,OOTTtreatmentshadincreased by179%andpharmaceuticalexpenditureby494%.Drugdistributionbymutationwas34%BRCA,28%EGFR,15% ALK/ROS1,13%BRAF,and11%MEK.Theeconomicimpact was108,138,186C ¼ accumulatedovertheentirestudyperiod. ConclusionandRelevance Targetedtherapieshavehadarelevantimpactinrecentyears,withnewdrugsanddiagnostic techniquesincreasingtheeligiblepopulation.Stringentevaluationandadequateselectionofthesedrugsarenecessaryin ordertooptimisetheincorporationofinnovativetherapies whileguaranteeingthesustainabilityofthepublichealthcare systeminSpain.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-002 PHARMACISTRISKSTRATIFICATION:A CHARACTERISATIONOFPATIENTSWITHLOW SOLUBLEUROKINASEPLASMINOGENACTIVATOR RECEPTORWHODIEDWITHIN90DAYSOFHOSPITAL DISCHARGE

1,2LWSChristensen*, 1EIversen, 1AAndersen, 3,4ABWalls, 1,5LJHRasmussen, 1,6,7OAndersen, 1TKallemose, 1,2,4MBHoulind. 1CopenhagenUniversityHospital-Hvidovre, DepartmentofClinicalResearch,Hvidovre,Denmark; 2RerlevHospital,TheCapitalRegion Pharmacy,Herlev,Denmark; 3Rigshospitalet-Copenhagen,TheCapitalRegionHospital Pharmacy,Copenhagen,Denmark; 4UniversityofCopenhagen,DepartmentofDrugDesign andPharmacology,Copenhagen,Denmark; 5DukeUniversity-Durham,Departmentof PsychologyandNeuroscience,NorthCarolina,USA; 6UniversityofCopenhagen,Department ofClinicalMedicine,Copenhagen,Denmark; 7CopenhagenUniversityHospital-Hvidovre, Emergencydepartment,Hvidovre,Denmark

10.1136/ejhpharm-2024-eahp.14

BackgroundandImportance Solubleurokinaseplasminogen activatorreceptor(suPAR)isamarkerofsystemicchronic inflammationthoughttoreflectoveralldiseaseburden.suPAR hasbeensuggestedasaprognosticmarkerinclinicalsettings, sinceelevatedsuPARlevelsarestronglyassociatedwithmortality.ResearchershavesuggestedusingasuPARlevel<3ng/ mLforsafeandearlydischargefromtheemergencydepartment(ED).However,asubsetofpatientswithlowsuPAR dieswithin90daysofhospitaldischarge,andtheriskissignificantlyassociatedwithanincreasedmedicationuse.

AimandObjectives TheaimofthepresentstudywastocharacterisepatientswithlowsuPAR(<3ng/mL)whodiedwithin 90daysofhospitaldischargebyexploringfactorsotherthan suPARthatmayexplainthiscontradictoryfindingofmortality amongpatientswithlowsuPAR.

MaterialandMethods Thisobservationalregistry-basedstudy includedconsecutivelyadmittedmedicalpatientstotheEDat ourhospitalfromNovember2013toMarch2017.Weused validateddatabasesandnationalregistriestodescribepatients’ characteristics(age,medicationuse,diagnoses,frailtyindex).

Results ComparedtopatientswithlowsuPARwhosurvived (n=15,122),thosewhodiedwithin90days(n=87)had higherage(75.4years),medicationuse(7.0;71.3%withpolypharmacy),morebloodtestsoutsidereferenceintervals(5.0) (includingC-reactiveprotein,neutrophils,albumin),andthe mostcommondiagnoseswerechronicpulmonarydisease (27.6%),cerebrovasculardisease(18.4%),anddementia (11.5%).Themostcommonmedicationswereantithrombotic

agents(44.8%),lipidmodifyingagents(plain)(39.1%),and otheranalgesicsandantipyretics(33.3%).

ConclusionandRelevance PatientswithlowsuPARwhodied hadotherriskfactorsexplainingtheirmorbidityandmortality riskthanwhatwasreflectedbytheirsuPARlevel.Using suPARasaproxyfordiseaseburdeninclinicalsettingsmay bechallenginginsituations,wherepatientsreceiveahigh numberofmedications.Wesuggestincludingmedicationuse, routinebloodtests,andselecteddiagnosiscodesincombinationwithsuPARwhenstratifyingpatientsbasedontheirrisk ofadverseclinicaloutcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-003 DIGITALTRANSFORMATIONOFTHEHOSPITAL/ TERRITORIALPHARMACY – TELEPHARMACYNEW DIMENSIONOFPATIENTCAREMODELS

1GMingolla*, 1DFerrante, 2CDeCastris, 2GFasano, 3FFasano, 4GMalagnino, 5VGColacicco. 1ASLTaranto,Pharmacy,MartinaFranca,Italy; 2UniversityofSiena, Pharmacy,Siena,Italy; 3UniversityofTaranto,MedicineandSurgery,Tatanto,Italy; 4ASL Taranto,HealthDirectorate,MartinaFranca,Italy; 5ASLTaranto,Generaldirection,Taranto, Italy

10.1136/ejhpharm-2024-eahp.15

BackgroundandImportance Digitalhealthpromisestotransformthewayinwhichhealthcareisprovided,makingitpossibletoexplorethepossibilityoftakingcareofthepatient whoaccesseshospitalpharmacieswithanorganisedmethod forappointmentsthattakeintoaccountthepersonalised therapiesofeachofthepatients,butalsoofthelogisticsof thespaces,ofthesustainabilityofthehealthcareservicein termsofhumanandeconomic-financialresources.

AimandObjectives Exploittechnologybystructuringnew organisationalmanagementmodelsforpatientcare,toreduce longwaitinglinesandfacilitateaccesstopharmacypremises.

MaterialandMethods Fortypercentofpatientstreatedatthe hospitalpharmacywithhigh-costtherapieswereenrolledin thetelepharmacypilotproject.Theuseofacomputerapplicationsystemwithconnectedsoftwarebymeansofapplications downloadedindependentlybythepatientswasimplemented. Thetwosystemscommunicatewitheachotherthankstothe pharmacist’scompilationofpersonalisedtherapysheetswhich reportthepersonalisedtherapeuticdiaryinthesystem.This allowsyoutocalculateexactlythedayonwhichthepatient willneedthenewdispensingaccordingtotheautonomy decidedbythepharmacist,inatimerangenolongerthan7 daysfromtheendofthetherapy.

Results Byassisting1800patients,reducingtheinfluxof them,fordaysandhours,allowsthepharmacisttoregulate andknowthenumberofpatientswhowillhavetoaccessthe Serviceduringtheday,organisingthecaretimes.Waiting timesarereducedby60%bybeingabletoanticipatethe preparationoftherapypackagestobedispensedthankstothe systemdashboardwhichshowsthenumberandtypeofpersonalisedtherapiestobeprovidedduringtheday.Thesame mechanismmadeitpossibletoestimatetheneed,reducing thestockofhigh-costtherapiesby1.8%,avoidingthefreezing ofresourcesandthepossibilitythatthepatientwillreceive thetherapyinduetime.

ConclusionandRelevance Facilitatingaccesstopharmacy premisesavoidsovercrowding,improvessafety,user

satisfaction,careplanningbythehospitalpharmacistandmultipliesthevalueofhumanresources,thequalityofproactive workandtheeconomicplanningofpurchasesofhigh-cost drugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-004 MULTIDISCIPLINARYMANAGEMENTOFCENTRAL VENOUSCATHETERS(CVCS)INHAEMODIALYSIS PATIENTS

1GMingolla*, 1DFerrante, 2CDeCastris, 2GFasano, 3FFasano, 4FLaghezza, 4ALaguardia, 4MAPerniola, 5GMalagnino, 6VGColacicco. 1ASLTaranto,Pharmacy,MartinaFranca,Italy; 2UniversityofSiena,Pharmacy,Siena,Italy; 3UniversityofTaranto,MedicineandSurgery, Taranto,Italy; 4ASLTaranto,NephrologyandDialysis,MartinaFranca,Italy; 5ASLTaranto, HealthDirectorate,MartinaFranca,Italy; 6ASLTaranto,GeneralDirection,Taranto,Italy 10.1136/ejhpharm-2024-eahp.16

BackgroundandImportance Theinternationalguidelines(IG) giveindicationsforthemanagementofcentralvenouscatheters,toguaranteecorrectactions,proceduresandcontrol measuresandpreventrelatedinfections.

AimandObjectives Theroleoftheclinicalpharmacistinthe multidisciplinarycontextconductedtosupportthemanagementofdevicesisfundamentalinthetreatmentandpreventionofcentralvenouscatheters(CVC)relatedinfections.

MaterialandMethods Followingaproceduralandrisk-costbenefitanalysisofCVCmanagementoperationsinhaemodialysispatients,itisdecidedtochangetheCVCwashing procedure.Weproceedwiththepurchaseofpre-builtwashingdeviceswhichreplacethephysiologicalbottles,spikes, syringesandeverythingcontemplatedbytheGuidelinesfor thepreparationofthesterilefi eldinasinglesolution,facilitatingoperationsandreducingwashingmanipulationsforthe 36CVCcarrierswhorepresent43%ofhaemodialysis patients.

Results Theuseofasingledeviceconsistingofapre-filled syringe,ratherthansix,hasmadeitpossibletoreducethe washingproceduretotwomanoeuvers,ratherthaneightdifferentmanoeuvers,reducingtheriskofinfectionshypotheticallybysixtimeswiththesameoperation,paradoxicallyalso a7%reductioninthecostofthesingleoperation.Consideringthatonaveragethreewashes/patientareperformed,for threeaccesses/weekthesavingtranslatesintoapproximately 1000euros/year.

ConclusionandRelevance Thecontinuoussearchforimprovementinthecareprocessesdefinedbythegoldstandardsgeneratestheneedfortargetedandaccurateinterventions,which donotalwayscorrespondtoanincreaseincosts,buttoa needformultidisciplinarycaresupportedbytrainingand knowledge.Theexperienceofwhathasbeenimplementedit hasgeneratedappropriatenessofoperationswithdirectbenefitsonthequalityofcare,withsignificantrepercussionsin termsofsustainabilityanddirectandindirectsavingsgiven theimpactthatpoormanagementofCVCsgeneratesinterms ofhospitalisations,antibiotictreatments,explantsandreplacementsofthesameaswellasofcaretimeandriskforthe patient.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-005 ASSESSMENTOFAMANAGEMENTTOOLREGARDING MEDICALDEVICEVIGILANCE

BGalhano*,MMNans,PGiacalone,GDusabe,JDeGregori,HFeyeux,VGomes, CBoronad,MAgullo. CentreHospitalierdeCannes,AlpesMaritimes,06400Cannes, France

10.1136/ejhpharm-2024-eahp.17

BackgroundandImportance Legislationregardingmedical devicevigilancerequiresthereportingofanyincidentinvolvingmedicaldevices.Withinourhospital,theadverseevent’ s declaration(AED)processhasbeenentirelycomputerisedsince July2019.Eachadverseevent(AE)reportedisaddressedto thededicatedvigilanceofficers.

AimandObjectives Theobjectiveofthisworkistocarryout anassessmentoftheAEDactivitybeforeandafterthesoftwarerollout.

MaterialandMethods ThereportingofAEswasinitiallyprocessedthroughpaperformatin2019andafterwiththeAE reportingsoftwarefromJanuary2020toDecember2022. EachdeclarationofAEwasanalysedbyapharmacistandcategorisedbasedonitsseverityandpreventability.

Results Over212AEDswerereported:32in2019,31in 2020,60in2021and89in2022.Themainreporting departmentsarethe:intensivecarecardiacunit,surgeryunit andhaemodialysisunitwithrespectively51%,13%and9% oftheAED.Damageorvisualdefectofthemedicaldevice representsabout40%oftheAEDwhileproductfailureduringuserepresents45%ofthereports.Followinganalysis, 16%oftheAEDhavebeenclassifiedas ‘almostaccident’ , 81%as ‘undesirableevents’,2%as ‘seriousadverseeventwith lowimpact’ and1%as ‘seriousadverseevent’.AllAEDswere declaredtotheFrenchAgencyforMedicinesandHealth ProductsSafety.Regardingtheiravoidability,theAEDswere classifiedas ‘preventable’ , ‘likelypreventable’ , ‘unavoidable’ and ‘likelyunavoidable’ withrespectively79%,13%,5%and 3%oftheAEDs.TheAEDsmadein2019,2020and2021 arealltreatedandclosed,for38AEDswearestillawaitinga responsefromthemanufacturers.

ConclusionandRelevance In4years,thenumberofAEDshas nearlyquadrupled.Thisincreaseislikelytheresultofaccessibilityanduserfriendlinessofthesoftware,aswellasthe implementationoflocalawarenesscampaignsregardingAEDs. AnewoverviewoftheAEDshouldbescheduled.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-006 ECONOMICSAVINGOFTHEPREPARATIONOF SUBCUTANEOUSFORMULATIONSCOMPAREDTO INTRAVENOUS:FOCUSONDARATUMUMABINTHREE HEALTHCARECOMPANIES

1TGregori*, 2AFerraioli, 3VBiasi, 1AVergati, 3GBagaglini, 3GBonanni, 2EGiordani, 1ACavaliere. 1ASLViterbo,HospitalPharmacy,Viterbo,Italy; 2ASLRieti,UOCPoliticadel FarmacoeDispositiviMedici,Rieti,Italy; 3ASLLatina,UOCAssistenzaFarmaceutica,Latina, Italy

10.1136/ejhpharm-2024-eahp.18

BackgroundandImportance Thenewonco-haematologicalformulationsaremovingmoretowardssubcutaneousadministrationwhichrepresentsatechnologicalinnovationcomparedto

intravenousformulationsandallowsforagreaternumberof accessestotherapiesgiventhereducedadministrationtimes.

AimandObjectives Theobjectiveofthisworkistocalculate thedirectcostsofthemedicaldevicesnecessaryforinfusion therapyandtheindirectcostsofthenursingstaffresponsible forsettingupintravenoustherapiesfordaratumumab.

Westudiedthe2022dataofthreelocalhealthcare companies.

MaterialandMethods Withcompanysoftwarewedetermined thecostofthedevicesusedinintravenousandsubcutaneous preparationandthenumberofpatientsreceivingdaratumumabtherapyin2022,consideringforeachpatient24cycles oftherapyasindicatedinthedosageschedules.

Results Thecostcalculatedforasingleintravenouspreparation isC ¼ 12.01,consideringthefollowingdevicesnecessaryfor administration:

Twovial-spikesC ¼ 2.84,twosyringeswithconnectors C¼ 2.48,clave-valveC ¼ 2.76,bagC ¼ 0.60,syring-luerlockfor diluentC ¼ 0.50,secondaryinfusionsetC ¼ 2.20,cap-capC ¼ 0.25, UV-protectorbagC ¼ 0.25.

Thecostforsubcutaneousadministrationisdifferent,equal toC ¼ 3.29forvial-spike,syringeandconnector,UV-protector bagandcap-cap.

Theindirectcostcalculatedontheaveragehourlynursing costofC ¼ 27.83andconsideringa10-minuteset-upcommitmentfortwonursingunitsisC ¼ 9.28.

In2022,55patientsinhealthcarecompany1,69patients inhealthcarecompany2,and12patientsinhealthcarecompany3weretreatedwithdaratumumab.

ConclusionandRelevance Thetotalcostofthedevicesand thehealthcarestaffresponsibleforpreparingtheinfusionis equaltoC ¼ 21.66comparedtoC ¼ 3.29forthecostofpreparingthesubcutaneousinjection.Thesubcutaneousadministrationismoreconvenientthanintravenous,withasavingof C¼ 18.55peradministration.Sincethepricesofthetwoformulationsofdaratumumabareequal,thiscorrespondstoan actualsaving.

Thissavingfortheentireyear2022andforthe24 plannedadministrationcycleswouldproduceareductionin spending,accountedforintheset-upcosts,equaltoC ¼ 24,486 forhealthcarecompany1,C ¼ 35,885forhealthcarecompany 2,andC ¼ 6,241forhealthcarecompany3.

Tothiswemustaddanincreaseinthesafetyoftheoperatorswhoprepareandadminister,greaterpatientcompliance andadecreaseinthesocialcostsofthepatientundergoing therapy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-007 HTAANALYSISFORTHEINCLUSIONOFANDEXANET ALFA(AA)WITHINTHEHOSPITALTHERAPEUTIC HANDBOOK(HTH) – THEEXPERIENCEOFANITALIAN CENTRESPECIALISINGINCARDIOVASCULAR DISEASES

1SZitelli*, 1AIezzi, 1VTeso, 1GBallardini, 1BTebaldini, 2EMFaioni, 3ABallotta, 4EOmodeo Sale’ 1MonzinoCardiologyCentre,HospitalPharmacy,Milan,Italy; 2MonzinoCardiology Centre,AnalysisLaboratory,Milan,Italy; 3MonzinoCardiologyCentre,Post-Operative IntensiveCareUnit,Milan,Italy; 4EuropeanInstituteofOncology,HospitalPharmacy,Milan, Italy

10.1136/ejhpharm-2024-eahp.19

BackgroundandImportance ThedrugAndexanetAlfa(AA), ananti-haemorrhagicantidotecapableofrapidlyreversingthe effectoffactorXainhibitorDOACS(Apixaban,Rivaroxaban), wasrecentlyintroducedonthemarket.The4-factorprothrombincomplex(CPP4),alreadyinuseatourcentre,also hasthesameindication.

AimandObjectives Incollaborationwithahaematologistand acardiologist-anaesthetist,anHTAanalysiswasconducted withtheaimofevaluatingtherealneedfortheinclusionof AAwithintheHospitalTherapeuticHandbook(HTH)andits useincardiacsurgeryemergencysituationsandcardiovascular emergency.

MaterialandMethods Abriefreviewoftheliteraturecurrentlyavailableonvarioussearchengines(PubMed,clinicaltrials.gov)wasconductedbythehospitalpharmacy,lookingin particularforcomparisonstudiesbetweenAAandCPP4.In parallel,asearchwasconductedforpoisoncontrolcentres (PCC)andhospitalcentresclosetothefacilitythathadthe drugavailable,aneconomicevaluationandananalysisofthe SummaryofProductCharacteristics(SmPC).

Results Fromtheretrospectivestudiesanalysed(eight,of whichonlythreemeta-analyses),datawerecollectedandsummarisedintermsofefficacy/haemostasisrate(AA:77.88%vs CPP4:76.47%,averagedata)andsafety/incidenceofposttreatmentthromboembolicevents(AA:10.47%vsCPP4: 5.98%averagefigure).

Fromtheparallelresearch,thefollowingresultsemerged: availabilityoftheantidote(onePCCandtwohospital centres);treatmentcosts(AA:Euro52,666.52vsCPP4:Euro 3795.90);reimbursement(non-reimbursabledrug);AApreparation/infusiontimes(approximately2h30).

ConclusionandRelevance Theanalysedstudies,subjecttobias duetothevariabilityoftheanalysedsample,weremainly focusedonintracranialhaemorrhageeventsandnotoncardiac surgicalcomplications.Fromthese,italsoemergedthatAA promotesarefractorinesstotheanticoagulanteffectofunfractionatedheparin,makingtheuseofAAincompatiblein patientcandidatesforacardiacsurgicalprocedurethat requirespre-heparinisation.

Therefore,byvirtueofthepoorandunfavourablequality ofthetrialsandtheunfavourablecost-effectivenessandriskbenefitratios,itwasnotconsiderednecessarytointroduce thedrugwithintheHTH.

REFERENCESAND/ORACKNOWLEDGEMENTS

Webreference(https://pubmed.ncbi.nlm.nih.gov)

DigitalObjectIdentifier(DOI):

1)https://doi.org/10.1016/j.jacc.2021.04.061;

2)https://doi.org/10.1016/j.ajem.2022.02.029;

3)https://doi.org/10.1177/10760296211039020;

4)DOI:10.1097/CCM.0000000000005059;

5)https://doi.org/10.1182/hematology.2019000074;

6)DOI:10.7759/cureus.20632;

7)https://doi.org/10.1002/rth2.12518;

8)DOI:10.1213/XAA.000000000000163;

9)https://doi.org/10.1007/s12028-022-01573-5;

10)DOI:10.1213/XAA.0000000000001636 ConflictofInterest Noconflictofinterest.

1ISG-008

USABILITYEVALUATIONOFANINSULIN MANAGEMENTSOLUTIONWITHINANELECTRONIC PATIENTRECORD

1ERoche, 1SKelly*, 2MVaughan, 1SRyan, 1DPaul, 2ERelihan. 1StJames’sHospital, InformationTechnologyIT,Dublin,Ireland; 2StJames’sHospital,Pharmacy,Dublin,Ireland

10.1136/ejhpharm-2024-eahp.20

BackgroundandImportance Thereisevidencetosuggestthat poorusabilityofhealthinformationsystemsisassociatedwith negativeoutcomesincludinglowefficiencyandincreasedrisk ofmedicalerror.Standardisedusabilityquestionnaireshave beendevelopedtoevaluateusabilityandrecentlyanoveltool wasdevelopedtomeasuretheusabilityofclinicaldecision supportsystemsinhealthcareenvironments. 1 Acustomised insulinmanagementsolutionwasdevelopedandimplemented inourhospitaltomigrateinsulinprescribing,administration andreviewfrompapertoourelectronicpatientrecord(EPR). Assessingtheusabilityofthesolutionwasidentifiedasaway ofdeterminingpotentialareasforoptimisationandtraining post-implementationandofinformingfuturedesigndecisions.

AimandObjectives

. Toassessusabilityoftheinsulinmanagementsolution

. Compareusabilityscoresacrosstheclinicaldisciplines

MaterialandMethods TheHealthcareSystemsUsabilityScale (HSUS)wasusedtoassessusabilityamongsystemusersfrom themedical,nursing,pharmacyandclinicalnutritionprofessions. 1 HSUSassessedusabilityinfoursubscales;patient safetyanddecisioneffectiveness,workflowintegration/easeof use,workeffectivenessandusercontrol.AnIndependent-SamplesKruskal-WallisTestwasusedforstatisticalanalysis.

Results 226usersfrommedical,nursing,pharmacyandclinical nutritiondisciplinescompletedtheHSUSassessment.The averageusabilityscorewas81%.Therewasnosignificantdifferenceinoverallusabilityscoresbasedontherespondents’ discipline.Concerningsubscales,theonlysignificantdifference betweendisciplineswasintheworkflowintegration/easeof usedomainbetweenthepharmacistandnursinggroups (70.8%vs79.6%p=0.020).

ConclusionandRelevance Theinsulinmanagementsolution implementedintotheEPRwasregardedashighlyusable basedontheresultsoftheHSUSincomparisontoanother studywheretheusabilityscorewasonly64%.1 Thevariability betweenthepharmacyandnursingresultwarrantsfurther investigationandwillinformengagementrequirementsfor futureprojectwork.Finally,thisstudyaddstotheevidence baseinthisimportantareawherereal-worlddataisstill limited.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.GhorayebA,DarbyshireJL,WronikowskaMW, etal.Designandvalidationofa newHealthcareSystemsUsabilityScale(HSUS)forclinicaldecisionsupport

systems:amixed-methodsapproach. BMJ Open2023;13:e065323.doi:10.1136/ bmjopen-2022-065323.

ConflictofInterest Noconflictofinterest.

1ISG-009 PHARMACOECONOMICANALYSISOFAN ALTERNATIVEDOSAGEREGIMENFORPALIVIZUMAB 1ACrespo*, 1ETevar, 1OMesa, 1DSRomero, 1JAMartin, 1JEsquivel, 2MMartinez-Pinna, 1ADominguez. 1ComplejoHospitalUniversitarioNuestraSeñoradelaCandelaria,Hospital Pharmacy,SantaCruzdeTenerife,Spain; 2HospitalUniversitariodeCanarias,Hospital Pharmacy,SantaCruzdeTenerife,Spain

10.1136/ejhpharm-2024-eahp.21

BackgroundandImportance AccordingtotheSummaryof ProductCharacteristics(SmPC)1 ofpalivizumab,theusualregimenconsistsoffivedosesof15mg/kg/dose,intramuscularly, every28days.

Forthe2022–2023campaign,weestablishedanovelregimenbasedontheReuteretal.,2 pharmacokineticmodel wherebythedosageperkgdecreasesastheseasonprogresses, andtheinitialdosageisdefinedbasedonpostmenstrualage (PAGE)whichisdescribedasgestationalagepluschronologicalage,bothmeasuredinweeks(Table1).

AimandObjectives Toassesstheeffectivenessofanovelpavilizumabregimenaswellastodeterminethecostsavings derivedfromtheimplementationofthisregime.

MaterialandMethods Patientswereclassifiedaccordingto theirPAGE.Thetotaldosagereceivedperchildwiththe novelprotocolwascomparedwiththedosagethattheywould havereceivedhadtheybeengiventhedosageasspecifiedin theSmPC.

Theeffectivenessofthenovelprotocolwasassessedshowingnohospitaladmissionsnoremergencydepartmentvisitsin patientsundertakingthenovelregimen.

Thetotalexpenditureonpalivizumabduringthe2022–2023seasonwasanalysedcomparingtheexpenditureonthe PAGE-definedregimentothetheoreticalexpenditureofSPCdefinedregimen.

Results

Abstract1ISG-009Table1 Showsthealternativedosage regimenbasedonthePAGEsystem

Abstract1ISG-009Table2 Showsthecostsavingsderivedfromtheuseofthenoveldosageregimen

ConclusionandRelevance ThePAGE-definedregimenresults insignificantcostsavingscomparedwiththeconventional SmPC-definedregimen.

Thepharmacist’sinterventioncontributestotheoptimisationofhealthresources,furtherincreasingthesustainabilityof thehealthsystem.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.ema.europa.eu/en/documents/product-information/synagis-epar-product-information_en.pdf

2.https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/psp4.12364

ConflictofInterest Noconflictofinterest.

1ISG-010 ECONOMICIMPACTOFTHECLINICALPHARMACIST ONTHEREDUCTIONOFDRUG-RELATEDPROBLEMS BEFORETHEINITIATIONOFANANTI-TUMOUR TREATMENT – APROSPECTIVEMULTICENTRETRIAL

1JSGiraud*, 2VSavoldelli, 2GPerrin, 2BSabatier, 1RBatista, 3FGoldwasser, 1AThomasSchoemann, 4ADegrassatTheas. 1CochinHospitalAssistancePublique – HopitauxdeParis, PharmacyDepartment,Paris,France; 2HopitalEuropeenGeorgesPompidou-Assistance Publique – HôpitauxdeParis,PharmacyDepartment,Paris,France; 3CochinHospital AssistancePublique – HopitauxdeParis,OncologyDepartment,Paris,France; 4General AgencyofEquipmentsandHealthProductsAgeps,PharmacyDepartment,Paris,France

10.1136/ejhpharm-2024-eahp.22

BackgroundandImportance Multiplestudieshaveshowna highrateofdrug-relatedproblems(DRP)inpatientswithcancer.Toreducethisrisk,severaloncologydepartmentshaveset upmultidisciplinaryassessmentprogrammesthatincludepharmaceuticalconsultation.

AimandObjectives Inacontextoflimitedresourcesallocation,ourstudyaimstoevaluatetheeconomicimpactofclinicalpharmacists’ interventions(PIs)onDRPdetectionfroma hospitalperspective.

MaterialandMethods AFrenchprospectivenon-interventional double-centrestudywassetupin2020.Patientstreatedfor solidtumourswereincludedbetweenFebruary2020and March2021.

First,wecalculatedthepharmaceuticaltimebasedonconsultationsandanalysistimes.Thetimespenthasbeenvalued (i)toanaverageannualfull-timeequivalent(FTE)and(ii)by thegradeofthecontributor(2022salaryscales).Twoscenarioshavebeenestablished(low/highsalarygrades).

Second,weselectedPIsregardingclinicallysignificantdrugdruginteractionsrelatedtodrugtoxicity(evaluationmadeby anexpertpanel).Wesoughttoestimatethecostbasedonthe avoidedclinicalconsequences.Wevaluedthelikely ‘diagnosis relatedgroups’ oftheavoidedeventthankstothe2019 nationalsurveyonhospitalcosts.Costswereweightedbyan occurrenceprobabilitybasedonthelevelofevidence:p=0.01 forverylow;p=0.1forlow;p=0.4formoderate;and p=0.6forhigh.

Results 438cancerpatientswereincluded:62%ofmales, meanageof65+/-13years.

Perpatient,thepharmacistaveragetimewas39+/-15 minutes:23+/-7minutesofinterviewand16+/-11minutesof analysis.Totaltimewas283hours,andtheestimatedannual FTEwas0.13.ThetotalcostwasestimatedbetweenC ¼ 4,199 (lowsalaries)andC ¼ 5,250(highsalaries)peryear.Costwas estimatedbetweenC ¼ 11.4andC ¼ 14.3perpatientandbetween C¼ 18.42andC ¼ 23.02perdrug-druginteraction.

122/266PIswereevaluatedtobeclinicallysignificantdrugdruginteractionsrelatedtodrugtoxicitythatcouldhave causedahospitalisation.Costofhospitalisationfortheseseriousavoidableadverseeventswasestimatedonaverageat C¼ 4,869.Avoidedhospitalisationcostswereestimatedat C¼ 180,633.

ConclusionandRelevance Clinicalpharmacistsareanindispensableandlegitimatememberoftherapeuticassessmentprogrammesforcancerpatients.TheyhelpinreducingDRPina cost-effectivemanner.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-011 OPPORTUNITYFORDAILYHOME-BASED MANAGEMENTOFCHRONICPATIENTSFROMTHE SAMEAREAUSINGANINTERPROFESSIONAL NETWORKMODELDEVISED,SETUPAND IMPLEMENTEDFORTHECOVID-19

IFiloso,MRIacolare,IMonti,ATortora,LMFalconio*. SanGiulianoHospital-U.O.S.D. HospitalPharmacyService-ASLNapoli2Nord,U.O.S.D.HospitalPharmacyService,San GiuglianoinCampania-Napoli,Italy

10.1136/ejhpharm-2024-eahp.23

BackgroundandImportance TheCoronavirusSARS-CoV-2 pandemichighlightedthefragilityofNationalHealthService basedonatoospecialisedandhospital-centredapproach.In thepandemiccontext,theneedtoreversethemodelby focusingontheneedsofthecommunitybecameclear.

AimandObjectives Themainaimofpromotinghome-based managementasmuchaspossibleforbothchronicandacute conditions,canbeachievedthroughtheutilisationofamodel ofanintegratednetworkinvolvingallstakeholdersinthecare andassistanceprocess,utilisingnewtechnologiesandtelemedicinesystemsasdoneduringthepandemicperiodwithanad hocinterprofessionalnetworkwithinalocalhealthauthority.

MaterialandMethods Themodelutilisedinterconnectedand functionallyintegratedstructuresandnodes,withdefined pathwaysandoperationalproceduresbasedondedicatedtelemedicineplatforms.TheseplatformsfacilitatethecomprehensivemanagementandcareofCovid-19patientsbyall networkstakeholders.Resultsweremonitoredusingspecific anddedicatedindicators,collectingandanalysingdatafrom theperiodwhenthecareofpositiveCovidpatientsbegan (November2020),whosemanagementdidnotrequire hospitalisation.

Results FromNovember2020toDecember2021,thenumber ofpatientslivingintheterritoryunderhomemanagementin HomeHealthCareUnits,non-ambulatoryresidentialfacilities undergoingnon-pharmacologicaltherapy,non-ambulatoryvaccinatedindividualsreceivinghomevaccination,andvaccinated individualsinresidentialfacilities,amountedto38,223. Amongthese,37.8%testedpositiveforCovid.Thetotal numberofaccessesduringthisperiodwasapproximately 94,000.Theshifthasbeensignificant,transitioningfrommanagingtheentiretyofpatientsinhospitalstoslightlyover 4.5%ofthetotalmanagedinthatperiod.

ConclusionandRelevance Thereproducibilityofthissystem assuresthepossibilityoffurthernetworkimplementation,not onlyinemergenciesbutalsoforthedailymanagementof chronicpatients.Moreover,inatimewhen,amongother things,Mission6ofthePNRRhasallocatedresources

amountingto15.63billioneurostobeinvestedinthehealthcaresector,mostofwhicharededicatedtorevolutionising ourSSNandensuringitsgreaterefficiencyandeffectiveness intheterritory.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.ColbertGB,Venegas-VeraAV,LermaEV.UtilityoftelemedicineintheCOVID-19 era. RevCardiovascMed. 2020Dec30;21(4):583–587.doi:10.31083/j. rcm.2020.04.188.PMID:33388003.

ConflictofInterest Noconflictofinterest.

1ISG-012 BALANCINGCLINICALBENEFITSANDCOSTSAVINGS: COMPASSIONATEDRUGUSEATANITALIAN UNIVERSITYHOSPITAL – EVIDENCEANDINSIGHTS

1MMezza*, 2RBrunoro, 3GIadicicco, 3MMiscio, 3DMengato, 1DGregori, 3FVenturini. 1UniversityofPadua,Biostatistics – Epidemiology – andPublicHealthUnitUBEP,Padua, Italy; 2UniversityHospitalofPadua,ClinicalResearchUnit,Padua,Italy; 3UniversityHospital ofPadua,HospitalPharmacy,Padua,Italy

10.1136/ejhpharm-2024-eahp.24

BackgroundandImportance Compassionateuseofdrugs(CU) allowspatientswithseriousdiseasesandnofurthertreatment optionstoaccesstreatmentsnotyetapproved.Specialistreferralcentresprovideareferencepointforaccesstothesemedicines,withsignificantbenefitsbothforpatienthealthandfor avoidedcoststothehealthcaresystem.1

AimandObjectives Theaimofthisstudyistodescribethe impact,intermsofclinicaloutcomesandsavedcosts,ofCU ataUniversityHospital.

MaterialandMethods An18-monthretrospectiveanalysisof approvedCUattheAziendaOspedale-UniversitàPadova (AOUP)wasconducted.AmonitoringactivitywasimplementedbytheAOUP ’sClinicalResearchUnitthroughcreationoffollow-upformssubmittedtocorporateOperational Units’ physicians,whichmadeitpossibletotrackthenumber ofpatientsinvolvedinCUprogrammes,theirclinicaloutcomesanddurationoftherapy.Theeconomicimpactwas assessedbycalculatingcost-therapyforeachpatientbasedon drugdosage,durationoftreatment,andex-factorypricepublishedintheOfficialGazetteofItalianRepublic,fordrugs availableonthemarket.

Results Intheanalysedperiod,aCUregimenwasapproved for84patientsmainlyinthehaematology(17patients)and paediatric(24)settings.Ofthetotal,fivepatientsdidnotstart therapyduetodeath,clinicaldeterioration,orpersonalreasons.Theremaining79underwenttreatment.In81%of cases,thisresultedinapartialorcompleteimprovementin theclinicalstatusor,whendegenerativediseasesoccurred,a stabilisationofthedisease.Ontheeconomicside,avoided costsamountedtoC ¼ 7,130,668,62%ofwhichresultedfrom CUofburosumabinpatientswithX-linkedhypophosphatemic osteomalacia.

ConclusionandRelevance CUinaUniversityHospitalbrings bothclinicalbenefitsandpotentiallysignificanteconomic savings.Earlyaccesstoexperimentaltherapiesbothenhancespatients ‘ lifeexpectancyandqualityandfacilitatesthe gatheringofvaluableclinicaldataonpromisinginvestigationaldrugs.Costsavingsgeneratedfromthisapproach canbereinvestedtoexpand,enhance,andmakethe nationalhealthcaresystemmore sustainable.Collaboration betweenteachinghospitals,pha rmaceuticalcompaniesand

regulatoryauthoritiesise ssentialtooptimiseCUprogrammesandensureequitablea ccesstopotentiallylifesavingtreatments.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PilunniD, etal.EurRevMedPharmacolSci 2021;25,20,6365.

ConflictofInterest Noconflictofinterest.

1ISG-013 REAL-LIFEDATAOFCDK4/6INHIBITORSPALBOCICLIB, RIBOCICLIBANDABEMACICLIBINLOCALLY ADVANCEDORMETASTATICBREASTCANCER: EFFECTIVENESSEVALUATION

AIsoardo*,APisciotta,LPoggio. ASLTo5,S.C.FarmaciaOspedaliera,CarmagnolaTo,Italy 10.1136/ejhpharm-2024-eahp.25

BackgroundandImportance Breastcanceristheworld’smost prevalentcancer.Thereareapproximately55000newdiagnosedcasesperyearinItaly.CDK4/6inhibitorsaretargeted orallyavailablecancerdrugs.ThesearehighlyselectiveinhibitorsofCDK4andCDK6,serine-threoninekinasesthatregulatethecellcycleprogression.CDK4/6inhibitorsareindicated forthetreatmentofhormonereceptor(HR)-positive,human epidermalgrowthfactorreceptor2(HER2)-negativelocally advancedormetastaticbreastcancer,incombinationwithan aromataseinhibitororwithfulvestrantinwomenwhohave receivedpriorendocrinetherapy.

AimandObjectives Toprovidereal-worldevidenceofCDK4/6 inhibitors,toanalysedrugeffectivenessinourhospital.

MaterialandMethods Weincludedallpatientsdiagnosedwith locallyadvancedormetastaticbreastcancerwhoreceived CDK4/6inhibitors(palbociclib,ribociclibandabemaciclib) fromnationalmarketingauthorisationto15September2023. Patientswerestratifiedbydrug,age,lineoftherapy,Eastern CooperativeOncologyGroup(ECOG)performancestatus(PS) andcancerstaging.Weassessedprogression-freesurvival(PFS) withtheKaplan-Meiermethod.

Results Sixty-threepatientsreceivedCDK4/6inhibitors.63% weretreatedwithpalbociclib,24%withribocicliband13% withabemaciclib.Themeanagewas65.MedianPFSwas 22.4months.Therewasnostatisticallysignificantdifference betweencasestreatedwithpalbociclibandribociclib.Median PFSintheabemaciclibgroupwasnotreached.Ageolder than65wasasignificantpredictorforPFSbenefit(median PFS27months).51%werefirst-linetreatments(medianPFS 22.4months).Beyondfirst-linetherapymedianPFSwas27 months.49%hadbaselinePSof0.PSwasidentifiedasan importantprognosticfactorforPFS:PS0medianPFS22.4 monthsversusPS1medianPFS15.9months.Locally advancedbreastcancercaseshadworseprognosis(median PFS13months).Werecorded10casesofdosereductiondue totoxicity,butonlyonepatientdiscontinuedtherapydueto treatment-limitingtoxicity.

ConclusionandRelevance AllCDK4/6inhibitorsarebeneficialintermsofPFS:wefoundnosignificantdifferences amongthethreedrugs.Toxicitiesweremanagedbydose reductions.CDK4/6inhibitorsconferPFSbenefitinelderly patientswithmetastaticdisease.Wecanconfirmthatthese drugshaveradicallychangedthetreatmentformetastatic breastcancerwithincreasedratesoftreatmentresponseand PFS.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-014 SUSTAINABLEHEALTHCARE:ANEXAMPLEOF PHARMACEUTICALINTERVENTION

1MPitard*, 1NRouviere, 2OMares, 1VChasseigne. 1NîmesUniversityHospital,Department ofPharmacy,Nîmes,France; 2NîmesUniversityHospital,DepartmentofOrthopaedic Surgery,Nîmes,France

10.1136/ejhpharm-2024-eahp.26

BackgroundandImportance Ourhealthfacilityconducts approximately400annualcarpaltunnel(CT)surgeriesusing threedistinctambulatorymethods:(1)ultrasound-guidedin theoperatingroom(OR),(2)ultrasound-guidedofficesurgery intheconsultationroom,and(3)endoscopy-assistedinthe OR.

AimandObjectives Thestudy ’sobjectivewastoassessthe environmentalfootprintofeachcarepathwayandtoecodesignthecarepathwaywiththelowestpossibleimpact.

MaterialandMethods Amixedmultidisciplinaryteam(pharmacist,surgeon,sustainabledevelopmentengineer)wasestablished.Thepharmacistwasdefinedasthepilotofthestudy. Threelifecycleassessments(LCA)wereconductedusing SimaProsoftware.Thefunctionalunitwas ‘PerforminganoutpatientCTsurgery,fromplanningtopost-opcare’.Ten impactcategorieswereconsideredincludingforexample globalwarming(kgCO2e),terrestrial;freshwaterandmarine ecotoxicity(kg1.4-DCB),assumingequalpatient-to-healthfacilitydistanceandsurgicalefficiency.

Results Carepathway(2)hasa20kgCO2ecarbonfootprint,whichishalfof(1)at43kgCO2e,andathirdof(3) at75kgCO2e.Themostsignificantimpactsarepatient transportandelectricity:for(2)74%frompatienttransport and1%fromelectricity;for(1)26%frompatienttransport and54%fromelectricity;for(3)40%frompatienttransport and36%fromelectricity.Healthcareproducts(HP)represent anaverageof25%ofthetotalimpact.Thestageswiththe highestHPimpactswere:drapingandsteriledressing (0.28kgCO2e(2),2.7kgCO2e(1)and6.7kgCO2e(3)); skinpreparationoftheoperatingarea(0.5kgCO2e(2), 0.9kgCO2e(1)and(3));andanaesthesia(0.3kgCO2e(1) and(2),1kgCO2e(3)).Inana esthesia,drugs(acetaminophen,lidocaine,mepivacaine )hadminimalimpact(10%), whereasforskinpreparation,drugs(alcoholicbetadine)had agreaterimpact(70%to100%)thansterilemedicaldevices. Modellingtheimplementation ofteleconsultationshoweda potentialsavingsof6kgCO2efor(1)and(2)and12kg CO2efor(3).

ConclusionandRelevance Officesurgery,withitsminimal impactandequivalentclinicaleffectiveness,shouldbepromoted.Furtherreducingitsenvironmentalfootprintrequires essentialsteps,suchaspromotingteleconsultation.Pharmacists canalsomakeasignificantimpactbyoptimisingHPutilisation(e.g.,right-sizeddrapes,noreinforcedgownsfornoninvasiveprocedures,controlledbetadineuse,efficientneurostimulationneedlecablerecycling).

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-015 ASSESSMENTOFPREPARATORYSTAFF’S KNOWLEDGEOFCARCINOGENIC,MUTAGENICAND REPROTOXIC(CMR)RISKS

ESimon*,CJurado. ChuToulouse,Pharmacie,Toulouse,France

10.1136/ejhpharm-2024-eahp.27

BackgroundandImportance Context:ThepreparationofpharmaceuticalproductsisgovernedbyGoodPreparationPractices (GPP).Guideline2: ‘Preparationofmedicinalproductscontainingsubstancesthatmaypresentarisktohealthandthe environment’ statesthatpersonnelmustbetrainedand informed.

AimandObjectives

Objectives Toassesstheinitialknowledgeofthepreparation teamoncarcinogenic,mutagenicandreprotoxic (CMR)risks andtoestablishappropriatetraining.

MaterialandMethods

Method ASPHINX® questionnairewasdevelopedbasedon bibliographicaldatawithmethodologicalsupportfromCOMEDIMS,riskpreventionistsandoccupationalmedicine.The12questionquestionnairecoverednotonlybasicknowledgeof therisk,butalsothepracticalapplicationofCMRriskmanagementintheunit.Itwassubmittedtoallstaffovera1monthperiod.Theanalysisoftheresultsledtotheimplementationofatrainingprogrammeadaptedtoallstaff.

Results

Results 28peoplecompletedthequestionnairewithamean scoreof12.5/20[5.8–17.9].Staffseniorityseemedtocontributetoabetterknowledgeofrisk(Student,p=0.06),witha meanof14.7forthoseworkinginourdepartmentformore than5yearscomparedto12.1fornewstaff.Intermsof knowledge,thebasicconceptsofCMRsandpersonalprotectiveequipmentwereacquired(64%and79%ofworkers answeredthesequestionscorrectly).Ontheotherhand,collectiveprotectionequipment,guidelinesandwhattodoin caseofexposurewerelesswellunderstood(39%,7%and 11%respectively).

ConclusionandRelevance

Discussion Basedontheresultsofthequestionnaire,CMR riskconceptsarenotfullyunderstoodbyallstaff,although seniorityinthedepartmentseemstoincreasetheirknowledge. Theresponseshaveenabledustoidentifythegapsinthe team’sknowledgeandtoproposeatargetedtrainingcourse forall,combinedwithsituationalexercises.Theeffectiveness ofthetrainingisthenevaluatedusingaquestionnairecombinedwithasatisfactionsurvey.

Conclusion Thisassessmentenablesustomeettheinitial trainingrequirementsofGuideline2.Thetrainingandassessmentmaterialswillformthebasisformaintainingskillsas partoftheunit’songoingtraining.

REFERENCESAND/ORACKNOWLEDGEMENTS

OCRELIZUMABFORTHETREATMENTOFRELAPSING ANDPRIMARYPROGRESSIVEMULTIPLESCLEROSISIN ANATIONALHEALTHSYSTEM:ACOST EFFECTIVENESSANALYSIS

1CLamesta*, 2RPetti, 3PVolpi. 1HospitalPharmacist,ItalianAssociationofHospital PharmacySifo,Bari,Italy; 2HospitalPharmacist,ItalianAssociationofHospitalPharmacy Sifo,Foggia,Italy; 3UniversityofParma,SchoolofSpecialisationinHospitalPharmacy, Parma,Italy

10.1136/ejhpharm-2024-eahp.28

BackgroundandImportance Ocrelizumabhasdemonstratedsignificantclinicalbenefitforthetreatmentofrelapsingmultiple sclerosis(MS)andprimaryprogressivemultiplesclerosis (PPMS),adiseasecharacterisedbydisability.

AimandObjectives Theaimofthestudyistoevaluatethe clinicalandeconomicimpactofocrelizumabcomparedtocurrentclinicalpractice,includingotherdisease-modifyingtherapies(DMTs).

MaterialandMethods Intheliterature,theshort-andlongtermcost-effectivenessimplicationsofDMTsforMShave beenestimatedthroughMarkovmodelling(MM)usingthe EDSSscore(0–9)todefinehealthstatesandmodeldisease progressionandtheprogressionofrelapsesovertime.The costandeffectivenessofocrelizumabwereestimatedusing MMsforthreepopulations:naiveRMS,previouslytreated RMS,andPPMS.Efficacywasexpressedinquality-adjusted lifeyears(QALYs).Asystematicreviewandmeta-analysiswere usedtoobtainefficacydata.ForRMS,interferonbeta1a, dimethylfumarate,glatiramer,teriflunomide,fingolimodand natalizumabwereselectedascomparators.ForPPMS,supportivecarewasconsideredthebest.

Results Theestimatedtime(years)beforeprogressiontoSPMS ofocrelizumabwascalculatedforpatientstreatedwithRMS from2020to2022comparedtotheotherdrugsunderanalysis.TheresultsexpressedinQALYsshowthatocrelizumab hasgainsof0.3comparedtonatalizumab,0.93comparedto dimethylfumarate,1.06comparedtoteriflunomide,1.07comparedtofingolimod,1.11comparedtointerferonbeta1aand 1.2comparedtoglatiramer.Calculatingtheincrementalcosteffectivenessratio(ICER)ofocrelizumabcomparedtointerferon-beta-1a,thelowestcostdrugamongitscompetitors,we obtainedacostof16,720eurosperQALY.Forpatientswith PPMS,theICERofocrelizumabcomparedtobestsupportive carewasestimatedat78,858/QALY.

ConclusionandRelevance Ocrelizumabprovidesimportant healthbenefits,andithasbeenshowntobemorecost-effectiveinRMSortohavecostsperQALYlikelytobelower thancommonlyacceptedcost-effectivenessthresholds.In PPMS,ocrelizumabfillsaclinicalgapinclinicalpractice,but itscostsperQALYarelikelytohaveamoresignificantimpact onpublicspending.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KurtzkeJF.Ratingneurologicimpairmentinmultiplesclerosis:anexpandeddisabilitystatusscale(EDSS). Neurology. 1983;33(11):1444–1444.

ConflictofInterest Noconflictofinterest.

1ISG-017 THETHREEHORIZONSMETHODASATOOLFOR DEFININGTHEHOSPITALPHARMACYRESIDENT OFTHEFUTURE(HPRF)

EDeLuca*,CBotto,GCancellieri,IMistretta,MSantonocito,GCappello,RSpatola, PPolidori. UniversitàDegliStudidiPalermo,SSFO – ScuoladiSpecializzazioneinFarmacia Ospedaliera,Palermopa,Italy

10.1136/ejhpharm-2024-eahp.29

BackgroundandImportance BasedonBillSharpe’stheorythe ‘ThreeHorizons’ methodservesasaforgeforshapingfuture reality.Throughcreativediscourseonfutureapproaches/scenarios,infact,ateam,composedofavisionary(thatpaints thefuturisticreality),amanager(whointhepresentensures correctsystemmanagement)andanentrepreneur(glue betweentheothertwothatinvestsinrealisationofinnovation),definesstrategiesforanidentifiablefuture.

AimandObjectives Throughintersectionofthreedifferent horizons(3H),fromH1(present’sreflectionandstarting pointofdiscussion)toH3(projectionofadreamlikereality withrespecttonowadays),bymeansofH2(bridgeforthe realisationofstrategy),HPRF’sfigurehasbeenpainted,using themostvividimaginationasameanstowishfora ‘renewed’ affirmationinourcountry.

MaterialandMethods Theexerciseinvolvedthedefinitionof ‘ThreeHorizons’,thinkingaboutanHPRFoperatinginthe year2038,andwasdividedintotwophases.Ontheone hand,ateamhasmappedhorizons(puttingdifferentcoloured Post-itsforeachoneonawhitewall),strictlyfollowingorder H1-H3-H2.Ontheotherhand,theteamaskeditselfaseries ofquestionstodrawupthe ‘actionplan’

Results Fromtheexerciseemergedanimageofthecurrent residentas ‘ behindthescenes ’ ,notfullyawareofhis/her potential/educationalrolean dnottotallyincludedinhospitaltissue,withoutrealpossibilityofgainingexperiencein allsectors,unpaidandtheref orenotincentivisedtolearn deeplyfrominternship,dissatisfied.ConverselyHPRFwill befullypaid/activeonwardbyquestionnairesproduction forpatients-medicalteam,raisingawareness,supporting pharmacovigilance ’ simportanceandpromotingfightagainst antimicrobialresistance,shar ingknowledge/entertaining interactionswithpatients,especiallyindifficultareas(for exampleClinicalTrials).Abridge(H2)isrepresentedbya StudyPlainorganisationfinalisedtocatapultresidentinto wardsfrombeginningtograspneedsofallhealthcaresystemplayers.

ConclusionandRelevance ‘ 3H ’ hasbeenastrategicframeworkusefultodefineactionstobetakenforrealisingfuture scenarios.Ithasbeenadaptedtopharmaceuticalpractice thatisevolvingfromsimplemedicinesdistributiontoeducationespeciallyintheperspectiveofpatientsthatareincreasinglyactiveplayersthatacquireknowledgefromboth diseaseexperienceandthehealthcaresystem,inamutual exchangeofinformationaboutpathophysiology/treatment/ supplychain.

REFERENCESAND/ORACKNOWLEDGEMENTS

TEN-YEARDRUGSURVIVALANALYSISINMODERATE TOSEVEREPLAQUEPSORIASISFIRST-LINE TREATMENT

CCarvalho*,JPCruz. HospitaldeSantaMaria – CentroHospitalarUniversitárioLisboa Norte-Epe,ServiçodeGestãoTécnico-Farmacêutica,Lisbon,Portugal

10.1136/ejhpharm-2024-eahp.30

BackgroundandImportance Drugsurvivalisdefinedasthe timeintervalbetweentreatmentinitiationanddiscontinuation. Severalfactorsmayinfluencedrugsurvivalsuchasefficacy, tolerability,andtreatmentadherence.Thus,drugsurvivalcan beusedasasurrogatefortreatmenteffectiveness.Biologics havechangedthetreatmentparadigminmoderatetosevere plaquepsoriasisimprovingefficacyandtolerability.

AimandObjectives Weaimedtodeterminethe10-yeardrug survivalforthebiologicsusedinthetreatmentofmoderate tosevereplaquepsoriasiswherepossible,inordertoestimate real-worldeffectivenessandimproveinitialtreatmentdecision making,consideringbiosimilar ’sfavourablecosts.

MaterialandMethods Alladultpatients(aged18–65years) withadiagnosisofmoderatetosevereplaquepsoriasiswho initiatedtreatmentwiththefollowingbiologicsbetween28 February2012and28February2022(10years)were included:adalimumab,brodalumab,certolizumab,etanercept, guselkumab,infliximab,ixekizumab,risankizumab,secukinumab,andustekinumab.Datawerecollectedfrompharmacy dispensingrecordsandincludeda6-monthwash-outperiod beforeinclusionanda1-yearminimumfollow-upforthelast patientincluded.Datawerecensored,consideringtreatment discontinuationifnorecordswerefoundinthelast3months ofthefollow-upperiod.DatawereanalysedusingRstatistical software.

Results Atotalof1,353patientswereincluded(41.3% females,median-age44years).Onlypatientswhoinitiated first-lineadalimumab(n=124),etanercept(n=56)andustekinumab(n=861)reacheda10-yeartreatmentperiod.The10yeardrugsurvival(%,95%confidenceinterval,natrisk) were:adalimumab(17.0,10.2–28.3,n=5),etanercept(14.5, 6.74–31.1,n=2),ustekinumab(21.8,18.1–26.3,n=29).Using adalimumabasreference,theCoxproportionalhazardratios foretanerceptandustekinumabwererespectively:0.90(0.63–1.28,p=0.557)and0.58(0.46–0.72,p<0.001).Treatinga patientfora10-yearperiodwithbiosimilaretanerceptor ustekinumabcostanadditionalC ¼ 46,033orC ¼ 84,504,respectively,comparingtobiosimilaradalimumab.

ConclusionandRelevance A10-yeardrugsurvivalanalysiswas onlyavailableforadalimumab,etanerceptandustekinumab. Comparingtoadalimumab,ustekinumabshowedasignificant higher10-yeardrugsurvival(21.8 vs 17.0%,p<0.001).A strategyofswitchingfromadalimumabtoustekinumabas soonasabiosimilarisavailableshouldbeevaluated.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-019 DOALLSURGICALSPECIALTIESHAVEANIDENTICAL CARBONFOOTPRINTWITHINANAMBULATORYUNIT?

OJouhet*,MQuentin,BRui,TDamien. HospitalCochin-APHP,CentralSterileServices DepartmentCSSD-PharmacyDepartment,Paris,France

10.1136/ejhpharm-2024-eahp.31

BackgroundandImportance Operatingtheatresproduce30% ofthehealthcaresystem’sgreenhousegas(GHGs)emissions. Aspartofitssustainabledevelopmentstrategy,ourhospital hasdecidedtoassessthegreenhousegasesemittedbyan AmbulatorySurgeryUnit(ASU).OpenedinApril2018,the ASUhasfiveoperatingtheatreswhereeightsurgicalspecialties canoperate22patientsaday.

AimandObjectives Theaimistoassessthecarbonfootprint ofsurgicalspecialtiesinordertoidentifythemostGHGemittingsources.

MaterialandMethods Thankstothehospital’sSustainable DevelopmentCommission(SDC),thecarbonfootprintofthe surgicalspecialtieswasassessedbytwocommunityservicestudents,oneexternandonepharmacyresident.TheGHGemissionsgeneratedin2022bywater,electricityandenergy consumption,equipment,drugs,gas,single-usemedicaldevices (SUMDs)andre-sterilisablemedicaldevices(RSMDs)procurement,RegulatedMedicalWaste(RMW)andMunicipalSolid Waste(MSW),patientandstaffmovementswereestimated basedonADEMEfactors.Emissionsassociatedwiththe acquisitionofSterileMedicalDevices,knownas ‘specificemissions’,varyaccordingtosurgicalspecialty.Theremaining emissionssourcesarecalled ‘commonemissions’

Results In2022,theASUemitted634tonnesofeCO2.Commonemissionsreached292teCO2:equipment(9%),energy (9%),travel(7%),RSMD(6%),drugs(4%),waste(1%)and gas(1%).Specificemissionsaccountfor54%(342tonnes eCO2).Orthopaedicsurgeryemits166teCO2peryear, including59teCO2fromcommonemissions.Orthopaedic, urological,dermatological,gynaecological,gastrointestinaland plasticsurgeryaccountfor171,117,84,93,93and85kg eCO2perpatientrespectively.

ConclusionandRelevance ThisstudyhighlightsthemostGHG emittingpositions(SMDprocurement)andspecialties(Orthopaedicsurgery)intheASU.Severalactionshavebeentaken towardssustainabledevelopment.Environmentally,theair-conditioningoutputisreducedwhentheoperatingtheatreis closed,wasteisdistributedinpaperorplasticgarbagebins, andsevofluraneistheonlygasadministered.Economically, hospitalstaysareshorterthanthoseforconventionalsurgery. Socially,theunitofferspatientsapeacefulenvironment.These findingswerepresentedtotheSDC.Suggestionsweremade torefineRSMDcompositionswithinputfromsurgeonsand replaceSMDwithRSMDwheneverpossible.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-020 DRUGDAYTHERAPYAPPLIEDTOLUSPATERCEPT: RESULTSOBTAINEDINANITALIANANTIBLASTIC DRUGUNIT

1ADeLuca*, 1AGhiori, 2CArria, 1COrsi. 1AziendaOspedalieroUniversitariaCareggi, Pharmacy,Firenze,Italy; 2UniversitàdiFirenze,DipartimentodiNeuroscienze-PsicologiaAreadelFarmacoeSalutedelBambino,Firenze,Italy

10.1136/ejhpharm-2024-eahp.32

BackgroundandImportance Luspaterceptisanerythroidmaturationagent,indicatedformyelodysplasticsyndromeand bthalassaemia,reimbursedbytheItalianNationalHealthService asof09/12/2021.Luspaterceptbindstoligandsofthetransforminggrowthfactor b familybyblockingtheSmad2/3signallingpathwaythatinducesmaturationoflateerythroid

Abstracts

precursors.Patientsreceiveluspaterceptevery3weeksata per-kilodose(threestepsofincrementaldosesinmyelodysplasticsyndromes,andtwostepsinb-thalassemia).Adrugday wassetuptogetherwiththeclinicians.

AimandObjectives Theobjectiveofthisstudywastoassess whethertheestablishmentofdrugdaycouldleadtosignificantsavingsforthepreparationofluspaterceptin2022.

MaterialandMethods Allprescriptionsandpreparationsmade atourUnitfrom1Januaryto31December2022wereanalysedbymeansofdataextractionfromtheinternalmanagementsystemforonco-haematologictherapies.Themilligrams andvialsthathypotheticallyshouldhavebeenusedwerecalculatedandvaluedwiththoseactuallyused.

Results In2022,21patientsweretreatedforatotalof155 treatments(averageof7.38dosesperpatient).Atotalof 16,658mgofluspaterceptwasprescribed.177bottlesof75 mgand61bottlesof25mgwereusedforatotalof14,800 mg.Thedifferenceof1,858mgbetweenhypotheticaland actualdatashowsthepresenceofanoverfillofaveragepowderequalto3,139mgforthepackagingof25mgand9,417 mgforthepackagingof75mg(12,56%ofnominalfilling).

TheVATcostsincludedfortheindividualbottleswere: 2421,02C ¼ forthe75mgbottleand807,01C ¼ forthe25mg bottle(exactly1/3ofthehigherdosage).ThetotalexpenditureincurredwasC ¼ 477,748.15againstthehypothetical expenditureofC ¼ 538,275.61,withanetsavingofC ¼ 60,527.52(11.24%ofthetheoreticalexpenditure).

ConclusionandRelevance Theadministrationofluspatarcept organisedindrugdayhasledtoasavingduetobettermanagementofwasteandoverfill.Theseresultsshowhowwellestablishedpharmaceuticalmanagementandmanagementstrategiesinclinicalpracticesuchasthedrugdayturnouttobe anexcellentmethodofminimisingprocessingresiduesand controllingexpenditure.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-021 1YEAR-REVIEWOFTHEEKOSONIC® ENDOVASCULAR SYSTEM(BOSTONSCIENTIFIC)INTHEMANAGEMENT OFPULMONARYEMBOLISMINANINTERVENTIONAL CARDIOLOGYDEPARTMENT

EMoguez*. OrléansUniversityHospitalCentre,Pharmacy,Orléans,France 10.1136/ejhpharm-2024-eahp.33

BackgroundandImportance SinceSeptember2022,theEkoS (BostonScientific)percutaneouslyinsertedthrombolysiscatheterhasbeenusedininterventionalcardiologyattheOrléans RegionalHospitalCentreforthetreatmentofintermediateriskorseverepulmonaryembolisms(PE).Thismedicaldevice (MD)enablesinsituadministrationofactilyse,whosediffusionwithinthethrombusispromotedbytheapplicationof ultrasound.Itisanexpensivemedicaldevicethatisnotcurrentlyreimbursed.

AimandObjectives Theaimofthisworkistocollectthe indicationsofpatientstreated,thetherapeuticprotocol(TP) usedandtoassessthefinancialimpactofEkosontheirstays.

MaterialandMethods OvertheperiodfromSeptember2022 toAugust2023,indications,clinicalcontextsandTPswere collectedfrompatientrecords.Aliteraturereviewwascarried outontherecommendedTP.Acostanalysiswascarriedout, takingintoaccounttheEKOSandassociatedactilyse,andthe

medicalinformationdepartment(MID)wascontactedforall PMSIdata.

Results Sixpatientsweretreated,withasexratioM/F=4/2 andamedianageof69.Theindicationofhigh-intermediateriskbilateralpulmonaryembolismwasfoundinallpatients, withtwocathetersusedforeach;nocomplicationsfollowing theirusewerefound.TheTPsusedindicateanadministration of6mgduring6hpercatheter.Withregardtofinancialdata, thecostofthetechniquewasC ¼ 6,300excludingVAT (C ¼ 3,000/catheterandC ¼ 150/actilysisvial).Thecodedmain diagnosiswasPEforallpatients.Fibrinolysisproceduresand theassociateddiagnosisofheartfailure(alwayspresentwhen fibrinolysisisindicated)werefoundforonlytwopatients.An intensivecarepackageisassociatedwitheachpatient.Intotal, theaverageamountreceivedwasC ¼ 6,453perstay.AsimulationwascarriedoutwiththeMIDinordertoimprovethe coding:thevalueofthestaycouldthenamountto C¼ 12,898.00i.e.doubletheinitialamount.

ConclusionandRelevance EKOSisusedfortheindications specifiedbythemanufacturer.TheTPmayevolveinline withnewpublications.Atpresent,theamountallocatedper staydoesnotcoverthetechniqueused.Inthecontextof healthcarecostcontrol,optimisedcodingwillenableusto continueusingEKOSatthishospitalinthefuture.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-022 HOSPITALPHARMACISTS’ PERCEPTIONSOFTHEIR PROFESSIONINTWOEUROPEANCOUNTRIES

1SElMershati*, 2EDegui. 1AssistancePublique – HôpitauxdeParis,Pharmacy,Paris, France; 2TheChristieNHSFoundationTrust,Pharmacy,Manchester,UK

10.1136/ejhpharm-2024-eahp.34

BackgroundandImportance While5yearsoftrainingarenecessarytobecomeahospitalpharmacist(HP)intheUnitedKingdom,9yearsarerequiredinFrance.TheUKsystem allowsHPstoacquireanindependentprescribingqualification whichisnotpossibleforFrenchHPswhotendtopracticea widerrangeofnon-prescribingroles.

AimandObjectives Theaimofthisstudyistocompare FrenchandUKHPs’ perceptionsabouttheirrolesandidentify thechallengestheyarefacing.

MaterialandMethods Resultsweregatheredthroughanelectronicsurveydistributedviaemailsandsocialnetworks.It wasproducedinEnglishandFrenchandencompassed26 questions;17mandatoryandsixopen.Statisticalanalysiswas performedwithaZtestandanalysistoopenquestionswas performedwithChatGPT.

Results After6weeks,164responseswerecollected:94from France,70fromtheUK.

Answershighlightthatbothgroupssharesimilarvalues suchasfeelingusefulinthepatients’ care.Perceivedworkload andstressarehigherintheUK(p<0.015,p<0.001).Patients andmedicalteamsvaluethepharmacists’ roletoahigher levelintheUKthantheydoinFrance(p<10-4,p<10-5).The levelsofpersonalandjobsatisfactionareequivalent.Similar issuesareraisedsuchasworkload,staffingandaneedfor moretraining.Totacklethesechallengesbothgroupswould prioritiseimprovementoftheITsystems,pharmacytechnicians’ recruitment,andadministrativeworkloadreduction.In

Abstract1ISG-022Table1 Percentageofpositiveresponsesby pharmacists

16months,havingrecorded1,075clinicalvisits(12visits/ patient)and2,997dispensations(26dispensations/patient).

ARTforintramuscularandoraladministrationwere studiedinthreeand10CTsrespectively,withamedianof twoinvestigationaldrugsperCT.ThealternativetherapeuticcombinationstoCTparticipationwere:dolutegravir +abacavir+lamivudine(32.6%),bictegravir+emtricitabine +tenofoviralafenamide(14.6 %),dolutegravir+lamivudine (14.6%),darunavir+cobicistat+emtricitabine+tenofoviralafenamide(13.5%).

Thetheoreticaltotalcostoft reatingpatientsoutsideof CTwouldhavebeenC ¼ 734,432.Thehospitalprovidedpart ofthemedicationofoneCT.Therefore,thetotalcost avoidedwasC ¼ 721,796,beingahospitalsavingof C¼ 333,136.60annually;C ¼ 8,110.10perpatientand C¼ 3,743.10peryear/patient.

theUK,pharmacistsalsowishtoreallocatetaskswithinthe team(p<0.005).

ConclusionandRelevance ThisstudyshowsthatHPsenjoy theirprofessiondespiteissuesthatrequireareorganisationat anationallevel.ResultssuggestthatUKpharmacistsaremore confidentwithbeingaprescriberthantheFrench,whoworry aboutresponsibilityandoverwork.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-023 ECONOMICIMPACTDERIVEDFROMPARTICIPATION ONANTIRETROVIRALTHERAPYCLINICALTRIALSINA THIRD-LEVELHOSPITAL

SGutiérrez,GMirallesAndreu,NOlcinaForner,OGuillénMartínez,CMatosesChirivella, ANavarroRuiz*. HospitalGeneralUniversitariodeElche,ServiciodeFarmacia,Elche,Spain

10.1136/ejhpharm-2024-eahp.35

BackgroundandImportance Antiretroviraltherapy(ART)cost isanimportantexpenseintheannualHospitalPharmacy Service(PS)investment.Clinicaltrials(CT)forARTdevelopmentrepresentahighpercentageoftheCTcarriedoutina PS,beinganopportunityforthehospitalintermsofcostsavingsforthesemedications.

AimandObjectives ToanalysetheavoidedcostofARTmedicationsbecauseofpatientparticipationinCT.

MaterialandMethods RetrospectiveobservationalstudycarriedoutfromJanuary2021toMarch2023.Allpatients whowereparticipatinginCTagainsthumanimmunodeficiencyvirus(HIV)treatedwithARTwereincluded.Variablescollectedwere:numberofpatients,investigational drugs,visitsanddispensationsperformed,treatmentthatthe patientwouldhavereceivediftheyhadnotparticipatedin theCTanditscost.Patient ’ streatmentbeforeenrollingin CTandstandardtherapiesaccordingGESIDAguidelinesat thetimeofinclusioninCTwereconsideredforthatpurpose.InformationwasobtainedfromFundanet ® and OrionClinic. ®

Avoidedcostwascalculatedasthedifferencebetweenthe costofthetreatmentthatthepatientwouldhavereceivedif theyhadnotparticipatedintheCTandtheCTtreatment costpaidbythehospital.

Results 13CTswereanalysedand89patientswereincluded withamedianageof44±12yearsoldandan87%(77)of maleprevalence.TheaveragetimeparticipatingintheCTwas

ConclusionandRelevance Patients’ inclusioninHIVCTconsiderablyreducesthepharmaceuticalexpensesrelatedtoART medicationssinceinvestigationaldrugsareprovidedfreeof chargebythesponsor.Therefore,CTsrepresentimportant economicsavingsforhospitals,contributetotheSpanish HealthSystemsustainabilityandallowaccesstonew therapies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

1ISG-024 SINGLE-USEMEDICALDEVICESINTHETREATMENT OFCHRONICDISEASES:WHATISTHE ENVIRONMENTALIMPACT?

MDSLourenço,BResende,CDiogo,MHDuarte,ASoares,SAnaMargarida,AAlcobia*. HospitalGarciadeOrta-Epe,PharmaceuticalServices,Almada,Portugal 10.1136/ejhpharm-2024-eahp.36

BackgroundandImportance Single-usemedicaldevicesarea commonpracticeinbiologicaldrugsadministration,potentially improvingcompliance,reducingtheriskofcontaminationand theneedforrechargeandsterilisationofuseddevices.

Risingprevalenceofautoimmunediseasesandtherapeutic innovationpromotetheirusage.However,thereislimitedliteratureregardingenvironmentalimpactresultingfrom increasedplasticconsumption,acomponentofthesedevices. AimandObjectives Toassesstheamountofplasticusedin biologicaltreatmentswithpre-filledpen/syringesingle-dose format.

MaterialandMethods Descriptivestudyconsistinginweighing devicesforambulatorydispensing,followedbycalculationof expectedannualplasticconsumption,perdruganddosage.

Extrapolationofresultsconsideringthetotalnumberof patientsundergoingtreatmentwiththesedrugsasofSeptember2023.

Comparisonofannualplasticconsumptionforthese patients,assumingasalternative,onereusablepen/device annually.

Results Twenty-twodrugsavailableintheinstitutionwere selected.Weightvaluesrangedfrom5.65g(anakinra)to 74.25g(golimumab),withanaverageweightof36.37gper device.

Regardingthenumberofdevicesneededforannualmaintenance,thelowerandupperlimitswerefourpens(ustekinumab,risankizumab,tildrakizumab)and365syringes(anakinra).

Thiscorrespondedtoanannualuseof215.8g,268g,191g and2062.3gofplastic,perpatient,respectively.

Byanalysingthecumulativeannualplasticconsumptionof patientsundergoingtreatmentintheinstitution(n=948),we obtainedthevalueof1980.1kg(32972devices).

Assumingthehypothesisofusingonlyonepen/deviceper year,withrefillsthatmayweighabout9.4g(usingtheexampleofinterferonbeta-1a),weobtainedavalueof345.4kg, leadingtoanannualreductionof1634.7kgofplastic.

ConclusionandRelevance Thesesystems,maintainingsafety, efficacy,andtherapeuticadherence,couldrepresentsignificant savingsinenvironmentalimpactandproductioncosts.The useofexistingtechnology,suchasrefillablecartridges,could addressthisissue.Despitetheaforementionedadvantages,the significantamountofwastedplasticisclear.

Anationalextrapolationbasedonrelativeweightofdrug consumptioninourinstitutionmayindicatethatitcouldbe possibletoavoidasmuchas65tonsperyear.

Anenvironmentalimpactofthismagnitudeshouldprompt areflectiononthealternativesthatcanbeemployed.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

1ISG-025 ANALYSISOFTHECOMPLEXITYOFTHECLINICAL TRIALSCARRIEDOUTINATHIRD-LEVELHOSPITAL

GMirallesAndreu,SGutiérrezPalomo,NOlcinaForner,LSorianoIrigaray,IJiménezPulido, ANavarroRuiz*. HospitalGeneralUniversitariodeElche,HospitalPharmacyDepartment, Elche,Spain

10.1136/ejhpharm-2024-eahp.37

BackgroundandImportance Clinicaltrials(CTs)involvedifferentproceduresinwhichPharmacyService(PS)participates. Difficultyevaluationoftheseactivitiesisimportanttoanalyse globalCTscomplexity,whichcouldbeusedasameasureof resourcesneededineachCTbyPS.

AimandObjectives ToassessthecomplexityoftheCTsin whichPSparticipates,dependingontheCTs’ characteristics. MaterialandMethods Observationalretrospectivestudywhich includesCTsstartedfrom2014toAugust2023whenCTs unitwasfoundedasanindependentareainPS.CTs’ characteristicswerecollected:medicalserviceinvolved,pathology, uni/multicentricandphase.ComplexityscalefromCalvinLamasetal.,2012wasused.Complexitypunctuationwas assessedaccordingtotheprocedureswherePSisinvolved (investigationalproducts(IP)receipt,conservation,assignment, preparation,conditioninganddispensation;randomisationand blinding).Complexitylevelswereestablished:low(until10 points),moderate(11–19points)andhigh(morethan19 points).Complexityanalysiswascalculatedforglobal,medical service,pathologyandCTs’ phase.Informationwasobtained fromFundanet®

Results 101CTsstartedduringthestudiedperiod.Distributionbetweenmedicalserviceswas:48.5%(49)oncology, 21.8%(22)infectiousdiseases,20.8%(21)neurology,5.9% (6)rheumatology,2.0%(2)sur geryand1.0(1)psychiatry service.Pathologiesmoreinvestigatedwererelatedto humanimmunodeficiencyvir us16.8%(17),breastcancer 12.9%(13),Parkinson ’ sdisease12.9%(13),colorectalcancer7.9%(8),Alzheimer ’ sdisease6.9%(7),lungcancer 5.0%(5),gastriccancer5.0%(5)andrheumatoidarthritis 5.0%(5).AccordingtoCTs ’ phase,1.0%;25.7%;67.3%

and5.9%correspondedtophasesI;II;IIIandIV,respectively.99.0%weremulticentricand52.5%(53)were unblinded.

CTswhichrequiredtwopharmacistsrepresented37.6% (38).Asepticpreparationwasneededin47.5%(48)anddispensationtotheresearchteamwasneededin74.3%(75).

Overallaveragecomplexity wasmoderate(15.1±4.0). 16.8%(17)presentedlowcomplexity,70.3%(71)moderate complexityand11.9%(12)highcomplexity.Thehigher complexitycorrespondstoneurologyCTs.Pathologieswith highercomplexityweregastriccancer(20.2±2.6),Alzheimer ’ sdisease(18.1±2.2)andlungcancer(18.0±3.3). AveragecomplexitywasmoderateforallCTs’ phases,being thepunctuationhigherinphaseIICTs(16.6±2.3),followed byphasesI(16.0±0),III(15.1± 4.2)andIV(12.2±4.8).Classifyingbytriennium,medianCTscomplexityhasgradually increased:11.0±1.0for2014–2016,13.7±8.9for2017 –2019 and15.3±5.2for2020 –2022.In2023,complexityremained at16.8±2.4.

ConclusionandRelevance ThecomplexityofCTshas increasedovertheyears,althoughmostCTshaveamoderate complexityregardlessoftheirphase.ThemostcomplexCTs correspondtooncologicalandneurologicalpathologies.Carryingoutthistypeofevaluationisimportanttooptimise resourcesandtoknowinwhichPSproceduresitisnecessary toinvestnewresources.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Calvin-LamasM,Pita-FernandezS,Pertega-DiazS,Rabunal-AlvarezMT,MartínHerranzI.Acomplexityscaleforclinicaltrialsfromtheperspectiveofapharmacy service. EurJHospPharm.2018Sep;25(5):251–256.

ConflictofInterest Noconflictofinterest.

2SPD-001 CLINICALIMPACTANDCOSTSAVINGSOFAN OUTPATIENTANTIMICROBIALTHERAPYPROGRAMME: AFOCUSONSELF-ADMINISTRATION

1MÁAmor*, 1CAApezteguia-Fernández, 1EMatilla-García, 1RVBlanca, 1LEHoyo-Gil, 1PBautista-Sanz, 1AMelgarejo-Ortuño, 1RMoreno-Díaz, 2JMAntón-Santos, 2AEstradaSantiago, 2MPCubo-Romano. 1HospitalUniversitarioInfantaCristina,ServiciodeFarmacia, Parla,Spain; 2HospitalUniversitarioInfantaCristina,ServiciodeMedicinaInterna,Parla, Spain

10.1136/ejhpharm-2024-eahp.38

BackgroundandImportance Outpatientantimicrobialtherapy (OPAT)programmesareincreasinglyusedtoreducehospitalisationcostsinhealthcarefacilities.

AimandObjectives Toanalysetheclinicalimpactandcost savingsofanOPATprogrammefocusedonself-administration bythepatientsofantibioticelastomericpumps(AEP)prepared inthepharmacyservice.

MaterialandMethods Observational,retrospectivestudy.It includedallpatientswhoreceivedOPATfrom1May2022 to31July2023,using30-minuteor24-hourAEPdepending ontheantimicrobial.Self-administrationwasofferedtoall patientswithprevioustraining.

Numberofpatients,episodesandAEPprepared,demographicvariables(sexandgender),startandendoftreatment (eitherinthehospitalorathome)andhospital-at-homestay, self-administrationepisodesandsourceofinfectionwere registered.

Theresolutionoftheinfectioussyndromeandhospital readmissionsat30dayswereevaluatedtoanalysetheclinical impact.

Toanalysecostsavings,thetimeneededbypharmacytechnicianstoprepareAEPandavoidedvisits(physiciansand nurses)forthosepatientsusingself-administrationwerecompiled.Costsassociatedwithdailyhospital-at-homestay,AEP usedandpharmacytechnicians´preparationwerecompared withcostsofhospitalstayandphysicianandnursevisits.

Results 161patients(172episodesand1,442AEPprepared) wereincluded.57.7%weremen,withamedianageof68 years(IQR54–81).Themediandurationoftreatmentwas9 days(IQR6–14),andhospital-at-homestaywas8days(IQR 6–14).64patients(39.8%)wereincludedforself-administration.Themostcommonsourceswererespiratory(25.5%), intra-abdominal(24.8%)andurinary(18.0%).

Resolutionandreadmissionat30dayswereregisteredin 91.8%and13.5%ofepisodes,respectively.

Thetimeneededbypharmacytechnicianswas0.2hours for30-minutesand0.3hoursfor24-hourAEP,havingacost ofC ¼ 4,952.20.Atotalof590avoidedvisitswereregistered, savingC ¼ 41,890.TotalexpenditureofOPATandhospital-athomestaywasC ¼ 386,344.60comparedtoC ¼ 1,583,109for hospitalstayandadditionalvisitsresultinginC ¼ 1,196,764.4 ofcostsavings.

ConclusionandRelevance OPATprogrammesposesignificant advantagesintermsofclinicalandeconomicimpact,formanagingpatientsneedinglongerantimicrobialtreatments.SelfadministrationofAEPisapromisingoptiontooptimisetheir resultsinclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-002 EVALUATIONOFTHEEFFECTIVENESSANDRELATED COSTOFONCOLOGYDRUGSUSEDINSPECIAL SITUATIONS,INATHIRD-LEVELUNIVERSITY HOSPITAL

1TLizondo*, 1ECarcelero, 1JMSotoca, 1IMonge, 1GRiu, 1ICarro, 1ATorrent, 2EPineda, 1MAlbanell, 1DSoy. 1HospitalClínicofBarcelona,PharmacyService,Barcelona,Spain; 2HospitalClínicofBarcelona,OncologyService,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.39

BackgroundandImportance Someoncologicaltreatmentsare usedinspecialconditionsduetothelackoftherapeuticalternatives.Theuseofdrugsinexceptionalcircumstancesorspecialsituations(compassionateuse(CU),off-labeluse(OLU), EMAapproveddrugswithoutarefundpriceinthecountry,

Abstract2SPD-002Table1

anddrugsnotincludedinthehospital’spharmacotherapeutic guide(non-HPG))isfrequent.Thesetreatmentsmustbe approvedbyaninternalcommitteeatthehospitallevel accordingtoSpanishlegislation.

AimandObjectives Toanalysetherequestsandeffectiveness ofdrugsinspecialsituationsinoncologypatientsatathirdleveluniversityhospital.

MaterialandMethods Anobservational,single-centre,retrospectivestudywasperformedtoanalysetheprescriptionof specialsituationdrugsinoncologypatientsbetweenJanuary 2021andDecember2022.Datawerecollectedregardingthe natureofthespecialsituation,cancertype,treatmentsetting (curativeorpalliative),ESMOclinicalbenefit,treatment acceptance,clinicalresponse,discontinuationreasons,number ofadministeredcycles,andassociatedcost,whichwascalculatedbasedonthetreatmentcyclesadministereduntiltheend ofthestudy.

Results 1045requestsweresubmittedtothehospitalcommittee:204(19.52%)belongedtotheoncologyfield(solid tumours).Amongthese,thetypesofspecialdrugpetitions were:CU(n=46,22.55%),OLU(n=102,50%),withouta refundpriceinthecountry(n=44,21.57%),andnon-HPG (n=12,5.88%).

Curativesetting(n=30):ESMObenefitcategoriesA (n=25,83.33%),B(n=0,0%),C(n=4,13.33%)andnot applicable(n=1,3.33%).Metastaticdisease(n=174)ESMO benefitscale1(n=32,18.39%),2(n=12,6.90%),3(n=58, 33.33%),4(n=55,31.61%),5(n=0,0%),andnotapplicable (n=17,9.77%).

Abstract2SPD-002Table2

Approvedtreatment(94.12%,N=192)N(%)

Notinitiated16(8.33)

Completed/continued

Ongoing51(26.56)

Completedadjuvanttherapy12(6.25)

Discontinued

Diseaseprogression76(39.58)

Adverseeffects22(11.46)

Deceased14(7.29)

Hospitaltransfer1(0.53)

DeniedtreatmentbyCatalanHealthService(5.88%,N=12)

Patientswhodidnotstartthetreatment(8.33%)were thosewithnofurthertherapeuticalternativeswhoprogressed anddidnothavetimetoinitiatethistherapeuticapproach.

Abstracts

Theaverage±SDofadministeredcycleswas5.89(±5.74), amountingtoatotalcostofC ¼ 2.597.220.

ConclusionandRelevance Thereisahighpercentageofmedicationrequestsinspecialsituationsintheoncologyfield,most oftheminthepalliativesetting(85.29%),withsignificant economicimpact.Itiscrucialtoregulatespecial-usemedicationstoensureequaltreatmentopportunitiesamongcancer patientsofdifferentcountryhospitals.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-003 PROPERMANAGEMENTANDECONOMICBURDENOF UNUSEDMEDICATIONSDISPOSALINASUSTAINABLE LATINAMERICANHOSPITAL:ARETROSPECTIVE STUDY

1EZavaleta*, 1BSerrano-Arias, 1SArguedas-Chacón, 2ACartín-Ramírez, 2AQuirós-Yen, 3JAVillalobos-Madriz, 1JPDíaz-Madriz. 1HospitalClinicaBiblica,PharmacyDepartment,San Jose,CostaRica; 2UniversidadIberoamericana,FacultyofPharmacy,SanJosé,CostaRica; 3UniversidadLatinadeCostaRica,FacultyofPharmacy,SanJosé,CostaRica

10.1136/ejhpharm-2024-eahp.40

BackgroundandImportance Theremarkableprogressmadein healthcarehasledtoasimultaneoussurgeinpharmaceutical wastegeneration,drivenbytheincreasingnumberofpatients, prescriptions,medicationconsumption,andoverproduction. Approximatelytwo-thirdsofprescriptionmedicationsgo unused.Environmentalcontaminationwithmedications,ifnot disposedofcorrectly,canhavefar-reachingimplications.

Forthisreason,conductingathoroughassessmentofpharmaceuticalwaste,consideringbothquantityandquality,is crucial.

AimandObjectives Thegoalofthisstudyistoillustratethe correctmedicationdisposalpracticesandtheireconomicrepercussionswithinasustainableLatinAmericanhospital.Additionally,itseekstocomprehendthelinkedindirectcostsand identifywhichmedicationsareatahigherriskofbecoming waste.

MaterialandMethods Inthisstudy,weconductedaretrospectiveanalysisofmedicationdisposalrecordsspanningtheyears 2020to2023.Therecordspertainedtoroutinemedication disposal,necessitatedprimarilybyreasonssuchasexpiration, damage,orrecalls.

Themethodologyinvolvedasystematiccategorisationof pharmaceuticalproductsearmarkedfordisposal.Foreach medication,wemeticulouslyrecordedthequantitythatwas discarded,thespecificreasonbehinditsdisposal,theoriginal sourceofthemedication,anditscorrespondingcategory.

Additionally,wegatheredcomprehensivedataontheproceduresemployedforthecontrolled,responsible,andsafedisposalofmedications,providinginsightsintothemethods utilisedtoensurethepropermanagementofpharmaceutical waste.

Results Table1showsthediscardedunitsofpreparations accordingtotheirclassificationbytherapeuticgroups,where itisnoteworthythatfoodproducts,cardiovascularsystem drugs,andnervoussystemdrugstakethetoppositions.

Ontheotherhand,whenestimatingthecostinUSdollars. (USD)associatedwiththiswaste,itwasfoundthatduringthe studyperiod,thecostsofdiscardedmedicationsamountto approximately300,000USD.Thisisledbyanti-infective drugs,antineoplastics,andimmunomodulators.

Abstract2SPD-003Table1

ConclusionandRelevance Whenanalysingtheoutcomeofthe medicationdisposalprocess,itisimportanttoemphasisethat thesedatawerecollectedthankstoasuccessfulprotocolfor managingsuchwaste.Theiranalysishighlightsasignificant monetarywastageandalsoposesarisktotheenvironment andpublichealth,asimproperdisposalofproductssuchas anti-infectivedrugs,antineoplastics,andimmunomodulators couldposeathreat.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-004 BUDGETARYIMPACTOFTHEINTRODUCTIONOF CABOTEGRAVIRPLUSRILPIVIRINELONG-ACTINGINA THIRD-LEVELHOSPITAL

RAsensiDiez*,ALinaresAlarcon,CFernándezCuerva. HospitalRegionalUniversitariode Málaga,Pharmacy,Málaga,Spain

10.1136/ejhpharm-2024-eahp.41

BackgroundandImportance Toanalysethepotentialbudgetary impactoftheintroductionofcabotegravir(CAB)plusrilpivirine(RPV)long-actinginathird-levelhospital.

AimandObjectives Toanalysethepossiblebudgetaryimpact onourcohortofhumanimmunodeficiencyvirus(HIV) patients.

MaterialandMethods Inclusioncriteria:AllactiveHIV-positive (HIV+)patients 18yearsold(withadherence 95%and undetectableviralload(<50copies/mL)inthelast6months) andwithprescriptionanddispensingofcombinationoralantiretroviraltherapy(ARTs)inourhospital.Studyperiod:JanuarytoDecember2022.Exclusioncriteria:historyofprevious failuretonon-nucleosideanaloguesorintolerance;HIVsubtypeA1-A6;bodymassindex(BMI) 30.

Variablescollected Numberofpatientswhomeettheinclusion criteria,costofactiveARTsin2022andCAB600mgIM +RPV900mgIMlong-acting(andCABandRPV(oralleadin)).Onlydirectpharmacologicalcostshavebeentakeninto account.

AScenario1(CAB+RPVlong-actingisnotused)vsScenario2(withtheintroductionofCAB+RPVlong-acting throughouttheyear2023).

Results Ofthetotalof2,065HIV+activepatientsinour hospital1,882patientshavebeenincluded.91%ofthemost prescribedARTs:BIC/TAF/FTCin32.74%(n=676);DTG/ 3TCin32.15%(n=664);TAF/FTC/RVPin8.09%(n=167); DRV/c/FTCin7.94%(n=164);DTG/ABC/3TCin5.33% (n=110)andDTG/RVPin4.89%(n=101).14%(n=268/ 1,882)alreadyhaveRPVintheiroralARTsandwouldnot havetodoorallead-inwithCABO+RPVthepreviousmonth. Only90%(n=1,694)metalltheinclusioncriteria.Ithas beenestimatedthatonly10%ofpatientswouldchangeoral ARTsforlong-actingtherapy(n=169).

Thecostofscenario1forthe169patientswouldbe C¼ 1,808,525.11/year.Inscenario2,87%ofthepatients (n=147/169)wouldswitchtolong-actingARTafteroralleadinwithCAB+RPVthepreviousmonthatacostof C¼ 1,659,737.31/year;and13%(N=22/169)wouldgodirectly toARTlong-actingwithacostofC ¼ 265,228.04/year.The overallvalueofscenario2wouldbeC ¼ 1,924,965.35/year.The differenceincostswouldbe+C ¼ 116,440.24/year.

ConclusionandRelevance Withouttakingintoaccountother typesofcosts,theintroductionofCAB+RPVlong-actingina third-levelhospitalwouldimplyahighercostvsusingoral ARTs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-005 ALTERNATIVETOTHETREATMENTOFPOORGRAFT FUNCTIONAFTERHAEMATOPOIETICSTEMCELL TRANSPLANTATION:ELTROMBOPAG

MDPMonteroAntón*,RColladoBorell,VEscuderoVilaplana,JLRevueltaHerrero, CVillanuevaBueno,YRiojaDiez,APrietoRomero,ACarrilloBurdallo,BSomoza Fernandez,AHerranzAlonso,MSanjurjoSaez. HospitalGeneralUniversitarioGregorio Marañón,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.42

BackgroundandImportance Poorgraftfunctionisarareand seriouscomplicationinpatientswhohaveundergonehaematopoieticstemcelltransplantation(HSCT).

Itischaracterisedbymoderatetoseverecytopenias(haemoglobinlessthan10g/dl,plateletslessthan20*10^9/L, neutrophilslessthan1*10^9/L)requiringtransfusionsupportorG-CSF,inpatientswithcompletechimerism.

Currently,treatmentoptionsareverylimitedandnotwithoutcomplications.

AimandObjectives Ouraimistoevaluatetheeffectivenessof eltrombopagasanoff-labelindicationinpatientswithpoor graftfunctionwhohaveundergoneHSCT.

MaterialandMethods Observational,retrospective,longitudinal studyinwhichtheeffectivenessandsafetyofeltrombopag wasevaluatedinpatientswithpoorgraftfunctionwho receivedHSCTbetweenJanuary2018toJanuary2023. Patientswereanalysedfromthestartofeltrombopaguntil recoveryoffunctionand/ordeath.

Poorgraftfunctionwasdefinedasthepresenceofsustainedthrombopenia(<20x10^9/L)despitetransfusion support.

Effectivenesswasassessedbytheoverallhaematological responserate:plateletrecovery(platelets>50x10^9/Lfor >4weeks).

DataanalysiswasperformedusingSPSS21.0statistical software.Variableswereanalysedusingdescriptivestatistics. Results 37patients(56.8%male),meanage50.9years(SD= 13.03)wereanalysed.Themostprevalentdiagnosiswas acutemyeloidleukaemia(43.2%),followedbymyelodysplasticsyndrome(13.5%)andnon-Hodgkin’slymphoma(10.8%). Themostfrequenttypeoftransplantwashaploidentical (78.4%).

ThemedianstartoftreatmentsinceHSCTwas76days. Mostpatientsstartedwithaneltrombopagdoseof50mg (56.8%).

Themeanplateletcountbeforethestartoftreatmentwas 25.378/mL,whileattheendoftreatmentthemeanplatelet countwas73.162/mL.

Plateletrecoverywasachievedin59.5%ofpatients.The mediandurationoftreatmentwas4.1months.

ConclusionandRelevance Amongthefewexistingtherapeutic alternativesforthrombopeniaresultingfrompoorgraftfunction,theuseofeltrombopagshowsresponseratescloseto 60%,soitappearstobeaneffectivealternative.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-006 IMPACTANDCONSEQUENCESOFTHEUSEOF HUMANPOLYVALENTIMMUNOGLOBULINDURING THECOVID-19PANDEMIC(2019–2022)

BJMontoroRonsano*,PMarreroÁlvarez,AGracia-Moya,HCGarcía-Díaz,MQGorgasTorner. HospitalUniversitariVallD’hebron,PharmacyDepartment,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.43

BackgroundandImportance Theuseofhumanpolyvalent immunoglobulin,intravenou sorsubcutaneous-IgIV/SChassufferedanotablein creaseinrecentyears – over10% peryear – giventhehighnumberofcomplexpathologies candidatesfortreatment,andduetotheerroneousperceptionofitssafety:thebenefit-riskbalanceisoftennotconsidered,noristhecost-benefit.However,theCOVID-19 pandemichaslimitedpatient flows,ontheonehand,and donationsand,consequently,t heavailabilityofthedrug, ontheother.

AimandObjectives Toevaluatetheuse – consumptionand indications – ofIgIV/SC,duringtheyears2019–2022,in adultandpaediatricpatients,inatertiaryhospital.

MaterialandMethods Analytical,observational,cross-sectional, retrospectivestudy,carriedoutduringtheyears2019–2022. Datacollectedfromtheprescriptionandmedicationadministrationrecordswerepatient,medication,indication,dispensing date,amountdispensed,anddepartment.

Therelevanceofthetherapeuticindicationswasevaluated accordingtotheclassificationproposedintheClinicalGuidelinesforImmunoglobulinUseoftheBritishHealthDepartment(2ndEdition,2008,andUpdates2011,2018),andtheir Spanishadaptation.

Results IgIV/SCconsumptionisshowninthefollowing table1.

Abstract2SPD-006Table1

2019202020212022

Routeofadministration

Intravenous(kg)169160151143

Subcutaneous(kg)16191623

Typeofpatient

Adult(kg)171164153151

Paediatric(kg)13151515

Total184179167166

Theanalysisoftheindicationfortreatment – year2022 –showsthat364patientsreceivedatleastonedoseofIgIV/ SCintheDayHospitaloratHome,withadegreeof adequacytotherecommendationsin339/364patients (95.1%);inhospitalisation,counting207patients,thedegree ofadequacywas160/207patients(77.0%).

ConclusionandRelevance TheglobaluseofIgIV/SChasbeen reducedby9.8%inthecontextoftheCOVID-19pandemic (2019–2022)duetoproblemsofavailabilityandtheprioritisationoftheindicationswiththegreatestevidence,existinga veryhighadequacyadaptationtoindicationrecommendations, especiallyinoutpatients(95.1%).However,theuseofIgIV/ SCinpaediatricpatientshasincreased(17.3%)andtheuseof IgSChasalsoincreasedglobally(40.4%).

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-007 USEANDCOSTEVOLUTIONOFADALIMUMABOVER8 YEARSINALOCALHOSPITAL

1JPoquet-Jornet*, 2MLlinares-Esquerdo, 3LYankova-Komsalova, 4JMonte-Serrano, 5GACastillo-Lopez, 4JCruañes-Montferrer, 5PCNuñez-Martinez, 3RAGhiglino-Novoa, 4ADAgullo-Perez, 5PBeso-Moreno. 1HospitaldeDenia,Pharmacy,Denia,Spain; 2Hospital ofDenia,Pharmacy,Denia,Spain; 3HospitalofDenia,Rheumatology,Denia,Spain; 4HospitalofDenia,Dermatology,Denia,Spain; 5HospitalofDenia,DigestiveMedicine, Denia,Spain

10.1136/ejhpharm-2024-eahp.44

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

AimandObjectives Theaimofthestudywastoevaluatethe useandcostevolutionandadalimumabinalocalhospital overthelast8years.Biosimilaradalimumabwasincorporated in2019.

MaterialandMethods Datawerecollectedbasedonconsumed unitsofadalimumabbetweenJanuary2016andJuly2023. Wehavemultipliedthenumberof80mgadalimumab syringesbytwotobeabletoaddthemtothe40mgpresentation.ConsumptionuntilJune2023wasextrapolateduntil December2023tobeabletocomparethevalueswithcompleteyears.Also,wegroupedthedifferentpresentationsof originalbrandandbiosimilarmoleculesavailable,andthecost associatedatthetimeitwasconsumed.

Results Adalimumabconsumption(brandnameandbiosimilar adalimumab)hasgraduallyincreasedoverthepast8years,

from2,424in2016to4,254unitsin2023(+75.5%).Consumption,between2016and2018,rosefrom2,424to2,558 units(+5,5%),andtheircostdroppedslightlyatthesame period,from1,070,460to1,053,300euros(-1.66%).Adalimumabbiosimilarwasnotintroducedinthehospitaluntil 2019(penetrationofbiosimilarsin2019was17.9%,reaching 99.6%in2023).Between2019and2023,consumption increasedfrom3,317to4,254units(+28.3%)withanabsolutecostreductionof752,553euros(-78.3%).Overall,adalimumabspendinghasdecreasedby81.6%overthe8years despitetheincreaseinconsumption(75.5%).

ConclusionandRelevance Innovationinbiologicaltherapies,as wellastheincreaseincandidatestoreceivethem,hasgrown significantly.Involvementofdifferentclinicalserviceswiththe biosimilarmoleculeshasledtosignificantsavings(-81.6%), despitetheincreaseinconsumption (75.5%). Thecommercialisationofbiosimilarmolecules,promotesthesystem’ssustainability,enablesaccesstoagreaternumberofpatients,while allowingforthecontinuedincorporationofinnovative molecules.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest

Noconflictofinterest.

2SPD-008 SWITCHINGTOABIOSIMILARADALIMUMABIN DUTCHUNIVERSITYMEDICALCENTRES:ITISNOT

THATHARD!

1JZwaveling*, 2ETielen. 1LeidenUniversityMedicalCentre,ClinicalPharmacyand Toxicology,Leiden,TheNetherlands; 2UniversityOfUtrecht,MasterPharmacy,Utrecht,The Netherlands

10.1136/ejhpharm-2024-eahp.45

BackgroundandImportance Monoclonalantibodieshave extendedpharmacotherapeutictreatmentoptionsforpatients butarealsogreatlyincreasingthecostofexpensivedrugs. Biosimilarsareequivalenttotheoriginalreferenceproductin termsofefficacyandsafetyandcansignificantlyattenuatethe costincrease.IntheNetherlands,UniversityMedicalCentres (UMCs)makesjointpurchasingagreementsforasmanydrugs aspossible.The2021procurementofadalimumab,atumour necrosisfactor(TNF)alphablockerfortreatmentofrheumatoidarthritis,Crohn’sdisease,psoriasisanduveitis,among others,resultedinthedesignationofabiosimilar(Hyrimoz®) asthemosteffectivechoice.

AimandObjectives InthisstudythequantitativeandqualitativeaspectsoftheimplementationofthebiosimilarforadalimumabinallDutchUMCsisanalysedandwehavesought successfulstrategies.

MaterialandMethods Theanalysistookplaceovertheperiod fromOctober2021toJanuary2023.Theproportionofbiosimilarswascalculatedasapercentageofthetotalnumberof adalimumabusersatt=-3,0,3,6,9and12monthsafter introductionofthebiosimilar.Thequantitativestudyuseda PharmaInsights® softwaretool,whichcollectedadd-ondrug claimsdataforeachoftheeightUMCs.

PharmacistsineachUMCwereinterviewedaboutthe implementationprocessandsuccessfactors,focusingonpreparation,divisionoftasks,contentofcommunication,instruction letters/materials,monitoringandevaluationoftheswitch.

Results Therelativeuptakeofthebiosimilaradalimumabis showninfigure1anddifferedbetweenmedicalspecialties. Interviewswith(hospital)pharmacistsrevealedthatthedesign

oftheimplementationprocessdifferedamongUMCsanda goodrelationshipandcommunicationbetweenthepharmacy andtheoutpatientclinicsalsoprovedessentialforasuccessful switch.

ConclusionandRelevance Inthisfieldstudyin6,000Dutch patients,weobservedthatthepaceandsuccessofimplementationvariedbyUMC,andourfindingsofferopportunitiesto improvethisprocessbysharingbestpracticeswithinUMCs and,forexample,payingmoreattentionto ‘smaller ’ specialties suchasOphthalmology.

Theuseofbiosimilarscontributestotheefficientuseof medicinesandcansavemillionsofeurosonanannualbasis.

REFERENCESAND/ORACKNOWLEDGEMENTS

MembersofthedrugpurchasinggroupoftheDutch UMC ’s(iZAAZ).

ConflictofInterest Noconflictofinterest.

2SPD-009 A5-YEARRETROSPECTIVEREPORTON COMPREHENSIVEMEDICINEPROCUREMENTWITHIN APUBLICGROUPPROCUREMENTORGANISATION

1AMoratallaRolanía, 1PHorsComadira, 2JMGuiuSegura*. 1ConsortiumofHealthand SocialCareofCatalonia,CentralProcurementBody,Barcelona,Spain; 2Consortiumof HealthandSocialCareofCatalonia,PharmacyandMedicines,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.46

BackgroundandImportance Centralisedprocurementbodies playacriticalroleintheefficientprocurementofessential medicines.However,inrecentyearstherehasbeenagrowing recognitionoftheneedtogobeyondthetraditionalapproach andintegratecomprehensiveapproachesintocentralprocurementprocesses.Thisshiftisdrivenbytheincreasingcomplexityofhealthcaresystems,risingcosts,andthedesireto optimiseresourceutilisation.

AimandObjectives Theobjectiveofthisstudyistoevaluate theimplementationofacomprehensiveframeworkformedicineprocurementwithinaregionalgroupprocurementorganisation(GPO).

MaterialandMethods Aretrospectivestudywasconductedto quantifyandassesstheoutcomesresultingfromthecomprehensiveframeworkimplementationofmedicineprocurement spanningfrom2018to2023.Thestudyaimedtodetermine theextentoftheintroducedprocurementactivities’ valueand thefinancialaswellasnon-financialbenefitsforhospitalsand otherhealthcareorganisations.

Thecomprehensivemedicineprocurementframeworkwas establishedin2018andintroducednewservicesand

approachestotheprocurementandtenderactivitiesofthe GPO.Thisnovelframeworkencompassedthefollowingcomponents:a)Standardisationofpre-tenderactivities:needsanalysis,horizonscanning,marketconsultations,benchmarking withotherGPOs,standardisationofpurchasingcriteria, opportunitycostandcost-effectivenessanddevelopmentof innovativeprocurementmodels;b)Theestablishmentofa technicalofficetocoordinatetheoperationalexecution;c) ImplementationofacontractingprocessderivedfromFrameworkAgreements;d)Ongoingmonitoringoftheresultsof awardedtenders,withfeedbackmechanisms;e)Alignment withthedrugpoliciesofpublicinsurance.

Results Atotalof127tenderswereconductedacross2018–2023.Withanincreasingnumberoftendersthoughtheyears. Byincorporatingservicessuchasdemandforecasting,market consultations,andclinicalinput,timeswerereducedforpurchasingdecisions.Thisoptimisationontheprocurementperformanceledtoreducedcosts,andenhancedsupplychain resilience.However,nosignificantdifferenceswerefoundin thepricereductionachievedthroughtheaggregationofpurchasingpowerbytheGPO.

ConclusionandRelevance TheComprehensiveMedicineProcurementofourGPOrepresentsatransformativeapproach thatalignswiththeevolvinghealthcarelandscape.Byoptimisingresourceutilisation,enhancingsupplychainefficiency,and improvingprocurementperformance,thisapproachensures effectiveresourceuseforhospitalpharmacies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-010 IDENTIFYINGANDQUANTIFYINGDRUG-RELATED WASTEINAHEALTHCAREESTABLISHMENT

1APlan*, 1EDelande, 2DAimar, 1BMandy. 1HospicesCivilsdeLyon,Pharmacy,Giens, France; 2HospicesCivilsdeLyon,Logistics,Giens,France

10.1136/ejhpharm-2024-eahp.47

BackgroundandImportance InFrance,8%ofCO2emissions comefromthehealthcaresystem,20%ofwhichareattributabletothemedicinesandmedicaldevicesusedinhealthcare establishments.Anumberofsustainabledevelopmentinitiatives arebeginningtobeimplementedinhospitals,includingthe managementofwasteassociatedwithmedicines.

AimandObjectives Theaimofthestudyistoidentifyand quantifythesourcesofmedicinalwasteinordertoimplement virtuoussustainabledevelopmentactions.

MaterialandMethods Wetargetedtwoclinicaldepartments (Follow-upandRehabilitationcare(FRC)forspinalcordinjuries(DepartmentA)andFRCforgeriatrics(DepartmentB)) andthepharmacy.Wechosethesewardsforthepatient typology,averagelengthofstay(ALOS),numberofbeds,dispensingmethodandtypeofstorage.

Medicines-relatedwastewasquantifiedover2023by recordingthenumberofbins,thefillrateandtheweight. Wastequalificationwasbasedonasampleofninebinsfor whichthetypeofwastetheycontainedwasrecorded.

Results DepartmentAwith25bedsandtwice-weeklynominativedispensing,theALOSis186days,with140,274dose unitsdispensedfor377references.Medicationwasterepresented138kgdividedinto25%glassbottles,23%tubular bags,20%flexibleblisters,13%lidsand19%other,witha binfillrateof67%.

DepartmentBwhichhas45bedsandisdispensedona weeklybasis,theALOSis48days,with185,990doseunits dispensedfor1,019references.Medicationwasterepresented 47.9kgdividedinto42%tubularbags,31.5%lids,14%glass bottlesand12.5%other,withabinfillrateof85%.

Forthepharmacy,wasterepresented177.4kgdividedinto 34.5%glassbottles,31.3%lids,10.5%glassampoulesand 23.7%other,withabinfillrateof79%.

ConclusionandRelevance Thepharmacyisthebackboneof thehospital’smedicationcircuitandmustthereforetakesteps toeliminatemedicinalwasteinanecologicallyresponsible way.Todothis,itisessentialtoknowtheamountofwaste andthespecificcharacteristicsofeachdepartment.Themain areasforimprovementinreducingourwasteareoptimising thefillingofbins,developingspecificsortingchannelsand startingworkonwastingmedicines.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-011 AVAILABILITYOFLIQUIDANTIMICROBIALS – A NATIONALANALYSISOFTHECURRENTSUPPLY SITUATION

1NRiesenhuber*, 1MKrauss, 1KMossburger, 2CGradwohl, 1GStemer. 1UniversityHospital Vienna,Pharmacy,Vienna,Austria; 2St.AnnaChildren’sHospital,Paediatrics,Vienna, Austria

10.1136/ejhpharm-2024-eahp.48

BackgroundandImportance Oralliquiddosageformsofvariousantimicrobialsrepresentthemainstayoftherapyforpaediatricinfections,especiallyininfantsandyoungchildren. However,shortagesofsuchpreparationshavedramatically increasedoverthepastyear,challengingadequatetherapy, especiallyinthecommunitysetting.

AimandObjectives Theaimofthisstudywastoassessthe supplysituationofvariousantimicrobialsinliquiddosage formsinAustria.

MaterialandMethods Theavailabilityofantimicrobialsin liquiddosageformswasexaminedoveraperiodof27weeks (FebruarytoAugust2023).Actualsupplydatawereextracted onceweeklyfromamajorAustrianfull-servicepharmaceutical wholesalerdatabaseandtheavailabilityofallliquidantimicrobialsauthorisedinAustriawasanalysed.

Results Atotalof42productscontai ning15differentantimicrobialsinliquiddosageformsareauthorisedinAustria. Duringthetimeperiodinves tigated,34products(81.0%) werenotavailableforover50%ofthetime;eightof those(19.0%)experiencedcomp leteunavailability.Only fourproducts(9.5%)demonstratedcontinuousavailability (i.e.preparationscontaining fluconazole,oseltamivir,and voriconazole).

Availabilityofcephalosporinantibioticswasspecificallylimited,withfirst-generationcephalosporins,beingunavailablefor prescriptionin74.1%oftheobservationperiod(20weeks). Cefpodoximeremainedinaccessiblefor96.3%oftheinvestigatedperiod(26weeks),cefaclorandcefalexinfor85.2%(23 weeks)and74.1%(20weeks),respectively.Cefiximeshowed betteravailability,experiencingstockoutsforonly44.4%of thetime(12weeks).

Regardingpenicillinantibiotics,amoxicillinwasnotavailablefor77.8%ofthetime(21weeks)andamoxicillin/clavulanicacidfor59.3%(16weeks).PenicillinVshowedbetter

availability,beingoutofstockonlyfor37.0%ofthetime(10 weeks).Regardingmacrolideantibiotics,azithromycinwasnot availablefor63.0%ofthetime(17weeks),whileclarithromycinexperienced37.0%unavailability(10weeks).

ConclusionandRelevance Medicinesshortages,especially involvingantibiotics,poseaglobalpublichealthdilemmathat canleadtoadversehealthoutcomes.Regularmonitoringof availabilitystatuscanhelpmitigatethisissue;however,crossnationalstrategiesareurgentlyneededtoguaranteeaconstant supplyinthefuture.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-012 APPLICATIONOFFAILUREMODEANDEFFECTS ANALYSISTOIMPROVEAUTOMATEDDISPENSING CABINETS’ DRUGSTOCKMANAGEMENTPROCESSES MFernándezGonzález,HLAcostaGarcía,PSuárezCasillas*,JLPérezBlanco,JPQuintero García,MVGilNavarro. HospitalUniversitarioVirgendelRocío,Pharmacy,Sevilla,Spain 10.1136/ejhpharm-2024-eahp.49

BackgroundandImportance Logisticsprocessesfordrugstock managementarecriticalintheorganisationofpharmacyservices.Automateddispensingcabinets(ADCs)allowforbetter controloftheseprocesses,increasingpatientsafety,optimising drugconsumptionandcosts.However,theuseofthesedevicesisnotalwaysthemostappropriate,compromisingits advantages.

AimandObjectives Tocarryoutafailuremodeandeffects analysis(FMEA)tooptimisetheuseofADCsbyallstakeholders(pharmacists,pharmacytechniciansandnurses).

MaterialandMethods Amultidisciplinaryteamwasestablished toperformananalysisusingFMEAmethodology(pharmacists, nurses,andpharmacytechnicians).Theydefinedallrelated failuremodesthatcouldoccur,indicatingcausesandconsequencesthroughbrainstormingmeetings.Fiveriskmapswere performedonthefollowingprocesses:ResupplyofADCs,in floorreturnofdrugstoADCs,restockoftemporarytransfer cabinets,reviewofdrugsexpirationdate,anddrugdispensing throughADCs.Theriskprioritynumber(RPN)wascalculated accordingtothefollowingindices:SeverityxFrequencyx Detectability,assigningvaluesfrom1to10toeachindex. MedianRPNvalueswereusedtoprioritise.Preventiveand correctiveactionswereproposed.

Results Atotalof27failuremodesweredefined,accumulating 3,553pointsofRPN(valuesranged9–300).Theprocess ‘drugdispensingthroughADCs’ obtainedthehighestmedian RPNvalue(192,126–246).Thenumberoffailuremodes withaRPN>200was6.Afterprioritisation,anactionplan consistingofseveralactivities,basedongoodpracticesguidelinesfromtheInstituteforSafeMedicationPractices(ISMP) wasproposed.Atrainingprogrammefornursesontheuseof ADCswasdesignedandimplementedtoensurecorrectuse onthehospitalisationfloor.Areceptionplanfornewpharmacytechnicians,consistingoftrainingdocuments,waselaborated.Finally,aplanforADCs’ setupandregularstock reviewbyspecialistpharmacistswasdesigned.After6months, anewanalysiswasperformed,andallthefailuremodesevaluatedscoredaRPNvalue<200.

ConclusionandRelevance TheFMEAmethodologyallowedus todetectandevaluatefailuremodesanditseffects,implementinganactionplantooptimisetheuseofADCs.Inthe

future,asurveyamongsanitaryprofessionalswillbecarried outtoanalysetheimpactoftheseactions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-013 ACOMPARATIVELIFECYCLEASSESSMENTOF DIFFERENTPACKAGINGOPTIONSFORALBUMIN DISTRIBUTION

1ABalaGala*, 2RAntúnezRetamal, 2LClementeMartí. 1Esci-Upf,UnescoChairinLife CycleandClimateChange,Barcelona,Spain; 2GrupCarles,EngineeringandSustainability, Igualada,Spain

10.1136/ejhpharm-2024-eahp.50

BackgroundandImportance Traditionally,albuminhasbeen presentedinglassvialpackaging,butisittheoptimalchoice foritsdistribution?

Inrecenttimes,manypharmaceuticalcompanieshave shiftedfromglassvialstoplasticbagstodelivertheirhospital products.Plasticbagshavedemonstratedclearadvantagesfor bothnurses(asglasscarriesahigherriskofbreakage)and patients(sincethebagdoesnotrequireairinlet,sothereis lessriskofcontamination).However,plasticbagsareoften perceivedasharmfultoecosystems.

LifeCycleAssessment(LCA)providesthescientificevidenceontheactualimpactoftheentireprocess.Therefore, whencomparingglassandplasticpackagingforthesame productunderLCAmethodology,thescientificproofregardingenvironmentalimpactsisstablished.

AimandObjectives Thegoalofthisstudyistocomparethe environmentalperformanceofglassandplasticpackaging optionsfordeliveringalbumin100mldosesintheEuropean market,consideringalltheirlifecyclestages.

MaterialandMethods Acradle-to-graveLCAhasbeenperformed,consideringthedistributionof10.000unitsofalbumin(20%)servedin100mldosestohospitalsasareference orfunctionalunit.

TheProductEnvironmentalFootprintmethod(E.F.3.0) hasbeenusedfortheenvironmentalassessmentofthealternatives.However,onlythemore9relevantimpactcategories afternormalisingtheresultspluswaterscarcityindicatorhave beenanalysedinfurtherdetail.

ThestudyhasbeenconductedfollowingISO14.044 standard,usingLCAforExpert ssoftwareGabi(untilvery recentlyknownasGaBi)andthe irrelativedatabases(2023_1 update).

Results Plasticbagsperformbetterthanglassvialsinallthe impactcategoriesanalysed.Regardingclimatechangetotal (CC)theimprovementis23%.Alsonoteworthyisthe55% reductioninwaterscarcityimpact.

ConclusionandRelevance Althoughplasticsarepopularlyconsideredharmfultoecosystems,plasticbagshavelessenvironmentalimpactthanglassvials.So,for10.000unitsof albumin(20%)servedin100mldosewithplasticbaginstead glassvial,theemissionof655kgofCO2eqandtheconsume of355m3 ofwaterareavoided.Thisisequivalenttotravellingabout3.930kminanaveragecarandtotake3.500 five-minuteshowers,respectively.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-014 ECO-CONSCIOUSHEALTHCAREPRODUCTSSUPPLY: INVESTIGATINGTHEEFFECTSOFFEWERORDERS

CFenat*,ELeroy,SProt-Labarthe,VLeBigot,DFeldman,AGoubil. NantesUniversitéChuNantes-Pharmacie-F-44000-France,Pharmacy,F-44000,France

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BackgroundandImportance Healthcaresectorcontributes8% ofthecountry ’scarbonfootprint,with50%attributedto healthcareproductsupply.Plasma-DerivedMedicinalProducts (PDMP)representasignificantportionofthisproductsupply. Animprovementprojectwasinitiatedinearly2023inour UniversityHospital(UH)toreducethefrequencyofweekly orderstomonthlyorders.

AimandObjectives EvaluatetheEnvironmentalImpact(EI)of a6-monthreductioninPDMPorders.

MaterialandMethods AqueryofthenumberofallPDMP orderswascarriedoutusing Pharma® software(Computerengineering,V5.9).TheresultsfromFebruarytoJulyin2022 and2023werecompared.Suppliers’ abilitytocommunicate theEIofordersiscomparedtoanestimateonliteraturedata andthe Empreinte® databaseoftheEnvironmentandEnergy ManagementAgency(ADEME).ResultsareinCO2 equivalents(eq.CO2).

Results Amongthe189listedPDMPsfrom17suppliers, reductionswereappliedtothreemajorsuppliers(32%of 2022orders).Theirordersdroppedfrom99(2022)to73 (2023),representinga26%decrease.Thenumberremained stableforothersandPDMPconsumptionwerecomparable betweentwoperiods.Supplierscouldnotestimatetheorders’ EI.Usingthe Empreinte® database,transportingproductsin fullyloadedvehiclesisecologicallyfavourable.Accordingto theShiftProject,a20–30%truckloadincreasesaves14%to 21%fuel.Theaverage400kmdistancetosuppliersanda 20m3 truckusing10L/100kmofdieselB7wouldsave5.6Lof fuelperroundtrip.Onelitreemits3.10kg.eq.CO2,saving 451.kg.eq.CO2 over6-months.However,thenumberof PDMPsreceiptshasnotdecreasedasmuchasthenumberof orders.ThecalculatedCO2 savingsareestimates,iftheratio orders/receiptstendtowards1.

ConclusionandRelevance Reducingorderscanoptimise vehiclefillingandlowerdelivery-relatedfuelconsumption. Coordinatingrouteswithothercentrescouldfurtherreduce EI.Routesharingcouldbeconsideredbycohabitatingflows withothercentres.Largerordersrequireadditionalstorage space,butitisnotaconcerninourestablishment.Fewer ordersalsoeasetheworkloadforlogisticsstaff.However,tensionsinhealthcaresupplycanleadtosporadicreceptions independentofourreductionpolicy,makinganexactorderreceiptmatchchallenging.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-015 INTEGRATEDHEALTHCARELOGISTICS:KANBAN SOLUTIONFORMANAGEMENTOFDIALYSIS WAREHOUSESPILOTCASE

1RCavi*, 2PGiovanni, 2SAlice, 1PLaura, 1MFrancesca, 3GPatrizia, 4BLaura. 1AsstSette Laghi,Pharmacy,Varese,Italy; 2AsstSetteLaghi,OperationsManagementandNext GenerationEu,Varese,Italy; 3AsstSetteLaghi,ExperienceManagement,Varese,Italy; 4Asst SetteLaghi,Dialysisunit,Varese,Italy

10.1136/ejhpharm-2024-eahp.52

BackgroundandImportance Theoutsourcingoftheintegrated healthcarelogisticsserviceandthecentralisationofthepublic healthcarecompanywarehousesrepresentaresponsetotechnicalandlogistical-managementcriticalissuestypicalofa decentralisedsystem(Hub&Spokewarehouses)characterised byobsoletetechnologiesandITsystemsforwarehousestock management.Theproject(a9-yearcontractthatstartedin June2022)involvesthecentralisationofallperipheralwarehousesinasinglewarehouseHUBandtheinstallationofa WarehouseManagementSystem(WMS)requiredforthemanagementofDrugs,MedicalDevices(stock,transits)andvariousmaterialusefulfordailyhospitalactivity.

AimandObjectives Thisabstractfocusesonmicrologisticsand, inparticular,onthereorganisationofadialysiswarehouse basedonaLeanManagementperspectivewiththeaimof optimisinglogisticsandprocurementprocesses.

MaterialandMethods Thepreparatoryphaseoftheproject involvesthevisualreorganisationofthedepartmentwarehouse,identifyingaunique,dedicatedandmarkedlocation foreachproductanddefiningthedepartmentstocks(3days ofautonomy)andthemechanismandfrequencyofresupply (daily).

ThekeytoolistheKanbanmethod:aftertakingeach productfromthedepartmentwarehouse,thedepartmentoperatorplacesan ‘X’ onadedicatedKanbanboard.Everyday,a warehousededicatedoperator(‘spider ’)collectstheboardand takestheconsumedquantitiesfromthecentralhospitalwarehousetoresupplydialysiswarehousestocks.Therestored quantitiesareplacedinthepreviouslyestablishedspacesin thedepartmentlocker.

Results Thedepartmentisabletomonitorstocksavailableon site,allowingamoreaccurateplanningandreductioninwaste duetoexpiredgoods.Departmentspacesdefinedfordialysis materialstorageareoptimised(from50m2 to15m2).The methodologyadoptedallowsustoguaranteeastandardised andnon-operator-dependentstockresupplymethod.Thetime spentbytheUnitCoordinatoronnon-valueactivitiesforthe reorganisationofthematerialisreduced(about7hours/ week).

ConclusionandRelevance

Resultsarerelevant Thispilotcase, whosemainobjectiveisto guaranteeoperationalefficiencyfordialysismaterialresupply throughstandardisedmanagement,providesasolidmodelthat canbeappliedinthefuturetootherbusinessunitsinorder toimprovedepartmentefficiencyandlogisticsservicequality.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-016 DATA-DRIVENSELECTIONOFAMEDICATION MANAGEMENTMODELINHOSPITALISATIONWARDS

1APérez, 2VCorrea, 3MIMartínez, 1RBorràs, 4RLópez, 1LEstrada*, 1ETerricabras, 1SAulet, 5SFernàndez, 3CMiret, 1CQuiñones. 1HospitalUniversitariGermansTriasIPujol, PharmacyDepartment,Badalona,Spain; 2ApexConsultoria,ApexConsultoria,SantQuirze delVallès,Spain; 3HospitalUniversitariGermansTriasIPujol,ProjectsandInnovationUnit, Badalona,Spain; 4HospitalUniversitariGermansTriasIPujol,InformationSystemsUnit, Badalona,Spain; 5HospitalUniversitariGermansTriasIPujol,NurseDirection,Badalona, Spain

10.1136/ejhpharm-2024-eahp.53

BackgroundandImportance Optimaldispensinganddistributionmanagementmodelofdrugsreducesinefficienciesand increasedrugsafety.

AimandObjectives Toselectbestmedicationmanagement model(centralisedinpharmacyvsdecentralisedinhospitalisationwards(HW))basedonmedicationconsumptionpattern ofdifferentHW,incontextoftheredesignofmedication managementsysteminahigh-complexityhospital.

MaterialandMethods ApplyingParetoprinciples,anABCXYZmatrixwasdesignedusingmedicationconsumptiondata fromHWinJanuary2022.Thisdata,obtainedfromthehospital’smanagementsystem,includedmedicationsnotlistedin apharmacotherapeuticguide(PTG).Informationanalysed includedmedication,guideinclusionsituation,dispensedquantities,andHW.WithineachHW,medicationswerecategorised accordingtoquantity(ABC)andvariability(XYZ),with ‘A’ denotinghighestconsumptionand ‘Z’ signifyingmaximum variabilityinconsumption.

ABC:

. A.x £ 80,0%(xmedicationsorderedfrommaximumto lowestconsumption)

. B.80,0%<x £ 95,0%

. C.95,0%<x £ 100,0%

XYZ:

. X.CV<0,3

. Y.0,3 £ CV £ 0,75

. Z.CV>0,75

Coefficientofvariability(CV)wasobtainedbydividing standarddeviationbythemean.Outlierswereremoved.ABCXYZcombinationdefinedconsumptionpatternofeachmedicationforeachHW,associatedwithamanagementsystem.

. GROUP1:AX,AY,BX,CX – Highconsumption,low variability.Decentralisationandreplenishmentbasedon standardminimums.

. GROUP2:BY,AZ – Moderatevolumeandvariability. Decentralisedwithreplenishmentbasedoncriticalityor consumptionpeaks.

. GROUP3:BZ,CY,CZ – Highvariability,regardlessof consumption.Centralisedinpharmacyordecentralisedwith systematicmonitoringofexpirationdates.

. GROUP4:zeroconsumption.

Results 13unitsand826referenceswereanalysed,37not includedinPTG.Consumptionpatternwassimilaracross HW.InHW, ‘A’ accountfor56–75medications, ‘B’ for63–99 andCfor105–151.A39–96[18%-32%]ofthereferences belongedtoGroup1,54–62[19%-24%]toGroup2,and 116–182[48%-58%]toGroup3.EachHWonlyconsumed 25%-36%oftotalreferencesusedinthehospital.

ConclusionandRelevance Optimalmedicationmanagement modelwasdeterminedbyconsumptionpatternofeachreferenceineachHW,ratherthanone-size-fits-allapproachfor entirehospital.However,datasupportsdecentralisingmedicationswithmonitoringofspecificreferences.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

2SPD-017

RISKIDENTIFICATIONINANTIDOTEANDEMERGENCY PREPAREDNESS

PGambin*,MAttardPizzuto,AAnastasi. FacultyofMedicineandSurgery,Universityof Malta,DepartmentofPharmacy,Msida,Malta

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BackgroundandImportance Globally,antidotepreparedness hasbeenidentifiedasamajorchallenge(Antonielloetal, 2023).Thehealthcaresystemmustbeabletoensureantidote availabilityandeffectivemanagementforbothindividualpoisoncasesandformasscasualties,whilstweighinginthe financialburden.Thisstudyrecognisedagapinliteratureon thelocalsituationofemergencypreparednesswithregardsto antidotesandtherisksinlocalantidoteavailabilityandaccessibility.Identificationofrisksiscrucialforthedevelopmentof riskmanagementstrategiestoensurenodisruptionsinthe antidotesupplychain.

AimandObjectives Theaimofthisstudywastoidentifyrisks intheavailabilityandaccessibilityofantidotesinasmall nation.

MaterialandMethods Verticalauditsofeightantidotes(pralidoxime,atropinesulphate600mcg/mlinjections,hydroxocobalaminkit,sodiumthiosulphate,sodiumnitrite,digoxinimmune fab,activatedcharcoaland,acetylcysteine)wereperformedat theprocurementunitandtwoacutegeneralhospitals,toidentifyrisksstartingfromthesourcingtothedispensingofantidotesforpatientuse.Aclinicalexpertfocusgroupwas establishedforvalidationandprioritisationofidentifiedrisks.

Results Fiveoftheantidoteswerenotedtohaveproblematic sourcingduetorestrictedavailabilityontheopenmarket.

Logisticsandcostsofantidoteshadamajorinfluenceonantidoteavailabilityandaccessibility.Otheridentifiedrisksinclude inadequatestockingofantidotes,lackofperiodicreviewof procurementspecifications,delayofantidotereleasefrom quarantineduetoregulatorybarriers,insufficienttraining,lack ofguidelinesandnationalcontingencyplan,unreliablesuppliersandbureaucraticprocurementprocesses.

ConclusionandRelevance Thisisthefirststudyofthisnature totakeplaceinthissmallnation.Findingsindicatecritical needforhealthcaresystemoptimisationinemergencypreparedness.Risksassociatedwithavailabilitycanbemitigated throughtheestablishmentofinternationalcooperationagreementsatEuropeanandgloballevels.Therisksidentifiedwill beutilisedinthedevelopmentofguidelinesandrecommendationsontheoptimisationofemergencypreparednessbasedon riskmanagementprinciples.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AntonielloAA,PaulsP,AwadNI,SobolewskiK,FernandezD,BridgemanP.Optimizationofantidotestocking,availability,andadministrationpracticesforalarge multihospitalorganization. AmericanJournalofHealthSystemPharmacy.2023;80 (1):S1-S10.doi:10.1093/ajhp/zxac191.

ConflictofInterest Noconflictofinterest.

2SPD-018 IMPACTOFINHALERSONCO2EMISSIONINA HEALTHAREA

ALuaces-Rodríguez*,PFeijoo-Vilanova,LCaeiro-Martínez,EGómez-Costa,AMartínezPradeda,SRotea-Salvo,SAlbiñana-Pérez,IMartín-Herranz. ACoruñaUniversityHospital Complex,Pharmacy,ACoruña,Spain

10.1136/ejhpharm-2024-eahp.55

BackgroundandImportance Thereareseveraltypesofdevices forinhaledtherapy,beingthemostusedones:pressurised metered-doseinhalers(pMDIs),dry-powderinhalers(DPIs) andsoftmistinhalers(SMIs).AllthetypeshavesomeenvironmentalimpactduetotheireffectonCO2 emissions, althoughverylowcomparedtototalCO2 emissions,pMDIs haveproventoexerthigherCO2 emissionsthanDPIsand SMIs.

AimandObjectives Themainobjectiveistoestimatethe impactofpMDIs,DPIsandSMIs,prescribedforanyindication,onCO2 emissionsinourhealthcareareaduring1year. MaterialandMethods Numberofinhalersconsumedinour healthcareareawithapopulationof550086inhabitantsduring2022wasextractedfromthePharmacyBenefitManagementData.

Theinhalers’ carbonfootprintvalueswereextractedfrom thepublicationMontoroetal.Theestimatedmeanvalueof KgCO2-eq/year/packwas16.69forpMDIs,1.02forDPIs and0.59forSMIs.

Results Ofthetotalamountofinhalersconsumedduring 2022,39.21%werepMDIs,54.47%wereDPIsandonly 6.33%wereSMIs.

Consideringtheestimatedcorrectionvalue,thecarbon footprintwas2297846kgCO2-eqforpMDIs(91.69%ofthe totalcarbonfootprintofalltheinhalers),195104kgCO2-eq forDPIs(7.79%)and13105kgCO2-eqforSMIs(0.52%).

ConclusionandRelevance ThecarbonfootprintofthepMDIs representedmorethan90%ofthetotalcarbonfootprintof alltheinhalers,evenwhenconsumptionofpMDIsrepresentedlessthanthe40%.ThisputinevidencetheconsiderablehigherenvironmentalimpactofpMDIscomparedto DPIs.

However,thisdoesnotgoinlinewithseveralsocieties andorganismswhichkeepdefendingthatefficacy,safetyand patientsuitabilitymustcontinuetobethemainfactorswhen choosingatypeofinhalerforeachpatient.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.MontoroJ,Antolín-AmérigoD,Izquierdo-DomínguezA,ZapataJJ,GonzálezG, ValeroA.ImpactofAsthmaInhalersonGlobalClimate:ASystematicReviewof TheirCarbonFootprintandClinicalOutcomesinSpain. JInvestigAllergolClin Immunol.2023Jul27;33(4):250–262.doi:10.18176/jiaci.0887.Epub2023Jan 4.PMID:36648318.

TheauthorsacknowledgethePharmaceuticalBenefitManagementService – SERGAS(Spain)forthedataprovided. ConflictofInterest Noconflictofinterest.

2SPD-019 TOWARDSASUSTAINABLEOPERATINGROOM: FEEDBACKONACTIONSCARRIEDOUTAROUND MEDICALDEVICES

MBabin*,CHay,LLedoux,FJoachim,MDufosse,APetit. CHUAmiensPicardie, Pharmacy,Amiens,France

10.1136/ejhpharm-2024-eahp.56

BackgroundandImportance Since2022withinourhealthcare establishment,amulti-professionalthinktankhasbeen engagedintheimplementationofasustainabledevelopment approachwiththreeobjectives:reductionofthevolumeof waste,energysavingandfightagainstpollutionintheoperatingroom(OR).

AimandObjectives RationaliseMedicalDevice(MD)referencesandmovesomedefinedasuncriticalintermsofinfectious

risk,sterilesingle-usedoublepackaging,towardsreusable ‘resterilisable’.Theapproachwasappliedtoskinpreparationsets, electricandcoldscalpelhandles.

MaterialandMethods Aworkinggroupwascreated,madeup ofpharmacists,pharmacytechnicians,ORmanagers,OR nurses,sterilisationandhygieneservice.Thenumberofreferences,quantitiesordered,andtheannualbudgetspentin 2022wereevaluated.Fortheskinpreparationsets,anaudit amongORnurseswascarriedouttoassessusagepractices andtofindoutifswitchingtore-sterilisableMDsforthe skinpreparationstagewaspossible.Theorganisational,economicandenvironmentalimpactwasassessed.

Results In2022,15,690skinpreparationsets(C ¼ 70,547), 15,455single-useelectricscalpelhandles(C ¼ 24,092)and 12,310single-usecoldscalpelhandles(C ¼ 2,050)wereused. Fortheskinpreparationsets,twoofthethreeavailablereferencesincludeadetersionset.Theworkinggroupdecidedto removethem,toreferenceadouble-packagedspongestick andtointegratere-sterilisablecupsintotheinstrumentation boxes(75%wereinfavour).Anupdateoftheprocedures concerningskinpreparationfortheoperationhasbeencarried out.Tointegrate:onecup,oneelectricscalpelhandleand twocoldresterilisablescalpelhandles,684instrumentation boxeswereidentified.ThecostofpurchasingMDsrepresents aninvestmentofC ¼ 27,600.Thatofsterilisationremainszero sincetheseboxesarealreadyincirculation.Finally,theestimatedgainfortheBOattheendofthefirstyearis C¼ 43,000,i.e.areductioninCO2emissionsof13,545kg.

ConclusionandRelevance Thisapproachhasbeenvalidated andhasbeeninplacesinceJune2023withevaluation plannedfortheendof2023.Otheractionsrelatedtothe reductionofwasteattheORareinprogress,withareflectiononthedoublepackagingofcertainMDs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

2SPD-020 DESIGNANDEVALUATIONOFANINNOVATIVE AIRBORNETRANSPORTSYSTEMFORBLOOD-DERIVED DRUGSUNDEREMERGENCYCONDITIONS

1DAngelini*, 1ECestino, 2DCestino, 2FCattel. 1PolitecnicodiTorino,Ingegneria Aerospaziale,Torino,Italy; 2A.O.U. ‘CittàdellaSaluteedellaScienzadiTorino’,Farmacia Ospedaliera,Torino,Italy

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BackgroundandImportance Blood-derivedmedicinesare administeredespeciallyinresponsetotraumaticevents.Since theiruseislinkedtotheoccurrenceofaccidents,theirneed isunpredictable.Consequently,itisdifficulttoapplytraditionalmanagementlogicofwarehouses.

AimandObjectives Thepresentresearchaimstocomparedifferentstrategiesoftransportingblood-deriveddrugsunder emergencyconditions.Specifically,currentlandtransportation iscomparedtoinnovativeElectricmannedTake-Offand Landingaircrafts(EVTOL)anddrones.Differentaspectsare analysedincludingsafety,aswellascost-effectiveness.Furthermore,theanalysisincludestheidentificationofthebestlocationofapossibledrugdistributionhubwithinthePiedmont region.

MaterialandMethods Firstly,anassessmentofthesafetyof airoverflightisconductedbyconstructingariskmap.Each cellcontainstheprobabilitythatacatastrophicfailureforthe

vehiclewillleadtoafatalimpactwithaperson.Thespatial distributionofpopulationdensityisobtainedfromadataset of ‘Meta’,whilethepresenceofbuildingsisestimatedusing ‘OpenStreetMap’.Secondly,Dijkstra’salgorithmisusedto determinetheminimum-riskaerialtrajectory;instead,forcars, ‘NetworkX’ isused.

Results Anindexofmeritisconstructedtocomparetransportationmeans.TheEVTOListhebestmeansoftransportation formakingdeliverybetweenhospitalsindenselypopulated areas,whilethedronedoesnotsufficientlymeetthesafety requirements.Thelatterisvalidforjoiningnon-denselypopulatedareas.Finally,withinthesamecityandforsmalldistanceslandtransportationisthemostsuitable.Asforthe deliveryhub,itisstrategictoplaceitinthevicinityofhospitalcentreswherethedemandforblood-deriveddrugsisgreatest.Also,itwouldreducethemajorriskscorrelatedtoproper medicinestorage.Forlanddelivery,itismoresuitableoutside Turin.

ConclusionandRelevance Thestudydemonstratesthatmanned EVTOLsaretheoptimalwayoftransportationfordrugdeliveryunderemergencyconditions.Atthesametime,thedrone representsaviablesolutioniftheareastobeflownoverare notdenselypopulated,also,theywouldbringreductionin costscomparedtolandtransportation.Thehublocationstudy wouldrepresentasignificantstepforwardinconnectinghospitalsandimprovingthelogisticsofdrugsadministered-asneeded.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-001 TOPICALCOMPOUNDEDCLINDAMYCINSOLUTION MADEFROMORALDOSAGEFORMS,CONTROLAND STABILITYSTUDY

AKurbegovic*. ClinicalCentre,UniversityofSarajevo,ClinicalPharmacy,Sarajevo,BosniaHerzegovina

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BackgroundandImportance Difficultiesindrugsupplymakes pharmacistsfindalternativewaystoprovidefunctionaltherapy.APIfromavailablepharmaceuticalformscanbeusedasa substanceforcompoundingmedicine.Drugeffectivenessneeds beconsideredaswellascompatibilitywithexcipientsandprimarypackingmaterial.Variabletemperature,humidity,light canstimulatechangesinallpharmaceuticalforms,especially insolutions.Primarypackingmaterialshouldprovideprotectionofdosageformsandcompatibilitywiththemedicine.

AimandObjectives Aimofthisstudywastoexaminecompoundingclindamycintopicalsolutionmadefromavailable clindamycinhydrochlorideoraldosageforms.Effectofexcipientsandfiltrationprocesswasevaluated.Drugstability determinenotonlyeffectivenessofdrug,butalsoitssafety. Patientsmaystoresolutioninplacesthatmaybeinadequate. Thestudycomparedglassandplasticbottlesforstoringthe solution.

MaterialandMethods Methodforassaydeterminationwas HPLCreversedphasewithUVdetector.Assayandpeaksof relatedsubstancesandimpuritieswereevaluated.Solutionwas dividedinglassandplasticbottlesandstoredatlightexposure,elevated,decreasedandroomtemperature.Samplingwas accordingtofreejudgment.

Results Samplesolutionmeetstheassayrequirementswith assay92%acceptancecriteriais90–110%.NosignificantAPI degradationandrelatedsubstanceswerenoticed.Samples storedinplasticbottlesshowedassayincreaseupto26% comparedtosamplesinglassbottleswherereportedgrowthis upto5%.

ConclusionandRelevance Clindamycinhydrochloridesolution fortopicalusecanbemadefromoralpharmaceuticalforms. Compoundingprocessdidnothaverelevantimpacttoassay ofAPI.Moleculeisstableatleast112daysundermentioned conditions.However,assayincreasewasnoticedinplastic HDPEbottlesduetovehiculumevaporationwhichismore expressedinsamplesconditionedinelevatedtemperatures. Containerclosuresystemshouldenableadequateclosing betweencapandbottlewhichisakeyparametertobe considered.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.JamesR.Falconer,KathrynJ.Steadman.Extemporaneouslycompoundedmedicines. AustralianPrescriber,2017;Vol.40(1).

2.HiteshChavda.In-Usestabilityguidelinesandchallenges. DrugDevelopmentand IndustrialPharmacy,2021;Vol.47(9).

3.EuropeanMedicinesAgency,Committeeforproprietarymedicinalproducts (CPMP),In-usestabilitytestingofhumanmedicinalproducts – Scientific guideline.

ConflictofInterest Noconflictofinterest.

3PC-002 STABILITYOFTENECTEPLASESYRINGESAFTER FRACTIONATION

MTGomezSanchez*,RGazquezPerez,FDFernandezGines,MSanchezValera,DGamez Torres,MGDiazLopez. HospitalTorrecardenas,Pharmacy,Almeria,Spain

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BackgroundandImportance Tenecteplaseisarecombinant plasminogenactivatorproteinindicatedinadultsforthe thrombolytictreatmentofsuspectedmyocardialinfarction within6hoursofsymptomonset.TheSpanishAgencyof MedicinesandHealthProductsreportedashortageoftenecteplase.Therefore,atenecteplasefractionationprotocolwas developedinourpharmacyservicebasedonastudythatanalysedthestabilityandbioactivityoffrozensyringes(-20°Cor -70°C)for1-month1,admittinguptosixfreeze/thawcycles. Nostudiesexploringstabilityandbioactivitybeyondthishave beenperformed.

AimandObjectives Toevaluatethephysicalandchemical stabilityoffrozensyringesofreconstitutedtenecteplaseovera 2-monthperiodusingprotonnuclearmagneticresonance(1HNMR).

MaterialandMethods Tenecteplasewasreconstitutedandfractionatedin5mg/1mLsyringes.Theywerestoredat-20°Cand evaluatedatdays0,30,45and60.Physicalparameterswere monitored:turbidityandcolour.Chemicalstabilitywasevaluatedby1H-NMRspectroscopy.Thespectroscopicsignals wereinterpretedandassignedtothechemicalstructureof tenecteplaseandsubsequentlycomparedwiththespectraat days30,45and60.AllspectrawereacquiredusingaBruker AvanceDRX500MHzspectrometer.

Results Intermsofphysicalparametersthereappearstobeno differencebetweenthesyringeatday0andatdays30,45 and60.Regardingchemicalstability,thespectrumresulting fromthesyringeatday30doesnotshowsignificantdifferencescomparedtothereferencespectrum.However,when

comparingthespectrumofthesyringeatday45withthe referencespectrum,theredoappeartobesignificantchanges thatcallintoquestionthestabilityandbioactivityofthefractionatedreconstitutedtenecteplase.Therefore,thestudywas stoppedandthespectrumatday60wasnotcomparedwith thereferencespectrum.

ConclusionandRelevance Thisstudyseemstoconfirmthe stability(physicalandchemical)andbioactivityoftenecteplase syringesfrozenat-20°Cforamonth.However,itdoesnot seemtomaintainchemicalstabilityat45days,soitis assumedthatat2monthsithasnostability.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SembaCP,WeckS,RazaviMK,TuomiL,PatapoffT.Tenecteplase:stabilityand bioactivityofthawedordilutedsolutionsusedinperipheralthrombolysis. JVasc IntervRadiol.2003.Apr;14(4):475–9.

ConflictofInterest Noconflictofinterest.

3PC-003 SUITABILITYOFELASTOMERICPUMPSFORDRUG STORAGE

1NOtt*, 2CLanfranchi, 3WBello, 1MCzernek, 1GKiefer, 1BThomas, 1MSenn, 1ULösch. 1UniversityHospitalBasel,Hospitalpharmacy,Basel,Switzerland; 2HôpitauxduJuraetdu JuraBernois,PharmacieInterjurassienne,Moutier,Switzerland; 3LausanneUniversity Hospital,PharmacyDepartment,Lausanne,Switzerland

10.1136/ejhpharm-2024-eahp.60

BackgroundandImportance Elastomericpumps(EP)areselfsufficientdeliverysystemsforthecontinuousintravenous administrationofdrugsandaremainlyusedinoutpatientsettings(e.g.oncology,infectiology).

Theproduct-contactingmaterialsofEPconsistofvarious polymersandadditives.Incontrasttosterileplasticsyringes, dataonleachablesforEPareonlyavailableinindividual cases. 1

AimandObjectives InordertoassessthesuitabilityoftheEP forthestorageofdrugsolutions,atransferofsubstances fromthepumpmaterialintothedrugsolutionwas investigated.

Furthermore,theweightlossofthepumpcontentsdueto thewatervapourpermeabilityoftheplasticlayerswasdetermined,whichcanleadtoanincreasedconcentrationofactive substances.

MaterialandMethods SevendifferentEPdeviceswereexamined:5to10pumpsofeachdevicewerefilledwithisotonic sodiumchloridesolution.Atday1,7,28,90and180the pumpcontentswerequantifiedtodeterminethewatervapour permeabilityaswellasaccordingtoPh.Eur.3.3.8interms ofabsorption,acidicoralkalinereactingandreducing substances.

BymeansofHPLC-MSleachableswereidentifiedfroma databaseof200substancesandrecordedsemi-quantitatively.2

Results SixofsevenEPshowedweightloss<8%after180 days(upperlimit:9.0%).Onedeviceshowedweightloss £7.0%at90daysand 11.4%at180days.

AllsevenEPdevicesmettherequirementsaccordingtothe monographPh.Eur.3.3.8regardingabsorption,acidicoralkalinereactingandreducingsubstances.

Thetransferofuptofiveantioxidantsandplasticisersinto thecontainedisotonicsodiumchloridesolutionswasdetected byHPLC-MSforallsevenEPdevicesfromday1.

ConclusionandRelevance Regardingwatervapourpermeability andtheadaptedrequirementsfromPh.Eur.3.3.8sixEP devicesaresuitablefor180daysandonefor90daysforthe storageofdrugsolutions.

Theeffectsoftheidentifiedleachablesonthehuman organismarethesubjectofcurrentinvestigationsandcannot beassessedconclusivelyatpresent.3

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TrittlerR,HaukA,HugMJ. Krankenhauspharmazie .2016;37:479–84.

2.BelloW,PezzattiJ,Berger-GryllakiaM,RudazS,SadeghipourS. J.Pharm. Biomed.Anal. 236(2023):115640.

3.https://echa.europa.eu/information-on-chemicals/evaluation/community-rollingaction-plan/corap-table/[cited:04.09.2023].

ConflictofInterest Noconflictofinterest.

3PC-004 DRUGWASTEOFREADY-TO-ADMINISTERSYRINGES INTHEINTENSIVECAREUNIT:ASEPTICALLY PREPAREDSYRINGESVERSUSPREFILLEDSTERILISED SYRINGES

1TVanGelder*, 1ALalmohamed, 1KDorst-Mooiman, 1JDekker, 1MSchinkel, 2MSikma, 1EUijtendaal, 1TEgberts. 1UniversityMedicalCentreUtrecht,ClinicalPharmacy,Utrecht, TheNetherlands; 2UniversityMedicalCentreUtrecht,IntensiveCareUnit,Utrecht,The Netherlands

10.1136/ejhpharm-2024-eahp.61

BackgroundandImportance Theavailabilityofready-to-administer(RTA)syringesforintravenousdrugsfacilitatesrapidand safeadministrationinemergencyandintensivecaresituations. However,thepreparationofthesesyringesinhospitalpharmaciesviaasepticbatchwisefillingresultsinsignificantdrug wasteduetoexcessproductionandtheirlimitedmicrobiologicalshelf-lifeof31days,whichcontributestoconsiderable environmentalpollution.RTAsterilisedsyringeshavemuch longershelf-lives(upto36months)thanasepticallyprepared RTAsyringesandmightcontributetoreducingdrugwaste.

AimandObjectives ThisstudyaimedtoevaluatethedifferenceindrugwastebetweenRTAsyringesthatwereprepared throughasepticbatchwisefillinginthehospitalpharmacyand RTAsterilisedsyringes(producedinalarge-scalecompounding pharmacy)intheIntensiveCareUnit(ICU).

MaterialandMethods Ina32-bedmixedmedical-surgical ICU,drugwasteofRTAsyringeswasmeasuredoveran8yearperiodfromAugust2015toMay2023.Anintervention groupofthreedrugproductsthatwerereplacedbyRTA sterilisedsyringes(potassiumchloride60mmol=60ml,midazolam50mg=50mlandmorphine50mg=50ml)was comparedtoacontrolgroupoffivedrugproductsthatwere notreplacedbysterilisedsyringesduringthestudyperiod. StatisticalanalysisincludedaKruskall-Wallistestalongwith twointerruptedtimeseries(ITS)analysestoassessandvisualisetheeffectofdifferentstudyperiodsonwastepercentages.

Results Atotalof319,621RTAsyringesweredispensedby ourhospitalpharmacyduringthestudyperiod.Introduction ofRTAsterilisedsyringessignificantlydecreaseddrugwasteof RTAsyringesirrespectiveofdrugtypeintheintervention group,from31%beforeintroductiontoonly5%afterintroduction(p<0.001).Thecontrolgroupshowednosignificant decreaseindrugwasteoverthesametimeperiods(from20% to16%;p=0.726).TheITSmodeloftheintervention groupshowedadirectdecreaseof17.7%inwastepercentage

aftertheintroductionoftheRTAsterilisedsyringes(p= 0.083).

ConclusionandRelevance RTAsterilisedsyringescansignificantlyreducedrugwasteintheICU,supportinghospitalsto enhanceenvironmentalsustainability.

REFERENCESAND/ORACKNOWLEDGEMENTS

None.

ConflictofInterest Noconflictofinterest.

3PC-005 PREPARATIONOFEPICUTANEOUSTESTSWITH MINOXIDILAT2%AND5%

1CChaguaceda*, 2VAguilera, 1MTBosch, 3NDepreux, 1AMorales, 1LLaguna, 1SGarciaXipell, 1LEstrada, 1ETerricabras, 1CQuiñones. 1HospitalGermansTriasIPujol,Pharmacy Department,Badalona,Spain; 2ConsorciSanitaridelMaresme,PharmacyDepartment, Mataró,Spain; 3HospitalGermansTriasIPujol,AllergologyDepartment,Badalona,Spain

10.1136/ejhpharm-2024-eahp.62

BackgroundandImportance Topicalminoxidilsolutionisasafe andeffectivetreatmentforalopecia.However,somepatients presentpruritusandscalping.Patientssufferingfromallergic contactdermatitismaybenefitfrompatchtestingtodetermine thecausativeallergen.Inthefewreportedcasesofsuspected hypersensitivitytotopicalminoxidil,propyleneglycoltriggered theallergicresponseinthemajorityofcases.

AimandObjectives Describethedesign,preparationand resultsofpatchtestsandpricktestsforminoxidil.

MaterialandMethods Theallergologydepartmentrequested toperformminoxidilpatchtestsandpricktestsforapatient withsuspectedtypeIVhypersensitivity.

Thepharmacydepartmentproposedcarryingoutabattery ofepicutaneoustests,bothforminoxidilandtheexcipients presentinthecommercialdrugthepatientused.

Forpatchteststwodifferentvehicleswereusedinthe compounding:Vaseline(usualexcipientforpatchtests)and dimethylsulfoxide(DMSO)sinceithasbeendescribedforits involvementinincreasingtheskinpenetrationoftheaccompanyingactiveingredient.

Results Asthecommercialdrugthepatientusedhadalcohol andpropyleneglycolasexcipients,thefollowingbatteryofepicutaneoussyringetestsforminoxidilpatchtestwasdesigned:

. Minoxidil2and5%inliquidVaseline(compoundedas20 mgand50mgin1mL).

. Minoxidil2and5%inDMSO(compoundedas20mgand 50mgin1mL).

. 1mLofliquidVaseline.

. 1mLofDMSO.

. 1mLofpropyleneglycol10,50and100%.

. 1mL70° alcohol.

Additionally,thepharmacypreparedthefollowingsyringes forpricktests:

. Sterileminoxidil2and5%insodiumchloride0.9% (compoundedas20mgand50mgin1mL).

. Propyleneglycolpricktestwasobtainedcommercially. Thecompoundingwaspreparedreadytouse.

Resultsafterexposurewerenegativeintheimmediatereadings,aswellasat48and96hours,rulingoutthisdrugand itsexcipientsascausingthehypersensitivity.

ConclusionandRelevance Thedesignandpreparationofpatch testsandpricktestsarekeywhenitcomestodismiss

hypersensitivitytoaspecificdrug.Excipientsmustbetaken intoaccounttoruleouttheirinvolvement.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-006 STABILITYSTUDYOFCLOBAZAMLIQUIDORAL FORMSFORPAEDIATRICPATIENTS

ALLeroy,LRégnier*,NLePotierCornen,GJouan,BMadigand,PNBoivin,MALester. CHURennes,Pharmacie – HôpitalSud,Rennes,France

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BackgroundandImportance Clobazamisabenzodiazepine usedasananti-epilepticdrugforpaediatricpatients.

Inourhospital,wefacedseveralsupplydifficultiesand evenstock-outsoftheoralsuspensionspecialityforpaediatric use.Thistreatmentcannotbeinterruptedduringasupplydisruptionanditisnotpossibletostoptreatmentinitiationfor thisindication.Aspaediatricdosesareweight-adjusted,the developmentofaliquidformulationwasnecessarytohandle thissupplyissue.

AimandObjectives Thestudyaimedwastodeterminethe stabilityofClobazamdrinkableformsintwodifferentcommercialcompoundingexcipients.

MaterialandMethods Astability-indicatingHighPerformance LiquidChromatographymethod,withUVdetection,was developed.Forceddegradationofclobazamwasstudiedunder severalconditions(acidandalkalinehydrolysis,oxidative,thermalstress).

Twoformulationsofclobazamat2mg/mLwereproduced: withInorpha® andwithSyrspend® SFPH4liquid.

Toassessphysical-chemicalstability,threebatchesofeach formulationwerepreparedandpackagedinamberglassvials, storedat25°C±2°Cwithrelativehumidityat60%±5%.

Visualappearance,clobazamconcentration,pHandosmolalitywereevaluatedthroughoutthestudyperiod(84days).

Results Thechromatographicmethodallowedgoodseparation ofclobazamandthedegradationproducts.Itsvalidationwas performedinaccordancewithICHQ2guidelinesoverthree days,bytwodifferentoperators.Themethodshowedgood injectionrepeatability,specificity,precision,accuracy,linearity andnomatrixeffectfromexcipients.

Atday84,theclobazamconcentrationofbothformulationsremainedabove95%oftheinitialconcentration (101.4%inInorpha® and99.6%inSyrspend®).

PH(4.8atD0,4.7atD84inInorpha® and4.2atD0, 4.1atD84inSyrspend®)andosmolality(169mosmol/kgat D0,170mosmol/kgatD84inInorpha® and52mosmol/kgat D0,53mosmol/kgatD84inSyrspend®)alsoremainedstable inbothbatches.

Visualappearanceremainedunchanged Asedimentationwith Inorpha® wasobserved,whichexplainsinterdaysvariability.

ConclusionandRelevance Aliquidformofclobazamcan thereforebeproducedineitherInorpha® orSyrspend® SF PH4andstoredfor84daysat25°C,protectedfromlightin caseofsupplyshortage.TheformulationwithSyrspend® seemstoguaranteeabetterhomogeneityduetoviscosity.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-007 CONTAINMENTPERFORMANCEASSESSMENTOF CHEMFORT® (ONGUARD®2)CLOSEDSYSTEM

TRANSFERDEVICEACCORDINGTO2016DRAFT NIOSHPROTOCOLATFIRSTANDTENTHACTIVATIONS ENDOFSHELFLIFE

AWilkinson*,LOzolina,KWalker,MAllwood,AWallace,RBon. BiopharmaStability TestingLaboratoryLtd,RandD,Nottingham,UK

10.1136/ejhpharm-2024-eahp.64

BackgroundandImportance TheNationalInstituteofOccupationalSafetyandHealth(NIOSH)definesaCSTDasadevice thatmechanicallyprohibitsthetransferofenvironmentalcontaminantsintoandescapeofhazardousdrugorvapouroutsideofthesystem.Afterseveralconnection/disconnection cycles(activations)andextendedstoragethecontainmentperformanceofaCSTDmaydeteriorateriskingexposure.The Chemfort® CSTDisapprovedfor10activations.

In2016,NIOSHissuedadraftperformancetestprotocol forCSTDs.Theprotocolrecommendsninepotentialsurrogatesforhazardousdrugsincluding2-phenoxyethanolwhich wasrecommendedbytheUKHealthandSafetyExecutive. AimandObjectives ThestudyaimwastoevaluatethecontainmentperformanceofChemfort® atfirstandtenthactivationsandtheendofits3-yearshelf-lifeinaccordancewith the2016draftNIOSHprotocolandinstructionsforuse.

MaterialandMethods NIOSHTasks1(reconstitution)and2 (administration)wereperformedusing3-yearagedChemfort® followingthe2016NIOSHprotocol,using2.5%v/v2-phenoxyethanolassurrogate.Deviceswereassessedinreplicate (n=4),onfirstandtenthactivation.Surrogatereleasewas quantifiedusingaqualifiedthermaldesorption-GC/MS method.Positivecontroltaskswereperformedwithneedle andsyringe.Limitsofdetection(LOD)andquantitation (LOQ)weredeterminedbasedonchamberblank measurement.

Results TheLODandLOQfor2-phenoxyethanolweredeterminedat0.36±0.013ppband0.62±0.013ppb(n=33) respectively.MeansurrogatereleasesforChemfort® fromboth taskswerebelowtheLODatendofshelf-lifeatbothone andtenactivations.Positivecontrolsgavemeanreleasesof 7.79ppband1.82ppbfortasks1and2,respectively. ConclusionandRelevance NodifferenceincontainmentperformancewasobservedforChemfort® componentsusedat firstvstenthactivationatendofshelf-lifeaccordingto2016 draftNIOSHprotocol.Alldevicesdemonstratedcontainment of2-phenoxyethanolsurrogate.Positivecontrolsdemonstrated >LOQreleasesof7.79ppband1.82ppbfortasks1and2, respectivelyforanopensystem.ThisisthefirsttimeCSTD performancehasbeenevaluatedatendofshelf-lifeandtenth activation.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.WilkinsonAS, etal.PloSOne 2018;13(10):p.e0205263.

2.NIOSH.Aperformancetestprotocolforclosedsystemtransferdevicesusedduring pharmacycompoundingandadministrationofhazardousdrugs.CDC-2016–00900002.

ConflictofInterest Conflictofinterest.

Corporatesponsoredresearchorothersubstantive relationships:

Theresearchstudydescribedwasthesubjectofaresearch grantprovidedbySimpliviaHealthcare(IL)whoalsokindly providedtheChemfort® CSTDdevicesfortesting.

3PC-008

STABILITYOFPARENTERALNUTRITIONADMIXTURES: FOCUSONPRECIPITATION

1LOteroMillan*, 1NLagoRivero, 1MAlfonsinLara, 1BBeaMascato, 2JLLegidoSoto, 1N MartínezLópezDeCastro. 1HospitalÁlvaroCunqueiro,Pharmacy,Vigo,Spain; 2UniversidadedeVigo,AppliedPhysics,Vigo,Spain

10.1136/ejhpharm-2024-eahp.65

BackgroundandImportance Parenteralnutrition(PN)hasa complexcomposition,sointeractionsbetweencomponents leadtoinstabilitycompromisingitssafety.Largeprecipitates cancausethromboembolismsanddeath.Lowconcentrations oflipidsandaminoacidsandhighconcentrationsofcations correlatewithpoorerstability(higherriskofprecipitate formation).

AimandObjectives ToanalysethestabilityofPNsamples attendingtotheappearanceofprecipitatesusingoptical microscopymeasurements.

Toevaluatetheinfluenceoftemperatureandtimeon stability.

MaterialandMethods Westudied5PNsamples(all-in-one). Fromabaselineformulation(standardmacronutrientratios), wedecreasedthelipidconcentrationsfromsample1to5. Micronutrientsamountsweregreaterthanthoserecommended,andvitamins(hydrosolubleandlyposolubles)and zincwerealsoadded.500mLpersamplewereprepared accordingtothecentre’sprotocols.Onday0,asinglestock samplewaspreparedfromwhich2aliquotsof250mLwere separatedandstoredatroomtemperature(RT)andina refrigerator(4°C)for14days.Inordertodeterminethe physicalstabilityofthesamples,precipitateformationwas assessedusingaFastReadBiosigma® countingcameraona NikonEclipse50imicroscope®.Imagesweretakenwitha 40Xmagnificationobjective.Measurementsweretakenonthe sampleonday1(4°C)andday14(RTand4°C).Onlyprecipitateslargerthan5micronsandwithaclearlycrystalline formwerecountedinthisanalysis.Resultsareexpressedin precipitatespermicrolitre(accordingtochambermanufacturer ’srecommendations).

Results Precipitateswereobservedin4/5samples.Allprecipitatescorrespondedtosamplesanalysedafter14daysofstorageatRT,noneinthosestoredintherefrigerator.Figure1 representsthedataobtainedandanexampleofthetypeof precipitatesfound.

Abstract3PC-008Figure1

ConclusionandRelevance Prolongedstorageatroomtemperatureclearlyinfluencestheappearanceofprecipitates.

Theobservedformoftheprecipitatesmaycorrespondto calciumoxalatecrystals,formedbythereactionbetweencalciumandvitaminCdegradationproducts.

Theimportanceoftheuseoffiltersintheadministration ofPNisemphasised.

ToestablishtheoverallstabilityofthePN,morecomplete studiesshouldbecarriedout,whichanalysemorestabilitydependentprocesses.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-009 THEEFFECTOFACCELERATEDLIGHT(STRESS)AND NATURALSUNLIGHTEXPOSURESONCETUXIMAB (ERBITUX®):EVALUATIONOFAGGREGATE FORMATIONANDFUNCTIONALITY

1ATorres-García, 1ATorrente-López*, 1JHermosilla, 1AAguilera-Ortega, 2JCabeza, 2ASalmerón-García, 1NNavas. 1BiomedicalResearchInstituteIBSGranada,Analytical Chemistry-ScienceFaculty-UniversityofGranada,Granada,Spain; 2BiomedicalResearch InstituteIBSGranada,Clinicalpharmacy-SanCecilioUniversityHospitalGranada-Spain, Granada,Spain

10.1136/ejhpharm-2024-eahp.66

BackgroundandImportance Cetuximab(CTX)isamonoclonal antibodyindicatedfortreatmentofmetastaticcolorectalcancerandsquamouscellcancerofheadandneck.Thesekinds ofproteinsaresusceptibletodegradeduringlong-termstorage and/orduringexposuretoenvironmentalconditions(high temperature,agitation,lightexposure,etc)whenhandledin hospitals.Therefore,itisessentialtodetectcriticaldegradationpointsbeforetheadministrationtopatientstoensurethe efficacyandsafetyofthemedicine.

AimandObjectives Toassesstheimpactofacceleratedlight (stress)andnaturalsunlightexposuresonCTX(Erbitux®,5 mg/mL)safetyandefficacythroughthestudyofaggregation formationandfunctionalitywhenmishandlinginrealhospital conditions.

MaterialandMethods CTX(Erbitux®,5mg/mL)freshopened vialswereusedtocarryoutthestudy.Lightstresswasperformedinanacceleratedstresstestchambertosimulatesunlight(250W/m2,24h,25°C),whileanothersampleofCTX wasexposedtonaturalsunlightfor24h.Aggregateformation wasevaluatedbySize-ExclusionUltra-High-PerformanceLiquid Chromatography(SE/UHPLC-UV)andfunctionalitywas assessedbyEnzyme-LinkedImmunosorbentAssay(ELISA).

Results SE/UHPLC-UVchromatogramsofCTXcontrolsample (5mg/mL)showedamainchromatographicpeakassignedto CTXmonomers.Thesamplesubjectedtolightstressrevealed theappearanceofthreenewchromatographicpeaksassigned tohighmolecularweightspecies(HMWS).However,exposure tonaturalsunlightonlyrevealedtheappearanceofonesmall newpeakassignedtoHMWSwithalowrelativeabundance.

ELISAshowedasignificantlossoffunctionalityofCTXmedicineinbothstressfulconditions:lightstressedsamplerevealed alossofbiologicalactivity(BA)ofaround20%,whilethe sampleexposedtonaturalsunlightshowedalossofBAof 10%.

ConclusionandRelevance ExposuretolightpromotesaggregateformationinCTX(Erbitux®),thiseffectbeingmore noticeableinacceleratedlightexposure.Moreover,CTXfunctionalitywasalsoaffectedaftertheexposuretobothstressful conditions,revealingalossofbiologicalactivity.Thus,werecommendpreventingCTXfromlightexposurewhenhandled inhospitals.

REFERENCESAND/ORACKNOWLEDGEMENTS

FundedbyprojectFISPI17–0547InstitutoCarlosIII,MinisteriodeEconomíayCompetitividad(Spain),alsosupported byEuropeanRegionalDevelopmentFunds(ERDF).A.T-L grantsaFPUpredoctoralcontract(FPU18/03131,Ministryof Universities,Spain).

ConflictofInterest Noconflictofinterest.

3PC-010 DEVELOPMENTOFASTABLEPARENTERALSOLUTION OFTOPIRAMATEFOREMERGENCYTREATMENTOF STATUSEPILEPTICUS

SWerner*,NOtt,SDeuster. UniversityHospitalBasel,HospitalPharmacyBasel,Basel, Switzerland

10.1136/ejhpharm-2024-eahp.67

BackgroundandImportance Statusepilepticusrequiresan emergenttreatmentascontinuousepilepticactivityresultsin increasedpharmacoresistance, morbidityandmortality.Topiramateleadstoacontrolofstatusepilepticusin70%ofthe patientswhoshowednoresponset ofirst-linetreatments.As therearenoparenteralformulationsavailable,topiramate tabletsareadministeredviaenteralfeedingtube.Thisis problematicinanemergency settingbecausepharmacokineticsareunpredictableandrapidtherapeuticdruglevelsare essential.

AimandObjectives Theaimofthisworkisthedevelopment ofaparenteralformulationoftopiramateof200mgwitha stabilityofatleast3monthstoallowtheproductionina hospitalpharmacyforastockattheintensivecareunit (ICU).

MaterialandMethods Duetopoorsolubility,differentintravenous(IV)formulationsweredevelopedforstabilityandpracticabilitytesting:4mg/mland8mg/mlwith0.025M phosphatebufferasreadytousesolutionsand20mg/mlsingledosevialswithmeglumine,asolubilityenhancer.Astabilitystudywasconductedattimepoints0and3months evaluatingtheconcentrationoftopiramateofthreedifferent batcheswithLC-MS,thepH,theclarityandcolouringofthe solutionaccordingtotheEuropeanpharmacopoeia.Thedifferentformulationsweretestedduringstorageatroomtemperatureandat2–8°C.

Results Allthreeformulationsoftopiramate(4mg/ml,8mg/ mland20mg/ml)passedthestabilityrequirementsandexhibitedaconcentrationof100.7%,101.2%,and104.4%respectivelyafter3monthsatroomtemperatureand106.3%, 101.7%and99.5%respectivelyat2–8 °C.Therewereno significantpHchangesandthecolourandclarityofthesolutionremainedclearandcolourless.

ConclusionandRelevance Ourresultsareinlinewith Cloyd ’ sextrapolatedstabilitydata,thattopiramate7mg/ml with0.1Mphosphatebufferisstablefor1.5yearsat5°C withaconcentrationofatleast90%topiramate.Wedemonstratedthattopiramateparenteralsolutionisstableat roomtemperatureforatleast3months,whichisfavoured inahospitalsetting.Therefore,thehospitalpharmacy ’ s productionunitcanprovidetheICUwithastockofanIV formulationoftopiramateandthestabilitystudywillbe continued.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-011 MUCOSECTOMY:FEASIBILITYSTUDYOFTHE AUTOMATEDPREPARATIONOFASTERILESOLUTION OF5/10%FRUCTOSEGLYCEROL

ABocquillon*,LGuiheneuc,SRobin,EClapeau,EOlivier,MBourget,NCormier. Centre Hospitalo-UniversitairedeNantes,Pharmacie,Nantes,France

10.1136/ejhpharm-2024-eahp.68

BackgroundandImportance Thedigestiveendoscopydepartmentsoughttheexpertiseofpharmaco-technologytodevelop asterilehospitalpreparationaimedatfacilitatingmucosectomies.Thishyperosmolarsolutionassistsinseparatingdigestive mucusandsubmucuslayers,facilitatingpolypremovalduring endoscopy.

AimandObjectives Thestudyaimstoassessproducinga5% fructose,10%glycerolsolution,andmethodicallypreparing andcontrolling30bagsof100mLusingasterileisolator andautomatedfilling.

MaterialandMethods Thestudyentailedliteraturereview, EuropeanPharmacopoeiaevaluation,RennesHospitalCentre procedureanalysis,andCivilHospicesofLyonstabilitystudy. Protocolsweredrafted,followedbytestproductions.Concentratedsolutionwith150gfructose,240mLnon-sterileglycerol,and250mLsterile0.9%sodiumchloride(NaCl)was preparedinasafetycabinet,transferredtoanisolatorina sealedErlenmeyerflask,thenfilteredintoanempty3Lbag. 0.9%NaClwasaddedviaperistalticpump,andsolutionwas distributedinto100mLbags.Sterilitywasensuredthrough asepticprocessingand0.22 mmfiltration.Controlsincluded osmolality,pH,sodiumviainductivelycoupledplasmaoptical emissionspectrometry,gravimetricchecks,andsterilitytesting.

Results Resultsvalidatedsolutionfeasibility,processefficacy, andqualitycontrols.Meanosmolalitywas1698.11[±33.70] mOsmol/L,pH5.64[±0.11],andsodium134.37[±4.39] mMwithin10%rangearoundtheoretical137.06mM.Averageweightwas103.42g,density1.06,confirmingvolume per100mL.SterilitytestpassedonDay14.

ConclusionandRelevance Discussionhighlightedchallenges likenon-sterilerawmaterials,peristalticpumpuseinisolator, batchsize,consumablevolume,and0.22 mmfilterintegration. Fructoseandglycerolmeasurementsposeddifficulties.Sodium measurementswerelowerduetofructose’simpactonadded 0.9%NaClvolume.Bagquantityvariationstemmedfrom NaClpouchoverfillingvariability.Preparationfeasibilityand controlswerevalidated.Inconclusion,thisstudysuccessfully demonstratedthefeasibilityofproducingthehyperosmolar solution,outlinedeffectivepreparationprocesses,andestablishedstringentqualitycontrolsforitshospital-scale implementation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-012 CONTENTUNIFORMITYOFSODIUMBENZOATE CAPSULES:VALIDATIONOFAMETHODUSING QCPREP®

NLoche*,FRoy-Ema,OBoyer,SRaspaud,JRousseau. UniversityMedicalCentreBicêtre Aphp,PharmacyDepartment,Paris,France

10.1136/ejhpharm-2024-eahp.69

BackgroundandImportance Inresponsetothelackofpaediatricformulationofsodiumbenzoateinthemarket,wehave

beenproducing250mgcapsulesofpureactiveingredient(AI), withoutexcipients,intendedforpatientswithureacycledisorders.TheAIcontentisverifiedviahigh-performanceliquid chromatographyspectrometry,butthismethodhaslimitations (highcostandlimitedavailability).

AimandObjectives Theobjectiveofthisstudywastodevelop andvalidateadosagemethodofAItoperformroutinecapsulecontenttestingusingUV/Ramanspectrophotometry.

MaterialandMethods Afteropeningthecapsuleanddissolving thepowderinsterilewater,weusedtheQcPrep® automated systemUV/RamanspectrophotometryforAImeasurementand identification.Themethodvalidationwasconductedaccording toICH-Q2-R1criteria.Thisconsistedofsixsteps.1)Search forthemostrelevantspectralband(maximumcorrelation betweenabsorbanceandlinearity).2)Linearityofthecalibrationcurvewasassessedbetween2.5and50.0mg/mLthrough linearregressionandvalidatedifthecorrelationcoefficient (r2)is>0.999.3)Repeatabilitywasdeterminedbyrepeating theanalysis(n=6)fortheroutinedosageconcentration(RDC: 25.0mg/mL)andvalidatedifthecoefficientofvariation(CV) <2%.4)Intermediateprecisionwasevaluatedbyrepeating theanalysis(n=3)onthreedifferentdaysfortheRDCand validatedifCV<5%.5)Accuracywasassessedatthreeconcentrations,75%,100%,and125%oftheRDC(n=3per concentration)andvalidatedifthedeviationwas<5%ofthe expectedvalue.6)Specificitywasnotassessedduetothe exclusivecompositionofthecapsuleswiththeAI.

Results Theobtainedresultsareasfollows:

1.Themostrelevantspectralband:279nm.

2.Linearity:r2wasequalto0.99993.

3.Repeatability:CV=1.94%.

4.Intermediateprecision:CV=0,99%.

5.Accuracyfor75%,100%,and125%oftheRDCare0.7%, 0.5%,and1.1%,respectively.

Allcriteriametthespecifiedrequirements.

ConclusionandRelevance Themethodisvalidated:ithas demonstratedlinearity,repeatability,intermediateprecision, andaccuracy.TheQc-Prep® isuser-friendly,fast,andreliable fortheroutinecontentuniformitycontrolofourpreparations. Theimplementationofthispre-releasecontrolwillbecontinuedforotherpreparationsintendedformultiplepatients, therebyensuringthesafetyofourpreparations.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-013 RADIOPHARMACEUTICALSINGLE-VIALCOLDKIT FORMULATIONOFFAPI-04,ANEXPERIMENTAL VECTORFORGALLIUM-68PETIMAGINGIN ONCOLOGY

1FGarnier, 1JFouillet*, 1CDonzé, 1LRubira, 1,2CFersing. 1InstitutRégionalduCancerde MontpellierICM,NuclearMedicineDepartment-RadiopharmacyUnit,Montpellier,France; 2InstitutdesBiomoléculesMaxMousseronIBMM,F9Team,Aminoacids – PeptidesAnd Proteins,Montpellier,France

10.1136/ejhpharm-2024-eahp.70

BackgroundandImportance Targetingthetumourmicroenvironmentrecentlygainedinterestinoncology,asevidencedby theuseoffibroblastsactivationproteininhibitors(FAPI)for cancer-associatedfibroblastsimaging.Amongthesederivatives, FAPI-04radiolabeledwithgallium-68emergedasapromising

PETdiagnosticagent.Todate,[68Ga]Ga-FAPI-04isconsideredanexperimentalradiopharmaceutical,withatediousand intricateradiolabelingprocess.Thus,thedevelopmentofasingle-vialcoldkit(SVCK)formulationofFAPI-04tosimplify thepreparationof[68Ga]Ga-FAPI-04wouldbeofparticular interest.

AimandObjectives VariousparametersinvolvedintheformulationofFAPI-04asaSVCKwereinvestigated.Then,optimal conditionsforsuccessfulradiolabelingof[68Ga]Ga-FAPI-04 wereidentified.

MaterialandMethods Kitvialswereconditionedtocontain severalbulkagents(fivetested),buffers(sixtested),antiradiolysiscompound(threetested)andFAPI-04.Mixtures weresolubilisedinwaterforinjectionandthenlyophilised. Theinfluenceofeachcomponentontheradiolabelingprocess wasstudied,aswellastheamountofvector(30,45or60 mg).[68Ga]GaCl3 waselutedfromaGalliAD® generator directlyintothekitvials,subsequentlyheatedfor10minutes at97°C.Radiochemicalpurity(RCP)ofeachreactionwas assessedbyradio-TLCandradio-HPLC.ThepHwaschecked bypHstripsduringthekit’sconditioningandaftereachreaction,aimingatanoptimalvalueof3.4(idealfor 68Ga radiolabeling).

Results Mannitol(50mg)wasthebulkagentwiththebest appearanceafterfreeze-dryingandwasretainedinsubsequent assays.Asexpected,thepHofthereactionmediumwascriticaltothesuccessofradiolabeling.HEPESbuffer0.3MpH 4allowedRCPof83.3%byTLCand78.9%byHPLC,comparedwithextremelypoorresultsobtainedwiththefiveother buffers.Anti-radiolysisagentsshowedamoderateimprovement inRCP(~10%increasewithascorbicacid)whichpersisted overaperiodof4hours,confirmingradiocomplexstability. Using45 mgFAPI-04insteadof30 mginthereactionslightly increasedRCP(>96%inTLC,>91%inHPLC).

ConclusionandRelevance Theimportanceofcarefullyselecting theingredientsofaradiopharmaceuticalSVCKwasdemonstrated,resultinginexcellentRCPvaluesfor[68Ga]Ga-FAPI04.AterminalpurificationstepwouldremoveHEPESbuffer tocomplywithEuropeanPharmacopoeiarequirements.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-014

PHYSICOCHEMICALSTABILITYOFBEVACIZUMAB25

MG/MLCONCENTRATE(VEGZELMA®)INORIGINAL GLASSVIALSAFTERFIRSTOPENING

HLinxweiler*,LKnoll,JThiesen,IKrämer. UniversityMedicalCentreJohannesGutenberg UniversityMainz,PharmacyDepartment,Mainz,Germany

10.1136/ejhpharm-2024-eahp.71

BackgroundandImportance Severalbevacizumabbiosimilars areEMA-approvedforthetreatmentofcancer.Foreachbevacizumabbiosimilar,product-specificstabilitydataregardingthe concentratedsolutionanddilutedinfusionsolutionsaretobe regardedbyhealthcareprofessionals.Toourbestknowledge, stabilityinformationismissingfortheconcentratedsolution ofthebevacizumabbiosimilarVegzelma® (Celltrion)afterfirst openingandprolongedstorage.

AimandObjectives Theaimofthestudywastoinvestigate thephysicochemicalstabilityofbevacizumab25mg/mLconcentrate(Vegzelma®)puncturedandstoredintheoriginalglass

vialattwodifferentstoragetemperaturesovera28-day period.

MaterialandMethods Threebevacizumab25mg/mLvials (Vegelzma®)eachwerestoredafterfirstopeningeitherlight protectedat2–8 °Corat25 °Cfor28days.Sampleswere withdrawnonday0,1,7,14,21,28andanalysedwithsize exclusionchromatography(SEC),ionexchangechromatography(IEC),anddynamiclightscattering(DLS).ThepHvalues weremeasured,andthetestvialswerevisuallyinspectedfor visibleparticlesandcolourchangesateachmeasuringpoint.

Results Aftera14-daystorageperiod,thequantitativeSEC analysisindicatedbevacizumabconcentrationsabove95%of theinitialconcentrationineachtestvial.DLSmeasurements showednosignificantvariationofthemeanhydrodynamic diameterandnoappearanceofsmallsizedaggregates.IEC analysisrevealednosignsofinstability.pHvaluesofallsamplesremainedconstant,andnovisibleparticlesorcolour changeswereobserved.

ConclusionandRelevance Bevacizumab25mg/mLconcentrate (Vegzelma®)revealedtobephysicochemicallystableinthe originalglassvialafterfirstopeningforatleast14dayswhen storedlightprotectedat2–8 °Corat25 °C.Investigations areongoinguntilday28andpresented.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Conflictofinterest.

Corporatesponsoredresearchorothersubstantive relationships:

ResearchgrantbyCelltrionHealthcare.

3PC-015 MICROBIOLOGICALPERFORMANCEQUALIFICATION OFTHEROBOTICSYSTEMSAPOTECASYRINGEAND APOTECAUNIT

DAckermann*,IKrämer,JThiesen. UniversityMedicalCentre-Johannes-Gutenberg UniversitätMainz,PharmacyDepartment,55131Mainz,Germany

10.1136/ejhpharm-2024-eahp.72

BackgroundandImportance Fullyautomatedasepticpreparationofcytotoxicready-to-administer(RTA)andready-to-use (RTU)parenteralsisalreadywellestablished.Morerecently, innovativeroboticsystemsforthepreparationofnon-cytotoxicparenteralswerebroughttothemarket.

AimandObjectives Theobjectiveofthestudywasthemicrobiologicalperformancequalificationofthefullyautomated roboticsystemsAPOTECAsyringeandAPOTECAunit(Loccioni,Italy)bymedia-filltestsandsupplementalenvironmental monitoringinthecriticalzones.

MaterialandMethods Duringtheperformancequalification phaseoftheAPOTECAsyringeovera5-dayperiod500 syringes(10mLvolume)wereautomaticallyfilledfromabag reservoircontainingsingle-strengthtrypticsoybroth,capped andlabelled.WiththeAPOTECAunit(designedforindividual/ inseriespreparationofbags,syringes)overa10-dayperiod 250bagsand250syringeswereprepared.Syringeswerepreparedbydilutionof25mLofdoublestrengthtrypticsoy brothwith25mLofwaterforinjectionin50mLsyringes. Bagswerepreparedbyinjectionof50mLdoublestrength trypticsoybrothintoinfusionbagsprefilledwith50mL 0.9%sodiumchloridesolution.Testsolutionswereincubated atroomtemperatureandvisuallyinspectedafter7and14 days.Supplementalenvironmentalcontrolsencompassedparticlecounting,activeairsampling(onlyAPOTECAunit),settle

Abstracts

plates,contactplatesforcriticalsurfaces,andfingerprints. Plateswereincubatedandcolonyformingunits(cfu)counted. Results Noneofthe500media-fillproductspreparedbythe APOTECAsyringeand500productspreparedbytheAPOTECAunitshowedturbiditywheninspectedafter7and14days ofincubation,therebyindicatingnogrowthofmicroorganisms.Particlenumberswerebelowthemaximumlimitssetfor cleanroomGradeA,EU-GMPGuide,Annex1andcfucounts oftheplatesmettheacceptancecriteria.

ConclusionandRelevance APOTECAsyringeandAPOTECAunitpassedthemicrobiologicalperformancequalificationand allowsafefullyautomatedasepticpreparationofnon-cytotoxic RTAandRTUparenterals.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-016 PHYSICOCHEMICALSTABILITYOFMOXIFLOXACIN1 MG/0.2MLSYRINGESFORINTRACAMERAL ADMINISTRATION

SHeinz*,ÁMYuste,PVillacorta,SGarcía,JJDuque,PGranda,IVillabona,MSánchezDe Castro,PPrats,ACorrea,MHGonzalo. HospitalCentraldeLaDefensa ‘GómezUlla’ , Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.73

BackgroundandImportance Moxifloxacinsyringesforintracameralinjectionareacompoundingformulapreparedinthe PharmacyDepartmenttopreventendophthalmitisincataract surgeries. 1 AccordingtotheSpanishGoodPracticeGuidesfor thepreparationofmedicationsinhospitalPharmacyDepartments,thiscompoundedformulawouldhaveashelflifeof9 daysintherefrigerator(2 °C – 8 °C).2 Thisphysicochemical stabilitystudyisproposedtoimprovetheefficiencyinour PharmacyService.

AimandObjectives Tocharacterisethephysicochemicalstabilityofintracameralmoxifloxacin1mg/0.2mlsyringesstored inrefrigeration(2 °C – 8 °C)andprotectedfromlightfor 90days.

MaterialandMethods Three50mlbatchesofmoxifloxacin werepreparedatdifferentconcentrations(1,2,4,5,and7 mg/ml)inahorizontallaminarflowcabinetusingwaterfor injectionasasolvent,startingfromthecommercialeyedrop Vigamox5mg/ml®

Concentrationmeasurementsofmoxifloxacinwerecarried outondays1,3,7,15,22,30,60,and90usingaPerkin ElmmermodelLambda40UV/visiblespectrophotometerata wavelengthof290nm(maximumwavelengthof moxifloxacin).

Results Throughouttheentireanalysisperiod,themoxifloxacinconcentrationsdeterminedbythespectrophotometer remainedconstantandwithinthevaluesacceptedbythe UnitedStatesPharmacopeiathatensureitsphysicochemical stability(±10%).Inaddition,linearitywasmetinallmeasurementswithadeterminationcoefficient(R2)>0.999,indicatingthatthepreparedconcentrationsofmoxifloxacin remainedstableovertime.

ConclusionandRelevance Theformulationsofintracameral moxifloxacin1mg/0.2mlinwaterforinjectionarephysicochemicallystableatleastfor3monthswhenstoredinthe refrigerator(2 °C – 8 °C)andprotectedfromlight.Further investigationwouldbeadvisabletocontinuewiththestudyin ordertoextendtheirshelflife.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AndersonJ,YoungS,CockerhamG, etal.EvidenceBrief:IntracameralMoxifloxacinforPreventionofEndophthalmitisAfterCataractSurgery.Washington,DC: DepartmentofVeteransAffairs(US);2022May.Availablefrom:https://www. ncbi.nlm.nih.gov/books/NBK581595/ 2.MinisteriodeSanidad.Guíadebuenasprácticasenlaadministracióndemedicamentosenserviciosdefarmaciahospitalaria[Internet].2014.Availablefrom: http://www.sefh.es/sefhpdfs/GuiaBPP_JUNIO_2014_VF.pdf

ConflictofInterest Noconflictofinterest.

3PC-017 ELABORATIONOFDEFEROXAMINEEMULSION0.5% FORHYPERPIGMENTATIONDUETOINTRAVENOUS IRONEXTRAVASATION

PPastorVara*,VPueblaGarcía,MFernández-VázquezCrespo,MDeLaTorreOrtiz, JCorazónVillanueva,NSánchez-OcañaMartín,LYbáñezGarcía,SLópezCedillo, AAparicioCarmena,JDominguezChafer,MTBenítezGiménez. HospitalClínicoSanCarlos, Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.74

BackgroundandImportance Cutaneoushyperpigmentationdue toironextravasationisadescribedadverseeffectofitsintravenousadministration.

AimandObjectives Todescribethecomponentsandmethod ofpreparationofa0.5%deferoxamineemulsionforthetreatmentofhyperpigmentationcausedbyironextravasation.To describetheefficacyandtoleranceofthepharmaceuticalcompoundonahospitalisedpatient.

MaterialandMethods Literatureresearchwascarriedoutin differentdatabasestodeterminetheclinicalevidenceand experience.(GoogleScholar,PubMed,SEFHformulary,Acofarmawebsite).

Inordertoassessefficacyandtolerance,directobservation ofthestainwasperformedtwiceaweekfor30days.Possible colourchange,andskinirritationwerecomparedwithphotographsandinterviewingthepatient.

Results Composition:deferoxamine0.5g(commerciallyavailablelyophilisedpowder),propyleneglycol20g;NeoPCLselfemulsifierO/W25gandpurifiedwaterinsufficientquantity for100g.Incontrasttotheavailableevidence,Beelerbase wasnotused.Instead,NeoPCLwaschosen,whichallowed theformationofanaqueousexternalphaseemulsion,not veryoily,dense,buteasytoapplytopically.

Methodology

. Deferoxamine-liophilisedwasreconstitutedwithpurified water.

. Water,propyleneglycolandNeoPCLwereweighed separatelyandplacedinawaterbathat60°C.

. NeoPCLwasstirredtofacilitatethefusionandpropylene glycolwasgraduallyaddedwhilestirringtoformtheoleoaqueousemulsion.

. Deferoxaminesolutionwasaddedoverthepreviousmixture, stirringconstantlyuntilobtainingtheoleo-aqueousemulsion.

. Itwasstirredfor2–3minuteswithanemulsifier.

ThefinalappearanceofPhCwasahomogeneouswhiteemulsionwithnolumpsandnocharacteristicodour.Accordingto thelocalGuideofGoodPractices,a30-dayexpirationperiod wasassignedaswellasstorageconditionsofroomtemperatureandproceptionfromlight.Galenicvalidationwasperformed,andtheemulsiondidnotlosethecharacteristics described.

Fifteendaysaftertheextravasation,theemulsionwas appliedevery12hoursforfourweeks.Aslightimprovement wasobserved.However,therewascompletetoleranceto emulsionwithnoadversereactionsreported.

ConclusionandRelevance Thedevelopmentoftheemulsion withaself-emulsifyingO/Wbaseensuredthattheemulsion remainedstablethroughouttheshelflife.

Theresultsdidnotmatchwiththosedescribedintheliterature.Timewasalimitingfactortohaveobservedbetter results.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-018 GLASSAMPOULEHANDLINGPRACTICESINDUTCH HEALTHCARE:ACOMPREHENSIVEASSESSMENT

1H Şahin*, 2ASingh, 3,4HAbdullah-Koolmees, 1,2,4FKarapinar-Çarkit. 1MUMC+Hospital, DepartmentofClinicalPharmacyandToxicology,Maastricht,TheNetherlands; 2Olvg Hospital,DepartmentofClinicalPharmacy,Amsterdam,TheNetherlands; 3Amsterdam UniversityMedicalCentre,DepartmentofPharmacyandClinicalPharmacology,Amsterdam, TheNetherlands; 4UtrechtInstituteforPharmaceuticalSciences-UtrechtUniversity,Utrecht PharmacyPracticeNetworkforEducationandResearch-DivisionofPharmacoepidemiology andClinicalPharmacology,Utrecht,TheNetherlands

10.1136/ejhpharm-2024-eahp.75

BackgroundandImportance Glassampoulesareextensively usedforintravenousadministration,pulmonarynebulisation, andoralpreparationssuchascaffeine.Dutchguidelinesrecommendfilterneedlesorstrawswhenhandlingglass ampoules,1 butcomplianceremainsuncertain.

AimandObjectives Thisstudyaimedtoevaluatetheutilisation offilterneedles/straws,theobservationofglassparticles,and thedisposalofampoulesamongpharmacytechniciansand nurses.Additionally,weexaminedthehandlingofglass ampoulesduringmedicationprocurementinhospital pharmacies.

MaterialandMethods Weemployedanobservationalapproach withaquestionnairedevelopedbyUtrechtUniversity ’sUPPER pharmacypracticeresearchsection.Thequestionnairecovered glassparticlemanagementandprocurementpolicies.Pharmacy studentsconductedinterviewswithpharmacytechnicians(both inthepharmacyandonhospitalwards)nursesandpharmacists,duringtheirinternshipsfromSeptembertoNovember 2022.Descriptivedataanalysiswasused.

Results Dataweregatheredfrom31Dutchhospitals,comprisingsixacademic,15topclinical,and10peripheralinstitutions.Interviewswereconductedwith50pharmacy techniciansinthepharmacy,51onthewards,and50nurses.

Concerningcompounding,14%ofhospitalsdidnotemploy filteringtechniques,exceptforintrathecalpreparations.On hospitalwards,23%ofpharmacytechniciansdidnotemploy filteringtechniques,risingto50%fornurses(irregularuse).

Theresultsrevealedthat82%ofpharmacytechniciansin thepharmacyencounteredglassparticlesduringcompounding, risingto92%onwardsand45%fornurses.Intermsof ampouledisposal,approximately16%ofpharmacytechnicians inthepharmacyreporteddiscardingampoulesduetothe presenceofglassparticles,comparedto19%onwardsand 20%amongnurses.Onlyninehospitalpharmacieshadestablishedpoliciesaimedatreducingtheprocurementofglass ampoules.

ConclusionandRelevance Thestudyhighlightsthevariability intheadoptionoffilteringtechniquesforglassampoules acrossdifferenthospitals,withhospitalpharmaciesdemonstratingbettercompliance.Bothpharmacytechniciansandnurses observedglassparticles,leadingtoampouledisposal.Future studiesshouldinvestigatethecausesofdisparitiesbetween pharmacydepartmentsandhospitalwards.Additionally,furtherresearchisneededtoassesspotentialhealthconsequences ofglassparticleexposure.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KNMP.LNA-procedures.[Internet].Availablefrom:https://kennisbank-knmp-nl. proxy.library.uu.nl/article/LNA-procedures_productzorg/asep/F114.html.[Accessed 31sAugust2023].

ConflictofInterest Noconflictofinterest.

3PC-019 DEVELOPMENTOFATOPICALEMULSIONFORTHE TREATMENTOFTHIRD-DEGREEBURNPATIENT CANDIDATESFORSKINGRAFT

1ECastellana*, 1SFelloni, 1MScaldaferri, 1RViglianti, 2BBussolino, 2FCuzzi, 2CCasalis, 2DRisso, 1MRChiappetta, 1FCattel. 1CittàdellaSaluteedellaScienza,HospitalPharmacy, Turin,Italy; 2CittàdellaSaluteedellaScienza,BurnUnit,Turin,Italy

10.1136/ejhpharm-2024-eahp.76

BackgroundandImportance Athird-degreeburn(TDB) destroystheepidermisanddermispresentingahighriskof infection.Theselesionsaretreatedwithskingrafts(SK)in theabsenceofinfection.

AimandObjectives Thehospitalpharmacistwasaskedto developanon-irritating,antibacterial,easilyspreadableand removabletopicalemulsionformulaspecifictopreparethe burnedtissueforSK.

Theaimistodescribeeffectivenessandtoleranceoftopical magistralformulaemulsion.

MaterialandMethods Ascientificliteraturesearchwas conducted.

Galenicdevelopmentandvalidationoftheformulawere describedinthemonograph ‘Semi-solidpreparationsforcutaneousapplication’ oftheOfficialPharmacopoeiaoftheItalian Republic.

Theefficacyoftheformulationwasevaluatedbythe physician.

Aretrospectiveobservationalanalysiswasperformed. PatientswithTDBwhowereeligibleforSKin2022–2023 arebeingevaluated.Thevariablescollectedwere:durationof treatment,dosage,clinicalresponseandadverseeffects.

Results WehaveformulatedOil-in-wateremulsions.Themain componentsare:

. C15–20–acid-PEG-8–ester-12%,hydrophilic-lipophilic balance12,emulsifier,non-toxicforskinenzymes,suitable forthemostsensitiveskin,andthemosthistophilicofknown emulsifiers.

. Squalane-7%,atexturiser,createsafilmthatprotectstheskin bydelayingthelossoftrans-epidermalwaterandimproves thespreadabilityoftheproduct.

. Sebopessina –2%,activeprincipleforsebaceoussecretion problemsbecauseburnedskinhasblisters.

. Siliconeoilimproves –0.3%theapplicationandabsorptionof creams.Thefavourableenvironment,createdbyocclusionhydration,theformationofhypertrophicscarsisprevented.

. Ceriumnitrate –2%combinedwithsilversulfadiazine-0.3% toprovidebroadantibacterialactivity,formsatemporary barrierandpromotesre-epithelialisation.

Ashelflifeof30dayshasbee nestablished,basedonthe criticalskinlesion.Odour,colourandphaseseparation remainedstableoverthemonth.Spreadabilityandemulsion removalwereexcellent.Fifteenpatientsweretreated;100% respondedwelltotreatmentaf teranaverageof2weeksand adosingfrequencyof3timesaday.Thephysicianconfirmedgooddelimitationandabsenceofinfectionsinthe burntareasthatwillreceivetheSK.Noadversereactions werereported.

ConclusionandRelevance Thegalenicemulsiondescribedisa goodtherapeuticsolutioninpatientswithTDBwhoarecandidatesforSK.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-020 PREVENTIONOFINFECTIOUSRISKINPATIENTS TREATEDWITHTUMOURNECROSISFACTORALPHA INHIBITORS(ANTI-TNFa)

1ZRiberaRuizDeVergara*, 1AIIdoateGrijalba, 1LCabiaFernández, 2MDeMiguelGaztelu. 1HospitalGarcíaOrcoyen,PharmacyService,Estella-Navarra,Spain; 2CentralServices, PrimaryCarePharmacy,Pamplona-Navarra,Spain

10.1136/ejhpharm-2024-eahp.77

BackgroundandImportance Tumournecrosisfactoralpha inhibitors(anti-TNFa)havebecomeacommontreatmentin manydiseases,buttheycanincreasesusceptibilitytoinfectious diseases,includingtuberculosis.

AimandObjectives Evaluatetheanalysisrecordandvaccinationschedulesinpatientswithanti-TNFa treatmentinour hospital.

MaterialandMethods Wehavereviewedclinichistoryofall outpatientsofthePharmacyServiceinaregionalhospital whoarecurrentlyadministeringsubcutaneousanti-TNF(adalimumab,certolizumab,golimumabandetanercept).TheinformaticsprogramsFarhoandHClareusedtoreviewif tuberculintestorQuantiferonassay,recommendedvaccination schedulebythePreventionServiceofthehospitalandhepatitisserologyhavebeenrequested(hepatitisBvirus(HBV),hepatitisCvirus(HCV)andhepatitisA(HAV)).

Results 147patientswithanti-TNFa havebeenanalysed,with ameanageof49years(14–84),ofwhich53%(n=78)are men.18.37%(n=27)hadrheumatoidarthritis,15.65% (n=23)psoriasis,14.97%(n=22)psoriaticarthritis,10.20% (n=15)ankylosingspondylitis,19.05%(n=28)otherspondyloarthropathies,1.36%(n=2)juvenileidiopathicarthritis, 17.01%(n=25)inflammatoryboweldisease,and3.40% (n=5)others.Tuberculin/quantiferontestingwascompletedin 87.07%ofpatients;12.50%ofthemwerepositiveand receivedisoniazidfor9months.Serologicalmarkershave beenrecordedin93.20%and91.16%ofpatientsforHBV andHCVrespectively,allofwhichwerenegative.41.50%of thepatientsreceivedfourdosesofHBVvaccine,becausethey presentedanti-HBs<10mUl/ml.10.88%ofthetotalpatients receivedtwodosesoftheHAVvaccinewithanintervalof6 months.81.63%ofpatientswerevaccinatedwiththepneumococcalvaccine.51.02%ofpatientshavereceivedtheflu vaccineannually.

ConclusionandRelevance Regardingthesafetyguidelines,the recommendedscreeningandvaccinationschedulesarecompletedandrecordedinthemajorityofpatients(>85% patients).Nevertheless,itwouldbenecessarytoreconcilethe wayofregisteringdatainordertosimplifytherecordingof testsperformedandthemonitoringofadministeredvaccines.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-021 FORMULATIONOFVORICONAZOLEOVULESAND EFFICACYINVULVOVAGINALCCANDIDIASISBY CANDIDAGLABRATA:ACASEREPORT

1ALópezGómez, 1LRodríguez-DeFrancisco, 1CCarrascal-Mozo, 1SJLora-Escobar, 1PSuárezCasillas*, 1EHevia-Álvarez, 1JPQuintero-García, 2MJRodríguez-Hernández. 1HospitalUniversitarioVirgendelRocío,PharmacyDepartment,Seville,Spain; 2Hospital UniversitarioVirgendelRocío,InfectiousDiseasesDepartment,Seville,Spain 10.1136/ejhpharm-2024-eahp.78

BackgroundandImportance Candidaglabrata isavaginalcolonisercausingvulvovaginalcandidiasis(VVC),usuallyasymptomatic.Typicalfirst-linetherapies,boricacidornystatin ovules,arenoteffectiveduetotheirinherentresistance.Flucytosine,amphotericinBorvoriconazolewouldbethetreatmentofchoice.

AimandObjectives Toformulatevoriconazoleovules(VO) anddescribeourclinicalexperienceinthetreatmentofVVC by C.glabrata.

MaterialandMethods Thepatientwasa52-year-oldwoman withVVCby C.glabrata whopresentedvulvarpain,irritation, andburning.Shewastreatedwithoralfluconazole,oralvoriconazole,topicalamphotericinB,boricacidovulesandcombinedtherapybyfluconazole-amphotericinB,buther symptomsdidnotresolveandthecultureremainedpositive.

Abibliographicsearchwascarriedout(Pharmacopoeia, UpToDateandPubMed)aboutVOformulationanditssolubilityinpolyethyleneglycol(PEG)wasconfirmed.OthermagistralformulationsofovulescontainingPEGasanexcipient wereusedasareferenceforformulationdesign.Galenicvalidationincludedorganolepticcontrolsandphysicaltests,mass uniformityanddissolutiontime.

Finally,treatmentefficacywasassessedbysymptomresolutionandnegativisationofthevaginalexudateculture.

Results Modusoperandifor30unitsVO15mgwithan excessof20%:

1.Melt:81.36gPEG400and54.72gPEG4.000.

2.Crush11tabletsofvoriconazole50mginamortarand pestle.WorkinbiologicalsafetycabinettypeIifthereis reproductiverisk,otherwisePersonalProtectiveEquipment (PPE).

3.Addpowdertothemeltedmassandhomogenise.

4.Pourmixtureinto3govulemouldsandallowtocool. 5.Unmould,packageandlabel.

Regardinggalenicvalidation,thesurfaceofVOwasshiny, smoothandwithoutcracks.Allwerewithintheweightrange (±5)andtook34minutestodissolve.Thegivenexpirydate was6months.

ThepatientstartedtreatmentwithdailyVOandafter3 monthsoftreatment,completeresolutionofsymptomsand negativecultureswereachieved.Thefrequencyofadministrationincreasedtoevery48hoursandthenevery72hours

until6monthsoftreatment,withoutreactivationofthe infection.

ConclusionandRelevance ThemagistralformulationwasvalidatedandprovedtobeeffectiveinthetreatmentofVVCby C.glabrata.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-022 DESIGNANDSTABILITYSTUDYOFANISONIAZID ANDPYRIDOXINEORALLIQUIDFORMULATION

1HGavilanGigosos*, 1PTardaguilaMolina, 2SVoyerConde, 1IHerasHidalgo, 1SCorrales Krohnert, 1TCarrascoCorral, 1AMirandaDelCerro, 1ACodonalDemetrio, 1AMHorta Hernandez. 1HospitalUniversitariodeGuadalajara,HospitalPharmacy,Guadalajara,Spain; 2HospitalUniversitariodeGuadalajara,Microbiology,Guadalajara,Spain

10.1136/ejhpharm-2024-eahp.79

BackgroundandImportance Infanttuberculosistreatmentisa combinedtherapy,whichentailstwomainissues:commercialisedpaediatricpresentationsscarcityandinadequateadherence. Isoniazidisindicatedasafront-linetreatment.Inorderto preventisoniazid’sinducedperipheralneuropathy,pyridoxine shouldbesupplemented.

AimandObjectives Theaimofthisstudywastodevelopand studythephysicochemicalandmicrobiologicalstabilityofa combinedisoniazid+pyridoxineoralliquidformulation.

MaterialandMethods Literaturesearchwasperformedto studyisoniazid+pyridoxineformulationstability.Asthere werenopublisheddatainthisfield,theactivepharmaceutical ingredientsphysicochemicalproprietiesandqualityconditions werecheckedinPharmacopeiaandscientificliterature.Stability-indicatingmethodswereconductedandvalidatedaccording totheMethodologicalGuidelinesfornon-sterileproducts.

. Physicalstudy:organolepticcharacters(colour,odour, flavour);clarityanddegreeofopalescence;andpH.ThepHgoalofcombineddosestoavoidanypossibleactive ingredientdegradationwassettledat5.

. Microbiologicalstudy:totalaerobicmicrobialcount<103 UFC/ml;totalcombinedyeasts/mouldscount<102UFC/ml; andabsenceofEscherichiacoli/ml.

. Chemicalstudy:high-performanceliquidchromatography (HPLC)analysisandmethodvalidationtoquantifyisoniazid +pyridoxinerecommendedacceptablepuritylimit(90–110%).

Results Isoniazid50mg/ml+pyridoxine8,3mg/mloral liquidformulationwascompoundedusingaquaconservans and70%liquidsorbitol.Sampleswerestoredataliquots,light andnon-light-exposed,atroomandrefrigeratedtemperature, for28days.Eachsamplewasanalysedat0,7,14,21and 28days.

RefrigeratedsamplesstayedphysicallystableandpHmeasurewas4,8±0,15.Roomtemperaturesamplesgotdarker,bitterandslightlyacidified.Theconcentrationofisoniazidand pyridoxinewasfoundtobeatday-2850,6±0,6+8,2±0,2 atroomtemperatureand51,3±0,6+8,3±0,1atrefrigerated temperature,respectively.Moreover,allsamplesmaintained microbiologicalstability.

Thevalidatedmethodprovedtobeselectiveandlinear.It exhibitedanadequaterepeatabilityandintermediateprecision withvariationcoefficientlowerthan2%,andarecovery higherthan98%.

ConclusionandRelevance

. Isoniazid+pyridoxineoralliquidformulationwas physicochemicalandmicrobiologicallystablestoredat refrigeratedconditionsfor28days.

. Theproposedanalyticalmethodwasviabletosimultaneously determinetwodifferentactiveingredients.

. Itprovidesareliablesolutiontoenhancetherapeutic adherenceofchildren.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-023 NEWACTIVITIESWITHINACLINICALTRIAL MANAGEMENTUNIT:WHATNEWRISKSFORTHE STAFF?

ABoutin*,BPetitjean,FFoursac,MAntignac,FChabonnierBeaupel,CMetz. PitiéSalpêtrière,Pharmacy,Paris,France

10.1136/ejhpharm-2024-eahp.80

BackgroundandImportance Pharmaceuticalpersonnelcontinuallyfaceoccupationalrisks(OR)duringclinicalresearch, necessitatingregularupdatestoaddressevolvingactivitieslike AdvancedTherapyMedicinalProducts(ATMPs)anddirect patientdispensation.

AimandObjectives Ourgoalwastocomprehensivelyassess theserisks,utilisingariskmappingapproachandimplementingtailoredpreventivemeasures(PM)foreffectivemitigation.

MaterialandMethods Incollaborationwithpharmacists,managers,andriskassessors,weconductedathoroughriskmapping,evaluatingORsbasedonseverity,frequency,andcontrol mechanisms.Criticalitylevelswereestablished,leadingtocategoriesofverysignificant,significant,tobemonitored,ortolerablerisks.Subsequently,PMsweredeveloped,andanaction planwascreated.Reassessmentusingthesameparameters resultedinresidualriskidentification,culminatinginacomprehensiveriskassessmentdocument.

Results OurassessmentrevealedninenovelORsinthreecategories:travelassociatedwithexperimentaltreatmentdelivery, biologicalriskslinkedtoATMPs,andworkplacehazardslike burnsfromnitrogenhandling.Fiveweredeemedsignificant, threerequiredmonitoring,andonewastolerable.Post-risk mapping,sevenPMswereidentified,includingindividualoximetersandrespiratoryisolationequipmenttoaddresshypoxia riskduringATMPhandling.Residualriskevaluationindicated threesignificantrisks,fiverequiringmonitoring,andonetolerable,withnorisksconsideredverysignificantafterPM implementation.

ConclusionandRelevance Inconclusion,theassessmentand targetedimplementationofPMssignificantlyreducedriskcriticalitywithinourunit.Thisapproachenhancesstaffprotectionduringnewassignmentsandactivities.Furtherevaluations willgaugePMeffectivenessinmaintainingasafeenvironment forpharmaceuticalpersonnelinvolvedincutting-edgeclinical researchandATMPmanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-024 IMPLEMENTATIONOFASTRATEGYTOOVERCOME THEPOTENTIALTOXICEFFECTSOFPROPYLENE GLYCOLINNEONATES

1RBarbosa*, 1SFraga, 1PSoares, 2FFernandez-Llimos, 3FBaltazar, 4CMBarbosa. 1Centro HospitalarUniversitárioSãoJoão,ServiçosFarmacêuticos,Porto,Portugal; 2Faculdadede FarmáciadaUniversidadedoPorto,LaboratóriodeFarmacologiadoDepartamentode CiênciasdoMedicamento,Porto,Portugal; 3EscoladeMedicinadaUniversidadedoMinho, InstitutodeInvestigaçãoemCiênciasdaVidaeSaúde,Braga,Portugal; 4Faculdadede FarmáciadaUniversidadedoPorto,LaboratóriodeTecnologiadoMedicamentodo DepartamentodeCiênciasdoMedicamento,Porto,Portugal

10.1136/ejhpharm-2024-eahp.81

BackgroundandImportance Availableevidenceonthesafety ofexcipientsincompoundedformulationsissomewhatlimited.Contributingtoahigherlevelofevidenceseemsrelevant,particularlyregardingcompoundedformulationsforuse inneonatology.Inapreviousstudyonthepresenceofproblematicexcipientsinoralcompoundedformulations,intake abovetherecommendedlimitswasreported,mainlyofpropyleneglycol(PG),inneonatesunder28daysofage.1

AimandObjectives ToimplementastrategyaimedatovercomingthepotentialtoxiceffectsduetotheexposureofneonatestoPGpresentinoralcompoundedformulations.

MaterialandMethods Evaluationofthecompositionofcompoundedformulationsregularlyusedinaneonatalintensive careunittoidentifythesourceofPG.

Assessmentofalternatives,consideringtheirpreservative power,bycalculatingtheconcentrationofparabens,andanalysingthesolubilityofthechemicalformsofparabensused. Results ThesourceofthePGintheformulationswasthe preservativesolutionused – ParabenConcentrate(B.8).2 Asan alternativetoB.8,weevaluatedthreeparabensolutions describedintheliterature,takingintoaccounttherespective parabensconcentrations,thenatureofthesolventandthe reportedstability.Sincetheparabensconcentrationswereat least100timeslowerthanthatoftheB.8,wedecidednotto adoptanyofthesolutionsdescribed,sincethiscouldcompromisethepreservationoftheformulationsand,atthetime,we wereunabletotestit.

Inanalternativeapproach,thepreparationofa10%parabenconcentrateinwater,insteadofPG,wasimplemented.To promotethedissolutionofmethylparabenandpropylparaben (7:3)inwater,therespectivesodiumsaltswereused.Thesolutionwaspreparedaftercalculatingtherespectiveequivalent concentrationsandensuringcompliancewiththesolubility data.3

ConclusionandRelevance Awater-based,PG-freeparabensolutionhasbeendeveloped,suitableforpreservingoralcompoundedformulations.Thisstrategymakesitpossibleto overcomethepotentialtoxiceffectsofPGinneonates, therebyincreasingthesafetyoftheformulations.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.BarbosaR, etal.Eur.J.Hosp.Pharm.2023;30:A178.

2.BarbosaCM(Coord.), FormulárioGalénicoPortuguês.ANF-CETMED,2005.

3. MartindaleTheCompleteDrugReference40thEdition.PharmaceuticalPress,Vol. A,pag.1826,2020.

ConflictofInterest Noconflictofinterest.

Abstracts

3PC-025 STABILITYSTUDYOFSTANDARDISEDFLUIDTHERAPY PREPAREDBYTHEPHARMACYDEPARTMENTTO TREATPAEDIATRICDIABETICKETOACIDOSIS

1MACrespiCifre*, 1MSanzMuñoz, 1CMarchFrontera, 1FDePacoMartin, 2MBBadal Cogul, 1MVilanovaBoltó. 1HospitalUniversitariSonLlàtzer,HospitalPharmacy,Palmade Mallorca,Spain; 2HospitalUniversitariSonLlàtzer,ClinicalAnalysisLaboratory,Palmade Mallorca,Spain

10.1136/ejhpharm-2024-eahp.82

BackgroundandImportance ThePharmacyDepartmentpreparesanddistributesfluidtherapy(2bags-system)forthe treatmentofdiabeticketoacidosis(DKA)inthepaediatric emergencyunit.

Theimplementationofthisprocedurehasimprovedpatient safety,sincestandardisedpreparationsareusedonlythe rhythmbeingmodifiedaccordingtothepatient‘sneeds.

Thetwobagssystemconsistsinsetsoftwobagsofmaintenanceelectrolytesin1litreof10%dextroseorisotonicsaline.Unfortunately,theirexpirationdatewasonly7daysdue tothelackofdataonstability.

Inordertoimprovetheconvenienceandreducewastage, wedesignedandcarriedoutaphysical-chemicalstabilitystudy ofthesesolutions.

AimandObjectives Theobjectiveofthisstudywastoevaluate thephysicalandchemicalstabilityofthesesolutionsprepared inthePharmacyDepartmenttomanagepaediatricDKA.

MaterialandMethods

1.Thetwobagssystemcontains:

Solution1:Potassium(k)38meq/l,phosphate(P)59mg/dl, magnesium(Mg)5mg/dlandSodium(Na)143meq/lin isotonicsaline.

Solution2:Thesameelectrolytesconcentrationindextrose 10%.

2.Weprepared8unitsofeachsolution,halfofthemwere storedatroomtemperature(23ªC),andhalfoftheminthe refrigerator(4°C).

3.Weanalysedtheelectrolytesconcentrationandmadevisual inspectionforphysicalchangesonthefollowingdays:0(d0), 14(d14),28(d28),49(d49)and92(d92).

ThechemicalanalysiswasperformedbytheLaboratory Departmentthroughthefollowingtechniques:sodiumand potassiumbyindirectpotentiometrywithselectiveelectrode, phosphatebyphosphomolybdatereaction;magnesiumandglucosebyenzymatictechnique.

Thephysicalanalysiswasdeterminedinpharmacythrough visualinspectionsearchingforchangesincolourandmatter particlesagainstawhiteandablackbackground.

Abstract3PC-025Table1

Theresultswereexpressedinmean+/-SD.Itwasaccepted adeviation<5%.

Results Theelectrolytesconcentrationremainedstableduring thestudyperiod.Thevisualinspectionshowedphysicalstability.Table1summarisestheresults.

ConclusionandRelevance Theresultsshowthestabilityofsolutionsintheperiodofstudy.Nevertheless,thebeyond-usedatewillbere-evaluatedwhenavalidatedsterilitytestis performed.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-026 COSTSAVINGSASSOCIATEDWITHROMIPLOSTIM REPACKAGINGINAPATIENTWITHIDIOPATHIC THROMBOCYTOPENICPURPURA

JCDelRíoValencia*,COrtegaDeLaCruz,RTamayoBermejo,ALunaHiguera. Regional UniversityHospitalofMalaga.,PharmacyService,Malaga,Spain

10.1136/ejhpharm-2024-eahp.83

BackgroundandImportance

Background Romiplostimisindicatedforthetreatmentofprimaryimmunethrombocytopenia(ITP)inadultpatientswho arerefractorytoothertreatments(corticosteroids,immunoglobulins).Thisdrughasanimportanteconomicimpact,inthis senseithasbeendecidedtostartaprotocolfortheuseof romiplostimwhichhasbeenestablishedtogrouppatientsor dispensetworepackagedromiplostimpre-filledsyringesfor eachpatientfractionatingvialsaccordingtothepatient´sdose insyringesasasavingstrategy.

AimandObjectives

Objective Evaluatingandquantifyingthecostsavingofthe optimisationoftheuseofromiplostimvialsthroughrepackagingintosyringeunderasepticconditions.

MaterialandMethods RetrospectivestudyfromJanuaryto June2023andpatientsdiagnosedfromITPandtreatedwith romiplostimwereincluded.Aprotocolisbeingimplemented, whichconsistsofdispensingtworepackagedromiplostimprefilledsyringes(7daysexpirationaccordingtoGoodPractice GuideofpreparationofmedicationsinhospitalPharmacy Service)foreachpatientorgroupingthepatientsreceiving treatmentwithromiplostimandfractionatingthevialin syringestoadjusttotherecommendeddoseaccordingtothe SummaryofProductCharacteristicsinaflowlaminarcabinet. Variablescollected:demographics(sex/age),numberof patients,andeconomic(priceofromiplostimvial).Datawere collectedfrompharmacyelectronicdispensingrecords.

Results Atotalof16patientssufferingfromITParebeing treatedinourhospitalwithromiplostim,50%ofthemare men,andmedianage54yearsold(21–90).Thistreatment hascostatotalofC ¼ 240,561.95forthese6months(January toJune),however,ifpatientshadbeendispensedtworepackagedromiplostimpre-filledsyringesorhadbeengroupedand givenappointmentonthesameoftheweekandromiplostim repackaginghadbeenperformedunderasepticconditions,the totalcosthadbeenC ¼ 158191,48thereforethecostsaving therewouldbeenC ¼ 82.370,47(C ¼ 164.740,94/year).

ConclusionandRelevance Thedispensingoftworomiplostim pre-filledsyringesorthegroupingofpatientsandthefractionationofromiplostimvialswouldsupposeasavingof C¼ 164.740,94(savingof86.342,21mcgromiplostim,345vials of250mcg)everyyear.Therepackagingcouldrepresenta significanteconomicsavinginthetreatmentofidiopathic thrombocytopenicpurpura,whilecontributingtomaintaining thesustainabilityofthenationalhealthsystem.

REFERENCESAND/ORACKNOWLEDGEMENTS

No-conflict-of-interest

ConflictofInterest Noconflictofinterest.

3PC-027 USEOFAUTOMATEDCOMPOUNDINGDEVICESIN PAEDIATRICPARENTERALNUTRITION:AGOODWAY TOENSURESAFETY

EGuerreroHurtado*,AMPadillaLópez,AVázquezPolo,PPoloMontanero,ACruz Sánchez,ELópezBriz. HospitalUniversitarioyPolitécnicoLaFe,Pharmacy,Valencia,Spain

10.1136/ejhpharm-2024-eahp.84

BackgroundandImportance Parenteralnutrition(PN),particularlyinpaediatricpatients,isacomplexandhigh-risktherapy duetosmallvolumesandhighsusceptibility.Expertrecommendationsadvocatetheuseofautomatedcompoundingdevices(ACD)toenhancethesafetyandqualityofpaediatric parenteralnutrition(PPN).

AimandObjectives Toevaluatetheimplementationofan ACD,takingintoaccountcriteriarelatedtocomplexityofthe task,safetyandworkload,aswellasthequalityandsafetyof thePN.

MaterialandMethods Observationalandretrospectivestudy fromJanuarytoJune2023inatertiarycarehospital.The number,volume,weightandcompositionofthePPNspreparedduringthisperiodwereevaluated.Qualityandsafetyof theadmixtureswereevaluatedthroughthealertsobserved (weightdeviation).Theweightlimitdeviationacceptedwas setin+/-5%forPPNover100mLand+/-3%forPPNwith avolumeof100mLorless.Theimpactontheworkload willbeassessedbasedonproductiontimes.

Results Duringthestudyperiod,2.483unitswereprepared, consistingofindividualisedPPNfor190patientsandstock preparations.

Thebreakdownbelowoffersdetailedinformationaboutthe PNs,patientcharacteristicsandthetimeneededforthewhole compoundingprocess,inpaediatricswiththeACDandadults, whereavacuumfillingmachineisused:

Anaverageof27nutrientswereusedtopreparethePPNs (minimum:4,maximum:33).In2.133units(86%)heparin wasmanuallyaddedafterthecompletionofthe compounding.

Therangeofweightdeviationwas[4,14%,-2,43%].The medianwas0,85%.Nodeviation>5%hasbeenrecordedin PPNswithavolume>100mL.InPPNswithavolume <100mLalldeviationsobservedwere<3%.

ConclusionandRelevance TheuseofanACDhasensured processqualityandsafety,asnosignificantweightdeviations wereobserveddespitethediversityofvolumes.Furthermore, itreducestheoperator ’shandling,simplifyingthetask,minimisingtheriskofmicrobiologicalcontaminationandthelikelihoodoferrors,withoutincreasingtheprocessingtimes comparedtolessprecisemethods.

Giventhecomplexityofpreparationsandtheachieved results,automatingPPNpreparationprocessesprovestobean

Abstracts

efficient,safe,andprecisemethodforcompounding admixtures

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-028 FORAMOREECONOMICALANDECOLOGICAL CENTRALSTERILESERVICESDEPARTMENT(CSSD): BACKTOTHECONTAINER

KSabrina*,CBenhia,RBatista,DTalon. HôpitalCochin,Sterilization,Paris,France

10.1136/ejhpharm-2024-eahp.85

BackgroundandImportance Thecentralsterilisationdepartmentisconductingacampaigntoreducethecostsandcarbon footprintofsterilisationandoperatingtheatres.

AimandObjectives Theaimofthisworkistoreducethepolypropylenesheetspackaging.

MaterialandMethods InMay2023,acontainermaintenance operationwascarriedoutatthehospital,recoveringthosenot usedintheoperatingtheatres.

Surgicaltrays(ST)wrappedinpolypropyleneenvelopes (PE)wereidentifiedusingT-Doctraceabilitysoftware (Getinge).AninventorywascarriedoutintheoperatingtheatretovalidatethefeasibilityofreplacingPEwithcontainers.

Theeconomicdimensionsineuros(C ¼ )takeintoaccount staffwork,maintenance,consumables,wastetreatment,aswell aswater,steamandenergyconsumption.

Results ThemaintenanceworkcarriedoutinMay2023 resultedintherecoveryof203containersofvarioussizes. 245PEwrapswereidentified,78ofwhichcouldnotbe packagedincontainers.Thecostofconsumablesandtime spentonwashingandpackagingamountedtoC ¼ 1.74fora containerandC ¼ 2.15foraPE.Otherre-sterilisationcostsare equivalentforbothpackagingsystems.ThePEwrapsidentifiedbyT-Docrepresent5,186re-sterilisationsperyear,and theeconomicgainfromreplacingpackagingwithcontainers correspondstoaprofitofC ¼ 2,126/year.However,thecompletereplacementprojectrequiresthepurchaseof48additionalcontainersataninitialcostofC ¼ 13,200.Thispurchase willpayforitselfin6years.

ThecarbonfootprintofacontainerissmallerthanaPE becauseitgenerateslesswasteinoperatingtheatres.ThePE consistsofasterilebarrierandprotectivepackaging,both madeofpolypropylene.Thesearedisposedofeachtimethey areusedintheoperatingtheatre,comparedwithtwofilters andtwoclipsforacontainer.

ConclusionandRelevance Thisoperationofferseconomicand ecologicaladvantagesafterashortreturnoninvestment,thus meetingtherequirementsoftheecologicaltransitionforour hospital.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-029 PHMEASUREMENT:NOTASSIMPLEASWETHINK?A CASEOFSODIUMPERCHLORATEINJECTIONS

RHSvendsen,VMichalsen*,TSDogbeten,VSavic. HospitalPharmaciesEnterprise-SouthEasternNorway,OsloHospitalPharmacy-Rikshospitalet,Oslo,Norway

10.1136/ejhpharm-2024-eahp.86

BackgroundandImportance Ampouleswithsodiumperchlorate100mg/mlforinjectionaremanufacturedattheHospital Pharmacyforuseasapremedicationbeforecertainnuclear imagingprocedures.TheQualityControldepartmentrecently becameawarethatpHmeasurementsduringqualitycontrol werevaryingmorethanexpectedbetweenbatches,resulting inoutoftrend/specificationresultsaswellasgreatervariation betweenin-processandreleasevalues.Nodataexplaining thesevariationscouldbefoundintheliterature.

AimandObjectives Todeterminefactorswhichcouldcause unstablepHmeasurementsofsodiumperchloratesolutions, andifchangingthepHelectrodecouldsolvetheproblem.

MaterialandMethodspH-meter:MettlerToledoSevenExcellenceS400-Bio,pH-electrodes:(A)InLabRoutinePro-ISM (Referenceelectrolyte:potassiumchloride(KCl)3M);(B) InLabSciencePro-ISM(Referenceelectrolyte:KCl3M);(C) InLabExpertPro-ISM(Referenceelectrolyte:XEROLYT®polymer).

Toestablishtheinfluenceofexternalfactors,pHwasmeasuredovertimeindifferenttypesofvials(glass/plastic)and withextendedexposureofsolutiontoair.Comparisonof electrodes:pHwasmeasureduninterruptedatregularintervals for420seconds(n=3).Ramanspectraoftheprecipitates wereacquiredbyusingaWITecAlpha300ApyronConfocal RamanMicroscope.

Results DifferenttypesofvialsaswellasextendedairexposureofsolutiondidnotresultinsignificantchangeofpHvalues.InitialtestingwithelectrodeAresultedinacharacteristic trendwherethepHincreased,stabilised,andthendecreased, whileelectrodeCremainedstable.ForelectrodeBthesame trendwasobservedasforelectrodeA,buttestingwasaborted duetovisibleprecipitationinthesample.Theprecipitates wereidentifiedasPotassiumperchloratebyRamanspectroscopy.Resultsfromsubsequentcomparisonisshownintable 1(mean±SD).

Abstract3PC-029Table1

ConclusionandRelevance Theunreliableresultscouldbe attributedtoaninteractionbetweensodiumperchlorateand KClreferenceelectrolyte.Thisalsocreatedaprecipitation, moreclearlyvisibleinelectrodeBduetohigherflowof referenceelectrolytetothesamplethanelectrodeA.Electrode Cwithpolymerelectrolytewasthemoststable,withoutthe characteristicdecreaseinpHaftertheinitialstabilisation,and noprecipitation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-030 STABILITYSTUDYOFANEPIDURALANALGESIC CONCENTRATEFORINFUSIONUSEDDURING CHILDBIRTH

RHSvendsen*,MSolås,TSDogbeten,SMFischer. HospitalPharmaciesEnterprises-SouthEasternNorway,OsloHospitalPharmacy-Rikshospitalet,Oslo,Norway

10.1136/ejhpharm-2024-eahp.87

BackgroundandImportance Infusionsforepiduralanalgesia arefrequentlyusedinmaternitywardstoeasepainduring childbirth.Astandardisedconcentrateforinfusioncontaining bupivacaine,fentanylandadrenalineusedforgeneralepidural analgesiaisproducedattheHospitalPharmacy1 anddiluted ininfusionbagsbyanexternalcompoundingunit.Recently,a maternitywardaskedtheHospitalPharmacytopreparea concentrateforinfusionmoresuitablefortheirpatientscontainingonlybupivacaine(inareducedconcentration)andfentanyl,reducingtheneedforin-housecompounded alternatives.

AimandObjectives Toconfirmthelong-termstabilityofthe newer,moresuitableconcentrateforinfusionthroughanongoingstabilitystudy.

MaterialandMethods Theconcentratewasfilledin50ml vialsandstoredat5°C±3°C,protectedfromlight.Samples wereassayedbyUHPLCaspreviouslydescribedelsewhere,1 andpHandconductivityweremeasured.Theanalytical methodisvalidatedforlinearity,precision,andspecificity. SterilitywastestedaccordingtoPh.Eur.2.6.1.

Results Chemicalandmicrobiologicaltestresultsduringthe stabilitystudy(mean±SD,n=3)aresummarisedintable1. Concentrationofbupivacaineandfentanylisreportedasa percentofreleaseconcentration.

Abstract3PC-029Table1

TestRelease9months24months

Bupivacaine(%) 100.00(±0.31)100.88(±0.09)101.39(±0.33)

Fentanyl(%) 100.00(±0.39)99.68(±0.51)100.68(±0.53)

pH 4.03(±0.02)4.14(±0.01)4.30(±0.04)

Conductivity(mS/cm) 1.696(±0.001)1.698(±0.000)1.711(±0.002)

Sterility NogrowthNogrowthN/A

ConclusionandRelevance Theconcentrateforinfusionwas foundstableintermsofdrugconcentration,conductivity,and sterility.TherewasaslightincreaseinpHovertime,insignificanttooverallstability.Basedonthecurrentdata,itcouldbe concludedthatremovingadrenalinefromtheformulationdid notdecreasestability,andtheshelflifecouldbesetto9 monthssimilartotheolderformulation.Furthermore,the studyshowedthatitmightbepossibletoextendtheshelflife to24months.Providingthehospitalwithaready-to-use productadaptedtotheirneedssavesthehospitalcosts,time, andresources,whileincreasingqualityandpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.BrustugunJ,TrolandS,BreivikH.Thestabilityofasulphite-freeepiduralanalgesicsolutioncontainingfentanyl,bupivacaine,andadrenaline. ActaanaesthesiologicaScandinavica. 2013;57(10):1321–1327.

3PC-031 USABILITYOFSEMI-SOLIDEXTRUSION3DPRINTING INHOSPITALPHARMACYSETTINGSTOPRODUCE PERSONALISEDORALMEDICATIONSFORPAEDIATRIC PATIENTS

1,2MRautamo*, 1,2HMTolonen, 3NAsinger, 1,2HRuutiainen, 1,2SKuitunen, 4SKälvemark Sporrong, 2MSivén, 3,5MPaulsson. 1HusHelsinkiUniversityHospital,HusPharmacy, Helsinki,Finland; 2UniversityofHelsinki,FacultyofPharmacy,Helsinki,Finland; 3Uppsala UniversityHospital,HospitalPharmacyDepartment,Uppsala,Sweden; 4UppsalaUniversity, DepartmentofPharmacy,Uppsala,Sweden; 5UppsalaUniversity,DepartmentofWomen’ s andChildren’sHealth,Uppsala,Sweden

10.1136/ejhpharm-2024-eahp.88

BackgroundandImportance Inpaediatrichospitals,thelackof age-appropriatelicensedmedicinesfororalusehastraditionallybeensolvedbyextemporaneousmanufacturingoforal liquids,suspensions,dosepowdersandcapsulesinhospital pharmacies,andmanualdrugmanipulationathospitalwards. However,thereisstillaneedfornewalternativestoprovide personalisedchild-friendlydrugformulationsandnovelprintingtechnologiesmaypresentasolution.Despitetherecent progressinthedevelopmentof3Dprintersforpharmaceutical applications,thereisalackofresearchontheirusabilityin extemporaneousmanufacturinginhospitalpharmacysettings. AimandObjectives Theaimofthisstudywastoevaluatethe perspectivesofhospitalpharmacypersonnelontheusability ofsemi-solidextrusionprinting.

MaterialandMethods Thisqualitativestudywasconductedas focusgroupdiscussionsintwouniversityhospitalsintwo Nordiccountries.Pharmacistsandpharmacytechnicians (n=43)fromthehospitalpharmacies,workingwithindrug manufacturing,compounding,orqualitycontrol,participated. Participantsdidnothavepreviousexperienceinusing3D printing.Priortoattendingthefocusgroups,theyreceiveda demonstrationonasemi-solidextrusion3Dprinter(Curify MiniLab,CurifyLabs,Finland)andperformedthestepsinthe manufacturingprocess.Asemi-structuredinterviewguidewas usedtomoderatethediscussions,whichwereaudio-recorded andtranscribedverbatim.Inaddition,observationsweremade duringthedemonstrationsaswellasthefocusgroup discussions.

Results Manyparticipantsperceivedtheequipmentaseasyto use.Suggestionsforequipmentspecificdevelopmentandprocessoptimisationwerebroughtupintheconversations,such as,useofauxiliarytools,disposablecartridgesandnozzles, andprintingdirectlyintoblisters.Benefitsandrisksassociated withqualityperspectives,suchasdrugaccuracyandstability, occupationalsafety,patientsafety,anddrugadministration wererecognised.Forexample,the3Dprinteddoseshada pleasantaromaandtextureandwereeasiertoproducethan dosepowders.

ConclusionandRelevance Toourknowledge,thisisthefirst studytoevaluatetheperspectivesofhospitalpharmacystaff ontheusabilityofsemi-solidextrusionprintingindrugmanufacturinginahospitalenvironment.Ourresultsshowthat, despiteidentifiedfurtherdevelopmentneeds,themanufacturingprocessshowsgreatpotential.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-032 OPTIMISATIONOFANINSULIN1IU/MLEYEDROP FORMULATIONFORTHETREATMENTOFCORNEAL ULCERS

1SPrietoRomán*, 1LLópezGuerra, 1EIzquierdoGarcía, 1MCCabelloCuevas, 1SLópez Morales, 1AGarridoDorao, 1PMonjeMontoya, 2TTalavánZanón, 1IEscobarRodríguez. 1InfantaLeonorUniversityHospital,PharmacyDepartment,Madrid,Spain; 2InfantaLeonor UniversityHospital,ClinicalAnalysisDepartment,Madrid,Spain

10.1136/ejhpharm-2024-eahp.89

BackgroundandImportance Accordingtoliterature,aformulationofregularhumaninsulin(Actrapid®)1IU/mLeyedrops waselaboratedusingasolutionofartificialtears(Systane Ultra®),insterileamberglassdropperbottlesforthetreatmentofcornealulcers.Totestthestability,a30-daygalenic

validationwasperformed,storingtheeyedropsinrefrigeration.ThesamplespreparedatthePharmacyDepartmentpresentedturbidityfromday0,thereforeitwasdecidedto formulateitin0.9%sodiumchloride(normalsaline).

AimandObjectives Optimiseandstudythestabilitythrough galenicvalidationof1IU/mLinsulineyedropsformulated usingnormalsalineinsterileamberglassdropperbottlesand inlowdensitypolyethylene(LDPE)dropperbottles.

MaterialandMethods Weelaborateda1IU/mLregular humaninsulineyedropsusingnormalsalinestoredinrefrigeration(2–8°C)inamberglassdropperbottles(IN1)and LPDEdropperbottles(IN2).Allsampleswerepreparedina horizontallaminar-flowcabinetfollowingtheGoodPractice Guidelinesforsteriledrugpreparation.A30-daygalenicvalidationwascarriedoutmonitoringclarity,colour,pH,osmolalityandsterilityondays0,1,2,7,15,22,30testingthree unitspersamplingpointandanalysedproperty.ThepHvalue atwhichinsulincommercialpresentationsarebufferedis6.9–7.8;andthepHvalueofnormalsalineis6.0.

Results IN1:atday0,thesamplespresentedapHaround 8.5.AfteranalysingthispHvalue,itisobtainedthatitwas duetothesterilisationprocessoftheamberglassdropper bottles,whichusesbufferedformol.Theformulationis,therefore,rejected.

IN2:allsamplespresented,duringthewholegalenicvalidation,atransparentandhomogeneousappearance,withabsence ofparticulates,pHvaluesof6–6.3,anosmolalityof282–286 mOsm/kgandnomicrobiologicalgrowth.

ConclusionandRelevance The1IU/mLinsulineyedrops packagedinLPDEdropperbottlesshowednochangesinthe parametersstudiedthroughoutthe30-daygalenicvalidation.

TheyalsoremainedwithintheeyepHrangeofmaximumtolerability(3.5–10.5).Itisrequiredmorephysicochemicaland microbiologicalstabilitystudiestoconfirmthestabilityofthe formulation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-033 KIROISOLATOR®:ANEW,RELIABLE,ROBOTICDEVICE FORTHECOMPOUNDINGOFINJECTABLE ANTICANCERDRUGS

1BQuitté*, 1CCros, 1LEscalup, 2JFouque, 2KRezai, 2SHuguet, 2OMadar, 1RDesmaris, 1AHurgon, 3AAcramel. 1InstitutCurie,PharmacyDepartment-PSLResearchUniversity, Paris,France; 2InstitutCurie,RadiopharmacologyDepartment,Saint-Cloud,France; 3UniversitéParisCité,Citcom-CNRSUMR8038-InsermU1268,Paris,France

10.1136/ejhpharm-2024-eahp.90

BackgroundandImportance Thecompoundingofinjectable anticancerdrugsinhospitalpharmaciesisinconstantgrowth andrequiresinnovationanddevelopmentofflexiblepreparationmethodswhilereducingtheriskofexposuretohazardousdrugsforhealthcareworkers.Tothispurpose,arobotic systemimplementedinsideanisolator,KiroIsolator® (Grifols, Spain),wasdesigned.

AimandObjectives Wereportthequalificationofthefirst KiroIsolator® fromamicrobiologicalandpreparationrobustnesspointofview.

MaterialandMethods Doseaccuracyandprecisionwere assessedforsamplingvolumesfrom1to48mLforthree drugsusedinourhospital:paclitaxel(viscoussolution),vincristine(aqueoussolution)andcyclophosphamide(aqueous

solutionwithreconstitution).Foreachvolumetested(1,5, 10,20and48mL),fivebagsofpaclitaxelandcyclophosphamidewereproduced.Avolumeof2mLwastestedwithvincristineonly(n=10bags).Testswererepeatedoverthree days.Allpreparationswerecheckedbygravimetriccontrol usingthescalesoftherobotwithaweighingtolerancethresholdsetat5%.Forpaclitaxelandcyclophosphamidepreparations,ananalyticalcontrolwasperformedtoconfirmthe reliabilityoftherobot’sgravimetriccontrolusinganLC-MS. Deviationfromthetheoreticalconcentrationwasexpectedto bewithin+/-15%.Microbiologicalqualificationwascarried outbyperformingMediaFilltests(MFT)overthreedays. Results Overall,75bagsofpaclitaxel,75bagsofcyclophosphamideand30bagsofvincristinewereproduced.Withthe exceptionofthe1mLvolume,accuracywasvalidatedwith gravimetriccontrolforallvolumestested.Analyticalcontrols werecompliantwiththespecificationsexceptforthreebags (twocyclophosphamideandonepaclitaxel).Weassumethese resultsarefalsenegativesduetoanissueofhomogenisation. Exceptedthelowestvolumeof1mL,ANOVAstestsshowed thatforpaclitaxelandcyclophosphamidetheconcentrations werenotdifferentfromthetheoreticalconcentrations.No growthwasobservedduringa15-dayincubationoftheMFT. ConclusionandRelevance Accuracywasvalidatedforsampling volumesfrom2to48mLwithareliablegravimetriccontrol. Therobot’sconfinementensurestechniciansafetyandenvironmentalprotectionwithoutaffectingitsperformance.Since itsqualification,nearly20%ofourtotalproductionisnow carriedoutwiththisinnovativerobot.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-034 FORMULATIONOFKETAMINE1%AND AMITRIPTYLINE1%GELINPRURITICEPIDERMOLYSIS BULLOSA:ACASEREPORT

AJReynerParra*,MDeCastroJulve,RBuenoUceda,JPinoGarcía,JDelgadoRodriguez, JDelEstalJimenez,LSorianoGutierrez,MOliverCervello,MGomez-Valent. ParcTaulí HospitalUniversitari,HospitalPharmacy,Sabadell,Spain

10.1136/ejhpharm-2024-eahp.91

BackgroundandImportance Epidermolysisbullosa(EB)isa groupofraregeneticdiseasescharacterisedbyfragilityofthe skin,resultinginpainfulanditchyblisters.Althoughthereis nocurativetreatmentforEB,somemeasuresmayhelpto relievesymptoms.

AimandObjectives Todescribeaclinicalcaseofapatient withEBandevaluatetheeffectivenessandtoleranceofaketamineandamitriptylineformula.

Todevelopandvalidateatopicalgelofketamineand amitriptyline.

MaterialandMethods A29-year-oldwomanwithdystrophic pruriticEBinherlowerextremitiessinceshewas3years old.Shewaspreviouslytreatedwithmethotrexate,oraland topicalcorticosteroidsandcyclosporine.Duetotheadverse effectsoforaltherapy,Dermatologyrequestedatopicalformulationofketamineandamitriptyline.

Aliteraturesearchontheefficacy,safetyandcomposition oftheformulawasconducted.A1%ketaminewith1%amitriptylinegelwasdevelopedandthephysicalandorganoleptic characteristicswereanalysedat0,14,28and42days.

Clinicalfollow-upwascarriedoutduringPharmacyandDermatologyvisitstoassesstheresponsetothetreatment.

Results Theliteraturereportedseveralcasesofketamineand amitriptylinegel(KAG)atdifferentconcentrationsfortreating chronicpruritusandEB.Theoff-labelusewasapprovedby themedicines-in-special-situationslocalcommittee.

Procedurefor400grams:Inphase1,dissolve0.6gof sodiummethylparabenin280mLofwaterandheatitupto 60–70°C.Inphase2,heat4gofamitriptylineand40gof glycerolinasecondbeaker.Addgradually4gofcarboxymethylcelluloseatphase2untilahomogeneoussuspensionis obtained.Mixbothphasesat70°Candstirvigorouslyuntila whitishgelisobtained.Aftercooling,add80gofketamine vial(50mg/mL)andhomogeniseit.Thegelishomogeneous, fluid,whitish,odourlessandhasgoodextensibility.

Fromthetreatment’sbeginning,thepatientshowed improvementofthepruritus,goodtoleranceandsatisfaction. After6weeks,shewasongoingwithKAGandappliesit every3hoursinstead.

ConclusionandRelevance Inourpatient,topicalKAGisan effectiveandsafealternativetoconsiderintheEBtreatment. Themediumlong-termeffectswillbeassessedthroughfollowup.Duringthestudiedperiod,theformuladevelopedmaintainsstability.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-035 PATCHTESTSWITHHAZARDOUSDRUGS:ISIT POSSIBLETOENSURESAFETYDURINGPRODUCTION?

MFernández-VázquezCrespo*,VPueblaGarcia,PPastorVara,NSanchez-OcañaMartín, JCorazonVillanueva,MDeLaTorreOrtiz,ADeDiegoPeña,JADominguezChafer, LYbañezGarcia,ERosonSanchez,AAGarcíaSacristán. HospitalClínicoSanCarlos, HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.92

BackgroundandImportance EpicutaneousPatchTests(EPTs) arethefirsttypeofskintestsperformedbyAllergology DepartmenttodiagnoseTypeIVhypersensitivityallergicreactions(IVHAR)todrugs.Theyinvolveapplicationofointments forepicutaneouspatchescontainingtheactiveingredient,preparedbythePharmacyDepartment,followedbyreading results48and72hourslater.Whenthereissuspicionofan IVHARtohazardousdrugs,compoundingprocessmustbe adaptedtoprotectthehandler.

AimandObjectives Theaimofthisstudyistodescribethe designandformulationofEPTwithImatinibandNilotinib, classifiedasHazardousDrugsGroup1bytheNationalInstituteforOccupationalSafetyandHealth(NIOSH).

MaterialandMethods ArequestwasmadetothePharmacy DepartmentforanEPTforapatientsuspectedofIVHAR aftertreatmentwithImatinibinordertoconfirmthediagnosisandconsiderswitchingtoNilotinib.

AliteraturesearchwasconductedtodeterminetheoptimalconcentrationofbothdrugswithineachEPT,aswellas thebestvehicle.Agaleniccontrolwasestablishedtoevaluate theextensibilityandorganolepticpropertiesoftheformula. Thestabilityoftheformulawasdeterminedinaccordance withtheriskmatrixincludedintheGoodPracticesGuide forthepreparationofmedicationsinHospitalPharmacy Services.

Thehandlingofthesedrugswasalwaysperformedina fumehoodwithHEPA-H14filter,wearingacap,glasses, FFP3mask,gloves,disposablegown,andshoecovers.

Results Imatinib5%petrolatum(pet.):

. Imatinibtablet0.4g

. Liquidpet.2g

. PetroleumJellyq.s.8g

. Nilotinib5%pet.:

. Nilotinibcapsule0.2g

. Liquidpet.1g

. PetroleumJellyq.s.4g

Forthepreparationofbothointments,thecommercial pharmaceuticalformwasplacedinaZIP-typeresealablebag withanENFitconnection.Theactiveingredientswerepulverisedusingaspecificroller-shapeddevice.Subsequently,liquid VaselinewasintroducedusinganENFitsyringethroughthe bag’sconnection.Afterhomogenisation,Vaselinefilantewas introducedinthesamemannerandhomogenisedagain. Finally,itwasdosedintoindividualised1mLENFitsyringes. ConclusionandRelevance ThepreparationofEPTwithhazardousdrugsintheHospitalPharmacyDepartmentistotally feasibleaslongastheappropriateproceduresandequipment areavailable.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-036 RISKANALYSISOFTHEPHARMACEUTICALCIRCUIT FORINJECTABLECHEMOTHERAPIESAFTER IMPLEMENTATIONOFDRUGLOG®

CVergnaud*,MDelamotte,ALebreton. ChuAngers,MaineEtLoire,Angers,France 10.1136/ejhpharm-2024-eahp.93

BackgroundandImportance Aspartofaqualityassurance approach,aUV-visiblespectrophotometerhasbeeninstalledin 2021inthecytotoxicreconstitutionunit(CRU),enablingprereleaseanalyticalcontrolofcytotoxicpreparations.Thisnew stephasledtoanewriskanalysisusingtheFMECAmethod (FailureModes,EffectsandCriticalityAnalysis).

AimandObjectives TheaimwastoevaluatetheentireinjectablechemotherapyprocesscomparedtoaninitialFMECAcarriedoutin2016inordertoassesstheaddedvalueofthe DrugLog® tool.

MaterialandMethods TheFMECAwascarriedoutbetween JuneandSeptember2023.Sixmultidisciplinaryworkingmeetingswereheld,attendedbytwopharmacists,oneinternand onepharmacytechnician.Thefailuremodes(FM)identified in2016werereassessedforatotalof97FMin2023,dividedinto10themes.ForeachFM,acriticalityindex(CI) basedonfrequency(F),severity(S)anddetectability(D)was calculatedusingtheformula:CI=F×S×D.TheCIsweredividedintothreecategories:mild(CI<25),moderate (25<CI<50)andsevere(CI>75).

Results Ofthe97FMsidentified,94wereofmildcriticality (97%),threemoderate(3%)and0severe.In2016and2023, 70itemswerecommon.ThecumulativeCIsweresimilar (806in2016comparedwith809in2023).Adecreasein cumulativeCIwasobservedinthepersonnel(-58%),validation(-69%)andrelease(-46%)themes.However,asharp increasewasobservedinthepremises(+55%),equipment

Abstracts

(+31%),traypreparation(+48%),andtransports(+41%) areas.

TheFMECAwasusedtoassessDrugLog®:18FMwere selected:100%wereofmildcriticality,foracumulativeCIof 163.

ConclusionandRelevance FMECA’scomparisonconfirmsthe addedvalueofDrugLog®.Itsimplementationsecuresthe releaseprocess.AlltheFMspecifictoDrugLog® areofmild criticalityandmakeitausefultoolfortheCRUprocess.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-037 ALUMINIUMINPAEDIATRICPARENTERALNUTRITION: AREMULTICHAMBERBAGSTHESAFERCHOICE?

1DBerlana*, 1APauParra, 2MDCSanchezValcarcel, 1CGarciaEsquerda, 1SClemente Bautista, 1PGarciaMora, 2JLopezHellin. 1VallHebronBarcelonaCampusHospital, Pharmacy,Barcelona,Spain; 2VallHebronBarcelonaCampusHospital,Biochemistry, Barcelona,Spain

10.1136/ejhpharm-2024-eahp.94

BackgroundandImportance Paediatricpatientsreceivingparenteralnutrition(PN)areparticularlyvulnerabletoaluminum exposure,aknowncontaminantinPNformulations.

AimandObjectives ThisstudyaimedtoquantifythealuminumconcentrationsinpaediatricPNadmixturesprepared usingcommerciallyavailablemultichamberbags(MCBs)for paediatricsandcomparethemwiththealuminiumcontentin compoundedPN(CPN)withanequivalentcompositionof ingredients.

MaterialandMethods WeconductedaluminiumcontenttestingonthethreecommerciallyavailableMCBformulations (Numeta® G13,G16,andG19).Simultaneously,weanalysed CPNpreparationswithidenticalcompositions.FortheMCB preparations,weutilisedtwobatchesofeachMCBpresentation,bothwithandwithoutlipids.ForCPN,wecreatedthree distinctformulationsforeachMCBpresentation:oneutilising Primene® astheaminoacidsource,anotherusingAminovenInfant®,andathirdmodifyingthesourceofelectrolytes (usingeitherAminoven-Infant® orPrimene®).CPNwaspreparedusingivelectrolytescompoundedbyanexternalpharmacyandcommerciallyavailableelectrolytes.The macronutrientsemployedforCPNincludedAminoven-Infant® orPrimene® foraminoacids,Glucose70%forcarbohydrates, andSmoflipid® 20%forthelipidsource.Aluminiumcontent

Abstract3PC-037Table1

AluminiumcontentinPNpreparations

PreparationMultichamber bag

CompoundedPNPvalue

Numeta® 9.83[2.20](n=12)20.68[4.19](n=18)<0.01

Numeta ®NoLipid9.85[2.61](n=6)20.79[4.00](n=9)<0.01

Numeta® withLipid9.81[1.94](n=6)20.57[4.62](n=9)<0.01

Numeta® G1311.94[2.68](n=4)23.00[5.34](n=6)<0.05

Numeta® G169.11[1.06](n=4)20.88[2.76](n=6)<0.05

Numeta® G198.44[0.43](n=4)18.16[3.08](n=6)<0.05

Primene® -18.76[3.00](n=11)0.07

Aminoven-Infant® -23.70[4.17](n=7)

wasquantifiedusingspectrometry.Mann-Whitneytestswere employedtocomparemeans.

Results Overall,wetested30PNpreparations(12MCBand 18CPN).Themeanaluminiumcontentwassignificantly higherintheCPNpreparationscomparedtoMCB,measuring 20.68and9.83 mg/L,respectively(seetable1).

Dataexpressedas mg/L[SD]

ConclusionandRelevance Thisstudyunderscoressignificant differencesinaluminiumcontentbetweencommerciallyavailableMCBsandCPNpreparations,emphasisingsafetyconcerns inneonatalandpaediatricpatients.Thefindingsunderscore theneedforeffortstoharmonisediscrepanciesacrossmanufacturersandsourcesofcontamination,ultimatelyenhancing thequalityandsafetyofpaediatricPNformulations.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-038 AUTOLOGOUSSERUMEYEDROPSPREPARATION: APPROACHTOTHEFILTRATIONSTEPIMPACTON THECONCENTRATIONOFACTIVEMOLECULES

1PMoncassin*, 1MColin, 1EBernikier, 1,2,3,4JJost, 5,6SHantz, 6,7MRocher, 8,9PAFaye, 1,2,3,4VRatsimbazafy. 1ChuLimoges,DepartmentofPharmacy,F-87000Limoges,France; 2Univ.Limoges-Epimact,EpidemiologyofChronicDiseasesinTropicalZone-Instituteof EpidemiologyandTropicalNeurology-Omegahealth,Limoges,France; 3IRD-U270Epimact,EpidemiologyofChronicDiseasesinTropicalZone,Limoges,France; 4InsermU1094-Epimact,EpidemiologyofChronicDiseasesinTropicalZone,Limoges,France; 5Chu Limoges,DepartmentofBacteriology-Virology-Hygiene,Limoges,France; 6Univ.LimogesInserm-ChuLimoges,Resinfit-U1092,Limoges,France; 7ChuLimoges,Departmentof Ophthalmology,Limoges,France; 8ChuLimoges,ServicedeBiochimieetdeGénétique Moléculaire,Limoges,France; 9UniversityofLimoges,NeuritUr20218-GeistInstitute, Limoges,France

10.1136/ejhpharm-2024-eahp.95

BackgroundandImportance Autologousserumeyedrops (ASEDs)arepharmaceuticalpreparationsusedinseveredry eyedisease.Sterilityisaspecificationforeyedrops,which canbeobtainedbyfiltration.Anymoleculewithamean diametergreaterthanthefilterporosityisthenretained.EGF (EpidermalGrowthFactor)isoneoftheactivemolecules (AMs)inASEDs.Withanintermediatemolecularmass(MM) (180kDa),itsinvestigationmakespossibletopredictthe impactoffiltrationontheconcentrationofothermolecules. AimandObjectives Toevaluatetheimpactofthissterilisation methodonAMbymeasuringEGFconcentrationsbefore/after filtrationofcollectedsera.

MaterialandMethods Four4mLtubesofhumanserum(P1P4)wereused,allfromahospitalbiologicalcollection.Each serumunderwentthefollowingoperations:zerofiltration, clarifyingfiltration(CF,at0.45 mmporosity)andsterilising filtration(SF,at0.20 mm).TheassaywasperformedinduplicateusingtheELISAtechnique(Quantikine® HumanEGF Immunoassaykit,R&DSystem,USA).Theimpactoffiltration isconsideredsignificantiftherelativedifferenceinconcentrationsaftertheprocessexceeds7.5%.

Results TheEGFconcentration(pg/mL)ineachunfiltered serumrepresentsthemaximumconcentration(100%),allowingtheimpactoffiltrationstobeexpressedasrelativepercentagesofthismaximum.UnderCF,thesepercentageswere respectively,forP1toP4:96.2%,97.2%,92.8%and97.1%, representingareductioninconcentrationsbetween2.8%and 7.2%.UnderSF,thepercentageswere:94.8%,93.4%,91.1%

and95.9%respectively,representingareductionof4.1%to 8.9%.

ConclusionandRelevance Asexpected,EGFconcentrations decreaseafterfiltration,especiallywhentheporosityofthe filterusedislow.Moreover,thesignificancethresholdis reachedforP3underSF.WemaysupposethatsmallerAMs (ieIGF-1,MM7.6kDa;TGF-b1,MM25kDa)willbeless retained.ForlargerAMssuchasfibronectin(MMaround 450kDa),thedecreaseinconcentrationislikelytohavean impactontheASEDsefficacy,justifyingamorespecificstudy. Othermethodsofensuringthemicrobiologicalsafetyof ASEDsshouldprobablyalsobeconsidered.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-039 EARLYDE-RISKINGOFTHESTABILITYOFA PERSONALISED,STERILEBACTERIOPHAGE SUSPENSIONONTHEBASISOFADVANCEDKINETIC MODELLING

1,2CMerienne*, 1,2,3BLapras, 1,2CMarchand, 2,4,5MMedina, 2,6TBriot, 1,2CPaillet, 2,5FLaurent, 1,2,3FPirot. 1Fripharm®,PharmacieÀUsageIntérieur-GroupementHospitalier Centre – HospicesCivilsdeLyonHcl-France,Lyon,France; 2ConsortiumPhag-One, HospicesCivilsdeLyon,Lyon,France; 3UMR5305:LaboratoiredeBiologieTissulaireet d’ingénierieThérapeutique,InstitutdeBiologieetChimiedesProtéines-Cnrs/Université ClaudeBernardLyon1,Lyon,France; 4LaboratoiredeBactériologie,InstitutdesAgents Infectieux-CentreNationaldeRéférencedesStaphylocoques – Hcl,Lyon,France; 5Centre InternationaldeRechercheenInfectiologie,InsermU1111-UniversitéClaudeBernardLyon 1-France,Lyon,France; 6PharmacieÀUsageIntérieur-GroupementHospitalierNord, HoscipesCivilsdeLyon,Lyon,France

10.1136/ejhpharm-2024-eahp.96

BackgroundandImportance Bacteriophages,naturalvirusesof bacteria,areapromisingtherapyagainstmultidrug-resistant bacteria.Theuseoftherape uticbacteriophages(TBP) requirestheselectionofthemostactiveonesandtheirindividualformulations(hospitalormagistralpreparations)bya hospitalpharmacyforapers onalisedmedicine.Theriskof TBPinstabilitymustbemanagedattheearlieststagesof development.

AimandObjectives AdvancedKineticModellingreliability assessmenttode-risktheinstabilityofBPTformulations.

MaterialandMethods Apurifiedanti-staphylococcalBP(Silviavirus)formulatedintwosolutions(AandB)wastested.The maincriticalqualityattributetoassesstheirstabilitywasthe biologicalactivity,determinedbynumerationofPlaqueFormingUnit(PFU)(SpotTest),withatargetsetat(10±9).108 PFU/mL.Thefollowingstudydesignswereperformed:(i)an accelerateddegradationwithseventemperatureconditions (from-80 °Cto+50 °C)during3months(analysisatD0, D7,D14,D28,D60,andD90),thedatageneratedbeing usedforAKMwithPREDISTABmethod;(ii)aprospective stabilitystudybasedonspottestperformed(n=3)at5and 25 °Cduring12monthsforAand6monthsforB.

Results Theresults(expressedinPFU/mL)oftheprospective vspredictedstabilitystudieswereasfollows:

. forsolutionA

. 8 vs2.43x108 (DLOG=0.66%)and1.04x105 vs2.65x105 (DLOG=8.1%)

. 8 vs1.46x108 (DLOG=2.05%)and3.56x102 vs4.76x102 (DLOG=4.94%)

. forsolutionBat5° and25°Cafter6months:2.56x108 vs 5.60x108 (DLOG=4.04%)and1.67x104 vs 2.69x103(DLOG=18.78%)

ConclusionandRelevance OurdatasuggestthatAKMallows rapidassessmentoftheriskofinstabilityforbothformulations.Comparisonoftheresultsofthepredictivevsprospectivestabilitystudiesshowedagoodprecisionat5 °Cand25 °Cduring12monthsforformulationAand6monthsfor formulationB.Theprospectivestudyisstillongoingforboth formulationstobecomparedwithpredictionsat24months. ThePREDISTABmethodbyidentifyingtheriskofinstability attheearlieststageofdevelopmentshouldallowtheearly selectionofthebestTBPformulationandpredicttheexpiry date.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-040 RADIOCHEMICALPURITYDETERMINATIONOF177LUPSMA-617:DEVELOPMENTANDVALIDATIONOFA HIGH-PERFORMANCELIQUIDCHROMATOGRAPHY ANALYTICALMETHOD

1ASallé, 1JFouillet*, 1CDonzé, 1LRubira, 1,2CFersing. 1InstitutRégionalduCancerde MontpellierICM,NuclearMedicineDepartment-RadiopharmacyUnit,Montpellier,France; 2InstitutdesBiomoléculesMaxMousseronIBMM,F9Team ‘Aminoacids-PeptidesAnd Proteins’,Montpellier,France

10.1136/ejhpharm-2024-eahp.97

BackgroundandImportance 177Lu-PSMA-617isatreatmentof progressive,metastatic,castration-resistantprostatecancers expressingPSMAreceptors,previouslytreatedwithtaxane andatleastonesecond-generationhormonetherapy. 177LuPSMA-617isaradiopharmaceuticaldrugwithamarketing authorisationandismanufacturedindustrially(PLUVICTO®, Novartis).However,itcanalsobepreparedin-house,especiallyforpreclinicalapplications.Thus,qualitycontrolproceduresarerequiredtodetermineradiochemicalpurity(RCP). AimandObjectives Todevelopandvalidatearadio-high-performanceliquidchromatography(HPLC)analysismethodto measureRCPof 177Lu-PSMA-617.

MaterialandMethods Radio-HPLCanalyseswerecarriedout onanapparatusequippedwithaC18 columnandaradioactivitydetector.Threecommercial 177Lu-PSMA-617batches wereusedassamples.Theparametersconsideredformethod validationwerespecificity,linearity,accuracy,precision,robustness,limitsofdetection(LOD)andlimitsofquantification (LOQ).Means,standarddeviationsandcoefficientofvariation (CV)forRCP,retentiontime(tr)andrecoverywerecalculated.LinearregressioncoefficientR2 wascomputedfor linearity.

Results Radiochemicalidentificationof 177Lu-PSMA-617consistedin10analysesofeachthreecommercialbatchesand showedaconsistenttrof10.07min(CV%<0.1).Recovery wasexcellent,with12.87±0.06MBqrecoveredatcolumn outletfora12.2MBqinjectedactivity.Theadditionofradioimpuritiesinknownquantitiesvalidatedtheaccuracyofthe method(differencesbetweenmeasuredRCPandtheoretical RCPrangingfrom101.57%to105.52%).CV%ofRCPand trvaluesover12measuresofasinglebatchwererespectively <0.11%and<0.12%,whichconfirmedtherepeatabilityof themethod.Forceddegradationconditionsinthepresenceof

acid,base,oxidativestressorheatingledtotheformationin situofimpuritieswithatrlargelydifferentfromtheanalyte, confirmingthespecificityofthemethod.LOQandLODwere 0.68and0.21MBq/mL,respectively,andtheradiodetector responsewaslinearfrom2to300MBq/mL(R2 =0.9977).

Robustnesswasfoundtobelimitedasthemeantrvaluesvariedby-4.8%whenthecolumnwasheatedto50 °Cinstead of25 °C.

ConclusionandRelevance Aradio-HPLCmethodforthequalitycontrolof 177Lu-PSMA-617wasvalidatedandcanbeused forin-housepreparationsforpreclinicalpurposesofthis radioactivedrug.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-041 PUBLICPRODUCTIONOFTHERAPEUTIC BACTERIOPHAGES

1,2CMerienne*, 1,2,3BLapras, 2,4,5CKolenda, 2,4,5MMedina, 1,2CMarchand, 2,4,5MBonhomme, 2,6TBriot, 1,2CPaillet, 2,4,5FLaurent, 1,2,3FPirot. 1Fripharm®,Pharmacie ÀUsageIntérieur-Groupementhospitaliercentre – HospicesCivilsdeLyonHCL,Lyon, France; 2ConsortiumPhag-One – Phageinlyon,HospicesCivilsdeLyon,Lyon,France; 3UMR 5305:LaboratoiredeBiologieTissulaireetd’ingénierieThérapeutique,InstitutdeBiologieet ChimiedesProtéines-Cnrs/UniversitéClaudeBernardLyon1,Lyon,France; 4Laboratoirede Bactériologie,CentreNationaldeRéférencedesStaphylocoques – Hcl,Lyon,France; 5CentreInternationaldeRechercheenInfectiologie,InsermU1111-UniversitéClaude BernardLyon1,Lyon,France; 6PharmacieÀUsageIntérieur-Groupementhospitaliernord, Hcl,Lyon,France

10.1136/ejhpharm-2024-eahp.98

BackgroundandImportance Tosternantibioticresistance-the deathtollofwhichispredictedtoreach10milliondeaths peryearby2050-newstrategiesareexploredsuchasphage therapy.Ittakesadvantageoftheabilityofbacteriophagesor phages – virusesofbacteria – toinfect,replicateandlyse theirhost.

AimandObjectives PHAG-ONEproject(20-PAMR-0009) allowedthecreationofanEtablissementFrançaisdesPhages Thérapeutiques(EFPT)workingwithFrenchhospitalstotreat patientswhoreachedtherapeuticdeadends.Thisworkdetails thefutureapproachforhospitalproductionofphage suspensions.

MaterialandMethods Selectionofproductionhost:An in-silico approach,basedonabioinformaticspipeline,wasdevelopedtoselectthebacterialstrainsthemostfreeofvirulence factorsandresistances.

Selectionofhightherapeuticpotentialphages:Phageswere sampledfromtheirnaturalenvironment,identifiedbygenetic sequencing;theiractivityrangewastestedonabacterialpanel representativeoftheclinicalandgeneticdiversityofthe pathogen.Phageswithbroadactivityspectrumandcomplementaryactivitieswereselectedforfurtherpharmaceutical development.

Results

Production Afteramplificationontheselectedhosts,phages werepurifiedbytangentialflowfiltrationandultrafiltration. Theoutputwasqualifiedasanactivepharmaceuticalingredient(API)authorisedbytheFrenchregulatoryhealthagency (ANSM).ThisAPIcanenterhospitalpreparations.

Formulationandqualitycontrol Theexcipientsforthehospital preparationswereselectedto(i)enhancethephagesuspension stabilityand(ii)besuitableforclinicaluse.Thequality

controlstarget(i)thephageidentityandactivity;(ii)therisks associatedwiththeadministrationroute;(iii)therisksassociatedwiththeproductionprocess.Thehospitalpreparation’ s stabilityisexploredfollowingbothICHandpredictive approaches.

ConclusionandRelevance Theauthorisationstoproduce phageAPIandhospitalpreparationsofphagesuspensions willbeaskedaccordingrespectivelytothefabrication(part2 andappendix2)andpreparationgoodpracticesandtothe futuregeneralchapter ‘ Phagetherapyactivesubstancesand medicinalproductsforhumanandveterinaryuse(5.31) ’ . InspiredbytheFrenchbloodestablishment,EFPT ’ spurpose willbetoofferphagesuspensionsagainstmultiresistantbacteriaortotreatpatientswithinfectiousrecurrencesand otherbacterialtherapeuticdeadendsinapersonalised approach.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-042 STERILEANDNON-STERILECOMPOUNDING:RISK

ANALYSISANDIMPROVEMENTMEASURES

MMensa*,RJudit,BLara,FEva,MGemma. HospitaldeTerrassa-ConsorciSanitaride Terrassa,PharmacyDepartment,Terrassa,Spain

10.1136/ejhpharm-2024-eahp.99

BackgroundandImportance Drugcompoundingerrorscan resultinpatientharm.Hence,theimportanceofreviewing formulationstoensuretheirqualityandsafety.

AimandObjectives Toanalysetheriskderivedfromourcurrentprocessofsterileandnon-sterilecompounding,through errorrecordsregisteredfor1year,andtolistandprioritise measurestosolvethem.

MaterialandMethods Adescriptivestudy,includingerrors relatedtosterileandnon-sterilecompounding(non-parenteral nutrition,non-chemotherapy)registeredfromOctober2022to September2023,wasconducted.Errorswereclassifiedaccordingtotheircauses.Error ’sseveritywasdeterminedsubjectivelybythepharmaceuticalteam.

Abrainstormingsessionwasorganised,withtechniciansand thepharmacistleadingsafety,todiscussthecriticalpointsof theentireprocess.AnIshikawadiagramwascreatedtovisuallycapturethecriticalpoints.Improvementmeasuresto reduceriskoferrorswerelistedandprioritisedbyfeasibility andeffectiveness.

Ourcurrentprocessconsistsof: – Organisation:Outlook schedule,emailrequests,electronicandpaperprescriptions –Non-sterilecompounding:managedthroughMagisfor® software – Sterilecompounding:managedthroughprocessing forms.

Results Sixty-fourerrorsweredetected:seven(10.9%)dueto organisationalcauses,six(9.4%)derivedfromsoftware/processingforms,eight(12.5%)compoundingprocess,five(7.8%) qualitycontrol,five(7.8%)packaging,23(35.9%)labelling, seven(10.9%)storage,andthree(4.7%)duetovalidation causes.

Twenty-five(39%)errorswereconsideredsevere.Errors weremainlydetectedbypharmacistsduringthevalidation process(n=54,84%),othersbytechnicians/nurses.

Intotal,25maincriticalpointsweredetectedthroughthe Ishikawadiagram.

Improvementmeasuresthatcouldbeimplementedare:

. Outpatientscheduling

. Traininginouractualsoftware,goodclinicalpracticeandthe compoundingprocess

. Evaluateotherprogrammesthatincludesterilecompounding

. Periodicrevisionoftheprocessingforms

. Strategicplacementormarkingactiveingredients/excipients susceptibletocauseconfusion

. Moremicrobiologicalcontrols

. Periodicrevalidationoftechnicians

. Reducetechnicianturnoverandlessmultitasking

. Measureswecouldprioritisewouldbethoserelatedto technicianstrainingandrevalidation.

ConclusionandRelevance Severalcriticalpointsweredetected inourprocessofsterileandnon-sterilecompounding.We foundsomemeasuresthatcouldhelpustoreduceriskof errors,butwethinkthatweshouldprioritisethoserelatedto technicianstrainingandrevalidation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

3PC-043 INTRAVITREALPREPARATIONOFLIPOSOMALB AMPHOTERICIN:FROMFORMULATIONSTUDYTO PREPARATION

ADeLuca*,EBoccia,ARettori,AGhiori,DTognoni,COrsi. AziendaOspedaliero UniversitariaCareggi,Pharmacy,Firenze,Italy

10.1136/ejhpharm-2024-eahp.100

BackgroundandImportance Fungalvitreitisavitreousbody infectionthatfallswithinth ebroaderfieldofendophthalmitis.Thetherapyforthispathologyistheintravitrealinjection ofantifungaldrugsthatcanbeaccompaniedbytopicalor intravenousadministrationofthesameantifungaldrug.The pharmacyhadtorespondtoarequestforintravitrealpreparationofliposomalbamphotericin0.01mg/0.1ml.The rationaluseoftheliposomalformulationhasbeentheelectivetoxicityintheeyecomparedtothenon-liposomalformulationofwhicharereportedintheliteraturepossible adverseevents.

AimandObjectives Thepurposeofthispaperistodescribe theprocesswhichledtotheformulationandcompoundingof theintravitrealpreparation.

MaterialandMethods Theexistingscientificliteraturehas beenanalysedinordertoidentifythecorrectprocedurefor settinguptherequiredgalenicpreparation.Thecompounding hasbeenstudiedfrombibliographicaldataanddiscussedinternallybyourteamofpharmacists,laboratorytechniciansand nurses.

Results Forthepreparation,carriedoutwithaseptictechnique, amphotericinbliposomiale50mgpowderforparenteraluse wasused.Thedrugwasreconstitutedwith12mlofwater forinjectablepreparation(APPI)toobtainaconcentrationof 4mg/ml.Thepreparationhadtobecarefullyshakenfor about30secondstoensurecompletedissolution.2,5mlof reconstitutedsolutionweretakenandthena5-micronfilter wasappliedandinjectedintoa100mlAPPIbottlepreviously emptiedofthesameml.A0,1mg/mlconcentrationsolution wasobtained.0,3mlofthefinalsolutionwasthentransferredtoa1mlluerlocksyringeandclosedwithaself-sealingdevice.Asecondsyringehasbeenpreparedfor microbiologicalcontrol.

ConclusionandRelevance Clinicalgalenicshasbeeninstrumentalinensuringtherapeuticopportunitiesnotavailablewith commerciallyavailablemedicinesforthepersonalisedtreatmentofapatientwithfungalvitreitassociatedwithchorioretinitis.Thepharmacistisessentialfortheparticularknowledge ofthedruginthefieldofformulationofgalenicprescriptions magistralandlaboratorytechniciansandnursesfortheimplementationofthesame.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KoçA, et-al.ParsplanavitrectomyandintravitrealliposomalamphotericinBin thetreatmentofCandidaendophthalmitis. OphthalmicSurgLasersImaging ConflictofInterest Noconflictofinterest.

3PC-044 APHYSICO-CHEMICALSTABILITYSTUDYOF VANCOMYCINEYEDROPSAFTERDIFFERENT THAWINGTIMES

AGillette*,ABourges,VLebreton. Pharmacie,LaboratoiredeControle,Angers,France

10.1136/ejhpharm-2024-eahp.101

BackgroundandImportance Inourestablishment,anexcursion temperatureoccurredonourfreezercontainingthehospital preparationincludingvancomycineyedrops25mg/mL.Due tothelackofdata,aquarantineoftheeyedropswasnecessary,resultinginatimeintervalwithouteyedropspreparation.Itwasnecessarytoquicklyobtainvancomycineyedrops fromtheotherhospitals.Rememberthatvancomycineye dropsareindicatedforthetreatmentofbacterialkeratitisand cornealabscesses.

AimandObjectives Wewouldliketocreatefourscenarios withdifferentthawingtimes(0.5h,2h,6hand12h)toimaginedifferentsituationscanmeetusersofeyedropstocheck thestabilityoftheeyedropafter7days.

MaterialandMethods Aftertotaldefrostingtheeyedrophave beenputbacktothefreezer.Afteranintervaltimeofatleast 48hat-20°Ctheeyedropwasthawedandstoredinthe fridgeconditionbetween2and8°Cfor7daystomimica normaluse.TheassayofvancomycinanddegradationproductshasbeendeterminedbyHPLCattheendofthefirst thawingtime(J0)andatday0,3and7ofthefridgestorage foreachbatch(D0,D3andD7).Onebatchperscenariowas tested,eachbatchcontainedthreesamplesandeachsample wasassayedintriplicate.

DetectionoftheanalytewasperformedbyUVandmass spectrometry(l=280nmand725Da).Likewise,detectionof degradationproductswascarriedoutbydiodearrayUVand massspectrometerdetector(210nmto400nmand50–1500 Da).

Results Withallthesescenarios,wedemonstratedthatvancomycineyedropsisstableatD7after12hoursofthawing. Theaveragevariationinvancomycinconcentrationislessthan 5%.Nodegradationproductswereobserved.

ConclusionandRelevance Thisphysico-chemicalstudycould bereproducedforourotherhospitaleyedroppreparation (ceftazidimeandamikacine)whicharealsousedforcorneal infections.Then,amicrobiologicalstudycouldbedoneinthe sameconditiontoprovesterilityofeyedropsafterathawing cycle.Thesefirstpromisingresultswillpermittoavoidquarantineafterunintentionallythawingoffrozeneyedrop preparations.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

3PC-045 RETROSPECTIVESTUDYOVER6YEARSOFTHETREND INFUNGALCONTAMINATIONOFCONTROLLED ATMOSPHEREAREASWITHINACELLTHERAPYUNIT

1TRMHien*, 1AJullien, 1VPersoons, 2AMoisan. 1ÉtablissementFrançaisduSang, DépartementdeContrôleQualité,Saint – Ismier,France; 2ÉtablissementFrançaisduSang, DépartementdeProduction,Saint – Ismier,France 10.1136/ejhpharm-2024-eahp.102

BackgroundandImportance Mouldsareaerobiceukaryotic organismsnaturallypresentintheenvironment.Accordingto regulations,nomouldshouldbepresentinacontrolledatmospherezone(ZAC).

Accordingtotheliterature,fungalsporescanreachsignificantquantities,uptoseveral10,000’sofparticles/m3 of ambientair.Thehighestconcentrationsarefoundduringthe summer-autumnperiodinEurope. Cladosporiumspp isthe predominantspeciesinmoststudies,withconcentrationsof over4,000CFU/m3 ofambientair.

Thetrendinoutdooraircontaminationiswellknown,but fewarticlesdealwiththetrendinfungalcontaminationin ZACs.

AimandObjectives Theprimaryobjectiveofthisstudywasto determinewhetherthereisaseasonaltrendincontamination inZACs.Thesecondaryobjectivesweretodeterminethe mostfrequentmouldsandtheeffectoffactorssuchasair conditioning,hygrometryandtemperatureonfungalcontaminationinZACs.

MaterialandMethods Basedonmicrobiologicalsurveillance registeroftheZACsattheSaint-Ismiercelltherapyandengineeringunit,wecollectedthecontaminatedsampleswithout countingthenumberofCFUscontainedinthiscontamination. Whenavailable,identificationwasprovided.Thevariablesof temperature,hygrometryandairconditioningwerecollected usingcentralisedtechnicalmanagementsoftwareforequipment andpremises.Allthedatacollectedwasrecordedmanuallyin aMicrosoftExcelspreadsheet,withdatadouble-checkedat thetimeofcollection.Statisticaltestswereperformedonthis table.

Results Theresultsofthetrendanalysisshowedasignificant differencebetweenfungalcontaminationfrequenciesinZACs dependingontheseason.Autumnandsummeraretheseasons withthehighestriskoffungalcontamination.Themainspeciesinourstudywere Cladosporium,sppandPenicillium, spp.

ConclusionandRelevance TheseresultsshowthattheevolutionoffungalcontaminationinZACsreflectsthatofexternal environment.Indeed,althoughZACairtreatmentsystemsare capableoffilteringlargequantitiesoffungalspores,factors suchaspersonnel,materialsandconsumablesarepotential vectorsformicrobialtransfer.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Avisdel’AnsesRapportd’expertisecollective.pdf. 2.BasilicoMdelaLZ,ChiericattiC,AringoliEE,AlthausRL,BasilicoJC.Influence ofenvironmentalfactorsonairbornefungiinhousesofSantaFeCity,Argentina. SciTotalEnviron.15avr2007;376(1):143–50.

ConflictofInterest Noconflictofinterest.

3PC-046 RISKOFPERSONNELEXPOSURETOHAZARDOUS DRUGSINROBOTICCOMPOUNDING

1ACRiestraAyora*, 1OOlariaga, 1MUrretavizcaya, 2AAsensio, 1MJTamés, 1AIglesias, 1MJArgandoña, 1YCamba. 1Onkologikoa,Pharmacy,SanSebastián,Spain; 2Hospital UniversitarioDonostia,Pharmacy,SanSebastián,Spain

10.1136/ejhpharm-2024-eahp.103

BackgroundandImportance Continuousoccupationalexposure tohazardousdrugs(HD)posessignificantriskstohealthcare personnel.Roboticcompoundingsystemshavebeenintroduced inpharmaciestoenhancepatientandstaffsafety.ThesesystemsoperatewithinenclosedISOClass5environmentswith negativepressure,whicheffectivelyminimisingpersonnel exposuretoHDduringcriticaloperations.However,thereis aconcernthatsurfacesinthecompoundingareamaygetcontaminated,potentiallyexposinghospitalpersonneltothese hazardoussubstances.

AimandObjectives Theprimaryobjectiveofthisstudywasto evaluatetheriskofoccupationalexposuretoHDwhenutilisingroboticcompoundingsystemsforthepreparationofantineoplasticsterilemedications.Specifically,weaimtoassessthe levelsofHDspresentonthesurfacesofready-to-usepreparationsandonthegloveswornbypersonnelinvolvedinthe compoundingprocess.

MaterialandMethods Thisstudywasconductedoveraperiod of3daysduringroutineproductionatKIROOncology(Kiro Grifols,Mondragon,Spain).Eachday,wecollectedwipesamplesfromthesurfacesof20HDpreparationsandfromthe glovesoftheoperatorengagedinthecompoundingprocess usingCytoxlabsamplingkits(CYTOXLab,Geneva,Switzerland).Ouranalysisincludedthedetectionandquantification of25anticancermoleculescommonlyusedinhospital pharmacies.

Results Throughoutthestudy,19differentdrugswerecompoundedbytherobot,including5-fluorouracil,bevacizumab, carboplatin,cisplatin,cyclophosphamide,docetaxel,doxorubicin,eribulin,etoposide,gemcitabine,irinotecan,nivolumab, oxaliplatin,paclitaxel,panitumumab,pembrolizumab,pemetrexed,trastuzumab,andvinorelbine.Weobservedonlyanegligibleamountofgemcitabine,whichfellbelowthe quantificationlimit(<0.005ng/cm2),onthesurfacesoftwo outofthe20bagsandontwooftheoperator ’sgloves. ConclusionandRelevance TheresultsofthisstudydemonstratethatlevelsofHDsurfacecontaminationinroboticcompoundingareexceedinglylowand,inmostcases, undetectable.OccupationalexposuretoHDremainsconsistentlybelow0.1ng/cm2,athresholddeemed ‘safe’ according tocertainstudies.Thisfindingassuresthesafetyofthecompoundingpersonnelandotherhospitalstaffmembersinvolved incancertreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ThisresearchwaspartiallysupportedbyKiro-Grifols. ConflictofInterest Noconflictofinterest.

3PC-047 PAEDIATRICIVANTIFUNGALADMIXTURES: CENTRALISATION’SECONOMICCONSEQUENCES

APrietoRomero*,FGarcíaMoreno,MSPerniaLopez,PRuízBriones,ACarrilloBurdallo, SHerreroBermejo,BSomozaFernandez,ITaladrizSender,AHerranzAlonso,MSanjurjo Saez. HospitalGeneralUniversitarioGregorioMarañón,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.104

BackgroundandImportance Mostintravenousadmixtures (IVA)arepreparedonthewards justbeforetheiradministrationtothepatient,discardingthesparevolumeleftin vialsafterwards.Thiswastedvolumeisespeciallysignificant ininjectablesusedinpaediatrics.Toavoidthis,hospital pharmacyCentralIntravenousAdditiveServices(CIVAS) centralisethepreparationofIVAs,reducingwasteandsavingcosts.

AimandObjectives ToevaluatetheeconomicimpactofcentralisinginjectablepaediatricantifungaldrugsinatertiaryhospitalCIVASfromJanuarytoDecember2021.

MaterialandMethods Thecostincurredbythepreparationof paediatricantifungalsonthewardsversusCIVASwasestimated.Todothis,datawerecollectedfromtheelectronic prescribingsystemandthecentralisedpreparationcostswere calculatedconsideringthenumberofvials,dilutingagents, extrapersonneltime(0.90C ¼ /preparation)andclothing(0,11C ¼ and0,16C ¼ inanon-hazardouscabinandhazardouscabin, respectively).Expensesonthewardwerecalculatedbasedon whatitwouldhavecostweretheynotcentralised.Thesecalculationswerebasedonthemaximumex-factorypriceplus VATminusanationaldiscount.

Results Threedrugswereselectedforcentralisation,namely liposomalamphotericinB(LAB),micafunginandvorizonazol. Stocksolutionswerepreparedforthesedrugsataconcentrationof1mg/mLforLABandmicafungin,and5mg/mLfor voriconazole,whichwerethenusedtopreparedifferent patientspecificIVAs.Duri ngthetimeperiod,atotalof 2,423paediatricantifungalswerecentralised,whichcomprised863LAB,1531micafungin,andonly29voriconazol IVAs.SavingcostsbetweenthewardandtheCIVASwere justabove26000C ¼ forLAB,about72000C ¼ formicafungin, and250C ¼ forvoriconazole,whichaccountedforatotalof 96500C ¼ approximately,consideringpersonnelandclothing costs.

ConclusionandRelevance Centralisingantifungaldrugsinto CIVASinhospitalpharmaciesisanefficientmeasureto reducewasteandcosts.Thisisespeciallyimportantforhighly prescribedpaediatricIVAssuchasLABandmicafungin,and lesssoforvoriconazolewhichisfarlesscommonlyprescribed inpaediatrics,beingmainlypreparedinCIVASforsafety reasons 1 .

REFERENCESAND/ORACKNOWLEDGEMENTS

1.NIOSHListofAntineoplasticandOtherHazardousDrugsinHealthcareSettings, 2020[Internet]U.S.DepartmentofHealthandHumanServices.LastUpdated September2020.Availablefromhttp://www.cdc.gov

ConflictofInterest Noconflictofinterest.

4CPS-001 COMPARATIVEANALYSISOFTWO PHARMACOKINETICPROGRAMSFORLITHIUM ADJUSTMENT

1ABPousadaFonseca*, 2NBarrerasRuíz, 3ÁLSalcedoMingoarranz, 3MRodríguez Fernández, 3CGómezRamírez, 1CMorielSánchez, 2FJBécaresMartínez, 3BGarcíaDíaz. 1HospitalUniversitariodeMóstoles,Hospitalpharmacy,Móstoles,Spain; 2Hospital UniversitarioFundaciónJiménezDíaz,Hospitalpharmacy,Madrid,Spain; 3Hospital UniversitarioSeveroOchoa,Hospitalpharmacy,Leganés,Spain

10.1136/ejhpharm-2024-eahp.105

BackgroundandImportance Therapeuticdrugmonitoring (TDM)istheclinicalpracticeofmeasuringdrugstomaintain

aconstantconcentrationinthepatient‘sblood,therebyindividualisingdosageregimens.TDMismainlyusedtomonitor drugswithanarrowtherapeuticrange,drugswithhighpharmacokineticvariability,anddrugswithahighincidenceof adverseeffects.

Thenarrowtherapeuticwindowoflithium(0.6 – 0.8 mmol/L)requiresaccuratemonitoringofitsserumconcentrationstoachieveasafeandeffectivetherapy.

AimandObjectives Tocomparetwopharmacokineticprogrammesandanalysetheprecisionandaccuracyoflithium serumconcentrationadjustment.

MaterialandMethods Retrospectiveobservationalstudyincludingadmittedpatientswithatleastonedeterminationofserum lithiumconcentrationbetweenJanuaryandDecember2020at asecondaryhospital.

Electronicmedicalrecordswereusedtoobtainthefollowingdata:lithiumdosage,serumlithiumconcentrations,date ofbloodanalysis,serumcreatinine,renalfunction(calculated usingtheCockcroft-Gaultequation),dateofbirth,sexand weight.

Serumlithiumconcentrationswereestimatedusingtwo pharmacokineticsoftwareprograms:MwPharm++andPKS.

AccuracyandprecisionwereevaluatedusingSheinerand Beal’spredictionerrortheory.Accuracywasestimatedwith themeanpredictionerror(MPE)andprecisionwiththemean absolutepredictionerror(MAPE)andthesquarerootofthe rootmeansquarepredictionerror(RMSE).Theseresultsare accompaniedby95%confidenceintervals.

Thestatisticalsignificancewasdeterminedusingat-student testforcomparingmeans.

Results Atotalof79plasmalithiumlevelsfrom18patients wereanalysed,55.6%weremale,withamedianageof52.4 years[IQI:41.7–55.4],andamedianweightof70.5kg[IQI: 66.8–82.15].Threepatients(16.7%)hadacreatinineclearance lessthan60ml/min,and17(94.4%)hadmultipleserumlithiumdeterminations.Themediannumberofdeterminations perpatientwere3IQI[2–4.5].

Thefollowingresultswereobtained:

Accuracy:MPE0.02(-0.025–0.065)and-0.02(-0.064–0.024)forMwPharm++andPKS,respectively.

Precision:MAPE0.14(0.11–0.18)and0.12(0.08–0.16), andRMSE0.20and0.20forMwPharm++andPKS, respectively.

NostatisticallysignificantdifferenceswerefoundforMPE (p=0.22)orMAPE(p=0.40).

ConclusionandRelevance MwPharm++andPKSshowedsatisfactorypredictivecapabilities,withnosignificantstatistical differences.Bothprogramsseemtobevalidoptions,but largerstudiesareneededforconfirmation.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-002 PHARMACEUTICALCAREINPOSTOPERATIVEPAIN MANAGEMENTATADMISSIONANDDISCHARGE

1ARibed*, 1AGimenez-Manzorro, 1ITaladriz-Sender, 2SAlvarez-Atienza, 3SMartin-Lozano, 1MPMontero-Anton, 1AHerranz-Alonso, 1MSanjurjo-Saez. 1HospitalGeneralUniversitario GregorioMarañon,Pharmacy,Madrid,Spain; 2HospitalUniversitarioFundaciónAlcorcon, Pharmacy,Madrid,Spain; 3HospitalGeneralUniversitarioGregorioMarañon,Orthopaedic, Madrid,Spain

10.1136/ejhpharm-2024-eahp.106

BackgroundandImportance Theprevalenceofpaininpostoperativepatientsis88.2%,withmoderatetoseverepainin 19.6%ofcases.

AimandObjectives Theobjectivewastodescribepharmaceuticalinterventionsinpainmanagementandtheimpacton patient-reportedpainonadmissionanddischargeandpatient satisfaction.

MaterialandMethods Aprospectiveinterventionalstudy (March-May2023)inhospitalisedadultpatientsadmittedin generalortraumasurgerywascarriedout.

Outcomemeasures patient-perceivedpain(VAS)andpatient satisfaction.

Pharmaceuticalinterventionsweremade 48and96hoursafter surgery(atbedside)and48hoursafterdischarge(bytelephone):

1.Admission:

1.1.RemindingnursesofrecordingVAS(onepernursing shift).

1.2.IfVAS 4,interventionsinanalgesiaprescriptionand/ orinnurse’sadministration

1.3PatienteducationonVASscale,therapeuticoptionsand theimportanceofaskingforanalgesiaifpain.

2.Discharge:

2.1.IfVAS>2patientswereremindedhowtotakeanalgesia.Ifnoanalgesiaprescribed,thepatientwasreferredtoa primarycarephysician(PCP).

2.2.IftheytooktheprescribedmedicationandVAS=4–6, theywerereferredtoPCPandifVAS 7,totheemergency department.

Adescriptiveanalysiswasused.

Results Sixtypatientswereincluded,meanageof66.7 (±16.4)years

Onadmission,94interventionsweremade(92.3% accepted):toencourageVASrecording(n=26),administer analgesia(n=18),prescribeanalgesia(n=18),increasetherapeuticstep(n=17)andpatienteducation(n=15).

AnincreaseinVASrecordingwasobserved(56.7%vs 76.3%).Therewasaprogressivedecreaseincurrentpatientreportedpain(2.1vs1.9vs1.4)andmaximumpaininlast 24hours(3.2vs2.7vs2.3)andinthenumberofpatients withVAS 4.

Atdischarge,39interventionswereperformed:23patients wereremindedhowtotaketheprescribedanalgesia,15were referredtoPCPforlackofanalgesiaprescriptionormoderate pain,andonewasreferredtotheemergencydepartment.

Satisfactionwithpostoperativepainmanagementandthe pharmaceuticalcarewas7.9(±2.1)and9.7(±0.5), respectively.

ConclusionandRelevance Pharmaceuticalinterventionsoneducation,recording,administrationandprescriptionofanalgesics mighthavecontributedtoagradualreductioninpatientreportedpain.Thepharmacistplaysaroleinthemanagement ofpostoperativepainduringadmissionandatdischargewith highpatientsatisfaction.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-003 EVALUATIONOFCLINICALVARIABLESIMPACTON ENOXAPARINDOSINGANDANTIXACONCENTRATION ATorrent*,TLizondo,CBastida,DSoy. HospitalClínicdeBarcelona,PharmacyService, Barcelona,Spain

10.1136/ejhpharm-2024-eahp.107

BackgroundandImportance Monitoringenoxaparinisnotroutineasperguidelinesbutisrecommendedinrenalinsufficiencyanddebatedforextremebodyweightsandpregnancy. AimandObjectives Thisstudyaimstoassessenoxaparinmonitoringinhospitalisedpatientsandidentifyvariablesthatcorrelatewithitsefficacy.

MaterialandMethods Adescriptive,single-centre,retrospective studywasconducted.Hospitalisedpatientsreceivingtherapeuticenoxaparindoseswereincluded,withmeasurementof peakanti-XaconcentrationbetweenDecember2021andJanuary2023.Patientsundergoingrenalreplacementtherapies wereexcluded.

Demographicdata,laboratoryandclinicalparameters,and enoxaparin-relateddetailswerecollected.Obesitywasdefined asbodymassindex 30kg/m2.Multiplelinearregressionwas usedtoanalysetherelationshipbetweenanti-Xaconcentration anddifferentvariablesincludingenoxaparindose,obesity, renalimpairment(ClCr<30mL/min),andcriticalstatus.Suggestedpeaktargetrangeforanti-Xais0.5–1.1IU/mL. STATA/BEwasusedtoassesstheircorrelationwithPearson coefficientanddeterminethebestpredictor.

Results Atotalof147patientswereincluded,withamean ±SDageof68years(±12.29),weightof85.03kg(±22.92), andaBMIof29.64kg/m2 (±0.61).Amongthestudypopulation,64patients(43.5%)wereobese,15(10.2%)hadrenal impairment,and78(53.1%)werecriticalpatients.Mean±SD enoxaparindosewas0.93mg/kg(±0.13),andnosignificant differenceswereobservedbetweenobese(0.91±0.15mg/kg) andnon-obese(0.95±0.02mg/kg)populations(p=0.104).Seventy-ninepatients(53.7%)presentedanti-Xaconcentrations outofrange;36ofthem(45.6%)wereobese.

Inthemultipleregressionanalysis,weobservedastatisticallysignificanteffectofenoxaparindose(p<0.001)andobesity(p=0.007)inanti-Xaconcentrations.

Usingthefinalmodel,wefoundagoodcorrelation betweenanti-Xaconcentrationandenoxaparindose (p<0.001).Pearsoncoefficientof0.56wasobtainedforthe non-obesepopulation,whileitwasof0.16intheobese population.

ConclusionandRelevance Inourstudy,weidentifiedobesity asavariablethatshowedasignificanteffectonanti-Xaconcentration.Weconfirmedtheexistenceofalinearassociation betweenanti-Xaconcentrationandenoxaparindoseforthe non-obesepopulation.Fortheobesepopulation,apoorcorrelationbetweenanti-Xaconcentrationandenoxaparinwas foundsuggestingtheneedformonitoringduetolesspredictablepharmacokinetics.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-004 IMPACTOFINADEQUATEEMPIRICALTHERAPYON THEMORTALITYRATEINPSEUDOMONAS AERUGINOSAINFECTIONS

EHerranzBayo*,RHuarteLacunza,MRAbadSazatornil,IAguilóLafarga,CIDíaz-Calderón Horcada,APeñasFernández,RBelloCalvo,OBoujedianeDerrous,AMirandaMarín, RJuliánMartín. MiguelServetUniversityHospital,HospitalPharmacy,Zaragoza,Spain

10.1136/ejhpharm-2024-eahp.108

BackgroundandImportance Theappropriateuseofantibiotics andtheirclinicalimpactisanecessaryfieldofstudyto addressthehighincidenceofresistance.

AimandObjectives Toanalysetheimpactofinadequate empiricaltherapy(IAT)onmortalityinpatientswithPseudomonasaeruginosa(PA)infectioninatertiaryhospital.

MaterialandMethods Observational,retrospectivestudyof patientswithPAinfectionandtreatedwithpreviousempirical antipseudomonalantibioticsfrom1January2021to31October2021.Variables:gender,age,placeofadmission,dosing regimen,primaryfocusofinfectionandmortalityduring admissionor30daysafterdischarge.DefinitionofIAT:nonadherencetothelocalguidelinesthatestablishthenew EUCAST2021dosingcriteriatoachievesufficientlevelsof antibioticsreportedas ‘sensitivewithincreasedexposure’ and which,basedontheprevalenceofmulti-resistanceinPA,recommendsempiricalusewithbiotherapyuntiltheantibiogram isavailable.Datasource:pharmacotherapeuticmanagement softplante(Farmatools®)andelectronicmedicalrecords.AnalysiswithSPSSStatistics21®

Results 92patientswereadmittedtoICUand126tononICU(men67.4%and69.8%respectively)withameanageof 62.9±12.5yearsinICUand71.4±15.3innon-ICU.

IntheICUthemainsourceofinfectionwasthelung (48.9%),whileinthenon-ICUthelungandurinarytract wereatthesamelevel(29.4%each).

Inbothgroupstheuseof b-lactams(76.8%ICUand 65.7%non-ICU),followedbyaminoglycosidesintheICU (13.5%)andquinolonesinthenon-ICU(22.5%).Theuseof monotherapywashigherinthenon-ICUthanintheICU (66.9%vs.49.2%,p<0.001).

TheIATwashigherinthenon-ICU(67.5%vs.47.8%ICU p=0.041).Innon-ICU,themortalityrateduringadmissionor at30daysinpatientswithIATwas22.4%vs7.3%with adequateempiricaltherapy(OR:3.64;95%CI1.01–13.13), thisdifferencebeingstatisticallysignificant.InICUtherewere alsohighermortalityratesintheIATgroup(50.0%vs 39.6%),butwithoutstatisticallysignificantdifferences (OR:1.53;95%CI0.67–3.49).

ConclusionandRelevance Thehighermortalityobservedin casesofIATimpliestheneedtoworkontheadequacyof dosageaccordingtoEUCASTcriteriaandtopromotebitherapyuntiltheantibiogramisavailable.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-005 DRUGPERSISTENCEOFJAKINHIBITORSCOMPARED TOBIOLOGICDRUGSINREAL-WORLDPRACTICEIN PATIENTSWITHRHEUMATOIDARTHRITIS

1PLlopis-Salvia*, 1MSaez-Bello, 1DViedma-Rama, 1MHermenegildo-Caudevilla, 2JJAlegre-Sancho, 1MClimente-Marti. 1HospitalUniversitariodrPeset,Pharmacy,Valencia, Spain; 2HospitalUniversitariodrPeset,Rheumatology,Valencia,Spain

10.1136/ejhpharm-2024-eahp.109

BackgroundandImportance JAK-inhibitors(JAKi)representan effectivechoiceforpatientsdiagnosedwithrheumatoidarthritis(RA).ThereislimiteddataavailableonrealuseofJAKi.

AimandObjectives TocomparepersistenceofJAKi,TNF-a inhibitor(TNFi)andnon-TNF-a inhibitor(non-TNFi)drugsin patientswithRAandreasonsfortreatmentdiscontinuation.

MaterialandMethods Anambispective,observationalstudy conductedatatertiaryhospital.PatientsdiagnosedwithRA evaluatedattheRheumatologyInterdisciplinaryCommitteeof BiologicalDrugsfrom1January2018to7January2022that

startedorswitchedtreatmentwithJAKi,TNFiandnon-TNFi wereincluded.Treatmentspreviouslyreceivedwereincluded. Follow-upwascarriedoutuntil7January2023.

Variablescollectedwereage,sex,typeofdrug,priorbiologics(naïve,second-lineandthird-orhigherline),patient’ s chronicitylevelaccordingtotheChronicityStrategyofValencianCommunity(0=healthyindividualto4=chronic patientofhighcomplexity),lengthoftreatmentandreasons fordiscontinuation.

Outcomevariablewaspercentageoftreatmentsthat reached12monthspersistenceestimatedfromthefirsttothe lastdrugdispensation.

Datawerecollectedfromtheelectronichealthandpharmacydispensingrecords.

Continuousvariableswereexpressedasmean(SD),andcategoricalvariablesasabsoluteandrelativefrequency.Chisquaretestandlogisticregressionwereusedtoidentifyvariablesassociatedwithpersistence.Statisticalsignificancewasset atp<0.05.AnalysiswascarriedoutwithR-4.3.1.

Results Therewereatotalof303patients(75%women), meanagewas53(16)years.Werecorded623treatments: JAKi156(25.0%),TNFi326(52.4%)andnon-TNFi156 (22.6%).

Chronicitylevel(n=177(58.4%)patients)was: ‘0’ 40 (11.7%), ‘1’ 143(41.7%), ‘2’ 109(31.8%), ‘3’ 51(14.8%). Treatmentline:first284(45.6%),second146(23.4%)and thirdorhigher193(31.0%).

NodifferenceinpersistencewasfoundamongJAKi108 (69.2%),TNFi215(66%)andnon-TNFi80(56.7%)treatments(p=0.06).Treatmentlineshowedpersistencedifferences:naïve213(75%),second-line81(55.5%)andthird-or higher109(56.5%)(p<0.01).Nodifferencewasfoundin persistenceaccordingtosex,ageorchronicitylevel.Multivariateanalysisconfirmedtheseresults.

Attheendoffollow-up460(73.8%)treatmentshadfinisheddueto:199(43.3%)secondaryfailures;100(21.7%) adverseeffects;74(16.1%)primaryfailuresandothers50 (18.9%).Nodifferenceswerefoundamongaccordingtotype oftherapy(p=0,48).

ConclusionandRelevance Inourhospital12-months’ persistenceandreasonsfordiscontinuationamongJAKi,TNFiand non-TNFiinpatientswithRAshowednodifference.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-006 ADHERENCETONEBULISEDANTIBIOTICSINCYSTIC FIBROSISPATIENTSAFTERSTARTINGELEXACAFTOR/ TEZACAFTOR/IVACAFTOR

1FMartínezdelaTorre*, 2LDiabCaceres, 1BBertranDeLisBartolome, 1MGonzalez sevilla, 1MDCanalesSiguero, 1MDCJimenezLeon, 1FMayoOlveira, 1ACastroFrontiñan, 1AGonzalezGomez, 1JMFerrariPiquero. 1HospitalUniversitario12deOctubre,Pharmacy, Madrid,Spain; 2HospitalUniversitario12deOctubre,Pneumology,Madrid,Spain

10.1136/ejhpharm-2024-eahp.110

BackgroundandImportance Elexacaftor/tezacaftor/ivacaftor (ETI)arebringingaboutamajorchangeinthetreatmentof cysticfibrosis(CF)patients.However,continuingwithother treatmentssuchasnebulisedantibioticsisnecessary. AimandObjectives ToassesstheadherencetoinhaledantibioticsbeforeandafterstartingETI.Secondaryobjectives:To assesseffectivenessofETI.

MaterialandMethods Observational,retrospectivestudycarriedoutbetweenMarch2023andSeptember2023,including patientswhostartedwithETIbeforeSeptember2022,12 yearsofageorolderwhentheystarted,andtreatedwithat leastonenebulisedantibiotic.

Variables:age,sex,changefrombaselineinpercentageof predictedforcedexpiratoryvolumein1second(FEV1)at month12,differenceinrateofpulmonaryexacerbations1 yearbeforeandafterstartingETI,differenceinMedication PossessionRatio(MPR)tonebulisedantibiotics1yearbefore andafterstartingETIandMPRtoETIfor12months.

Datawerecollectedfromelectronicmedicalrecordsand pharmacydispensingprograms.

Astatisticalanalysiswasperformedusingdependentsamplest-testwithIBMSPSSStatisticsv21.0.

ThestudywasapprovedbyEthicsCommitteeofthe hospital.

Results Intotal,33patientswereincluded,21/33(63.6%) werefemale.Themeanagewas28.1(±12.5).14/33(42.4%) patientshadbeenpreviouslytreatedwithtezacaftor/ivacaftor.

PercentageofpredictedFEV1was17.8%higher(95%CI 11.8–23.7)at12months.Rateofpulmonaryexacerbations was70.2%lower(95%CI43.3–97.2)andrateofseverepulmonaryexacerbationswas86.1%lower(95%CI43,2–128,9) 12monthsafterstartingETI.MPRtonebulisedantibiotics was22%lower(95%IC7,5–36,5)12monthsafterstarting ETI.(P<0,001forallcomparisons).MPRtoETIwas89,7% (±18,5).

ConclusionandRelevance TheintroductionofETItoCF treatmenthasbeenahopefuladvance.ETIhasshownagood efficacyinourpopulation.However,theadherencetonebulisedantibioticsdecreasedsignificantly.Morestudiesareneeded toevaluatethesafetyofwithdrawingnebulisedtherapiespostETI.AstrategytoimproveadherenceinpatientswithCFhas beeninitiatedincollaborationwiththeCFunitofour hospital.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SongJT, etal.Researchletter:Theimpactofelexacaftor/tezacaftor/ivacaftoron adherencetonebulisedmaintenancetherapiesinpeoplewithcysticfibrosis. J CystFibros 2022;21:1080–1

ConflictofInterest Noconflictofinterest.

4CPS-007 ADALIMUMABINTHETREATMENTOFRECALCITRANT SWEETSYNDROME:ACASEREPORT

LToríoÁlvarez*,AIglesiasLambarri. HospitalUniversitarioGaldakao-Usansolo,Hospital Pharmacy,Galdakao,Spain

10.1136/ejhpharm-2024-eahp.111

BackgroundandImportance Sweetsyndrome(SS)isarare febrileneutrophilicdermatosischaracterisedbyedematousand erythematouspapules,plaquesornodulesontheskin,and fever.SSisassociatedwithinfection,malignancy,pregnancy anddrugexposure.Highdosesofsystemicglucocorticoidsare thefirst-linetreatment.Colchicine,dapsone,andpotassium iodideareadditionaltherapies,reservedforrefractorycases. Inaddition,classicimmunosuppressantshavebeeneffective. Newercasereportssuggestbenefitfrombiologicaltherapiesin recalcitrantcases.

WehavefoundtwootherrefractorySScasesinthe literature.

AimandObjectives Toassesstheeffectivenessofadalimumab ina50-year-oldpatientdiagnosedwithrefractoryidiopathic SSinatertiaryhospital.

MaterialandMethods In2019,amanpresentedwithfever, episcleritis,jointpain,andelevationofacutephasereactants (RFA)(C-reactiveproteinlevel(PCR),35mg/L;erythrocyte sedimentationrate(VSG),48mm;ferritin416ng/L).Early detectionofautoimmuneandinfectiousdiseaseswasnegative. Finally,hewasdiagnosedwithidiopathicSSin2022.Initially, colchicinewasstartedwithoutclinicalresponse.Therefore, systemicglucocorticoidswereinitiated.Theresponsewas excellent,buthedevelopedacentralserouschoroidopathy secondarytoglucocorticoids,whichcontraindicateditsuseat highdoses.Prednisone5mgdailywasmaintained.Later,dapsonewascommencedbutitwasineffectiveandcausedhaematologicaltoxicity(anaemia).Afterdapsonewithdrawal, anaemiabloodmarkersimproved.InApril2023,methotrexate 15mgweeklyandprednisone10mgdailywerecommenced. Aftertwomonths,hepresentedskinlesions,fever,asthenia, arthralgiaandelevatedRFA(PCR,46mg/L;VSG,84mm; ferritin603ng/L).ConsideringitwasarefractorySS,adalimumaboff-labelwasrequested.

Results On5Julyadalimumab40mgbiweeklywasinitiated. Previously,informedconsentwassigned.Methotrexateand prednisoneindescendingdoseswerecontinued.Aftertwo injections,thediseasehadeased(nofever,skinlesionsor inflammation)andwithoutadverseeffects.On28September, hestartedtreatmentwithprednisone5mgdaily,methotrexate 10mgweeklyandadalimumab40mgbiweekly,andRFAare normal(PCR,<1mg/L;VSG,16mm).

ConclusionandRelevance -Adalimumabiseffectiveinthe treatmentofrecalcitrantSS.

-Alongerfollow-upisneededtoassesstheeffectivenessin thelongterm.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-008 ANALYSISOFPHARMACEUTICALINTERVENTIONS RELATEDTOANTITHROMBOTICDRUGSIN EMERGENCYDEPARTMENT

MHijaziVega*,LRubio-Ruiz,ALópez-García,JSánchez-Rubio-Ferrández,NIbáñez-Heras, AOnteniente-González,TMolina-García. HospitalUniversitariodeGetafeMadrid, Pharmacy,Getafe,Spain

10.1136/ejhpharm-2024-eahp.112

BackgroundandImportance AntithromboticDrugs(AD)belong toatherapeuticgroupconsideredashigh-riskmedicationand theyareahighpriorityinpatientsafetystrategies.

AimandObjectives Toanalysepharmaceuticalinterventions accordingtoADsattheEmergencyDepartment(ED),andto evaluatethefactorsthatcouldinfluencetheacceptanceof pharmaceuticalrecommendations.

MaterialandMethods Prospective,longitudinal,observational studywasconductedovera9-monthperiod.Weselected pharmaceuticalinterventionsperformedbyemergencymedicinepharmacistsinpatientsreceivingADsduringtheEDjourney.Acompletepharmacotherapeuticreviewwasperformed foreachpatientinordertodetectdrug-relatedproblems (DRP)andarecommendationwasissuedtotheresponsible physician.

Collecteddata sex,age,numberofchronicmedications,polymedication(simplepolymedication5–9drugs;extremepolymedication>9drugs),patientclinicalcomplexitylevel(low, moderate,high),druginvolved.

WeanalysedtypeofinterventionsandDRPsseverity accordingtotheNationalCoordinatingCouncilforMedicationErrorReportingandPrevention(NCC-MERP)thatclassifiestheerroraccordingtotheseverityoftheoutcome (CategoryA:noerror,CategoryB-D:errorwithoutharm,EH:errorwithharm,I:death).Severitywasnotevaluatedin patientswhoseclinicalsituationchangedbeforeconsidering intervention.

AChi-squaredtestwasappliedforcategoricalvariables. Forquantitativevariables,t-Student-testortheequivalentnonparametricMann-WhitneyU-testwasused.Statisticalanalysis wasperformedusingSPSS®V22.

Results Intotal,809patientswithantithromboticmedications (AD)wereassessed.Atotalof237interventionswereperformedin227patients(28.05):59.9%men,79±12.4years, 59%hadamedium-highcomplexityleveland60.8%had extremepolymedication.

Regardingtheinterventionsperformed,75.9%relatedto indication(57.7%startnewmedicationand13.3%discontinuingmedication)and20.2%toposology.Accordingtothe DRPseverityassessment,206interventionswereclassifiedfollowingNCC-MERP:117C,48B,27A,7D,5F,1Gand1I.

Concerningpharmaceuticalinterventions,72.6%were accepted,14.35%wererejectedand13.1%wererelatedto patientswhoseclinicalsituationhadchanged,andtheinterventionperformedwasnolongerconsideredappropriate. Regardinginfluencingfactors,therewasanon-significance trendfortypeCerrorseveritytobeacceptedmorefrequently (OR2.03CI95%0.91-4.52)p=0.07.

ConclusionandRelevance Acceptancerateofpharmaceutical interventionswashigh.Mostoftheinterventionswererelated todrugindication.MorethanahalfoftheDRPswereerrors thatreachedthepatientwithoutcausingharm.Nofactorshad aninfluenceonacceptanceratio

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-009 NEONATALDIAGNOSISANDTREATMENTOFSTIFF BABYSYNDROME:ACASEREPORT

1SErdozain*, 1RJuanbeltzZurbano, 2ACastroQuiroga, 1APinoRamos, 1AYerroYanguas, 1ARodriguezEsquiroz, 1MSarobeCarricas. 1HospitalUniversitariodeNavarra,Pharmacy Department,Pamplona,Spain; 2HospitalUniversitariodeNavarra,NeonatalUnit, Pamplona,Spain

10.1136/ejhpharm-2024-eahp.113

BackgroundandImportance STIFFsyndromeisararedisease withgeneticmutationCr5GLRA1.Itischaracterisedbya neurologicaldisorderwithstiffnessandmusclespasms,which affectsthequalityoflifeofthesepatients.

AimandObjectives Describethediagnosticandtherapeutic managementofaneonatalpatientwithStiffsyndrome.

MaterialandMethods Literaturereviewofcasesdescribed withsimilarclinicalfeaturesbythepharmacyandneonatology serviceofatertiaryhospital.Testswererequestedfordifferentialandconfirmatorydiagnosis(wholegenomesequencing).

ThePharmacyServicecollaboratedinthesearchforapossible effectivetreatmentandinadaptingittoapaediatricpatient.

Results Prematurepatient(41+2)hospitalisedthe16of August2022inatertiaryhospitalduetorespiratorydistress andabnormalneurologicalsigns,followedbyahypertonic seizurewithgeneralisedrigidity.Abolusofmidazolam0.1 mg/kgwasadministeredwithoutimprovement,followedby phenobarbital3mg/kg/24hwithoutclinicalresponse.After negativetests,thegeneticstudydetectedanalterationofthe GLRA1geneinthepatient,andaheterozygousmutationin themother.Ametabolicstudywasperformed,detectingelevatedlevelsofglutamicacid.1 Atherapeutictrialwasstarted the28ofAugustwithoralClonazepamat0.1mg/kgevery8 hours.1 Asthiswasacompoundingpreparation,thepharmacy preparedthesuspensionataconcentrationof0.1mg/mlfrom 2mgtablets.2 Duetotheimprovementinstiffnessandhypereplexiasincethestartoftreatment,clonazepamwasmaintainedatdischarge,andcontinuesbeingactiveat0.3mg/kg/8 hours.Atfollow-upat11monthsofage,thepatientwasin goodgeneralcondition.Theconditionhadattenuated,with lessstartleandreflexes.

ConclusionandRelevance Stiffsyndromeisadiseasethatis difficulttodiagnoseandtotreatduetoitslowprevalence. Thefavourableclinicalresponseafterstartingtreatmentwith clonazepamshouldbehighlighted.ThepreparationofapharmaceuticalformulationfromthePharmacyServiceallowedto individualisethedoseaccordingtothepatient‘sweightand clinicalevolution.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SainiaAG,PandeyS.Hyperekplexiaandotherstartlesyndromes. JNeurol Sci.2020,216:117051.

2.PoloniniHC,LouresS,LimaLC, etal.StabilityofAtenolol,Clonazepam,Dexamethasone,DiclofenacSodium,Diltiazem,EnalaprilMaleate,Ketoprofen,Lamotrigine,Penicillamine-D,andThiamineinSyrSpendSFPH4OralSuspensions. IntJ PharmCompound. 2016;20:167–74.

ConflictofInterest Noconflictofinterest.

4CPS-010 CANERENUMABIMPROVEQUALITYOFLIFE PERCEIVEDBYPATIENTS?

AVélezBlanco*,SLlamasLorenzana,XCasasFernández,JCSáezHortelano,LOrtega Valín,EGutiérrezGutiérrez,RVarelaFernández,AFernándezVázquez,DOzcoidiIdoate, CDeCastroAvedillo,JJOrtizDeUrbinaGonzález. ComplejoAsistencialUniversitariode León,HospitalPharmacy,León,Spain

10.1136/ejhpharm-2024-eahp.114

BackgroundandImportance Migraineisahighlydisabling chronicdisease.Erenumabisapreventivetreatmenttoreduce frequency,intensityanddurationofmigrainecrises,to improvethequalityoflife,reducingtheimpactofthedisease onthefunctionalityofthepatient.

AimandObjectives Theaimwastoevaluatethequalityoflife perceivedbythepatientbeforestartingtreatmentwitherenumabandafter12months.

MaterialandMethods Prospectiveobservationalstudywhich includespatientswithchronicorepisodichigh-frequency migrainetreatedwitherenumab(August2020toDecember 2022),whohadcompleted12monthsoftreatment.

Demographicdata(sex;age),clinicaldata(typeof migraine;monthlymigrainedaysandintensityatthebeginningoftreatmentand12monthsafter)werecollectedand EuroQol-Questionnairewasperformedtoassessqualityoflife atthebeginningand12monthsafter.

WithEQ-5D-5L-Questionnaire,patientsevaluatehisown healthstatus.CrosswalkIndexValueCalculatorandSPSS-Statisticsv28.0.1.1wereusedforthehealthstatuscalculation.

Results Weanalysed32patientswithamedianageof52 years(IQR:46.45–59.4)being27women.Twenty-eightof themwerediagnosedwithchronicmigraineandfourwith highfrequencyepisodicmigraine.Twopatientsstoppedtreatmentbefore12monthsduetolackofresponse(excluded fromtheanalysis).

Averagereductioninmonthlymigraineswas10.75days (7.07–14.42).Meanmigrainesintensitybeforetreatmentwas 8.6(7.97–9.3);and5.28(4.18–6.37)after.Numberof patientswhoreportnothavingproblemsrelatedtomobility, personalcare,dailyactivities,pain/discomfortandanxiety/ depressionhasincreasedand/ormaintainedafter12months oftreatmentcomparedtobaseline:18vs21;23vs23;9vs 18;3vs12;and6vs11,respectively.Meanaccordingto EQ-5D-questionnairebeforeerenumabwas0.5694(-0.008–1) and0.7198(-0.096–1)after.Improvementofqualitylifewas consideredstatisticallysignificant(p<0.01).Meanvalueof EVAscalebeforetreatmentwas50%(10–95%)and68.5% (15–100%)after.Improvementinqualityoflifeisconsidered statisticallysignificant(p=0.008).

ConclusionandRelevance Itisimportanttocarryoutstudies thatincludegreatersample,butinourexperiencetreatment witherenumabhasbeenagreatimprovementinqualitylife ofpatientswithmigraine,thusreducingtheimpactoftheir diseaseintheirdaytoday.

REFERENCESAND/ORACKNOWLEDGEMENTS

1. EurJNeurol.2021May;28(5):1716–1725.

ConflictofInterest Noconflictofinterest.

4CPS-011 REAL-WORLDEFFECTIVENESSANDSURVIVALOF GUSELKUMABINPATIENTSWITHPSORIASISAND PSORIATICARTHRITIS:MULTICENTREANALYSISIN DAILYCLINICALPRACTICEBYTHEVALENCIAN COMMUNITYPSORIASISGROUP

1JPoquet-Jornet*, 2FRogriguez-Lucena, 3MCRodriguez-Samper, 4MABernabeu-Martinez, 5AGarcia-Monsalvez, 6MACia-Barrio, 7MPrieto-Castello, 8RFuster-RuizDeApodaca, 9AMoya-Martinez. 1HospitaldeDenia,Pharmacy,Denia,Spain; 2HospitalVegaBaja, Pharmacy,Orihuela,Spain; 3HospitalGeneralUniversitariodeElda,Pharmacy,Elda,Spain; 4HospitalUniversitarioSanJuan,Pharmacy,SanJuan,Spain; 5HospitalGeneralUniversitario deElche,Pharmacy,Elche,Spain; 6HospitalMarinaBaixa,Pharmacy,VilaJoiosa,Spain; 7HospitalVirgendeLosLirios,Pharmacy,Alcoy,Spain; 8HospitalGeneralUniversitarioDr. Balmis,Pharmacy,Alicante,Spain; 9HospitalGeneralUniversitariodeElche,Statistical, Elche,Spain

10.1136/ejhpharm-2024-eahp.115

BackgroundandImportance Guselkumabisapprovedforthe treatmentofpsoriasisandpsoriaticarthritis.Nonetheless, patientswhoparticipateinclinicaltrialsarequitedifferent fromthoseseenindailyclinicalpractice.

AimandObjectives Theobjectiveofourstudywastoassess theeffectivenessanddrugsurvivalinpatientswhosufferfrom psoriasisandpsoriaticarthritisinreal-lifesettingstreatedwith guselkumabineighthospitalsinValencianCommunity(Spain).

MaterialandMethods Thiswasamulticentricretrospective study,adultpatientswithpsoriasisandpsoriaticarthritisand wasapprovedbytheDrugResearchEthicsCommittee (CEIm).Weincludedpatientswhohadpreviousexposureto

oneormorebiologicdrugsandreceivedguselkumab(April 2019toOctober2022(42months)).

Results Atotalnumberof184patientswithplaquepsoriasis (81.5%n=150)orpsoriaticarthritis(18.5%n=34)were enrolledinthisstudy,withapredominanceofmalepatients (52.2%;n=88).Mean(±SD)ageattheinitiationofguselkumabtherapywas37,3±17.0forpsoriasispatientsand 47,1±14,1forpsoriaticarthritispatients(p<0.05).

Aboutthepreviouslinesoftreatmenttheyhadbeen received:91.8%(n=169)receivedone,62.5%(n=115) receivedtwoand44.0%(n=81)hadreceivedmorethanthree previouslines.Asfirst-lineoftreatment,65.7%(n=111)had beentreatedwithtumournecrosisfactor(TNF)inhibitor, 17.2%(n=29)withIL-12/23inhibitor,8.3%(n=14)with IL17inhibitors,3.0%(n=5)withIL23inhibitors,and3.0% (n=5)withapremilast.

Themean(±SD)PASIscoredecreasedfrom7.6±5.8at baselineto1.5±6.8after24weeksoftherapy(p<0.05), andto0.0±1.2after52weeks(p<0.05).Theseresultsare similartothoseobservedinpivotaltrialsVOYAGE1,VOYAGE2andNAVIGATE(1,2,3)Reasonfordiscontinuation: lossofeffectiveness14(7.6%),lostfollow-uptwo(1.1%), securityissuestwo(1.1%),andotherssix(3.3%).Overall cumulativedrugsurvivalwas87.0%at42months.

ConclusionandRelevance Thismulticentreretrospectivestudy analyseddatafromeighthospitals,demonstratingeffectiveness anddrugsurvivalofguselkumabinareal-worldsetting,similartothoseobservedinpivotaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.VOYAGE1.https://www.jaad.org/action/showPdf?pii=S0190-9622%2816% 2931157-4

2.VOYAGE2.https://www.jaad.org/action/showPdf?pii=S0190-9622%2816% 2931158-6

3.NAVIGATE.https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjd.15750

ConflictofInterest Noconflictofinterest.

4CPS-012 IMPROVINGPARENTALMEDICATIONLITERACYBY PHARMACIST-LEDDISCHARGECOUNSELLINGIN PAEDIATRICHAEMATOPOIETICSTEMCELL TRANSPLANTATION

1CGradwohl*, 1BBirkenau, 2GStemer, 1HPichler. 1St.AnnaChildren’sHospital, DepartmentofPaediatrics-MedicalUniversityofVienna,Vienna,Austria; 2University HospitalAKH,PharmacyDepartment,Vienna,Austria

10.1136/ejhpharm-2024-eahp.116

BackgroundandImportance Childrenundergoingallogeneic haematopoieticstemcelltransplantation(HSCT)requirea broadspectrumofpharmacotherapy.Afterdischarge,parents areliableforsafeandeffectivedruguse.Asdosagedepends onbodyweightandpaediatricformulationsarecommonly lacking,childrenarepronetomedicationerrors.Therefore, parentsandchildrenrequireasufficientlevelofmedication literacy(ML).

AimandObjectives Toevaluatetheimpactofapharmacist-led dischargecounsellingforparentsonapaediatrictransplant unitatatertiarycarechildren’shospital.

MaterialandMethods Apharmacy-leddischargecounselling programwasdevelopedbasedonthefindingsofaliterature reviewandontheresultsofastatusquoanalysisofthe actualmedicationeducationprocess.Servicedeliverywas implementedasapreplannedcounsellingsessionwithparents

ofnewlytransplantedchildrenpriortodischarge.Toevaluate theimpactoftheservice,apeer-reviewedknowledgetest(11 pointsequalinghighestknowledge)wasperformedbeforeand aftercounselling.Resultswerecomparedusingatwo-sample t-testfordependentsamples.Parentswereencouragedtoask questionsregardingtheirmedication.Awrittenmedication plancontainingrelevantdruginformationwasfurthermore provided.

Results BetweenNovember2022andMay2023,10parents receivedcounselling.Themedianageofchildren[malen=8 femalen=2]was4.5years(range2–15).Childrentook8.9 ±2.0differentdrugsanddurationofcounsellingwas41±17 minutes.Theparentsscored6.2±1.3and9.7±0.8of11 pointsontheknowledgetestbeforeandaftercounselling, respectively(p<0.001).

ConclusionandRelevance Ingeneral,pharmacist-leddischarge counsellingwashighlyappreciatedbyparentsandthe involvedhealthcareteam.Counsellingmightsubstantially improvetheparents’ knowledgeonquestionsregardingdrug therapyandwillhelpparentsmakeinformeddecisionsafter discharge.

BasedonVaillancourtetal., 1 itcanbehypothesisedthat highermedicationliteracytranslatesintoimprovedclinical outcomes.However,evaluationinourprojectwaslimitedto asinglesessionandawrittenmedicationplan.Todocumenta sustainedimpactonmedicationliteracy,itwouldbenecessary tofollowupwithparentsandchildrenduringaftercare.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.VaillancourtR,CameronJD.Healthliteracyforchildrenandfamilies. BrJClin Pharmacol. 2022.

ConflictofInterest Noconflictofinterest.

4CPS-013 INTRAVENOUSLEVETIRACETAMSUPPLETIONDURING HAEMODIALYSISPRESERVEDSTABLETHERAPEUTIC SERUMCONCENTRATIONS:ACASEREPORT

1JVanDerMast*, 2PDouwes-Draaijer, 1MJDeenen, 1CMHKerskes. 1CatharinaHospital, ClinicalPharmacy,Eindhoven,TheNetherlands; 2CatharinaHospital,Nephrologyand Dialysis,Eindhoven,TheNetherlands

10.1136/ejhpharm-2024-eahp.117

BackgroundandImportance Levetiracetamisawidelyused antiepilepticdrug.Duetoitspharmacokineticproperties includinglowmolecularweight,lowvolumeofdistribution andsmallproteinbinding,itisahighlydialyzedduringhaemodialysis(HD).1 Therefore,itisdifficulttopreservestable plasmalevelsduringdialysisandpatientsstartingwithHDare oftenswitchedtootherantiepilepticdrugs.Informationabout levetiracetamconcentrationsinthisgroupofpatientsare rarelydescribedandshowconflictingdata.Wedescribeacase reportinwhichlevetiracetamwassupplementedduringHD andwheremultiplelevetiracetamlevelsweremeasuredduring HDsessions.

AimandObjectives Todeterminewhetherstablelevetiracetam plasmaconcentrationscanbepreservedduringHDbyintravenoussuppletion.Wereportacaseofa63-year-oldwoman whostartedintermittentHDbecauseofrenalfailuredueto diabeticnephropathy.Shewastreatedwithlevetiracetam250 mgb.i.d.fortherapy-resistantfocalepilepsy.Levels<10mg/L resultedinfrequentseizures,thereforethetargetvaluesinthis patientweresetat10–25mg/L.

MaterialandMethods HDsessionslasted4hours.Additional intravenousdosesoflevetiracetamwereadministeredduring bypasspre-HD,after2hoursHDandpost-HD(seetable1). Levetiracetamconcentrationsweremeasured30minutesafter levetiracetamsupplementation.Pre-HDsamplesweremeasured beforethefirstsupplementationdosewasgiven. Results

Abstract4CPS-013Table1 Levetiracetamsupplementaldose andserumconcentrationspre-HD,duringHDandpost-HD

HDsession1234567

Supplementalintravenousdose(mg)oflevetiracetam

Plasmaconcentrationsremainedmoststablewithsuppletion dosesof500–250-250mganddidnotresultinseizuresfollowingHD.

ConclusionandRelevance HDshowedtoeliminatelevetiracetamsignificantly.Inthiscasereport,intravenouslevetiracetam suppletionduringHDsafelypreservedstablelevetiracetam plasmaconcentrationspreventingseizures.Closemonitoringof plasmaconcentrationsisrecommendedtodeterminethe appropriatesupplementaldosetomaintaintherapeuticlevels.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RenalDrugDatabase,Levetiracetam,accessed21–06-2023,via:https://renaldrugdatabase.com/monographs/levetiracetam

ConflictofInterest Noconflictofinterest.

4CPS-014 REALWORLDDATAONTHEUSEOFPCSK9INHIBITOR TREATMENTSINHYPERCHOLESTEROLEMIA

1PSelvi-Sabater, 2CRamirez-Roig, 3ALazaro-Cebas, 2AAranda-Garcia, 2VJRausell-Rausell, 4POrtizFernandez*. 1HospitalReinaSofia,Pharmacy,Murcia,Spain; 2ServicioMurcianode Salud,ServicioDeGestiónFarmacéutica,Murcia,Spain; 3HospitalSantaLucia,Pharmacy, Murcia,Spain; 4ReinaSofíahospital,Pharmacy,Murcia,Spain

10.1136/ejhpharm-2024-eahp.118

BackgroundandImportance LDLlevelshavebeenconsidered asurrogatemarkerofcardiovascularrisk,whichhastakenon greaterrelevanceinrecentyears.

AimandObjectives Toanalysetheuseandeffectivenessof PCSK9inhibitors(PCSK9i)inrealworlddata

MaterialandMethods Retrospectivestudythatincludes patientstreated>3monthswithiPCSK9from1/1/2016to 12/31/2022intheMurciaHealthService.Theparameterscollectedwereage,sex,indication,LDL,iPCSK9used,useof previousstatinsandmortality.

Datacollection/analysiswascarriedoutwithAccess® and PowerBi®.Thedrugconsumptiondatawasobtainedfromthe BusinessIntelligencePortalandtheclinicalparametersofanalysis/clinicalhistoryapplication

Results Atotalof266patients(61%men)withamedianage of58yearswereincluded.Theindicationwas,59%familial hypercholesterolemia(FH)and41%withestablishedcardiovasculardisease(CD).

ThemedianLDLbeforetreatmentwas138mg/dl,being 172forFHand117forCD.

The93%ofpatientshadreceivedastatin(73%high-intensitystatintherapy:rosuvastatin 20mgoratorvastatin80 mg).ThePCSK9idrugsusedwereevolocumabin58%of patientsandalirocumabin42%.

ThemedianLDLat3monthswas79mg/mland68mg/dl inthelastyearoftratament(reductionof74mg/dlcompared tobaseline)andwas92forthoseonFHand65forpatients withCD.

The72%ofpatientsreduced>30%theirbaselineLDL, 52%reachedlevels<70mg/dland74.5%reachedlevels <100mg/dl.

Thepercentageofpatientswhoreachedlevels<100mg/dl washigherintheCVgroup78%comparedtoHF62% (p<0.04).

Regarding(anycause)mortality,therewasatotalof7 deaths(2.6%)distributedevenlyinthetwoindications,witha probabilityofsurvivalof90%at5years.

ConclusionandRelevance ThemedianLDLatthebeginning oftreatmentwasgreaterthan100mg/dl,and93%had receivedstatinspriortotreatment.

TheeffectivenessofthetreatmentsregardingLDLreductionissimilartothosepublishedinpivotalclinicaltrials.The 5-yearmortalitypublishedinthisreal-worlddatastudyis somewhatlowerthanthatpublishedintheFOURIERand ODYSSEYtrials(2.6%vs4.7%and5%)

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-015 ASSESSMENTOFIN-HOSPITALANTIBIOTICS CONSUMPTIONPATTERNACCORDINGTOTHEWHO AWARECLASSIFICATIONINALOCALHEALTH AUTHORITY

FPappalardo*,EGaraffo,MAD’agata. CataniaLocalHealthAuthority,Departmentof Pharmacy,Catania,Italy

10.1136/ejhpharm-2024-eahp.119

BackgroundandImportance Antimicrobialresistance(AMR)is arecognisedglobalhealthconcern.Forthisreason,in2017, theWorldHealthOrganization(WHO)developedtheAWaRe classificationofantibiotics,whichgroupedthemintothree maingroups: Access, Watch and Reserve.WHOAWaReclassificationisahelpfultooltopromotetheappropriateand responsibleuseofantibacterials,reduceAMR,monitorantibioticsconsumptionandassesstheeffectivenessofstewardship programs.

AimandObjectives WeaimedtoevaluatetheantibioticconsumptionpatternofthesevensuburbanhospitalsofourLocal HealthAuthority,comparinga6-monthperiodin2023toa 6-monthperiodin2022.Themaingoaloftheanalysiswas toassesstheperformanceofstewardshipinitiatives.

MaterialandMethods First,antibioticconsumptiondata regardingin-hospitalsettingsfromJanuary1,2022,toJune 30,2023,wereextractedfromtheNationalHealthSystem (NHS)dispensingdatabase.ThetotalDefinedDailyDose (DDD)asapercentageandtheDDDper100beddayswere

usedasmeasuresofantibioticconsumption.Second,theAnatomicalTherapeuticChemical(ATC)4thlevelcodewasused tocategoriseantimicrobialswithinthedifferentAWaRe groups.

Results Thecomparativeanalysisofthetimeperiodconsidered showedasimilaroverallDDDconsumptionofantibiotics. Noteworthy,amongthedifferentAWaRegroups,anincrease inconsumptionintheWatchgroupantibioticsequaltoplus 10.5%(202375%vs.202264.5%)andareductioninthe Accessgroupequaltominus10%(202323%vs.202233%) wereobserved.TheDDDconsumptionofReservegroupantibacterialswasquitesimilaramongthetwoperiods(20232% vs.20222.3%).WithintheWatchgroup,themostconsumed antimicrobialsaccordingtoATC4thlevelwereJ01DDwith 29.6DDD/100bed-days,J01MA22.5,J01FA11.7,J01CR 10.3,J01DH9andJ01XA5.3respectively.

ConclusionandRelevance IncontrastwithWHOindications (atleast60%oftotalantibioticsinthe Access group),our findingsshowthatinourLocalHealthAuthoritythemajority ofantimicrobialsconsumedbelongtothe Watch group.The resultsofourinvestigationhighlighttheneedforfurther effortsbytheAntimicrobialStewardshipTeaminorderto improvetheappropriateuseofantibioticsinthehospitalsettingandfightAMR.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-016 EXPERIENCES,VIEWSANDATTITUDESOFHOSPITAL NURSINGSTAFFTOWARDSTHEIMPLEMENTATIONOF THEUNITDOSEDISPENSINGSYSTEMFOR INPATIENTS:AQUALITATIVEINTERVIEWSTUDY

1TDrechsel, 1AWeidmann*, 2TSteindl-Schönhuber, 2GGittler. 1Pharmacy,Clinical Pharmacy,Innsbruck,Austria; 2BarmherzigeBrüderHospital,Pharmacy,Linz,Austria 10.1136/ejhpharm-2024-eahp.120

BackgroundandImportance Medicationerrorsposeamajor economicproblemand,moreimportantly,amajorcauseof avoidableharminmedicalcare.WiththeGlobal ‘Patient safetyactionplan2021–2023’ theWorldHealthOrganisation (WHO)callsforarethinkofprocessesandstructureswithin thehealthcaresystemtoensureoptimalpatientsafety.One suchoptimisationmeasurecouldbetheintroductionofthe Unitdosedispensingsystem(UDDS),whichisthoughtto havemultiplebenefitsfromavoidanceofmedicationerrorsto improvedpatientautonomy.

AimandObjectives Todeterminehospitalnurses’ attitudes towardstheUDDS,examinetheirperceptionsofopportunities andbarriersineverydaypracticeandexploretheirexperiences withitsimplementation.

MaterialandMethods Aprospectivequalitativeinterviewstudy with23nursesfromtheBarmherzigeBrüderHospitalLinz, Austriawasconducted.Thevalidatedandpilotedsemi-structuredinterviewguidewasbasedonexistingliterature,best practiceguidelinesforqualitativeinterviewstudiesandthe constructsoftheConsolidatedFrameworkforImplementation Research(CFIR).Interviewsweretranscribedverbatimand mappedagainsttheFrameworkofImplementationofServices inPharmacy(FISpH)bytworesearchersindependently.

Results Nurses’ satisfactionwiththeUDDSwashighasit affordsthemaconsiderabletimesaving,easeofuseindaily practiceandreducedworkload.Furthermore,UDDSis

consideredtoreducemedicationerrorsandimprovepatient safety.However,thestudyalsorevealedchallengesmainly concerningmedicationchangesandnon-blisteredmedication –oftenresultinginre-dispensingtheUDDSblistersintoindividualpatientdosetteboxes – aswellasmechanicalhandlingof theblisters.Nursesareconcernedaboutthedeclineintheir personalmedicationknowledge.Reducedstocklevelsonthe wardssavetimeandresourcesbutcanposeinconveniences fornursingstaff.Severalpossibilitiesforimprovementofthe workflow,trainingandcommunicationbetweenwardstaffand pharmacycouldbeidentified.

ConclusionandRelevance ResultsshowthattheUDDSprovidesseveralsignificantbenefitstonursingstaff.Inaddition patientsafetyisthoughttohaveimproved.Cooperationofall hospitalstakeholderswithwardnursesisofimmenseimportancetofurtheradvancetheUDDS.Theseresultsmaybeof interest.toanyhospital/pharmacymanagementplanningto implementaUDDS.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-017 COMPARATIVESTUDYBETWEENTIXAGEVIMAB/ CILGAVIMABANDSOTROVIMABINPATIENTSWITH COVID-19:AMONOCENTRICEXPERIENCEAT UNIVERSITYHOSPITAL

LAFiorito*,NPerrotta,RVescovo,RGentile,GCasini,GPolito,EMProli. Policlinico UmbertoI,Pharmacy,Rome,Italy

10.1136/ejhpharm-2024-eahp.121

BackgroundandImportance Tixagevimab/cilgavimabandsotrovimabareonlymonoclonalantibodies(Mabs)recommended againstrecentvariantsneutralisingSARS-CoV-2.TheseMabs havebeeneffectiveinreducinghospitalisationandmortality ratesinoutpatientsdiagnosedwithmildtomoderateCOVID19.However,theemergenceofnewSARS-CoV-2subvariants (BA.2.75;BA.5;XBB.1.5)maychangetheirefficacy.

AimandObjectives Theobjectiveofthisstudywastoevaluate theeffectivinessofbothMabsagainstrecentvariantsof Covid-19intermsofreductionofdurationofvirological clearance,worseningofsymptomsandmortality.

MaterialandMethods Anobservational,retrospectivestudy wasconducted,whichincludedalleligiblepatientswho receivedtixagevimab/cilgavimab600mgandsotrovimab500mg fromSeptember2022toMay2023.Clinicaldatawere recordedthroughanelectronicprescriptionsystem.Univariate andmultivariateanalyseswerecarriedouttoevaluatethe impactoftheMabsonstudyoutcomes.Rsoftwarewasused forstatisticalanalyses.

Results Atotalof284patientswereexamined,150(53%) havereceivedsotrovimaband134(47%)hadreceivedtixagevimab/cilgavimab.Sotrovimabgrouphadamedianageof62 years(range,18–99),whiletixagevimab/cilgavimabgrouphada medianageof69years(range,26–97).Insotrovimabgroup, 82%ofpatientswerevaccinated(69%ofthesewithin120 days)andcomorbiditywas91%.Intixagevimab/cilgavimab group,97%ofpatientswerevaccinated(16%ofthesewithin 120days)andcomorbiditywas69%.Datashowedthatthe patientsadministratedwithtixagevimab/cilgavimabexhibiteda significantreductioninclearancetimecomparedtothose patientsreceivedsotrovimab(Beta=-4.8days,95%CI:-7.0,-2.7, p<0.001).Furthermore,virologicalclearance’stimewas

increasedbycomorbidities(Beta=3.0days,95%CI:0.67,5.3, p=0.01)anditwasdecreasedinpatientswhohadreceived thevaccinewithinthelast120days(Beta=-2.3days,95%CI:4.4,-0.21,p=0.032).Itwasobservedthat2.2%ofpatientsin sotrovimabgroupexperiencedaworseningofsymptomswith norecordeddeaths,whereastixagevimab/cilgavimabgroup showedaworseningin9.9%ofpatients,resultingin3.4% deaths.However,logisticmultivariateanalysiswasnotstatisticallysignificant.

ConclusionandRelevance Ourfindingssuggestthattheadministrationoftixagevimab/cilgavimab,maybemoreeffective thansotrovimabinreducingtheclearancetimeinthepatients affectedofCOVID-19.However,therewasnomarkedreductionbetweentwoMabsconcerningworseningandmortality rates.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-018 SWITCHINGBETWEENCALCITONINGENERELATED PEPTIDEMONOCLONALANTIBODIESINTHE PROPHYLAXISOFMIGRAINE

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

10.1136/ejhpharm-2024-eahp.122

BackgroundandImportance Therapeuticoptionsformigraine preventioninnon-responderpatientstomonoclonalantibodies (mAbs)targetingCalcitoninGene-RelatedPeptide(CGRP)and itsreceptorareoftenlimited.Therearenorecommendations ofswitchingbetweenmAbsclasses.

AimandObjectives Toassesstheeffectivenessandsafetyof mAbswitchinginnon-respondermigrainepatients.

MaterialandMethods Retrospectiveobservationalstudyina tertiaryhospital(1-January-2021to31-July-2023).We includedpatientswhoreceivedafirstmAbfor 3months, werenon-respondersandswitchedtoanothermAbclass. Patientswereexcludediftheyswitchedduetosideeffects. Monthlyheadachedays(MHD)werecollectedtoassessthe 50%responderratesandtheabsolutereductionofMHDat

Abstract4CPS-018Table1

Switchedfromligand mAbtoreceptor mAb(n=23)

Switchedfrom receptormAbto ligandmAb(n=28)

Female,n(%)21(91,3)27(96,4)

Ageinyears,mean(SD)44,9(11)46,5(12,6)

Diseasedurationinyears,median (IQR) 13(8,3–18,5)12(8–23,3)

Diagnosis,n(%)

High-frequencyepisodicmigraine

Chronicmigraine

2(8,7)21(91,3)10(35,7)18(64,3)

Aura,n(%)2(8,7)4(14,3)

Comorbidities,n(%)

Anxious-depressivesyndrome

Fibromyalgia

4(17,4)2(8,7)10(35,7)1(3,6)

Concomitantprophylaxis,n(%)8(34,8)13(46,4)

Treatmentdurationinmonths, median(IQR) 5(3,75–7)9(5–11)

3months,aswellastheabsolutereductionofmonthlyacute medicationdays(AMD).Datawererecordedfromelectronic medicalrecordsandpatientinterviews.Thestudywas approvedbytheEthicsCommittee.Informedconsentwas obtained.

Results Weidentified110patientswhohadreceivedgalcanezumab(n=57)andfremanezumab(n=53)astheirfirstmAb. Ofthese,24(21,8%)switchedtotheCGRP-receptormAb, erenumab.Of105patientstreatedwitherenumab,30 (28,6%)switchedtoaCGRP-ligandmAb.Threepatients switchedbecauseofsideeffects,so51patientswereincluded.

The 50%responderratewas40%and61,9%at3 monthswitherenumabandCGRP-ligandmAb,respectively. MHDreduction:17±7,4to13,8±8,7and16±7,7to8,4 ±6,1,respectively.AMDreduction:16,1±9,9to15,4±10,2 and11,7±9,2to7,6±7,3.Sevenpatients(35%)changedtoa thirdmAbinpatientsthatswitchedfromligandmAbto receptormAb,23,8%intheothergroup.

ConclusionandRelevance Switchingseemstobeapromising treatmentoptionespeciallyinmigrainepatientsthatswitched fromCGRP-receptormAbtoCGRP-ligandmAb.However, someofthemneedtoswitchtoathirdmAb.Morestudies areneededtodescribewhichpatientswillrespondtoCGRPmAbswitching.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-019 DIFFERENCESINMEROPENEMDOSEADJUSTMENT WITHCALCULATIONOFGLOMERULARFILTRATION RATETHROUGHDIFFERENTFORMULAS

NLópez,ACorralAlaejos,SFernándezCañabate,JJiménezCasaus,JRoldánGonzález*, MCorralesPaz,IGilNavarro,MDAlonsoCastañé,MLParedesBernaldoQuiros,GGoda Montijano,CGilValiño. Pharmacy,ComplejoAsistencialdeZamora,Zamora,Spain

10.1136/ejhpharm-2024-eahp.123

BackgroundandImportance Meropenemisacarbapenemic antibioticthatismainlyeliminatedbyrenalroute.Therefore, analterationoftheglomerularfiltrationrate(GFR)may affecttheeliminationofthedrug.GFRcanbecalculated usingseveralvalidatedformulasusingdifferentparameters.

AimandObjectives Theaimofthestudywastoanalysethe discrepanciesbetweentheresultsofthedifferentGFRequationsandthedosageadjustment.

MaterialandMethods Adescriptive,retrospectiveandcrosssectionalstudythatincludedpatientstreatedwithmeropenem for3monthswasperformed.Thestandarddosewas1gevery 8hours.Doseadjustmentsweremadeaccordingtoadata sheet(TFG<50mL/minand<25mL/min).

Age,sex,weight,creatinine(mg/dl),urea(mg/dl),albumin (g/dl))andmeropenemdoseswererecorded.Withthesedata, theGFRwascalculated:ChronicKidneyDiseaseEpidemiologyCollaboration(CKD-EPI)(ml/min/1.73m2);Modification ofDietinRenalDiseaseStudyEquation(MDRD)(ml/min/ 1.73m2);andCockcroft-Gault(CG)(ml/min).

Results Atotalof136patientswereincluded.Themeanage was76.84+12.7years.ThecalculationofmeanGFR accordingtothedifferentequationswasasfollows:60.46± 49.0ml/min/1.73m2(MDRD);72.12±49.6ml/min(Cockroft-Gault)and86.17±63.1ml/min/1.73m2(CKD-EPI).

Doseadjustmentwascarriedout In19.12%(26)ofthe patientsmeropenemdoseadjustmentwasperformedwith

GFR<50ml/minandin12.5%(17)GFR<25ml/minwas adjusted.

Thedoseadjustmentofmeropenemshouldhavebeenwith MDRD:39.8%(54)ofthepatientshadaGFRlowerthan 50ml/minand23.53%(32)hadaGFRlowerthan25ml/min. AccordingtoCockroft-Gault:38.23%(52)ofthepatientshad GFR<50ml/minand16.17%(22)hadGFR<25ml/min. Finally,accordingtoCKD-EPI,36.03%(49)hadGFR<51ml/ minand12.5%(17)hadGFR<25ml/min.

Finally,itwasobservedthat2.2%(3)ofthepatientshad nodoseadjustmentforGFR<50ml/minwhenanyofthe equationsindicatedthis;andthatin14.0%(19),doseadjustmentbyGFR<25ml/minwasnotperformedwhenrequired it.

ConclusionandRelevance Therearesignificantdiscrepanciesin thecalculationofGFRwithdifferentequations,whichaffects thedoseadjustmentofmeropenem.Takingintoaccountthe valuesofseveralequationswouldimproveboththeefficacy andsafetyofmeropenemtreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-020 EVALUATIONOFTHEEFFECTIVENESSOF MONOCLONALANTIBODIESAGAINSTMIGRAINE HEADACHE

AGómez,RLReyMontalbán,VFernánderMartinez,MBRamisBarceló*,JSánchez Gundín,DGómezGómez,CFernándezMartínez,MBAznarDeLaRiera,ALaborie Martínez,APinedaSánchez,MValeroDomínguez. HospitalUniversitarioMarquésde Valdecilla,HospitalPharmacy,Santander,Spain

10.1136/ejhpharm-2024-eahp.124

BackgroundandImportance Erenumabandgalcanezumabare monoclonalantibodiesthatactatthelevelofthecalcitonin gene-relatedpeptide,elevatedinpatientswithmigraine. AimandObjectives Toestablishtheeffectivenessoferenumab andgalcanezumabinthetreatmentofmigraine.

MaterialandMethods Observational,single-centre,retrospectivestudy.Alladultpatientswhoinitiatedtreatmentbetween February2020toMarch2023wereincluded.

Demographicdatawerecollected(ageandsex),drugdiscontinuationanditsreason(primary,secondaryfailureor adverseeffects[AE])anddurationoftreatment.

Accordingtoourcentre’sprotocol,thesetreatmentsare intendedtobewithdrawnafteroneyear,astheyareprophylactictreatments,notcontinuationtreatments.Thus,themain endpointtodeterminethedrug’seffectivenesswasthe responseat1yearoftreatmentandtheevolutionafterwithdrawal(resumptionoftreatmentvsnotreatment).

StatisticalanalysiswasperformedusingPearson’sChi-square test(SPSSv.26.0).

Results Weincluded273patients(59%erenumab,41%galcanezumab),ofwhom82%werewomen.Medianage:52years [19 – 83].

Witherenumab,9%ofpatientsachievedcompleteresponse at1yearandwereabletowithdrawtreatment.However, 21%ofpatientshadapartialresponse,11%weresecondary failuresand10%continuedwithoutwithdrawingthedrug. 43%discontinued;afterprimaryfailure(37%)orAE(6%), mainlyconstipation.

Withgalcanezumab,10%ofthepatientsachievedacompleteresponseatoneyearandwereabletowithdrawthe

drug.Nevertheless,22%ofpatientshadapartialresponse, 3%weresecondaryfailuresand19%werestillunableto withdrawthedrug.34%discontinued;afterprimaryfailure (29%)orAE(5%),mainlyconstipation.

Attheendofthestudy,27%ofpatientstreatedwitherenumabdidnotcomplete1yearoftreatmentduetolackof time,andthesamewastruefor34%ofpatientswith galcanezumab.

Patientswhoreachedtheprimaryendpointwerestillwithoutanytreatmentafterameanof4months.

ConclusionandRelevance Resultsobtaineddonotdemonstrate ahigheffectivenessafteroneyearoftreatmentwiththese drugsordifferencesbetweenerenumabandgalcanezumab,so morestudiesarenecessarytocontinueevaluatingeffectiveness.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-021 PERFORMANCEOFMULTIPLETRIGGERTOOLSIN IDENTIFYINGMEDICATION-RELATEDHOSPITAL READMISSIONS

1ASingh*, 2NLipsNLips, 3DWeir, 1,4FKarapinar – Carkit. 1OlvgHospital,Departmentof ClinicalPharmacy,Amsterdam,TheNetherlands; 2OlvgHospital,DepartmentofInternal Medicine,Amsterdam,TheNetherlands; 3UtrechtInstituteforPharmaceuticalSciencesUtrechtUniversity,DivisionofPharmacoepidemiologyandClinicalPharmacology,Utrecht, TheNetherlands; 4MUMC+,DepartmentofClinicalPharmacyandToxicology,Maastricht, TheNetherlands

10.1136/ejhpharm-2024-eahp.125

BackgroundandImportance TheDutchpolypharmacyguidelinerecommendsusingatriggertooltoidentifymedicationrelatedhospital(re)admissions.Manytriggertoolsexistfor thispurpose.Yet,theeffectivenessofthesetriggertoolsand clinicalapplicabilityremainsuncertain.

AimandObjectives Theaimofthisstudyistoevaluatethe performanceoftriggertoolsinidentifyingmedication-related readmissions(MRRs).

MaterialandMethods Inasingle-centrecross-sectionalstudy, datawasanalysedfromapreviousstudyassessing1120readmissions.Inthispriorstudy,apanelofphysiciansandpharmacistsretrospectivelyassessedreadmissionsasmedicationrelated(n=181),includingpreventability.

Thiscurrentstudyemployedfourtriggertools(STARTSTOPPcriteria,OPERAM,ADR-tool,andQUADRAT*)on clinicallyadjudicatedMRRs.TheSTART-STOPPcriteriafocus onunder-andovertreatment,OPERAMonmultiplecauses, whileADRandQUADRATtoolsfocusonsideeffects.The toolsincludeexplicittriggers(medication+symptom,e.g., diureticsanddehydration)andimplicittriggers(generaltriggersrequiringextensivereviewerknowledge,e.g.,avoiding overtreatment).Thetriggertoolswereappliedtoclinically adjudicatedMRRsinduplicate.Theprimaryoutcomewas eachtool’sperformanceinidentifyingMRRs.Secondaryoutcomesincludedassessingtheperformancesofthesetoolsin identifyingMRRsbasedonthepotentialpreventabilityand ageofpatients(mosttoolsaredevelopedforpatients 70 years).Descriptivedata-analysiswasused.

Results Of181MRRs,159(88%)wereregardedpotentially preventablebythepanel.Amongthe181MRRs,the OPERAMtriggertoolidentified92%ofMRRs(62%explicit and30%implicittriggers),whiletheQUADRAT,ADRand START-STOPPcriteriarespectivelyidentified76%,51%and

7%ofMRRs.Thetoolsweremoreeffectiveinidentifying non-preventableMRRs.Thetoolsmissedtriggersregarding transitionincareerrors,non-adherenceorsickdayrules.The triggertoolsidentifiedanequalproportionofMRRsfor patientsbelowandabove70years.

ConclusionandRelevance Multipletriggertoolswereapplied toreal-lifepatientdata.START-STOPPcriteria,ADR-tool,and QUADRATwereunsuccessfulinidentifyingMRRsinthis study.OPERAMperformedthebestbutincludedmany implicittriggersnecessitatingsubstantialreviewerknowledgeto assessMRRs.Consequently,indailyclinicalpractice, OPERAMisnoteasytoapplyasaquickscreeningtoolbut couldbeagoodtoolforresearchpurposes.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-022 THEEFFECTOFDIGITALCLINICALDECISIONSUPPORT ONPHARMACOTHERAPYINHOSPITALISED (MORBIDLY)OBESEPATIENTS:APROSPECTIVE INTERVENTIONSTUDY

1AKeyany*, 2IGroenen, 1SSaini, 1BMaat. 1ElisabethTweestedenHospital,Departmentof HospitalPharmacy,Tilburg,TheNetherlands; 2UtrechtUniversity,Departmentof PharmacoepidemiologyAndClinicalPharmacology,Utrecht,TheNetherlands

10.1136/ejhpharm-2024-eahp.126

BackgroundandImportance Thepharmacokineticsand dynamicsofmedicationcanbealteredin(morbidly)obese patients.Standardmedicati ondosesmaybesuboptimalin thesepatientsandadjustmentsbasedonbodymassindex (BMI)orbodyweight(BW)maybeneeded.Digitalclinical decisionsupport(eCDS)mayhelpoptimisepharmacotherapy inthesepatients.

AimandObjectives Theaimofthisstudywastoassessthe effectofeCDSonadjustmentsinpharmacotherapybasedon BMIorBWinhospitalised(morbidly)obesepatients.

MaterialandMethods Thisprospectiveinterventionstudywith retrospectivebaselinemeasurementincludedhospitalised patients 18yearswithBMI 30kg/m2 and/orBW 90 kgfrom1January2022to30September2022(pre-eCDS group)andfrom10October2022to25November2022 (post-eCDSgroup).Intheinterventionperiod,hospitalpharmacyrecommendedpharmacotherapyadjustmentstoprescribersbasedoneCDS.eCDSisatool,integratedinthe hospital’selectronichealthrecordsystem,thatdetected patientswhosemedicationorder(s)neededtobeadjustedto BMIorBW.Studyoutcomeswere(i)prevalenceofmedication ordersadjustedtoBMIorBWpre-eCDSversuspost-eCDS, (ii)prevalenceofpost-eCDSpatientswith 1medication ordersresultinginarecommendationforadjustment,includingmedicationdetails,(iii)numberandpercentageofrecommendationsthatactuallyledtoanadjustmentin pharmacotherapy,includingreasonsforrejectinga recommendation.

Results Inthepost-eCDSgrouppharmacotherapywassignificantlymoreoftenadjustedtoBMIorBW:77.7%(912of 1,173medicationorders)post-eCDSvs58.2%(3,519of 6,049medicationorders)pre-eCDS(p<0.0001).Post-eCDS 328patientshad 1medicationorder(s)resultinginarecommendationforadjustment.Themajorityofrecommendations andadjustmentswerefornadroparin,93%(324/349)and 89%(163/186)respectively.186of349(53.3%)

recommendationsactuallyledtoanadjustmentinpharmacotherapy.Themainreasonfornotacceptingarecommendation byaphysicianwasneardischargefromhospital:90.8%(148 of163recommendations).

ConclusionandRelevance ImplementationofeCDSinhospital pharmacyledtoasignificantincreaseinmedicationorders adjustedtoBMIorBW,in(morbidly)obesepatients.Itis importanttoimplementandevaluatesuchinterventionsto optimisetreatmentforthisgrowingpopulation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-023 OPTIMISINGBIOLOGICTHERAPYINSEVERE UNCONTROLLEDASTHMAPATIENTSON OMALIZUMABTREATMENT

MRCantudoCuenca*,AMartínRoldán,MDMSánchezSuárez,LMartínez-DueñasLópezMarín,AJimenezMorales. HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada, Spain

10.1136/ejhpharm-2024-eahp.127

BackgroundandImportance Severeuncontrolledasthma(SUA) isachronicpathologythatrequiresclosemonitoringofthe effectivenessofbiologicaldrugsandanassessmentofthe safetyandeconomicimplicationstoindividualisetherapeutic goals.

AimandObjectives Evaluatetheeffectivenessandsafetyof omalizumab,proposeaswitchtobiologictreatmenttooptimisetherapyandevaluatetheeconomicimpactafter intervention.

MaterialandMethods ProspectivestudyfromJanuary2021to April2023.Allpatientsontreatmentwithomalizumabfor SUAwereincluded.Patientswithallergicasthmaphenotype wereexcluded.Candidatesforoptimisationwerepatientswellcontrolledorthosewhohadexacerbationsinthelast12 months,AsthmaControlTest(ACT)score<20,forcedexpiratoryvolumein1second(FEV1)<80%,needfororalcorticosteroidsandthepharmacydispensingrecord.Toassessthe effectivenessoftheintervention,datawerecollectedonbiologicaltreatment,FEV1,ACT,IgEandeosinophilvalues beforeandafterthetreatmentswitchordiscontinuation.The exacerbationsortreatmentwithoralcorticosteroidswerealso recorded.Clinicalvariableswereobtainedusingelectronic medicalrecords.

Results Sixty-onepatientswithmixedoreosinophilicphenotypeSUAontreatmentwithomalizumab.Ofthese,30 patientsmetcriteriaforwell-controlleddiseaseand31 (50.8%)werecandidatesforoptimisationoftherapy.55.5% womenwithamedianageof51years(IQR66 – 42).The medianpre-testIgEvaluewas459UI/mL(734.7 – 239.1), eosinophils300/ mL(445 – 140),ACT17(23 – 12)andFEV1 78%(100 – 65).Eightpatientsswitchedtobenralizumab, seventomepolizumabandsixtodupilumab.Sevenpatients werediscontinuedduetowell-controlledSUA,twopatients wereexpectedtoswitchduetotheneedforpreviouscomplementarytests,onepatientdiedofanothercause.After optimisationtheeosinophilvalueatweek16and32 droppedto80and50respectively.MedianACT18(20 –16)andFEV183.5(98.5 – 59.5).Fivepatientshadexacerbationsandsixpatientsrequiredoralcorticosteroids.Twoof thepatientswithmepolizumabreturnedtoomalizumab.

OptimisationoftherapyforSUAresultedina38.2%cost saving.

ConclusionandRelevance Optimisationofpharmacotherapy allowsforindividualisationoftreatmentanddosage,which hasanimpactoneffectivenessandsafetywhileminimising costsinthehealthsystem.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-024 ANALYSISOFPOLYMEDICATIONANDADEQUACY TREATMENTRECOMMENDATIONSINPATIENTSWITH MULTIPLESCLEROSISINATERTIARYLEVELHOSPITAL MDMSanchezSuarez,AMartínRoldán*,RCantudoCuenca,LMartínez-DueñasLópezMarín,AJimenezMorales. VirgendeLasNievesUniversityHospital,PharmacyDepartment, Granada,Spain

10.1136/ejhpharm-2024-eahp.128

BackgroundandImportance Multiplesclerosis(MS)population hasbeenaginginparalleltotheincreasinglifeexpectancyof thegeneralpopulation.Thiscouldberelatedtopotentially inappropriatemedicationprescriptions,drug-druginteractions andtherapeuticnon-adherence.

AimandObjectives DeterminetheprevalenceofpolymedicationinanMSpopulationaged55yearsormoreandprovide therapeuticrecommendationstoadjusttreatmentofthe patient.

MaterialandMethods Observational,cross-sectional,study thatincludedpatientsover55yearsofagewithMSatatertiarylevelhospitalbetweenDecember2022-February2023. Demographicvariables:age,sex,dateofMSdiagnosis,type ofMSandtheExpandedDisabilityStatusScale(EDSS). Medication,polypharmacy(fi veormoredrugs),majorpolypharmacy(10ormoredrugs),ant icholinergicburden,potentiallyinappropriatemedication,drug-druginteractions (Lexicomp® database)andnon-adherencetoconcomitant medicationwerecollected.Statisticalanalysiswascarriedout withRCommander® software.Datawasobtainedfromelectronicprescription(Prisma® )andmedicalrecords(Diraya® ) applications.

Results 95MSpatientsaged55yearsorolderwereincluded. 68.4%werewomen.Themedianagewas61years(IQR58–65).Medianageatthediagnosis45.2years(IQR38.5–50.2). TypeMS:recurrentremitting(71.6%),secondaryprogressive (19%)andprimaryprogressive(9.4%).MedianEDSSscale2 (IQR1–3).Themostfrequentdisease-modulatingdrugs (MSD)were:interferon(23.1%),fampridine(16.8%),teriflunomide(14.7%),fingolimod(8.4%)andglatirameracetate (7.4%).MediannumberofdrugsconcomitantwithMSD6 (IQR3–9).Polypharmacy68.4%.Hightreatmentcomplexity index40%.Non-adherencetoconcomitantmedicationwas identifiedin84.4%ofpatientsanddrug-druginteractionsin 56.2%(categoryD83.8%andX16.2%).Anticholinergic load:norisk20%,moderaterisk22.1%andhighrisk 57.9%.Atotalof20pharmaceuticalinterventionswerecarriedoutin17patients(17.9%),thepotentiallyinappropriate medicationcriterionwasresponsiblefor11interventions,nonadherenceforsevenandinteractionsfortwo.Ofthe11interventionsoninappropriatemedicationcriteria,nine(81.8%) wereaccepted,resultinginthediscontinuationof15drugs thatwereappropriatelyprescribed.

ConclusionandRelevance Polypharmacyplaysaveryimportant roleinadultMSpatientsasitisassociatedwithahigher prevalenceofinappropriatemedicationprescriptions,drugdruginteractionsandtherapeuticnon-adherence.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-025 MANAGEMENTOFCOVID-19WITHNIRMATRELVIR/ RITONAVIRANDTACROLIMUSMONITORINGIN RENALTRANSPLANTATION:ACASEREPORT

MFalcón,PSuárezCasillas*,MMejíasTrueba,ABGuisadoGil,MVGilNavarro, JPQuinteroGarcía,EHeviaÁlvarez,PBarrigaRodríguez,SJLoraEscobar. HospitalVirgen delRocío,PharmacyDepartment,Seville,Spain

10.1136/ejhpharm-2024-eahp.129

BackgroundandImportance Nirmatrelvir/ritonavir(N/R)isan oraltreatmentforCOVID-19thatreducestheriskofdevelopingseveredisease.Renaltransplantpatientsaretreatedwith immunosuppressantssuchastacrolimus,thatismetabolisedby CYP43AaswellasN/R.Co-administrationwiththeirreversibleCYP3A4inhibitorritonavir,isassociatedwithserious interactionsandtoxicityinpatients.

AimandObjectives TodescribethemanagementofCOVID-19 treatmentwithN/Randtacrolimusinrenaltransplant patients.

MaterialandMethods A49-year-oldwomanwithchronickidneydiseasewhounderwentkidneytransplantationinFebruary 2019.Shewasontreatmentwithprednisone,mycophenolate andtacrolimus,presentingchronicrejectioninApril2023for whichshereceivedrituximab.

InJune2023shewasadmittedtoatertiaryhospitalwith adiagnosisofCOVID-19andseverepneumonia,requiring supplementaloxygen.Shehadreceivedfourdosesofthe COVID-19vaccineandwasontacrolimus5mg/day,witha creatinineof1.7mg/dl.Duetotheinteractionoftacrolimus withN/R,shewasfirsttreatedwithremdesivir.

Results Duetothelackofclinicalimprovement,theInfectious Diseases,Nephrology,andPharmacyunitsdecidedtoinitiate N/Radjustedtorenalfunction(eGRF30–60ml/min)ata dosageof150/100mg/12hoursfor5days.Tacrolimuswas suspendedduringthetreatment,withdiligenttherapeuticdrug monitoring(TDM).

TacrolimusconcentrationwasmeasuredpriortocommencingN/Rtherapy.Becauseofthesomewhatelevatedtacrolimus concentration(16.4ng/mL),itwasdeterminedtopostpone theinitiationofN/Rfor48hours.DuringN/Rtreatment, tacrolimusconcentrationremainedaround6–7ng/ml(target: 5–15ng/ml).FourdaysaftertheendofN/R,theplasmalevel was2.2ng/mL,leadingtothedecisiontoreintroducetacrolimusatareduceddailydoseof2.5mg.

Theinfectiousconditionwassuccessfullyresolvedfollowing N/R,withoutanytransplantrejection.However,thepatient experiencedaslightdeteriorationofcreatininelevels,which returnedtobaselinevaluesafterrestartingtacrolimus.

ConclusionandRelevance Ourexperiencecontributesadditionalevidenceindicatingthatthisinteractionshouldnotbe consideredacontraindicationforN/RtreatmentinCOVID-19 pneumoniapatientsandcanbeeffectivelymanagedthrough TDMoftacrolimus.Nevertheless,furtherstudiesinvolvinga largerpatientpopulationarenecessarytoestablishmorepreciseconclusions.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-026 ACCEPTABILITYANDWILLINGNESSTOSWITCH ANTIRETROVIRALTREATMENTINPATIENTSWITH LONG-ACTINGINJECTABLETHERAPYCRITERIA CSubiranaBatlle*,MBrugueraTeixidor,COrtíJuan,XLarreaUrtaran,IGómezIbáñez, YOrtuñoRuiz,ÀCastellóNoria,LViñasSagué,CDíezVallejo,EMartínezDíaz,ACouso Cruz. HJosepTrueta,PharmacyDepartment,Girona,Spain

10.1136/ejhpharm-2024-eahp.130

BackgroundandImportance Thedevelopmentoflong-acting injectabletreatmenthasbecomeanewtreatmentstrategythat couldchangethehandlingofpatientswithantiretroviraltherapy(ART)forHIVinfection.

Cabotegravir/rilpivirinerepresentsthefirstlong-actingdrug combinationapprovedbytheFoodandDrugAdministration (FDA)andtheSpanishAgencyforMedicinesandHealth Products(AEMPS)forthisindication.

AimandObjectives Toknowtheacceptabilityandwillingness ofpatientswithHIVinfectiontoswitchtheiroralantiretroviraltreatmenttoalong-actinginjectable.

MaterialandMethods Qualitativedescriptivepopulationstudy carriedoutatathird-levelhospital.Alladultpatientswithan indicationforcabotegravir/rilpivirinetreatmentattendedatthe pharmacyconsultwereincluded.

Aquestionnairewaspreparedwherethepatient‘sdatawere collectedandthedegreeofsatisfactionwiththeirtreatment andtheacceptanceofthetherapywithlong-actinginjectables wereevaluated.

Results Atotalof57patients[70.2%(n=40)menand29.8% (n=17)women]withamedianageof54years[range:28 –78]completedthequestionnaire.TheARTtheyreceived were:Dovato®,Triumeq®,Juluca®,Biktarvy®,Odefsey®,Genvoya ® orSymtuza®.

Patientsexpressedbeingsatisfied[33,3%(n=19)]orvery satisfied[66,7%(n=38)]withtheirusualARTandthatitwas notaninconveniencetotakethemedicationorallyeveryday [75,4%(n=43)].Themajoritystatedthattheywerewilling [54,4%(n=31)]orverywilling[31,6%(n=18)]tocontinue withtheirtreatment.

Furthermore,mostofthepatientshadpriorknowledgeof long-actinginjectabletherapy[71.9%(n=41)]andexpressed thattheydidnotmindreceivingtwointramuscularinjections every2months[86.0%(n=49)]andthattheywerenotworriedaboutthesecondarypain[57.9%(n=33)].Themajority statedthattheywerewilling[52.6%(n=30)]orverywilling [35.1%(n=20)]toswitchtreatment.

Themainreasonsforswitchingtreatmentweretoremove thestigma,toavoidforgettingtotakethemedicationandthe worryaboutrunningoutofmedication.

ConclusionandRelevance Resultsreflectedagreatacceptabilityandwillingnessofourpatien tstoreceivelong-actingantiretrovirals,showingagreementwithpreviouslyconducted studies.

Inaddition,thepatientsalsoappreciatedbeingaskedtheir opinionaboutthetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-027

ANALYSISOFCARDIOVASCULARRISKASSOCIATED WITHIRREVERSIBLEINHIBITOROFBRUTON’S TYROSINEKINASETREATMENTINPATIENTSWITH CHRONICLYMPHOIDLEUKAEMIA

MDMSánchezSuárez,AMartínRoldán*,CAlarcónPayer,MISierraTorres,AJimenez Morales. HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada,Spain

10.1136/ejhpharm-2024-eahp.131

BackgroundandImportance SideeffectsofinhibitorsofBruton’styrosinekinase(BTK)includehypertension,arrhythmias andcardiacevents.Thecardiovascularrisksassociatedwith ibrutinibandacalabrutinibmayvarydependingonindividual patientfactors.

AimandObjectives Outcomeanalysisoftheoccurrenceofcardiovascularadverseeventsandcardiovascularriskinchronic lymphoidleukaemia(CLL)patientsontreatmentwithBTK.

MaterialandMethods Observationalretrospectivestudyfrom January2017toMay2023.Clinicalvariables:sex,age,obesity,smoking,EasternCooperativeOncologyGroup(ECOG) scale,TP53mutation,dateofdiagnosis,treatment,duration, adverseeffectsordosemodifications.Cardiovascularriskat baselinewasobtainedwiththeSCORE2(healthypatients), SCORE2-OP(over70yearsofage),ADVANCE(diabetics) andSMART(previouscardiovasculardisease)calculator.Data wasobtainedfromoncologyelectronicprescriptionandelectronicmedicalrecords.Rcommanderwasusedforthestatisticalanalysis.

Results Fifty-sixpatientswithBTKtreatmentwereincluded. 55.3%male,medianage73(IQR66–79).51.7%TP53mutationpositive.Medianyearsofdiagnosiswas2014(IQR 2010–2018).30.3%obesity,21.4%smokersand16ex-smokers.Themedian10-yearriskofcardiovasculareventswas 8.3%(IQR4–11).Atthestartoftreatment:53.5%arterial hypertension,26.7%dyslipidemia,23.2%diabetes,16%ischemicheartdisease,5.3%atrialfibrillationand3.5%pulmonary embolism.49patientsreceivedtreatmentwithibrutinib (26.5%first-line)and7patientswithacalabrutinib(85.7% first-line).Themediantreatmentdurationis30months(IQR 12–46).23.2%reducedthedoseand42%discontinuedtreatment(25%remainedintherapeuticabstinence).24%developedsomecardiovascularpathologyduringthecourseof treatment(14.2%developedmajoradversecardiovascular events(MACE)withhospitalisation).Themedianyearof treatmentatwhichMACEdevelopedwasthesecondyear (IQR1–3).Statisticallysignificantdifferenceswerefound betweentheoccurrenceofMACEandsex(p=0.04),duration oftreatment(p=0.02)andhypertensionbeforestartingBTK (p=0.009).28.5%died(twopatientsduetoMACEandone patientduetoCLLprogression).

ConclusionandRelevance TheoccurrenceofMACEoccursin amodestnumberofpatientswithalowassociatedmortality. Astatisticallysignificantassociationwasfoundwithsex,durationoftreatmentandhypertensionatthestartofBTK.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-028 ANALYSISOFINTERACTIONSDETECTEDINTHE CONCOMITANTUSEOFANTINEOPLASTICAGENTS ANDPHYTOTHERAPYINONCO-HAEMATOLOGY PRACTICEANDINTERVENTIONSCARRIEDOUT

CAlarcónPayer,AMartínRoldán*,MDMSánchezSuarez,MISierraTorres,AJimenez Morales. VirgendeLasNievesUniversityHospital,PharmacyDepartment,Granada,Spain

10.1136/ejhpharm-2024-eahp.132

BackgroundandImportance Theuseofphytotherapyisvery widespread.Onco-haematologypatientsareparticularlyatrisk ofdrugorphytotherapeuticinteractionsthatmaycompromise theefficacyandsafetyofchemotherapytreatment.

AimandObjectives Todetectpatientswhoconsumephytotherapeuticproductsaswellastheirinteractionswithanticancer agentsinonco-haematologypatientsandtoprovidepharmaceuticalinterventionstooptimisetreatment.

MaterialandMethods ProspectiveobservationalstudyofoncohaematologypatientsinatertiaryhospitalfromJanuary2023 toAugust2023.Demographicvariables(age,sex,pathology) werecollected.Toidentifythetypeofinterventionperformed, adatabasewascreatedusinganExcel® spreadsheettorecord andcategoriseit.InteractionsweredetectedusingtheapplicationsDrugs®,Lexicomp® andAboutHerb®.Thepharmacologicalinterventionwasrecordedinelectronicmedical records.

Results Sixty-threepatientswerefoundtobetakingherbal medicineconcomitantlywithonco-haematologictreatment. 57%ofpatientswerewomen.Themedianagewas62[61.5–65.4]years.Thepatientsbelongedtotwoclinicalservices, 39.6%toHaematologyand60.4%toOncology.Themost frequentonco-haematologicpathologies:ProstateCancer (33%),ColonCancer(23%),ChronicLymphocyticLeukaemia (12%),MultipleMyeloma(11%),OvarianCancer(8%),Brain Tumours(5%),LungCancer(6%)andBreastCancer(2%). Themainsupplementswithapotentialriskofinteractions wereechinacea(39%),magnesium(32%),greentea(21%), soy(5%),capsaicin(4%),ashwagandha(1%)anddevil’sclaw (1%).Thepotentialconsequenceswereanincreaseora decreaseintheconcentrationoftheanticanceragents(82%), anincreaseintheriskofbleeding(13%),hepatotoxicity(3%), andhypokalaemia(2%).Theconsumptionofphytotherapy wasunknownbyahealthprofessionalfor48%ofthe patients.100%ofthepharmaceuticalinterventionswere enteredinthepatient‘sclinicalhistoryasaclinicalreport. 95%wereacceptedandpreventederrorsofmedicationerrors inpatients.

ConclusionandRelevance Theriskofinteractionsbetween plantsandantineoplasticagentsisfrequentlyobservedinclinicalpracticeandduetoitsincreasingpopularity,healthcare professionalsneedtobealert.Multidisciplinaryteamsworking togethercandetectthisproblemandavoidlossofeffectivenessortoxicityofchemotherapytreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

USEOFTOPICAL1%CIDOFOVIRONSKINLESIONSIN APATIENTWITHMONKEYPOX

BMonteroSalgado,MEguiluzSolana,ASalamancaCasado*,NJimenezRivero, BTortajadaGoitia. HospitalCostadelSol,ClinicalPharmacist,Marbella,Spain

10.1136/ejhpharm-2024-eahp.133

BackgroundandImportance Monkeypox(MPX)isazoonosis causedbyanorthopoxvirustransmittedbydroplets,direct contactorfomites.Differentsignsandsymptomsarecaused, includingavarietyofskinlesions.

AimandObjectives Theaimistoevaluatetheresponseof vesiculo-pustularlesionstotreatmentwithatopicalmagistral formulation(MF)ofcidofovir.

MaterialandMethods Onasecond-levelhospital,duringSeptember-November2022,aMFoftopical1%cidofovirin BaseBeelerwasdevelopedbythepharmacotechnicalareafor thetreatmentofpapillomatou slesionsinthefacialregion, perianalareaandextremitiesassociatedtotheMPX diagnosis.

Thepatient‘sevolutionwasmonitoredfor4months,variableswerecollected,basedontheelectronicmedicalrecords andthecentre’sprescriptionrecords.

Results A31-year-oldmalewasadmittedinJuly2022after 7–10daysofuncontrolledpainintheperianalareaandskin lesionsonthefaceandtorsoof3–4daysofevolution.SuspicionofMPXledtoarequestforOrthopoxvirusreal-time PCR.Diagnosiswasconfirmedwithcompleteserologyand positivedetectionforHIV(stageC3)andcoronavirus.

Initially,thelesionsweretreatedwith1/1000zincsulfate andtopicalfusidicacidevery12hours.Giventhepoor response,fusidicacidwasmodifiedfortopicalLiade® (antibioticointment:polymyxinBsulfate,neomycinandbacitracin). ItwasalsoaddedApodrex®,steriledressingappliedtothe perianallesionfortheabsorptionofexudate.

DuetolackofresponsethePharmacyservicewas requestedtodevelopatopical1%CidofovirMF;Zincsulfate wasdiscontinuedandLiade® wasmaintained.

Theregimenwasoneapplicationtoeachlesiontwicea day,aswellasLiade®.

Vesiculo-pustularlesionsinnecroticphaseevolvedtocrusty phaseandthentolesionswithgranulationtissueandsomeof themeventohealingprocess.

Fourmonthslater,duetolackofresponseandwithout achievingthecompletedisappearanceofthelesions,itwas returnedtotheinitialtreatment.

ConclusionandRelevance Intheabsenceofconsensusonthe treatmentoflesionscausedbyMPX,theapplicationoftopical 1%cidofovirimprovestheselesionspartially,someofthem uptothescarringphase.Itcanbeconsideredasanalternativetozincsulfatetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-030 ANALYSISOFADHERENCETOGROWTHHORMONE TREATMENTINPAEDIATRICPATIENTS

MEchavarriDeMiguel*,MPGarcíaRodriguez,AMAguíCallejas,PRanzOrtega, LFernándezRomero,BRivaDeLaHoz,BLealPino,DGonzalezAndres,MTPozasDelRío. HospitalInfantilUniversitarioNiñoJesús,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.134

BackgroundandImportance Adherencetogrowthhormone treatmentiscriticalasitisassociatedwithincreasedgrowth velocityandimprovedadultheight.However,becauseit requiresdailyinjections,adherencemaydeclineinpaediatric patients.

AimandObjectives Theobjectivesofthisstudyaretomeasure patientadherencetogrowthhormonetreatment,evaluatethe influenceofageonadherence,andidentifypatientgroups needingclosepharmacistmonitoring.

MaterialandMethods Aretrospectiveanddescriptivestudy includedallpatientsundergoinggrowthhormone(somatostatin)treatmentfrom1January2017,to31December2022. Variablesconsideredincludedage(calculatedfromthelastdispensation),gender,dispensationdates,anddispensed quantities.

Adherencewasestimatedusingtheindirectmethodof measuringmedicationdispensedoveraninterval(CSA:ContinuousSingleIntervalMeasureofMedicationAcquisition); percentageofdayscoveredrelativetothetotaldaysinthe interval,usingthecomputersoftwareFarmatools® (Dominion).

Results Thestudyincluded160patients(52.5%girls,47.5% boys),aged4–18years,withanaverageageof12.5years andameantreatmentdurationof3.2years.Agegroupscomprised4–6years(10patients),7–9years(21patients),10–12 years(39patients),13–15years(53patients),and16–18 years(37patients).

Regardlessofage,80.63%ofthepatientshadanadherencerateofover90%(68.13%over95%adherence).

Whenanalysingadherencewithintheseageranges,30% (threepatients)hadadherencebelow90%inthegroupaged 4–6years,4.76%(onepatient)aged7–9years,15.38%(six patients)aged10–12years,13.21%(sevenpatients)aged13–15yearsand37.84%(14patients)aged16–18years.

Onlyonepatient(10%)inthegroupaged4–6yearshad adherencebelow85%,0%inthegroupaged7–9years, 5.13%(twopatients)inthegroupaged10–12years,7.55% (fourpatients)inthegroupaged13–15yearsand16.22% (sixpatients)inthegroupaged16–18years.

ConclusionandRelevance Mostpatientshadoptimaladherence,withtheworstadherenceintheextremeagegroups.In youngerchildrenthismaybeduetofearofinjectionsandin adolescentsduetorelaxationovertimeandlackoffamily supervision.

Theseagegroupscouldbenefitfromcloserpharmaceutical care.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-031 APOPULATIONPHARMACOKINETICMODELOF VEDOLIZUMABINADULTPATIENTSWITH INFLAMMATORYBOWELDISEASE:APRELIMINARY ANALYSIS

1OBallesta-López*, 1MMarqués-Miñana, 2JEPeris-Ribera, 1JLPoveda-Andrés. 1Hospital UniversitarioyPolitécnicolaFe,Pharmacy,Valencia,Spain; 2UniversitatdeValència, PharmaceuticalTechnology,Valencia,Spain

10.1136/ejhpharm-2024-eahp.135

BackgroundandImportance Understandingdeterminantsof vedolizumabclearancemayenhancetreatmentoptimisationas therearelimiteddataontherapeuticdrugmonitoring(TDM) inpatientswithinflammatoryboweldisease(IBD).

AimandObjectives Theobjectiveofthisstudywastoperform apreliminarypharmacokinetic(PK)modelofvedolizumabin real-lifetoevaluatecovariatespotentiallyresponsibleforthe PKvariabilityinadultpatientswithIBD.

MaterialandMethods A5-yearretrospectiveunicentrestudy wasperformedincludingadults(>18years)diagnosedwith IBDandtreatedwithintravenousvedolizumab.Demographic andclinicaldatawerecollected,includingserumalbumin,C reactiveprotein(CRP)andfaecalcalprotectin(FCal).Vedolizumabtroughlevels(VTL)wereobtainedbeforeadministrations. Vedolizumabconcentrationsandanti-vedolizumabantibodies (AVA)weredeterminedbyELISA.Themodelwasdeveloped inNONMEMv7.4byapproximatingthenon-linearmixed effectsmodels.Thefirstorderconditionalestimationmethod withinteraction(FOCEI)wasusedformodelbuilding.Body weight(WGT)wasincludedinPKparametersfollowingan allometricrelationship.

Results Sixty-onepatients(27women)wereincluded,34 (56%)werediagnosedwithulcerativecolitisand27(44%) withCrohn’sdisease.Medianage(range)was43(IQR:35–59) yearsandweight70.9(CI95%:67.2–74.7)kg.Atotalof 101concentrationsweredetermined,withamedianconcentrationof25.9(IQR:10.4–47.1) mg/mL.Medianserumalbumin,CRPandFCallevelswere:4.5(IQR:4.2–4.7)g/dL,3.6 (IQR:1.3–8.0)mg/dLand404.2(IQR:105.3 –1329) mg/g, respectively.AnypatienthasdevelopedAVA.PopulationPK model(PopPK):aonecompartmentwithfirstordereliminationdescribedadequatelytheVTL.Amongtheclinicalvariablesanalysed,nonewasfoundsignificantonclearance(CL) anddistributionvolume(Vd).ThefinalPopPKmodelinthe absenceofAVAwasasdefinedas:V=4.55LandCL(L/day) =0.15(WGT/70kg)0.75.Interindividualvariabilityassociated withCL(IIVCL)from14.2%.Proportionalresidualerrorestimatedwas15.1%.

ConclusionandRelevance VedolizumabPKinadultpatients withIBDwasbestdescribedbyaonecompartmentmodel withfirstorderelimination.WGTwasincludedinCL,followinganallometricrelationship.Furtherinvestigationisrequired inordertofindpossiblecovariatesandvalidatethisPK model.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RosarioM, etal.Populationpharmacokinetics-pharmacodynamicsofvedolizumab inpatientswithulcerativecolitisandCrohn’sdisease. AlimentPharmacolTher 2015Jul;42(2):188–202.

ConflictofInterest Noconflictofinterest.

4CPS-032 PHARMACEUTICALINTERVENTIONSFORMEDICATION RECONCILIATIONINCOMPLEXCHRONICALLYILL PATIENTS

1PCiudadGutierrez, 1ARodríguezPérez, 1LRodríguezDeFrancisco, 1PSuárezCasillas, 2MEspinosaMalpartida, 1SLora*, 1EHeviaÁlvarez. 1HospitalUniversitarioVirgendel Rocío,HospitalPharmacy,Sevilla,Spain; 2HospitalUniversitarioVirgendelRocío,Internal Medicine,Sevilla,Spain

10.1136/ejhpharm-2024-eahp.136

BackgroundandImportance Elderlypatientswhoreceive chronicmedicationformultiplepathologieshaveahighrisk ofsufferingfrommedicationdiscrepanciesandadversedrug events.Theroleofpharmacistsisvitaltoimprovehealthoutcomesbyavoidingthesemedicationerrors.

AimandObjectives Toanalysethepharmaceuticalinterventions (PIs)ofmedicationreconciliationinhospitalisedmultipathologicalpatientsover65yearsofageandtoevaluatethe degreeofacceptancebythephysicians.

MaterialandMethods Aprospectiveobservationalstudywas conductedbetween1March2023and15April2023.We analysedthePIsontherapeuticconciliationperformedinmultipathologicalpatientsadmittedtothehospitalisationward wherethepharmacisthasrecentlybeenintegratedincollaborationwithaninternistandanurse.

Thefollowingvariableswerecollected numberofpatients admittedtothewardandthoseonwhomPIswereperformed,pathologiesinvolvedaccordingtothedrugsused, numberandtypeofPIsidentified.Inaddition,thedegreeof acceptanceofthePIswasmeasuredandPIswereidentified withdrugsconsideredhigh-riskinchronicpatientsaccording totheMARClist.

Results Eighty-threepatientswereadmittedtotheInternal Medicinehospitalisationward.Ofthetotalnumberof patients,52PIswereperformedin33patients.Thenatureof thediseasesassociatedwithPIswerecardiovascular (n=16.48%),metabolic-renal(n=9.28%),neurological(n= 5.15%)andrespiratory(n=3.9%).

TherecommendationsmadeinthePIswere:discontinuationofmedication(n=16),dosageadjustment(n=14),prescriptionofmedication(n=11),substitutionofthedrugfora moreeffectiveone(n=7),exchangeofthedrugforatherapeuticequivalent(n=3)andchangeoftherouteofadministration(n=1).

Thedegreeofacceptancewas86.54%.

OfthePIsperformed,27%(n=14)involvedahigh-risk drug.Specifically,loopdiuretics(4),anticoagulants(4),antiplateletagents(1),beta-blockers(2),NSAIDs(1),hypoglycaemic agents(1)andinsulins(1).

ConclusionandRelevance MostofthePIswererelatedtothe additionordiscontinuationofadrug,aswellastothedose adjustmentofadrug.ThedegreeofacceptanceofthePIs wasveryhigh,whichreinforcestheroleofthepharmacist withinamultidisciplinaryteam.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-033 REAL-WORLDTREATMENTPATTERNSAND OUTCOMESOFSELECTIVECYCLIN-DEPENDENT KINASE(CDK)4/6INHIBITORSUTILISATIONIN METASTATICBREASTCANCER – REVEALSTUDY

1JPCruz*, 2LPereira, 3JBSantos, 4ACastanha, 4ACRodrigues, 5ICosta, 5CVarela, 6FDimas, 7AAraújo, 8VAndreozzi, 9JFélix. 1CentroHospitalarUniversitárioLisboaNorte, ServiçosFarmacêuticos,Lisboa,Portugal; 2HospitalEspíritoSanto – Évora,Serviços Farmacêuticos,Évora,Portugal; 3CentroHospitalarTondela-Viseu,ServiçosFarmacêuticos, Viseu,Portugal; 4HospitaldoDivinoEspíritoSanto,ServiçosFarmacêuticos,PontaDelgada, Portugal; 5InstitutoPortuguêsdeOncologiadeCoimbra,ServiçosFarmacêuticos,Coimbra, Portugal; 6CentroHospitalarBarreiroMontijo,ServiçosFarmacêuticos,Barreiro,Portugal; 7HospitaldaSenhoradaOliveiraGuimarães,ServiçosFarmacêuticos,Guimarães,Portugal; 8ExigoConsultores,QuantitativeMethods,Lisbon,Portugal; 9ExigoConsultores,Director, Lisbon,Portugal

10.1136/ejhpharm-2024-eahp.137

BackgroundandImportance Activeinvolvementofhospital pharmacistsinreal-worldeffectivenessstudiesisparamount togenerateevidenceaboutthevalueofinnovative

medicinesinclinicalpractice.TheREVEALstudywas designedandimplementedbyacooperativeresearchgroup ofhospitalpharmaciststoassessthetherapeuticvalueof currentstandardofcarewithCDKi4/6inHER2-negative, hormonereceptor-positivemetastaticbreastcancer(MBC: HR+;HER2(-)).

AimandObjectives Tocharacterisetreatmentpatternsof CDK4/6inhibitorspalbociclibandribociclibuseinwomen withMBC.Toquantifydoseadjustmentsuntil6monthsof CDKi4/6treatment.Toestimatepersistenceontreatmentwith ribociclibat12and24months.

MaterialandMethods Retrospectiveobservationalcohortstudy, includingadultwomenwithMBC:HR+;HER2(-)whoused CDKi4/6(ribocicliborpalbociclib)inadditiontohormone therapy,betweenMarchandDecember2019.Datawasfrom recordsoftheHospitalPharmaceuticalServices.Thestudy comprisedtwofollow-ups:untilJune2020toquantifydose adjustments;until24monthstoassesspersistenceontreatmentwithribociclib(lastobservation31December2021).

Studyprotocolwasapprovedbyhospitals’ EthicsCommittees. Persistenceontreatmentwithribociclibwascalculatedusing theKaplan-Meierestimator.Asignificancelevelof5%was adopted.

Results Weincluded121womenfromsevenpublichospitals: palbociclib(n=86;71.1%);ribociclib(n=35;28.9%).The averageage(min;max)was58(27;92)years.Mostpatients startedCDKi4/6treatmentinpostmenopause(n=85;70.2%) andassecond-linetherapy(n=87;71.9%).Combinationwith hormonaltherapywasaromataseinhibitors97%inribociclib and71%inpalbociclibpatients(p-value=0.003);fulvestrant in6.1%ribocicliband33.9%palbociclibpatients(pvalue=0.003).Themajority(76%)ofpatientshadnodose adjustmentinthefirst6months.Therewerenosignificant differencesintheproportionofpatientswithdosemodificationsaccordingtoCDK4/6inhibitor,patient’sage,typeof hormonotherapyortherapyline.Themedianpersistenceon treatmentwithribociclibwas16.3months(95%CI=[10; NA]).Persistence[95%CI]ontreatmentwithribociclibat12 monthswas57%[40%;81%]andat24months43%[26%; 73%].

ConclusionandRelevance TheREVEALstudyconfirmedthe effectivenessofCDKi4/6inreal-worldsettings,includingdose adjustmentsandpersistenceontreatment.Leadershipinrealworldeffectivenessstudiesisparamounttoelevatetheroleof pharmacistsinestablishingthetherapeuticvalueofinnovative medicines.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest

Conflictofinterest.

Corporatesponsoredresearchorothersubstantive relationships:

ThisprojectwasdevelopedwithintheframeworkofaclinicalresearchcollaborationprotocolestablishedbetweenNovartisFarma,ProdutosFarmacêuticosS.A.,ExigoConsultoresand agroupofPortuguesehospitals.

4CPS-034 REAL-WORLDSAFETYANDTOLERABILITYIN PATIENTSTREATEDWITHABEMACICLIBAND ENDOCRINETHERAPY:ARETROSPECTIVE OBSERVATIONALSTUDY

NPerrotta*,LAFiorito,RGentile,RVescovo,GCasini,GPolito,RLobello,EMProli. PoliclinicoUmbertoI,Pharmacy,Rome,Italy

10.1136/ejhpharm-2024-eahp.138

BackgroundandImportance AbemaciclibisaselectiveCDK4/6 inhibitoranditisauthorisedincombinationwithendocrine therapy(ET).Itsusewasassociatedwithsuperioroutcomes comparedtoETaloneinwomenwithHR+/HER2-metastatic breastcancer(mBC),providinganewstandardofcarefor thispatientpopulation.

AimandObjectives Theaimofthestudywastoevaluatethe safetyprofileofabemaciclib,theseverityandtypesoftoxicitiesandthefactorsleadingtodiscontinuationoftreatment. MaterialandMethods Aretrospective,observational,descriptivestudywascarriedoutatatertiarycarehospital.Women aged>18yearswithHR+/HER2-mBCreceivingabemaciclib incombinationwithETbetweenJune2019andJuly2022 wereincluded.Variables:age,hormonaltherapyincombination,concomitanttherapies,durationoftreatments,adverse events(AEs),doseadjustmentandtreatmentdiscontinuation. AEswereclassifiedaccordingtoCTCAE.Clinicalandanalyticaldatawerecollectedfromelectronicclinicalrecords. Results 39patientswereincluded,medianagewas68(56–76) years.Abemaciclibwasadministeredincombinationwith tamoxifen(39%),letrozole(18%),anastrozole(26%)and exemestane(17%).67%ofpatientsreportedatleastone comorbidity.45%ofpatientsused3–5drugsand18%used 6–10drugsasconcomitanttherapy.74.4%followedforthe wholedurationofthestudy,while25.6%discontinuedtherapyduetotoxicity.Diseaseprogressionwasexperiencedby 15.4%ofpatientsanddosereductionwasachievedin33% ofcases.AEsoccurredin89.7%ofpatients,ofthese74% weremildtomoderate(G1-G2)and26%weresevere(G3G4).ThemostcommonAEsreportedwereneutropeniain 23%ofpatients(55.5%G3-G4),anaemia38.5%,diarrhoea 74.3%(onlyonesevere),nausea10.2%,asthenia51.3%(10% G4),liverdysfunction15.4%(33.3%G3-G4),renaldysfunction15.4%.Multivariateregressionanalysisshowedan increaseofseriousAEsassociatedwiththeuseofabemaciclib incombinationwith3–5concomitanttherapies(p<0.001)and 6–10concomitanttreatments(p=0.018).

ConclusionandRelevance Ourdatashowedthattheconcomitantuseofpolytherapyisassociatedwithhighertoxicityin patientsaffectedbymBCtreatedwithabemaciclib+ET.However,thiscombinationdemonstratedanacceptable,safeand tolerableprofile.MostAEswerereversibleandwellcontrolled withconcomitantmedicationsand/ordosemodifications, accordingtothereportedtoxicitydatafromtheclinicaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-035

IMPACTOFANTIBIOTICSTEWARDSHIPPROGRAMME (ASP)ONANTIBIOTICUSEANDCLINICALOUTCOMES INPATIENTSHOSPITALISEDWITHCOMMUNITYACQUIREDPNEUMONIA(CAP):RETROSPECTIVE OBSERVATIONALBEFORE-AFTERSTUDY

1AFésüs*, 1PBaluku, 1ÉSipos, 2SSomodi, 3AVaskó, 4ILekli, 4EBerczi-Kun, 1IBácskay. 1UniversityofDebrecen,FacultyofPharmacyDepartmentofPharmaceuticalTechnology, Debrecen,Hungary; 2DebrecenUniversityClinicalCentre,EmergencyDepartment,Debrecen, Hungary; 3DebrecenUniversityClinicalCentre,DepartmentofPulmonology,Debrecen, Hungary; 4UniversityofDebrecen,FacultyofPharmacyDepartmentofPharmacology, Debrecen,Hungary

10.1136/ejhpharm-2024-eahp.139

BackgroundandImportance Community-acquiredpneumonia (CAP)isstilloneoftheleadingcausesofdeathworldwide. Inourpreviousstudies,theguidelineadherencetonational andinternationalCAPguidelinesintermsofagentchoicewas foundtobepoor.ImplementationoftheAntibioticStewardshipProgramme(ASP)aimedtoimprovethecorrectand responsibleantibioticusebyencouragingguidelineadherence.

AimandObjectives ThisretrospectiveobservationalbeforeafterstudyaimedtoevaluatewhethertheASPmayimprove guidelineadherence,antibioticexposureandclinicaloutcomes inpatientshospitalisedwithCAPinHungary.

MaterialandMethods ThestudywasconductedataPulmonologyDepartmentofatertiarycaremedicalcentreinHungary.TheASPimplementationconsistedofwrittenand publishedguidelinesavailabletoallprofessionals,continuous supervisionandcounsellingserviceonantibiotictherapies.The interventionwasperformedbyamultidisciplinaryantibiotic stewardshipteam(AST)atanindividuallevel,withtheaimto ensurecompliancewithCAPguidelines.Overallguideline adherence(agentselection,routeofadministration,dose),clinicaloutcomes(lengthofstay-LOS,30-daymortality),andantibioticexposurewerecomparedbetweenthepre-intervention andASPperiods(bothretrospectiveobservational).Fisher ’ s exacttestandt-testwereappliedtocomparecategoricaland continuousvariables,respectively.Significantpvalueswere definedasbelow0.05.

Results SignificantimprovementinoverallCAPguideline adherence(by30.2%,from46.6%to76.8%,p=0.017)and significantreductioninthetotaldurationofantibiotictherapy (by13.5%,7.58±3.83vs.6.15±3.72days,p=0.002)were observed.Guidelinenon-adherentcombinationtherapieswith metronidazoledecreasedsignificantlyby28.1%(from31.1% to3.0%,p<0.001).Antibioticexposuredecreasedby7.2% (from17.9±10.64to15.47±11.03DDD/patient,p=0.061) andsequentialtherapyincreasedsignificantlyby10.5%(from 3.9%to14.14%,p=0.01).Moreover,ASPhadbenefitson clinicaloutcomes(LOS:decreasedby13.5%,from8.85±6.1 to7.09±5.84days,p=0.016;30-daysurvival:increasedby 5.9%,from72.5%to78.4%,p=0.711).

ConclusionandRelevance Availabilityofwrittenprotocolson thewardandthecontinuouscounsellingserviceiscrucialin optimisingantibioticuse.ImplementationofASPledtoasignificantimprovementinCAPguidelineadherenceandsequentialtherapy,thatalsoentailedthesignificantreductionoftotal durationofantibiotictherapy,andlengthofstay.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-036 EVALUATIONOFTHEDIAGNOSISANDANTIBIOTIC PRESCRIPTIONPATTERNINPATIENTSHOSPITALISED WITHURINARYTRACTINFECTIONS(UTIS)

1AFésüs*, 2MMatuz, 2HHambalek, 2RRuzsa, 3BTánczos, 1IBácskay, 4ÁIllés, 2RBenkő 1UniversityofDebrecen,FacultyofPharmacy,DepartmentofPharmaceuticalTechnology, Debrecen,Hungary; 2UniversityofSzeged,ClinicalPharmacyDepartment,Facultyof Pharmacy,Szeged,Hungary; 3UniversityofDebrecen,FacultyofPharmacy,Departmentof Pharmacology,Debrecen,Hungary; 4UniversityofDebrecen,DepartmentofInternal Medicine,FacultyofMedicine,Debrecen,Hungary

10.1136/ejhpharm-2024-eahp.140

BackgroundandImportance UrinaryTractInfections(UTIs) arecommonbacterialinfectionswithnon-negligiblehospitalisationrate.ThediagnosisofUTIsremainsachallengefor prescribersandcommonsourceformisdiagnosis.

AimandObjectives Thisretrospectiveobservationalstudy aimedtoevaluatewhetherrecordeddiagnosisbyclinicians andempiricalantibiotictherapymettheEuropeanAssociation ofUrology(EAU)guidelineinpatientshospitalisedwitha UTI.

MaterialandMethods Thestudywasconductedataninternal medicineunitofatertiarycaremedicalcentreinHungary. Diagnosiswasassessedbasedontheclinicalpresentation, physicalexamination,andlaboratory(inclusivemicrobiological) resultsconsideringriskfactors.Diagnosiswasconsideredmisdiagnosiswhenwasnotconfirmedbyclinicalpresentationor clinicalsignsandsymptoms.Analysesforempiricalantibiotic therapywereperformedonlyforconfirmedUTIs.Empirical treatmentwasconsideredguidelineadherentwhencomplying withtherecommendations.Fisher ’sexacttestandt-testwere appliedtocomparecategoricalandcontinuousvariables betweengroups.Significantpvaluesweredefinedasbelow 0.05.

Results Outof185patients41.6%(n=77)havenotmetEAU diagnosiscriteria,ofwhich27.6%(n=51)weremisdiagnosis and14.1%(n=26)wereABU(asymptomaticbacteriuria).The diagnosisofurosepsisrecordedatadmission(9.7%)wasnot supportedinanycasesneitherbyclinicalnorbymicrobiologicaltests.TheinitialempiricaltherapiesforUTIshowedarelativelylowrate(45.4%,49/108)ofguidelineadherence regardingtoagentselection.Themostcommonguideline non-adherenttherapieswerecombinationswithmetronidazole (16,7%,18/108).Althoughdosageappropriatenessassessments showedahigherguidelineadherencerate(36.1%,39/108), underdosingduetothehigherbodyweightwasrelatively high(9.3%,10/108).Overall(agent,routeofadministration, dose,duration)guidelineadherencewasfoundtobesubstantiallylow(10.2%,11/108).

ConclusionandRelevance Wefoundarelativelyhighrateof misdiagnosedUTIs.Writtenprotocolsonthewardmaybe crucialinreducingmisdiagnosisandinoptimisingantibiotic use.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-037 INTEGRATIONOFTHEPHARMACISTINTHE MULTIDISCIPLINARYCOMMITTEEOFUROONCOLOGICALPATHOLOGY

1LMartinez-Dueñas*, 2AMartinRoldan, 2YSalmeronCobos. 1HopitalUniversitarioVirgen deLasNieves,Pharmacy,Granada,Spain; 2HospitalUniversitarioVirgendeLasNieves, Pharmacy,Granada,Spain

10.1136/ejhpharm-2024-eahp.141

BackgroundandImportance Thefigureofthepharmacist wasincorporatedintotheMultidisciplinaryCommitteeUroOncologicalPathology(MCUP):Oncology,RadiationOncology,Urology,PathologicalAnatomy,NuclearMedicine, Radiology),fortheevaluationofpatientswithlocally advancedormetastaticprostatecancer(PC),participatingin theselectionofthemostappropriatetreatment(effectiveness,safety,efficiency,comorbiditiesandinteractions)and appropriatenessofprescriptio n(financingcriteriaofMinistryofHealthandMultidisciplinaryCommissionRational UseofMedicines).

AimandObjectives TodescribetheintegrationofthepharmacistintheMCUP,participatingintheselectionoftreatment, adequacyoftheprescriptionandconcomitantmedication. Degreeofacceptance(GA)oftherecommendations.

MaterialandMethods Observational,retrospectivestudyof patientswithprostatecancerreviewedatMCUPbetweenJanuary2022andJune2023.

VariablescollectedfromelectronicmedicalrecordDiraya®: age,functionalstatus(ECOG),Gleason,comorbidities,diagnosis,previoustreatment,proposedtreatmentatMCUP,home medicationandallergies.

InteractionswithMicromedex®,CancerDrugInteractions, druglabelsandpatientinterviewwereverified.

Registrationofmedicationintheoutpatientdispensingprogramme(AthosPrisma®,)orFarmisOncofarm.®

Continuousvariableswereexpressedasmedian[(InterquartileRange(IQR)].

Results 69treatmentswerereevaluated.72years(IQR:66–78). Medianofassociatedcomorbidities:4(IQR:2.75–5)among them:

Arterialhypertension(n=60),dyslipidaemia(n=35),cardiovasculardisease(n=30)anddiabetesmellitus(n=29).Median numberofmedicationsprescribed:8.5(IQR:5–10.25; 527medicationswerereviewed,85interactionsdetected. Selectionofbesttreatmentaccordingtocomorbidities/interactions(n=20,GA:85%)andmodification/monitoringofconcomitantmedication(n=65,GA:87%).

Previoustreatment androgendeprivationtherapy(n=45), radiotherapy(n=39),radicalprostatectomy(n=36),chemotherapy(n=16),newantiandrogens(n=14).

Thefollowingrequeststostarttreatmentwereevaluated andagreedupon:10requeststostartapalutamide[(nine metastatichormone-sensitive(mHSPC),onenon-metastaticcastration-resistant(CRPC0)],13abiraterone(ninemetastaticcastration-resistant(mCRPC),fourmCSPC),14enzalutamide(12 mCRPC,twoCRPC),ninedocetaxel(sixmCRPC,three mCPHS),sevendarolutamide(CPHSM0),12abirateronein combinationwithdocetaxel(CPHSMnewhigh-riskdiagnosis, off-labeluse),fourcabazitaxel(mCRPC).

ConclusionandRelevance Theintegrationofthepharmacist intoMCUPforassessmentofPCtreatmentimprovesthe qualityofcare,guaranteeingpatientsafety,compliancewith protocols,individualisationoftherapy,improvingaccessto drugs,favouringtheinnovationandthesustainabilityofthe

healthsystem.Degreeofacceptanceofrecommendationswas high.

REFERENCESAND/ORACKNOWLEDGEMENTS ThanksMCUP

ConflictofInterest Noconflictofinterest.

4CPS-038 CASEREPORTONAUTONOMICNEUROPATHY INDUCEDBYBORTEZOMIB

1GMolas*, 1AManzaneque, 1BTenas, 1CNoguera-Jurado, 1LLopez-Torres, 2FVall-Llovera, 2MTVillalobos, 1JNicolas. 1HospitalUniversitariMutuaTerrassa,PharmacyDepartment, Terrassa,Spain; 2HospitalUniversitariMutuaTerrassa,OncologyDepartment,Terrassa, Spain

10.1136/ejhpharm-2024-eahp.142

BackgroundandImportance Peripheralneuropathyisoneof themostcommonadversereactionstobortezomib.However, bortezomibcanmuchlessfrequentlyproduceothernervous systemalterations.Wepresentthecaseofapatientundergoingbortezomibtreatmentformultiplemyeloma(MM),who developedtoxicityintheformofautonomicneuropathy.

AimandObjectives A68-year-oldpatientwithahistoryof hypertension,dyslipidaemiaanddepressivesyndrome.InMay 2023,MMwasdiagnosed,andinductiontreatmentwithdaratumumab/bortezomib/lenalidomide/dexamethasone(D-VRd)was initiated.

Duringthefirstcycleoftreatment,tolerancewasexcellent. Thepatientwasincludedinthehomechemotherapyadministrationprogrammeforthesecondcycle.Onthe8thdayof thesecondcycle,thepatientreportedsignificantdiarrhoeain thepreviousdays.Hygienic-dietaryrecommendationswere provided.Aftersevendosesofbortezomib(cumulativedose: 16.8mg),onthe11thdayofthesecondcycle,whenthe nursevisitedthepatientathome,shefoundthepatienthyporeactive,havingdifficultyspeakingandstanding,non-reactive pupils,andskinpallor.

MaterialandMethods Duringhospitalisation,thepatientexperiencedsignificanthypotension(76/52mmHg),anddizziness, alongwithintolerancetostandinganddiarrhoea(grade2). Afterrulingoutcardiaccauses(echocardiography),structural brainabnormalities(CTscan),amyloidosisandinfectiousorigin,itwassuspectedtobevasovagalepisodessecondaryto autonomicneurologicaltoxicityduetobortezomib.Intensive fluidtherapywasadministered.Progressiveimprovementwas observedandthepatientwasdischargedonthesixthdayof admissionwiththeabilitytowalkwithoutrecurrenceof symptoms.

Results ThetreatmentforMMwasresumedafter15days withoutbortezomib.Bortezomibwasnotadministeredagain, andthesymptomsdidnotrecur.Thereactionwasclassified as ‘probable’ accordingtotheNaranjoalgorithm.

ConclusionandRelevance Therearefewreportedcasesof autonomicneurologicaltoxicityduetobortezomib.1–4 Similar toourcase,Suyanietal.andStratogiannietal.reportedtwo casesofpatientswhorequiredhospitalisationduetodizziness andorthostatichypotension,ultimatelyassociatedwithbortezomib.Inconclusion,autonomicneuropathictoxicitycaused bybortezomibshouldbeconsideredinthedifferentialdiagnosisoforthostatichypotensioninhaematologicalpatients. Homechemotherapyadministrationallowsforearlydetection oftoxicitiesandstreamlineshealthcareprocesses.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.10.1007/s10286–012-0164–8 2.10.5505/tjh.2012.90377

3.10.1182/blood.V108.11.5101.5101 4.10.1182/blood-2022–166437

ConflictofInterest Noconflictofinterest.

4CPS-039 DRUG-RELATEDPROBLEMSATHOSPITALADMISSION INELDERLYPATIENTSWITHCARDIOVASCULAR DISEASES

1A Štehec, 2ISamardžić, 2VBačić Vrca, 3MOrtnerHadžiabdić, 2IMarinović*. 1Pharmacy Zubić,Pharmacy,Krapina,Croatia; 2UniversityHospitalDubrava,DepartmentofClinical Pharmacy,Zagreb,Croatia; 3FacultyofPharmacyandBiochemistry,CentreforApplied Pharmacy,Zagreb,Croatia

10.1136/ejhpharm-2024-eahp.143

BackgroundandImportance Cardiovasculardiseases(CVD)are theleadingcauseofmortalityandmorbidityintheworld. Agingdecreasesorganfunctionwhichcanalsoincluderenal impairment.Decreasedrenalfunctionmayincreasetheriskof adversedrugeventsandrequiresdoseadjustment.Morethan halfoftheelderlypatientsareexposedtopolytherapy(five ormoredrugs).Polytherapycomplicatesdrugmanagement andincreasestheriskofpotentiallyinappropriatemedications (PIMs)anddrug-druginteractions(DDIs)whichcancomplicatethecourseoftreatmentandthreatenpatientsafety.

AimandObjectives Theaimofthestudywastoevaluatethe prevalenceofdrug-relatedproblemsusingthe ‘Bestpossible medicationhistory ’ (BPMH)andtheprevalenceofcardiovasculardrugsamongidentifieddrug-relatedproblems.

MaterialandMethods Thestudyincluded105patientsaged 65yearsorolder,admittedtoDubravaUniversityHospital, DepartmentofCardiology.Polypharmacywasdefinedasthe simultaneoususeof5–9drugs,whiletheuseof10drugsand morewasdefinedasexcessivepolypharmacy.TheEU(7)-PIM criteriawereappliedforPIMsdetection.PotentialDDIswere detectedusingLexicompsoftware.Theanalysisofinappropriatelyprescribedrenalriskdrugswasperformedinpatients witheGFR<60ml/min/1.73m2 (KDIGOstagesG3a,G3b, G4andG5).

Results Theresearchdeterminedthepresenceofpolypharmacy in56.2%ofpatients,while27.6%ofthemused10ormore medications.DrugsbelongingtoATCgroupCaccountedfor 47.6%ofalldrugsinpatientswithpolytherapyand43.7%of alldrugsinpatientswithexcessivepolypharmacy.PIMswere foundin74.3%ofpatients,ofwhich20.7%wereATCgroup C.Atleastonepotentialclinicallysignificantinteractionwas foundin93.3%ofpatients,ofwhich72.1%involveddrugs ofATCgroupC.Atotalof35renalriskdrugsweredetected inpatientswithrenalimpairment,ofwhich62.9%ofdrugs belongedtoATCgroupC.

ConclusionandRelevance Thisresearchdeterminedhighexposuretopharmacotherapyproblemsinelderlypatientswith CVD.Cardiovasculardrugsweresignificantlyrepresentedin theanalysedpharmacotherapeuticproblems.Theobtaineddata highlightstheimportanceofusingtheBPMHindeterminationofpharmacotherapyproblemsinelderlypatientswith CVD.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-040 ADHERENCETOGUIDELINESANDPRESCRIBING TRENDSOFSTATINSINPATIENTSWITHACUTE CORONARYSYNDROME

1KIoannidis*, 1IScarlatinis, 2NAntonelos, 3NChatzigeorgiou, 4MVlachou, 4GChatzidimitriou, 4PStathopoulou, 5VPapandreou, 6MKaravitaki, 7SLMarkantonis. 1HygeiaHospital,ClinicalPharmacy,Athens,Greece; 2NavalHospitalAthens-AthensGreece,PharmacyDepartment,Athens,Greece; 3251AirforceGeneralHospital-AthensGreece,PharmacyDepartment,Athens,Greece; 4EvaggelismosHospitalAthens-AthensGreece,PharmacyDepartment,Athens,Greece; 5IppokrateioGeneralHospitalofAthens, PharmacyDepartment,Athens,Greece; 6NationalandKapodistrianUniversityofAthensAthens-Greece,DepartmentofPharmacy,SchoolofHealthSciences-,Athens,Greece; 7NationalAndKapodistrianUniversityofAthens,Athens,Greece,DepartmentofPharmacy, SchoolofHealthSciences,Athens,Greece

10.1136/ejhpharm-2024-eahp.144

BackgroundandImportance Earlyuseofstatinsinpatients withAcuteCoronarySyndrome(ACS)wasassociatedwitha reducedin-hospitalmortalityrate.Furthermore,thereisevidencethatapartfromLDL-Clowering,statintherapyprovidesotherclinicalbenefits,referredaspleiotropiceffects, whichcanbebeneficialearlyafteranACS,includingenhancementofplaquestabilisation,improvementofendothelialfunction,anti-inflammatoryeffectsanddecreasedthrombogenicity. Despitethis,epidemiologicalstudiesinUSAsuggestthata largeproportionofpatientswithACSdidnotreceivehigh intensitystatins.

AimandObjectives Thegoalofthecurrentstudyistoevaluatetheprescribingtrendsofhighintensitystatintreatment earlyinthepost-ACScourseinhospitalisedpatientsin Greece.

MaterialandMethods WeconductedamulticentreretrospectivestudyofpatientswhohadexperiencedanACSeventduringtheperiodbetweenJanuary2012andDecember2016in fourhospitalsinGreece.TheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems – TenthRevision – ClinicalModification(ICD-10-CM)wasusedto identifyACSeventsintheelectronicinpatientmedical records.Demographics,baselinelipidlevels,statindosageregimens,daysofhospitalisationandin-hospitalmortalitywere recorded.

Results Among2,708patientsmeetingtheinclusioncriteria, 41.8%receivedhigh-,37.2%moderate-,andonly0.2%lowintensitytherapy,while19.8%didnotreceiveanystatins. Outofthehigh-intensityregimens,atorvastatin40mgwas themostcommonregimenprescribedfollowedbyrosuvastatin 20mg.Only29.9%ofpatientsaged>75receivedintensive regimens,whilethepercentageforpatientsaged £75was 46.9%.Asignificantcorrelation(p<0.05)wasfoundbetween thedecisiontoprescribeastatinandthemeanbaselineLDLcholesterollevel.

ConclusionandRelevance ThemajorityofACSpatientsinthe fourGreekHospitalsincludedinthestudydidnotreceive high-intensitystatins,butthepercentagewhodidreceivethese drugswashigherthanthatreportedinothersimilarstudiesin theUSA.Adherencetorecommendedguidelinesforstatins shouldbeencouragedwithinthehealthsysteminorderto optimisetheutilisationoftheselipid-loweringagentsand reducetheriskofrecurrentcardiovasculareventsinACS patients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-041 SILENCESPEAKSLOUDERTHANWORDS:OMISSION OFPRESCRIPTIONINTHEEMERGENCYROOM

AMoralesPortillo*,MMirCros,MBardollCucala,MCuy,AGalindoVerdugo,CSantos Rodriguez,BMartinezCastro,IManguesBafalluy,JASchoenenbergerArnaiz. Hospital UniversitarioArnaudeVilanova,Farmacia,Lleida,Spain

10.1136/ejhpharm-2024-eahp.145

BackgroundandImportance Medicinesreconciliationisthe processofaccuratelylistingaperson’scurrentmedicines.This isrecommendedwhenadmittedintoaserviceortreatment changes.TheEmergencyRoom(ER)isonewayfromprimary healthcaretosecondaryandtertiary;assuch,medicinereconciliationplaysacriticalrole.Electronicprescriptionallowsthe trackingofprescriptionsduringtheadmissionofpatientsto theER.

AimandObjectives Thisprojectaimedtoassessthecurrent situationregardingmedicinesreconciliationduringERadmissionandtoestimatethedegreeofelectronicprescription omissionintheER.

MaterialandMethods

Onehundredpatientswereregistered Theexclusioncriteria wasdischargetimeinferiorto4hoursafteradmission.

Over10consecutiveworkdays,10patientswerechosen everydayinthefollowingmanner:Thefivemostrecent patientsadmittedtotheERduringthenightshift(0–8am) andthefirstfivepatientsadmittedduringthemorningshift (8amto3pm).

Currentmedicinesforeachpatientwereobtainedfrom electronicrecordspriortoadmission,currentmedicalvisit and,incaseofdoubt,directpatientinterview.

Sex,ageandomissionbetweenelectronicprescriptionin theERandeachpatient’scurrentmedicineswereregistered.

OmissionswereconsideredjustifiedwhenomittedmedicinewasthereasontovisittheER,acuteclinicalsituations madethemedicinecontraindicated,andtherewasasignificantinteraction(levelDorX)betweentheomittedmedicineandanymedicineorprocessindicatedduringthe admission.

OmittedmedicinesweresortedoutbyATCgroupofactive principle.

Results Amongthe100patients,47werewomen,and53 weremen.Agewas66.5±21.4years.

Outof100patients,71haderrorsintheirelectronicprescriptions,resultingin121omissions.Oftheseomissions,61 (50.4%)wereclassifiedasunjustified.MedicinesfellintoATC groupsbyC(41%,25),N(27.9%,17),B(11.5%,7),S (9.8%,6),R(4.9%,3),A(3.3%,2)andJ(1.6%,1).

ConclusionandRelevance Omissionsofprescriptions,particularlyforcardiovascularandnervoussystemmedications,are commoninourhospital’sER.Thisissuemustbeaddressedas itmayresultinnegativeclinicaloutcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-042 OVERDOSEOFDARBEPOETININPATIENTSWITH CHRONICKIDNEYFAILURE.ROOMFOR IMPROVEMENTWITHPHARMACISTINTERVENTIONS

1MMirCros, 1PTabernerBonastre, 1MBardollCucala, 1MCuyBueno, 1AGalindo Verdugo, 2FITorresBondia, 1SMCanoMarrón, 3JFSarróSobrín, 3LSCraverHospital, 1JASchoenenbergerArnaiz*. 1HospitalUniversitariArnaudeVilanova,Pharmacy,Lleida, Spain; 2HospitalUniversitariSantaMaria,Pharmacy,Lleida,Spain; 3HospitalUniversitari ArnaudeVilanova,Nephrology,Lleida,Spain

10.1136/ejhpharm-2024-eahp.146

BackgroundandImportance Darbepoetinisusedtotreat symptomaticanaemiaassociatedwithchronickidneyfailure (CKD)andtoincreasehaemoglobinconcentrationtoalevel nohigherthan12g/dl.

Patientsshouldbecloselymonitoredtoensurethatthe lowestauthorisedeffectivedoseofdarbepoetinadequately controlstheanemia-relatedsymptomswhilemaintainingahaemoglobinconcentrationbeloworequalto12g/dl.

AimandObjectives Toimprovethesafetyofdarbepoetin treatment,thisstudyaimedtoidentifypatientswithCKDand haemoglobinlevelsexceeding12g/dl.

MaterialandMethods Anobservational,descriptive,andretrospectivestudywasconductedtoanalyseCKDpatientswho receivedtreatmentwithdarbepoetinfromJanuary2022to August2023.

Datacollectedincludedgender,dateofbirth,darbepoetin dosageinmcg,andhaemoglobinvalueing/dl.

Forthisstudy,weretrievethedatafromElectronicHealth Records(HER).

Results Duringtheanalysedperiod,darbepoetintreatmentwas administeredto567CKDpatients,56%weremanwitha medianageof72,and129/567(22.7%)hadhaemoglobinlevelsabove12g/dl.

Amongthese129patients,86(66.7%)hadahaemoglobin valuebetween12and13.9g/dl,15(11.6%)patientsbetween 14and15.9g/dl,and2(1.5%)patientshadahaemoglobin valuehigherthan16g/dl.

Furthermore,5(3.8%)patientswithhighhaemoglobinvaluesstillreceivedadoseofdarbepoetinhigherthan100mcg. ConclusionandRelevance Accordingtotheproductinformationdocument,thereisroomtoimprovethesafetyofdarbepoetintreatmentsasmanypatientscontinuetreatmentwith darbepoetinevenwhenthetargethaemoglobinlevelhasbeen reached.

Itiscrucialtocloselymonitorpatientsstartingdarbepoetin treatmentandadjustdosestoachievethedesiredhaemoglobin levelsafely.

Whenpatientspickuptheirmedicationfromthehospital pharmacy,analyticalhaemoglobinvaluesmustbechecked,and theattendingpharmacistscancommunicatewithnephrologists ifpatientsdonotfulfillthetreatmentcriteriafordarbepoetin.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-043

EFFICACYANDSAFETYOFANTI-CALCITONINGENERELATEDPEPTIDEMONOCLONALANTIBODIESFOR MIGRAINEPROPHYLAXIS:ONE-YEARREAL-LIFE EXPERIENCE

LEstrada*,GCardonaPeitx,LDoradoBouix,SMarin,ETerricabrasMas,ABocos-Baelo, CGarcía-Castiñeira,SGarcia-Xipell,CRodríguez-González,CQuiñones. Hospital UniversitariGermansTriasIPujol,PharmacyDepartment,Badalona,Spain

10.1136/ejhpharm-2024-eahp.147

BackgroundandImportance Clinicalmanifestationsofmigraine compromisepatient’squalityoflife(QoL).Randomisedstudies showedmonoclonalantibodiesagainstcalcitoningene-related peptide(AM-anti-CGRP)reducefrequencyandintensityof migraineepisodesbutthereisstilllackofreal-lifeeffectivenessandsafetydatainsomeclinicalscenarios.

AimandObjectives Assesstheone-yearefficacyandsafetyof AM-anti-CGRPinthosepatients’ refractorytootherprophylactictreatmentsthroughclinicalpharmacistassessment.

MaterialandMethods Observationalandretrospectivestudy includingpatientswithchronicmigraine(CM)orepisodic migraine(EM)whostartedtreatmentwithAM-anti-CGRP betweenMarch2020andMarch2022completingone-year treatment.

Pharmacotherapeuticfollow-upwasperformedtogether withtheNeurologyteam.Sex,age,typeofmigraineand numberofprevioustreatmentswerecollected.Migraine dayspermonth(MDM)andQoLscale(HIT-6)was assessedatbaseline,6-and12-monthsfollow-up.Treatment responsewasconsiderediftherewasanimprovementof 50%MDMat6monthsor 30%ofHIT-6atoneyear. Drugadverseeffectsthatconditionedtreatmentcontinuation wereassessed.

Results 42patientswereincluded(CM=29;EM=13),69% female,meanage44.6±9.9years.51treatmentswere recorded(22erenumab,23galcanezumab,6fremanezumab). Patientsreceivedameanof6±1.6(erenumabgroup),5.4±1.4 (galcanezumabgroup)and6.2±1.5(fremanezumabgroup) priortreatments.

Mean±SDbaselineMDMandmedian(range)HIT-6values were:17.6±8.0and67(52–74)(erenumabgroup),20.7±7.7 and68(53–78)(galcanezumabgroup)and20.8±8.7and70 (52–72)(fremanezumabgroup)days.

Mean±SDMDMvaluesat6-and12-monthfollow-up were:6.4±4.6and6.2±4.5(erenumab),10.7±8.2and10.3 ±7.7(galcanezumab)and6.7±0.6and7.5±2.1 (fremanezumab).

Median(range)HIT-6valuesat6-and12-monthfollow-up were:58.5(44–78)and53(44–74)(erenumab),62(46–78)and 65(54–76)(galcanezumab)and62(46–78)and65(54–76) (fremanezumab).

14(63.6%),15(65.2%)and3(50%)ofpatients, respondedtoerenumab,galcanezumabandfremanezumab, respectively.

3patientsdiscontinuedtreatmentduetoadverseeffects (n=2erenumab-group,n=1fremanezumab-group).

ConclusionandRelevance Highresponsesrates 50%were observedinthethreegroups,higherinthegalcanezumab groupalthoughconclusionslimitedduetosmallsample. Resultsshowtreatmentsweresafeandwell-tolerated,with only5.88%treatmentdiscontin uationsduetoadverseeffects. Multidisciplinaryfollow-upincludingclinicalpharmacist assessmentcouldhelpoptimisingtreatmentresponseand safety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-044 PRE-EXPOSUREPROPHYLAXISDROP-OUT:FOLLOW-UP ANDRELINKINGTHROUGHTELEPHONECONTACT

1ACalvoGarcía*, 2LJGarcíaFraileFraile, 1GEscuderoSánchez, 1BRamosMartínez, 1ERamírezHerraiz, 1JMSerraLópez-Matencio, 2ÁGutiérrezLiart, 1AArangurenOyarzabal, 2IDeLosSantosGil, 1AMorellBaladrón. 1HospitalUniversitariodeLaPrincesa,Pharmacy, Madrid,Spain; 2HospitalUniversitariodeLaPrincesa,InfectiousDiseases,Madrid,Spain

10.1136/ejhpharm-2024-eahp.148

BackgroundandImportance Pre-exposureprophylaxis(PrEP)is aneffectiveHIVpreventionstrategyforpeopleathighrisk ofinfection.Long-termadherencetoPrEPprograminour healthcaresettingisunknown.

AimandObjectives ToidentifyuserswhodroppedoutPrEP andtoevaluatetheusefulnessoftelephonecontactforrecapturing,throughamultidisciplinarystrategy(InfectiousDiseases-Pharmacy).

MaterialandMethods TransversalstudyonacohortofPrEP users(April2022-July2023).Potentialuserswithoutdrugdispensinginthelastthree-monthswereidentified.Clinicalhistorieswerereviewedtodetermine ‘truetreatment discontinuations’ (TTD).Thosepatientswerecontactedbytelephonetoofferrelinking.Statisticalanalysis:valueswere expressedasmedians(interquartilerange-IQR)andpatients (percentages).

Results Follow-upin292users:47(16%)potentialdropouts, 23(7.9%)TTD.Theremaining24:15casesweresuitable discontinuations,1unsuitablediscontinuation,3usedPrEPon demandwithoutrequiringstandarddispensing,1wastransferredtoanotherhospitaland4wereawaitingdispensation.

Abstract4CPS-044Table1 Characteristicsof23TTD

N(%)/median(IQR)

GenderCisman23(100)

Age33.6(29.5–39.7)

OriginSpainLatin-AmericaEurope/Western12(52.2)8(34.8)3(12)

MedicalhistoryPsychiatristsSmokerAlcoholNonsexualdrugsChemsexThree-month sessionsSlamsex

Previoussexually transmitted infection(STI)

6(26.1)11(47.8)16(69.6) 16(69.6)6(26.1)2.5(5)2 (8.7)

SyphilisMonkeyPox8(34.8)1(4.3)

%preservative65(52)

Couples/month6.5(4.3–11.5)

PreviousPrEP6(26.1)

Previouspost-exposureprophylaxis(PEP)NumberofPEPs13(56.5)1(0–2)

BaselinetestsVIHHepatitisBvirusHepatitisCvirus NeisseriagonorrhoeaeChlamydia trachomatis Lymphogranuloma venereum Mycoplasmagenitalium Syphilis

0001(4.3)002(8.7)0

N° users/month3.9(2.8–6.0)

Medicalrevisions1(0–2)

Reasonforlossof tracking DiscontinuationEndingriskybehaviour TransferMissedappointmentOthers

14(60.9)1(4.3)3(13)4 (17.4)1(1)

Relinkedpatients8(34.8)

ConclusionandRelevance AdherencetoPrEPprogramisa healthcarechallenge.UsersshowedhighriskofHIVandSTI transmission,andPrEPdrop-outcouldleadtonewavoidable HIVinfections.Telephonecontactcouldbeinsufficientto guaranteecontinuityinthisprogram.Thecollaborationof InfectiousDiseasesandPharmacyDepartmentensurescommunicationwiththeseusersandretentioninthisprogram.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-045 OPTIMISATIONOFOMALIZUMABFORSEVERE ALLERGICASTHMAINPAEDIATRICPOPULATION

CMDominguezSantana,FJSalmeronNavas,YReyesDeLaMata,ERiosSanchez, JMBorreroRubio*. HospitalUniversitarioPuertoReal,HospitalPharmacy,PuertoReal, Spain

10.1136/ejhpharm-2024-eahp.149

BackgroundandImportance Omalizumabisindicatedinchildrenaged6yearsandolderasadjunctivetherapytoimprove thecontrolofuncontrolledsevereallergicasthma(SAA).

AimandObjectives Toassesstheeffectivenessofomalizumab optimisationinpaediatricpatientswithSAA.

MaterialandMethods Retrospectivedescriptivestudyincludingallpaediatricpatientswhoreceivedomalizumabforthe treatmentofSAA.Theinitialdoseofomalizumabwas determinedaccordingtoIgElevels(IU/mL)andbodyweight (Kg).Optimisationstrategies:reductionofthedosereceived whilemaintainingtheadministrationintervalormaintaining thedoseandincreasingtheadministrationinterval,until discontinuationifpossible.Thefollowingvariableswere recorded:sex,age,initialdose,optimisations,treatment timetooptimisationandtreat mentdiscontinuation.Effectivenesswasmeasuredasthemaintenanceofstabledisease afteroptimisation.Safetywasassessedbyadversereactions (AR).

Results Thirty-eightpatients,25males,withamedianageof 10(6–13)yearswereincluded.22patientsstartedtreatment every4weeks(Q4W)and16patientsevery2weeks(Q2W). Themediandurationoftreatmentwithomalizumabwas59 (3–96)months.Thirty-sixpatientsunderwenttreatmentoptimisations.Themediantimefr omomalizumabinitiationto optimisationwas36(12–84)months.Thenumberofoptimisationsperformedwere:1(n=14),2(n=5), 3(n=8).26 patientsachievedtreatmentdiscontinuationduetodisease stability,9ofthemwithoutprioroptimisation.Sincetreatmentoptimisation,10patients experiencedlossofasthma stabilityduetoexacerbationofthedisease,3ofthem resumedthepreviouslyusedregimen.Allofthemsubsequentlyachievedasthmastabilisation.Sixpatientshadsome AR:fourhadheadaches,onehadweightgainandonehad flu-likesyndrome.

ConclusionandRelevance Omalizumaboptimisationguidelines inpatientswithallergicasthmawithstablediseasehavebeen effectiveinmostpatients,achievingdrugwithdrawalinmore thanhalfofthepatients.ThisomalizumaboptimisationstrategycouldreducetheriskofARofomalizumabinchildren andhelpstodecreasethecostsassociatedwiththedrug.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-046 EVALUATIONOFHEALTHIMPACTININFLIXIMABTREATEDPATIENTSWITHINFLAMMATORYBOWEL DISEASE:INCORPORATIONOFPATIENTREPORTED OUTCOMEMEASURES(PROMS)

LEstrada*,SMarin,GCardonaPeitx,AMorales,ETerricabrasMas,ABocos-Baelo,NFeliu Mas,CGarcía-Castiñeira,SGarcia-Xipell,CRodríguez-González,CQuiñones. Hospital UniversitariGermansTriasIPujol,PharmacyDepartment,Badalona,Spain

10.1136/ejhpharm-2024-eahp.150

BackgroundandImportance Anti-TNF-alphatherapy,suchas infliximab,istheinitialchoiceamongbiologictreatmentsfor inflammatoryboweldisease(IBD)whenconventionaltherapies fail.IBDcanimpactspatient‘slifequality.Therefore,integrate PatientReportedOutcomeMeasures(PROMs)offersavaluableapproachtomonitorttreatmentfromthepatient‘ s perspective.

AimandObjectives Assessdiseaseimpactininfliximab-treated patientsaffectedwithIBDsusingPROMs.

MaterialandMethods Cross-sectionalstudy.Patientswere includediftheywereoutpatientstreatedwithinfliximabfor ulcerativecolitis(UC)andCrohn ’ sdisease(CD), 18years. Socio-demographicandclinicalcharacteristicswerecollected fromclinicalrecords:age,gender,typeofIBD,starting dateofbiologicaltreatment,healthstatus,previousbiologicaltreatment,concomitantimmunosuppressivetreatment.To determinehealthstatus,weusedHarvey-BradshawIndex (HBI)forCDandPartialMayoScoreIndex(PMSI)for UC.Clinicalpharmacistsperformed2questionnairesto evaluatePROMsatoutpatientfacilties:IBDControl(IBDControl-8-scoreplusvisualanaloguescale(VAS),thatrange from0 – 16and0 – 100,respectively,higherscoresrepresentingbetterdiseasecontrol)andIBD-Disk(thatrangesfrom 0 – 100,higherscorerepresentinghigherIBDdaily-life burden).

Results 51patientswithCDand20withUCwereincluded (meanage44.4±13.5,63.4%men).

ThemeannumberofpatientspreviouslytreatedwithbiologicagentsinCDandUCwas13.7%and35%,respectively. Inbothgroupsthemajorityofpatientsweretreated>6 monthswiththeircurrentbiologicalagent(CD:50,UC:19). Patientstookconcomitanttreatmentwithoralimmunosuppressantsin80.4%inCDand65%inUC.

HealthstatusbyHBIinCD-groupwas:43remission-state, 5mild-disease,2moderate-diseaseand1severe-disease. Accordingtoquestionnaires:meanIBD-Control-8-scoreand VAS-scorewas11.9±4.2and82±21.4,respectively.Mean IBD-Diskscorewas33.6±27.4(70.6%ofpatients<50 points).

HealthstatusaccordingtoPMSIinUC-groupwas:16 remission-state,2mild-diseaseand2moderate-disease. Accordingtoquestionnaires:meanIBD-Control-8-scoreand VAS-scoreswas12.6±4and90.1±20.3,respectively.Mean IBD-Diskscorewas37.3±27.5(60%ofpatients<50 points).

ConclusionandRelevance Theresultsshowthatmostpatients inbothgroupswereinremissionasreflectedintheIBD-Control-8andVASscores.IBD-DISKshowsmoderatedailylife impact,with 60%scoring<50.Therefore,PROMsareusefultoolsandcouldbeincludedwithinpharmaceuticalpractice strategies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

Abstracts

4CPS-047

EVALUATIONOFANTIRESORPTIVEAGENT-RELATED OSTEONECROSISTHERAPYBYMEASURING CONCENTRATIONSOFPENICILLINGINJAWBONE

1RTrittler*, 2AErmer, 2PPoxleitner, 1MJHug. 1MedicalCenter-UniversityofFreiburg, Pharmacy,Freiburg,Germany; 2MedicalCenter-UniversityofFreiburg,DepartmentofOral andMaxillofacialSurgery,Freiburg,Germany

10.1136/ejhpharm-2024-eahp.151

BackgroundandImportance Antiresorptiveagent-relatedosteonecrosisofthejawbone(ARONJ)isaseverecomplication aftertherapywithbisphosphonatesordenosumab.ThecurrentARONJguidelinebytheGermanDentalandGerman OralandMaxillofacialAssociationsstatestheadministration ofsystemicantibioticsintendedasanadjuncttosurgeryto beobligatoryinalloperativeARONJtreatment.Penicillinbasedantibiotics(aloneorincombinationwithbeta-lactamaseinhibitorsormetronidazole)aretheagentsadministered mostfrequently.Knowledgeoftheachievableantibioticconcentrationsisimportantspeciallyastheefficacyofantibiotic treatmentdependssignificantlyonthepenetrationtothe infectionsite.

AimandObjectives TheaimofthisstudywastoobtainqualitativeandquantitativedataonpenicillinGconcentrationsin boneaffectedbyARONJfollowingintravenousadministration andgetcomparableresultstootherconcentrationsmeasured withthesameextractionmethod.

MaterialandMethods Samplesofnecroticboneandpre-and intraoperativebloodsampleswereobtainedat18to72min aftercompletionofasingleperioperativeinfusionwith10 millionIU(6000mg)ofpenicillinGfromatotalof19 patientsmeetingallinclusioncriteria.Thebonesampleswere extractedwithphosphatebuffersolutioninaproportionof 1:10asinthecomparativestudies.Afterdeproteinisationwith acetonitrile,weusedLC-MS(q-TOF)toanalysethebone extractsandtheserumsamples.Toevaluateminimuminhibitoryconcentrationsin mg/mltheboneconcentrations(mg/g) weremultipliedby1.5.

Results Asexpected,thevaluesoftheboneconcentrations werelowerthancomparableresultsreportedforhealthy jawbone(medianconcentrations2.7 mg/gvs.17.4 mg/g).The calculatedboneconcentrationsin mg/mlwere:14samples >1 mg/mL,2samples>0,1 mg/mLand3samples<0,1 mg/ mL.Withregardtobacteriacommonlyfoundinbone affectedbyARONJ,theminimum inhibitoryconcentrations (MIC/MIC90)valuesforpenicillinGweremostly exceeded.Themedianintraope rativeserumconcentration was116 mg/mL.

ConclusionandRelevance Theconventionalanalyticalmethod, developedinthehospitalpharmacyledtocomparableresults andwasrelevanttoevaluatethepreoperativeinfusionofpenicillinG.Asoraladministrationofantibioticsiscommonin clinicalpractice,asimilarstudymightbecarriedoutfocusing onantibioticsadministeredorally.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-048

ACOMPLEX,ADHERENCE-IMPROVINGPHARMACIST INTERVENTIONTOREDUCEHYPERPHOSPHATEMIAIN HEMODIALYSISPATIENTS

1CVanDeOever, 1EVasbinder*, 2TVanGelder, 1YSchrama, 3PVanDenBemt. 1Franciscus GasthuisandVlietland,Pharmacy,Rotterdam,TheNetherlands; 2LUMC,Pharmacy,Leiden, TheNetherlands; 3UMCG,Pharmacy,Groningen,TheNetherlands

10.1136/ejhpharm-2024-eahp.152

BackgroundandImportance Suboptimaltreatmentadherence tophosphate-bindingdrugsfrequentlyoccursinhemodialysis patients,mostlybecauseofahighpillburdenandacomplex treatmentschedule.Severalpharmacistinterventionshavebeen developedtoimproveadherencetophosphate-bindingdrugs, oftenwithminoreffectsonadherenceandphosphate concentrations.

AimandObjectives Wedesignedacomplex,adherence-improvingpharmacistinterventioninwhichbarrierstoadherenceare discussed,combinedwithadosereductionofphosphate-bindingdrugswiththeaimtoincreaseadherenceandthereby reducephosphateconcentrations.

MaterialandMethods Weperformedaprospective,singlecentreinterventionstudyin69hemodialysispatientswith hyperphosphatemiaandahighpillburdenofphosphate-bindingdrugs.Thecomplex,adherence-improvingintervention consistedofthreepharmacist-patientconsultationsatbaseline, at1–2weeks,andat3months.AtbaselinetheQuickBarrier Scan(QBS),toinvestigatebarrierstoadherence,andMARS-5 (MedicationAdherenceReportScale5,patient-reportedadherence),wereadministered.At1–2weeks,thepharmacistprovidedpatientrecommendationsbasedontheQBS,plusadose reductionforphosphate-bindingdrugs.Afterthreemonths, patientexperienceswerediscussed,andMARS-5wasrepeated. Theprimaryoutcomeparameterwasthemeanphosphateconcentrationinthethreemonthsafterstartoftheintervention versusthethreemonthsbefore.Secondaryoutcomeparameterswerepillburdenforphosphate-bindingdrugsandpatientreportedadherence(MARS-5)atbaselineandafterthree months.DatawereanalysedwithSPSSversion28.0,apaired T-testwasusedtocomparephosphateconcentrationsandpill burden,theWilcoxonsignedranktestwasusedtocompare MARS-5.

Results Themean(±SD)phosphateconcentrationdidnot change(1.99±0.38mmol/Lbeforeversus2.04±0.35mmol/L after,p=0.193).Meandailyphosphate-binderpillburden decreasedfrom8.6±3.1to5.7±2.7units(p<0.001).Patientreportedadherenceincreased,althoughthemedianadherence didnotchange(24IQR22–25,before,versus24IQR23.25–25after,p=0.008).

ConclusionandRelevance Althoughtheinterventiondidnot reducephosphateconcentrations,amajorreductioninphosphate-binderpillburdenwasachieved,whichimpliesamore effectiveuseofthephosphate-bindingdrugs.Thiscomplex, adherence-improvinginterventionseemspromisingindecreasingpillburdenandimprovingadherence,butourresultsneed tobeconfirmedinlarger,controlledstudies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Conflictofinterest.

Corporatesponsoredresearchorothersubstantive relationships:

ThestudywaspartiallyfinanancedwiththePIONIER+ fundfromtheDutchKidneyfoundation

4CPS-049 TREATMENTOFROSAIDORFMAN’SHISTIOCYTOSIS: CASEREPORT

1SErdozain*, 1BLarrayozSola, 2JIllarramendiEsteban, 2AAldeaGarciaDeVicuña, 1NLarreaGoñi, 1APinoRamos, 1MSarobeCarricas. 1HospitalUniversitariodeNavarra, PharmacyDepartment,Pamplona,Spain; 2HospitalUniversitariodeNavarra,Hematology, Pamplona,Spain

10.1136/ejhpharm-2024-eahp.153

BackgroundandImportance RosaiDorfmandisease(DRD)isa rarenon-Langerhanshistiocytosis.Thereisnoestablished treatment,andifnecessarytherearefewtherapeuticoptions whichhavelimitedevidence.DRDhasrecentlybeenrelated totheidentificationofmutationsinthemitogenicactivation proteinkinase(MAPK)-dependentsignalingpathway,beingan interestingtargetforitstreatment.

AimandObjectives Thisreportwilldiscussthecaseofa patientwithDRDwhorespondedadequatelytotargetedtherapywithtrametinib,afterfailuretoseverallinesoftreatment.

MaterialandMethods Theepisodesinoncohematologyday hospitalofpatientsdiagnosedinatertiaryUniversityHospital arereviewed.Abibliographicreviewofcasesdescribedwith similarsymptomswascarriedout.ThePharmacyServicecollaboratedinthesearchforapossibleeffectivetreatmentand justifiedtheneedtostarttreatmentwithaMEKinhibitor.

Results 45-year-oldpatientbeingfollowedupforgastrointestinalepisodesandlymphadenopathywhowasdiagnosedwith histiocytosiscompatiblewithDRDin2021.Itwasstarted treatmentwithcorticosteroidsatadoseof1mg/kg,whichin theeventofrefractorinesswaschangedtopeginterferonalfa (90mcg)withoutresponse.AtthebeginningofMarch2023, hewasadmittedtothewardduetodeepveinthrombosis andpulmonarythromboembolism.Hereceivedanewtreatmentregimenwithanakinrafor13dayswithoutsuccess.The caseisconsultedanditisdecidedtochangetoaMEKinhibitor.Itsuseisrequestedoutsideofindicationdespitenot obtaininganyalterationintheMAPKpathway.Trametinib wasstartedatadoseof1mg/day.After3months,shecurrentlyhasgoodtolerancewithplateletcountsof37,000and decreasedlymphadenopathy.Astoxicitytotrametinib,acneiformrashhavebeenreported.

ConclusionandRelevance Thereisnowell-definedprotocol forthetreatmentofDRDandthereforetheyrepresentadiagnosticandtherapeuticchallenge.Thiscasecontributestothe limiteddatapublishedontargetedtherapywithMEKinhibitorsinDRDwhencasesarerefractorytotraditional therapies.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SuccessfulTreatmentofNon-LangerhansCellHistiocytosiswiththeMEKInhibitor Trametinib:AMulticenterAnalysis. BloodAdvances. 2022,Dr.Diamond. 2.MultipleDrugRegimen-RefractoryRosai-Dorfman-DestombesDiseaseMimicking RelapsingPolychondritisSuccessfullyTreatedwithCobimetinib. EuropeanJournal ofCaseReportsinInternalMedicine, 2022.

ConflictofInterest Noconflictofinterest.

4CPS-050 PRE-EXPOSUREPROPHYLAXISFORHIVINFECTION: PREVALENCEOFSEXUALLYTRANSMITTED INFECTIONS(STIS)ANDADHERENCEDURINGTHE PROGRAMME

SMagantoGarrido,AFijóPrieto,MMonteroLázaro,EAbadLecha,PBlancoGarcia*, CGuitianBermejo,AParienteJunquera,MGómezDíaz,MLlorenteGómez,CGonzález Sama,TSánchezSánchez. HospitalClínicoUniversitariodeValladolid,Farmacia Hospitalaria,Valladolid,Spain

10.1136/ejhpharm-2024-eahp.154

BackgroundandImportance Pre-exposureprophylaxis(PrEP)is apreventivemeasuretoavoidHIVinfection.TheEuropean MedicinesAgencyapprovedtheguidelineofanalreadymarketedantiretroviraldrug,Emtricitabine+Tenofovirdisoproxil fumarate,foronce-dailyuse,which,combinedwithotherpreventionandeducationmeasures,aimstodecreasethetransmissionofthisdisease.Thisprogrammewasimplementedin ourhospitalinNovember2021.

AimandObjectives Toanalyseadherencetotreatmentandthe occurrenceofSTIsinpatientsincludedinPrEP.

MaterialandMethods Observational,prospective,single-centre study.Inclusioncriteria:subjectswhometthecriteriafor PrEPprogramfunding,fromJanuary2022toMarch2023in atertiarylevelhospital.ThevariablescollectedwereadherenceandSTIoccurrencebeforesubjects’ inclusionintheprogramandthosedetectedduringprogrammeparticipation. AdherencetotreatmentwasestimatedthroughtheSimplified MedicationAdherenceQuestionnaire(SMAQ)anddispensing records(DR).

Results 50candidateswereincludedinthestudywithamean ageof39years(range:23–68).Atthebeginning,18subjects (36%)showedatleastonesexuallytransmittedinfection:6/18 (33%) Ureaplasmaurealyticum,3/18(17%), Neisseriagonorrhoeae,3/18(17%), Chlamydiatrachomatis,3/18(17%) Mycoplasmagenitalium,2/18(11%) Haemophilus and1/18 (5%) TreponemaPallidum,whileatquarterlycontrolatleast oneSTIwasdetectedin22(44%)ofsubjects:6/22(27%) Chlamydiatrachomatis,4/22(18%) Neisseriagonorrhoeae,4/ 22(18%) Haemophilus,3/22(14%) Streptococcusagalactiae, 2/22(9%) Ureaplasmaurealyticum,2/22(9%) Mycoplasmagenitalium and1/22(5%) TreponemaPallidum.Adherenceto treatmentbyevaluationwiththeSMAQandRDquestionnaire was96%and92%respectively.

ConclusionandRelevance Inourstudyweobservedan increaseinSTIsaftertheinclusionofsubjectsinthisprogramme,duetosexualriskcompensation.However,thisprogrammehasboostedtheincreaseofSTIscreeningtestsand moreSTIscanbediagnosedandtreated.Regardingadherence, inourstudyweobtainedhighadherenceratesmeasuredby twomethods(SMAQandDR).

REFERENCESAND/ORACKNOWLEDGEMENTS

COSTSAVINGIMPACTOFBIOSIMILARTRASTUZUMAB FORTHETREATMENTOFHER-2POSITIVEBREAST CANCERINAHOSPITAL

JDParadasPalomo*,JCDelRioValencia,RTamayoBermejo,IMuñozCastillo,SMartin Clavo,BMoraRodriguez,MEspinosaBosch. Hospital,PharmacyService,Malaga,Spain

10.1136/ejhpharm-2024-eahp.155

BackgroundandImportance Theongoingriseinhealthcare costsmakesitnecessarytoestablishcontainmentstrategies,in parallelwiththecommitmenttoimproveaccesstothemost effectiveandsafesttreatments.Inthissense,itispostulated thattheavailabilityofthebiosimilartrastuzumabofferscost savingscomparedtotheinnovator,whichcouldleadpatients toswitchdrugs,maintainingefficacywhiledecreasingthecost ofHER-2positivebreastcancertreatment.

AimandObjectives Theaimofthisstudywastoevaluatethe costsavingimpactoftheintroductionofbiosimilartrastuzumabinthetreatmentofHER-2positivebreastcancerina tertiaryhospital.

MaterialandMethods Observational,retrospectivestudyof patientstreatedwithbiosimilartrastuzumabbetweenJanuary 2022andDecember2022inatertiaryhospital.

Variablescollected demographics(sexandage),numberof patients,stage(earlystage,locallyadvancedormetastatic)and economic(priceoforiginaltrastuzumabandbiosimilar trastuzumab).

Variablesanalysed economicsavings,estimatednumberof patientswhocouldbenefitfromtreatmentbasedonthesavingsachieved.

Results 59patientsincludedbetweenJanuaryandDecember 2022withamedianageof54.7+/-12.27.42.4%(n=25)had anearlystage,23.7%(n=14)locallyadvancedand33.9% (n=20)metastatic.

Inourhospital,thepriceofonebiosimilar-trastuzumab420mgvialisC ¼ 130(0.31C ¼ /mg)andC ¼ 414.4for1originaltrastuzumab-150mgvial(2.76C ¼ /mg).Treatmentofour patientswithbiosimilartrastuzumabcostatotalof C¼ 66,011.4.Ifthesepatientshadbeentreatedwiththeoriginaltrastuzumab,thecostwouldhavebeenC ¼ 587,714.4,a savingof88.7%(C ¼ 521,703).

Iftheaverageweightofa54-year-oldwomaninSpainis about70–75kgaccordingtotheStatisticsNationalInstitute, thesavingofC ¼ 587,714.4(1,895,852.9mg)wouldallowthe 18-cyclefinitetreatmentbetween229and246womenwith early-stagebreastcancer.

ConclusionandRelevance Innovationinbiologicaltherapies,as wellastheincreaseincandidatestoreceivethem,hasgrown significantly.Itisassociatedwithanincreaseincoststhatmay becomeunaffordableforpublicHealthService.Theinclusion ofbiosimilardrugsinbreastcancerrepresentsasignificant economicsavinginthetreatmentofbreastcancer,whilecontributingtomaintainingthesustainabilityofthenational healthsystem.

REFERENCESAND/ORACKNOWLEDGEMENTS Noconflictofinterest.

ConflictofInterest Noconflictofinterest.

4CPS-052 EVALUATIONOFUSTEKINUMABUSEIN INFLAMMATORYBOWELDISEASES

MJLucasMayol,OGuillénMartiínez,ICastejónGrao,MMoranteHernández,ACMurcia López,ANavarroRuiz*. HospitalGeneralUniversitariodeElche,FarmaciaHospitalaria, Elche,Spain

10.1136/ejhpharm-2024-eahp.156

BackgroundandImportance UstekinumabisamonoclonalantibodyusedininflammatorydiseaseslikeCrohn´sdisease(CD) andulcerativecolitis(UC).Sometimes,anintensificationofits dosageisnecessarytoachievethegoal.

AimandObjectives Theobjectiveistoknowthedosageusuallyusedinourpatientscomparedtothatindicatedinthe label,andtheeconomicimpactwhenanintensifieddosageis used.

MaterialandMethods Retrospective,observationalstudy. Patientswithinflammatoryboweldisease(IBD)treatedwith UstekinumabfromJanuary2022toMarch2023.Thevariablescollectedwereage,sex,weight,indication,dosage(inductionandmaintenanceregimen)andpriorbiological treatments.ThedatawasobtainedthroughOrionClinic® and FarmisOncofarm®.Theeconomicdatawereobtainedusing OrionLogis®

Results 39patientstreatedwithUstekinumabwereanalysed, being59%(23)men.Themedianagewas54yearsandthe averageweightwas67kg.TheindicationforwhichUstekinumabwasprescribed:CDin82%(32)andUCin18%(7). Regardingprevioustreatmentswithbiologicaldrugs,82%(32) hadbeentreatedwithasinglebiologicaldrug,while18%(7) hadusedtwopreviouslinesoftreatment.Inallcases,the intravenousinductionregimenwasinaccordancewiththe labelaccordingtoweightrange:9patientswere260mg(£ 55 kg),24received390mg(>55kgto £ 85kg),and6patients 520mg(>85kg).Regardingthemaintenanceregimen,49% (19)ofthepatientscontinuedwiththedosageestablishedin thelabel(90mgsubcutaneous(sc)every8weeks).Inthe remainder,correspondingto51%(20),thedosageregimenwas intensifiedmainlyduetoclinicalcriteria:3%(1)continued with90mgsc/6weeks,3%(1)with40mgsc/4weeks,41% (16)intreatmentwith130mgIV/monthly,and5%(2)with 130mgIV/15days.Theaveragecostofthetreatmentthe firstyearinpatientswhousethedosageofthelabelis 20148C ¼ ,whereastheaveragecostinintensifieddosageis 38533C ¼

ConclusionandRelevance Inhalfofthepatients,themaintenancedosagewasofflabel,requiringchangesinboththedosageregimenandtherouteofadministrationtoachievethe clinicalobjectives,highlightingtheneedofindividualisation.In addition,theintensificationdosageinvolvesafinancialcostof almosttwiceasmuch.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest

4CPS-053 OUTCOMESOFINFRADOSEDANTIMICROBIALS PATIENTSWITHBACTEREMIAINTHEEMERGENCY DEPARTMENT

1AMonje*, 1SOjeda, 2BTorrecilla, 1JRuiz, 1APlaza, 1AJuanes. 1HospitaldelaSantaCreu ISantPau,Pharmacy,Barcelona,Spain; 2HospitaldelaSantCreuYSantPau,Pharmacy, Barcelona,Spain

10.1136/ejhpharm-2024-eahp.157

BackgroundandImportance Bacteremiaisamajorcauseof sepsisandisassociatedwithhighmorbidityandmortality. Suboptimalantibioticdosinginthebacteraemicpopulationhas previouslybeenassociatedwithpooreroutcomesintheEmergencydepartments(ED).

AimandObjectives Thisstudyhasbeendesignedtoanalyse clinicaloutcomesinpatientswithbacteraemiawhenreceiving suboptimalantibioticdosing(SAD).

MaterialandMethods Observational,retrospectivecohort studyperformedinathird-levelhospitalinSpain.The populationstudiedincludedp atientsadmittedinanED withpositivebloodcultures fortruepathogenicmicroorganisms(November2021toJune2022).SADwasdefined accordingtoStanfordSevereSepsisandSepticShockAntibioticGuide(2020),exceptforceftriaxone,inwhichwe usedtherecommendationof AaronJ.Heffernanetal, 2020 (2g/24h).Datawerecolle ctedondemographics, microorganismsresponsiblefortheinfection,focusof infection,antibioticsanddosesusedandoutcomesinterms of30-daymortality.

Results Atotalof442patientswithbacteremiacausedbya microorganismsusceptibletotheantibioticprescribedinthe EDwereevaluated(Meanage:73±15years,54%male), being54(12%)consideredasSAD.Fromthesepatients,24 infections(44%)werecausedby E.coli, beingthemainfocus theurinarytract(n=29,54%).ThemostfrequentlySAD treatmentswerebeta-lactams(n=35,65%),followedbycarbapenems(n=17,32%),vancomycin(n=8,15%)andaminoglycosides(n=5,9%).Amongbeta-lactams,ceftriaxonewas prescribedinSAD(1g/24h)in8patients(22%);withincarbapenems,meropenemwasusuallyprescribed(withoutloading dose)adjustedtokidneyimpairmentinthemomentofadmission.PatientswhoreceivedSADpresentedahigher30-mortalitythanthosewhoreceivedanappropriatedosing(22%vs 7%;p=0.001).

ConclusionandRelevance SADinbacteraemicpatientsinthe EDis12%,beingassociatedwithhigherriskofmortality. Beta-lactamsandcarbapenemsarethemostprescribedantibioticsinbacteraemiatocovergram-negativespectrum.ApossibleexplanationforSADintheEDmightbethatantibiotics areadjustedaccordingtorenalfunctioninthemomentof admission.Wedon’trecommendadjustingdosesofantibiotics duringthefirst24–48hoftreatmentinordertoreducethe riskofSAD.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-054 NETWORKMETA-ANALYSISOFTHERAPEUTIC ALTERNATIVESFORMODERATETOSEVERE ULCERATIVECOLITIS

1AMartinezSuarez, 1JCorderoRamos, 2MDGil-Sierra, 1LAmaro*. 1HospitalUniversitario VirgenMacarena,PharmacyDepartment,Seville,Spain; 2ServicioAndaluzdeSalud, PharmacyDepartment,Jerez,Spain

10.1136/ejhpharm-2024-eahp.158

BackgroundandImportance Moderate-to-severeulcerativecolitis(UC)canbetreatedwithseveraltherapeuticalternatives. Recently,newdrugshavebeenevaluatedinthisdisease.

AimandObjectives Todevelopanetworkmeta-analysis (NMA)tocomparetheefficacyoftreatmentsformoderate-tosevereUC.

MaterialandMethods Scientificpublicationsindexedin

Pubmedwereused.Inclusioncriteria:pivotalrandomisedclinicaltrials(RCT)includingrecentdrugs(filgotinib,ozanimod, tofacitinib,upadacitinib,ustekinumabandvedolizumab)inmoderate-to-severeUC.Exclusioncriteria:RCTwithoutacomparatorcommon(placebo).Relevantclinicalbaseline characteristicsofpopulationswereconsidered:age,gender, diseasedurationandpriorbiologicuse.Efficacyendpointwas clinicalremissionaccordingtoFullMayoScore.Induction (week6,8or10)andmaintenance(week52,48or60) resultswereanalysed.Rv4.2.3statisticalsoftwarewasusedto performtheNMA.Oddsratio(OR)werecalculatedbybayesianmethodsandfixedeffectmodelwereassessed.

Results

ElevenRCTwereselected Agewassimilarinallpopulations. Femalegenderreachedpercentagesofapproximately40%of patients,exceptforfingolimod200mg/day(49.8%)andtofacitinib5mg/12hoursmaintenance(46.1%).Diseasedurationwas generallybetween6–7years,beingmoredurableinpatients receivingupadacitinib45mg(induction)and15–30mg(maintenance)/day(8.6years),andvedolizumab300mginweeks0–2-6 andthenevery8weeks(8.3years).Pre-treatmentwithbiologicalagentswasaround51%ofpopulationsinmostRCTs, exceptforvedolizumab300mginweeks0–2-6andthenevery 8weeks(42.6%),vedolizumab108mg/biweeklysubcutaneous inmaintenance(39.2%)andozanimod1mg/day(30.2%).In inductionresults,upadacitinib45mg/day(OR9.43;95%CI 5.38–16.54)achievedthegreatestmagnitudeofeffectand onlyozanimod1mg/day(OR5.15;95%CI2.76–9.61)showed similarefficacy.Inmaintenanceresults,upadacitinib30mg/day (OR7.87;95%CI4.38–14.13)reachedthebesteffectmagnitude.Regardingupadacitinib30mg/day,nostatisticallysignificantdifferenceswerefoundwithupadacitinib15mg/day (OR5.25;95%CI2.91–9.48),filgotinib200mg/day(OR 4.68;95%CI2.35–9.33)andvedolizumab108mg/biweeklysubcutaneous(OR4.23;95%CI2.14–8.39).

ConclusionandRelevance ThisNMAprovidedareviewof efficacyofrecenttherapiesformoderate-to-severeUCaccordingtoclinicalremission.Ininduction,upadacitinib45mg/day andozanimod1mg/daywerethemosteffectiveschemes.In maintenance,similarbenefitwasobservedwiththefollowing regimens:vedolizumab108mg/biweeklysubcutaneous,filgotinib 200mg/dayandupadacitinib15mg-30mg/day.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-055

PHARMACOGENETICSANDITSAPPLICATIONSIN PERSONALISEDMEDICINE:ASYSTEMATICREVIEW

LAmaro*,JCordero,AMartínez-Escudero,AAguado,MÁCalleja. HospitalUniversitario VirgenMacarena,HospitalPharmacy,Seville,Spain

10.1136/ejhpharm-2024-eahp.159

BackgroundandImportance Pharmacogeneticsevaluateshow geneticvariationsinfluencedrugresponses.Nowadays,genetic testshaveadvanced,becomemoreaffordable,anditsintegrationaresupportedbystrongerclinicalevidence.Guidelines suchasthosefromCPICandresourceslikePharmGKBfacilitategenotype-basedprescribing.OrganisationsliketheFDA promotegenetictestingbeforeinitiatingcertainmedications. Preventivepharmacogeneticpanelsseemspromising,butfurtherresearchonbiomarkersanddiversepopulationsis needed.

AimandObjectives Thisreviewexaminesrecentevidenceon thegenotype-drugresponserelationshipanditsapplicationin clinicalpractice.

MaterialandMethods Asystematicsearchwasconductedon PubMedtoidentifyarticlesinvestigatingthegenotype-drug responserelationship.Thesearchstrategyincludedtermssuch as ‘pharmacogenetics,’‘personalisedtreatment,’‘precisionmedicine,’‘doseadjustment,’‘individualiseddosing,’‘clinicalroutine,’ and ‘clinicalpractice.’ Studiessuchasclinicaltrials, observationalstudies,andmeta-analyseswereincluded.The

Abstract4CPS-055Table1

initialsearchyieldedatotalof136articlespublishedbetween 2013and2023foranalysis.

Results 49articleswereincludedforthefinalanalysis.The characteristicsofthearticlesareexplainedintable1.

Arelationshipbetweengeneticpolymorphismsanddrug responseortoxicitywasfoundfordrugssuchasopioids, GLP-1agonists,tacrolimus,oralanticoagulants,oralantineoplastics,atypicalantipsychotics,efavirenz,clopidogrel,lamotrigine,anti-TNFa agents,voriconazole,SSRIs,orstatins,among others.However,fordrugslikemetformin,quetiapine,irinotecan,bisoprolol,andanti-VEGFagents,nostatisticallysignificantassociationbetweengenotypeandresponsewasfound. ConclusionandRelevance Thestudiesanalysedinthisreview suggestastrongcorrelationbetweengeneticvariabilityand individualdrugresponses,supportingtheuseofpharmacogeneticsfortreatmentoptimisation.However,forcertaindrugs likemetformin,quetiapine,etc.,theinfluenceofgenotypeon theirresponseremainsunclear.Morestudieswithlargersamplesizes,greaterethnicdiversity,andconsiderationofnongeneticfactorsareneeded.Lackofstandardisationinanalysis methodsandaccessibilitytogenetictestingaresignificantchallengesinthisfield.Insummary,pharmacogeneticsshows immensepotentialinpersonalisedmedicine,butfurther researchisrequired.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-056

EFFECTIVENESSANDSAFETYOFERIBULINTHERAPY INPATIENTSWITHMETASTATICBREASTCANCER

MJGándaraLadrónDeGuevara,SCanoDominguez,MPAznartePadial,LMatínezDueñas-Lópezmarín,AJimenezMorales*. HospitalUniversitarioVirgendeLasNieves, HospitalPharmacy,Granada,Spain

10.1136/ejhpharm-2024-eahp.160

BackgroundandImportance Eribulinisoneofthetherapeutic alternativesforpatientswithmetastaticbreastcancer.Inclinicalpractice,itsusewilldependontheparticularcharacteristicsofeachpatient.

AimandObjectives Toreviewthetreatmentusedwitheribulin inourpatientsandtoanalysetheeffectivenessandsafety achieved.

MaterialandMethods Retrospectiveobservationalstudyof patientsdiagnosedwithmetastaticbreastcancerwasconducted.Age,doseanderibulincyclesreceivedwererecorded. Previouslinesoftreatmentwereanalysed.Progression-freesurvival(PFS),overallsurvival(OS)andsafetyoferibulintreatmentinourpatientswereevaluated.

Results Fortywomendiagnosedwithher2-metastaticbreast cancerduringJanuary2021untilJanuary2023wereincluded.

Themeanagewas60years(42–80years).58%(23/40) receivedfulldosesoftreatmentand42%(17/40)received reduceddoses.Theaveragenumberofcyclesreceivedwas6 cycles(2–19).Themeannumberoftreatmentspriortoeribulinwas3treatments(1–6).Eribulinwasusedinmostpatients inthefourthlineoftreatment58%(23/40),secondandthird line20%(8/40),fifthline15%(6/40),betweensixthandeighth lines20%(8/40).Thefirstlineoftreatmentusedwasestrogen blockerstogetherwithcyclininhibitors(48%).Thesecond lineoftreatmentwasoralcapecitabine(45%)andvinorelbine (37%).Inthethirdlinecapecitabine(18%),vinorelbine (18%),taxol(15%)andliposomaldoxorubin(15%).ThePFS achievedwitheribulintreatmentwas6months(3–20)andthe OSwas3months.(6–2).Eleven(27%)patientswereexitus. GradeIIIadversereactionsdescribedwerealopecia(20%), neurotoxicity,neutropeniaandpain(2%).GradeIIwereasthenia,alopecia,mucositis,neurotoxicityanddiarrhoea(2%). GradeIbonepain,mucositis,asthenia,increasedtransaminase levels(10%).

ConclusionandRelevance Eribulinhasbeenabletobeusedat fulldosesdespitebeinganadvancedlineoftreatmentin multi-treatedpatients.

Progression-freesurvivalandoverallsurvivalachievedis acceptableasatreatmentinpatientswithadvancedmetastatic disease.

Alopeciaisafrequentandimportantreactionthatcanconditionthechoiceoftreatmentinthesepatientsandjustifies theuseoferibulininlaterlinesoftreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-057 EFFECTIVENESS,SAFETY,ANDPATIENT-REPORTED OUTCOMEOFJANUSKINASEINHIBITORSIN RHEUMATOIDARTHRITISINCLINICALPRACTICE

MIglesiasRodrigo*,NMecaCasasnovas,JPardoPastor,FSalazarGonzalez,BTenasRius, IVázquezMajó,CSebastiánCarrasco,JNicolásPicó. Pharmaceutic,HospitalaryPharmacy, Terrassa,Spain

10.1136/ejhpharm-2024-eahp.161

BackgroundandImportance Januskinaseinhibitors(iJAK)are emergingasaneffectivealternativeinthetreatmentofrheumatoidarthritis(AR),withamanageabletoxicityprofile.Currently,thereisagrowingemphasisonachieving comprehensiveremissionthatincludespatient-reportedoutcomes(PROs).

AimandObjectives AssesstheeffectivenessandsafetyofiJAK treatmentinclinicalARpractice.

AnalyzetheresultsobtainedfromspecificPROstoAR. MaterialandMethods Retrospectivedescriptivestudyincluding patientswithARtreatedwithiJAKsbetweenFebraury2018June2023.Datacollectedfromelectronicmedicalrecords: sex,age,iJAKtreatment,drugpersistence,concomitantdisease-modifyingantirheumaticdrugs(DMARDs),treatmentregimen,currenteffectivenessparameters(DiseaseActivityScore on28jointcounts[DAS28],andClinicalDiseaseActivity Index[CDAI]),specificPROs(RheumathoidArthritisImpact ofDisease[RAID]andRoutineAssessmentofPatientIndex Data[RAPID3]),andadverseeffects(AE).

Results 34patientsincluded.Meanage:58,12years(SD: 8,21).91,18%women.52,94%ofpatientsundergoingtreatmentwithbaricitinib,20,59%upadacitinib,14,71%filgotinib,11,76%tofacitinib.Averagedrugpersistence:26,84 months(SD:20,00).32,35%ofpatientsreceivingconcomitanttreatmentwithDMARDs.Treatmentregimen:35,30% ofpatientsinfirst-linetreatment,32,35%second/third-line, 32,35%fourth-line/higher.AccordingtoDAS28,44,12%of patientswereinremission(DAS28:2,16;CDAI:3,21;RAID: 1,62;RAPID3:4,15),32,35%lowdiseaseactivity(DAS28: 2,99;CDAI:8,09;RAID:4,24;RAPID3:10,38),17,65% moderateactivity(DAS28:3,97;CDAI:13,42;RAID:3,93; RAPID3:11,80),and5,88%highactivity(DAS28:5,66; CDAI:20,50;RAID:5,35;RAPID3:14,80).23.52%of patientsexperiencedAE:8,82%gastrointestinal,5,88%cardiovascular,2,94%infectious ,2,94%metabolicdisorder, 2,94%headache.

ConclusionandRelevance Nearlyhalfofpatientsreceiving iJAKtreatmentareinclinicalremission,andalmost75%demonstratefavourableoutcomesinactivityparameters(remission/ lowactivity).Therefore,iJAKsmayrepresentapromising treatmentalternativeinAR.Parametersofeffectivenessalign withPROsresults.Regardingsafety,iJAKsexhibitamanageableandexpectedsafetyprofile.

InclusionofPROsintheconceptofcomprehensiveremissioninARprovidesamorecompleteperspectiveofthe patient‘scondition.Thisenablesguidingfutureinterventions, suchasprioritisingpatientswithpoorerARcontrolorimplementingstrategiestooptimisehealthcaremanagement.

Theroleofthepharmacistiscrucialinensuringtreatment efficacy,adherence,andearlydetectionoftoxicities.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-058 ANALYSISOFANTIFUNGALCONSUMPTIONINAN INTENSIVECAREUNITOVER5YEARS

1IPatier*, 2MAchaques-Rodriguez, 3FJAlonso-Zazo, 4FFernandez-Fraga. 1Hospital UniversitariodeSanJorge,Pharmacy,Huesca,Spain; 2UniversitarioQuironsaludMadrid, Pharmacy,PozuelodeAlarcon,Spain; 3HospitalClínicoSanCarlos,Pharmacy,Madrid, Spain; 4HospitalUniversitariodeMostoles,Pharmacy,Mostoles,Spain

10.1136/ejhpharm-2024-eahp.162

BackgroundandImportance Fungalinfectionsposeahigh cost,bothintermsofmorbidityandmortality,aswellaseconomically.Antifungaltreatments(AF)generallyreceiveless attentionandreviewinAntimicrobialStewardshipPrograms (ASP)thanantimicrobials.Theseinfectionshaveincreasedin recentyears,primarilyduetotherisingnumberofpatients withriskfactorsforinvasivefungalinfection,suchasimmunosuppressedpatientsandthosewhohavereceivedbroadspectrumantibiotictreatments.

AimandObjectives Toanalysetheconsumptionofbroad-spectrumantifungalsintheIntensiveCareUnit(ICU)ofour centreovera5-yearperiod,observetrends,andassess whethertheSARS-CoV-2pandemichasalteredtheirusage.

MaterialandMethods Thisisacomparative,retrospective, longitudinalstudyoftheconsumptionofsystemicbroad-spectrumantifungals(liposomalamphotericinB,voriconazole,caspofungin,anidulafunginandmicafungin)intheICUofa third-levelUniversityHospitalinSpain.DDDandDOT/100 BedDayswerecalculatedforeachAF.Dataontreatment durationandthenumberofepisodeswithprescribedantifungalswereobtained.

Results Overthe5-yearstudyperiod,atotalof855admissionswereincluded,generatingacumulativestayof10,686 days,withAFprescribedin12episodes/100admissions.A consistentdistributionpatternwasobserved,withliposomal amphotericinB(LBL)beingtheprimaryprescribedAF(close to50%),followedbyechinocandins(30%),andfinallyvoriconazole(25.3%).Themedianoverallconsumptionwas39.26 DDD/100B(39.21–65.12)and9.03DOT/100B(8.34–10.46). Thisrepresenteda42.9%decreaseinDDD/100Banda 42.5%decreaseinDOT/100B,primarilyduetoreducedLBL usage,whichdecreasedby54.3%.RegardingtheaveragedurationofeachAFcycle,therewasadecreasingtrendfrom 12.65to9.4days.

ConclusionandRelevance TheconsumptionofAFinour centre’sICUhassignificantlydecreasedduringthestudy period,coupledwithareductionintheaveragetreatment duration.ConcerningthemostacutephaseoftheCOVID-19 pandemic(2020),thereisanincreaseinAFconsumption relatedtoanincreaseinthenumberofepisodeswithAFand overallICUactivity,whichdecreasesin2021and2022.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-059 SEVENTEENDRUGS,ONESAMPLE:ANALYSING MULTIPLEANTI-TUBERCULOSISDRUGS SIMULTANEOUSLYUSINGONEMETHOD 1MBolhuis*, 1EJongedijk, 2OAkkerman, 3DTouw, 1MSturkenboom. 1UniversityMedical CenterGroningen,ClinicalPharmacyandPharmacology,Groningen,TheNetherlands; 2UniversityMedicalCenterGroningen,PulmonaryDiseasesandTuberculosis-TbCenter Beatrixoord,Groningen,TheNetherlands; 3UniversityMedicalCenterGroningen,Clinical PharmacyandPharmacology-UniversityofGroningen-DepartmentofPharmaceutical Analysis-GroningenResearchInstituteofPharmacy,Groningen,TheNetherlands

10.1136/ejhpharm-2024-eahp.163

BackgroundandImportance In2021,atotalof1.6Mpeople diedfromtuberculosis(TB),althoughitisapreventableand curabledisease.Dependingonsusceptibility,TBistreatedwith acombinationofseveralof20anti-TBdrugsfromtheWorld HealthOrganization(WHO)treatmentguidelines.Interindividualvariabilitymayresultintoxicityorineffectivetreatment.

Therapeuticdrugmonitoring(TDM)canbeusedtooptimise dosingandtreatment.However,severalanalysesmaybe needed,whichistimeconsuming,expensive,andmayresult inneedingmultiplesamplesfromapatient.

AimandObjectives Therefore,weaimedtodevelopasimple methodtoanalyseallanti-TBdrugsinoneanalysis.

MaterialandMethods Wedevelopedaliquidchromatography tandemmassspectrometry(LC-MS/MS)methodinplasma, serumorsaliva,allowingsimultaneousanalysisof17anti-TB drugsand6metabolites.Theruntimeofanycombinationof these17drugsonlytakes1.7minutes.Wecheckedallstandardparametersassuringthequalityofouranalysisand checkedtheexpiryofthesamplesatdifferenttemperatures, allowingextrapolationtolow-incomecountries.

Results Withthismethod,weareabletoanalyseallfirst-line andmostsecond-lineanti-TBdrugs,ifprocessedimmediately (e.g.pretomanid,delamanid,levofloxacin,moxifloxacin,gatifloxacin,bedaquiline,linezolid,tedizolid,clofazimine,ethionamide,prothionamide,rifapentine,andrifabutin)usinga methodthatwasvalidatedaccordingtotheEMAGuidance.

ConclusionandRelevance Inconclusion,wedevelopeda methodtoanalyse17anti-TBdrugssimultaneouslyinone sampleofplasma,serumorsaliva:allfirst-line,BPaLM(bedaquiline,pretomanid,linezolid,andmoxifloxacin),and9mall oralregimenformultidrug-resistant/rifampicinresistant(MDR/ RR-TB)drugs,and63%ofthelongerMDR-TBregimen drugs.Thismethodwillsavetimeandwillfurtheroptimise therapeuticdrugmonitoring.

REFERENCESAND/ORACKNOWLEDGEMENTS N/A

ConflictofInterest Noconflictofinterest.

4CPS-060 IMPACTOFOBESITYONVANCOMYCIN PHARMACOKINETICPARAMETERSINADULT PATIENTS

MRCandela*,ILeon-Murciano,CSaez-Pons,MMartinez-Cabanes,MSaez-Garrido, ATalens-Bolos,MReal-Panisello,MAmat-Diaz,CColomer-Aguilar,NBujaldon-Querejeta, MCRodriguez-Samper. HospitalGeneralUniversitarioElda,Pharmacy,Alicante,Spain 10.1136/ejhpharm-2024-eahp.164

BackgroundandImportance Informationregardingtheimpact ofobesityonthepharmacokineticsofmostdrugsislimited. Obesityisassociatedwithphysiopathologicalchangesthatmay affectthepharmacokineticsofvancomycin.Therefore,thereis aneedforpharmacokineticmodelsspecifictotheobesepopulationtooptimisedosingschedulesinthisgroupofpatients.

AimandObjectives Todeterminethedifferencesinpharmacokineticparameters(PKP)inhospitalisedobesepatients.

MaterialandMethods RetrospectiveobservationalstudyincludingadultpatientswhohadaplasmaticconcentrationofvancomycinbetweenMarch2022andAugust2023.Criticallyill patientsandthosewithrenalfailurewereexcluded.Demographicvariablescollectedwere:sex,age,weight,height, bodymassindex(BMI),PKP(volumeofdistribution(Vc), stadestatevolumeofdistribution(Vss),clearance(Cl),halflife(t1/2)),peak(Cmax)andthrough(Cmin)level,startdate ofvancomycintreatmentandsamplecollectiondate.Patients weregroupedaccordingtoBMI:obese(BMI 30kg/m2)and non-obese(BMI<30kg/m2).Alldatawerecollectedfrom electronichealthrecordsandpharmacokineticreports.This reportincludesthePKPcalculatedusingapharmacokinetic

programme(PKS®),basedonabicompartimentalmodel.Data wereanalycedbySPSSstatistics21®.Qualitativevariables werepresentedbyfrecuencyandquantitativevariablesby mean±standarddeviationandmedian(interquartilerange). T-studentandU-Mann-Whitneywereusedtocompareparametricandnon-parametricvariables.

Results 57patients(63.2%men)withameanageof67.3 ±12.8years.17.5%wereobese.Thepharmacokineticdatain theobesegroupwere:Cmin=10±7.7mg/L,Cmax=39.3± 28.1mg/L,Vc=19.8(19–23.4)L,Vss=74.6±19.8L,Cl=5 ±2.4L/h,t1/2=11.4(7.5–15.2)h.Thepharmacokineticdata inthenon-obesegroupwere:Cmin=12(9–16.7)mg/L, Cmax=24.7±7.2mg/L,Vc=14.4±2.3L,Vss=49.1±8.8L, Clp=4(3.25–4.59)L/h,t1/2=9.6(8.1–12.1)h.Statisticallysignificantdifferenceswereonlyfoundbetweenbothgroupsin Vc(p<0.05)andVss(p<0.05).

ConclusionandRelevance Thevolumeofdistribution(Vcand Vss)inobesepatientsishigherthaninnon-obesepatients, withsignificantdifferencesbeingfound.Fortherestofpharmacokineticdata,nosignificantdifferenceswerefound.Itis necessarytocarryoutstudiesthatallowdesigningapharmacokineticmodelofvancomycininobesepatientsinorderto optimisetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-061 SAFETYANDEFFECTIVENESSOFTHEOFF-LABELUSE OFCANGRELORINPERIOPERATIVEBRIDGING:A CASESERIES

1JSantanderReboreda*, 1PLaluezaBroto, 1PMarreroÁvarez, 2MBoschFerrer, 1HCGarcía Diaz, 1DAnguitaDomingo, 1MQGorgasTorner. 1Valld’hebronUniversityHospital,Hospital PharmacyDepartment,Barcelona,Spain; 2Valld’hebronUniversityHospital,Farmacology Department,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.165

BackgroundandImportance Cangrelorhasbeenproposedfor theoff-labelindicationofantiplateletbridgingpriortosurgery inpatientsathighriskforthromboticcomplicationsinurgent ornon-delayablesurgeryorprocedure,particularlyinthose whohavehadrecentcoronarystentingandarethereforeat higherriskforsubacutestentthrombosis.

AimandObjectives Todeterminethesafetyandeffectiveness ofcangrelorbridgingtherapyforpatientsundergoingurgent invasiveprocedures.

MaterialandMethods Retrospectiveobservationalstudythat includedallpatientswhoreceivedcangrelorforoff-label

Abstract4CPS-061Table1

bridgingpurposesfromJanuary2022andJune2023inatertiaryhospital.

Demographic,clinicalandthosevariablesrelatedwiththe treatmentwerecapturedfrompharmacyandmedicalelectronicrecords.

Relatedtoefficacy,wereportin-hospitalmortalityand thromboticevents,includingstrokeandmyocardialinfarction, during30daysaftercangreloradministration.Relatedto safety,bleedingwasonlyconsideredassociatedwithcangrelor ifitoccurredduringadministrationorupto48hoursafter discontinuationaccordingtoBleedingAcademicResearchConsortium(BARC)3–5.

Results Sevenpatientswereidentified(100%male;median age71years(interquartilerange:59–79)).Allofthemhad coronaryarterialstentingwithintheprevious1month.The restofpatientandtreatmentcharacteristicscanbefoundat thetable1.

Nopatientinthestudydevelopedin-stentthrombosisor otherthromboticcomplicationwhilereceivingcangrelorneitherwithing30daysofstoppingtherapy.NopatientexperiencedclinicallyrelevantbleedingaccordingtoBARC.

ConclusionandRelevance Thisstudyofpatientsreceivingcangrelorasshort-termantiplatelettherapypriortosurgicalprocedureswithhistoryofcoronarystentplacement demonstratedthatalowdoseof0,75mcg/kg/minprovided adequateeffectivenessandsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-062 POSITIVEIMPACTOFEXTENDINGNATALIZUMAB DOSAGEINTERVALFROMEVERY4WEEKSTOEVERY 6WEEKSINMULTIPLESCLEROSISPATIENTS

OSerna-Romero,AMIglesias-Bolaños,CGastalver-Martín,IEscribano-Valenciano, CCapilla-Montes,SBuendía-Bravo*,TCruz-Cruz. HospitalUniversitariodelSureste, PharmacyDepartment,ArgandadelRey,Spain

10.1136/ejhpharm-2024-eahp.166

BackgroundandImportance Natalizumab(NTZ)isamonoclonalantibodywhichtargetsaproteincalled a4b1integrinon whitebloodcellsinvolvedininflammationthathasdemonstratedremarkableefficacyinreducingrelapseratesanddisabilityprogressioninrelapsing-remittingmultiplesclerosis (RRMS).ThemainriskoftreatmentwithNTZisthepossibilityofdevelopingprogressivemultifocalleukoencephalopathy,whichisrelatedtoJCviruspositivityandthenumber

PatientsSurgical intervention Hemorrhagicrisk (HAS-BLEED) Previous antiaggregant Daysofantiplatelet withdrawal Starttimesofthecangrelorbefore theprocedure(hours) Anti-aggregant restarted Anti-aggregationstarttimes afterprocedure(hours)

1Catheter implantation 3Clopidogrel221Clopidogrel2

2Femurfracture3Clopidogrel572Clopidogrel1

3Catheterism4Ticagrelor572Clopidogrel24

4Femurfracture3Ticagrelor372Ticagrelor12

5Catheterism6Clopidogrel572Clopidogrel120

6Catheterism6Clopidogrel372Clopidogrel4

7Catheterism5Ticagrelor212Clopidogrel6

ofNTZinfusions.Thishasledustosearchanoptimaldosing strategy.

AimandObjectives Inthisstudy,weexploretheimpactof extendingthedosingintervalofNTZfromeveryfourweeks toeverysixweeksinRRMSpatients.

MaterialandMethods Aretrospectiveobservationalstudywas carriedoutinageneralhospitalfromJanuary2023toSeptember2023.RRMSpatientswhohadbeenreceivingNatalizumabeveryfourweeksforatleastoneyearand subsequentlyswitchedtoasix-weekdosingintervalwere included.Clinicaldatawerecollectedandanalysedincluding relapserates,disabilityprogression,andadverseevents.

Results 11RRMSpatientswereincluded.Noneofthemhad newfocalneurologicalsymptoms,asevidencedbystableMRI (MagneticResonanceImaging)findingsandabsenceofclinical relapses.Importantly,nocasesofPMLorotherserious adverseeventswerereportedduringthestudyperiod.One patientreportedvisualworseninginthelefteyebutthiswas attributedtootherfactorsunrelatedtothedosinginterval change.

ConclusionandRelevance Inthisstudy,theextensionofNatalizumabdosingintervalinRRMSpatientsdemonstratedpromisingresults,includingstablediseaseactivityandanabsenceof PMLcases.

TheabsenceofPMLcasesinourcohortisparticularly encouraging,suggestingthattheriskofPMLmaynotbesignificantlyincreasedwiththisextendeddosingregimen.

Thisdosingstrategymayofferabalancebetweenmaintainingtherapeuticefficacyandminimisingpotentialsafetyconcerns.However,morestudiesareneededtoconfirmthese findings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-063 CLINICALPHARMACISTINTHEMULTIDISCIPLINARY TEAMINTHEINTENSIVECAREUNITIMPROVETHE QUALITYOFMEDICINETHROUGHOUTTHEPATIENT’S HOSPITALSTAY

1KHeier*, 2MDavies, 3YAndersson. 1HospitalPharmacyØstfold-Kalnes,Hospital PharmaciesEnterprice-South-Eastern-Norway,Sarpsborg,Norway; 2HospitalPharmacy Vestfold-Tønsberg,HospitalPharmaciesEnterprice-South-Eastern-Norway,Tønsberg, Norway; 3HospitalPharmaciesEnterprice-South-Eastern-Norway,HospitalPharmacies Enterprice-South-Eastern-Norway,Oslo,Norway

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BackgroundandImportance Medicationerrorsduringahospitalstaycanendangerpatientsafety,prolongthepatientshospitalstayandevenbefatal.Thecriticallyillpatientsinthe intensivecareunit(ICU)areparticularlyvulnerabletoerrors inmedicationmanagement,andeachcaretransitionincreases theriskofmedicationdiscrepancies.

AimandObjectives Theaimsofthestudywere1)todevelop aworkflowforclinicalpharmacisttobecomeanintegralpart ofthemultidisciplinaryICUteam,2)toperformapharmacist-ledinterventiontoimprovethedocumentationofmedicationlists,optimisemedicaltreatmentandavoiddrug-related problems(DRPs).

MaterialandMethods Apreinterventionretrospectivecontrol cohortattheICU(n=34)wasusedtoassesstheeffectof pharmacist-ledintervention.Clinicalpharmacistregistered medicationinformationaboutthepatientsbeforeadmissionto

ICU,qualityscoreofthemedicationinformationinthe admissionrecords,medicationinformationwhenpatientswere transferredin-hospital,andinthedischargesummary.Additionalinthepharmacist-ledintervention(n=23)medication reconciliationanddrugreviewwereperformed.

Results Clinicalpharmacistfounddiscrepanciesinmedication informationand/orelectronicprescribingfor55different drugs(n=19patients,82%),inaverage2.4drugsperpatient. Mostcommondiscrepanciesweredrugsmissing(n=25,45%), importantinformationaboutpoorcomplianceweremissing (n=12,22%)anddrugsnolongerinusewerelistedinmedicationinformationand/orelectronicprescription(n=10, 18%).

Mostofthepatients(n=20,87%)hadDRPsorpotentially DRPs,intotal85DRPs.MostcommonlyDRPsincluded drugsneededmonitoring(n=16,19%)anddrugswerefound unnecessaryforpatient(n=15,18%).TheATCgroupN includingcentralnervousagentslikeanxiolytics,hypnoticsand sedatives,antipsychoticsandantidepressantswerecommonly relatedtotheDRPsorpotentiallyDRPs(n=26,31%).

Theaveragequalityscoreofmedicationinformationindischargesummerywerehigherintheinterventiongroup(n=18, score:11.5)comparedtothecontrolgroup(n=31,score: 8.3).Maximumscoreis21.

ConclusionandRelevance InanICUmultidisciplinaryteam, clinicalpharmacistshouldbeintegralparttoincreasepatient safety.Theclinicalpharmacistcontributedtolessmedication errorsandDRPsandimproveddocumentationofthemedicationliststhroughoutthehospitalstay.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-064 REVIEWOFUSEOFIMMUNOGLOBULINSINTERTIARY HOSPITAL

1SRuizBoy*, 1CAlberdiLema, 1TLizondo, 1ICarro, 1MMartin, 1MTuset, 2JHernández, 3RAmaro, 4FFernándezAvilés, 5CCardozo, 6DSoyMuner. 1HospitalClínic,Pharmacy Service.DivisionofMedicines,Barcelona,Spain; 2HospitalClínic,InternalMedicineServiceAutoimmuneDiseasesUnit,Barcelona,Spain; 3HospitalClínic,PneumologyService, Barcelona,Spain; 4HospitalClínic,HematologyService,Barcelona,Spain; 5HospitalClínic, InternalMedicineService-InfectiousDiseasesUnit,Barcelona,Spain; 6HospitalClínic, PharmacyService.DivisionofMedicines-UniversityofBarcelona,Barcelona,Spain

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BackgroundandImportance Humanimmunoglobulins(HI)are essentialfortreatmentofprimaryimmunodeficiency(PI). Theyarealsousedforotherconditions,someofwhichdo nothaveveryhighevidenceorhavetherapeuticalternatives otherthanHI.GiventhecurrentshortageofHI,carefulconsiderationofitsindicationsandadministrationiswarranted.

AimandObjectives I)TodescribetheuseofHIofanadult populationtreatedinatertiaryuniversityhospital(767beds), whichisareferencehospitalforPIandotherminoritypathologies.II)Toidentifythoseindicationsforwhichtheuseof HIhasalowlevelofevidenceaccordingtothenational guidelines.

MaterialandMethods

Observationalretrospectivestudy Nointervention.Allpatients whoreceivedHIduring1/1–31/12,2022wereincluded.Data wasobtainedfromelectronicmedicalrecords.

Results Atotalof104786gofHIwereadministeredto432 patients(52.3%women).Medianageandweightwere60.0

years(IQR:45.0–71.3)and68.0kg(IQR:59.0–80.0),respectively.Seventypatients(16.2%)hadaBMI>30kg/m2.Two hundredelevenpatients(48.8%)receivedHIforthefirst time.Therewere209(48.4%)long-termHItreatments(minimumthree-monthduration)and224(51.6%)short-term treatments.

Only13200gofHI(12.6%)wereadministeredto134 inpatients.Highnumberofpatients(85.2%)receivedintravenousHI,consuming87495g(83.5%).Theindicationswith thehighestconsumptionofHIwereimmunomodulatorytreatmentofdermatomyositisandotherinflammatorymyopathies (4.9%and4.6%ofpatients;19,2%and10.0%ofconsumption,respectively)andreplacementtherapyincommonvariableimmunodeficiency(11.1%ofpatients,10.0%of consumption).HIwereprescribedfrom12differentspecialties,withinternalmedicine,neurologyandhematologybeing themost,with32.5%,15.8%and15.4%oftotalconsumption,respectively.

An8.3%oftotalHIconsumptionwasadministeredto33 patients(7.6%)withindicationswithlowevidenceofHIefficacy.Oftheseindications,themostcommonwereBKvirus nephropathyinkidneytransplantpatients(n=5),autoimmune dermatologicaldiseases(n=5),severemyocarditis(n=3)and autoimmunehaemolyticanaemias(n=3).

ConclusionandRelevance HIarewidelyusedbymultiplespecialties.HIforlow-evidenceindicationsareusedinalow,but notminimal,percentage.Theseusesmustbereviewedbya multidisciplinaryteaminordertooptimisetheprescriptionof HI.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-065 EXPERIENCEOFIMMUNOCHEMOTHERAPYVERSUS STANDARDTREATMENTINSMALL-CELLLUNG CANCER

1ETejedorTejada*, 2MRodriguezGoicoechea, 3SCanoDominguez, 4ACrisCercós. 1BarcelonaClinicHospital,Pharmacy,Barcelona,Spain; 2ComplejoHospitalariodeJaen, Pharmacy,Jaen,Spain; 3HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada, Spain; 4HospitalUniversitarioDoctorPeset,Pharmacy,Valencia,Spain

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BackgroundandImportance Immunotherapyhasemergedasa revolutionaryapproachtothetreatmentofsmall-celllungcancer.Thisaggressiveformoflungcancerpresentssignificant challengesduetolimitedtherapeuticresponseandevenresistancetoandevenresistancetoconventionalchemotherapy. However,thestrategyofcombiningimmunotherapywithchemotherapymakesitpossibletostimulateapatient‘ sown immunesystemtofightcancercells,triggeringaspecific immuneresponse.ThisnovelcombinationhasshownpromisingresultsinimprovingsurvivalandqualityoflifeforsurvivalandqualityoflifeofpatientswithmetastaticMPCin clinicaltrials.

AimandObjectives -Toevaluatetheeffectivenessandsafety ofcombinationimmunochemotherapyinpatientswithmetastaticsmallcellcancer.

-Compareimmunochemotherapyvsstandarofcaretreatmentdata.

MaterialandMethods Anobservational,multicentre,retrospectivestudywasconductedtoevaluatetheeffectivenessand safetyoftreatmentsusedinpatientsdiagnosedwithmetastatic

MPC.Patientdemographics,clinicalandtreatmentvariables werecollected.Treatmentconsistedofcoursesofcarboplatin, etoposideandatezolizumab,followedbyatezolizumabmaintenance.TumourresponseswereclassifiedaccordingtoRECIST 1.1responsecriteriaandtoxicitieswereassessedaccordingto commonadverseeventcriteriaCTCAEv5.0

Results Datawerecollectedfrom63patientsdiagnosedwith metastaticsmallcelllungcancer.50.8%receivedcombination chemotherapywithatezolizumabandcarboplatinplusetoposide,while49.2%receivedchemotherapyalone.Medianoverall survivalwas7.5monthsinthecombinationarmand7.3 monthsinthecombinationarm.Themedianprogression-free survivalwas7.12monthsinthecombinationarmand3.1 monthsinthechemotherapyarm.Theadverseeventratefor thecombinationwas78.2%vs75%forchemotherapy. Adverseeventsinthecombinationarmwereasthenia,neutropenia,anaemia,nauseaandnausea,anaemia,nauseaand infections

ConclusionandRelevance Thecombinationofatezolizumab withcarboplatinandetoposideshowsbettersurvivaloutcomes withoutincreasingtoxicity,thanstandardtherapy.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Dingemans,FrühM,ArdizzoniA,BesseB,Faivre-FinnC,HendriksLE, etal. Small-celllungcancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatment andfollow-up. AnnOncol.2021Jul;32(7):839–85.

ConflictofInterest Noconflictofinterest.

4CPS-066 THERAPEUTICDRUGMONITORINGOFANTI-TNF THERAPYININFLAMMATORYBOWELDISEASE

1EMatillaGarcía*, 2BRodriguezVargas, 3BBotellaMateu, 3DMartinRodriguez, 2CApezteguiaFernandez, 2PBautistaSanz, 2LEHoyoGil, 2AMelgarejoOrtuño, 2MAAmor Garcia, 2RMorenoDiaz. 1HospitalUniversitarioInfantaCristina,Pharmacy,Madrid,Spain; 2HospitalInfantaCristina,Pharmacy,Madrid,Spain; 3HospitalInfantaCristina, Gastroenterology,Madrid,Spain

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BackgroundandImportance Anti-TNFdrugsareoftenconsideredtheprimarytreatmentformostpatientswithinflammatoryboweldisease.However,thereisasignificant interindividualvariabilityinthetherapeuticresponse.Approximately30%ofpatientsdonotrespondtoinduction(primary failure)andmorethan50%ofpatientsloseresponseover time(secondaryfailure).Giventhatthereisastrongcorrelationbetweenanti-TNFdruglevelsanditsefficacy,pharmacokineticmonitoringofplasmalevelshasbecomeauseful strategytooptimisethetreatments.

AimandObjectives Toanalysethepercentageofpharmacokineticrecommendationsacceptedbythephysiciantooptimise anti-TNFtreatmentinpatientswithinflammatorybowel disease

MaterialandMethods Prospective,observationalstudy,which includedpatientswithinflammatoryboweldiseasetreated withadalimumabandinfliximabfromfebruarytooctober23. Demographicvariables(age,sex),diagnosis(Crohn’sdiseaseor ulcerativecolitis),treatment(adalimumaborinfliximab)and typeofrecommendation(doseintensification,intervalintensificationorboth,regimenmaintenance,treatmentchange,treatmentde-intensificationorsuspension)werecollected.The measurementofdruglevelswasconductedusingarapid determinationsystem(RIDA®QuickSystem)followedby

interpretationusingacomputerapplicationbasedonanalysis byBayesianmethods.(PKS® Abbott).Thedataanalysiswas basedonpharmacokineticmodelspublishedintheliterature.1,2 Subsequently,thepharmacokineticrecommendation wasprovidedtothephysician,whomadethefinaldecision.

Results Twenty-eightpatients(50%menand50%women) withameanageof40yearswereincluded.Regardingdiagnosis,53,6%wasulcerativecolitisand46,4%wasCrohn’ s disease.Thirty-threedeterminationsweremade(17adalimumaband13infliximab).Thetotalpercentageofacceptanceof thepharmacokineticrecommendationswas84,8%andwas distributedasfollows:Maintenanceofregimen(33.3%),intervalintensification(27.7%),doseintensification(12.12%),dose andintervalintensification(12.12%),changeoftreatment (9.09%),de-intensification(3.03%)anddiscontinuationof treatment(3.03%).

ConclusionandRelevance Thedegreeofacceptanceofthe pharmacokineticrecommendationswashigh.Itremainstobe determinedinthelongtermwhetherthistypeofintervention willyieldapositiveclinicalimpact,potentiallyenhancing treatmentpersistence.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AdedigboAFasanmade,OmoniyiJAdedokun, etal.EurJClinPharmacol(2009) 65:1211–1228.

2.NielsVandeCasteele,FilipBaert, etal.JournalofCrohn’sandColitis. 2019, 1248–1256.

ConflictofInterest Noconflictofinterest.

4CPS-067 EFFECTIVENESSANDSAFETYOF1IU/MLTOPICAL INSULINTOTREATPERSISTENTCORNEALULCERS

JCSáezHortelano*,DOzcoidiIdoate,MCGuindelJiménez,AVélezBlanco,XCasás Fernández,CDeCastroAvedillo,RVarelaFernández,AFernándezVázquez,AMartínSanz, DLópezSuárez,JJOrtizDeUrbinaGonzález. ComplejoAsistencialUniversitarioDeLeón, HospitalPharmacy,León,Spain

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BackgroundandImportance Thepresenceofepithelialcorneal ulcersduetovariousreasonssignificanttlyimpactsinplenty ofpatient‘squalityoflife.Recently,theuseoftopicalinsulin hasemergedasapotentialalternativetreatment,withpromisingpreclinicalresults.However,clinicalevidenceremains limited.

Thepresenceofinsulinandinsulin-likegrowthfactor receptorsincornealkeratocytesandepithelialcellsmay explainthesefindings.

AimandObjectives Thesestudyaimsistoassesstheeffectivenessandsafetyofinsulin1IU/mLeyedropsforpersistent cornealulcers(PCU).

MaterialandMethods Observationalretrospectivestudyconductedinatertiaryhospitalamongpatientsreceivingtopical insulin1IU/mLtreatmentforPCUbetweenJanuary2021 andJuly2023.Datacollectedincludedpatientdemographics, PCUetiology,treatmentduration,priorandconcurrenthospitaltreatments,clinicalresponse(assessedviaanteriorsegment biomicroscopy)andadverseeffects.

PharmacyHospitalpreparedinsulineyedropsataconcentrationof1IU/mL,andwereadministrated3or4times daily.

Results 54patientsweretreatedwith1IU/mLtopicalinsulin forPCU,including23(43%)males,withamedianageof70 (58–79)years.ThemostcommonPCUetiologieswerepost-

surgicalin11(20.4%)patients,herpeticin10(18.5%),neurotrophicin9(16.7%),dryeyein6(11.1%)andinfectious in5(9.3%)patients.8(14.8%)patientshaddiabetes.

12(22.2%)and16(29.6%)patientspreviouslyreceived autologousserumorcyclosporineeyedrops,respectively;and 9(16.7%)and12(22.2%)concurrentlyusedautologous serumorcyclosporineeyedrops,respectively.

Themediandurationoftreatmentwas2,2(1.4–5.6) months.17(31.5%)patientsfinishedtreatmentduetoPCU improvement,6(11.1%)duetoPCUresolution,18(33.3) duetolackofefficacy,1(1.9%)duetointoleranceand7 (13.0%)continuedintreatmentatfollow-upending.Patients withimprovementorresolutionhadatreatmentdurationof lessthan5months.

Response(PCUimprovementorresolution)werebetterin infectious(60.0%)andpost-surgical(54.5%).

ConclusionandRelevance The1IU/mLtopicalinsulineye dropsformulationappearstobeaneffective,safeandrapid optionforpatientswithPCU.However,treatmentswithout effectivenessinthefirst5monthsdonotseemtobeeffective.Furtherstudiesareneededtoconfirmthesefindings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-068 TARGETTHERAPYINNON-SMALLCELLLUNGCANCER (NSCLC):ARETROSPECTIVEANALYSISTO GUARANTEETHEAPPROPRIATENESSOFTHE

PRESCRIPTIONSINOURHOSPITAL

1IMartignoni*, 1ESantarossa, 2LStefanizzi, 1MGambera. 1OspedaleP.Pederzoli, Pharmacy,PeschieraDelGardaVR,Italy; 2OspedaleP.Pederzoli,Pathology,PeschieraDel GardaVR,Italy

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BackgroundandImportance Duringpastyearsseveraltarget therapieshavebeenapprovedforvariousmutationsinnonsmallcelllungcancer(NSCLC).Targettherapyhasbeen showntobeeffectiveinseveralmetastaticcancerswithspecificgenemutationsormolecularbiomarkers,andsophisticatedmoleculardiagnosticsallowgreaterpersonalised treatmentselectiontopreventtreatmentfailure,avoid unnecessarytreatment,andimprovesurvival.

AimandObjectives Theaimofthisretrospectiveanalysisisto verifythatintheactualclinicalpracticeofourhospitaltarget therapyprescriptionsanddeliveriesforpatientsdiagnosed withNSCLCmatchwithapropermoleculardiagnostictesting (humanDNA/RNAanalysis).

MaterialandMethods Thepharmacistcrossesdataregarding patients’ genemutationsandanti-canceroraldrugsdeliveries topatients.Datasourcesarepathologydepartmentsoftware thatincludesmutationstestedwithareal-timePCRfullyautomatedandpharmacysoftwarethatincludesforeachpatient thenameoftheanti-cancerdrug,thenumberofconfections, thedateofdelivery.

Results FromApril2020toAugust2022,targetoraltherapies forlungcancerwereprovidedto90patients:53treatedwith osimertinib,16withalectinib,3withgefitinb,8withafatinib, 3patientswithtrametinibanddabrafenib,1withentrectinib, 1withcrizotinib,2witherlotinib.58patientsweretransferredfromanothercentrewithaprescriptionyetandforthe other32patientsweperformedthemoleculartestinsite.25 ofthe53patientstreatedwithosimertinib,carriedoutthe

moleculartestonsitewithadiagnosisofdeletionofexon19 oftheEGFRgene(17patients),andonepatientalsohada T790Mresistancemutation.6diagnosedwithEGFRL858R mutationand1withEGFRG719Smutation.Ofthe16 patientstreatedwithalectinib,5underwenton-sitemolecular investigationswithapositiveALKgenemutationdiagnosis. Ofthe8withafatinib,2werediagnosedwithanEGFRgene mutation.

ConclusionandRelevance ThisretrospectiveanalysisofrealworlddataamongpatientswithNSCLChasfoundthattarget therapiesprescribedinourhospitalarelinkedtoanoncogene mutation.NextstepistodevelopanITintegrationbetween departments ’ softwareinordertoallowthepharmacistto checkthefullyappropriatenessofprescriptionbeforedelivery.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-069 OUTPATIENTSATISFACTIONINTHETELEPHARMACY PROGRAMOFATERTIARYHOSPITALPHARMACY SERVICE

ACouso*,ADordàBenito,CDiezVallejo,LViñasSague,CSubiranaBatlle,APerez Plasencia,XLarrea,EMartínezDiaz,MOliverasPérez. HospitalUniversitariDr.Josep Trueta,PharmacyDepartment,Girona,Spain

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BackgroundandImportance Telepharmacy(TPh)consistsof telematicpharmaceuticalcareanddeliveryofhospitaloutpatientmedication,avoidingpatient‘sdisplacementtothehospital.TherearedifferentTFmodelsdependingonthedelivery destination:patient‘shome,pharmacyofficesandhealthor social-healthcentres.TobeincludedinTFprogram,patients mustmeetaseriesofinclusioncriteria,includinghomedistancefromthehospital,fragilityandfunctionaldependence, amongothers.

AimandObjectives Toevaluatetheopinionofpatients includedinTPhprogramandthetelematicpharmaceutical carereceivedthroughasatisfactionsurvey.

MaterialandMethods Prospectiveobservationalstudyinwhich allpatientsinTPhprogramwhoreceivedamedicationshipmenttoapharmacyofficeduringMay2023wereincluded. Theinformationwasobtainedthroughatelematicanonymous survey.DifferentaspectsaboutTPhwerescored:circuit,deliverydestination,pharmacistavailabilityduringdelivery,shippingplanning,medicationaccessthroughpharmacyoffice, quantityofdispensedmedication,possiblefinancialcontributionandpharmaceuticalcarereceived.Overallsatisfaction levelwasalsorated.Thesatisfactionpatientdegreewasevaluatedwithanumericalresultfrom1(minimumsatisfaction) to10(maximumsatisfaction).

Results Duringdatacollectionperiod,30patientsanswered thesurveyand3refusedit.57%(17)oftheparticipants werefemale.Themostprevalentagegroupwasover65years in57%(17)ofsurveyrespondents.Themeansatisfaction scoreswere10forcircuit,9.9fordeliverydestination,9.9 forpharmacistavailabilityduringdelivery,10forshipping planning,10formedicationaccess,9.9forquantityofdispensedmedication,6.7forpossiblefinancialcontributionand 10forpharmaceuticalcarereceived.Regardingoverallsatisfaction,anaveragescoreof10wasobtained.

ConclusionandRelevance TheTPhserviceandtelematicpharmaceuticalcarereceivedarehighlysatisfactoryfromthe

surveyrespondents’ pointofview.Evenso,tryingtoadapt thedeliverydestinationandquantityofdispensedmedication couldbesomeareastoimprovetheservice.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-070 EVALUATIONOFAVOIDEDCOSTINCLINICALTRIALS WITHIMMUNOTHERAPYINLUNGCANCER

LEscobarHernández*,OBallestaLópez,JEMegiasVericat,TPalanquesPastor,NBenito Zazo,MMMar,MTorderaBaviera,JLPovedaAndres. HospitalUniversitariIPolitècnicLa Fe,HospitalUniversitariIPolitècnicLaFe,Valencia,Spain

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BackgroundandImportance Lungcancer(LC)isthethird mostcommonprevalentcancerandtheleadingcauseofcancer-relateddeath.TherapeuticoptionsforLCarelimited.A largenumberofimmunotherapy-basedclinicaltrials(CT)are underwayduetotheirpromisingresults.Therefore,itisnecessarytoevaluatetheeconomicimpactofCTinLCpatients. AimandObjectives ToevaluatetheeconomicimpactofparticipatinginCTwithimmunotherapyprovidedbythesponsorin patientswithLC.

MaterialandMethods Single-centremultidisciplinarystudycalculatingthecost-savingimpactoftheuseofimmunotherapy providedbythesponsorinCTinatertiaryhospitalbetween January2019andDecember2022.

Inclusioncriteria patientsdiagnosedwithLC(smallcelland non-smallcell)treatedwithcommercialisedimmunotherapyin CT(amivantamab,atezolizumab,avelumab,durvalumab,ipilimumab,nivolumabandpembrolizumab).Exclusioncriteria: CTwithplacebo-maskedimmunotherapy.

TheinformationwasretrievedfromFarmis-Oncofarm®, pkEnsayos® andOrion-Logis®.Baselinecharacteristics(ageand sex),diagnosis,clinicaldata(trialsperphaseanddrugadministered)andconsumptiondata(quantityexpressedinmgand costsavoidedperCT,perpatientandperdiagnosis)were analysed.

Statisticalanalysis calculationofpercentagesandmeanswith 95%confidenceintervals(95%CI).Economicdatawas expressedinavoidedcosts.

Results Thestudyincluded81patients(71.6%male)withan averageageof65.7years(95%CI:63.8–67.6).Mostof patientswerediagnosedwithnon-small-cellLC(85.2%, n=69).

Atotalof27CTwereincluded(81.5%fornon-small-cell and18.5%forsmall-cell):phaseI(n=1),phaseI/II(n=2), phaseII(n=6),phaseIIa(n=1),phaseIII(n=12),phaseIIIb (n=2),phaseIIIb/IV(n=2)andphaseIV(n=1).Nineof themusednivolumab(33.3%);6atezolizumab(22.2%);6 pembrolizumab(22.2%);3durvalumab(11.1%);2ipilimumab (7.4%);1amivantamab(3.7%)and1avelumab(3.7%).

Theoverallavoidedcostwas2,178,167C ¼ (1,715,360C ¼ and462,807C ¼ fornon-smallcelllungcancerandsmallcell lungcancer,respectively),perCT80,673C ¼ andperpatient 26,891C ¼ .

ConclusionandRelevance PatientparticipationinCTwith immunotherapyinLChasagreateconomicimpactinterms ofdirectcostsavoidedinantineoplastictreatment.TheinclusionofpatientsintheseCTcontributestothesustainabilityof thehealthcaresystemandallowspatientsaccesstoinnovative therapies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-071 ANTIBIOTICCONSUMPTIONMONITORINGBYAWARE CLASSIFICATION:A6-MONTHANALYSIS

1CBotto*, 1IMistretta,GCancellieri, 1EDeLuca, 1MSantonocito, 2MIannelli, 2PPolidori. 1UniversitàDegliStudiDiPalermo,ScuolaDiSpecializzazioneInFarmaciaOspedaliera, Palermo,Italy; 2AoorVillaSofia – Cervello,UocFarmacia,Palermo,Italy

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BackgroundandImportance TheAWaReclassificationofantibiotics,developedbytheWorl dHealthOrganization,isa usefultoolformonitoringantibioticconsumption,defining targetsandverifyingtheeffectsofstewardshippoliciesthat aimtooptimiseantibioticsusea ndreduceantimicrobialresistances.Antibioticsareclassi fiedintothreegroups,Access, WatchandReserve,consideringtheimpactonantimicrobial resistanceandemphasisingtheimportanceoftheirappropriateuse.The ‘Access’ groupcontainsantibioticsusedinthe first-andsecond-linetreatmentofinfections.The ‘Watch’ groupcontainsbroad-spectrumantibioticswithahigher potentialofdevelopingresistance.The ‘ Reserve’ groupcontainslast-resortantibioticsusedformultidrug-resistant infections.

AimandObjectives Theaimofthisstudywastoevaluateand monitortheconsumptionofantibioticsforparenteralusein thehospitalwards,consideringtheAWaReclassification,duringaperiodof6months(fromJanuary2023toJune2023).

MaterialandMethods FromJanuary2023toJune2023all therequestsofantibioticsforparenteralusewereanalysed usinganinformaticdatabaseandclassifiedaccordingtothe AWaReclassificationandthehospitalwards.Moreover,the prescriptionsappropriatenesswasverifiedbycheckingthevalidityofthedocumentationneeded(antibiograms,infectivologistreports).

Results Intheperiodconsidered110.662vialsofantibiotics forparenteraluseweredispensed.Amongthese,68.096vials (61.53%)wereantibioticsfromthe ‘Watch’ group.MeropenemandCeftriaxoneresultedthemostadministeredmolecules,especiallyinRespiratorydiseaseandEmergencywards.

26.942(24.34%)antibioticvialsweredispensedfromthe ‘Access’ groupand15.624(14.11%)fromthe ‘Reserve’ one. CefazolinandMetronidazole(‘Access’)andColistimethate (‘Reserve’)resultedthemostusedantibioticsintheircategories,withhigherprevalenceinObstetricsandGynecology,SurgeryandRespiratorydiseasewards,respectively.

ConclusionandRelevance Wefoundouthighantibioticconsumptions,inparticularforthe ‘Watch’ category,probablydue toantibioticresistancetowardsthemoleculesfromthe ‘Access’ group.Thesedataconfirmtheimportanceoftheroleofthe hospitalpharmacist,whocanpromoteadherencetoguidelines andthecorrectuseofantibiotics,activelycontributingtothe antimicrobialstewardshipprogramme

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Mudenda, etal.AntimicrobStewardHealthEpidemiol. 2023;3(1):e84.

ConflictofInterest Noconflictofinterest.

4CPS-072 SETMELANOTIDEINMONOGENICOBESITY:ACASE REPORT

MSuarezGonzalez*,JGonzalezChavez,PDiazRuiz,AMartinLopez,JEsquivelNegrin, ASantosFagundo,JMerinoAlonso. HospitalNuestraSeñoraDeCandelaria,Pharmacy, SantaCruzDeTenerife,Spain

10.1136/ejhpharm-2024-eahp.176

BackgroundandImportance Themelanocortin4receptor (MC4R),componentoftheleptin-melanocortinpathway,plays apartinbodyweightregulation(hunger,satietyandenergy expenditure).

SetmelanotideisahighlypotentMC4R-agonistthatleads toweightlossinMonogenicObesity(MO)individualswith completepro-opiomelanocortin(POMC)deficiencyorleptin receptor(LEPR)deficiency.

AimandObjectives Toevaluatetheefficacyofsetmelanotide ina3-year-oldpaediatricpatientwithMOduetoLEPRdeficiency(off-labeluse).

MaterialandMethods Observational,retrospectiveanddescriptivestudyofachildwithMOinathird-tierhospitalfor6 months(ApriltoSeptember2023).

TheinformationwasobtainedfromtheElectronicClinical HistoryandthePharmacyServiceManagingSoftware.

Results Thechildbornat36+2weekswithaweightappropriatetohisgestationalage(2.5kg).

HewasadmittedinanobesitystudyinMay2021.He wasdiagnosedwithMOduetoLEPRdeficiencyinSeptember 2021.

Thechildstartedwithsetmelanotide0.5mginApril2023 andwasincreasedtoacurrentdoseof1.5mgdailysubcutaneousinjection.

Hehaslostweightfrom40to38kgin6months.He alsoeatslessfoodandhiscravingforfoodhasdecreased. AnalyticallevelsimprovedfromOctober22toMay23:triglycerides:99to75mg/mL;cholesterol217to139mg/dL; LDL144to72mg/dL.Thepatienthasdecreasedinadipose componentandhasincreasedinmusclemass.Progressin mobility,crawlingandkneeling.Sleepsthroughthenightwith adaytimenap,notalways.

Therearenoalternativetreatmentssuitableforthepatient‘ s age.

Setmelanotidehasdemonstratedstatisticallysignificant weightlosswithatleasta5%decreaseinbodyweightafter 6monthsanddecreasedappetite,thereforeitcouldreacha 10%after1year.

Thechildhasskinrashandskinhyperpigmentation(activityatmelanocortin1-receptors(MC1R)asadverseeffects. ConclusionandRelevance SetmelanotideisthefirstEuropean MedicinesAgencyapprovedmedicationforthetreatmentof POMCandLEPRdeficiencyinpatients(childrenfrom6years oldandadults)withMO.

Inourcasereportisanoff-labeluseandthechildhas beentreatedefficientlywithsetmelanotidefor6monthswith areductioninweight,hungerandanalyticalparameters.

Weshouldevaluatetheresponseafter1-yearwithsetmelanotidetoconfirmthatthetreatmentobjectivesareachieved (10%weightlossin1-year).

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-073 ANALYSISOFTHEREASONSFORCHANGING TREATMENTINPATIENTSWITHMULTIPLESCLEROSIS

1FArtimeRodríguez-Hermida, 1MPerpinyàGombau, 1MComaPunset, 2MBruguera Teixidor*, 2CDiezVallejo, 2ADordàBenito, 1MOlmoMartinez, 1MDMallaCanet, 2AFayet Perez. 1HospitalSta.Caterina,InstitutD’assistènciaSanitària,Pharmacy,Salt,Spain; 2HospitalUniversitari,Dr.J.Trueta,Pharmacy,Girona,Spain

10.1136/ejhpharm-2024-eahp.177

BackgroundandImportance Treatmentformultiplesclerosis (MS)haschangedinthelastfewyears.Theintroductionof newtherapieshasledtoimprovedtoleranceandnewoptions intheprogressionofdisease.

AimandObjectives ToevaluatethereasonsforchangingtreatmentinpatientsdiagnosedwithMSanditseconomicimpact. MaterialandMethods Descriptive,retrospectiveandobservationalstudyofpatientswithMS,whochangedtreatmentduring2022.

Thevariablescollectedfromtheclinicalhistorywere:age, sex,typeofMS,EDSSscale,previousandnewtreatmentand reasonforthechange.Theeconomicimpactassociatedwith treatmentchangeswasalsoevaluated.

Results During2022therewasa12%changeintreatments (n=63/535patients,67changes).

68%(n=43)werewomenwithameanageof45years.At themomentofchange,meanEDSSwas2.9(0.0–7.0)and 86%(n=54)hadadiagnosisofrelapsing-remittingMSand 14%(n=9)ofsecondaryprogressivemultiplesclerosis (SPMS).

Treatmentchangesweredueto:46%(n=31)adverse events(AEs),46%(n=31)progression,5%(n=3)AEs/progressionand3%(n=2)pregnancydesire.

TheAEswere:50%injectionsitedisordersand/orflu-like symptoms(100%IM/SCdrugs),17%gastrointestinaldisorders ±flushingoruncontrolledbloodpressure(100%oraldrugs), 15%infusion-relatedreactions,12%lymphopeniaand3% hepatotoxicityandincreasedanti-JCtitre.100%SC/IMtreatmentsswitchedtooraldrugsand100%natalizumabIV was changedtonatalizumabsc

Changesforprogression(n=34)were:74%highlyeffective drugs(12ocrelizumab,7cladribineand6natalizumab),21% progressiontoSPMS(5siponimodand2rituximab),and5% dimethylfumarate.

Previoustreatmentswere 19%dimethylfumarate,16%teriflunomide,15%natalizumabIV,9%glatiramer,9%fingolimod, 7%interferonbeta-1aIM,7%peginterferonSC,6%interferon beta-1bSC,4%interferonbeta-1aSC,3%rituximab,1%siponimodandcladribine.

Newtreatmentswere 19%ocrelizumab,18%teriflunomide, 15%cladribine,10%dimethylfumarate,9%natalizumabSC, 7%natalizumabIV,7%siponimod,6%rituximab,3%glatiramer,1%ozanimod,ponesimodanddiroximelfumarate.

Themeanmonthlycostbeforethechangeswas833C ¼ and 1,543C ¼ withthenewtreatments.

ConclusionandRelevance Theintroductionofnewtherapies hasledtohavingmoretherapeuticalternativesandtheyare welltoleratedinthosepatientswithAEsorprogressiveMS, buttheeconomicimpactishigher.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-074 DRUGCLASSESCOMMONLYRELATEDTO MEDICATIONERRORSATTRANSITIONOFCARE KSivabalanathan*,MGCeppi. ZugerKantonsspital,HospitalPharmacy,Baar,Switzerland 10.1136/ejhpharm-2024-eahp.178

BackgroundandImportance Transitionsofcare,suchasfrom hospitaltocommunitysettings,areoftenassociatedwith changesinmedicationregimens,andpatientsarethereforeat riskofdrug-relatedproblems(DRPs).1 MedicationreconciliationbyclinicalpharmacistsaimstoreduceDRPsandthus improvepatientsafety.

AimandObjectives Weaimedtoidentifydrugclassesmost susceptibletoDRPsandtoquantifytheproportionofDRPs originatingfromtransitionofcare(admissionordischarge). Thiscouldsupportclinicalpharmacistsinmoretargetedmedicationreconciliation.

MaterialandMethods Medicationreconciliationwasperformedbyclinicalpharmacistsinaregionalhospitalfor patientsdischargedfrominternalmedicine,surgical,orthopaedic,andgynaecologicalwards.ForeachidentifiedDRP,the involveddrugclass(ATCcode)anditsorigin(transitionof care,orotherorigin,suchaspriortoorduringhospitalisation)weresystematicallydocumented.Forthisdescriptive observationalstudy,weanalyseddataover3.5yearstocalculatethefrequencyofDRPsofspecificdrugclassesandtheir origins.

Results BetweenJanuary2019andJune2023,atotalof 25,298medicationreconciliationswereperformed,DRPswere documentedfor3,401dischargeswithaprevalenceof13.4%. ThefivedrugclassesmostoftenrelatedtoDRPswerecardiovascularagentswith836records(18.2%),gastrointestinaltract drugswith751records(16.3%),analgesicswith615records (13.4%),antithromboticdrugswith470records(10.2%),and anti-infectiveswith390records(8.5%).Otherdrugclasses accountedforfewerDRPs.

78.8%ofDRPsinvolvingcardiovascularagentsoriginated fromatransitionofcare,alongwith56.7%foranti-infectives, 52.3%forantithromboticagents,51.9%forgastrointestinal tractdrugsand,49.3%foranalgesics.

ConclusionandRelevance Weidentifiedasetofdrugclasses commonlyrelatedtoDRPs.Furthermore,weobservedthat mostoftheDRPsoriginatedfromatransitionofcare.This studyemphasisestheimportanceofmedicationreconciliation duringtransitionsofcareandidentifieswhichdrugclasses shouldbefocusedon.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.FatemaAAlqenae, etal.Prevalenceandnatureofmedicationerrorsandmedication-relatedharmfollowingdischargefromhospitaltocommunitysettings:asystematicreview. DrugSafety. 2020;43:517–537.

ConflictofInterest Noconflictofinterest.

4CPS-075

ASYSTEMATICREVIEWOFTHETARGET PHARMACOKINETIC/PHARMACODYNAMICPARAMETERSOFANTIBIOTICSTREATINGGRAM-NEGATIVE INFECTIONS

1HTran*, 2NHenney, 1JMadden, 1PPenson, 1SCulter. 1LiverpoolJohnMooresUniversity, SchoolofPharmacyandBiomolecularSciences,Liverpool,UK; 2UniversityofLiverpool, SchoolofMedicine,Liverpool,UK

10.1136/ejhpharm-2024-eahp.179

BackgroundandImportance Followingtheintroductionof pharmacokinetic/pharmacodynamic(PK/PD)parametersinpreclinicaldevelopmentofantibiotics,theapplicationofPK/PD inguidingdoseshasbeenhighlyencouraged.Previousfindings remaincontroversialandvarygreatly,causingdifficultiesin determiningtheappropriatePK/PDparametersforindividuals inpractice.

AimandObjectives Thissystematicreviewaimstoidentifythe PK/PDtargetsofantibioticstreatinggram-negativeinfections inclinicalpractice,focusingonmulti-drugresistantgram-negativeinfections.

MaterialandMethods DatabasefromCochraneCentral,Web ofScience,PubMed,EmbaseandScopusweresearchedusing definedterms.StudiesusingPK/PDtargetstodeterminedosingregimensofparenteralantibioticsforpatientswithgramnegativeinfectionsinpracticewereselected.Studieswere excludedifexaminingthePK/PDtargetsofantibioticsfor healthyparticipants,virtualpatients,andgram-positiveinfections.StudybiaswasevaluatedusingtheCochraneriskof biastool.

Results Atotalof41studiesinvestigating21antibioticsand twocombinationsinvolving799participantswereselected. Themajorityofeligiblestudies(21articles,51.2%)werecase studies,whichwereevaluatedashighriskofbias.Three (5.9%)studieswereRCTsand17(33.3%)werenon-RCTs.

OnlyoneRCTwasevaluatedasatlowriskofbias.58%of theinvestigatedpopulationwastreatedusingpredefinedPK/ PDindicesderivedfrompreclinicalstudies.Yet,amongthem, morethan60%modifiedthedosingandthedurationof administrationtoattainahighertargetvalue.Cefiderocoland meropenemwerethetwoantibioticsmostprescribedfor multi-drugresistantbacteria,usuallycombinedwithotherantibiotics.Extendedinfusionofmeropenemtoatleast30 minutesperadministrationresultedintheachievementof 100% fT>MICor100% fT>4–6MICinsteadof40% fT>MICwhiletheprescriptionofCefiderocolfollowedthe labelledinstructionofuse.Still,about79%ofthesecasestargetedahighervalueofpredefined77% fT>MICderived frompreclinicaldata.

ConclusionandRelevance ThePK/PDtargetvaluesofantibioticstreatingresistantgram-negativebacteriaarevariableand divergentfrompreclinicaldata.ArangeofPK/PDtargetsmay bemorerealisticinpracticetooptimisedosingregimensfor thefacilitationofclinicaloutcomes,andPK/PDtargetsshould beusedtoinformdosingregimens.Furtherresearchwith standardisedpatientoutcomesisrequired.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-076 EFFECTIVENESSANDSAFETYOFDUPILUMABAND TRALOKINUMABINATOPICDERMATITISINCLINICAL PRACTICE

1ADomínguez, 1MMasip, 1HRuppmann, 1PLozano, 1CSocias, 1APlaza, 1SOjeda*, 2ESerra, 2JLSpertino, 1NPagès, 1PRiera. 1HospitalDeLaSantaCreuISantPau,Hospital Pharmacy,Barcelona,Spain; 2HospitalDeLaSantaCreuISantPau,Dermatology, Barcelona,Spain

10.1136/ejhpharm-2024-eahp.180

BackgroundandImportance Dupilumab,anIL-4/IL-13antagonist,andtralokinumab,anIL-13antagonist,areapprovedfor thetreatmentofmoderate-to-severeatopicdermatitis(AD). Untilnow,nopublishedstudieshavecomparedthesetreatmentsinclinicalpractice.

AimandObjectives Toevaluateandcomparetheeffectiveness andsafetyofdupilumabandtralokinumabinADpatientsin clinicalpractice.

MaterialandMethods Weconductedaretrospectivestudyina tertiaryhospital.WeincludedADpatientswhoinitiateddupilumabortralokinumabasthefirsttargetedtreatmentbetween 11/2017and5/2023.

Wecollectedthefollowingdatafromelectronicmedical andpharmacyrecords:age,sex,EczemaAreaandSeverity Index(EASI),PeakPruritus-NumericalRateScale(PP-NRS), andadverseeffects(AE).EffectivenessendpointswereEASI andPP-NRSatthefirstfollow-upmedicalvisit.SafetyendpointswerethenumberandtypeofAEduringthestudy period.

Results Intotal,78patientswereincludedinthestudy.Mean age(±SD)was40.8(±17.4)years.Thirty-nine(50.0%) patientswerewomen.Dupilumabgroupincluded61patients, whereastralokinumab,17.

Indupilumabgroup,meaninitialEASI(±SD)was32.5 (±9.7)andPP-NRS,8.2(±1.3).Atfirstfollow-up,themean EASIwas7.1(±6.0)andPP-NRS2.7(±1.8).Inthetralokinumabgroup,meaninitialEASI(±SD)was26.4(±8.3)and PP-NRS,7.3(±1.7).Atfirstfollow-upvisit,themeanEASI was2.4(±4.8)andPP-NRS1.9(±2.7).Thereductionin EASIandPP-NRSwasstatisticallysignificant(p<0.001)in bothgroups.Atfirstfollow-upvisit,tralokinumabwassuperiortodupilumabinthereductionofEASI(p=0.005),but notinPP-NRS.However,comparingthenormalisedreductionsofEASIandPP-NRS,therewerenosignificantdifferencesbetweendupilumabandtralokinumabgroups.

AEwerereportedin23(37.7%)dupilumab-treatedpatients and5(29.4%)tralokinumab-treatedpatients,whichwere mostlyophthalmologic(52.2%and60.0%,respectively).Eight (13.1%)dupilumab-treatedpatientsand2(11.8%)tralokinumabhadtodiscontinuethetreatmentduetoAE.

ConclusionandRelevance Inourcohort,dupilumabandtralokinumabwereeffective.Ourstudyshowsasignificant improvementinEASIandPP-NRSinthefirstfollow-upvisit. AEdatashowthatcloseophthalmologicmonitoringisrecommendedinthesepatients.Furtherstudiesarewarrantedto validatethedifferencesfoundbetweenbothtreatments.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-077

PHARMACEUTICALINTERVENTIONSAFTERDETECTION OFNON-HANDLINGMEDICATIONSINPATIENTSWITH DYSPHAGIA

LHernándezSilveira*,CJuezSantamaría,APonsMaria,EBofillRoig,FBarceloSanso, JALuqueMesa. HospitalCanMisses,FarmaciaHospitalaria,Eivissa,Spain

10.1136/ejhpharm-2024-eahp.181

BackgroundandImportance Geriatriccommunityisthemain groupofpatientsaffectedbyoropharyngealdysphagia.In thesepopulation,numerouspharmaceuticalformsneedtobe handledforsubsequentadministration.However,thismanipulationcancompromisethedrug´ssafetyandefficacy.

AimandObjectives Toanalysetheinterventionsfortheadaptationofpharmacologicaltreatmentinnursinghome(NH) patientswithdysphagia.

MaterialandMethods Anobservational,retrospectiveand descriptivestudywascarriedoutintwoNHfromJune2023 toSeptember2023.Allpatientswithmedicationcrushedwere identifiedwiththecollaborationofthenursingstaff.Biodemographicdata,prescribedmedicationsandthesuggestedinterventionswererecorded.TheDEGLUFARM® guidewasused fortheinterventionsperformed.Theprescribingclinicians werenotified.

Results 184NHpatientswereincludedinourstudy.60of them(32.61%)hadtheirmedicationcrushed.Ofthese,19 weremale(31.67%)and41female(68.33%)withamedian ageof86years(agesrangingfrom38to100years).Atotal of509oralmedicationswereanalysed,withamedianof9 drugsperpatient.Ofallprescribedmedications,23conflicting drugsprescribedin20patientswereidentified(33.33%ofthe patientswhohadtheirmedicationcrushed).

AccordingtoATCclassification,themostcommonconflictingdrugswere:6Alpha-adrenoreceptorantagonists(26.09%), 3drugsforconstipation(13.04%)3antidepressants(13.04%), and2anticholinesterases(8.70%).Thepharmaceuticalforms thatsholudnotbecrushedwere:8retardtablets(34.78%),5 gastroresistanttablets(21.74%),5retardcapsules(21.74%)4 coatedtablets(17.39%)and1capsulecontaininggastrorresistantpellets(4.43%).

Theprescribingphysicianwa snotifiedinallcases,with thefollowingproposals:12changestoadifferentactive ingredient(52.17%),10changestoadifferentpharmaceuticalformwiththesameactiveingredient(43.48%)and1 proposalforwithdrawingduetoanegativebenefit-riskbalance(4.35%).

ConclusionandRelevance Highpercentageofpharmaceutical formsthatsouldnotbemanipulatedisprescribedinNH patientswhohavetheirmedicationcrushedduetodysphagia Mostoftheproposedchangesinvolvechangesinactiveingredients,sofurtherclinicalmonitoringcanbeimportant.The pharmacistsarequalifiedtocarryoutthistypeofintervention,improvingtheefficacyandsafetyofpharmacological treatments.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-078 QUALITYOFLIFEANDPATIENT-REPORTED OUTCOMESWITHMULTIPLEMYELOMATREATEDS WITHDARATUMUMAB

MMañesSevilla*,MVazquez-Castillo,APousadaFonseca,MSeguraBedmar. Hospital UniversitarioMostoles,PharmacyDepartment,MóstolesMadrid,Spain

10.1136/ejhpharm-2024-eahp.182

BackgroundandImportance Multiplemyeloma(MM)isan incurableandchronicdisease,sothequalityoflife(QoL)of patientswithMMisanimportantcriteriontoconsider.The patient-reportedoutcomes(PROs)areafundamentaltoolto knowthesuccessofatreatmentinclinicalpractice.

AimandObjectives AssessingQoLasaPROsinadultwith MMtreatedwithdaratumumab.

MaterialandMethods Retrospectiveobservationalstudywhich includedpatientswithMMtreatedwithdaratumumab between01/2019and04/2023inasecond-levelHospital.

Theelectronicmedicalrecordwereusedtosearchpatients andtreatmentsvariables.QoLwasanalysedusingastandardisedquestionnaire(EORTCQLQ-C30v3)andtheMM-specificquestionnaire(QLQ-MY20)tobeansweredbythe patientsthemselves.Theitemstobeansweredwerethepresenceofsymptomsclassifyingas ‘notatall’ , ‘alittle’ , ‘quite’ and ‘alot’.ThegeneralhealthandtheQoLwereassessed withascoreof1to7,being1terribleand7excellent.

Results Ofthe39patients(58.97%men,medianage70 years)treatedwithdaratumumabinthestudyperiod,11completedthequestionnaires.In5ofthem,thequestionnairewas completedontwooccasions:beforestartingandduringtreatment.Intheremaining6,onlyduringtreatment.Theaverage oftreatmentsreceivedatthetimeofcompletingtheformwas 23.25months(SD:7.39).Inactivetreatment,58.17%ofthe responsesweresymptoms ‘notatall’.In30.29%were ‘alittle’,in10.10% ‘quiteabit’ anda1.44% ‘alot.’ General healthwasassessedwithanaverageof4.2pointsbeforetreatmentand4.89pointsduringtreatment.TheQoLwasassessed with4.4pointsbeforetreatmentand5pointsduring treatment.

ConclusionandRelevance Ingeneral,thepresenceofsymptomsorproblemsrelatedtothediseaseweremostlyconsideredbythepatientsthemselvesasnull.Inaddition,general healthandQoLimprovinginthepatientswhoweregiventhe questionnaireatthebeginningandduringtreatmentwith daratumumab.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-079 INDIRECTCOMPARISONOFIL-13INHIBITORSPLUS TOPICALCORTICOSTEROIDSINMODERATETO SEVEREATOPICDERMATITIS

FJSalmerón-Navas,MDominguez-Cantero,MABlanco-Castaño,JDiaz-Navarro*. Hospital UniversitarioPuertoReal,HospitalPharmacy,PuertoRealCádiz,Spain

10.1136/ejhpharm-2024-eahp.183

BackgroundandImportance Lebrikizumab,tralokinumaband dupilumabareanti-interleukin-13monoclonalantibodyusedas therapyinpatientswithmoderatetosevereatopicdermatitis (msAD).Therearenodirectcomparisonsamongthem.

AimandObjectives Toestablishwhetherlebrikizumabplus topicalcorticosteroids(L-TC),tralokinumabplustopicalcorticosteroids(T-TC)anddupilumabplustopicalcorticosteroids (D-TC)canbedeclaredequivalenttherapeuticalternatives (ETA)inpatientswithmsADthroughanadjustedindirect treatmentcomparison(ITC)usingacommoncomparator.

MaterialandMethods Abibliographicsearchwasconductedto identifyphaseIIIclinicaltrial(CTs)withL-TCorT-TCorDTCwithsimilarpopulations,durationandendpoints.Inclusion criteriawere:phaseIII,randomised,double-blinded,placebo controlledandinpatientswithmsAD.The90%improvement inEczemaAreaandSeverityIndex(EASI90)atweek16was usedasthemainvariable.AnITCofL-TCversusT-TCand L-TCvsD-TCwasperformedusingtheBuchermethod,using theIndirectTreatmentComparisonscalculatorfromtheCanadianAgencyforHealthTechnology.Deltavalue(D,maximum differenceasaclinicalcriterionofequivalence)wascalculated usinghalfoftheARRinEASI90obtainedinthepivotalCT ofdupilumab(pooledARR=29%; D =15%).Theresultswere analysedgraphicallyandtherelativepositionofthe95%CI andtheequivalencemarginwereobserved.Positioningwas establishedfollowingtheETAGuide.

Results IncludedthreeCTsintheITCbetweenL-TC(Adhere), T-TC(ECZTRA3)andD-TC(LibertyadChronos).ThedifferenceinEASI90expressedasARR(IC95%)ofL-TCversus T-TC,andL-TCversusD-TC,was:6.6(-9–22.2)y-11(-27–5).ApplyingtheETAGuide,L-TC,T-TCandD-TCcouldbe consideredETA,beingtheprobabilityofclinicallyrelevantdifference<50%(mostofthe95%CIisintheequivalence range),andthefailuredoesnotinvolveserious/irreversible damage.

ConclusionandRelevance TheITCshowednostatisticallysignificantandclinicallyrelevantdifferencesinEASI90between anti-interleukin-13plustopicalcorticosteroids.Thesedrugs couldbeconsideredETAinmostpatientswithmsDA.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-080 METASTATICHER2-POSITIVEBREASTCARCINOMA CASEREPORT:ANTI-HER2TREATMENT MAINTENANCEDESPITEOLIGOPROGRESSION 1ATrujillano*, 2FJValdiviaGarcia, 1MCSánchezArgaiz, 1MGallegoGalisteo, 1ECampos Dávila. 1HospitalDeLaLínea,Pharmacy,LaLíneaDeLaConcepción,Spain; 2HospitalDeLa Línea,Oncology,LaLíneaDeLaConcepción,Spain

10.1136/ejhpharm-2024-eahp.184

BackgroundandImportance Thenewanti-HER2conjugated drugshaverepresentedasignificantadvancementinthetreatmentandmanagementofmetastaticHER2-positivebreastcancerpatients,enablingtheapplicationoflocalablativetherapy inthecaseofoligoprogression,withapositiveimpactonthe survivalofthesepatients.

AimandObjectives Theobjectiveofthistextistoprovidea comprehensiveoverviewofthepatient‘smedicalhistoryand treatmentprogressioninmanagingHER2-positivebreastcarcinoma.Itaimstounderscoretheimportanceofpharmaceutical interventions,interdisciplinarycooperation,andadaptabilityin

achievingfavourabletreatmentoutcomesforpatientswith complexoncologicalconditions.

MaterialandMethods 51-year-oldwoman.DiagnosedinMay 2005withinfiltratingductalcarcinomaoftheleftbreast, underwentsurgeryafterneoadjuvantchemotherapy+Trastuzumab,luminalBHER2-positiveimmunophenotype.Subsequently,receivedadjuvantradiotherapy+trastuzumab+ hormonetherapy.AlltreatmentsconcludedinApril2011.

Results InJanuary2020,shewasadmittedtotheInternal Medicinewardduetodyspnearelatedtobilateralparaneoplasticpulmonaryembolism,promptinganextensionstudy revealingmultiplemetastaticbonelesions.BonebiopsyconfirmedinfiltrationbyHER2-positivebreastcarcinoma.InFebruary2020,shecommencedfirst-linesystemictreatmentwith Docetaxel+Trastuzumab+Pertuzumab,withexcellent tolerance.

InDecember2021,diseaseprogressionwasobservedwith theemergenceoflungmetastasesandapre-sternalnodule, whilebonediseaseremainedstable.Arequestwasmadeto PharmacyforTrastuzumab-Emtansinetreatment,whichcommencedinJanuary2022.

InMay2023,therewasgrowthofthepre-sternallesion whileotherlesionsremainedstable.Afterhistologicallyconfirmingthesameimmunophenotype,thecasewasdiscussedin amultidisciplinarycommittee,anditwasdecidedtoadministerstereotacticbodyradiationtherapy(SBRT)whilemaintainingsystemictreatmentforproperlocalcontrol.Thepatient continuestreatmentwithagoodclinicalcourse.

ConclusionandRelevance Thispharmaceuticalperspective highlightsthepatient‘streatmentjourneyandtheroleofvarioustherapiesinmanagingHER2-positivebreastcarcinoma, emphasisingtheneedforadaptabilityandinterdisciplinarycollaborationtooptimiseoutcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-081 CONSENSUSONINDICATORSFORMEDICATIONRELATEDREADMISSIONS:ADELPHISTUDY

1,2NSchönenberger*, 3,4ALBlanc, 5,6BHug, 1MHaschke, 1,2AGoetschi, 1,2UWernli, 1,7CMeyer-Massetti. 1ClinicalPharmacologyAndToxicology,DepartmentOfGeneral InternalMedicine-Inselspital-UniversityHospitalBern-UniversityOfBern,Bern, Switzerland; 2GraduateSchoolForHealthSciences,UniversityOfBern,Bern,Switzerland; 3PharmacyOfTheEasternVaudHospitals,-,Rennaz,Switzerland; 4InstitutDesSciences PharmaceutiquesDeSuisseOccidentale,UniversityOfGeneva,Geneva,Switzerland; 5DepartmentOfInternalMedicine,LuzernerKantonsspital,Lucerne,Switzerland; 6Faculty HealthSciencesAndMedicine,UniversityOfLucerne,Lucerne,Switzerland; 7InstituteOf PrimaryHealthcareBiham,UniversityOfBern,Bern,Switzerland

10.1136/ejhpharm-2024-eahp.185

BackgroundandImportance Medication-relatedreadmissions (MRRs)representasignificantburdenonpatientsandhealthcaresystems.DespitetherelevanceofMRRs,aconsensuson themostimportantriskfactorsiscurrentlylacking.

AimandObjectives Thisstudyaimedtodevelopacomprehensivesetofindicatorsfor30-dayMRRsthroughaconsensusbasedDelphistudy.Wesoughttoidentifyandprioritisekey riskfactorsassociatedwithMRRs.

MaterialandMethods Weassembledanexpertpanelconsisting ofclinicalpharmacists,physicians,andnursingexperts.The potentialindicatorsweredevelopedbyconductingascoping literaturereview(n=20).Thestudyteamaddedeleven

indicatorsnotfoundintheexistingliteraturebutconsidered potentiallyrelevant.The31proposedindicatorswereratedby theexpertsonascaleof1to9forrelevance.Indicatorswith amedianratingof7orhigherwereconsideredrelevant.ConsensuswasdeterminedusingtheRAND/UCLAmethod.Inthe secondround,expertsre-evaluatedindicatorswithoutconsensusandprovidedspecificationsforindicatorsrequiringfurther detail.

Results Inthefirstround,38expertsparticipated,leadingto theinclusionof25indicatorsandtheexclusionofsix.All indicatorsreachedconsensus,andfivenewindicatorswere suggested.Inthesecondround,34expertsparticipated,resultingintheinclusionoffouroutoffivenewlyproposedindicators,allofwhichreachedconsensus.Theexpertpanel prioritisedthefollowingindicators:(1)insufficientcommunicationbetweendifferenthealthcareproviders,(2)polypharmacy (sevenormoremedications),(3)lowmedicationadherence (forgettingoradministermedicationswronglyatleasttwice perweek),(4)complexmedicationregimenthatinvolvestakingatleastthreedosesperday,usingatleasttwodifferent dosageforms,andadministeringthemthroughatleasttwo differentrouteseachday,and(5)multimorbidity(threeor morechronicconditions).

ConclusionandRelevance ThecomprehensivesetofMRR indicatorsdevelopedinthisstudyaddressestheneedfora standardisedMRRriskassessmentandoffersatoolforpharmaciststoprioritiseclinicalpharmacyservicesduringhospital discharge.Thiscouldleadtomoreefficientresourceallocation andpotentiallyimprovepatientoutcomes.Futureworkwill focusonvalidatingtheidentifiedindicators.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-082 DESCRIPTIVESTUDYOFPOST-SURGERYANALGESIC PRESCRIPTIONS

LHernándezSilveira*,MPratsRiera,CJuezSantamaría,APonsMaria,EBofillRoig, FBarceloSanso,JALuqueMesa. HospitalCanMisses,FarmaciaHospitalaria,Eivissa,Spain 10.1136/ejhpharm-2024-eahp.186

BackgroundandImportance Inadequatelytreatedpostoperative paincancompromisethepatient‘srecovery,prolonghospital stayandcontributetochronicpain.Inourhospitalthereare onlysomesurgicalserviceswithanalgesiaprotocols.Forthis reason,it’sproposedastudyofpost-surgicalpaintreatment.

AimandObjectives Descriptivestudyofthemanagementof acutepostoperativepaininhospitalisedpatientsafterscheduledsurgeryandthedegreeofadherencetotheanalgesia protocolsavailableinthehospital.

MaterialandMethods Retrospectiveobservationalstudyof hospitalisedadultsforscheduledsurgeryduringNovember 2022.DatacollectionwascarriedoutthroughtheclinicalhistoryandHospiwin2000® electronicprescriptionprogram.The collectedvariablesweresex,age,prescribedanalgesicregimen, usanceornotofanalgesiaprotocolandpainregistration accordingtothenumericalscale(NS).TheNSclassifiestypes ofpainintothreeranges:NS1–3mildpain,NS4–6moderatepain,NS7–9severepain.

Results 125patientswereconsidered(49.6%male;50.4% female).Ofwhichthemeanagewas57years(19–89).Out ofthe125cases,therewere22differentanalgesiaregimens.

Themostfrequentlyusedintravenousanalgesiatreatment wasdexketoprofen50mg/8h+acetaminophen1g/8h (19.2%);followedbydexketoprofen50mg/8h+acetaminophen1g/6h(17.6%).Overall,inonly59%ofthecasesthe prescriptionofanalgesiacorrespondedtotheavailableprotocolsintheelectronicprescriptionprogram.Painlevelwas recordedin69%ofthepatients.Allthosepatientsinwhom theNSwascollectedpresenteddifferentrangeofpainduring thehospitalstay:5%recordedseverepain;29%moderate pain;and66%mildpain.43prescriptionsweredetectedthat didnotcomplywiththetechnicaldatasheetrecommendations forintravenousanalgesicdrugs(Metamizoledose>5g/day, dexketoprofen>48hours).

ConclusionandRelevance Ahighprevalenceofpatientswith painandhighvariabilityofnon-protocolisedanalgesicguidelines,andevenwithdosesnotincludedinthetechnicaldata sheetoftheanalgesicdrugs,weredetected.

Theanalysisofthecurrentsituationinourhospitalisthe startingpointforreviewingtheexistingprotocolsanddevelopingnewonesthatunifyandoptimisetheanalgesiaprescriptionguidelines.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-083 MEDICATIONRECONCILIATIONINTERVENTIONSINAN EMERGENCYDEPARTMENTATADMISSION

YCampos-Baeta*,BZurita,MEstelrich,MMartí-Navarro. FundaciónHospitalSantJoanDe Déu,Pharmacy,Martorell,Spain

10.1136/ejhpharm-2024-eahp.187

BackgroundandImportance TheInstituteforHealthcare Improvement(IHI)definesMedicationReconciliationasthe formalprocessofobtainingacompletelistofthepatient‘ s medicationpriortoadmission,comparingitwiththeonethat hasbeenprescribedinthehealthcentre,intransfersandmedicaldischarge.

Reconciliationerrorsoccurin50%ofpatientsadmittedto hospitalsandhavebeenidentifiedbyorganisationssuchasthe WHOorNICEasaprioritypracticeforpatientsafety.

AimandObjectives Theaimofthestudyistodescribethe pharmaceuticalinterventionsrelatedtomedicationreconciliationinanEmergencyDepartmentattheadmissionprocess, thedegreeofacceptancebycliniciansandthemostcommonly pharmacologicalgroupsinvolvedintheseinterventions.

MaterialandMethods Itwasadescriptiveandtransversal studyconductedintheEmergencyDepartmentofaRegional Hospital(<150beds)duringFebruary2021-July2023.

Areviewofusualmedicationsofpatientsadmittedduring thenightwasperformeddaily.Reconciliationinterventions wereregisteredinadatabase(MicrosoftExcel(r))andclassifiedinfivetypes:omission,dose,therapeuticequivalents, drugnotnecessaryandadverseevent.Drugsinvolvedwere classifiedaccordingtotheAnatomicTherapeuticClassification (ATC).

Results Sixhundredandeighty-twopharmaceuticalinterventionswerecarriedout,ofwhich59%wereofthemedication reconciliationtype.Thedegreeofacceptancebytheclinicians was75%.

Themedicationreconciliationinterventionsweremadein 228patientsofwhom55%weremale.Themeanageofthe patientswas75.86years(range20–97).

Themostfrequentreconciliationerrorswererelatedtothe omissionofthedrug(46.03%),dosageerrors(37.37%)and therapeuticequivalents(6.93%).

DrugsmostfrequentlyinvolvedinpharmaceuticalinterventionsbelongedtothefollowingATCgroups:cardiovascular system-C(43.06%),nervoussystem – N(33.41%),blood-B (7.17%)andsystemichormonalpreparations-H(5.69%).

ConclusionandRelevance Morethanahalfoftheinterventionswererelatedtomedicationreconciliationwhichshows thatthisprocessisimportantathospitaladmission.Thehigh degreeofacceptancebycliniciansshowsthatthepharmacist shouldbepartofamultidisciplinaryteamandcancontribute improvingpatients’ safety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-084 GENOTYPINGANALYSISOFPOLYMORPHISMSINTHE DIAHYDROPYRHYDROMIDINEDEHYDROGENASE (DPYD)GENEPRIORTOADMINISTRATIONOF FLUOROPIRMIDINES

AMelgarejo-Ortuño*,MPBautistaSanz,CAApezteguiaFernandez,EMatillaGarcia, LEHoyoGil,MAAmorGarcia,BRodriguezVargas,RMorenoDiaz. HospitalUniversitario InfantaCristina,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.188

BackgroundandImportance ItishighlyrecommendedtogenotypeDPYDgenepolymorphismsbeforeadministration.CompletedeficiencyofDPDactivityisveryrare,estimatedat 0.01%to0.5%ofindividuals,partialdeficiencyhasbeenestimatedat3%to8%.

AimandObjectives Theaimsofthestudyincludedthe descriptionandfrequencyofDPYDgenepolymorphismsprior tofluoropyrimidineadministrationinalltumourtypesandthe measurestaken.

MaterialandMethods Retrospective,multidisciplinarystudyin atertiaryhospital,withtheparticipationofpharmacy,clinical analysisandoncologydepartments,byreviewingthegenotypingofDPYDgenepolymorphisms.Oncologypatientswho weregenotypedintheperiodfromJune2020toDecember 2021wereincluded.FourDPYDvariantswereanalysed: DPYD*2A,c.2846A>T,c.1679T>Gandc.1236G>A(HapB3) andthegenotypeof82polymorphicregionsoftheDPYD generelatedtothelevelofenzymeactivity.Variables recorded:sex,age,tumourlocation,variantfoundanddegree ofenzymeactivity(poormetaboliser(0–0.5),intermediate metaboliser(1 –1.5)andnormalmetaboliser(2).

Results Atotalof150patients,56.7%female,withamedian ageof68.9years(53.2–84.6)werescreened.Tumoursites were:colorectal(48.7%),breast(22.7%),gastric(8.7%),pancreatic(8.7%),cholangiocarcinoma(6%),headandneck(2.7%)and others(2.5%).15patients(10%)hadsomedegreeofenzyme deficiency.5(30%)ofthepatientspresentedanenzymeactivitylevelof1.5,8(53%)presented1,1(6%)presented0.5 and1(6%)presented0.Thevariantsfoundwere:in6 patients(40%)c.2846A>T,3(20%)c.1129–5923C>G,7 (46.7%)c.1156G>T(*12),1(6.7%)c.1777G>A,1(6.7%) c.1905+1G>A,1(6.7%)c.483+18G>Aand1(6.7%) c.1236G>A.2(13.3%)ofthepatientshadbothalleleswith mutatedvariants.11(73.3%)ofthepatientshadonevariant, 3(20%)had2variantsand1(6.7%)had3variantsaffected. Intermediatemetabolisershadtheirdoseoffluoropyrimidines

reducedby50%andpoormetabolisersweresparedtheuse offluoropyrimidines.

ConclusionandRelevance Themaindiagnoseswerecolonand breastcancer.10%ofpatientsstudiedhadsomedegreeof enzymedeficiencyaccordingtothevariantsanalysed,8.6% withpartialdeficiencyand1.3%withcompletedeficiency. Ourpopulationshowedahighprevalenceofdeficienciesin relationtotheliteraturedescribed.Thisdeterminationallowed doseadjustmentofthesedrugs,whichrepresentsanadvance intermsofsafety,allowingpersonalisedtreatments,individualisingdosesandavoidingtoxicities.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-085 LONG-TERMPERSISTENCEINPSORIASISPATIENTS WITHHIGHRESPONSETOGUSELKUMAB:AREALWORLDRETROSPECTIVESTUDY

AValcuendeRosique*,JBorrás-Blasco2, 2SCornejo, 3RAlcalá, 4JIMarí, 2ECasteraMelchor, 1ASánchez-Alcaraz. 1HospitalUniversitarioDeLaRibera,PharmacyService,Alzira, Spain; 2HospitalDeSagunto,PharmacyService,Sagunto,Spain; 3HospitalDeSagunto, DermatologyService,Sagunto,Spain; 4HospitalUniversitarioDeLaRibera,Dermatology Service,Alzira,Spain

10.1136/ejhpharm-2024-eahp.189

BackgroundandImportance Guselkumabrepresentsanimportantadvancementinthetreatmentofpsoriasis.Bytargeting theIL-23pathway,itaddressestheunderlyingimmunedysregulationthatdrivespsoriasis,leadingtosignificantimprovementsinsymptoms,qualityoflife,andlong-termdisease managementformanypatients.

AimandObjectives Thisstudyaimstoevaluatethereal-world persistenceofGuselkumabinadultpatientswithmoderate-toseverepsoriasisinamulticentreanalysis.Secondaryobjectives ofthestudyweretoanalysetheeffectivenessandsafetyof Guselkumabinthesamecohortofpatients.

MaterialandMethods Thisretrospectivecohortstudyused registriesandmedicalrecordsfrom2differenthospitals(Apr 2019toSept2023).Adultswithmoderate-to-severepsoriasis whoinitiatedGuselkumabtreatmentwereidentifiedandfollowed-upuntilSept2023,ordisenrollment.Baselinedemographicandclinicalcharacteristicsstudiedincluded:sex,age atdiagnosis,currentage,psoriasisareaseverityindex(PASI), previoustreatment,andcomorbidities.Kaplan-Meieranalysis wasusedtoestimateGuselkumabpersistenceatone,twoand threeyears.

Results Atotalof62patientswithmoderate-to-severepsoriasis wereincluded(age49.3±13.7years;64.5%men).29%of includedpatientswerenaïvetobiologicaltreatment.Baseline PASIscorewas8.4andpatientsreceived1.9±0.9priorlines oftreatment.Mostcommonpreviousbiologicaltreatments includedustekinumab(59.1%),anti-TNFa (52.3%)andIL-17 inhibitordrugs(31.8%).5outof62patientsdiscontinued Guselkumabtreatmentduetothefollowingreasons:lackof efficacy(4.8%),transaminaseelevation(1.6%)andpregnancy (1.6%).Guselkumabpersistencewas21.6±[2.0]monthsfor allpatients.Whenperformingasubgroupanalysis,non-naïve patientsobtainedapersistenceof23.0±[1.5]monthsfollowedby16.6±[4.1]monthsfornaïvepatients(p=0.250). Guselkumabpersistenceat1year,2yearand3yearwas 95%,93%and91%,respectively.

ConclusionandRelevance Guselkumabdemonstratedhighpersistenceduringthestudyperiod,suggestingpatientandhealthcareprofessionalsatisfactionwithefficacyandtolerabilityover timeinpatientswithmoderatetoseverepsoriasis.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-086 ASSESSMENTOFTHECLINICALRELEVANCEOF

LEVETIRACETAMMONITORING

ICastejonGrao,VGarciaZafra,OGuillenMartinez,GMirallesAndreu,LSorianoIrigaray, ANavarroRuiz*. HospitalGeneralUniversitarioDeElche,ServicioDeFarmacia,Elche,Spain 10.1136/ejhpharm-2024-eahp.190

BackgroundandImportance Monitoringoflevetiractetamis necessaryfortreatmentoptimisationduetotheirwideinterindividualpharmacokineticvariability.Age,clinicalsituationand pregnancycontributegreatlytoitspharmacokineticalterations.

AimandObjectives Toevaluatetheimpactandusefulnessin clinicalpracticeofpharmacokineticmonitoringoflevetiracetaminatertiaryuniversityhospitalcarriedoutbythepharmacyservice.

MaterialandMethods Retrospectiveobservationalstudyin53 patientsbetween02/2016–05/2023.Pharmacokineticand patientdatawereobtainedfromGestlab® andOrionClinic® software:sex,age,weight,concomitantantiepileptic,creatinine valueandhepaticinsufficiencydiagnosis.Patientswereclassified:paediatric(0–14years),pregnant,criticalilloroutpatients.The clinicalrelevanceoflevetiracetammonitoringwasassessedby whetherthefirstlevetiracetamlevelofpatientswaswithinor outsidethetherapeuticrange(12–46mcg/mL)andthepharmacokineticrecommendationmadebythepharmacyservice.

Results

Fifty-threepatientswerestudied 25menand28womenwitha medianof4(4)yearsand18(20)Kginpaediatricandof42 (32.25)yearsand69(34)Kginadults.Therewere33%paediatric,6%pregnant,15%criticalilland45%outpatients.Two patientshadcreatininelevelsabove1.3mg/dL,twodiagnosed withliverfailureand43%hadconcomitantantiepileptictreatment.53%ofpatientshadlevetiracetamleveloutof range,79%werebelow:14%pregnant,41%paediatric,9%criticalilland36%outpatient.68%wereadjustedaccordingto thepharmacyserviceofwhich100%decidedtoincreasethe dosage:100%ofpregnantandcritical,63%ofoutpatientand 55%ofpaediatric.In32%notadjusted,29%gotthetreatmentsuspended,29%wasincreasedbythephysicianand14% wasnotpossibletocarryoutthepharmacokineticreport.The remaining21%wereabovetherange:17%werecriticalill and83%outpatient,50%percentwereadjustedaccordingto thepharmacyservice:60%ofoutpatientinwhich100% decidedtoreducethedosage.In50%notadjusted,33%it wasnotpossibletocarryoutthepharmacokineticreport. Treatmentwasadjustedin2patientsdespitetheywerewithin rangeduetopoorrenalfunctionorbydecisionofthe physician.

ConclusionandRelevance Monitoringoflevetiracetamlevels hasbeenshowntobeclinicallyrelevantforbetterindividualisationoftreatmentsincemorethanhalfofthepatientswere outofrange.Thishasallowedpharmacokineticadjustmentin mostcasestomaintainthedrugintherapeuticrangeandoptimisetreatment,especiallyinpregnant,criticalillandpaediatric patients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-087 ADALIMUMABPERSISTENCEINCLINICALPRACTICE ATAREGIONALHOSPITAL

JMartínezGonzález*,PCastroSalinas,VCharquesTrallero,ARetameroDelgado, SMendiolaGarcía,JSerraisBenavente,DFerràndezMartí. HospitalD’igualada,Pharmacy, Igualada,Spain

10.1136/ejhpharm-2024-eahp.191

BackgroundandImportance Currently,biosimilardrugsarea greatcost-effectivealternativetomaintainthepublichealth systemsustainable.

AimandObjectives Toanalysepersistencebetweenbiosimilar andoriginatoradalimumab,aswellaspredictorsassociated withahigherriskofdiscontinuation.

MaterialandMethods Retrospectivestudyconductedina regionalhospitalwithareferenceareaof133,734inhabitants.

Allpatientswhohavebeentreatedinourhospitalwith originatororbiosimilaradalimumabwereincluded.Patients switchingwereexcluded.

Variablesstudied sex,age,treatment,indication,startingand endingdate,previoustreatmentsandreasonforinterruption.

Kaplan-Meiermethodwasusedtoanalysethe48month retentionrateandcomparedbyastratifiedlogranktest.A Coxproportionalhazardsregressionanalysisstratifiedbyage, sex,indication,yearofprescriptionandreasonforinterruptionwasdone.

StatisticalanalysiswasperformedusingSPSSStatisticsv22. Categoricalvariablesareshownwithpercentagesandquantitativevariableswithmedianandinterquartilerange.

Results Thestudyincluded401patients,222women(55.4%), medianage54.0(43.0–63.0)years.Adalimumabbiosimilar wasindicatedin185(46.1%)patients.Treatmentdurationfor theoriginatorvsbiosimilarwas21.9(5.7–61.8)vs9.3(5.0–20.7)months.

Indicationdistribution 137(34.2%)rheumatoidarthritis,74 (18.5%)psoriasis,63(15.7%)Chrondisease,50(12.5%) psoriaticarthritis,50(12.5%)spondyloarthitis,21(5.2%) hidradenitissuppurativa,3(0.7%)ulcerativecolitis,2juvenile idiopathicarthritis(0.5%),1SAPHO(0.2%).

Mainreasonsforstoppingadalimumab 74(18.5%)no response,58(14.5%)adverseeffect,47(11.7%)lossofeffectivenessand33(8.2%)remission.

Theoverall48-monthretentionratewas17.2%.Estimated proportionsofpatientsmaintainingoriginatorandbiosimilar were30.1%vs2.2%after48months.Originatorshoweda highersurvivalretention(HR0.42,95%CI0.34–0.53, p<0.0001).

TheCoxproportionalhazardregressionshowedthatthe predictorssignificantlyassociatedwithadalimumabdiscontinuationwereage,reasonfordiscontinuationandyearof prescription.

ConclusionandRelevance

. Biosimilarpersistencewaslowerthanexpected.Probable reasonswerelackofclinician’sconfidenceandtheincreasing variabilityoftreatments.

. Thedurationoftreatmentwithoriginatorwasmorethan twicelongerthanbiosimilar.

. Thehighestnumberofdiscontinuationstookplaceinthefirst 12months.

. Thehighnumberofdiscontinuationscausesalotof biologicalturnover.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-088 FOLICACID,FOLINICACIDANDHEMATOTOXIC TREATMENTS:AREVIEWATAUNIVERSITYHOSPITAL CENTRE

AMHami*,MHocine,FPetan-Ranguin,DAuvray,GMaquin,GBaroux. UniversityHospital CentreOfMontpellier,InternalUsePharmacyOfSaint-Eloi,Montpellier,France

10.1136/ejhpharm-2024-eahp.192

BackgroundandImportance Studieshaveshownthatfolicacid (FA)andfolinicacid(FAi)areequallyeffectiveinpreventing methotrexate-relatedhaematotoxicity.Accordingtoitsmarketingautorisation(MA),FAisindicatedforthetreatmentof folatedeficiency,chronicintestinalabsorptiondisordersand supplementationduringpregnancyandFAifortheprevention andcorrectionofhaematotoxicitycausedbyco-trimoxazole (CMX),pyrimethamine(PYM)andmethotrexate(MTX).

AimandObjectives AssessmentofthecomplianceofprescriptionswiththeindicationsforFAandFAiatouruniversity hospitalcentre(UHC).

MaterialandMethods Aretrospectivestudywascarriedout onnominativedeliveriesin2022on2UHCestablishments.

Theindication(preventionorsupplementation),whetherit wascombinedwithhaematotoxictreatment,andthesearch forvitaminB9(VB9)deficiencypriortoinitiatingtreatment weresoughtusingtheprescriptionassistancesoftware.

Results 266patientswereincludedinourstudy:56% (n=150)receivedFAand44%FAi(n=116).84%ofprescriptionscompliedwithMAindications.

RegardingFA,aVB9dosagewasperformedin42% (n=63)ofpatientsandadeficiencywasobservedin57% (n=36)ofcases.90%(n=135)ofpatientsreceiveditfora supplementationand10%(n=15)topreventhaematotoxicity duetotreatment(n=11onCMX,n=4onMTX)andare thereforeoff-label.

RegardingAFi,aVB9dosagewasperformedin20% (n=23)ofpatientsandadeficiencywasidentifiedin22% (n=5).In77%(n=89)ofcases,FAiwasusedtopreventhaematotoxicityduringtreatment(n=85onCMX,n=3onPYM, n=1onMTX)and23%(n=27)receiveditasasupplement andarethereforeoff-label.

ConclusionandRelevance Someprescriptionsdon’tcorrespond totheMAindications,andtheefficacyofFAhasnotbeen demonstratedinthepreventionofCMXhaematotoxicity. Moreover,theunitcostofFAiishigher:failuretocomply withtheindicationsmayresultinhighertreatmentcosts.

Disagreementbetweenprescribersisobservedthroughthe heterogeneityofprescriptions.Toreducetherateofnon-compliantprescriptions,consultationbetweendoctorsandpharmacistsneedstobedevelopedtoreachaconsensus.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SheaB, etal.Folicacidandfolinicacidforreducingsideeffectsinpatients receivingmethotrexateforrheumatoidarthritis. CochraneDatabaseSystRev.doi: 10.1002/14651858.CD000951.pub2.

ConflictofInterest Noconflictofinterest.

4CPS-089 CLINICALPHARMACISTEFFECTIVENESSIN HOSPITALISEDPATIENTS:ANALYSISOFTHE INTERVENTIONRECORDINASECONDARYACUTE HOSPITAL

1RIglesiasGómez*, 2ISacanellaAngles, 3JJimenezJimenez, 1SMartinezPerez, 1AMartinezValero, 1JMCrespoBernabeu, 4ESaurasColon, 1MEJulianAvila. 1Hospital TortosaVirgenDeLaCinta,PharmacyDepartment,Tortosa,Spain; 2HospitalUniversitario JoanXxiii,Pharmacy,Tarragona,Spain; 3HospitalUniversitarioYPolitecnicoLaFe, Neurology,Valencia,Spain; 4HospitalTortosaVirgenDeLaCinta,ResearchSupportUnit, Tortosa,Spain

10.1136/ejhpharm-2024-eahp.193

BackgroundandImportance Clinicalpharmacistactivityisfundamentalinthehospitalisedpatient,sinceitpreventsmedicationerrors,participatesintheselectionofmedicationand facilitatesmedicationcomplianceintermsofdispensingand administration.

AimandObjectives Toanalysetheprofileoftheclinicalpharmacist’sinterventionsinpatientshospitalisedinasecond-level hospital.Therefore,clinicalneedscanbediscoveredandpreventiveactionspromoted.

MaterialandMethods Retrospectivemultidisciplinary,interventionalstudy,from08/2023to09/2023.Acute-hospitalised patientsfrommedicalandsurgicalareaswereselected.

Thevariablesrecordedwere intervention/dayratio,medications prevalenceandtheirincidencesandreasonsforintervention. Adescriptiveanalysiswasperformedusingabsolutefrequenciesandpercentages.

Results 1555pharmaceuticalinterventionswererecorded,with a12.34interventions/dayratioand7.05implementedinterventions/day/100patients,considering175hospitalbeds.

Medicationswithmorethan10interventionsandtheir incidencewere:non-guideoralmedications(183,hospital admissionconciliation),intravenousdexketoprofen(33,kidney-failureadjustment),intravenousacetaminophen(31,therapeuticduplicity),piperacillin-tazobactam(31,treatment duration,kidney-failureadjustment),oralallopurinol(30,hospitaladmissionconciliation),non-guideinhaledmedications (25,hospitaladmissionconciliation),intravenouspotassium chloride(24,improperdosage,frequencynotcompatiblewith fluidtherapy),intravenousmetamizole(22,excessivedose), amongothers.

Abstract4CPS-089Table1 Showsmainreasonsforthe interventions

Oftheimplementedinterventions,50.48%correspondedto surgicalareasand49.52%tomedicalareas.

ConclusionandRelevance Thetaskcarriedoutbytheclinical pharmacistisfundamentalinthehospitalenvironment,since itensurestheproperuseofmedicationstomaximisetheir effectiveness,minimisethesideeffectsandpreventmedication errors.

Thisstudyshowsthattheregistryofinterventionsiscrucial tocarryoutpreventivestrategieswithapopulationimpactin themostprevalentinterventions.Thankstothis,strategies wereimplementedsuchasmandatoryallergyregistration, assistedprescriptionmodificationtoavoidoverdoses(e.g. metamizole,dexketoprofen)orexpandingthehospital’spharmacotherapeuticguide.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-090 REAL-WORLDPERSISTENCEWITHFREMANEZUMAB VERSUSERENUMABAMONGMIGRAINEPATIENTS

1MGómezBermejo*, 1LMartín-Zaragoza, 1JSánchez-RubioFerrández, 1CGarzo-Bleda, 1AMaraver-Villar, 1NHerranz-Muñoz, 1AOnteniente-González, 1LRubio-Ruiz, 2GMartínÁvila, 2RTerrero-Carpio, 1TMolina-Garcia. 1HospitalUniversitarioDeGetafe,Hospital Pharmacist,Getafe,Spain; 2HospitalUniversitarioDeGetafe,Neurology,Getafe,Spain

10.1136/ejhpharm-2024-eahp.194

BackgroundandImportance Migrainetherapyisamajorchallenge.Monoclonalantibodiesagainstcalcitoningene-related peptide(anti-CGRPmAb),asfremanezumabanderenumab, areindicatedformigraineprophylaxisinadults.

Littleisknownaboutthecomparativepersistenceoffremanezumabanderenumab,twoanti-CGRPmAbscommonly usedinourclinicalpractice.

AimandObjectives Tocomparethepersistenceoffremanezumabanderenumabinpatientswithmigraineandtoidentify factorsassociatedwithit.

MaterialandMethods Weconductedaretrospective,non-interventional,longitudinalstudy.Allchronicorepisodicmigraine naivepatientsover18yearstreatedwithfremanezumabor erenumabinourcentrewereincluded.

Persistencewasdefinedasthedurationoftimefrominitiationtodiscontinuationoftherapy(lastdispensingorendof follow-upinAugust2023).Permissiblegap(daysbetweentwo prescriptionfillsexceedingtheallowablerefillperiod)was60 days.

Covariatescollectedfrommedicalrecordwere:age,gender, baselinemigrainedayspermonth(MDM)andMedication PossessionRatio(MPR).

Wecomparedqualitativevariablesusingthe c2 distribution. Forquantitativevariables,weusedeithertheMann-Whitney UtestortheStudent’st-distributionbasedonnormality assessment.

Kaplan-Meiersurvivalanalysiswasperformedanddifferenceswereevaluatedusingthelog-ranktest.Adjustedriskof discontinuationwasassessedwithCoxProportionalHazard models.Significancelevelwas0.05.

Results Eightypatientswereincluded,86.3%werefemale. Age(mean±SD)was48±10years.MPRwas98.4±4.1, 61.3%weretreatedwithfremanezumab.BaselineMDM

(median)was17days(IQ12–28).Therewerenostatistically significantdifferencesbetweenthegroups.

Overall,meanpersistencedurationwas482days(CI95% 404–559).Persistencewithfremanezumabwas743days(CI 95%638–848)andpersistencewitherenumabwas548days (CI95%368–729);p=0.001.AccordingtoadjustedCoxmodelbyMDMHRwas3.5(CI95%1.7–6.9;p=0.001)for anti-CGRPmAband1.1(CI95%,1.04–1.15p=0.001)for baselineMDM.

ConclusionandRelevance Inourstudy,naivepatientstreated withfremanezumabhadhigherpersistenceratesthanthose treatedwitherenumab.BaselineMDMwasalsofoundto influencepersistence.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-091 REAL-LIFEPERSISTENCE,EFFECTIVENESSANDSAFETY OFFREMANEZUMABINPATIENTSWITHCHRONIC MIGRAINE

SOjeda*,PRiera,NPagès,MMasip,RPelegrin,ADeDios. HospitalDeLaSantaCreuI SantPau,HospitalPharmacy,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.195

BackgroundandImportance Chronicmigraine(CM)isa highlydisablingdisordercharacterisedbyrecurrentepisodesof moderatetosevereheadache.Severalpreventivetreatments areavailable,includingmonoclonalantibodiesagainstcalcitoningene-relatedpeptide(CGRP),suchasfremanezumab.

AimandObjectives Theaimofthisstudywastoevaluatethe persistence,effectivenessandsafetyoffremanezumabinclinicalpracticeinpatientswithCM.

MaterialandMethods Thisisarestrospectiveanddescriptive studyconductedatatertiaryteachinghospital.Allpatients whostartedfremanezumabasafirst-lineanti-CGRPtherapy betweenAugust2020andDecember2022wereincluded. Inclusioncriteriawere:age 18years,diagnosisofCMand aminimumfollow-upof3months.

Patientsdemographicandclinicaldatawereobtainedfrom electronicmedicalrecords.Thesedataincludedage,sex, comorbidities,numberandtypeofpreviouspreventivetreatments,andmonthlymigrainedays(MMD)atinitiation,3 monthsand6months.Persistencewascalculatedasthenumberofdaysbetweentreatmentinitiationanddiscontinuation ortheendofstudyfollow-up,whicheveroccurredfirst.Efectivenesswascalculatedconsideringa 50%reductionof meanMMDat3and6months.Safetywasanalysedaccordingtothenumberandtypeofadverseeventsthatoccurred duringtreatment.

Results Atotalof207patientswereincluded,ofwhom190 (92%)werewomenwithamedianageof48years(18–81 years).Thetwomostfrequentcomorbiditiesweredepression (23%)andanxiety(20%).Patientshadreceivedameanof 4.6preventivetreatmentsbeforeanti-CGRPinitiation,highlightingtheuseofantidepressants(72.4%)andonabotulinum toxin(89.3%).At3and6monthsoffollow-up,persistence were92.6%and80.0%,respectively.Thepercentageof patientswhoachieveda50%MMDreductionwas56.8%at 3monthsand54.5%at6months.Atotalof27patients (13%)developedsideeffectsduringfremanezumabtherapy,

beingthemostcommonallergicreactionorpruritus(11 patients;5.3%)constipation(5patients;2.4%)andinjection sitereaction(5patients;2.4%).

ConclusionandRelevance Ourresultsshowthatfremanezumab isaneffectiveandsafetreatmentforCM,whichhasdemonstratedgoodpersistencedatainclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-092 ANALYSISOFANTIBIOTICSCONSUMPTIONATAN ITALIANCARDIOLOGYCENTRE:PHARMACOUSE PROFILEACCORDINGTOTHEAWARE CLASSIFICATION

1AIezzi*, 2VTeso, 3MCella, 2SZitelli, 2GBallardini, 2BTebaldini, 4EOmodeoSalè. 1Centro CardiologicoMonzino,ServizioDiFarmaciaOspedaliera,Milano,Italy; 2CentroCardiologico Monzino,FarmaciaOspedaliera,Milano,Italy; 3UniversitàDegliStudiDiPavia,FacoltàDi Farmacia,Pavia,Italy; 4CentroCardiologicoMonzino – IstitutoEuropeoDiOncologia, FarmaciaOspedaliera,Milano,Italy

10.1136/ejhpharm-2024-eahp.196

BackgroundandImportance Resistantbacteriaandmultidrugresistantbacteria(MDRO)representaproblemforpublic health,bothfortheepidemiologicalimpactandclinicalmanifestationsandfortheassociatedeconomicconsequences.

AimandObjectives Antimicrobialstewardshipincludestheuse oftheAwaReclassificationwhichdividesantibioticsinto Access,WatchandReservecategories.AnanalysisoftheDDD (defineddailydose)consumptionofantibioticsdistributedby theHospitalPharmacytothedepartmentsbetween2018and 2021wasconductedinordertoimplementtheuseofantibioticdrugsassuggestedbytheWorldHealthOrganization Healthcare(WHO).

MaterialandMethods Inordertomonitortheuseofdrugs, thehospitalpharmacyextractedtheconsumptionintodosage unitsusingtheSAPsoftwareandthenconvertingtheminto DDD.Tocomparetheconsumptiondatawiththeliterature reports,itwasnecessarytorelatetheDDDstothedaysof hospitalisation.Finally,thedrugsweredividedintoAwaRe categoriesandthetrendinconsumptionofeachmoleculein theperiodconsideredwascalculated.

Results Theanalysisrevealedthatthemostusedcategoryis Watch,whoseconsumptiondecreasedin2019comparedto thepreviousyearby-6.31%,andthenincreasedin2020by +21.49%.Watchconsumptionin2021iscomparabletothat of2019.Accessconsumptionunderwentaslightincreasein 2019comparedto2018of+24.77%,whileitdecreasedin thefollowingtwoyears(-21.19%in2021vs2019).The Reservesshowedagrowthtrendbetween2018and2020 (+83.90%).Comparedto2020,in2021thedatarelatingto theuseoftheseantibioticsdecreasedslightly(-24.36%).

Finally,theAccesstoWatchindicatorwascalculatedtoevaluatetheappropriatenessofantibioticconsumption.Theresults emergingfromthisreportdoesnotmatchtotheidealvalue recommendedbytheWHO.1

Conclusionandrelevance Theconsumptionofantibioticsin theWatchandReservecategoriesshoulddecreaseinfavourof thosebelongingtotheAccesscategory.TheuseoflatestgenerationantibioticsbelongingtotheReservecategoryshouldbe limitedtocasesinwhichantibioticsfromotherclassesare inappropriate.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.WHORegionalOfficeforEurope,«AntimicrobialMedicinesConsumption(AMC) Network.AMCdata2019»WHO.RegionalOfficeforEurope,Copenhagen,2022.

ConflictofInterest Noconflictofinterest.

4CPS-093 ANTIBIOTICRESISTANCEINTHEHOSPITALCONTEXT: RETROSPECTIVEANALYSISOFANTIBIOGRAMS, RESISTANCEANDSENSITIVITYPROFILESATAN ITALIANHEARTCENTRE

1AIezzi*, 2VTeso, 2SZitelli, 2GBallardini, 2BTebaldini, 3EOmodeoSalè. 1Centro CardiologicoMonzino,ServizioDiFarmaciaOspedaliera,Milano,Italy; 2CentroCardiologico Monzino,FarmaciaOspedaliera,Milano,Italy; 3CentroCardiologicoMonzino – Istituto EuropeoDiOncologia,FarmaciaOspedaliera,Milano,Italy

10.1136/ejhpharm-2024-eahp.197

BackgroundandImportance Thefightagainstantibioticresistanceisoneofthemainchallengesofthetwenty-firstcentury. Hospitalantimicrobialstewardshipactivitiesarefundamental forappropriateantibiotictherapiesagainstmulti-resistantbacteria(MDRO).

AimandObjectives Aretrospectivedescriptiveanalysisofa sampleofpatientshospitalise dtoacardiaccentrebetween 2018and2021andsubjectedtocultureexaminationwas conductedinordertoevaluatetheresistanceandsensitivityprofileofMDROthroughtheevaluationofMICs (minimuminhibitoryconcentration)expressedinthe antibiograms.

MaterialandMethods TheMICsofsomeantibiotic-MDRO combinationswereevaluatedcomparedtotheepidemiological cut-offECOFF.Thecalculateddifferenceswereevaluated usingtheStudent’sttestforpairedsamples.Allresultsare presentedastwo-sidedvaluesandapvalue<0.05isconsideredsignificant.analyseswereperformedwithSASsoftware.

Results Theretrospectiveanalysiswasconductedon167adult subjects.Themajorityofpatientsaremale(65.27%,n=109) agedbetween56and75years(50.9%,n=85).Themajority testedpositiveforgram-negativebacteriathroughoutthe period(55.56%n=30in2019,65.85%n=27in2020,68% n=34in2021),withtheexceptionof2018inwhichaprevalenceofgram-positiveswasdetected(55.41%,n=41).The mostwidespreadbacterialspecieswereEscherichiacoliand KlebsiellaPneumoniaeamonggram-negativesandStaphylococcusepidermidisandStaphylococcusaureusamonggrampositives.

TheMICsofthesebacteriaareincreasing,asinthecase ofKlebsiellaPneumoniae,forwhichtheMICvalueofmeropenemexceedstheECOFFwithafrequencyof99.9%.The StaphylococcifamilyexpressedMICvaluesfortheantibiotic linezolidequaltotheECOFFwithafrequencyof5.38%. TheMICofdaptomycinwasequaltotheECOFFfor 17.58%oftheisolates.

ConclusionandRelevance Fromthiswork,theneedforclinicianstoconsultantibiogramsandevaluatetheECOFFparameterhasemerged.Theprojectwillbecontinuedinthefuture inordertomonitortheevolutionoftheresistanceprofilesof MDROsandtoevaluatetheprescriptiveappropriateness throughtheanalysisoftheclinicaloutcomeoftreatment efficacy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-094 RISKFACTORSFOREMERGENCYDEPARTMENTREVISITINELDERLYPATIENTSWITH GASTROINTESTINALBLEEDINGSECONDARYTO DIRECTORALANTICOAGULANTS

1JRuizRamos*, 1CSociasCanelles, 1APlazaDiaz, 2MCMéndezPérez, 1SOjedaGil, 3PArenalesCaceres, 1AJuanesBorrego. 1InstitutDeRecercaDeL’hospitalDeLaSanta CreuISantPau,Pharmacy,Barcelona,Spain; 2InstitutDeRecercaDeL’hospitalDeLaSanta CreuISantPau,EmergencyDepartment,Barcelona,Spain; 3TxagorritxuHospital UniversitarioAraba,Pharmacy,Vitoria,Spain

10.1136/ejhpharm-2024-eahp.198

BackgroundandImportance Gastrointestinalbleedingrelated toantithrombotictherapyisamaincauseofemergency department(ED)consultation.Dataregardingtheriskfactors involvedintheonsetofnewbleedingepisodesassociated withnewanticoagulanttreatmentafterthefirstepisodeis scarce.

AimandObjectives ToevaluatethefrequencyofEDre-visits amongelderlypatientswithgastrointestinalbleedingsecondary todirectoralanticoagulant(DOACs)treatmentandtoidentify riskfactorsassociatedwithanincreasedriskofEDre-visits.

MaterialandMethods Afouryears(2018 – 2022)retrospectiveobservationalstudywasdesigned,includingadult patients( 18years)withatrialfibrillationandundergoing oralanticoagulationtherapywhovisitedtheEDforgastrointestinalbleeding.Toevaluatetheriskfactorsfor90days re-visit,amultivariateanalysiswasdesignedincluding patientscomorbidities,conc omitanttreatment,changein anticoagulanttreatmentandprescriptionofdirect-acting oralanticoagulants.

Results 127patients(Meanage(SD):84.7(7.6)years;61.4% females)wereincluded.Atdischarge,anticoagulationtherapy wasmodifiedin45(35.4%)patients;changedfromanoral anticoagulanttoheparinin18(18.9%)patients,toanother DOACsin21(46.7%)andtoavitaminKantagonistinfour (0.9%).Anticoagulanttreatmentwaswithdrawnineleven (9.0%)patientsatdischarge.15(12.2%)patientsrevisitedthe ED90daysafterhospitaldischargeforbleedingorthromboticepisodes.Anon-significantdecreaseinthefrequencyof EDre-visitswasobservedinthosepatientswhochangedtheir anticoagulanttreatmentatdischarge(10.1%vs17.5%; p=0.241).Inthemultivariateanalysis,chronickidneydisease wastheonlyfactorsignificantlyassociatedwithrevisitsat90 days[OR:1.58(1.01–4.05)]

ConclusionandRelevance Elderlypatientswhoexperiencea firstepisodeofgastrointestinalbleedinghaveahighriskof re-visitingtheEDforableedingepisode.Thosepatientswith antithromboticchangeatdischargemaydecreasetheriskof newemergencyvisits.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-095 EXPLORATORYANALYSISOFCARDIOVASCULAR EVENTSINANASTHMATICCOHORT

1VLColladaSánchez*, 1EVillamañán, 2PGranda, 1CMateos, 1CSobrino, 1MGolovkina, 3LDeLasVecillas, 4DLaorden, 4RÁlvarez-Sala, 1AHerrero. 1HospitalUniversitarioLaPaz, Pharmacy,Madrid,Spain; 2HospitalGomezUlla,Pharmacy,Madrid,Spain; 3Hospital UniversitarioLaPaz,Allergology,Madrid,Spain; 4HospitalUniversitarioLaPaz, Pneumology,Madrid,Spain

10.1136/ejhpharm-2024-eahp.199

BackgroundandImportance Asthmaoftenaccompaniesarange ofconcurrenthealthconditions.However,thereisascarcity ofevidenceconcerningthecardiovascularconsequencesin individualswithasthma.

AimandObjectives Theprimaryobjectiveofthestudywasto analysetheimpactofcardiovascularfactorsonagroupof asthmapatientsinourhospital.

MaterialandMethods Thiswasaretrospective,observational studyincluding206patientswithasthmawhowereassessed attheDifficultAsthmaControlUnitofatertiaryhospital. Patientswhohadexperiencedacardiovasculareffectbefore thediagnosisofasthmawereexcluded.

Wegathereddemographicandclinicaldata,aswellas comorbidities,asthmasubtypes,biologicalmarkersandspirometricmeasurementsusingtheelectronicmedicalrecordvia theHCISapplication.Wealsodocumentedthepatients‘ cardiovasculareventhistory,specifyingthetypeofevent.Furthermore,werecordedinformationregardingthepatients‘ useof biologicaltherapy,systemiccorticosteroidsandinhalation therapy

Results Themajorityofpatientswerewomen(65,6%)withan averageageof57±18years.Amongthem,121patientshad allergicasthma.Othercomorbiditiesinclude:obesityoroverweight(98),diabetes(24),hypertension(65),dyslipidemia(52) andsleepapnea(21).

108patientsweretreatedwithomalizumab,35withmepolizumab,18withbenralizumaband40werentreceivingbiologicaltreatment.Atotalof125patientshadmorethan300 eosinophilsand110hadatotalimmunoglobulinE(IgE)level greaterthan100kU/L.

114patientsexperiencedatleastoneasthmaexacerbation peryear,while109patientshadforcedexpiratoryvolume (FEV1)values<80%ofpredicted.77patientshadarecent fractionofexhalednitricoxidegreaterthan40ppb.

23patients(11%)sufferedacardiovascularevent,including 5anginaspectoris,5myocardialinfarction,6heartfailures,8 supraventriculararrhythmias,5thromboembolisms,5strokes, and1withlowerlimbthrombosis.

ConclusionandRelevance Cardiovasculareventsaremore prevalentinourasthmaticpatients(11%)comparedtothe generalEuropeanpopulation(7%).Itisessentialtodetermine whetherthereisarelationshipbetweencardiovascularprocessesandasthma,andifso,evaluatethemutualimpactof bothprocesses.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-096 USEOFCOVID-19ANTIVIRALSINPATIENTS PREVIOUSLYTREATEDWITHTIXAGEVIMAB/ CILGAVIMABPROPHYLAXIS:EXPERIENCEOFAN ITALIANHOSPITAL

IRestivo*,CGaluppi,FChiari,CCasella,GPenocchio,DPaganotti,TETesta. AsstSpedali CiviliDiBrescia,HospitalPharmacy,Brescia,Italy

10.1136/ejhpharm-2024-eahp.200

BackgroundandImportance SomeCOVID-19authoriseddrugs targettheentryofSARSCoV-2intothehostcell,suchasthe combinationofmonoclonalantibodiestixagevimab/cilgavimab (T/C),whileotherspreventviralreplication,suchastheantiviralsremdesivirandnirmatrelvir/ritonavir.Pre-exposureprophylaxiswithT/Cisindicatedinfrailpatientsatriskof

developingsevereCOVID-19.Onepivotalstudyreporteda 77%reductionindiseaseriskcomparedtoplacebo,withprotectionestimatedatleastsixmonths.

AimandObjectives ToevaluatehowmanypatientshavedevelopedCOVID-19thatrequiredtreatmentwithaspecificantiviralamongtheonesinprophylaxiswithT/Cinourhospital.

MaterialandMethods ThroughtheanalysisofAIFAMonitoringRegistersitwaspossibletoobtaindataofpatientsinprophylaxiswithT/CandsubsequentlytreatedwithCOVID-19 antiviral.Thedataobtainedreferstotheperiodbetween10th March2022(dateofthefirstadministrationofprophylaxisin thehospital)and10thSeptember2023.CasesofineffectivenessofT/ChavebeenreportedintheNationalPharmacovigilanceNetwork.

Results Duringtheconsideredperiod,314patientswere treatedwithT/Cprophylaxis.Ofthese,9(2.9%)received remdesivir,6(1.9%)remdesivirearlytreatment,4(1.3%)nirmatrelvir/ritonavir.1patient(0.3%)contractedtheinfection3 timesafterprophylaxis(thefirstwithin1monthandthefollowingafter6months)requiring3antiviraltreatments:nirmatrelvir/ritonavir,remdesivirearlytreatmentandremdesivir. Overall,6.4%ofpatientsundergoingprophylaxisweresubsequentlytreatedwithatleastoneantiviral,85%ofthem within6months.Theaveragetimebetweenprophylaxisand antiviraltreatmentwas113days.

ConclusionandRelevance TheAIFAMonitoringRegisters havebeenausefultoolfortheclinicalevaluationofthe therapeuticefficacyofT/Cpr ophylaxisandforpharmacovigilanceactivities.Inthesampl econsidered,93,6%ofpatients whoreceivedprophylaxisdidn’tdevelopCOVID-19that requiredantiviraltreatment inahospitalsetting.Ourdata onlyreferstoinpatientssubjects,thusrepresentingalimitationfortheanalysis;T/Cprophylaxisforfrailpatientshas howeverprovedtobeavaluableresourceinadditionto vaccination.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.EVUSHELD-EPAR.

2.StudioPROVENThttps://classic.clinicaltrials.gov/ct2/show/NCT04625725 3.https://www.aifa.gov.it/registri-farmaci-sottoposti-a-monitoraggio

ConflictofInterest Noconflictofinterest.

4CPS-097 REAL-WORLDSTUDYOFAPALUTAMIDETREATMENT INPATIENTSWITHMETASTATICHORMONE-SENSITIVE PROSTATECANCERINNINEHOSPITALSOF VALENCIANCOMMUNITY

1FJRodriguezLucena, 2JPoquet-Jornet*, 3FMendoza-Otero, 4JPolache-Vengud, 5MDíazGonzález, 6MÁBernabeu-Martínez, 2MLlinares-Esquerdo, 7RGarcia-Garcia, 8NGarciaDel Busto, 9AGarcia-Monsalve. 1HospitalVegaBaja,Pharmacy,Orihuela,Spain; 2HospitalDe Denia,Pharmacy,Denia,Spain; 3HospitalGeneralUniversitarioDeElda,Pharmacy,Elda, Spain; 4HospitalGeneralUniversitarioDr.Balmis,Pharmacy,Alicante,Spain; 5Hospital MarinaBaixa,Pharmacy,Vilajoiosa,Spain; 6HospitalUniversitarioSanJuan,Pharmacy,San Juan,Spain; 7HospitalUniversitarioDeTorrevieja,Pharmacy,Torrevieja,Spain; 8Hospital VirgenDeLosLirios,Pharmacy,Alcoy,Spain; 9HospitalGeneralUniversitarioDeElche, Pharmacy,Elche,Spain

10.1136/ejhpharm-2024-eahp.201

BackgroundandImportance Systemicinvolvementofprostate cancer(PC)typicallyoccursatthebonelevel(65–85%). Patientswithmetastatichormone-sensitiveprostatecancer (mHSPC)havesurvivalratesrangingfrom1–6years,dependingonhigh-riskprognosticfactorssuchas:

• Elevatedlevelsofprostate-specificantigen(PSA>20)at diagnosis.

• HighGleasonscore(8–10).

• Increasedvolumeofmetastaticdisease.

• Poorfunctionalstatus.

• Bonesymptomsorthepresenceofvisceralmetastases. Apalutamide,abiraterone,andenzalutamideareorally administeredtreatmentsfinancedforuseincombinationwith androgendeprivationtherapy.Theyhavedemonstrated improvementinoverallsurvival(OS),particularlyinhigh-risk progressionpopulations,andafavourablesafetyprofile. AimandObjectives Studytoassestheefficacyprofile,safety andclinicalfollow-upofpatientswithmHSPCundergoing Apalutamidetreatment.

MaterialandMethods Aretrospectiveobservationalstudywas conductedonpatientswithmHSPCwhoinitiatedApalutamide treatmentin9publichospitalsinValencianCommunity, Spain.Thesepatientshadaminimumclinicalfollow-upof6 monthsasofMarch2023.Clinicalrecords,PSAevolution, andtoxicityreportedbyhealthcareprofessionalsorthe patientsthemselveswerereviewed.Acomprehensivedescriptivestatisticalanalysiswasconducted,bothoverallandbydiseasevolume.

Results Atotalof172patients(73±8years)wereincluded, withhighdiseasevolume(n=80;46.5%)andlowdiseasevolume(n=92;53.5%).41.3%hadreceivedpriorlocaltreatment. Themedianpre-treatmentPSAlevelwas22.2(3.4–97.9)ng/ mL,69.8%hadmetastasesatdiagnosiswithpredominantly bonemetastasis(61.6%),andamediantimefromdiagnosisto theinitiationofapalutamidewas4(2–51)months.

At3months,69.7%ofpatientsachieved>90%reduction inbaselinePSA,andan87.7%reduction>50%inPSAin real-worldconditions.After12monthsoftreatment,80%of patientscontinuedwithapalutamide,withdiscontinuationdue totoxicityin4.2%andprogressionordeathin13.1%of patients.

ConclusionandRelevance Wedidnotobservesignificant responsedifferencesbetweenlowandhighvolumegroups. Apalutamideinreal-worldtreatmentofmenwithmHSPC demonstratesafavourablesafetyprofilelikedatapublishedin clinicaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Cornford,Philip&Bergh,Roderick&Briers, etal.EAU-EANM-ESTRO-ESUR-SIOG GuidelinesonProstateCancer.PartII-2020Update:TreatmentofRelapsingand MetastaticProstateCancer. EuropeanUrology.2020;79.10.1016/j. eururo.2020.09.046.

ConflictofInterest Noconflictofinterest.

4CPS-098 EFECTIVENESSANDSAFETYOFLONG-ACTING CABOTEGRAVIR/RILPIVIRINEINREAL-LIFE POPULATION

CGarcíaCastiñeira*,SGarcia-Xipell,SMarin,GCardona,IGarcíaGiménez,ABocosBaelo,LEstrada,ETerricabras,CRodríguez-González,CQuiñones. GermansTriasIPujol Hospital,Pharmacy,Badalona,Spain

10.1136/ejhpharm-2024-eahp.202

BackgroundandImportance Simplificationstrategiesaimedto improveantiretroviraltherapyadherence,tolerabilityandcompliancehaveemergedduringrecentdecades.Inthiscontext, long-actingcabotegravir/rilpivirineinjectablehasbeenrecently

commercialisedasanewpromisingtreatmentalternative,and pharmacist-ledlong-termmonitoringcouldbebeneficialto ensuretreatmenteffectivenessandsafety.

AimandObjectives Assessthelong-termreal-lifeeffectiveness andsafetyofcabotegravir/rilpivirine.

MaterialandMethods Thiswasanobservational,longitudinal andprospectivestudyperformedbetweenMarchandSeptember2023.Patientswereincludediftheystartedtreatment witheitheraone-monthorallead-in(OLI)withcabotegravir/ rilpivirinefollowedbylong-actingtherapyordirectlywiththe long-actinginjectionregimen(atmonth0,1,3and5)and receivedatleast4injectabledosesandexcludedifparticipated inFLAIRandATLASstudies.Sociodemographic(age,sexat birth),anthropometric(bodymassindex[BMI])andviral (HIV-RNAviralloadatbaselineand5-monthfollow-up)data werecollected.Treatmentwasconsideredeffectivewhen patientsachievedormaintainedvirologicalsuppression

Drugadverseeffectswerecollectedandfollowed-up throughactivepharmacistvalidation,andclinicalandnursingstaffmonitoring.

Results 30patientswereincluded(90%malesexatbirth, meanage43.7years).1patienthadaBMI>30.Atbaseline, allpatientshadundetectableviralload(HIV-RNA<50copies/ mL)and6(20%)startedwithOLI.

At5-monthsfollow-up,28(93.3%)patientshadanundetectableviralload.2patientsabandonedtreatmentafter1 month,duetoanunknownarchivedrilpivirinemutation(one patienthadaVLof113,146copies/mLandtheother remainedundetectable).

90%ofpatientsreportedatleast1adverseeffect,being themostfrequent:injection-sitereactions(83.3%ofpatients reportedglutealpain,13.3%induration),followed-bylowgradefever(10%),fatigue(6.7%)anddiarrhoea(6.7%).

ConclusionandRelevance Cabotegravir/rilpivirineeffectiveness andsafetywerefavourableinthiscohortofbaselinevirologicallysuppressedpatients.Notreatmentinterruptionsdueto adverseeffectswereobservedbutresistancemutationsneedto beconsidered.

Althoughsmallsamplesize,lowproportionoffemale patientsandashort-termfollow-upduetorecentcommercialisation,thisstudycouldbeofhelpduetolackofstudies reportingdataoncabotegravir/rilpivirineeffectivenessinreallifepopulationandlong-termpharmacisttreatmentmonitoring

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-099 CHIMERICANTIGENRECEPTOR-TCELLS(CAR-TCELLS) ANDANTIBIOTICS:ANOT-SO-INNOCENT ASSOCIATION

MHocine*,AQuintard,IRoch-Torreilles,GBaroux. ChuMontpellier,PharmacieSaint-Eloi, Montpellier,France

10.1136/ejhpharm-2024-eahp.203

BackgroundandImportance AccordingtoanAmericanstudy1, priorexposuretoPiperacillin/tazobactam(P/T),Imipenem/cilastatin(I)andmeropenem(M)iscorrelatedwithreducedoverallsurvivalanda71%higherriskofdeathinpatientstreated withCAR-Tcells(ChimericAntigenReceptorTcells).This exposureisalsoassociatedwithanincreasedriskofimmune effectorcell-associatedneurotoxicitysyndrome(ICANS).

AimandObjectives TheaimistodemonstrateiftheAmerican resultsapplytoourreal-liferesults.

MaterialandMethods ForeachpatientwhoreceivedaCAR-T cellsinjectionbetweenJanuary2019andAugust2023,the ‘CAR-Tcells’ pharmaceuticalteamchecked:antibioticprescription4weekspriortoCAR-Tcellsinjection,post-injectiontoxicities(ICANSandcytokinereleasesyndrome(CRS))and deathwithin6monthsofCAR-Tcellsinjection.

Tohavepopulationscomparabletothoseinthestudy,we definedtwogroups: ‘P/T/I/M’ ispatientswhoreceivedP/T/I/ Mantibiotics,and ‘Otherantibioticsandnaive’ ispatients whoreceivedantibioticsotherthanP/T/I/Morantibiotic naive.weselectedallCAR-Tcellswithmarketing authorisation.

StatisticalcomparisonsweremadeusingtheFischertest (risk=5%bilateral).

Results Two-hundredandfivepatientsreceivedCAR-Tcells: 172 ‘OtherATBandnaive’ patients(84%)and33 ‘P/T/I/M’ patients(16%)inthe4weekspriortoinjection.

Inthe ‘P/T/I/M’ population,therewere12CRS(36.5%),0 ICANS,12ICANS+CRS(36.5%)and9(27%)withouttoxicities.Seven(21%)patientsdied.

Inthe ‘Otherantibioticsandnaive’ population,therewere 100CRS(58%),2ICANS(1%),43ICANS+CRS(25%)and 27notoxicities(16%).Twenty-fourpatients(14%)died.

AhigherriskofCRShasbeenidentifiedinthe ‘P/T/I/M’ group(p=0.02).

Noothersignificantdifferencewasfoundbetweenthe2 groupson:ICANS+CRS(p=0.2),ICANS(p=1),ordeath (p=0.29).

ConclusionandRelevance Ourstudyshowsahigherriskof CRSforpatientsexposedtoP/T/I/M4weekspriorto injection.

OurstudyalsoshowsnoexcessriskofICANSnortoxicitiesanddeathfor ‘P/T/I/M’ patients.Ourresultsaretherefore notsimilartothoseoftheAmericanstudy.

Thesedifferencescouldbeexplainedbythesizeofour populationandthefactthattheAmericanstudyonlyselected anti-CD19CAR-Tcells.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://doi.org/10.1038/s41591-022-01702-9

ConflictofInterest Noconflictofinterest.

4CPS-100 THEUTILITYOFEARLYPHARMACEUTICAL VALIDATIONOFSELECTEDHIGH-RISKDRUGSINA HOSPITALEMERGENCYDEPARTMENT

CPuivecinoMoreno,YCastellanosClemente,JPedreiraBouzas*,MGarciaGil. Hospital UniversitarioDeFuenlabrada,HospitalPharmacy,Fuenlabrada,Spain

10.1136/ejhpharm-2024-eahp.204

BackgroundandImportance High-riskmedicationandthe associatederrorsrepresentapotentialsourceofadverseeffects andreadmissionsforpatients.

AimandObjectives Toanalysetheutilityofearlypharmaceuticalvalidationofdirectoralanticoagulants(DOACs)andlongactinginsulins(LAIs)inaHospitalEmergencyDepartment (ED).

MaterialandMethods Thisretrospectivestudywasconducted betweenMay15,2023,andSeptember28,2023.Twogroups ofhigh-riskmedications(HRMs)wereselected:DOACs

(apixaban/dabigatran/edoxaban/rivaroxaban)andLAIs(degludec/detemir/toujeo(glargine))duetotheirhigh-risknature, requiringvalidationbyapharmacistfortheearlyinthe morningdispensation.Onweekdays,thesemedicationswere identifiedintheEDthroughtheelectronicprescriptionprogramandsubjectedtopharmaceuticalvalidation.Alllocations, appropriateness,and,incasesofinappropriateness,boththe underlyingreasonsandtheiracceptancewererecorded.Recommendationswerecommunicatedthroughthepatient‘selectronicmedicalrecordorbytelephonetotheattending physician.Locationsreviewedonpreviousdayswereexcluded topreventduplication.Theprimaryvariablewasthedegree oftotalnon-appropriateness,bothoverallandbytherapeutic group.Secondaryvariablesincludedthereasonsfornonappropriateness,thedegreeofacceptanceofpharmaceutical recommendations,and,incasesofnon-acceptance,theoccurrenceofadversedrugevents(ADEs)foreachtherapeutic group.TheanalysiswasperformedusingMicrosoftExcel® for Microsoft365MSO(2308version).

Results Duringthestudyperiod,atotalof338locationswere recorded:193DOACsand145LAIs.Theoveralldegreeof non-appropriatenesswas16.6%(56/338),with13.0%(25/ 193)forDOACsand21.4%(31/145)forLAIs.Themainreasonsfornon-appropriatenessforDOACswere52.0%temporarycontraindication(13/25),36.0%inappropriatedosage(9/ 25),and12.0%reconciliation(3/25);forLAIs:58.1%inappropriatedosage(18/31),32.3%contraindication(10/31),and 9.7%inappropriatepresentation(3/31).Theoverallacceptance rateofrecommendationsmadewas86.0%(49/57),withrates of100%(13/13)and88.0%(22/25)forDOACsandLAIs, respectively.NoADEsoccurred.

ConclusionandRelevance Earlyandproactivevalidationby thepharmacistintheEmergencyDepartmentofselectedhighriskdrugsappearstooptimisepharmacotherapyandreduce theoccurrenceofadverseeventsassociatedwiththese medications.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-101 MONITORINGMETABOLICSYNDROMEIN OLANZAPINETREATEDPATIENTS

LCosinMunilla*,IRuiz-Jarabo,NIbañez-Heras,MGomez-Bermejo,CGarzo-Bleda, AMaraver-Villar,TMolina-Garcia. GetafeUniversityHospital,HospitalPharmacyService, Madrid,Spain

10.1136/ejhpharm-2024-eahp.205

BackgroundandImportance Neuropsychiatricdisordersare associatedwithsignificantreductioninlifeexpectancyand increasedriskofcardiovascularmortality.Olanzapine,can exacerbatethedevelopmentofmetabolicsíndrome(MS),especiallyatthebegginingoftreatment

AimandObjectives Mainobjetivesaretoanalysethemetabolicmonitoringofpatientsreceivingoralolanzapinetreatment,tostudytheassociationbetweenolanzapineuseandthe developmentofmetabolicalterations(MA)andtoinvestigate theprescriptionofspecifictreatmentsforMSinpatientswho developit

MaterialandMethods Thiswasanobservational,descriptive, andretrospectivestudythatincludedadultpatientsadmitted tothepsychiatrichospitalunitandprescribedoralolanzapine betweenJanuary2023andApril2023.

Thecollectedvariablesincluded sex,age,riskfactors(smoking andsubstanceuse)andBodyMassIndex(BMI).

Itwasrecordedwhethertherewasaninitialbloodtestand afollow-uptestconductedbetweentwoandtwelvemonths afterthestartoftreatment,alongwiththetimeelapseduntil thefollow-uptest.Thefollowingparameterswerecollected: cholesterol,triglycerides,high-densitylipoprotein(HDL),lowdensitylipoprotein(LDL),andbloodglucose.

ForpatientsdevelopingMA,thestudyexaminedtheprescriptionofhypoglycemicandlipid-loweringmedications. Results 42patientswereincluded,57%womenandMeanage (±SD)was40±15.5years.Riskfactorsincludedsubstanceuse in19.05%ofpatientsandtobaccousein16.6%.Themean BMIwas24.5±5kg/m2

Only45%ofpatientsunderwentaninitialbloodtest. Noneofthemhadhyperglycemia,but31.6%hadlipidabnormalities(LA),withhypertriglyceridemiain50%ofcasesfollowedbyhighcholesterolandelevatedLDL.

Withinthefirstfewmonthsoftreatment(4.5±2.5), 54.8%hadfollow-upbloodtests.Noneofthesepatientshad hyperglycemia,but52.17%showedLA,increasedTGin50% anddecreasedHDLin41.6%.

Onlyoneofthesereceivedlipid-loweringmedication. ConclusionandRelevance Asubstantialpercentageofpatients werenotmonitoredforthepotentialdevelopmentofMS associatedwitholanzapineuse.Therewasanobserved increaseinLA,possiblylinkedtoit.Importantly,lipid-loweringmedicationusewaslimitedwhenLAwerepresent.

Thestudyhighlightstheneedtoraiseawarenessamong healthcareprofessionalsabouttheimportanceofmonitoring MSinthesepatients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-102 AMIODARONEANDLITHIUM-INDUCEDTHYROID DYSFUNCTION:WHOINITIATESTHEPRESCRIBING CASCADE?

1MDeWeerd-Slot*, 1,2MHSchipper, 3CEHSiegert, 4AMarmorale, 2MLBecker, 1,5FKarapinar-Carkit. 1OlvgHospital,DepartmentOfClinicalPharmacy,Amsterdam,The Netherlands; 2SpaarneGasthuisHospital,DepartmentOfClinicalPharmacy,Haarlem,The Netherlands; 3OlvgHospital,DepartmentOfInternalMedicine,Amsterdam,The Netherlands; 4EPic,EpicSystems,VeronaWi,Usa; 5Mumc+Hospital,DepartmentOf ClinicalPharmacyAndToxicology,Maastricht,TheNetherlands

10.1136/ejhpharm-2024-eahp.206

BackgroundandImportance Prescribingcascadesoccurwhen anunrecognisedadversedrugreaction(ADR)leadstotheinitiationofadditionalmedication,contributingtopolypharmacy. Itremainsunclearwhetherprescribingcascadesareinitiated byphysiciansfromspecialtiesotherthantheinitialprescriber. Thisstudyfocusesonamiodaroneandlithium,twomedicationsexclusivelyinitiatedinhospitals,whiletheADRthyroid dysfunctionoccursinprimarycare(median:aftertwoyears).

AimandObjectives Toassesswhetherthespecialtyofthe physicianinitiatingamiodaroneorlithiumdiffersfromthe specialtyofthephysicianinitiatingthethyroidmedication.

MaterialandMethods Aretrospectivestudywasconducted (twoteachinghospitalsand22communitypharmacies). Patientsinitiatingamiodaroneorlithium(index)andsubsequentlyreceivingthyroidmedication(marker)within24 monthswereincluded.Theprimaryoutcomewasthe

proportionofdifferentspecialtiesinitiatingtheindexand markermedication.Secondaryoutcomesincludedtherecognitionofprescribingcascadesinhospitals,communicationof theADRtogeneralpractitioners(GPs)throughdischargeletters,andtheknowledgeofthesecascadesamongcommunity pharmacists,aswellastheirpreferencesforaddressingthem (interviews).Descriptiveanalysiswasused.

Results Thestudycomprised100amiodaroneand17lithium userswhosubsequentlyreceivedthyroidmedication.Different specialtieswereinvolvedforamiodarone(62%)andlithium (71%).Foramiodarone(initiatedbycardiologists),internists initiated48%ofthemarkermedication,andGPsinitiated 11%.Forlithium(initiatedbypsychiatrists),GPs(47%)and internists(24%)initiatedthemarkermedication.

In75%(n=59)ofhospitalcases,themedicalspecialistinitiatingmarkerand/orindexmedicationrecognisedthecascadesassuchandinformedGPsin89%ofthesecases.Inthe remaining25%ofunrecognisedcases,thethyroidmedication wasprimarilyinitiatedbyanotherspecialty(93%).Interviews withcommunitypharmacistsrevealedlimitedawarenessof theseprescribingcascadesandtheyexpressedtheneedfora clinicaldecisionsupportsystem.

ConclusionandRelevance Thisstudydemonstratedthatvarious physicianscanbeinvolvedinprescribingcascadeswithinthe continuumofcare.GPsarenotconsistentlyinformedabout managingADRs,andcommunitypharmacistslackawareness oftheseprescribingcascades.Hospitalpharmacistscouldplay acrucialroleinrecognisingandmanagingthesecascadesin collaborationwithcommunitypharmacists.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-103 ANALYSISOFPNEUMONIAASSOCIATEDWITH MECHANICALVENTILATIONINCRITICALLYILL PATIENTSUNDERGOINGSELECTIVEDIGESTIVE DECONTAMINATION

JIBretonesPedrinaci,NJimenezCarbelo,MDLMMartinMira,MACastroVida*. Hospital DePoniente,Pharmacy,Almeria,Spain

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BackgroundandImportance PneumoniaZeroprojectisamultifactorialnationalintervention,basedontheconcurrentapplicationofmeasurestopreventventilator-associatedpneumonia (VAP).Withinthepackageofmeasures,selectivedigestive decontamination(SDD)isincludedasanoptionalbuthighly recommendedmeasure.

AimandObjectives SDDwasrecentlyimplementedinour centrewithapasteandsolutionformulationbasedoncolistin, tobramycinandnystatin.Ouraimisanalysingincidenceand mortalityofVAPafterSDDimplantationandrelatedfactors.

MaterialandMethods Retrospectiveobservationalstudyinsecond-levelhospitalincludingallpatientswhoconsumedDDS formulainIntensiveCareUnit(ICU)during2022.Datawere collectedfromdigitalmedicalrecordsandFarmaTools® electronicprescriptionsoftware:age,sex,causeofadmissionto ICU(medical,surgicalortrauma),daysofICUstay,dayswith mechanicalventilation(MV),presenceorabsenceofVAPduringadmission,useofintravenousantibioticsduringMV,presenceorabsenceofmultidrug-resistantmicroorganismin culturesanddeaths.

Fordataanalysis,wecalculatedincidenceofVAP,median dayswithMVinpatientswithVAP,multidrug-resistantorganismsinpatientswithVAP,incidenceofdeathsinpatientswith andwithoutVAP.

Results

Sample 71patients(73%male).Medianage:61[17–85]. CauseofICUadmission;medical:61(81%),surgical:6(8%), trauma:4(7%).MediannumberofdaysinICU:14[1–82]. MediandayswithMV:10[1–75].PatientswithVAP:18 (25%).UseofantibioticsduringMV:57(80%).Multidrugresistantmicroorganisms:10(14%).Deaths:41(57%) VAPincidence 25%.MediandaysofMVinVAPpatients:14 [4–63].Multidrug-resistantmicroorganismsinVAP:9(50%). DeathincidencewithoutVAP:18%.Deathincidencewith VAP:44%.

ConclusionandRelevance Datasuggestasignificantincidence ofVAPandahigherassociatedmortalitycomparedwhohave notsufferedthiscomplicationduringadmission.Aswouldbe expectedtheincidenceincreaseswiththenumberofdayson MV.Mostcases,intravenousantibioticswereusedasameasureincludedintheZeroPneumoniaprotocol.Itshouldbe notedthathalfofthemicro-organismsisolatedinpatients withVAParemulti-resistant.Moredatafrompreviousyears priortotheintroductionofSDDwouldbeneededtocompareareal-worldeffectiveness

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-104 COMORBIDITYPATTERNSINTHEOLDERHIVPATIENT

DGarciaMartinez*,MRMegualBarroso,NGarridoPeño,ÁBPousadaBenito,IGonzález García,AFuentesGonzález,YMateosMateos,MCarreraSánchez,LFernándezValencia, LCorralesPérez,MSeguraBedmar. HospitalUniversitarioDeMóstoles,Farmacia Hospitalaria,Móstoles,Spain

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BackgroundandImportance ThelifeexpectancyofpeoplelivingwithHIV(PLHIV)hasrisen.However,PLHIVpresent chronicsystemicinflammation,whichresultsinprematureageingandanincreasedriskofage-associatedcomorbiditiescomparedtothegeneralpopulation.

AimandObjectives TodeterminetheprevalenceofcomorbiditiesamongPLHIVwhoare65yearsoldorabove,andto categorisetheirdistributioninmultimorbiditypatternsaccordingtothestudybyPradoTorresetal:cardio-metabolic, depressive-geriatricandmechanical-thyroid.

MaterialandMethods Prospectivedescriptivestudythrough interviewswith47PLHIVover65yearsofageonactiveantiretroviraltreatmentseenintheoutpatientpharmaceuticalcare clinic.Thecomorbiditieswereobtainedfromthecomputerised clinicalhistory(Selene®),theprimarycarehealthhistory (Horus®)andtheclinicalinterviewwiththepatient.The comorbiditieswereclassifiedintocomorbiditypatternsaccordingtothestudybyPradoTorresetal,whichisincludedin the ‘ModelofSelectionandPharmaceuticalCareforHIV Patients’ bytheHospitalPharmacySocietyofourcountry.A comorbiditypatternisdiagnosedinapatientiftheypresent atleasttwopathologiesofthesamepattern.Multiplepatterns ofcomorbiditymaybepresentinapatient.

Results Thepatientshadamedianof5comorbidities(RIQ: 2–6).Outof47patients,28(60.0%)presentacardio-metabolicpattern,13(27.7%)adepressive-geriatricpatternand18

(38.3%)amechanical-thyroidpattern.Twopatientshadupto 7pathologiesofthesamepattern.4patients(8.5%)hadover 10comorbidities.57.4%ofthepatientssufferedfromarterial hypertension,53.2%dyslipemia,31.9%diabetesand23.4% benignprostatichypertrophy.

ConclusionandRelevance Inconclusion,non-HIV-related comorbiditiesareincreasinglyimportantinolderHIV-infected people.Itisimportanttodetectandpreventmodifiableagerelatedrisksofnon-HIVcomorbidities.Itisnecessaryto developamultidisciplinaryapproachtoensurehigh-quality clinicalcareinthesepatients.Understandingtherangeof comorbiditypatternsfacilitatesprecisionindevelopingforthcominghealthinterventionsincomplexelderlyPLHIV.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-105 MEDICINESOPTIMISATIONFORPATIENTSINA NURSINGHOME

1FMFerrerSoler*, 1CMCuadrosMartínez, 1PLópezSánchez, 2MVPerazaPérez, 1JJMárquezNieves. 1HospitalGeneralDeTomelloso,Pharmacy,Tomelloso,Spain; 2GerenciaDeAtenciónIntegradaDeTomelloso,PrimaryCare,ArgamasillaDeAlba,Spain

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BackgroundandImportance Inappropriateprescribingisassociatedwithincreasedmorbidityandmortality,especiallyinthe elderly.Itisnecessarytofindtoolstoimprovethecareof thesepatients.

AimandObjectives Theobjectivewastoevaluatetheresults ofamedicationreviewprograminnursinghome(NH) patients,analysingtheacceptanceofpharmacotherapeuticrecommendationsandidentifyingthemostfrequentinterventions andthepharmacologicalgroupsinvolved.

MaterialandMethods Prospective-multidisciplinaryinterventionstudycarriedoutbetween03/07/23and25/09/23using atreatmentreviewprogramforinstitutionalise dpatientsin NH.

Allinstitutionalisedpatientswereincluded.Patientswho diedwereexcluded.Sex,age,NG-tube,creatinine,bloodpressure,maindiagnoses,anddrugsprescribedwerecollected. UsingthesoftwareCheckthemeds®,thepharmacistreviewed treatments,preparingareportthatincludedtheproblems detectedandsuggestions:Startdrug,stopdrug,substitution, dosechange,ormonitoring.Therefore,theNHdoctorcould assesstheneedfortreatmentsmodifications.

Numberofinitialandfinaldrugs,interventionsperformed andaccepted,andtypeofinterventionswereanalysed.

ThedescriptiveanalysiswasperformedusingMicrosoft Excel® (percentages,means,standarddeviations).

Results Atotalof46patients(28women),meanage85.95 years[7.96],werereviewed.Twowereexcludedduetodeath. Atotalof526drugswereanalysed.Eachpatientwasprescribedanaverageof11.95[4.45].In5patientsnorecommendationwasmade.Eighty-ninerecommendationswere made,46(51.7%)wereaccepted,beingtherecommendations: 2newmedicinessuggestions,noneaccepted;75medication discontinuations,40accepted;5therapeuticsubstitutions,3 accepted;6dosemodifications,2acceptedand1monitoring, 1accepted.Thefinalnumberofdrugswas11.02[4.21]. DrugsinvolvedweremainlyCentralNervousSystemdepressants(34recommendations);ProtonPumpInhibitors(20);and antianemicpreparations(12).Themaincauseofnon-

acceptancewasthereluctanceofrelativestomodifyantipsychotictherapies.

ConclusionandRelevance Themedicationreviewprogramfor NHresidents,throughthecollaborationofahospitalpharmacistandaprimary-carephysician,optimisesthepharmacotherapyofinstitutionalisedpatients.Theinterventionsofthe multidisciplinaryteamprovidegreatvalueindeprescribing, reducingthenumberofdrugsused,andareavaluabletool toimprovethesafetyandeffectivenessoftreatments.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-106 AUC-SURVIVALREANALYSISOFTROPICS-02TRIAL WITHSACITUZUMABGOVITECANFORMETASTATIC LUMINALBREASTCANCER

1JIBretonesPedrinaci, 2CMDominguezSantana, 1NJimenezCarbelo, 1MACastroVida*, 2EJAlegreDelRey. 1HospitalDePoniente,Pharmacy,Almeria,Spain; 2HospitalUniversitario PuertoReal,Pharmacy,Cadiz,Spain

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BackgroundandImportance Sacituzumabgovitecan(SG)was recentlyapprovedbyEuropeanMedicinesAgencyforheavily treatedmetastaticbreastcancer(mBC)patientspositivehormonereceptor(HR+)andhumanepidermalgrowthfactor receptor-2(HER2)negativesupportedbyTROPiCS-02trial whichcomparestandardchemotherapy(ChT).Pivotalstudy resultsinoverallsurvival(OS)wasHR=0,78IC95%(0,65–0,95).OSdifferenceinmediansurvivaltimeswas:3,3 months.Althoughmediansarecommonlyusedinoncologyto measurethemagnitudeofthebenefitbetweendifferentdrugs, thisisnotaccuratebecauseonlymeasuresthedifferencein onepointofthecurves.AvisualinspectionofKaplan-Meier ’ s survivalfunctionsofTROPiCS-02suggestedthatthedifferenceofmedianscouldoverestimatetheOSbenefit,asthe curvesseparateinthecentralarea.

AimandObjectives TheaimofstudywastoreanalysetheOS benefitofSGfrompivotalclinicaltrialbycalculatingthedifferenceinmeansurvivaltimebyarea-undercurves(AUC)basedmethods.

MaterialandMethods WeuseWebPoltDigitizer4.6toextract survivaldataat100pointsineachKaplan-Meier ’sOScurves. MeansurvivaltimeswereestimatedbyAUCwithSeruga’ s method(AnnOncol2012).withorwithoutacorrectionfrom Fenix’smethod(EurJClinPharm2015).Thelaterprevents underestimationbysubtractingtheareascorrespondingtothe proportionofthepopulationwhosesurvivalisgreaterthan themaximumobservationtime.

Results TheAUC-estimateddifferenceforSGvs.standard ChTwere2,30bySeruga’sAUCmethodand2,35months withthecorrectionfromFenixetal.Itwas1monthless thanthedifferenceofmediansshowedthepivotalstudy.

ConclusionandRelevance EuropeanSocietyMedicalOncology ratedthisdrug-indicationwithascoreof3(notsubstantial benefit)intheirMagnitudeofClinicalBenefitScale(0to5). Moreover,thedifferenceofmediansoverestimatedthebenefit inthepivotaltrial,asitwasjustshownbyAUC-methods. TheseresultssuggestamodestbenefitforSGinmBCHR+/ HER2-.IndeedAUC-methodscouldbeagoodoptionwhen differenceofmediansaredoubtfultoestimatethebenefit;its useshouldbeextended.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SerugaB,PondGR,HertzPC.Comparisonofabsolutebenefitsofanticancer therapiesdeterminedbysnapshotandareamethods. AnnOncol. 2012;23 (11):2977–82.

ConflictofInterest Noconflictofinterest.

4CPS-107 ADHERENCETODAILYORALTREATMENTIN MULTIPLESCLEROSIS

DGarciaMartinez*,LCorralesPerez,MCarreraSánchez,YMateosMateos,LFernández Valencia,AGonzalezFuentes,MRMengualBarroso,ÁBPousadaFonseca,IGonzalez García,IMoronaMinguez,MSeguraBedmar. HospitalUniversitarioDeMóstoles,Farmacia Hospitalaria,Móstoles,Spain

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BackgroundandImportance Severalstudiesconcludethat correctadherenceofpatientswithmultiplesclerosis(MS)is relatedtohigherefficacyandlowerriskofrelapses,disease progression,hospitalisations,emergencydepartmentvisits, andultimatelylowerhealthcarecosts.Therefore,itisa prioritytodetectnon-adherenceinordertooptimise therapy.

AimandObjectives Toassessadherencetodailyoraltreatment inpeoplewithMS.Toperformadetaileddescriptiveanalysis ofnon-adherenttreatments,identifyingreasons,previoustreatmentsreceivedandcurrentstatus.

MaterialandMethods UsingtheHospital’soutpatientmodule, arecordwasobtainedofthecorrespondingdispensingdates betweenDecember2017andSeptember2023.Thisinformationwasusedtocalculateadhe rencefortreatmentsexceeding6months,whichwascompl ementedwiththeelectronic medicalrecordandpatientint erviews.Amedicationpossesionrate(MPR)oflessthan90%wasconsiderednon-adherence.Interruptionsduetomedicalreasonsweretakeninto account.

Results Atotalof114patientswereincludedand144treatmentswereanalysed,correspondingto66treatmentswith dimethylfumarate(9non-adherent,13.6%),63withteriflunomide(3non-adherent,4.8%),13withfingolimod(2nonadherent,15.4%)and2treatmentswithponesimodwithout adherenceproblems.

Therewasnon-adherencein14treatmentscorresponding to12patients,withamedianMPRof84.4%(interquartile range78.0 – 85.5%).Ofthese,7patientsremainedonthe sametreatmentdespitenon-adherence,withnoworseningof lesionsdetectedbymagneticresonanceimaging.4patients switchedtoanothertreatmentand1patientdiscontinued treatmentwithoutswitchingtoanothertreatment.Ofthe12 patients,7hadpreviouslyreceivedothertreatments,withglatiramerbeingthemostcommon,alongwithinterferonand teriflunomide.

Reasonsfornon-adherencein14treatmentswereadverse effects(4),misseddoses(4)andin6patientswecouldnot clearlyidentifythecause.

ConclusionandRelevance Wefoundgoodadherenceinalmost allpatients.Innon-adherentpatientstherateofmedication possessionremainshighanddidnottranslateinmostcases intoclinicalworsening.

AdherenceassessmentandsubsequentdetectionofnonadherentpatientsinMSisakeystrategyforpharmaceutical interventionsaimedatachievingbetterhealthoutcomesand efficiency.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-108 CLINICALIMPACTOFPHARMACOKINETIC MONITORINGOFINFLIXIMABANDADALIMUMABIN INFLAMMATORYBOWELDISEASE

MDCGONZALEZESCRIBANO*,MDMAlañonPardo,TESalinasMuñoz,JJSaizMolina, BProyVega,NAndresNavarro. HospitalLaManchaCentro,Pharmacy,AlcazarDeSan Juan,Spain

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BackgroundandImportance Failureofbiologictherapy(antitumournecrosisfactor(TNF)drugs)isacommonproblem. Pharmacokineticmonitoringcancontributetoearlyidentificationoftherapeuticfailureandthusoptimisetreatmentby keepingdrugconcentrationswithinthetherapeuticinterval (TI)wheretheprobabilityofefficacyishigherandthelikelihoodoftoxicityanddevelopmentofimmunogenicityis minimal.

AimandObjectives Toassesstheacceptabilityofpharmacokineticrecommendationsforadalimumab(ADA)andinfliximab (IFX)inclinicalpracticeinpatientswithinflammatorybowel disease(IBD).

MaterialandMethods Retrospectiveobservationalstudy(June 2023 – September2023)inpatientswithIBDtreatedwith anti-TNFdrugs.AllpatientswhowererequestedforADAor IFXplasmalevelswereincluded.

Variables sex,age,typeofpathology(Crohn’sdisease(CD)or UlcerativeColitis(UC)),anti-TNFregimen,concomitantimmunomodulators,typeofrecommendation(maintenanceofregimen,optimisation,intensification)andacceptanceof recommendations.Thetherapeuticinterval(TI)was3–10 mcg/ml(IFX)and5–12mcg/ml(ADA).

Datasource electronichealthrecord(MambrinoXXI®)and MwPharm++pharmacokineticmonitoringsoftware.

Results Seventy-twopatients(65%male)wereincluded,witha medianageof47(16–77)years.Ofthese,75%hadCDand 25%hadUC.53patientswereonADAand19onIFX.Seventy-eightpharmacokineticmonitoringtestswereperformed. 60%werewithintheTI,21%weresubtherapeuticand19% weresupratherapeutic.In3patients,theconcentrationwas higherthantheTIandwasnotinaccordancewiththepreviousones,soanewcontrolwasrequested.Afterthis,itwas confirmedthattheywerewithintheTIandmaintenanceof theregimenwasrecommended.

Thepharmacokineticrecommendationsconductedwere maintenanceofregimen(73%),intensification(17%)andoptimisation(10%).94%ofrecommendationswereaccepted.The recommendationsthatwerenotaccepted(6%)weredueto clinicalworseningofthepatientandachangeoftherapeutic targetwasmade.

ConclusionandRelevance Basedontheresultsofourstudy, thedegreeofacceptanceofpharmacokineticrecommendations washigh(94%).Pharmacokineticmonitoringisanimportant elementofsupportinclinicaldecisionmaking.Throughthis practice,thehospitalpharmacistcontributestotheoptimisationofthesetreatments,helpingtoensurethattheappropriateadjustmentismadeforabetterresponse.

REFERENCESAND/ORACKNOWLEDGEMENTS

SEX-RELATEDDIFFERENCESINTHEEFFECTIVENESS OFJANUSKINASEINHIBITORSINRHEUMATOID ARTHRITISTREATMENT

1CMartinez-Molina*, 2SVidal, 3CDiaz-Torne, 3HSPark, 1BTorrecillaVall-Llossera, 1AFeliu, 3HCorominas. 1HospitalDeLaSantaCreuISantPau,DepartmentOfPharmacy,Barcelona, Spain; 2SantPauBiomedicalResearchInstitute,Immunology-InflammatoryDiseases ResearchArea,Barcelona,Spain; 3HospitalDeLaSantaCreuISantPau,DepartmentOf RheumatologyAndSystemicAutoimmuneDiseases,Barcelona,Spain

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BackgroundandImportance Thereisevidenceontheinfluence ofsexontheeffectivenessandsafetyofdrugs,aspharmacokineticsandpharmacodynamicsdifferbetweenwomenandmen. Womenexhibithigherblooddrugconcentrationsandlonger drugclearancetimescomparedtomen.Todate,thereislimitedreal-worlddataassessingtheinfluenceofsexonthe effectivenessofJanuskinaseinhibitors(JAKi)inrheumatoid arthritis(RA)treatment.

AimandObjectives (a)Tocomparetheprobabilityofreaching remissioninwomenandmentreatedwithJAKi,and(b)to analysethepotentialimpactofsexonJAKitreatmentdiscontinuationduetolackofeffectiveness.

MaterialandMethods Thisobservationalretrospectivestudy involvedtheRApatientswhoweretreatedwithtofacitinib, baricitinib,upadacitinib,orfilgotinibatatertiaryhospital, betweenSeptember2017andSeptember2023.

Logisticregressionwasappliedtocomparetheoddsof reachingremission(definedbytheDiseaseActivityScore28jointsusingErythrocyteSedimentationRate[DAS28-ESR]of <2.6)at6monthsinwomenversusmen.TheCoxmodel wasusedtoanalysesexasapotentialpredictivefactorthat couldinfluenceJAKitreatmentdiscontinuationduetolackof effectiveness.Statisticalanalyseswereperformedutilising STATAsoftware.

Results 184JAKitreatmentswereincluded,correspondingto 123RApatients(86%women,63±13yearsold).

TherewerenosignificantdifferencesinbaselineRAdisease activitiesbetweenwomen(DAS28-ESR:5.0[SD1.3])and men(DAS28-ESR:4.7[SD1.3]), p=0.251.At6monthsof JAKitreatment,womenweremorelikelytoreachDAS28-ESR remissionincomparisonwithmen(oddsratio[OR]:2.72, 95%CI:1.05–7.10; p=0.040).DiscontinuationratesofJAKi treatmentduetolackofeffectivenesswerenotrelatedwith sex(hazardratio[HR]:1.14,95%CI:0.54–2.41; p=0.732).

ConclusionandRelevance WomenwithRAwhoreceivedtreatmentwithJAKipossessedhigheroddsofreachingremission at6monthsoftreatmentthanmen.Sexwasnotfoundto impactonJAKitreatmentdiscontinuationduetolackof effectiveness.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-110 SYSTEMATICREVIEWANDE-QUESTIONNAIREONTHE SERVICECHARACTERISTICS,OPERATIONSAND ACTIVITIESOFCENTRESFORMEDICINES INFORMATION(CMI)

1Evandenbroucke*, 2LCosemans, 3MMinTeh, 2TdeRijdt, 2CQuintens, 1ISpriet. 1UniversityHospitalLeuven,HospitalPharmacyDepartment/FacultyofPharmacologyand PharmaceuticalSciences,Leuven,Belgium; 2UniversityHospitalLeuven,HospitalPharmacy Department,Leuven,Belgium

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3UniversityCollegeLondon,SchoolofPharmacy,London,UK BackgroundandImportance Clinicalpharmacyiswell-developedinourcountry,butiscurrentlymainlybedside-oriented anddrivenbypharmacistinitiatives.Furthermore,astandardizedapproachforprovidingandfollowing-uponclinical pharmacyondemandislacking.Inourcentre,onlyabasic serviceisforeseeninwhichrecommendationsaregivenin responsetotelephoneinquiries.Thereisaneedtodevelop andimplementaCentreforMedicinesInformation(CMI

4CPS-111 PHARMACEUTICALINTERVENTIONSINPATIENTS UNDERCHRONICOPIOIDTREATMENTADMITTEDTO TRAUMATOLOGYUNITS

RGómezNavas,GGallegoHernandez,AOlivaOliva*,AMLópez-González,MAFernández DeLaFuente,LEnriquezOlivar,MJOteroLópez. Hospital,PharmacyService,Salamanca, Spain

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BackgroundandImportance Opioidanalgesicsareconsidered highriskmedications.Theirgrowinguseinpatientswithnononcologicalchronicpainhasincreasedinrecentyears,making itimportanttoreviewtheappropriatenessoftheprescriptions inordertominimisetheriskofadverseevents.

AimandObjectives Theobjectiveofthestudywastoanalyse pharmaceuticalinterventionscarriedoutinhospitalisedtrauma patientsalreadyreceivingchronictreatmentwithopioidsat thetimeofadmission.

MaterialandMethods Prospective,observationalstudy,carried outbetweenAprilandJuly2023.Pharmacistsdailyreviewed thechronictherapiesthatincludedopioidsprescribedto patientsadmittedtothetraumaunit,andrecordedthepharmaceuticalinterventionsthatwerecarriedout.Thefollowing variableswereconsidered:age,sex,diagnosis,indicationof chronictherapywithopioids,opioidsprescribed,adverse events,typeofinterventionscarriedout,anddegreeof acceptanceoftheinterventionsbytheclinics.Informationwas obtainedfromelectronicclinicalrecordsforprimarycareand specialisedcare,andfromthehospitalelectronicprescription program.

Results Duringthetimeofthestudy,prescriptionswerevalidatedfor596patientsandpharmacistsintervenedin34 patients(73.5%women)withameanage[range]of73.5 [62.5–81.5]years.Atotalof45interventionswerecarried out,withadegreeofacceptancebyclinicsof76%.Most interventions(52%)involvedpatientsbeingtreatedwithfentanylpatches,followedbytapentadoltablets(25%).

Theinterventionswerefocusedtowarnprofessionalsabout reconciliationerrorswithchronicopioidtherapyatadmission (53.3%),inappropriateprescriptionoftwoormoreopioids (20%),dosageerrors(17.8%)andriskofrespiratorydepressionduetocomorbidityand/orconcomitantmedications (8.9%).

Thepercentageofpatientswithadverseeventswas21%, andconsistedofwithdrawalsymptoms,dizziness,hypotension, disorientation,andconstipation.

ConclusionandRelevance Prescriptionreviewbypharmacists allowedustodetectandavoidnumerouserrorsintreating traumapatientswhoreceivechronicopioidstotreatnononcologicpain,leadingtosaferuseofthesemedications.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-112

ANTIMICROBIALSTEWARDSHIPPROGRAMME INTERVENTIONSININTENSIVECAREUNIT

1RPuértolas*, 1SGarcía, 1MDBellés, 2RRoig, 2ICatalán, 2IHermosilla, 3BGomila, 3LDarocas, 1DMarín, 1AMartínez, 1RFerrando. 1HospitalGeneralUniversitarioDe Castellón,HospitalPharmacy,CastellónDeLaPlana,Spain; 2HospitalGeneralUniversitario DeCastellón,IntensiveCareUnit,CastellónDeLaPlana,Spain; 3HospitalGeneral UniversitarioDeCastellón,Microbiology,CastellónDeLaPlana,Spain

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BackgroundandImportance Theantimicrobialstewardship programmesareessentialtoachieveappropriateuseofantibiotics.Theobjectivesofthismultidisciplinaryprogramme(MP) aretooptimisetheprescriptionofthesedrugstoimprove patient’sprognosis,tominimiseadverseeffects,tocontrolthe emergenceofantimicrobialresistanceandtoensuretheuseof cost-effectivetreatments.Theintensivecareunitsarecomplex oneswithahighpercentageofpatientswithantibiotic treatment.1

AimandObjectives Todescribetheinterventionscarriedout byaMPintermsofantimicrobialstewardshipanditsacceptanceinanintensivecareunit(ICU).

MaterialandMethods Aretrospectivedescriptivestudywas conductedbetweenJanuary2023andSeptember2023ina tertiaryhospital.Intensivists,pharmacistsandmicrobiologists composedtheMP.

VariablesincludedwerenumberofICUadmission,number ofpatientswithantibioticprescription,numberofinterventions,typeofinterventionsandacceptancerate.ThisMPmet dailytoreviewantibioticsprescriptionsinICU.Theinterventionswereclassifiedintoninegroups:therapeuticindication oradditionofanotherantibiotic,discontinuation,therapeutic window,de-escalating,therapeuticdrugmonitoring(TDM), dosageadjustment,microbiologicalcultivationandcentral venousorurinarycathetersreplacement.

Results Atotalof4770clinicalepisodeswerereviewedof which47.2%ofcasesinvolvedatleastoneantibiotic.The MPperformed947interventions.The17,7%wasrelatedwith therapeuticindicationoradditionofanotherantibiotic,the 16,3%todiscontinuationtheantibiotic,the3,3%totherapeuticwindow,the20,1%tode-escalating,the12,0%toTDM, the12,7%todoseadjustment,the15,2%tomicrobiological cultivation,the0,4%tocentralvenouscatheterreplacement andthe3,4%tourinarycatheterreplacement.98,2%ofthe suggestionswereaccepted.

ConclusionandRelevance Theantimicrobialstewardshipprogrammeinterventionsobtainedanacceptanceratio>98%in thatperiod.Thisprogrammehasbeenincludedinthedaily clinicalpracticeinICUbeing essentialtoensuretheappropriateuseofantimicrobialtherapy.TheintegrationofaclinicalpharmacistinthisMPincreasestheoptimisationofthe antimicrobialtreatmentparticularlyintermsofefficacy,medicationsafetythroughdoseadjustmentandTDM,andcost effectiveness.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.ProgramasdeOptimizacióndeUsodelosAntibióticos(PROA)[Internet].Plan NacionalResistenciaAntibióticos[citedseptember2023].Availablein:https:// www.resistenciaantibioticos.es/es/lineas-de-accion/control/programas-de-optimizacion-de-uso-de-los-antibioticos-proa

ConflictofInterest Noconflictofinterest.

4CPS-113

THEEFFECTIVENESSOFJANUSKINASEINHIBITORSIN MODERATETOSEVEREACTIVERHEUMATOID ARTHRITIS

1CMartinez-Molina*, 2HCorominas, 2CDiaz-Torne, 2HSPark, 1SOjeda, 1AFeliu, 3SVidal. 1HospitalDeLaSantaCreuISantPau,DepartmentOfPharmacy,Barcelona,Spain; 2HospitalDeLaSantaCreuISantPau,DepartmentOfRheumatologyAndSystemic AutoimmuneDiseases,Barcelona,Spain; 3SantPauBiomedicalResearchInstitute, Immunology-InflammatoryDiseasesResearchArea,Barcelona,Spain

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BackgroundandImportance Januskinaseinhibitors(JAKi)are indicatedforthetreatmentofmoderatetosevereactiverheumatoidarthritis(RA).Theirmechanismofpharmacological actiondependsontheircompetitionwithadenosinetriphosphate(ATP)forthecatalyticsiteofJanusKinases.ATPlevels havebeencorrelatedwiththesystemiccytokinestorminductionandinflammation.Todate,thereislimitedreal-world dataassessingtheinfluenceofRAdiseaseactivityonthe effectivenessofJAKitreatment.

AimandObjectives ToevaluatetheinfluenceofRAdisease activityontheeffectivenessofJAKitreatment,withinrealworldscenarios.

MaterialandMethods Thiswasaretrospectivestudy(2017/ 09–2023/09)thatincludedallRApatientswhoweretreated withtofacitinib,baricitinib,upadacitinib,orfilgotinibatatertiaryhospital.

Treatmentretentions,forthediscontinuationreasonoflack ofeffectiveness,wereexaminedthroughtheCoxmodeland theKaplan-Meierestimate.TheCoxmodelwasappliedto analysethediseaseactivityasapotentialpredictivefactorthat couldinfluencetreatmentretention.TheDiseaseActivityScore 28-jointsusingC-ReactiveProtein(DAS28-CRP)wasconsideredformeasuringdiseaseactivity.TheKaplan-Meierestimate wasusedtoevaluatetreatmentretentioncurves,withthelogranktestemployedforcomparison.Statisticalanalyseswere performedutilisingSTATAsoftware.

Results 184JAKitreatmentswereincluded,correspondingto 123RApatients(86%women,63±13yearsold).AtJAKi treatmentinitiation,RAdiseaseactivitieswere:moderateactivity(47.8%)andhighactivity(52.2%).

Abstracts

TheCoxmodel’sanalysisindicatedthathighactivitysignificantlyincreasedtheriskoftreatmentdiscontinuationdueto lackofeffectiveness(HR:1.91; p=0.025).TheKaplan-Meier estimateshowedthatdiscontinuationratesduetolackof effectivenessweregreaterforhighactivitycomparedtomoderateactivity(p=0.022;figure1).

ConclusionandRelevance OurfindingssuggeststatisticallysignificantdifferencesintheinfluenceofhighRAdiseaseactivity comparedtomoderateactivityontheeffectivenessofJAKi treatment.Ahighactivitywassignificantlylinkedtoan increasedriskoftreatmentdiscontinuationduetolackof effectiveness.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-114 SUBLINGUALADMINISTRATIONOFTACROLIMUSIN LIVERTRANSPLANTPATIENTWITHINTESTINAL MALABSORPTION:ACASEREPORT

AMerchán,LSOPENA*,MAAllendeBandrés,MAAlcáceraLópez,MArenereMendoza, INavarroPardo,MPAibarAbad,MPMonforteGasque,EFernándezAlonso,TSalvador Gómez. HospitalClínicoUniversitarioLozanoBlesa,Pharmacy,Zaragoza,Spain

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BackgroundandImportance Acombinationofacalcineurin inhibitorwithanantimetaboliteandcorticosteroidsisthe standardimmunosuppressionregimeafterlivertransplant. Therapeuticdrugmonitoring(TDM)isrecommendedfor tacrolimusduetoitsnarrowtherapeuticmargininorderto avoidtransplantrejection.

AimandObjectives Toreportacaseofaliver-transplant patientthatrequiredsublingualtacrolimusowingtointestinal malabsorptiontoreachtherapeuticlevels.

MaterialandMethods A37-year-oldwomanwithhistoryof obesityandbariatricsurgery(gastricbypasswithunionof ileumtostomach)wasadmittedtoourcentreinJanuary 2023withthediagnosisoffulminantliverfailureand receivedanemergencytransplant.Prolonged-releasetacrolimustablets0.1mg/kg/day(withsubsequentadjustments accordingtobloodtroughconcentrations),intravenousmycophenolatemofetil1000mg/12hours,andintravenousmethylprednisolonewereinitiated.Duringherevolution,she presentedsustainedsub-therapeutictacrolimusconcentrations (targettroughconcentrationsforthefirst4weekspost-transplantwhencombinedwithmycophenolateandcorticosteroids:6–10ng/mL)(figure1A),aswellaselevatedlevelsof transaminases,whichtogetherwithabiopsyconfirmeda typeIIacuterejectionandwasre-transplantedinFebruary 2023.Giventhesuspicionoftacrolimusmalabsorptiondue toherhistoryofbariatricsurgery,alternativesweresought.

Asystematicreview 1 concludedthatsublingualadministrationofimmediate-releasetacrolimuswasanadequatestrategy toreachtherapeuticlevelsin lungandkidneytransplant patientswitha1:2sublingual:oralratio.ThePharmacy Serviceproposedswitchingtoi mmediate-releasetacrolimus capsulesandsublingualadministration.

Results 3mg/12hourssublingualtacrolimuswasstarted(previousprolonged-releasetacrolimusdose:12mg/day)withsubsequentadjustmentaccordingtoTDMresults.Capsules contentwasdepositedunderpatient‘stongue,avoidingswallowingfor15minutesanddrinkingliquidsfor30minutes. Sustainedtherapeuticlevelsoftacrolimuswerereached(figure

1B)andaprogressivedecreaseintransaminaseswasobserved untilreachingnormalrangevalues.

Abstract4CPS-114Figure1

ConclusionandRelevance Sublingualadministrationoftacrolimuscouldbeafeasiblestrategytoreachtherapeuticlevelsin patientswithintestinalmalabsorptionandavoidpossible rejections.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PenningtonCA,ParkJM.Sublingualtacrolimusasanalternativetooraladministrationforsolidorgantransplantrecipients. AmJHealPharm.2015;72(4):277–84.

ConflictofInterest Noconflictofinterest.

4CPS-115 CHRONICMIGRAINEREVERSIONANDSYMPTOMATIC MEDICATIONREDUCTIONWITHFREMANEZUMAB

1JTudela*, 2MCorrales, 2YMenguiano, 2MManzano, 2MHuertas, 2MERodriguez. 1Puerta DelMarUniversitaryHospital,Pharmacy,Cadiz,Spain; 2PuertaDelMarUniversitary Hospital,Pharmacy,Cádiz,Spain

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BackgroundandImportance Thediagnosisofchronicmigraine (CM)includesheadachesformorethan15dayspermonth foratleastthreemonthsandsufferingthispainwithmigraine criteriaforatleasteightdaysTheclinicalmanifestationsof CMhaveahighimpactonthequalityoflifeofpatients.Failuretocontrolthepaincanleadtoahighriskoftreatment abuse.Monoclonalantibodiessuchasfremanezumabareused asprophylactictreatment.

AimandObjectives Theobjectivesofthisreal-lifestudywere toanalysethereversionofCMtoepisodic(EM)andevaluate thebenefitonthesymptomatologyinyoungpatientstreated withbotulinumtoxin-resistantfremanezumab.

MaterialandMethods Patientsaged18–65yearsdiagnosed withCMandunderneurologicalfollow-up,treatedforat least3monthswithfremanezumabasa225mgmonthly inyectionwereinterviewed.Thedatatoassesseffectiveness

werebeforetreatmentandatthetimeoftheinterview: monthlyheadachedays(MHDs),monthlysymptomaticmedicationdays(MSMDs)andpercentageofpatientswithsymptomaticmedicationoveruse(SMO).Convertersweredefinedas thosepatientswhosenumberofMHDsdecreasedtolessthan 15daysafteratleastthreemonthsoffremanezumabtreatment.Thecriterionforconsideringstrongmedicationuseas abusivewassetattakingmedicationatleast15daysa month.

Results

Fifty-fourpatientswereinterviewed Themedianageofthe studypopulationwas51.5yearsold(47.4–55.3,95%CI), withamediantreatmentdurationof12months(9.4–15.0, 95%CI).FourtypatientswereconverterstoEM.Themedian ofMHDsdecreasedfrom28.7(27.1–30.0,95%CI)to4.0 (3.9–6.4,95%CI;p<0.001)inconverters.Themedianof MSMDsfellfrom28.9(27.8–30.0,95%CI)to4.0(3.0–4.6, 95%CI;p<0.001)inconverters.Thepercentageofpatients withSMOdecreasedfrom97.5%to2.5%(p<0.001)in converters.

ConclusionandRelevance Thedecreaseinconvertersofall theeffectivenessvariables,showsahighbenefitinpatients‘ clinicalandqualityoflife,supportingtheoutcomesobtained inclinicaltrials.Thelargedecreaseinthepercentageof patientswithSMOreflectsthehighabilitytocombatoneof themostinterrelatedclinicalconsequencesofCM.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-116 REAL-WORLDEFFECTIVENESSANDCOSTSOF USTEKINUMABINPATIENTSDIAGNOSEDWITH INFLAMMATORYBOWELDISEASE

1DViedmaRama*, 2PLlopisSalvia, 2MHermenegildoCaudevilla, 3MSáezBelló, 1VMartínezToledo, 4PMartinezAlbadalejo, 1IRicoySanz, 2CBravoCrespo, 5JPoloDurán, 6MClimenteMartí. 1ResidentPharmacist,HospitalUniversitarioDoctorPeset,Valencia, Spain; 2Pharmacist,HospitalUniversitarioDoctorPeset,Valencia,Spain; 3Pharmacist, HospitalUniversitarioDoctorPeset.,Valencia,Spain; 4ResidentPharmacist,Hospital UniversatarioDoctorPeset,Valencia,Spain; 5Pharmacist,HospitalUniversitarioDoctor Pesetr,Valencia,Spain; 6Pharmacist,HospitalNiversitarioDoctorPeset,Valencia,Spain

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BackgroundandImportance Realworlduseofustekinumabin inflammatoryboweldisease(IBD)influencerealcostsof treatment.

AimandObjectives Toevaluatetheeffectivenessofustekinumabintermsofpersistence,dosesdispensedandeconomic annualimpactperpatientinreal-worldclinicalpractice.

MaterialandMethods RetrospectivereviewofpatientsdiagnosedwithIBDthatstartedtreatmentwithustekinumabfrom 01/01/2018to06/30/2022.Follow-upwascarriedoutuntil 06/30/2023.

Variablescollected sex,weight,height,age,diagnosis,prior biologicorJAK-inhibitor(iJAK)therapies,timeintreatment withustekinumab,reasonfordiscontinuationandcumulative dosedispensedduringthefollow-upperiod.

Outcomevariables:persistencedefinedaspercentageof patientsthatreached12monthstreatmentandmedianannual costoftreatmentwithustekinumab.Asdosingofustekinumab inreal-worldpracticeisdynamic,costoftreatmentonmaintenancewasevaluatedusingthenumberofdosesdispensed.

Theoreticalcostwasobtainedfromthedoseprovidedinthe drugfile.

Datawerecollectedfromtheelectronichealthandpharmacydispensingrecord.

Statisticalanalysis Continuousvariableswereexpressedas mean(SD)ormedian(Q1-Q3),andcategoricalvariablesas absoluteandrelativefrequency.StatisticalanalysiswasperformedwithR-commander_v.2.9.

Results Fifty-ninepatientswereincluded,30(50.8%)men,50 (84.7%)Crohn`sdisease,meanage46(14.3)years,mean weight67(14)kgandmeanheight168(8.9)cm.

Patientstreatedwithustekinumabinfirstlinewere10 (17.0%),secondline24(40.6%)and25(42.4%)othertreatmentlines.

Twelvemonthspersistenceofustekinumabwas79.6% (n=47patients).Reasonsfordiscontinuationwere6(42.8%) secondaryfailure,4(28.6%)primaryfailure,2(14.4%)side effects,2(14.2%)others.Mediantimeontreatmentwas16 (RIC31)months.

Medianannualcumulativedoseperpatientwas783.5mg (RIC429),whiletheoreticalannualdosewas585mg(dosage of90mg/8weeks)and387mg(dosageof90mg/12weeks)representingadose-escalationof33%and102%comparedwith thetheoricaldoserespectively.Medianannualcostperpatient was18102.C ¼ ,whiletheoreticalannualcostwas15027.3C ¼ (90mg/8weks)and9941C ¼ (90mg/12weeks),whichrepresents anincreaseof20.4%and82.1%respectively.

ConclusionandRelevance Ustekinumabwasassociatedwitha 12monthspersistenceof66%.Doses-escalationiscommon clinicalpracticeinIBDwithustekinumab.Consequently,this hasimportantimplicationsforrealcosts.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-117 UPDATEOFSTOPP/STARTCRITERIAIN2023:WHAT ARETHEIMPACTSONOURPHARMACEUTICAL INTERVENTIONS?

1MVerchin, 2AFillatre*, 2ADupont, 2KCottrez, 2YMahboub. 1Saint-QuentinHospital, GeriatricUnit,Saint-Quentin,France; 2Saint-QuentinHospital,Pharmacy,Saint-Quentin, France

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BackgroundandImportance Sincetheirfirstversions1,the STOPP/STARTcriteriahavedemonstratedtheirinterestinclinicalpharmacypractices.In2023,thesecriteriawereupdated inlinewithadvancesinclinicalresearch.Thisnewversion requiresustoupdateourknowledgeandpractices.

AimandObjectives Assesstheimpactofthe3rdversionof theSTOPP/STARTcriteriaonourpharmaceuticalinterventions (PI)inbothgeriatricandnon-geriatricservices.

MaterialandMethods Prospectiveanalysisof75prescriptions: 50fromgeriatricservices(acutecareandnursinghomes)and 25fromnon-geriatricmedicalserviceswithpatientsover65 yearsold.ThenumberofPIsconcerningthecommontoversions2and3wasrecordedandthenumberofPIsrelatedto thenewcriteriain2023(version3).

Results Theaverageagewas84.2and83.7yearsfornon-geriatricandgeriatricservices,respectively.Theaveragenumber ofprescriptionlineswas11.5and12.2.

Abstracts

Theprevalenceofprescriptionscontainingatleastone inappropriatemedicationaccordingtothenewversionwas 84%and72%(1.24and1.7criteriaperpatient).

Commoncriteriabetweenthetwoversionsresultedin51 PIs,19and32PIs,respectively,equatingto0.76and0.64 criteriaperpatient.Themostcommonlyencounteredcommon criteria(8)wasbenzodiazepinesforanxietyfor 4weeks.

Newcriteriainversion3represented31PIs,10and21 PIs,respectively,representing0.16and0.42criteriaper patient.Themostcommonlyencounterednewcriteria(13) wasbenzodiazepinesforinsomniafor 2weeks. ConclusionandRelevance ThethirdversionoftheSTOPP/ STARTcriteriaimpactsourclinicalpharmacypractices,leading toanincreaseinthenumberofPIsinprescriptionsanalysed withinourinstitution,acrossallsectors.Thisnewversionwill affectthemedicationmanagementofthesepolypharmacyelderlypatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.GallagherP,RyanC,ByrneS,KennedyJandD.O’Mahony.STOPP(Screening ToolofOlderPerson’sPrescriptions)andSTART(ScreeningTooltoAlertdoctors toRightTreatment).Consensusvalidation.2008;46:72–83.doi:10.5414/ CPP46072.

ConflictofInterest Noconflictofinterest.

4CPS-118 MEDICATIONADHERENCETOPSORIASIS TREATMENTS:APOPULATION-BASEDSTUDY

MSerino*,SMucherino,EMenditto,VOlrando. Cirff-CenterOfPharmacoeconomicsAnd DrugUtilisationResearch-Naples-Italy,DepartmentOfPharmacy-UniversityOfNaples FedericoIi-Italy,Naples,Italy

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BackgroundandImportance Psoriasisisachronicinflammatory skindiseasewithasignificantgeneticpredispositionandautoimmunemechanism.Medicationadherenceiscrucialforeffectivediseasemanagement,leadingtoimprovedoutcomesand qualityoflife.However,adherencetopsoriasistreatmentsis ofteninadequate,resultinginadversehealthoutcomesand increasedcosts.

AimandObjectives Studyaimwastoassessmedicationadherencetopsoriasistreatmentsinareal-worldsetting.

MaterialandMethods Incidentsubjectsreceivedatleastone prescriptionofbiologicdrugtherapyforpsoriasis(including apremilast)and/orwithapsoriasisdiagnosiswereidentified fromaspecificDatabasein2017–2019andfollowedfor1yearfromtheindex-date.Thethreephasesoftheadherence processwereassessedasperEMERGEguidelines:Initiation, expressedintermsofnumberoftreatmentplansprescribed/ dispensed;Implementation,intermsofswitchandswaprates; Discontinuation,intermsofdruginterruptionwithin6-and 12-months,stratifiedbybiologicdrugtherapy.

Results Studycohortincluded811subjectsaged49.2±16.3 years,60%male.Amongmales,secukinumabwasthemost commonlyprescribed(66.7%);whilstamongfemales,apremilastwasthemostprescribed(44.8%).Overall,36.2%of cohortwasinexcessivepolypharmacy.Suboptimallevelsof adherenceweredetected:7% ofpatientsdidnotstartthe prescribeddrugtherapy(init iationphase);swaplevelswere about13.1%withanaveragetimetoswapat1-month(29 ±84.8days)(implementationphase);overall,51.5%of

subjectsinterruptedbiologicdrugtherapywithin87.5±127.7 days(figure1).

Persistence(thirdphase)varieddependingontheindividualdrugs;patientstreatedwithanti-IL17/23recorded higheradherencelevels(60.1% ).Highestadherencerates wereobservedforpatientsonsecukinumab(60.1%)and adalimumab(50.0%)treatme nt.Incontrast,thehighest discontinuationrateswerefou ndforpatientstreatedwith ustekinumab(67.7%)withi nthreeandahalfmonthsof startingtherapyandApremila st(52.7%)withinabouttwo months.

Abstract4CPS-118Figure1 Swaptherapypattern

ConclusionandRelevance Thisstudyhighlightslowlevelsof medicationadherenceinindividualsundergoingpsoriasistreatment,withsignificantdiscontinuationrateswithinthefirst threemonths.Higheradherencewasobservedamongpatients treatedwithanti-IL17andanti-IL23therapies.Further researchisneededtoidentifypredictorsofmedicationnonadherence,particularlyduringthediscontinuationphase,to enhancethemanagementofpsoriasistreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-119 AREAL-LIFESTUDYOFPHARMACOKINETIC MONITORING:NEPHROTOXICIMPACTOF AMINOGLYCOSIDESANDVANCOMYCIN

1PBlancoGarcia*, 1MAntonMartinez, 1SMagantoGarrido, 1MMonteroLázaro, 1AParienteJunquera, 1AFijóPrieto, 1CGuitiánBermejo, 2CMesaArevalo, 1MTSánchez Sánchez. 1HospitalClínicoUniversitarioDeValladolid,HospitalPharmacy,Valladolid,Spain; 2HospitalUniversitarioRíoHortega,HospitalPharmacy,Valladolid,Spain

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BackgroundandImportance Therapeuticdrugmonitoring (TDM)isessentialtoachievethepharmacokinetic/pharmacodynamictargetavoidingtoxicities.

AimandObjectives Toevaluatetheimpactofrenaldamageof aminoglycosidesandvancomycininpatientsmakingaproactiveTDMinatertiary-hospital.

MaterialandMethods Retrospectiveobservationalanalysis fromJanuarytoDecember2022.

Nephrotoxicityvariables:shiftoffinal-serumcreatinineand initial-serumcreatinine(fCr-iCr)andvariationofglomerular filtrationrate(GFR),estimatedaccordingtotheCKD-EPI (2009)formulaattheendofTDMrespecttothebaseline. Impactkidneydamage:increaseofserumcreatinineabove0.5

mg/dlor 50%theinitialvalue.PharmacokineticBayesian estimationwasperformedwithPKS-Abbott® Variablescollected demographic(age,sex),clinical(GFR,fCRiCr,plasmadruglevel)andhospitalisationunit.

Results Weincluded123patientsinthestudy(81men,mean age66.6±16.6years)receivingvancomycin(57/123)and aminoglycosides(66/123).Thepharmacistassessed367TDM and255dosagerecommendation.

AllpatientspresentedameaniCrof1,02g/dl(±0,69)and fCrof1,02g/dl(±0,72):norenalworseningwasobserved.7 patients(12.3%)aggravatedtheirGFRwithvancomycin,and 10(15,2%)withaminoglycosides.

AtthebeginningofTDM:53/123patients(43,1%)presentedaGFR>90ml/min,findingthat,attheendoftreatment,48ofthemmaintainedthesameGFRand5 deterioratedit.34/123patients(27,6%)showedamoderate GFR(60–89ml/min)beforeextractingdruglevels;only4 patients(11,8%)exceededtheestablisheddamagelimit.36/123 patients(29,3%)presentedworstGFR(29–45ml/min),registering7patients(19.4%)withassociatednephrotoxicitytothese drugs.

Lookingatthecritical-careunits:64/123patientspresented aniCrof0.93g/dl(±0.67)andfCrof0.98g/dl(±0.81).We saw9(14.1%)patientswithrenaldeterioringdespiteTDM. ConclusionandRelevance Patientswithaslightlydecreased GFRatthebaselineshowedahigherriskofnephrotoxicity associatedtotheuseofthesenephrotoxicdrugs.Kidneydamageismoreevidentincritically-carepatients.Oursampleregisteredanephrotoxicityresultslowerthanthosepublishedin thestudiesbyMañezSevillaMetal.(2015)andthemetaanalysisbySJvanHaletal.(2013).Just17patients(13.8%) worsenedtheirkidneyfunctionafteritsuse.

StrategiessuchasTDMarenecessarytooptimisedoses andavoidharm.Evenso,itisnecessarytocontinuecollecting datatoexpandotherpossiblecauses.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-120 EFFICACYOFPEMBROLIZUMABFORNON-SMALL CELLLUNGCANCER(NSCLC):PRELIMINARYREALWORLDANALYSISANDCOMPARISONWITHTHE PIVOTALSTUDY(PS)

1ACar*, 1ACois, 1MBoni, 1SAina, 2GBorra, 2AGennari, 1APisterna. 1Azienda Ospedaliero-UniversitariaMaggioreDellaCaritàDiNovara,HospitalPharmacy,Novara, Italy; 2AziendaOspedaliero-UniversitariaMaggioreDellaCaritàDiNovara,Oncology, Novara,Italy

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BackgroundandImportance Pembrolizumab(P)isamonoclonalantibodyusedinimmunotherapy,indicatedforNSCLC.

AimandObjectives EvaluatetheeffectivenessofPintermsof progressionfreesurvival(PFS)inpatientsaffectedbyNSCLC inanItalianHospital(IH),andcomparingitwiththePS. TheItalianregulatoryagency(AIFA)authorisedPat2mgper kgdose,subsequentlyataflatdoseof200mg. 1 Therefore, asecondaryaimistoverifywhethertherewasadifferencein termsofPFSbetweenflatdoseandperkgdose.

MaterialandMethods Thedeathandprogressiondatawere takenfromtheAIFAmonitoringregisters(RA)andcompared withthecompanymanagementsystem.PFSisthetimefrom thefirstprescriptiontothedateofendoftreatmentdueto

deathorprogression.Theperiodconsideredis2017–2023. ThePSisKeynote0242.Patientsweredividedintotwohomogeneousgroups:thefirstat<3mg/kg(group1)andthesecond 3mg/kg(group2).WecalculatedOSandPFSforeachgroup. Results Patientsevaluatedwere165,71.6%male,medianage 71years.AlladministrationswererecordedintheRAs. MedianPFSIH218days(0.95CI114;230) vs PS288 (0.95CI187.6;nr).At182days,57%ofpatientsprogressed (IH) vs 62.1%(PS).52%ofpatientstookadose<3mg/kg, 48% 3mg/kg.MedianPFSis258daysforthegroup1 (0.95CI186;456)and218forthegroup2(0.95CI158;393). At182days:30patientshadanevent(group1) vs 29patients (group2).

ConclusionandRelevance PFSdataresemblesPSdata.There isnosignificantdifferenceinusingadose>3mg/kgcomparedtoalowerone,thismeansthatadoseperkgwould leadtoareductionindrugconsumptionandincosts.The futuregoalistoreachsignificantnumbersandtoinvestigate adversereactionsfromimmunotherapy,relatedtodifferent doses.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.GazzettaUfficialeRepubblicaItaliana,n° 328,2019.

2.ClinicalTrials.govIDNCT02142738:StudyofPembrolizumab(MK-3475)ComparedtoPlatinum-BasedChemotherapiesinParticipantsWithMetastaticNonSmallCellLungCancer(MK-3475–024/KEYNOTE-024).

ConflictofInterest Noconflictofinterest.

4CPS-121 OPTIMISINGANTIDIABETICTREATMENTFORELDERLY PATIENTSACCORDINGTOTHEIRFUNCTIONAL STATUS

1LRubio-Ruiz*, 2NFernández-Fernández, 2MCastro-Rodríguez, 1MHijazi-Vega, 1MGómez-Bermejo, 1TMolina-García. 1HospitalUniversitarioDeGetafe,Pharmacy,Getafe, Spain; 2HospitalUniversitarioDeGetafe,Geriatric,Getafe,Spain

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BackgroundandImportance Treatmentsforelderlypatients withdiabetesmellitus(DM)prioritiseimprovingthequalityof life,preservingtheirfunctionalstatus,andavoidinghypoglycemia,whichisassociatedwithanincreasedriskoffalling,morbidityandmortality.

AimandObjectives Theaimofthisworkistodeterminethe DMprevalenceinhospitalisedpatientsattheAcuteGeriatric Unit(AGU)andtoassesstheadherencetotherecommendationsstablishedbytheAmericanDiabetesAssociation(ADA). Theserecommendationsincludehavinganadequateantidiabetictreatmentbasedonpatients’ functionalstatusandan updatedglycatedhaemoglobin(HbA1c)value.

MaterialandMethods Thisobservational,retrospectivestudy includeshospitalisedpatientsadmittedtotheAGUanddischargedbetweenJanuaryandFebruary2023.

WecollectedHbA1cvaluesandfunctionalstatus(Barthel Index)ofAGUDMpatients.TheHbA1cwasconsideras updatedifthemeasurewasdoneduringthehospitalisationor thelastthreemonths.

Theantidiabetictreatmentadequationwasevaluatedbased onHbA1candpatientfunctionality.TheHbA1cADArecommendationsare7–7.5%(functionallyindependentpatients), 7.5–8%(functionallydependentpatients),andpreventsymptomatichyperglycemia(end-of-life).Thepatientswerecategorisedascontrolled(complieswithADA´srecommendations),

Abstracts

over-controlled(lowerHbA1clevels)andinadequatelycontrolled(higherHbA1clevels).

Modificationstoantidiabetictreatmentatdischargewere documentedincludingthedrugsinvolvedandthetypeof modificationapplied(treatmentordoseinitiation/increase,discontinuation/reduction).

Results Thisstudyincludes300patientswitha33%prevalence ofDMattheAGU(107patients).Fromthediabeticpatients, 90%(n=96)hadanupdatedmeanvalueofHbA1cof7.4 ±1.5%.Amongthese96patients,46%achievedappropriate control,41%wereover-controlledand13%wereinadequately controlled.Thus,52patients(54%)hadaninadequatedisease controleitherexcessiveorinsufficient.

Fromthese52patientswithinadequatecontrol,75%had guideline-basedantidiabetictreatmentmodifications.Themain druggroupsinvolvedwereinsulins(46%),biguanides(27%), andDPP-4inhibitors(13%).Thetreatmentmodifications appliedwere75%discontinuation/reductionand25%initiation/ increase.

ConclusionandRelevance Approximatelyone-thirdofAGU patientshavediabetesand,inmostthecases,anupdated HbA1cvalueswereavailable.

Onhospitaladmission,overhalfofthepatientsdidnot followADArecommendationsformetaboliccontrol,leading toover-control.Mostpatientswithinadequatecontrolhad dischargechangesADArecommendationsbased.Mainmodificationwerediscontinuationordosereductioninantidiabetic treatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-122 ANALYSISOFTHEUSEANDEFFECTIVENESSOF FIDAXOMICININCLOSTRIDIOIDESDIFFICILE INFECTION

LOyague*,MEiroaOsoro,IMaray,SFernandezLastras,IDeLaFuenteVillaverde, CRodríguez-TenreiroRodríguez,MMuñozVillasur,CFadonHerrera,CDiazRomero, ALozanoBlazquez. HospitalUniversitarioCentralDeAsturias,Pharmacy,Oviedo,Spain 10.1136/ejhpharm-2024-eahp.226

BackgroundandImportance Clostridioidesdifficileinfection (CDI)isthemaincauseofinfectiousdiarrhoeainthehospital setting.

AimandObjectives Theaimofthisstudyistoanalysethe useandeffectivenessoffidaxomicininCDI.

MaterialandMethods Anobservational,descriptiveandretrospectivestudywasconductedinpatientstreatedwithfidaxomicinbetweenApril2018-August2023.Variables,collected throughtheelectronicmedicalrecord,were:sex,age,patient location,immunosuppression,severityandtypeofepisode, previousantibiotictreatment,indication,doseandduration, timetoclinicalcure(daysbetweenfidaxomicinstartedand diarrhoearesolution)andrecurrence(presenceofdiarrhoeaor positivetoxininstoolwithin4weeksaftertreatment).Effectivenesswasassessedbyclinicalcurerate,recurrencerateand overallcurerate(absenceofstool-positivetoxinanddiarrhoea within4weeksaftertreatment).Outpatientswereexcluded fromtheclinicalcureanalysis.Continuousvariablesare expressedasmedianandinterquartilerangewhilecategorical variablesasfrequencyandpercentage.

Results Atotalof37patientswereincluded,17(46%)male, aged73[62–80]years,25(67.6%)wereinpatientsand14

(37.8%)immunocompromised.Mostofthemweresevere caseswithhighriskofrecurrence(20(54.1%)).

Mostpatientsreceivedfidaxomicinduringthefirst(13 (35.1%))orhigher(16(40,5%))recurrenceepisodeandonly 8(21.6%)duringthefirstCDIepisode.Previously,28 (75,7%)patientshadreceivedoralvancomycinand22 (59.5%)metronidazole.Vancomycinrefractoriness(35 (94.6%))wasthemainindication.Thedoseusedinallcases was200mg/12hfor10days[10–15].

Theeffectivenessanalysiswasconductedin35patients(2 diedduringthestudyperiod)(table1).

Abstract4CPS-122Table1 Effectivenessanalysis

Allpatients (n=35)

FirstEpisodeCDI (n=8)

RecurrenceCDI (n=27)

ClinicalCure(days) 5[3–6]5[3–6]5[3–6,8]

RecurrenceRate(N(%)) 12(34,3)2(25)10(37)

DaystoRecurrence(days) 14[13,3–16,8]18,5[17,2–19,8]14[12,3–14,8]

OverallCureRate(N(%)) 23(65,7)6(75)17(63)

ConclusionandRelevance Inthisstudy,fidaxomicinhasbeen showntobeeffectiveinresolvingCDIdiarrhoea,although withalessfavourableclinicalcure,recurrenceandoverall cureratethanobtainedinpivotaltrials.Duetothesmall samplesizefurtherresearchisneededtosupporttheresults obtainedhere.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-123 SARGRAMOSTIMANDLIPOSOMALAMPHOTERICINB FORTHETREATMENTOFCHRONICVISCERAL LEISHMANIASISINHIVCO-INFECTEDPATIENT:A CASEREPORT

1MFernándezGonzález, 1ÁMVillalbaMoreno, 1MMejíasTrueba, 1ERAlfaroLara, 1Slora*, 2LFLópezCortés. 1HospitalUniversitarioVirgenDelRocío,Pharmacy,Sevilla,Spain; 2HospitalUniversitarioVirgenDelRocío,InfectiousDiseases,Sevilla,Spain 10.1136/ejhpharm-2024-eahp.227

BackgroundandImportance InSpain,leishmaniasisiscaused by Leishmaniainfantum,whosemainreservoirsaredogsor smallmammals,transmittedthroughthebiteofdipterian insectsofthegenus Phlebotomus.Leishmania infectioncauses diseaserangingfromlocalisedcutaneoustovisceralleishmaniasis(VL),themostsevereform,affectingfrequentlytoprofoundlyimmunocompromisedindividuals,suchaslate-stage HIV-infectedpatients,withhighratesoftreatmentfailure, relapses,andmortality.

LiposomalamphotericinB(LAB)istheVLtreatmentof choice,withaninductionregimenfollowedbymaintenance (3–5mg/kg/monthly).Publisheddata1 suggeststhatsargramostim,arecombinanthumangranulocyte-macrophagecolonystimulatingfactor,haspotentialasco-adjuvanttreatmentto LABinVL-HIVtoaugmentimmuneresponsesandclinical control.

AimandObjectives ToreportacaseofVL-HIVco-infection successfullytreatedwithmonthlyLABandsargramostimfor 12weeks.

MaterialandMethods A47-year-oldmale,diagnosedwith HIVinfectionin2017(CD4Tcellcount:14/ml;viralload: 1380000copies/mL. Pneumocystisjirovecii pneumoniaand esophagealcandidiasis).Despiteacontinuousundetectableviral loadwithantiretroviraltreatment,CD4countremained £75–100/mL.InDecember2020,hepresentedamixedcryoglobulinemicmembranoproliferativeglomerulonephritissecondaryto VL.Despitehavingreceivedacompleteinductionregimen withLAB,febricula,systemicsymptomsandpositive Leishmania PCRpersisted,thereforemonthlyLAB3mg/kgwere administereduntilMarch2023.

Off-labeluseofsargramostim150mcgsubcutaneously everytwoweeksfor3monthswasrequestedasco-adjuvant treatmenttoLAB3mg/kg/monthly,wasapprovedbytheofflabelPharmacycommitteeandauthorisedbynationalspanish drugregulator(AEMPS).Successofthetreatmentwasdefined asthediscontinuationofLABwithoutclinicalrelapse.

Results Afterhavingcompleted3monthsofsargramostimplus LAB,thepatientwasasymptomatic,HIVviralloadwasundetectableand Leishmania PCRinbonemarrowwasstillpositive,butmicroscopicallynegative.LABandsargramostimwere discontinuedandthepatientwasmonthlyevaluated.Four monthslater,thepatientremainedcompletelyasymptomatic, awaitingfurtherevaluation.

Regardingsargramostimsafety,thepatientpresentedfever aftertwodoses,requiringadosereductionbyhalf.Treatment wasafterwardswelltoleratedandcompletedwithfullsargramostimdose.

ConclusionandRelevance Sagramostimco-adjuvanttreatment withLABmaybeeffectiveforthetreatmentofVL-HIVcoinfectedpatients,althoughfurtherlong-termrevaluationis needed.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.https://pubmed.ncbi.nlm.nih.gov/15711134/

ConflictofInterest Noconflictofinterest.

4CPS-124 MONITORINGOFHIGH-COSTANTIBIOTIC’S PRESCRIPTIONSINORDERTOENSUREPRESCRIPTIVE APPROPRIATENESS,PATIENTSAFETYAND CONTAININGEXPENDITURE

1GCancellieri*, 1CBotto, 1MSantonocito, 1EDeLuca, 2PPolidori. 1UniversitàDegliStudiDi Palermo,Ssfo-ScuolaDiSpecializzazioneInFarmaciaOspedaliera,Palermo,Italy; 2Aoor ‘VillaSofia – Cervello’,UocFarmacia,Palermo,Italy

10.1136/ejhpharm-2024-eahp.228

BackgroundandImportance Inappropriate/unnecessaryhighcostantibioticsprescription(suchascefiderecol,ceftazidime/ avibactam,meropenem/aborbactam)canleadtodevelopment ofresistantgerms,patienttoxicityandincreasedhealthcarecosts.Fortheseantibiotics,RegulatoryAuthorityofourcountryhasdecidedthat,togetherwithrequestofhospitalward, anofficialpaperformmustbesentobligatorilytopharmacy, inwhich,foreachpatient,diagnosis,dosage,antibiogram (whereapplicable)isreported.Hospitalpharmacisthasthe dutyofcheckingexhaustivenessandaccuracyofthedocumentationreceived,inordertoobtainappropriate/completeprescriptions,toensuresuccessoftheclinicalpurpose,patient safetyandcontainingexpenditure.

AimandObjectives Theaimofstudyistoquantifythepharmacist’sinterventionsinrequestingclarificationsand/or

integrationstothedocumentationprovidedbyward,inthe periodbetween01/05/2022–30/04/2023.Withoutsuchmeasures,unnecessaryantibioticswouldhavebeendispensed:this wouldhavehadnegativeimpactonpatientsafetyandhealthcare-costs.

MaterialandMethods Theanalysiswasconductedonprescriptionsreceivedinhospitalpharmacyunit.Thedataobtained weredividedby:activesubstance,hospitalward,request/not requestforclarifications/integrationsbypharmacisttoward, typeofclarification/integrationrequested.

Results Among258requestsreceived(146/258ofceftazidime/ avibactam,61/258ofcefiderecol,51/258ofmeropenem/vaborbactam)97/258wereappropriateandcomplete;161/258 insteadneededtorequestthewardforclarificationand/or integrations.Amongthelatter,in48.7%ofcasesthequantity ofvialsrequireddidn’tcomplywiththeprescribeddosage; 21.5%didn’treportattachedantibiogram,whereinsteadit wasmandatory;in14.8%ofcasestheofficialpaperformwas completelymissingand,in11,4%ofcases,itwasnotcompleteduetolackofdiagnosisand/ordurationoftherapy. Finally,in3,6%ofcases,theprescriptionwasn’tperformed bytheinfectiousspecialist,wherenecessary.

ConclusionandRelevance Theanalysishasrevealedalarge numberofirregularprescriptions:implementationsrequested byhospitalpharmacistwereessentialtoobtainvalidrequests, tothebenefitofbothpatientsafetyandtheexpenseforhospital.Infact,throughanaccurateanalysisofthedosageunits requiredandthecompletenessofattachedinformation,ithas beenpossibletoreducenotonlyeconomicwaste,butalsothe onsetoftoxicityand/orantibiotic-resistancederivingfrom inappropriateprescriptions.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-125 PHARMACEUTICALCONSULTATIONSDEDICATEDTO DIRECTORALANTICOAGULANTSFORCANCER PATIENTS:ASINGLE-CENTREPROSPECTIVESTUDY 1JSGiraud*, 1TInouri, 1PRipoche, 1CMoine-Picard, 1RBatista, 2FGoldwasser, 3BBlanchet, 1AThomas-Schoemann. 1CochinHospitalAssistancePublique – HopitauxDeParis, PharmacyDepartment,Paris,France; 2CochinHospitalAssistancePublique – HopitauxDe Paris,OncologyDepartment,Paris,France; 3CochinHospitalAssistancePublique – Hopitaux DeParis,DrugBiologyAndToxicologyDepartment,Paris,France 10.1136/ejhpharm-2024-eahp.229

BackgroundandImportance Theuseofdirectoralanticoagulants(DOACs)incancerpatientsiscomplexwithfrequent drug-druginteractions(DDIs)andsuboptimaladherence.We thereforesetuphospital-basedpharmaceuticalconsultations dedicatedtoDOACsinanoncologydepartment.

AimandObjectives To(i)characterisetheprevalenceand natureofDDIsanddrug-relatedproblems,(ii)assesspatients’ adherencerates,and(iii)detectoccurrenceofoverdosingclinicalsignsamongcanceroutpatientstreatedwithDOACs. MaterialandMethods Anobservationalprospectivecohort includedcancerpatientstreatedwithapixabanorrivaroxaban. Twopharmaciststandardisedinterviewsatsixmonthsinterval wereusedtoassess(a)drug-relatedproblems,(b)patient adherence(Girerdscoreandmedicationpossessionratio [MPR])and(c)theoccurrenceofoverdosingclinicalsigns. Antitumortreatmentchangebetweentheinterviewswasan exclusioncriterion.Resultsarepresentedasmean[minimum-

maximum].Statisticalanalyses(Pairedt-test,McNemar ’sChisquaredtest)wereperformedwithRsoftware.

Results 56cancerpatients(28women,28men,meanage:70 years)wereincluded:34outpatientsreceivinganantitumor treatmentand22outpatientsbeforetheirantitumortreatment initiation(mainlychemotherapy(27)andimmunotherapy (15)).Theirnumberofmedicationswas6[0–15];15/56used complementarymedicines.Theyweretreatedwithapixaban (77%)orrivaroxaban(23%)forvenousthromboembolism (69%)oratrialfibrillation(27%).36patients(64%)were concernedbydrug-relatedproblems:side-effects(2/36),underdosing(2/36),andDDI(32/36),thatfrequentlyleadto DOACmonitoring(58%).Ofnote,37/56patientsknewno DDIwiththeirDOACs(aspirin ).MPRwas102[40–162]% andGirerdscorewas1.2[0–6].Adherencewasoptimal(MPR >80%andGIRERDscoreof0–1)for36/56patients(64%). 24patientshavereported0.7[0–4]clinicalsignstypicalof overdosing.Thesecondinterviewwasassessedin18/56 patients(31excludedpatients).Therewasnostatisticaldifferencebetweenthetwointerviewsinpatientadherence (p>0.05),knowledgeaboutDDIorsignsofDOACsover-or under-dosing(p>0.05).

ConclusionandRelevance AdherencetoDOACsseemedoptimalinoursingle-centrecancerpatients’ cohort.PharmaceuticalconsultationsmayhelptooptimiseDOACsusewithDDI detectionin56%cancerpatientsandclinicaltoxicitiesmanagement.Unfortunately,pharmacistinterviewsdidn’timprove patientknowledgeaboutDOACs.A ‘cancerandthrombosis’ therapeuticeducationprogramcouldbeevaluated.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-126 ADHERENCE,PERSISTENCE,ANDSWITCHING MEDICATIONINPATIENTSWITHMULTIPLESCLEROSIS INITIATINGORALDISEASEMODIFYINGTHERAPIES:A RETROSPECTIVEREAL-WORLDSTUDY

MRivano*,FLombardo. BinaghiHospital,HospitalPharmacy,Cagliari,Italy 10.1136/ejhpharm-2024-eahp.230

BackgroundandImportance Therapeuticefficacyofdisease modifyingtherapies(DMTs)formultiplesclerosis(MS)is oftenhinderedbypoorpersistenceandadherence,impacted bypatient-perceivedefficacyconcerns,adverseeffectsandforgetfulness.Real-worldstudieshaveshownthatnonpersistence andnonadherencetoDMTscanleadtonegativeclinicaloutcomes,includinghigherratesofrelapseanddisease progression.

AimandObjectives Thisstudymeasuredpersistence,adherence,andtimetoswitchingtoothertherapyamongpatients withMSinitiatingteriflunomideordimethylfumarate treatment.

MaterialandMethods Thisretrospectivestudyuseddatafrom patientswithMSnewlyinitiatedoralDMTsteriflunomide, dimethylfumaratewithinthequalifyingtimeperiod(January 1,2019throughDecember31,2019).Patientdemographics werecollectedforeachpatientandincludedage,sex,and treatmenthistory.Patientswerefollowedfromthestartofthe initialtreatmentuntilDecember2021.Persistencewasdefined asthedurationapatientcontinuedtheirmedication.KaplanMeiercurvesassessedpersistence.Adherencewasmeasured usingmedicationpossessionratio(MPR);patientswith

MPR>80%wereconsideredadherent.Switchingwasmeasuredbycomparingnumberofpatientsswitchingandmean timetoswitchtoothertherapies.

Results Thebaselinecharacteristicsofthe201patients includedinthisstudywerecollected.Themajorityofpatients wereondimethylfumarate(72,6%;n=146),followedby teriflunomide(27,3%;n=55).Themajorityofpatientswere female(75,1%).Teriflunomideanddimethylfumaratepatients hadahighpersistencerates,74,5%and68,4%,respectively, after12months.Theproportionofpatientsadherent(MPR> 80%)toteriflunomideanddimethylfumaratewere90%and 72%,respectively.Patientsnewlyinitiatedondimethylfumaratehadthehighestrateofswitchingtoothertherapy (32,1%;n=47),followedbypatientsonteriflunomide (21,8%;n=12).Themeantimetoswitchingrangedfrom 277daysforteriflunomideto342daysfordimethyl fumarate.

ConclusionandRelevance Thisreal-worldclaimsdatastudy demonstratesthatpatientswithMSnewlyinitiatedonteriflunomideanddimethylfumaratehadhighpersistenceand adherenceat12months.

Giventheimportanceoftreatmentpersistence,adherence, andtimetoswitchingonclinicaloutcomesforpatientswith MS,ourfindingscanbeusedtoinformtreatmentdecisionmakingbyhealthcareproviders.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-127 PERSISTENCEOFBIOLOGICALDISEASE-MODIFYING DRUGSANDPHOSPHODIESTERASE-4-INHIBITORSIN PATIENTSWITHPSORIATICARTHRITHIS

1LRubio-Ruiz*, 1AOnteniente-González, 1LMartin-Zaragoza, 1JSánchez-Rubio-Ferrández, 1NHerranz-Muñoz, 1SSolís-Cuñado, 2ÁAragón-Díez, 1TMolina-García. 1Hospital UniversitarioDeGetafe,Pharmacy,Getafe,Spain; 2HospitalUniversitarioDeGetafe, Reumatology,Getafe,Spain

10.1136/ejhpharm-2024-eahp.231

BackgroundandImportance Persistenceprovidesinformation ontreatmenteffectiveness,durability,andtoleranceinrealworldpatientpopulations.LittleisknownaboutthepersistenceoftreatmentsusedinPsoriaticArthrithis(PsA).

AimandObjectives Thisworkcomparesthepersistenceof biologicaldisease-modifyingdrugs(bDMARDs)andphosphodiesterase-4-inhibitors(PD-4-Is)inPsApatientsandinvestigate thereasonsfortreatmentdiscontinuation.

MaterialandMethods Longitudinal,retrospective,andobservationalstudy.ItincludedPsApatientswhoinitiatedbDMARDs (anti-TNF,anti-IL12/23,anti-IL17andanti-IL23)andPD-4-Is treatmentbetweenJanuary2014andJune2022,withfollowupuntilDecember2023.

Persistenceistheperiodfrominitiationtodiscontinuation. Persistencewasalsocalculatedasadichotomousvariableat6 monthsfromthetreatmentinitiation.Thepermissiblegap (thresholdofaperiodwithouttreatment)was60days.

Thevariablesanalysedincludeage,gender,treatmentline, treatmentstartandenddates,reasonsfordiscontinuation, treatment-naiveandadherence(medicationpossessionratio >90%).

Persistenceaftersixmonthswascomparedusingthe c2 test.Kaplan-Meiersurvivalanalysiswasperformed,anddifferenceswereevaluatedusingthelog-ranktest.Adjustedriskof

discontinuationwasassessedwithCoxProportionalHazard models.StatisticalanalysiswasconductedwithSPSS®V27.0. Results 206patientswereincluded,47.6%weremen.The meanage±SDwas53.2±11.6years.Atotalof354treatment lineswererecorded(37.3%anti-TNF;25.2%PD-4-Is;20.3% anti-IL17;9.0%anti-IL12/23;8.2%anti-IL23).

Overalltreatmentpersistencerateat6monthswas86.4% (96.8%anti-IL12/23;95.2%anti-IL23;91.2%anti-TNF; 83.8%anti-IL17;75.9%PD-4-Is).

Meanoverallpersistencedurationwas1542days(CI95% 1376–1707).AccordingtoCoxregression,themeanpersistencewas1626(CI95%1436–1815)daysforbDMARDs and1086days(CI95%863–1310)forPD-4-Is.Menwere morepersistent[HR1.41(CI95%1.04–1.93),p<0.05]. bDMARDsweremorepersistent[HR1.11(CI95%1.02–1.21)p<0.05].

13.6%(n=46)PsApatientstreatedwithbDMARDsorPD4-Isdiscontinuedtreatmentbefore6months.Thereasons were:55.5%lackofeffectiveness(37.5%anti-TNF;37.5% anti-IL17;20.8%PD-4-Is;4.2%anti-IL12/23);39.5%adverse effectsassociatedwithPD-4-Isand5.0%unknownreason.

ConclusionandRelevance PatientswithgreatertreatmentpersistencearethosetreatedwithbDMARDsandarepredominantlymale.Lackofeffectivenesswerethemainreasonfor earlydiscontinuationoftreatment.AllpatientswhodiscontinuedtreatmentforadverseeffectsweretreatedwithPD-4-Is.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-128 POTENTIALDRUG-DRUGINTERACTIONSIN HYPERTENSIVEPATIENTS

1APeric*, 2SVezmarKovacevic. 1MilitaryMedicalAcademy – FacultyOfMedicine,Sector OfPharmacy,Belgrade,Serbia; 2FacultyOfPharmacy,DepartmentOfPharmacokineticsAnd ClinicalPharmacy,Belgrade,Serbia

10.1136/ejhpharm-2024-eahp.232

BackgroundandImportance Hypertensionisamongthemost frequentlydiagnosedchronicmedicalconditioninadults. Treatmentofhypertensionrequiresoneormoredrugs(usually thiazide,angiotensinconvertingenzymeinhibitor(ACEI), angiotensin-II-receptorblocker(ARB),calciumchannelblocker (CCB)and/orbeta-blockers).Potentialdrug-druginteractions (pDDIs)arehighlyprevalentinhypertensivepatientsreceiving multidrugtherapy.KnowledgeaboutpDDIsmayhelpphysiciansminimiseadverseeffectsbycarefulchoiceofdrugs.

AimandObjectives ToanalysepDDIsamonghypertensive patientsandevaluatethemechanismandseverityofpotential outcomesofsuchinteractions.

MaterialandMethods Weconductedacross-sectionalstudy duringatwomonthsperiod,whichincluded350patients withhypertension,treatedinuniversityhospita,whohad 2 medicationsprescribed.ApprovalwasgrantedbytheEthics Committeeofthehospital.MedicationprescriptionswereanalysedforclinicallyrelevantpDDIsusingLexi-Interactdatabase (Lexi-Comp,Inc,Hudson,Ohio.StatisticalanalyiswasperformedusingthesoftwarePASWStatistics(PASWInc.,Chicago,IL,USA)version22andMicrosoftExcel® 2010.An expertgroup,consistingoftwoclinicalpharmacistsandtwo hospitalpharmacists,assessedthebenefitsandrisksofeach prescribeddrugbyusingtheMedicationAppropriateness

Index.Discontinuationorsubstitutionwithanotherdrugwith lessinteractingpotentialwassuggested.

Results Atotalof350patientswereincludedinthisstudy, withaverageage77(36–98)yearsand6.1(2.5)medications. Themajorityofpatients(86.0%)hadatleastoneclinically significantpDDI,averagewas3.78(range1–25).Suggestions fortreatmentchangeaimedmainlyateliminatingdrugduplications,reducingtheuseofthiazidediuretics,sulfonylureas, alpha-lipoicacidandpentoxiphyllineandincreasingtheuseof calcium-channelblockers,whenappropriate.pDDIswould havedecreasedto2.10,p<0.001,yetmalegender, 6medications,cardiovasculardiseases,diabetes,benignprostatic hyperplasia,wouldbepredictiveof 2pDDIs.Themain potentialadverseoutcomesofpDDIswerehypotension,renal failure,hypoglycemia,bradycardiaandlacticacidosis.

ConclusionandRelevance Carefulchoiceofdrugscanreduce, butnoteliminatepDDIsinhypertensivepatients.Closemonitoringforhypotension,renalfailure,hypoglycemia,bradycardiaandlacticacidosisisnecessary.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.BurnierM,PolychronopoulouE,WuerznerG.Hypertensionanddrugadherencein theelderly. Frontiersincardiovascularmedicine. 2020;7:49.

ConflictofInterest Noconflictofinterest.

4CPS-129 EVALUATIONOFTHEBENEFITOFCAROBFLOURON NINTEDANIBDIARRHOEAINTHETREATMENTOF DIFFUSEINTERSTITIALLUNGDISEASE

1AMartínLópez*, 1JGonzálezChávez, 2IJiménezOrmazábal, 2JHernándezGonzález, 1ASantosFagundo, 1JEsquivelNegrín, 1PDíazRuíz, 1MSuárezGonzález, 1PJoyCarmona, 1AMagdalenaPérez, 1FJMerinoAlonso. 1HospitalUniversitarioNuestraSeñoraDe Candelaria,ServicioDeFarmaciaHospitalaria,SantaCruz,Spain; 2HospitalUniversitario NuestraSeñoraDeCandelaria,ServicioDeNeumología,SantaCruz,Spain

10.1136/ejhpharm-2024-eahp.233

BackgroundandImportance Nintedanibisatyrosinekinase inhibitordrugindicatedforidiopathicpulmonaryfibrosisand otherchronicprogressivephenotypefibrosis.However,itis difficulttomaintainthefulldoseduetoitsmostfrequent adverseeffect:diarrhoea.

Becauseofthecomplexityofthesepatients,multidisciplinarycarebetweennursingandpharmacyisperformed.Before startingtreatment,oralintakeofcarobflourisindicatedto preventandtreatdiarrhoea.

Carobisaplantwithmedicinaluseingastrointestinaldisordersasithasanti-inflammatory,anti-diarrhoealandantiulcerproperties.Werecommend,accordingtobibliography, theintakeof20gramsonceortwiceaday.

AimandObjectives Toevaluatethebenefitofdailyintakeof carobflourondiarrhoeacausedbytheantifibroticdrugnintedanibinatertiarylevelhospital.

MaterialandMethods Allpatientsdispensednintedanibfrom March2022toJuly2023wereincluded.Informationregardingnintedanibinitiationdate,durationoftreatment,indication,dosingatcut-offandco-medicationswascollectedfrom medicalhistory.Carobflourintakesandincidenceofdiarrhoeawereregisteredbynursingandpharmacyonfollow-up. Results Forty-sevenpatientswereincluded,highlightingtwo groups:

Patientswhotookcarobflour 48.9%(n=23),ofwhom20did nothavediarrhoea.Theotherthreepatientshaddiarrhoea,

suspectingthattheytooklessthanrecommended,intwoof themitwasnecessarytoreducethedose.

Patientswhodidnottakeflour:51.1%(n=24),ofwhom 16didnothavediarrhoea.Theremainingeightpatientshad diarrhoea,decreasingthedoseinfourofthem.

Mostofthepatientswhodidnottakeflourstartedtreatmentmorethan12monthsago(62.5%),whenthisdietary recommendationwasnotmade.

ConclusionandRelevance Carobflourisusefulinpreventing diarrhoeacausedbynintedanibduetoitsanti-diarrhoealpropertiesbecauseitisrichinstarchandfibre,whichleadstoa decreaseinstoolproductionanddiarrhoea.Inaddition,the proteinspresentutiliseseparateglucoseandaminoacid cotransportersthatpromoteglucoseabsorption.Byimproving stoolconsistency,itcontributestobettertoleranceof nintedanib.

Moreexhaustivestudiesshouldbeperformedtoconfirm theseresults,bearinginmindthecarobflourintakevaries frompatienttopatient,makingresultsdifficulttoassess.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-130 RISKOFHYPOKALAEMIAINHOSPITALISEDPATIENTS ASSOCIATEDWITHTHECOMBINATIONOFDIURETICS

YReyes-DeLaMata,JDiaz-Navarro*,GCano-Martínez,FJSalmerón-Navas. Hospital UniversitarioPuertoReal,HospitalPharmacy,PuertoRealCádiz,Spain

10.1136/ejhpharm-2024-eahp.234

BackgroundandImportance Loopdiureticsandthiazidesare commonlyknowntocausehypokalaemia.Severalcasesof hypokalaemiawerediscoveredinpatientsundergoingdiuretic treatmentduringpharmaceuticalvalidation.

AimandObjectives Mainobjectivewastostudytheriskof hypokalaemiainhospitalisedpatientsreceiving 2diuretics.

MaterialandMethods Adescriptiveandretrospectivestudy wasdesigned.Thenumberofadmissionstreatedwithdiuretics fromAugust2022toJuly2023wereextractedfromelectronicprescriptionsoftware(DominionFarmaTools®)and potassiumbloodlevelsfromlaboratorysoftware(Modulab®).

Theoutcomewastheproportionofincludedpatientswith hypokalaemia.Inclusioncriteria: 2diureticsfor 2consecutivedayswith 2serumpotassiumlevels.Assesseddiuretics were:furosemide(F),hydrochlorothiazide(H),eplerenone (E)andspironolactone(S).Assessedpotassiumsupplement (PS)were:potassiumhydrogencarbonateandpotassium chloride.

‘Diuretic-associatedhypokalaemia’ wasdefinedaspotassium level<3.5mEq/dLatleasttwodaysafterinitiatingtreatment with 2diuretics.Additionally,PSwerealsocollectedfrom admissionswithhypokalaemia.

Results Atotalof4,127registersofpatientsadmittedwith diuretictreatmentwereinitiallyreviewed,988had 2concomitantdiureticsand517ofthemwereprescribedfor 2 days.

Hypokalaemiawasidentifiedin40.8%ofpatientsadmitted. LoopdiureticcombinedwitheitherSorEhadsimilarhypokalemicrates(42,7%;41,4%respectively)butnotashighas whencombinedwithH(59.4%).

Inaddition,PShadtobeaddedto124(58.8%)ofpatients thatdevelopedhypokalaemia.

Abstract4CPS-130Table1

TotalHypokalemian(%)

Admissions517211(40.8;IC9536.6–45.0)

F+H13882(59.4;IC9551.2–67.6)

F+S13156(42.7;IC9534.3–51.2)

F+E14058(41.4;IC9533.3–49.6)

F+H+S427(16.7;IC955.4–27.9)

Otherassociations668(12.1;IC954.2–20)

ConclusionandRelevance Almosthalfofadmissionswithcombinationofdiureticsdevelopedhypokalaemiaduetothese drugcombination.

Fwasinvolvedineverytreatment.F+Hwasthecombinationmorecommonlyassociatedwithhypokalaemia(riskdifference25.4%;IC9515.9–34.9vstherestofassociations).

Thecombinationofloopandpotassium-sparingdiuretics alsoleadstohypokalaemiadespiteSorE.

MorethanhalfofadmissionsrequiredtheadditionofPS. Potassiumlevelsshouldbemonitoredregularlyinallpatients receivingdiuretictreatmentwith 2drugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-131 UTILISATIONANDSAFETYPROFILEOFUPADACITINIB INATERTIARYHOSPITAL

CDeCastroAvedillo*,JCSaezHortelano,RVarelaFernandez,DOzcoidiIdoate, AFernandezVazquez,MFloresFernandez,JAyalaAlvarezCanal,SLlamasLorenzana, AVelezBlanco,JJOrtizDeUrbinaGonzalez. HospitalUniversitarioLeón,Farmacia Hospitalaria,León,Spain

10.1136/ejhpharm-2024-eahp.235

BackgroundandImportance Upadacitinibisaselectiveand reversibleinhibitorofJanuskinases(JAK),indicatedinseveral immune-mediateddiseases.Theprofileofpatientswhouse thisdrugisverydiverseandhasrelevantadversereactions (ARs)ofwhichitisimportanttocloselymonitor.

AimandObjectives Describetheprofileofpatientstreated withupadacitinib,itsconditionsofuseanditssafetyprofile inatertiaryhospital.

MaterialandMethods Descriptiveandretrospectivestudyof allpatientstreatedwithupadacitinibbetween01/02/2021and 06/30/2023.Thevariablescollectedwere:age,sex,pathology, dosage,ARs,durationoftreatment,toxichabits,previous treatmentandadherence.Datawereextractedfromtheoutpatientmodule(Farmatools®)andthecomputerisedelectronic history(Jimena®).Thedatacollectionandanalysiswascarried outinaMicrosoftExceltableofourowncreation.

Results 34patientswereincluded(9wereexcludeddueto off-labeluse).Half(17)weremen.Meanageof41.03±13.76 years.12(35.29%)hadtoxichabitsand15(44.11%)werein psychiatrictreatment,ofwhich10(66.67%)sufferedfroma rheumaticpathology.Theywereprescribedfor:2(5.89%) ankylosingspondylitis,5(14.70%)inflammatoryboweldisease,9(26.47%)atopicdermatitis,5(14.70%)psoriatic arthritisand13(38.24%)forrheumatoidarthritis(RA).10 (29.41%)discontinuedtreatmentduetolackofefficacy.8 (23.53%)startedwithadoseof30mg/24h.Onaveragethey had2.23+-1.71previousbiologics.Themediandurationof

treatmentinthesepatientswas144(49–435)daysand7 (20.58%)had<90%adherence.ThemainAEswere:3 (8.82%)lipidalterationsand7(20.59%)infectiousprocess.In nopatientdidithavetobediscontinuedduetosevereAR.

ConclusionandRelevance Themajorityofupadacitinibinour hospitalisprescribedforrheumatology,specificallyforRA, andasignificantnumberofthesepatientssufferfromsome psychiatricpathology.Themostcommondoseis15mg/24h.The safetyprofileisgood,althoughthemainARfoundisan alterationofthelipidprofilethat,ifthehighpercentagethat hassometoxichabitistakenintoaccount,cannegatively affectcardiovascularhealth.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-132 RIBOCICLIBINMETASTASICBREASTCANCER TREATMENT:FRECUENCYANDANALYSISOF DIFFERENTSADVERSEEFFECTSWHICHREQUIRED INTERVENTION

HVelazquez*,AGilGarcia,ARojasAlbarran,MGrageraGomez,MDZambranoCroche. ComplejoHospitalarioUniversitarioDeBadajoz,Pharmacy,Badajoz,Spain

10.1136/ejhpharm-2024-eahp.236

BackgroundandImportance Ribociclibisaselectivecyclindependentkinase4/6(CDK4/6)inhibitorapprovedforthe treatmentofhormonereceptor-positive,humanepidermal growthfactorreceptor2-negative(HR+/HER2 )locally advancedormetastaticbreastcancer(LA/MBC)incombinationwithanaromataseinhibitororfulvestrantasinitialhormonaltreatment.Multipleadverseeffectswereadvertisedin clinicaltrialswhichledtomodificationssuchasdosereductionsordrugchange.

AimandObjectives Theaimofthisstudywastoevaluatethe sideeffectsduetoribociclibandtoanalysehowmodifications intreatmentsaremadeinclinicalpractice.

MaterialandMethods Weconductedadescriptive,observationalandretrospectivestudyofpatientstreatedwithRibociclib from2017topresentinathird-levelhospital.Thedatawere obtainedfromtheelectronicmedicalrecordsofthepatients andtheFarmatoolsManagementprogram.Theparameters analysedwere:demographicinformation,timefromfirstdose tofirsteventnoticed(dosereduction/drugchange),doses reductions,changestootherCDK4/6inhibitor,frecuencyand descriptionofadverseeffectsanddiscontinuationtreatment. DatawereprocessedbyMicrosoftExcelsoftware.

Results Atotalof81womenwithHR+/HER2 MBCwere studied.Medianagewas62years.62%(50/81)hadto undergosomemodificationwithrespecttheoriginaltreatment duetoadverseeffects.40%(32/81)requiredsomedose reduction[35%(28/81)onlyonereduction;5%(4/81)needed tworeductions].22%(18/81)hadtoswitchdrug.Mainsigns involvedwerehematologicaltoxicity-neutropenia-(24cases), dermaltoxicity(8),livertoxicity(5),gastrointestinaltoxicity (3),hearttoxicity-longQTsyndrome-(2).Averagetimeto firstdosereductionwas83days.Averagetimetodrugchange was117days.Averagecyclesuntilfirsteventwas2,5.Averagecyclesuntilendofstudyoreventwas6,9.Totheendof study,64%(32/50)continuetreatmentwithribociclib,26% (13/50)changedtoothercyclineinhibitorand10%(5/50) changedtoanotherdrugs.Restofthemwassuspendedby cancerprogression.

ConclusionandRelevance Thefrequencyofdosereductions andinterruptionsoftreatmentinourpopulationwassimilar toclinicaltrials(MONALEESA).Thekindofadverseeffects observedwassimilartoo,althoughwefocusedonthosewhich supposeddosereductionordrugchange.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-133 EFFECTIVENESSANDSAFETYOFANTIIL-5DRUGS BENRALIZUMABANDMEPOLIZUMABINSEVERE UNCONTROLLEDEOSINOPHILICASTHMAPATIENTS

MDLRGarciaOsuna,EFernandezAlonso,JMVinuesaHernando,MAAlcaceraLopez, BBonagaSerrano,MAAllendeBandres,LSopenaCarrera,AMerchanFlores,EChilet Rodrigo,MPAibarAbad. HospitalClinicoUniversitarioLozanoBlesa,PharmacyService, Zaragoza,Spain

10.1136/ejhpharm-2024-eahp.237

BackgroundandImportance Severeuncontrolledeosinophilic asthma(EA)isdefinedbypulmonaryinflammationcausedby eosinophiliccells.Itisassociatedwithanincreased-oncytokineIL-5.Patientsdiagnosedwiththisphenotypeofasthma arecorticoidsresistant.Amongthenewtreatments,biological therapywithmonoclonalantibodiesagainstIL-5seemstobea suitableoption.

AimandObjectives Analyzetheeffectivenessandsafetyin dailyliferoutinepracticewithantiIL-5biologicaldrugs,benralizumabandmepolizumab,usedbysevereuncontrolledEA patients.

MaterialandMethods Retrospectiveobservationalstudyina dailylifeclinicalpracticeofathird-levelhospital.Patients selecteddiagnosedwithEAtreatedwithbenralizumaband mepolizumabforatleast12monthsfromJanuary2018to March2023.

Datawascollectedfromelectronicmedicalrecordsand drugdispensingprogram:sex,age,ForcedExpiratoryVolume in1second(FEV1),comorbidities,bloodeosinophiliccount (EOS),AsthmaControlTest(ACT),exacerbation’snumber, oralglucocorticoid(OCS)basedonequivalentdosesofprednisone,inhaledtreatment.Effectivenesswasassessedbythe reductionofEOS,OCSandexacerbations;andbythe improvementofFEV1andACT.Safetyprofilewasdemonstratedbasedonadverseeffects(AE)described.Thesoftware usedfordatacollectionwasMicrosoftExcelandforstatistical analysisJAMOVI.

Results 45patientswereincluded,31women(68.9%),mean age65.6years(42–81).26patients(57.8%)weretreatedwith benralizumaband19(42.2%)withmepolizumab.Mostfrequentcomorbiditiespresentedbypatientswere:21nasalpolyposis(46.7%),eightrhinosinusitis(17.8%)andseven Samster ’striad(15.6%).Twopatientsweresmokers(4.4%). After12monthsoftreatmentFEV1increasedby20.4%(18.0–45.5;n=32).13patientsdidnotcompletethetestdue toCOVIDpandemicsituation.EOSbloodtestwasreduced by96.7%(81.8–100.0)frombasallevelconcentrations.Exacerbations’ numberpresentedonthepreviousyearwere reducedfrom3.75(0.0–9.0)to0.5(0.0–6.0).ACTimproved 6.5points(-6.0–16.0).Only21patients(46.7%)required diaryOCS,andtheirdosewasreducedto4.67mgperday (0.0–30.0).Allpatientscontinuedinhaledtherapy.AnyAE weredescribed.

Abstracts

ConclusionandRelevance Theuseofanti-IL5,benralizumab andmepolizumab,insevereuncontrolledEApatientshas showntobeeffectiveandsafeondailylifeclinicalpractice, experiencinggreatercontrolofasthma.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-134 REAL-WORLDEVIDENCEOFCEFIDEROCOLIN CLINICALPRACTICE

ERanucci,SCorridoni,PSorice,FVernacchio,ACostantini. Hospital ‘SantoSpirito’ Pescara, Pharmacy,Pescara,Italy

10.1136/ejhpharm-2024-eahp.238

BackgroundandImportance Antimicrobialresistanceisaserioushealththreat.InItalythereare56,600totalcasesof resistantinfections.Cefiderocolisanantibacterialforsystemic usebelongingtotheclassofsiderophorecephalosporins.Itis indicatedforthetreatmentofseriousinfectionscausedby aerobicgram – (g-)organismsinadultswithlimitedtherapeuticoptions.

AimandObjectives Describetheuseofcefiderocolinreal clinicalpracticeandcompareitseffectivenessdatawiththose presentintheliterature.

MaterialandMethods Asingle-centreretrospectiveobservationalstudywasconductedtakingintoaccountcefiderocolprescriptionsintheperiodfromApril-22toSeptember-23.The datawereextrapolatedfromacomputerisedpersonalisedprescriptionsystemandfromacomputerisedlaboratorytestdata collectionsystem.Personaldata(ageandsex),etiological agent,antibiogram,averagedailydose,durationoftherapy, causeofhospitalisationandhospitalisationdepartmentwere analysed.Theeffectivenessofthetherapywasobtainedfrom theoutcomeofthemicrobiologicalexaminationattheendof administration.

Results 48patientswereenrolledwithanaverageageof 72.5years(26 –95)ofwhich62%weremale.96%of patientshadag-infection,ofwhich35%alsoshowedpositivityforgram+(g+).Themost isolatedbacterialstrains wererespectively:Acinetobact erbaumanii(87%),Stenotrophomonasmaltophilia(17%)a ndKlebsiellapneumoniae (17%).69%ofpatientsshowedsusceptibilitytocolistinantibiogramtesting.Onaveragepatientsreceivedadailydoseof 4.5g(1 –8).Theaveragedurationoftherapywas6days(1–39)with71%ofpatientsreceivingtherapyinaperiodof 5>days<21.17%ofpatientsreceivedtherapyfor<5days and12%>21days.Thecausesofhospitalisationwere71% infections,13%surgical,12% organfailure.Thegreatest numberofprescriptionscomesfromthedepartmentsof: infectiousdiseases(25%),resuscitation(21%)andgeriatrics (17%).Aftercefiderocolad ministration,52%ofpatients testednegativeforg-culture.

ConclusionandRelevance Cefiderocolshowedeffectiveness comparabletothatreportedintheCREDIBLE-CRand APEKS-NPphaseIIIclinicaltrials(58.3%).1 Notreatments weresuspendedduetotoxicity.Itisusefultoevaluatethe follow-upofpatientsparticularlythosewhoshowedsensitivity tocolistin.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TimsitJ-F, etal.ClinicalInfectiousDiseases. 2022;75(6):1081–4.

ConflictofInterest Noconflictofinterest.

4CPS-135 EVALUATIONANDMANAGEMENTOFCONSTIPATION INTHECRITICALLYILLPATIENT

1APuertasSanjuan, 1LDomenechMorales, 1JSantanderReboreda, 1SFernandezMolina, 2ANietoRuiz, 2LVidalTarrason, 1MQGorgasTorner. 1VallD’hebronUniversityHospital, HospitalPharmacyDepartment,Barcelona,Spain; 2VallD’hebronUniversityHospital, IntensiveCareDepartment,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.239

BackgroundandImportance Constipation(CIN)isaprevalent concernincriticallyillpatients(CIP)withinintensivecare units(ICU),potentiallyexacerbatingtheircondition.

AimandObjectives EvaluatethemanagementofCINinCIP, discernitscausesandconsequences,andproposeprophylactic andtherapeuticmeasures.

MaterialandMethods Adescriptiveobservationalstudywas conductedinatertiary-levelhospital’sICU.Demographicdata, medicalhistory,enteralnutrition(EN)type,factorsinfluencing constipation(treatmentregimens,clinicalstatus,anddevices), stoolhistoryinthelastweek,andinterventionswerecollected throughacross-sectionalapproach.CINwasdefinedas ‘absenceofstoolafter3daysfromthestartoftheEN/oral diet’.Sixty-threepatientswerereviewed,and20were excluded.Exclusioncriteria:admissionlessthan3daysand nooral/NEtolerance.

Results Forty-threepatientswereincluded,withameanageof 57±13.4yearsandanaveragestayof23±16.7days.58% sufferedCIN.Thepatientsshowedameanof2.93±2.61days sincethelaststooland3.98±2.13dayswithoutstoolinthe last7days.Mobilitygrades0and2werepredominant (37.21%;25.58%),with81.40%requiringmechanicalventilation;ofthese,62.8%sufferedCIN.Themostprevalentdiseaseswererespiratory(46.51%),septicshock(25.58%),and neurological(23.26%).Opioids(53.49%)werethemostcommonpharmacologicaltreatment;73%sufferedCIN.Non-fibre diets(48.9%)werethemostcommonlyusedEN;57%of thesepatientssufferedCIN.Only39.5%receivedafibre-rich diet,witha64.7%constipationincidence.Laxatives(25.6%), followedbyenemas(16.3%),werethemostused.CINwas elevatedinbothgroups(72%;71%).Prokineticswereusedin 13.9%ofpatientsandincombinationwithlaxativesin6.9%. Nointerventionwasappliedto46.5%ofpatients,50%of whomhadCIN.Lactulose(50%),followedbymagnesium hydroxide(37.5%),werethemostcommonlyusedlaxatives. ThemostcommonenemausedwasCasen® in85%of patients.

ConclusionandRelevance Thisstudy ’simplicationsaresignificant,highlightingthenecessityforvigilantmonitoringof CIN-inducingmedicationsincriticallyillpatients,earlyimplementationofhigh-fibrediets,andtheproactiveuseoflaxativesandprokinetics,possiblyincombination.Furthermore, thestudyunderscorestheurgencyofcreatingastandardised protocolforCINprophylaxisandmanagementinICU settings.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-136

ANALYSISOFTHESITUATIONOFPHARMACEUTICAL CAREFORPATIENTSWITHIMMUNE-MEDIATED INFLAMMATORYDISEASESBEFOREANDAFTERTHE COVID-19PANDEMIC

1TPalanques-Pastor, 2PLópezSánchez, 3MOIbarraBarrueta, 4ERamírezHerráiz, 5MCasellasGibert, 6EMonteBoquet, 7NRudiSola. 1HospitalUniversitariIPolitècnicLaFe, Pharmacy,Valencia,Spain; 2HospitalGeneralDeTomelloso,Pharmacy,Tomelloso,Spain; 3HospitalGaldakao-Usansolo,Pharmacy,Galdakao,Spain; 4HospitalUniversitarioDeLa Princesa,Pharmacy,Madrid,Spain; 5HospitalUniversitarioDeBellvitge,Pharmacy, HospitaletDeLlobregat,Spain; 6HospitalUniveritariIPolitècnicLaFe,Pharmacy,Valencia, Spain; 7HospitalGeneralDeGranollers,Pharmacy,Granollers,Spain

10.1136/ejhpharm-2024-eahp.240

BackgroundandImportance Pharmaceuticalcareinpatients withimmune-mediatedinflammatorydiseasesisessentialfor thecorrectmanagementofpharmacotherapy.However,the arrivalofthesevereacuterespiratorysyndromecoronavirus2 hasrequiredtheadaptationofconsultationstopreservethe healthofpatients.

AimandObjectives Todescribe,analyseandcomparethesituationofpharmaceuticalcareconsultationsforoutpatients withimmune-mediatedinflammatorydiseasesofthePharmacy ServicesofSpainattwodifferenttimes.

MaterialandMethods Longitudinal,multicentreandunidisciplinarydescriptiveobservationalstudy,carriedoutbythe Immune-mediatedInflammatoryDiseasesWorkingGroupof theSpanishSocietyofHospitalPharmacythroughavirtual surveyin2019and2021.Variableswerecollectedregarding coordination,resources,biosimilars,unmetneedsandtelepharmacy.Numericalresultswerepresentedinabsolutevalueand percentageandfreetextresponsesweregroupedbytopic areas.Tocomparetheresultsbetweenthetwocollection times,theChi-Squaretestwasusedwithasignificancelevel ofp<0.05.

Results Thelevelofparticipationwas70pharmacistsin 2019and53in2021.Themainsignificantfindings obtainedwereanincreaseinparticipationinasthmabiologiccommittees(p=0.044)andcarecoordinationindermatology(p=0.003)anddigestivesystem(p=0.022).The wideuseofbiosimilarbiologicalmedicinesstoodout,with a15%increaseintheexchangeofthereferencebiological tothebiosimilar.Thelackofresearchinthefieldand insufficienthumanresources,amongotherunmetneeds, wererevealed.Intheoutpatientunits,theuseofthestratificationmodelofthestrategicmapofoutpatientpharmaceuticalcarewasaminorityandanincreaseintheuseof informationandcommunicationtechnologieswaspromoted. Motivatedbythepandemicderivedfromcoronavirusdisease2019,telepharmacywasestablishedforthefirsttime in85%ofthecentres,maintainingtheserviceat66%at thetimeofthesecondsurvey.

ConclusionandRelevance Outpatientunitsareundergoing constantchangetoadapttonewtimes,forwhichinstitutional supportisneededtoinvestmoreresourcestopromotethe developmentofstrategiestoreduceunmetneeds.Wemust continueworkingtoachieveapharmaceuticalpracticethat providesefficiency,safety,qualityoflifeandaccesstoinnovativedrugsinpatientswithimmune-mediatedinflammatory diseases.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-137 CEFIDEROCOL:UTILISATIONPROFILEINTHE TREATMENTOFMULTIDRUG-RESISTANTBACTERIA,A RETROSPECTIVEOVERVIEW

ACalvoGarcía,AIbáñezZurriaga,MPérezAbánades,ERamírezHerráiz,SRuíz-García, GEscuderoSánchez,AColladoMohedano,AArangurenOyarzabal,AMorellBaladrón. HospitalUniversitarioDeLaPrincesa,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.241

BackgroundandImportancegram-negativebacterialmultidrugresistancehasreachedalarminglevelsworldwide.Cefiderocol isanovelsiderophore-cephalosporinconjugate,withactivity againstcarbapenem-resistantandmultidrug-resistantgram-negativebacilli.

AimandObjectives Todescribetheutilisationprofileofcefiderocolinthetreatmentofmultidrug-resistantgram-negative infections.

MaterialandMethods Retrospectivestudyincludingallpatients treatedwithcefiderocolduringMarch2021toJuly2023. Patientdemographics(age,sex,hospitalstay,intensivecare unit(ICU))stay,andclinicalandinfectiousvariables(infection/colonisationsite,isolatedgram-negativebacteria,and mechanismsofresistance)werecollected.Statisticalanalysis: valueswereexpressedasmedians(interquartilerange)and patients(percentages).

Results Fifty-threepatientsstartedtreatmentwithcefiderocol: 10/53(18.9%)colonisationsand43/53(81.1%)activeinfections.34/53(64.2%)weremalewithamedianageof65.6 (56.6–72.3)years.Themedianhospitalstaywas57.3(31.5–82.2)days,31/53patients(58.5%)requiredadmissiontothe ICU,withamedianstayof40.0(25.0–76.5)days.Themain focusofinfectionwasrespiratory(16/53,30.2%),followedby urinary(10/53,18.9%),intra-abdominal(5/53,9.4%),skin andsofttissue(5/53,9.4%),endovascular(4/53,7.5%)and osteoarticular(3/53,5.7%);and10/53(18.9%)werecolonisationsamples(rectalexudates).7/53(13.2%)patientshad anotherfocusand11/53(20.8%)hadsepsis.Atotalof73 isolatesofmultidrug-resistantgram-negativebacteriawere obtained.Microorganismswithmorethanoneisolationwere: 18/73(24.7%)IMPcarbapenemase-producing Pseudomonas aeruginosa,7/73(9.6%)VIMcarbapenemase-producing Pseudomonasputida,6/73(8.2%)multidrug-resistant Stenotrophomonasmaltophilia,5/73(6.8%)Carbapenem-resistant Acinetobacterbaumannii,4/73(5.5%)VIMcarbapenemaseproducing Pseudomonasaeruginosa,3/73(4.1%)IMPcarbapenemase-producing Klebsiellaoxytoca,3/73(4.1%)VIMcarbapenemase-producing Klebsiellaoxytoca,3/73(4.1%)VIM carbapenemase-producing Serratiamarcescens,2/73(2.7%) multidrug-resistant Proteusmirabilis and2/73(2.7%)multidrug-resistant Pseudomonasaeruginosa.Just4/57isolateswith resistancetocefiderocolwererecorded.In5/43(11.6%) patientstreatmentwasempirical.Themediandurationof treatmentwas9.0(6.0–15.0)days.

ConclusionandRelevance Cefiderocolwasmainlyusedasa targetedtreatmentofrespiratoryandurinarytractinfections inapopulationwithlonghospitalstaysandahighrateof ICUadmission.Mostoftheisolatedbacteriapresentedcarbapenemases,especiallyVIMandIMP,withalowresistance ratiotocefiderocol.Therefore,cefiderocolwaswellutilised, beingrestrictedtopatientswithsevereinfectionscausedby pathogenswithcarbapenemases.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-138 CEFIDEROCOL:EFFECTIVENESSANDMORTALITYOF MULTIDRUG-RESISTANTBACTERIAINFECTIONS,A RETROSPECTIVEOVERVIEW

ACalvoGarcía,SRuíz-García,ERamírezHerráiz,MPérezAbánades,AIbáñezZurriaga, AÁlvarezYuste,PDuqueTebar,AMorellBaladrón,AArangurenOyarzabal. Hospital UniversitarioDeLaPrincesa,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.242

BackgroundandImportance Cefiderocolisanovelsiderophore-cephalosporinconjugate,withactivityagainstcarbapenem-resistantandmultidrug-resistantgram-negativebacilli.The noveltyofandneedforcefiderocolareclearbutavailable real-settingclinicaldataarelimited.

AimandObjectives Todeterminetheeffectivenessofcefiderocol(microbiologicaleradication,clinicalcure,andrecurrence), andmortalityoftreatedinfections.

MaterialandMethods Retrospectivestudythatincludedall patientswithactiveinfectionandtreatmentwithcefiderocol duringMarch2021toJuly2023.Demographic,clinical,infection,andtreatmentvariableswerecollected.Patientswith microbiologicaleradication(negativeculture),clinicalcure, recurrenceofinfection(positiveculture),early(7–10days frominitiationofcefiderocol),and30-daymortalitywerecalculated.Statisticalanalysis:valueswereexpressedasmedians (interquartilerange)andpatients(percentages).

Results Forty-threepatientsinitiatedtreatmentwithcefiderocol,27/43(62.8%)weremalewithamedianageof66.0 (57.7–73.5)years.Themedianhospitalstaywas64.1(29.9–89.3)days,29/43(67.4%)patientsrequiredintensivecareunit (ICU)admission,withamedianstayof42.0(25.0–83.0)days. Themainfocusofinfectionwasrespiratory(16/43,37.2%), followedbyurinary(10/43,23.3%),intra-abdominal(5/43, 11.6%),skinandsofttissue(5/43,11.6%),endovascular(4/ 43,9.3%)andosteoarticular(3/43,7.0%).5/43(11.6%) patientspresentedanotherfocusand11/43(25.6%)hadsepsis.Atotalof57multidrug-resistantgram-negativeand14 gram-positivebacteriawereisolated.In19/43(44.2%)patients morethanonemicroorganismwereisolated.Resistanceto cefiderocolwasrecordedin3/43(7.0%)patients.Themedian treatmentwas9.0(6.0–17.5)days.In36/43(83.7%)patients morethanoneantibioticwasused,and18/43(41.9%)of them,withsynergisticaction.

In31/43(72.2%)patientsmicrobiologicaleradicationwas achieved,in4/43(9.3%)itwasindeterminate,andin35/43 (81.4%)patientsachievedaclinicalcure.Mortalityrates:early 2/43(4.7%),at30days7/43(16.3%)andintra-hospital13/43 (30.2%).Therecurrenceratewas8/43(18.6%).

ConclusionandRelevance Cefiderocolwaseffectiveinthe treatmentofmultidrug-resistantgram-negativebacteriainfectionsinourcohort,withahighrateofadmissiontothe ICU,andlargehospitalstay.Microbiologicaleradicationwas lowerthanclinicalcure,influencedbylossofvalues.Mortalityrateswerelowinthisclinicalstage,withintra-hospital mortalitybeingthehighest.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-139 VORICONAZOLESERUMCONCENTRATIONS MONITORING

CMoyaMangas*,LAmaro,MJTirado,VMerino. HospitalUniversitarioVirgenMacarena, HospitalPharmacy,Sevilla,Spain

10.1136/ejhpharm-2024-eahp.243

BackgroundandImportance Invasiveaspergillosisisontherise duetofactorslikeincreasedoncologicaltherapies,corticoid treatments,andviralinfections.Managingthisinfectionis challenging,especiallywiththedrugvoriconazole,whichhasa narrowtherapeuticrangeandvariableeffectsbetween individuals.

AimandObjectives Todescribeserumlevelsofvoriconazole inacohortofpatientsintwotertiary-levelhospitals.

MaterialandMethods Descriptiveobservationalretrospective multicentrestudyenrollingpatientswhoreceivedantifungal treatmentwithvoriconazoleforthediagnosisorhighsuspicionofinvasiveaspergillosisintheperiodbetween1January to31August2023.Patientsreceived6mg/kgonthefirstday andamaintenancedose4mg/kg/12h.Serumlevelswere measuredusingtheHPLCmethodatsteadystate,considering 1.5–5.5mg/Lasthetherapeuticrange.Thefollowingvariables werecollected:age,gender,weight.

Results 53patientswereevaluated(36,67.9%male),alladults withameanage±SD62.7±9.8yearsandmeanweight± SD68.6±17.3kg,andatotalof90determinationswere carriedout.

42.2%ofthecaseswereinthetherapeuticrange,butthe 57.8%not.Ofthem,61.5%hadsubtherapeuticlevelsand 38.5%supratherapeutic.

Incaseoflevelsintherapeuticrange,thesamedosewas maintained.

Incaseoflevelsinsubtherapeuticrange(meanlevels±SD 0.7±2.7),doseswereincreasedby25–50%untiltherapeutic levelswereachieved.Iftheywerenotreached,aswitchto isavuconazolewasmade.

Incaseoflevelsinsupratherapeuticrange(7.2±2.7) dosesweredecreasedby25–50%.Insomecases,monitoring wasrepeatedduetoimpropersamplecollection.

ConclusionandRelevance Thehighinterindividualvariability ofvoriconazolebringstolighttheneedofmonitoringserum levels,toadjustthedosetoreacheffectivelevelsandavoid toxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-140 EXPERIENCEOFUSINGPALBOCICLIB,RIBOCICLIB ANDABEMACICLIBINATERTIARYHOSPITAL

LGutiérrezLucena,MDCórdobaSotomayor,RContrerasCollado,BOyaAlvarezDe Morales,PLópezLópez. HospitalaryComplexOfJaén,HospitalPharmacy,Jaén,Spain

10.1136/ejhpharm-2024-eahp.244

BackgroundandImportance Thecyclin-dependentkinase4 and6(CPKi)inhibitordrugspalbociclib,ribociclibandabemaciclib,incombinationwithhormonetherapyhavebeenshown toimproveprogression-freesurvival,andinsomecases,overallsurvival,inwomenwithHER2-positive,hormonereceptorpositiveorlocallyadvancedbreastcancer.

AimandObjectives Evaluatedoseadjustmentduetosafety datainroutineclinicalpracticeinwomenwithmetastatic breastcancer.

MaterialandMethods Observational,descriptiveandretrospectivestudyincludingwomentreatedwithpalbociclib,ribociclib andabemaciclibincombinationwithhormonetherapy betweenJanuary2018andDecember2021.

PatientswithactiveCPKitreatmentwereselected.Datacollectedbyreviewingdigitalmedicalrecords.Thesedatawere: age,initialdose,whethertheyreceivedCPKiasthefirstline oftreatment,dosereduction,treatmentinterruption,and monthsoftreatmentduringthestudyfollow-upperiod.

AimandObjectives Theprimaryobjectivewastoassessthe impactofincludingmontelukastaspremedicationontheincidenceofIRR(iIRR)associatedwiththeadministrationof isatuximab.

SecondaryobjectivesincludeddescribingtheiIRRinareallifesettingandevaluatingpossibleriskfactors:food,environmentalormedicineallergies;previousIRR;andinfusionbag concentration.

MaterialandMethods Multicentricretrospectivestudyconductedinonesecondaryandthreetertiaryhospitals.Eligibility criteriaincludedadultshavingstartedisatuximabandexcluded patientsreceivingoff-labelcorticosteroiddosesandthose enrolledinclinicaltrials.Follow-upwascarriedoutuntilSeptember2023,treatmentdiscontinuationordeath.

Baselinecharacteristicsweresex,age,treatmentregimen, premedicationregimen,numberofisatuximabdosesand occurrenceofIRR.Thesenumericalandcategoricalvariables wereexpressedasnumberofobservationsandmedians respectively.

Oddsratios(OR)andMann-WhitneyUtestswerecalculatedtoevaluatequalitativeandquantitativeRF,respectively. Absoluteriskreduction(ARR)andnumberneededtotreat (NNT)wereusedtoassesstheimpactofmontelukastaspremedication.95%confidenceintervals(95%CI)wereapplied. Results 40patientswereincluded,withamedianageof66 (54 – 72)years,60.0%beingmen.Themediannumberof isatuximabdosesperpatientwas8(4–18).

ConclusionandRelevance RibociclibistheCPKimostcommonlyprescribedasthefirst-line.Intheabemaciclibgroup, morepatientsmaintainedinitialdose,andfewerpatients reducedthestartingdosecomparedtopalbociclibandribociclibgroups,butthesmallpopulationofourcohortdoesnot allowtoassumethisresults.However,thereweremoreinterruptionsoftreatmentsinthisgroup.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-141 REAL-LIFEIMPACTOFINCLUDINGMONTELUKASTAS PREMEDICATIONONTHEINCIDENCEOFINFUSIONRELATEDREACTIONSTOISATUXIMABAND DESCRIPTIONOFRISKFACTORS

1MDCJiménezLeón*, 1JAHernándezRamos, 2MMartínRodríguez, 3EGuerreroHurtado, 4APrietoRomero, 1FMayoOlveira, 1FMartínezDeLaTorre, 1MDCanalesSiguero, 1JMFerrariPiquero. 1HospitalUniversitario12DeOctubre,HospitalPharmacy,Madrid, Spain; 2HospitalUniversitarioPrincipeDeAsturias,HospitalPharmacy,Madrid,Spain; 3HospitalUniversitarioYPolitécnicoLaFeDe-Valencia,HospitalPharmacy,Madrid,Spain; 4HospitalUniversitarioGregorioMarañón,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.245

BackgroundandImportance Infusion-relatedreactions(IRR) areoneofisatuximab’smostfrequentandsignificantadverse reactionsthatmayleadtotreatmentdiscontinuationdespite premedicatingwithdexamethasone,paracetamol,andanti-H1 antihistamines.Similarlytodaratumumab,addingmontelukast aspremedicationcouldimproveitstolerability.Additionally, therearenostudiestodatedescribingwhichriskfactors(RF) mayaffectthelikelinessofanisatuximabIRR.

TheiIRRforcycle-one-day-onewas7.7%forthegroup premedicatedwithmontelukastand29.6%without.ORwas 0.20(95%CI0.02 – 1.79),ARRwas0.22(95%CI-0.01 –0.44)andNNTwas5.NoIRRwerefoundforsecondorfurtherdosesinanypatientandnoriskfactorswerefound. ConclusionandRelevance Inourexperience,iIRRobserved forisatuximabwaslowercomparedtopivotalclinicaltrials. Theinclusionofmontelukastaspremedicationmightreduce IRR,whichshouldbeconfirmedinsubsequentstudies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-142 COMMUNITYPHARMACY-BASEDHBA1CSCREENING FOREARLYDETECTIONOFDIABETESANDPREDIABETES

1,2JPapastergiou*, 3MElsabakhawi, 3LLori, 3CPotter, 4BVanDenBemt. 1UniversityOf Toronto,LeslieDanFacultyOfPharmacy,Toronto,Canada; 2UniversityOfWaterloo,School OfPharmacy,Kitchener,Canada; 3ShoppersDrugMart,Pharmacy,Toronto,Canada; 4Sint Maartenskliniek,ResearchAndInnovation,Nijmegen,TheNetherlands

10.1136/ejhpharm-2024-eahp.246

BackgroundandImportance Diabetescontinuestoaffectan increasingnumberofCanadianseachyearandthreatensthe sustainabilityofourhealthcaresystem.Earlydetectioniskey toimprovedhealthoutcomes,yetaccesstotestingwaslimited duringtheglobalpandemic.Point-of-careHbA1Cscreening technologyallowsfordetectionofdiabetesandpre-diabetesin thecommunitypharmacysetting.

AimandObjectives Toevaluatetheeffectivenessofastandardisedcommunitypharmacist-directedpoint-of-careHbA1C screeningprogramandtoidentifytheprevalenceofdiabetes andpre-diabetesinpreviouslyundiagnosedpatients.

MaterialandMethods Patients40yearsorolderwithnodiabetesdiagnosisorHbA1Cresultinthelast6monthswere

offeredacomplimentaryHbA1Ctestacross40community pharmaciesinAlberta(15)andOntario(25).Theyprovideda sampleofperipheralbloodviafinger-prickandHbA1Cand lipidswerereportedbyapoint-of-caretestingdevice(Abbott Affinion2™ analyser).Onceresultswereavailable,thepharmacistconductedacomprehensivereviewwiththepatient andrecommendedcertainfollow-upactionsifappropriate.

Results 9041participantswerescreenedovera13-week periodbetween18Juneand15September2023.6%of patientswereidentifiedwithundiagnoseddiabetes(HbA1C valueequaltoorgreaterthan6.5%)while13%presented withHbA1Cvaluesconsistentwithpre-diabetes(HbA1Cvalue between6.0% – 6.4%).PharmacistconductedFramingham® riskassessmentsrevealed24%ofpatientsatmoderatetohigh riskofacardiovasculareventoverthenext10years.Of thosescreened,62%wereattachedtoaregularprimarycare physicianand38%wereunattached.Thedetectionratefor pre-diabetesanddiabeteswas18.2%inattachedpatientsand 18.5%inunattachedpatients.

ConclusionandRelevance Theseresultsillustratetheprevalenceofabnormalglycaemiccontrolamongundiagnosedcommunitypharmacypatients.Pharmacists,asthemostaccessiblehealthcarepractitioners,areideallypositionedtoutilise novelpoint-ofcaretechnologiestoimproveaccesstoHbA1C screeningandincreaseawarenessaroundtheimportanceof earlydetectionofdiabetes.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-143 ADESCRIPTIONOFPHARMACISTS’ INTERVENTIONS TOOPTIMISETHETREATMENTOFADULTSWITH ORALLYAVAILABLECOVID-DRUGPAXLOVID®

1AStoiber, 1GGray, 2GSailer, 3WHuf, 1ATonna. 1RobertGordonUniversity,SchoolOf PharmacyAndLifeSciences,Aberdeen,UK; 2WienerGesundheitsverbund-KlinikHietzing, Anstaltsapotheke,Vienna,Austria; 3WienerGesundheitsverbund-KlinikHietzing,Ärztliche Direktion,Vienna,Austria

10.1136/ejhpharm-2024-eahp.247

BackgroundandImportance RitonavirisoneofthemaincomponentsofPaxlovid® anoralCOVID-drugwithnumerous clinicallysignificantinteractions.This,resultsinincreased numbersofadverseevents,raisingconcernsforpatientsafety.

AimandObjectives Theaimwastodescribethefrequency, type,andseverityofdetecteddrug-druginteractionsinPaxlovid® recipientsidentifiedduringpharmacyscreening.This servicewasintroducedsincenumerousinstancesofinappropriateprescribing,particularlywithco-medications,werenotedat thepharmacydespiteprescriberconsiderationatthepointof prescribing.

MaterialandMethods Aretrospectivemonocentricquantitative dataanalysiswasperformedafterethicalapprovalinanAustrianclinicinVienna.AllpatientsprescribedPaxlovid® were includedanddatacollectedfromthepatients’ electronic records.Adatacollectiontoolwasdevelopedandpilotedto ensureinter-raterreliability.Drug-druginteractionsincluding prescribingrecommendationsweredeterminedusingthe COVID-19DrugInteractionscheckerdevelopedbytheUniversityofLiverpool.

Results 122of140(87.1%)includedpatientsrequireddose reduction,alternativeCOVIDmedication,orinterventionsto preventinteractionsoroverdosing.In33casesthenecessary

actionwasperformedbythedoctorsatthepointofprescribing.However,in89(63.6%)casestherequiredactionwas notidentifiedatthepointofprescribingbutidentifiedduring thepharmaceuticalmedicationanalysisafterPaxlovid® was orderedinthepharmacy.Sinceinterventionsweremadeprior tothepatientreceivingthesupply,allpatientsinthisgroup benefittedfromthepharmaceuticalserviceleadingtoenhancementofpatientsafety.

ConclusionandRelevance Thisstudydemonstratedthatmany drug-druginteractionswereidentifiedthroughthepharmaceuticalintervention.Thisshowsthatpharmacistinvolvementin prescribinghighlyinteractingdrugssuchasPaxlovid® isbeneficialtoenhancepatientsafetyandmitigaterisks.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-144 BIOLOGICALTREATMENTSINTHEPREVENTIONOF MIGRAINE:RESTARTANDDURATIONOF THERAPEUTICREST

CDeCastroAvedillo*,LOrtegaValin,JCSaezHortelano,RVarelaFernandez,AFernandez Vazquez,DOzcoidiIdioate,JAyalaAlvarezCanal,MFloresFernandez,XCasasFernandez, MFloresFernandez,MFloresFernandez,MFloresFernandez,MFloresFernandez,JJOrtiz DeUrbinaGonzalez. HospitalUniversitarioLeón,FarmaciaHospitalaria,León,Spain

10.1136/ejhpharm-2024-eahp.248

BackgroundandImportance Accordingtothepharmacotherapeuticguideofourhealthsystem;monoclonalantibodies (MCA)againstcalcitoningene-relatedpeptide(CGRP)were startedforamaximumperiodof1year,andcouldbe restartedifnecessaryafteratherapeuticbreak.

AimandObjectives TodescribewhichMCAwasusedtotreat chronicmigraineduringthefirstandsubsequenttreatment cycles,thedosageusedandthetherapeuticresttimeexperiencedinatertiaryhospital.

MaterialandMethods AllpatientstreatedwithanMCA againstCGRPinatertiaryhospitalfromAugust2020to August2022wereanalysed.Thevariableswerecollected:sex, age,treatmentduringthefirstandsubsequentyears,duration oftreatment,dosage,therapeuticresttimeandadherence. Datawereextractedfromtheoutpatientmodule(Farmatools®)andthecomputerisedelectronichistory(Jimena®).The datacollectionandanalysiswascarriedoutinanExceltable ofourowncreation.

Results 74patients(N=74)wereincluded,withamedianage of46±12years.58women(78.38%).Duringthefirstcycle, 60(81.08%)startedwitherenumaband14(18.91%)with galcanezumab.Ofthepatientswhostartedwitherenumab,66 (89,19%)maintainedthedoseof140mg/4weeksandonly 8(10.81%)maintainedthedoseof70mg/4weeks.Onaverage,thisdosewasmaintainedfor3.51±1.64dosesbefore escalating.43(58.10%)haverestartedtreatmentaftercompletingthefirstcycle:21(48.84%)witherenumaband22 (51.16%)withgalcanezumab.Onaverage,patientswerewithouttreatmentfor183,60days.Only2(4.65%)hadatherapeuticbreakoflessthan90days.

ConclusionandRelevance Mostofthepatientstreatedhave beenwomen.Duringthefirstcycle,theyweremostlytreated witherenumab,ahighpercentagewithadoseof140mg/4 weeks.Almosthalfofthepatientshadtorestartafteratherapeuticbreak.Thetherapeuticbreaklastedonaveragearound 6months.Practicallyhalfrestartedwiththesamedrugasthe

firstcycle.Thesedatawillallowustoanalysetheminthe futureandmodifyourtherapeuticattitudetoimprovecare forourpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-145 COLLABORATIVEIMPLEMENTATIONOF ‘WALANT’ (LOCALANAESTHETIC)TECHNIQUEINAHAND SURGERYWARD

1EENagy*, 1ABor, 1NGyimesi, 2HKovács. 1Jenő ManningerTraumaCentre,Department ofPharmacy,Budapest,Hungary; 2Jenő ManningerTraumacentre,DepartmentofHand Surgery,Budapest,Hungary

10.1136/ejhpharm-2024-eahp.249

BackgroundandImportance TheWide-AwakeLocalAnaesthesiaNoTourniquet(WALANT)t echniqueisanalternative approachincertainhand-andupperextremitysurgeryprocedures,thatutilisesacombinationoflocalanaestheticand haemostaticagenttoreplacetra ditionalgeneralanaesthesia andtourniquetapplication,ma kingprocedurestime-saving, cost-effectiveandalsoenablesfasterrecovery.Tomeetthese expectations,arequestfordevelopinganadaptedformulationofWALANTsolutionarrivedfromHandSurgery Department.

AimandObjectives Ouraimwastodesignatetheobtainable andsuitablepharmaceuticalproductsservingasthebasisof theWALANTsolution.Also,weaimedtodesignapractical andvisuallycomprehensibledosageguide(intableform),as wellastoreplytovariousprofessionalquestionsthatmay arise(durationofaction,shelflife,sideeffects,etc.).

MaterialandMethods Anadaptedformulationwasdeveloped, relyingoninternationalrecommendationsandextensiveliteratureresearch,consideringprofessionalandeconomicissues, harmonisingdifferentmeasurementunits.Thedosageguide wascompiledinaccordancewiththeinstructionsprovidedby SPCs,intwoeffectiveconcentrationsofvariouscommercially availableproducts.

Results Thelocalconcentrationofhaemostaticadrenalinesolutionwasdeterminedtobe0.005%(1:200,000ratiofor adults).Forchildrenandcardiologypatients,exceedinga 0.0025%(1:400,000)localadrenalineconcentrationisnot recommended;therefore,ourdosagetableincludestheformulaofdilutedsolutionaswell.Asforthelocalanaesthetic, lidocainewasusedin1%concentration.Chemicalstabilityof thesolutionwasensuredbyaddingsodiumbicarbonate (0.84%).Theappropriateamountofnormal(0.9%)salinesolutionwasusedfordilution,dependingonthedesiredtotal volume(5,10or20ml).After ‘insitu’ preparationof WALANTsolutionbyphysicians,openedampuleswere advisedtobediscarded,duetoconcernsofmicrobiological stability,labellingandstoragesafety.HandSurgeryDepartmentspecialistswereeducatedonpotentialadversedrugreactionsandmanagement.Theworkloadoftheanaestheticteam hasbeenconsiderablyreducedbyapproximately30–40%, whichhashadgoodimpactonhumanresourcecapacitiesand cost-effectivity.

ConclusionandRelevance TheintroductionofWALANTtechniquehashadabeneficialeffectoncost-effectivitywhile maintainingpatientsafety.Thissuccessfulcollaboration

strengthenedtheprofessionalrelationshipandtrustbetween theHandSurgeryDepartmentandHospitalPharmacy.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-146 ECONOMICIMPACTONMULTIPLEMYELOMA CLINICALTRIALSINTHEPHARMACYSERVICE

AMartinezOrea,PTorrano-Belmonte*,MDNájeraPérez,LFructuosoGonzalez, JAGutierrezSánchez,MHernándezSánchez,MGuillénDíaz. HospitalMoralesMeseguer, Pharmacy,Murcia,Spain

10.1136/ejhpharm-2024-eahp.250

BackgroundandImportance Clinicaltrials(CTs)offerachance touseinnovativetherapies,discovernewtreatments,and expandoptionsforspecificdiseases.Accordingtocurrent legislation(RD1090/2015),sponsorsarerequiredtoprovide allinvestigationalmedication,exceptforcertainexceptions.

AimandObjectives Giventheincreaseinclinicaltrialsofmultiplemyeloma(MM)inourcentre,wefocusedondeterminingtheeconomicsavingsthisentailed.Thisisbecausethe medicationforpatientsincludedinthetrialwasprovidedby thesponsor,resultinginzerocostforthecentre.

MaterialandMethods Retrospective,single-centreobservational studyencompassedallMMCTsconductedatthehospital from2018to2022.Exclusioncriteria:CTsthatdidnotenrol patientsduringthestudyperiodordidnotdispense medication.

Thecalculationofmedicationcostsavingstookinto accountmedicationsprovidedbyCTsponsors,leadingto reducedtreatmentexpensesforpatientssincethehospital wouldhavecoveredthesecostsifpatientshadnotparticipatedintheclinicaltrial.Medicationsnotavailableonthe marketduringthestudyperiodwerenotconsideredinthe analysis.CostcalculationswerebasedonPVL-DISCOUNT (discountagreedwiththelaboratories)+VATatthetimeof thetrial.

Themainstudyvariablewastheavoidedmedicationcost over5years,whilesecondaryvariablesincludedtheaverage costsavedperCTandtheaveragecostsavedperpatient.The analysisdidnottakeintoaccountthecostofmaterialsused inCTdevelopment,personnel,othermedications,dayhospital costs,etc.

Results Currently,thereare298activeCTsrelatedtoMMin Europe,ofwhich123areinSpain,and19areinourregion. Outofthese19activeCTs,14areactiveinourHealthArea. However,onewasexcludedbecausenodispensationswere madewithintheanalysisperiod,resultinginatotalof13 includedCTs(PhaseI:0%;PhaseII:33.3%;PhaseIII:66.6%), whichrecruitedonly67patientsduringthestudyperiod,due tothepandemic(average5.15patients/CT;range1–22).

Thedirectcostsavedover5yearsamountedto C¼ 2,920,608.28,averagesavingsperCTC ¼ 224,662.17.

ConclusionandRelevance Inconclusion,thedevelopmentof CTsinthestudycentregeneratedsignificanteconomicsavings inMMtreatment.Thiscostprovidedbysponsorsshouldbe reinvestedinthecreationofwell-equippedclinicaltrialunits.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-147

OSIMERTINIB:APROMISINGTREATMENTFOREGFR MUTATION-POSITIVENON-SMALL-CELLLUNGCANCER

RTamayoBermejo,JCDelRíoValencia,MEspinosaBosch,ALunaHiguera. Regional UniversityHospitalOfMalaga,PharmacyDepartment,Málaga,Spain

10.1136/ejhpharm-2024-eahp.251

BackgroundandImportance Atotalof10–40%ofnon-smallcelllungcancer(NSCLC)tumoursharbourEGFR-sensitising mutations.EGFRtyrosine-kinaseinhibitors(TKIs)inhibitthe proliferationoftumourcellsviabindingtoEGFRspecifically andshowfavourabletherapeuticeffectsonadvancedEGFRmutatedNSCLC.ThepresenceoftheT790Mvariantreduces theabilityofthereversibleEGFR-TKIs.Osimertinibisan orallytakenthird-generationEGFR-TKIwhichcanforman irreversiblecovalentbondviathecysteine797residueand T790MorotherEGFRmutations.Osimertinibhasshowedan impressiveantitumouractivityintreatment-naïveadvanced NSCLCharbouringEGFR-TKI-sensitisingmutations.

AimandObjectives Theaimofthestudywastoevaluatethe effectivenessandsafetyofosimertinibinpatientswithEGFR mutationpositiveNSCLC.

MaterialandMethods

Observationalretrospectivestudy AllpatientswithNSCLC undergoingtreatmentwithosimertinibwereincluded(July 2017toAugust2022).Demographicvariables:ageandsex. Clinicalvariables:diagnosis,stage,performancestatus(PS) accordingECOGscale,lineoftreatment,anddose;andother variables:smoking.Overallsurvival(OS)andprogression-free survival(PFS)wereanalysedusingKaplan-Meier.Adverse events(AE)werealsoassessed.

Results 39patientswereincludedwithactivatingEGFRmutations(25.6%T790M),averageagewas64.6±11.1years, 76.9%werewomen.NSCLCstagewasIVin100%of patients,23.1%sufferedfrombrainmetastases,and79.5% hadECOG-PS0–1.Patientsstartedtreatmentwithosimertinib asfirst-linetherapyin66.6%,23.1%assecond-lineand 10.2%asthird-line.Previoustherapiesreceived:erlotinib (n=3),gefitinib(n=5),afatinib(n=5),chemotherapy(n=4). 17.9%underwentosimertinibdose-reductionmainlydueto pneumonitis.38.5%werepastsmokersand17.9%smokers. MedianPFSwas10months(95%CI4.0–16.0)andOS28 months(95%CI14.1–41.8).84.6%ofpatienthadatleastone AEofanygrade.MostfrequentAEwereG1–2asthenia (46.1%),G1–2cutaneous(35.9%),andG1–2diarrhoea (30.8%).

ConclusionandRelevance OsimertinibdemonstratesaPFSsimilartothatobservedinthesecond-lineAURA-3trial,although itislowerthanthesurvivaloutcomesreportedinthefirstlineFLAURAtrial.Thesefindingsarereasonablewhenconsideringourcomprehensivedataset,whichencompassesbothpretreatedandbrainmetastaticpopulations.Additionally,osimertinibexhibitsafavourabletoxicityprofile.Giventhelimited samplesize,furtherinvestigationsareneededtovalidatethese findings.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-148 EAVLUATIONOFDAILYDOSEMANUALDRUG DISPENSINGACCURACY

ABor*,EENagy,ASzilvay,ÁKiss,NGyimesi. Jenő ManningerTraumaCenter,Department OfPharmacy,Budapest,Hungary

10.1136/ejhpharm-2024-eahp.252

BackgroundandImportance Medicationerrors(MEs)associatedwithdrugtherapyposeadirectrisktopatientsafetyand negativelyaffecttherapeuticsuccess.Identifyingdrugdispensing-relatedMEsallowsforrootcauseanalysisandtheimplementationofpreventivemeasures.Clinicalpharmacyserviceis oneapplicableresourceofminimisingMEs.

AimandObjectives Priortoextendingclinicalpharmacycontrolondailydosemanualdrugdispensing(MDD)innew hospitalsettings,ourstudyaimstoassesstheaccuracyand appropriatenessofthismethod,aswellastocommunicate findingstorelevantdepartmentsandtodevelopstrategiesto rectifyidentifiederrors.

MaterialandMethods Unannouncedpointprevalencestudies wereconductedinSeptember2023,ontwodifferentoccasions.Datawerecollectedineightinpatientcareunits(30 bedseach)usingcamera-equippedmobilephones.PhotographiccomparisonofMDDboxeshasbeenmadevisuallyby clinicalpharmacists(CP),comparingboxcontentwithrelevant medicationcharts.Indepartmentsunderclinicalpharmacy control(=controlgroup)drugdispensingwasperformedby pharmacyassistantsunderCPsupervision,whileindepartmentswithnoclinicalpharmacycontrol(=casegroup)MDD wasaccomplishedbynurseswithoutdouble-checkorsupervision.ClassificationofMEs(usingPCNEcategories,PharmaceuticalCareNetworkEurope,version9.1.)andprescribed drugsonATC7levelwererecordedandanalysedinanExcel table(MSOffice2021).

Results Drugdispensingerrorswerefrequentinthecase group:38falseboxesoutof95(40%failurerate).Overall, 59mistakeswereidentified.Inappropriatedosingintervals (PCNEC.6.1.)happenedin5.0%ofallmistakes,wrongdrug wasadministered(C.6.5.)in13.6%,deviationfromtheprescribeddosage(C.6.2.andC.6.3.)occurredin17.0%,drug administrationwasmissed(C.6.4.)in64.4%.Omittedmedicationsweremainlydrugsactingonthecardiovascularsystem. Inthecontrolgroup,outof103boxesoneerror(<1%)was identifiedduringthestudyperiod.

ConclusionandRelevance Identifyingdrugdispensing-related MEsenablestheintroductionoftargetedinterventionsthat minimisemistakes,enhancepatientsafetyandpromoteaccuracyinpractice.Additivesafetycontrolsimplementedinunits withCPsupervisioncansignificantlyreducetheoccurrenceof MEsindailydosemanualdrugdispensingsystems(failure prevalenceapproachingzero).

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-149

CENTRALVENOUSCATHETER-RELATED BLOODSTREAMINFECTIONSINPATIENTSONTOTAL PARENTERALNUTRITION

NJimenez,MMMartin-Mira,JIBretones-Pedrinaci,MACastroVida*. HospitalUniversitario Poniente,FarmaciaHospitalaria,ElEjido,Spain

10.1136/ejhpharm-2024-eahp.253

BackgroundandImportance Currentevidenceshowsthatthe centralline-associatedbloodstreaminfections(CLABSI)frequencyisbetween15–30%andtherearerelatedriskfactors, suchastheinsertionlineanditsduration.CLABSIisassociatedwithhighmortalityandeconomiccostsincreased.

AimandObjectives AnalysingtheCLABSIfrequencyandcharacteristicsinpatientsontotalparenteralnutrition(TPN)and tocomparewiththecurrentdata.

MaterialandMethods Retrospectiveobservationalstudy,carriedoutsinceJanuarytoApril2023inaregionaluniversity hospital.Selectedpatients:alladultpatientsonunderthecare ofIntensiveCareUnit(ICU)andGeneralSurgery(GS).Collecteddata:demographicdata(sex,age),TNPduration,central venouscatheter(CVC)-relateddata(insertionplace,insertion line)andpatientsCLABSIdiagnosed,daysuntiltheinfection developmentandmicrobiologicalculture.Searchsources:medicalhistoriesdatabase,electronicprescriptionandnutrition program(CLINUS).

Results 64patientswereenrolled,70%men,averageage60 years(SD±16).67.19%weresurgicalpatientsand32.81% wereICUpatients.TheaverageTPNdurationwas14.7days (SD±11.43).CVCinsertionplaces:64%operatingroomand 36%ICU.Themostfrequentlineinsertionwasthejugular vein(68.75%).Therewas15%CLABSIdiagnosedpatients. Theaveragenumberofdaysuntilbacteremiadevelopment was25.4days(SD±18.41).Themostisolatedmicroorganism wasS.epidermidis(60%).

ConclusionandRelevance TheCLABSIfrequencyinourhospitalcoincideswiththecurrentdata.Althoughthesubclavian veinisthemostrecommendedbecauseofitslowerriskof infection,thejugularlinehasbeenthemostfrequentlyused inthishospital.NoneoftheCVCwereinsertedonthehospitalward,whichreducestheriskofinfection.However,wedo nothavedataonthelinesnursingcareandthisisanother riskfactorthatshouldbeconsidered.Theresultsshowthat CLABSIisstillacommoncomplicationinpatientsonTPN anditisneededtoincreasethehealthcareeffortstoreduce itsfrequency.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.FonsecaG,BurgermasterM,LarsonE,SeresDS.TheRelationshipBetweenParenteralNutritionandCentralLine-AssociatedBloodstreamInfections:2009–2014. JPENJParenterEnteralNutr.2018Jan;42(1):171–175.-LINK:https://pubmed. ncbi.nlm.nih.gov/29505142/

2.LafuenteCabreroE,TerradasRobledoR,CivitCuñadoA,GarcíaSardelliD, HidalgoLópezC,GiroFormatgerD,LacuevaPerezL,EsquinasLópezC,Tortosa MorenoA.Riskfactorsofcatheter-associatedbloodstreaminfection:Systematic reviewandmeta-analysis. PLoSOne.2023Mar23;18(3):e0282290.-LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035840/

ConflictofInterest Noconflictofinterest.

4CPS-150 PHARMACEUTICALINTERVENTIONSINOBESE PATIENTSINHAEMATOPOIETICSTEMCELL TRANSPLANTATION

CMontero-Vilchez,SCanoDominguez,MJGándaraLadrónDeGuevara,MISierraTorres*, AYSalmeronCobos,AJimenezMorales. HospitalUniversitarioVirgenDeLasNieves, Pharmacy,Granada,Spain

10.1136/ejhpharm-2024-eahp.254

BackgroundandImportance Althoughobesityisariskfactor ofinferiorhealth,ithasnotbeenconclusivelyproventobe associatedwithworseoutcomesinhaematopoieticstemcell transplantation(HSCT).Despitetheinsufficientscientificevidence,theAmericanSocietyforBloodandMarrowTransplantation(ASBMT)considerthatsomedrugsusedin conditioningtherapybeforeHSCTmayneeddoseadjustment inobesepatientsinordertoreducetoxicities,suchasgastrointestinalandhaematologictoxicities.

AimandObjectives Theobjectiveofthisstudyistoassess pharmaceuticalinterventionsofdosedrugadjustmentinobese patientsduringhospitaladmissionfollowingtheASBMT recommendations.

MaterialandMethods Prospectiveobservationalstudyofobese patientsreceivingHSCTfromJanuary2021toAugust2023. Drugsthatrequiredweightdoseadjustmentwerebusulfan, etoposide,cyclophosphamide,thiotepaandcarmustine.Patients werecategorisedbybodymassindex(BMI):normal(<25kg/ m2),overweight(25–29.9kg/m2),obese(30–39.9kg/m2)or severelyobese(BMI>40kg/m2).Doseadjustmentwasmade whenrealweightţ >120%ofidealweightandBMI 27kg/ m2.Pharmaceuticalinterventionswerecarriedoutforacorrectdrugdosage.

Results 154adultpatientsreceivedHSCTinthestudyperiod (87autologous,67allogeneic)forhaematologicaldiseases.In 77(50%)patientshadbeenprescribedachemotherapydrug thatrequiredweightdoseadjustment,31.2%(24/77)patients wereoverweightorobese,sotheyneededaprescription, pharmaceuticalreview.MedianBMIofthesepatientswere31 kg/m2(28–32).Outofthese24obesepatients,17(70.8%) medicalprescriptionswerereviewedand23drugdoseswere modifiedafterpharmaceuticalinterventiontogetanappropriatedoseinobese(10busulfan,6thiotepa,5carmustine,2 cyclophosphamide).

ConclusionandRelevance Selectingtheoptimaldoseofconditioningchemotherapyinobesepatientsiscomplicated,butthe roleofthepharmacistisessentialtooptimisechemotherapy inobesepatientsreceivingHSCT,workingwiththehaematologistinamultidisciplinaryteam.Furtherresearchisnecessary tocorroboratewhetherthesedoseadjustmentsprovidereal benefitinreducingtoxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

Abstracts

4CPS-151 ANALYSISOFANTIBIOTICTREATMENTINPATIENTS WITHVENTILATORASSOCIATEDPNEUMONIA

1BTorrecillaVall-Llossera*, 1LGrasMartín, 2PVeraArtázcoz, 2APCortesPalacios, 1EFernandezDeGamarraMartinez. 1HospitalDeLaSantaCreuISantPau,Pharmacy Department,Barcelona,Spain; 2HospitalDeLaSantaCreuISantPau,IntensiveCareUnit Department,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.255

BackgroundandImportance Pneumoniaisthemaininfectious complicationinpatientswithmechanicalventilation.Early adequateempiricaltherapyisanimportantdeterminantof clinicaloutcome.Oncethepathogenhasbeenidentified, empiricaltreatmentmustbeadjustedtothedrugswiththe narrowestspectrumandfortheshortesttime.

AimandObjectives Todescribetheantibiotictreatmentof patientswithventilator-associatedpneumonia(VAP)andevaluatewhetheritwasappropriateaccordingtothehospitalprotocols(choiceofempiricaltreatmentandduration).

MaterialandMethods Anobservational,retrospectiveandmultidisciplinaryanalysisinatertiaryhospitalwasperformed.All patientswithVAPduringayear(January-December2022) wereincluded.Variablescollectedwere:demographics,treatment,durationandclinicaloutcome(exitusornot).Appropriatetreatmentwasconsideredwhenpiperacillin/tazobactam, cefepimeormeropenem(+/-amikacin)wereprescribedfor7–15days,accordingtohospitalprotocols.

Adescriptivestatisticalanalysiswasdonewithmeasuresof centraltendencyanddispersion.

Results Antibiotictreatmentsof32patientswithVAPwere analysed(81%men,meanage:61yearsold).Empiricaltreatmentswerepiperacillin/tazobactam(n=23),cefepime(n=2) andmeropenem(n=7),inmanycasesassociatedtoamikacin, accordingtohospitalprotocols.

Allpatientsreceivedappropriatetreatmentconsideringthe identifiedpathogen. Staphylococcusaureus (n=6), Klebsiella pneumoniae (n=6), Pseudomonasaeruginosa (n=5)and Serratiamarcescens (n=4)werethemostfrequentmicroorganisms.

Theaveragedurationinthisstudywas14days(SD:9, median:11),whichiswithintherangeestablishedforVAPin thehospitalprotocols.

Mostpatients(n=23,72%)weretreatedfor15orfewer days.Threepatientsdiedinthefirstfivedaysoftreatment andfivepatientsreceivedantibiotictreatmentfor7–9days.In somecases(n=9,28%)treatmentswereprolongedformore than15days.Sixofthemreceivedantibioticsfor16–21days andintheremainingthreecasesantimicrobialswereprescribedfor26,40and50daysduetoclinicalcomplications andthepresenceofextremelyresistantmicroorganisms.

ConclusionandRelevance EmpiricaltreatmentsforVAPwere appropriatedaccordingtohospitalprotocols.Althoughingenerallengthoftreatmentrangedbetween7–15daystherewere someexceptionsinwhichthisdurationneededtobeprolonged.Aneffortshouldbemadetoestablishshorterduration whenpossible.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-152 THEINCLUSIONOFTRAMADOLFORPARENTERAL ADMINISTRATIONINTHENARCOTICTABLEOF PHARMACOPOEIA:ANALYSISOFEFFECTSAND CONSUMPTIONINAGENERALHOSPITALSETTING

1MSantonocito, 1GCancellieri, 1CBotto, 1EDeLuca, 2VIsgrò, 2PPolidori. 1UniversitàDegli StudiDiPalermo,Ssfo-ScuolaDiSpecializzazioneInFarmaciaOspedaliera,Palermo,Italy; 2OspedaliRiunitiVillaSofia – Cervello,UocFarmacia,Palermo,Italy

10.1136/ejhpharm-2024-eahp.256

BackgroundandImportance Tramadolisanopioidanalgesic drugformoderatepain.From8November2022theMinister ofHealthofaEuropeancountryorderedtheinclusionoftramadol(onlyforparenteraladministration(Inj.))inthenarcotictableofPharmacopoeia.Thedrugwasinsertedona narcoticregister,allowingconsumptiontobecontrolledlike othernarcotics.Thismeasurereflectstheconcernsbythe WorldHealthOrganizationregardingthepotentialabuseof tramadol(Inj.),whosedependenceiscomparabletomorphine andmethadone.

AimandObjectives Theobjectiveofthestudywastoevaluate theeffectsofthedecreeontheconsumptionoftramadol (Inj.)onthewardsofageneralhospital,comparedtoother painkillers.

MaterialandMethods Theanalysisoftheconsumptionoftramadol(100mg/2ml)comparedtoke torolac(30mg/ml),diclofenac(75mg/3ml)andparacetamol(10mg/ml)wascarriedout intheperiodbetween8May2022and8May2023,consideringthe13wardswiththehighesttramadolconsumption. Wecomparedthequantityoftramadolrequestedtothe pharmacy6monthsbeforeand6monthsafterthedecree wasissued.

Results Alltheanalysedwardsreduceduseoftramadol(Inj.) (Δ%:90.2;2150vs210vials,beforeandafterthedecree, respectively).Thewardswithatotalreductionofconsumptionresultedorthopedic(Δ%:100;760vs0)andemergency room(Δ%:100(555vs0).Thesewardssimultaneously recordedanincreaseof26.6%respectively(2,970vs2,346) inrequestsofnon-steroidalanti-inflamatorydrugs(NSAID) (diclofenacandketorolac)anda39.1%increase(1,476vs 2,054)indiclofenac.Ingeneral,paracetamolunderwentthe mostsignificantincreasein92.8%ofthewards(12/13)with a Δ%:110.6%(2810vs5918).Thewardswiththemostsignificantincreaseswerevascularsurgery(Δ%:233.3;90vs300), thoracicsurgery(Δ%:167.7;270vs723)andtraumacentre(Δ %:173;150vs410).

ConclusionandRelevance Thedecreelimitedtheuseoftramadol(Inj.).Beforethedrugwasdelivereduponsimplewards requestwithoutsupervision.Theinclusioninthenarcotics registerhasinsteadallowedthepharmacisttosupervisetheir consumptionbythewardswhonowhavetosubmitarequest onaspecificform.Thisledtoadiscussionwiththeclinical onthechoiceofanalternativetherapyinthetreatmentof moderatepain,movingtoNSAIDsandparacetamolwhen possible.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-153

ECONOMICBENEFITANALYSISONLUNGCANCER CLINICALTRIALS:MEDICATIONANDMEDICALTESTS

1CPizarroGómez, 1APrietoRomero*, 2TMassarrahSanchez, 2MMartinJimenez, 1VEscuderoVilaplana, 1RColladoBorell, 1AHerranzAlonso, 1MSanjurjoSaez. 1Hospital GeneralUniversitarioGregorioMarañón,ServicioDeFarmacia,Madrid,Spain; 2Hospital GeneralUniversitarioGregorioMarañón,ServicioDeOncologiaMedica,Madrid,Spain

10.1136/ejhpharm-2024-eahp.257

BackgroundandImportance Clinicaltrialsarethemainsource ofinformationtoestablishnewtreatments’ efficacyandsafety. Patients’ enrolmentinthesestudiesmayresultineconomic benefitsfortheparticipatingsitessinceusuallythecosts derivedfromtheirinclusionarefundedbysponsors.However, theseeconomicbenefitsarerarelyquantified.

AimandObjectives Theprimaryobjectofthisstudywasto calculatetheeconomicbenefitobtainedfrompatients’ inclusioninlungcancerclinicaltrialsintwoscopes:medication andmedicaltests.Thesecondaryobjectwastodetermine whetheravoidedcostsinmedicationweresignificantlydifferentfromthoseinmedicaltests.

MaterialandMethods Anobservationalretrospectivestudywas conductedinallpatientsenrolledinlungcancerclinicaltrials from2017to2021atourhospital.

Theavoidedcostsinmedicationwerecalculatedconsideringthemedicationwhichwouldhavebeengiventothe patientinthestandardofcaretakingintoaccounttheirspecificdata.

Theavoidedcostsinmedicaltestsperpatientwerecalculatedfromthepricespublishedandthetotalnumberofeach testperformedoneachpatientfromtheirfirsttreatmentvisit untiltheendofthetreatmentvisit.

Thehomogeneityofthetwogroupswasanalysedusinga univariateanalysisbyapplyingthechi-squaretestforqualitativevariablesandthettestorMann-Whitneytesttocompare quantitativevariables.Apvalueof<0.05wasconsideredstatisticallysignificant.

Results Theeconomicbenefitgeneratedfromsponsor-provided drugsinthe35clinicaltrialswas3,778,393.93C ¼

Atotalof642medicaltestswereperformedinthe117 patientsunderstudy.Specifically,546wereCTs,58were MRs,6PETsand32weregammagraphics.Thetotaleconomicbenefitgeneratedinfiveyearsbythesponsorfinancing thesetestswas128,448C ¼

Theresultsfromthestatisticalanalysisrevealedthatthe economicdifferencesbetweensponsorsprovidingthemedicationandfinancingthemedicaltestsweresignificantlydifferent withp<0.05(p=0.0482).

ConclusionandRelevance Inthe5yearsstudied,over3.9millioneurosweresavedbyincludingpatientsinlungcancertrialsinonesite,being96.7%derivedfromavoidedcostsin medication.Thus,theparticipationofpatientsinclinicaltrials iseconomicallybeneficialforthemandsociety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-154 THERAPEUTICDRUGMONITORINGOFAMIKACININ NEONATES:ABOUTANEWPROTOCOL

MRodenasRovira*,MGilCandel,MRMarquésMiñana,JGarcíaPellicer,JLPoveda Andrés. HospitalUniversitarioYPolitécnicoLaFe,Farmacia,Valencia,Spain

10.1136/ejhpharm-2024-eahp.258

BackgroundandImportance Amikacinisawidelyusedantibioticinneonates.Anadequatedosingregimenisessentialfor effectiveandsafetherapy;however,manypatientsdonot achieveadequateplasmaconcentrationsduetohighinterindividualvariabilityinthispopulation.

AimandObjectives Tocomparetheamikacinplasmaconcentrationsinneonatesaccordingtotheadministered15mg/kg/ 24hdosingregimen(15-DR),apreviouslyestablishedprotocol,versustheamikacin12mg/kg/24h(12-DR)newprotocol, withtheaimofestablishingbestinitialdosingregimen(DR) thatguaranteesaneffectiveandsafetreatment,aswellasanalysingdifferencesbetweensubpopulations(pretermorterm). MaterialandMethods

Retrospectiveobservationalstudy Allpatientsadmittedtoneonatalunitorneonatalintensivecareunitunderamikacintreatmentandwith12-DRor15-DRbetweenJanuary-July2023 wereincluded.PatientswithdifferentDRwereexcluded.

Thefollowingvariableswerecollectedfromthepatients’ clinicalhistories(OrionClínic®):gender,age,weight,preterm (<37gestationweeks)/term,DR,minimum(Cmin)andmaximum(Cmax)plasmaconcentrations.Theoptimallevelsestablishedwere:Cmin<5 mg/mLandCmax20–30mg/mL.

Quantitativevariablesareexpressedasmeanandstandard deviation(SD)andqualitativevariablesasnumberandpercentage(%).TheChi-squaretestwasusedtocomparequalitativevariables.Statisticalsignificancewasconsideredwhenp £ 0.05.StatisticalanalysiswasperformedwithSPSSversion 23.0.

Results Atotalof88patientswereidentified,11were excludedbecausetheywerenotneonatesand27patients becausetheypresentedadifferentDR.Finally,50patients wereincluded,26(52.0%)weremale,meanageatleveltime was7.6(1.7)days,weight2.9(1.0)kg,and35(70.0%)were atterm.

Regardingtreatment,24(48.0%)patientsweretreatedwith 12-DRand26(52.0%)with15-DR.ThemeanCminwas1.4 (0.2) mg/mLand2.3(0.3),respectively,andmeanCmaxwas 26.0(0.9) mg/mLfor12-DRgroupand33.5(1.3) mg/mLfor 15-DRgroup.Atotalof18(75.0%)patientswith12-DR achievedtargetplasmaconcentrationscomparedto7(26.9%) inthe15-DRgroup,statisticallysignificantdifferenceswere observed.Whencomparingbetweenprematureandterm patients,nostatisticallysignificantdifferenceswereobserved. ConclusionandRelevance Thisstudydemonstratesthatamikacin12mg/kg/24hdosingregimenguaranteesbetterresultsin termsofoptimalplasmaconcentrationsinneonatalpatients, whichallowsustoestablishthisdosageregimenastheinitial doseinourpatients.Clinicalpharmacokineticsisessentialfor improvingoutcomesinneonates.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-155 PERCEPTIONOFHOSPITALPHARMACIESABOUT TELEPHARMACYINTHEPROVISIONOFHEALTHCARE FORPEOPLELIVINGWITHHIV

NBadracim*. HospitalProfessorDoutorFernandoFonsecaEpe,Pharmacy,Amadora, Portugal

10.1136/ejhpharm-2024-eahp.259

BackgroundandImportance Theaimoftelepharmacy(TF)is tomaximisethepotentialoftelehealthandtransformremote

monitoringbyhospitalpharmacies(HP)intoaddedvalueto society.Thisserviceshouldbemadeavailablepreferablyto themostvulnerablepatientsintermsofmobility,geographic distance,economiccapacityorworkconstraints.

AimandObjectives ToevaluatetheknowledgeofHPabout TFinPortugalwithregardstopossiblebenefitsandbarriers fortheimplementationofaregulatedandfundedmodelfor antiretroviraltherapy(ART)deliveryproximityprogrammefor peoplelivingwiththeHumanImmunodeficiencyVirus (PLHIV).

MaterialandMethods Aquantitative,cross-sectionalandanalyticalstudywascarriedoutt hroughapplicationofapreviouslyvalidatedquestionnaireto32HPinPortugalthat provideART.OutpatientcareforHPandtheirperceptionof follow-upusingTFwascharacterised.Itwasassessed whethertherewasastatisticalcorrelationbetweenmedicines deliveryproximityprogrammeandremotefollow-upof PLHIV.

Results OurdatashowsthatmorethantwothirdsoftheHP haveopeninghoursoutsideregularhoursand>90%are openedduringlunchtime.MorethanhalfofPLHIVliveclose tothehospital,>80%haveoutreachprogrammesthatare closetoPLHIV,andaround60%havelong-distancefollow-up forthispathology.Morethan60%ofHPsbelievethatTFis usefulintheabsenceofface-to-facecontacts.ThereisaconsensusabouttheadvantagesofTFforpatients,HPandhealth systems.AllHPhaveconsideredanelaborationofaTFregulationmanualanditsinclusioninhospitalfunding.Wehave foundcorrelationbetweentheexistenceofARTdeliveryproximityprogrammetoPLHIVandhighrurality(p<0.05)and lowpopulationdensity(p<0.05).TheexistenceofARTdeliveryproximityprogrammetoPLHIVhasalsobeenassociated withadherencetothisservice(p<0.05).

ConclusionandRelevance Theresultsofthisstudysuggest thatmedicinesdeliveryproximityprogrammeandthefollowupofpatientsthroughTFenhancetheadherenceofPLHIV, thusavoidingunnecessarytripstothehospital.Distanceor timeconstraintsareminimisedandhealthoutcomesare maximised.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SociedadEspañolaFarmaciaHospitalaria.ProyectoMAPEX:marcoestratégicoen telefarmacia,Availablefrom:https://www.sefh.es/mapex/images/Telefarmacia_SEFH.pdf

ConflictofInterest Noconflictofinterest.

4CPS-156 ANALYSISOFTHEPRESCRIPTIONPATTERNAND DAYSOFHOSPITALISATIONAVOIDEDBYOUTPATIENT INTRAVENOUSANTIBIOTICTHERAPYANDTHE SAFETYOFTHISPRACTICE

EGomezBayona*,PMCovadonga,PBFernando,ECBeatriz,GLElena,GDSLDEsther, PRMariaRosario,ADAna. HospitalUniversitarioRamonYCajal,Pharmacy,Madrid,Spain 10.1136/ejhpharm-2024-eahp.260

BackgroundandImportance Theuseofintravenousanti-infectivetherapyfornon-hospitalisedpatientsisanincreasingly commonpracticethatallowsprescriberstotreatpatientswith intravenoustherapywithoutlengtheninghospitalstay.

AimandObjectives Toassesstheprescriptionpatternanddays ofadmissionavoidedwithoutpatientintravenousantibiotic therapy(OPAT).Also,toanalysethesafetyofthispractice.

MaterialandMethods Wemadearetrospectiveobservational studyincludingpatientswhoreceivedout-of-hospitalintravenousanti-infectivetreatmentinatertiary-levelhospitalin Madridbetween1August2021,to31August2022.Wecollectedfromtheelectronicprescriptionindication,etiologic agent,prescribingphysicianaswellasdaysofhospitalisation avoided,understoodastotaldaysofhospitalisationavoided bythenumberofdaysofintravenoustreatmentduration. Also,werecalledadversereactionsthatoccurredduringthe therapyperiod.

Sociodemographic,clinicalandpharmacologicalvariables werecollectedfromtheelectronicmedicalrecord. Results Weincluded85patients(52.9%women)inthestudy, withamedianageof75years(62–86).

Amongthemostfrequentlyprescribedanti-infectiveswe foundertapenem(32.6%),dalbavancin(15.3%),amoxicillin/ clavulanicacid(9.2%),ceftriaxone(7.1%)andpiperaziline/ tazobactam(7.1%).Themostfrequentindicationswereurinarytractinfections(26.5%),skinandsofttissueinfections (18.4%)andrespiratoryinfections(14.3%).Asforthoseinfectionscausedbybacteria(64.7%),44.6%weregram-negative multi-resistant.Fungiaccountedfor4%ofthecausative agents,protozoafor1%andvirusesfor1%.

Infectiousdiseasesdepartmentwasresponsibleof61.2%of theprescriptions.In68.4%ofcases,therewasacomplete antibiogramatthetimeofprescription.

Themedianofhospitalisationdaysavoidedwas7(19–6). Thehighestamountofdaysavoidedwas365daysforthree patients,treatedforvisceralleishmaniasis,mycobacteriainfectionandinfectionofsanitarymaterial.

Only1patient(1%)presentedadverseevents(renaltoxicityduetoamphotericin)thatdidnotrequirehospitalisation, onlysuspensionoftreatment.

ConclusionandRelevance OAPATreceiversinourhospitalare mostlyelderlypatientswithbacterialinfections.Prescribers madeprescriptionsbasedontheresultsofanantibiogramon morethanhalfoftheoccasions.Theout-of-hospitaladministrationofthesedrugssavesamedianof7daysforpatient, beingapracticewithlowappearanceofadverseeffectsduring treatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-157 PERSPECTIVESOFPATIENTSANDMEDICAL PROVIDERSONMULTIDISCIPLINARYMEDICATION RECONCILIATIONSSERVICEINADULTPATIENTS UNDERGOINGTHORACICANDCARDIOVASCULAR SURGERY(MERITSSTUDY)

1JYSeok*, 1,2SYoon, 2SPark, 2KNHeo, 2HWChae, 1AJKim, 1SHKim, 1EJCho, 1YSCho, 3,4HJLee, 2JYLee. 1SeoulNationalUniversityHospital,DepartmentofPharmacy,Seoul, SouthKorea; 2SeoulNationalUniversity,CollegeofPharmacyandResearchInstituteof PharmaceuticalSciences,Seoul,SouthKorea; 3SeoulNationalUniversityHospital, DepartmentofThoracicandCardiovascularSurgery,Seoul,Korea-South; 4SeoulNational University,CollegeofMedicine,Seoul,SouthKorea

10.1136/ejhpharm-2024-eahp.261

BackgroundandImportance Theimplementationofmedication reconciliation(MR)servicesisaglobalendeavour,butstill facestechnologicalanddata-relatedbarriers.Topromotewidespreadadoption,understandingtheperspectivesofpatients andmedicalprovidersonMRservicesiscrucial.

AimandObjectives ThisstudyaimedtoinvestigatethesatisfactionlevelsandperceptionsofpatientswhohaveexperiencedMRservices,aswellasthesatisfaction,perceived needs,andexpectationsofmedicalproviders.

MaterialandMethods Thisresearchisapartoftheprospectivestudyevaluatingofmultidisciplinarymedicationreconciliationserviceinadultpatientsundergoingthoracicand cardiovascularsurgery(MERITSstudy).Theprotocolofthe studywasapprovedbyInstitutionalReviewBoardofSeoul NationalUniversityHospital(IRBNo.2109–135-1257). Patients’ feedbackwascollectedthroughsurveysusing5-point Likert-scales,encompassingtheirawarenessofservices, improvementinmedicationbehaviours,perceptionaboutpharmacists,andoverallsatisfactionwithservices.Inparallel, healthcareprovidersweresurveyedaddressingtheirperceptions,satisfactionlevel,needs,andexpectationsconcerning MRservices.

Results Among216patientsenrolledinMERITSstudy,208 patientscompletedthequestionnaires.Thesepatientsexpressed ahighdegreeofsatisfactionwithMRservices(averagescore 4.67).Theaspectreceivingthehighestrating(4.79)pertained totheprofessionalismexhibitedbypharmacists,whereasthe lowestscore(4.61)wasattributedtotheneedforrevisiting theservice.Averagescoreof4.63wereratedforimprovement inmedicationbehaviours.Medicalstaff(12outof22, responserate54.5%)expressedsatisfaction,withninerating theoverallservicesas ‘verysatisfied’.Theyshowedthehighest satisfactionin ‘comprehensivemedicationreviewandresolving drug-relatedproblems’ and ‘dischargecounselling’.Intermsof theneedforservices,eightrespondentsanswered ‘verymuch inneed’ whilefourconsideredthey ‘needed’,withthegreatest demandfor ‘providingthebestpossiblemedicationhistory ’ . Additionally,theservices’ overallexpectationswerealsopositive,especiallyforidentifyingandimprovingdiscrepancies duringtransitions.

ConclusionandRelevance ThefindingsofthisstudyunderscoreapositivereceptionofMRservicesfrombothpatients andmedicalstaff.ThesefindingsemphasisetheneedtofurtherpromoteandenhanceMRservicesinKorea.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-158 RELAPSED/REFRACTORYMULTIPLEMYELOMAAND NEWTHERAPEUTICOPTIONS:EXPERIENCEINA PHASE1CLINICALTRIALSUNIT

1AMartínSiguero*, 1CDonosoRengifo, 1ELagunaCeba, 1AHernándezGuío, 2MGDaniel, 2GVegaAchabal, 2SRamosCillan. 1HospitalUniversitarioFundaciónJiménezDíaz,Start PhaseIUnitPharmacy,Madrid,Spain; 2HospitalUniversitarioFundaciónJiménezDíaz,Start PhaseIUnitHaematology,Madrid,Spain

10.1136/ejhpharm-2024-eahp.262

BackgroundandImportance Treatmentlandscapeforrelapsed/ refractoryMultipleMyeloma(RRMM)haschangedsignificantlyduetotheavailabilityandgoodresultsofnewdrugs suchasimmunotherapyagents.

PhaseIclinicaltrials(CTs)allowpatientstoaccessnew drugsprematurely,butthehighcomplexityoftheseCTs makesessentialtheintegrationofapharmacistinthePhaseI teamtoensurethesafepreparationanddispensationofinvestigationaldrugs.

AimandObjectives ToknowRRMMpatient’sprofiletreated inaPhaseIUnit,describeoverallresultsintermsofefficacy andadverseeffects,andanalysethepharmaceuticalinterventions(PIs)carriedoutandthemedication-relatedproblems (MRPs)detected.

MaterialandMethods Observational,retrospectivestudy,with RRMMpatientstreatedwithinvestigationaldrugsinaPhaseI CTUnit.Maindatacollectedweredemographics;numberof previoustreatmentlines;ECOGatinclusioninCT;typeof investigationaltreatmentreceived;treatmenteffectiveness:type ofresponse,overallsurvival(OS),progression-freesurvival (PFS);adverseeffects(AEs);PIsanddetectionofMRPs. Results 42patientswereanalysed,averageagewas67.6years, 71.4%women,averagepreviouslines5,ECOG1andtypes ofinvestigationaltreatmentsreceivedweremostlyBispecific Antibody(Ab)(antiGPRC5D-CD3)+BispecificAb(antiBCMACD3)(26.2%)andBispecificAb(antiBCMA-CD3)+antiCD38Ab(26.2%).

54.8%ofpatientsobtainedpartialorgreaterresponse. MedianPFSwas11.5months.MedianOSwas25.3months. 93%ofpatientsexperiencedsomeAEs,mostcommonwere haematological,includingneutropenia(29%),anaemia(21%), andplatetopenia(12%).

36PIswerecarriedout,mainlyrelatedtoprescription errors(44%)anddetectionofdruginteractions(33%).API wasperformedforeachMRPdetected,preventingnegative resultsinallcases.

ConclusionandRelevance PatientswithRRMMinPhaseICT Unitaremiddle-oldage,highlypretreatedandwithacceptable functionalstatus.Overallefficacyandsafetyresultsarepositive,whichreinforcesparticipationinPhaseICTasanoption tobeevaluated.

Thedetectionofprescriptionerrorsanddruginteractions werehighinnumberandwithpotentialimpact.BispecificAbs seemtobeapromisingtreatmentforpatientswithRRMM andduetotheircomplexity,thefigureofthepharmacist provestobeessentialwithinthehealthcareteamofPhaseI CTUnits.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-159 ANALYSISOFTHEINTERVENTIONSCARRIEDOUTIN THEGERIATRICSERVICEINCOLLABORATIONWITH THEINTERNALMEDICINEANDMICROBIOLOGY SERVICES

1JGonzálezBartolomé*, 1AAlmanchelRivadeneyra, 1MCastillloMedrano, 1RFernández Galán, 1CCabaHernández, 2JLuengoÁlvarez, 2MIMartínMartín. 1HospitalUniversity Cáceres,HospitalPharmacy,Cáceres,Spain; 2HospitalUniversityCáceres,InternalMedicine, Cáceres,Spain

10.1136/ejhpharm-2024-eahp.263

BackgroundandImportance Controllingtheprescriptionof antibioticsisimportantforbetterpatientcareandreducing theemergenceofresistance.

AimandObjectives Analysingtheinterventionscarriedouton patientsadmittedtothegeriatricservicefromtheantimicrobialuseoptimisationprogramme(PROA)ofourhospitaland evaluatingthedegreeofacceptance.

MaterialandMethods Observational,descriptiveandprospectivestudyoftheinterventionscarriedoutbythePROAteam (pharmacists,internistsandmicrobiologists)topatients

Abstracts

admittedtotheGeriatricsserviceintheperiodbetweenJanuary2022andMarch2023.

Allpatientswithanyprescribedantimicrobialwere included,reviewingtheirdailyclinicalevolutionduringthe durationoftreatment.Thedatacollectedwere:sex,age,analyticalvalues,antimicrobialsprescribed,interventionsperformedandacceptanceofthem.Thetypesofinterventions wereclassifiedasempiricaltreatmentadjustment,targeted treatmentadjustment,endoftreatmentandrenalfunction adjustment.

Datawereobtainedfromtheinpatientelectronicprescribingprogrammeandtheelectronichealthrecord.Datawere processedbyMicrosoftExcelsoftware.

Results Duringthestudyperiod,atotalof840patientswith ameanageof90years(±4SD)wereadmittedtothegeriatricsserviceandtheystartedantimicrobialtreatment.

Atotalof180interventionswerecarriedout,158 (87.78%)wereaccepted.Empiricaltreatmentadjustmentwas suggestedin8.34%(15/180),targetedtreatmentadjustmentin 28.33%(51/180),treatmentcompletionin30%(54/180)and adosageadjustmentbasedonrenalfunctionin33.33(60/ 180).

Amongthemostnotableinterventionswouldbemeropenem,with24interventionscarriedout,83.33%were accepted;andpiperacillin-tazobactam,with24interventions andwithanacceptancerateof79.17%.Althoughinalower percentage,wealsofoundotherhigh-impactantimicrobials, suchaslinezolid,withnineinterventionsandanacceptance rateof77.78%;andceftazidime-avibactam,withsixinterventionsperformedandallofthemwereaccepted.

ConclusionandRelevance Withsuchprominentdataregarding acceptance,thetrainingandvalueofthepharmacist’srole withinthemultidisciplinaryteamformedincollaborationwith InternalMedicineandMicrobiologyisdemonstrated.Furthermore,theimportanceoftheexistenceofantimicrobialuse optimisationprogrammesinthehospitalsettingishighlighted, showinghowtheinappropriateuseofcertainhigh-impact medicationsisreduced,achievingadecreaseintheappearance ofresistance.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-160 LONG-TERMEFFECTIVENESSANDSAFETYRESULTS OFGALCANEZUMABINREAL-WORLDDATAIN MIGRAINEPROPHYLAXIS

LLosaLopez*,BGraciaGarcia,APueblaVillaescusa,AMurgadellaSancho,MCasellas Gibert,EHidalgoAlbert. HospitalSantJoanDespíMoisèsBroggi.Csi.,Pharmacy,SantJoan Despi,Spain

10.1136/ejhpharm-2024-eahp.264

BackgroundandImportance Galcanezumabisamonoclonal antibody(MAB)formigraineprophylaxis.MABhasbeen showntobesafeandeffectiveinreducingthenumberof migrainedayspermonthinshort-durationclinicaltrials. However,theoptimaldurationoftherapyremainsunresolved. Clinicalpracticeguidelinesrecommendmaintainingtreatment for12months.

Drugisdispensedinthehospitalpharmacyservice,where pharmacistsfollow-uptheeffectiveness,safetyandadherence ofMAB.

AimandObjectives Toassessthelong-termeffectivenessand safetyofgalcanezumabinepisodicmigraine(EM)andchronic migraine(CM).

MaterialandMethods Retrospectiveobservationalstudyina second-levelhospital.Studyperiod:September2020– July 2023.

Migrainepatientstreatedwithgalcanezumabwereevaluated foratleasta12-monthfollow-upperiodfromthestartof treatment.

Accordingtohospitalprotocol,after12monthsofMAB, neurologistsdecidewhethertocontinueordiscontinueitand re-assess3monthslaterandrestartMABifmigraine worsens.

Datawerecollectedfromtheelectronicmedicalrecord. Thedatabaseincludeddemographicvariables,migraine-related variables,treatment-relatedvariables,andadverseevents(AE). Results 64patients,54CMand10EM,medianage48years (76–21),women84%.Meanofdaysofmigrainepreviousto galcanezumab:20.46±6.55(CM)and12±1.48(EM).

Themediandurationofgalcanezumabwas18.4(1.9–34.9) months.

48patients(n=64)completedthefirst12-monthoftreatment.32patients(n=45)continuedat18months,19(n=26) at24months,14(n=18)at30monthsand8(n=8)at34 months.Theywerechronicallymaintainedgalcanezumabto preventworseningifMABwasdiscontinued.

24patientsdiscontinuedgalcanezumab:lackofresponse (20),injectionsiterash(2),pregnancy(1),excellenttreatment response(1).17patientswereswitchedtoanotherMAB(15: rebound;2:injectionsiterash).

2patientsrestartgalcanezumab:afterpregnancy(1)andfor rebound10monthsafterstopgalcanezumab(1).

AE:constipation(12),injectionsitepain(3),dizziness(3), rhinitis(3),diarrhoea(2),injectionsiterash(2).

ConclusionandRelevance Inourstudy,galcanezumabremained long-termeffectiveness,safe,andwelltoleratedwithfew adverseeventsformorethan12monthsinpatientswithepisodicandchronicmigraine.Itwasonlydiscontinuedincase ofgreatimprovementortherapeuticfailure.Studieswith largersamplesarerequiredtoestablishwhetheritcouldbe usedasachronictreatmentinpatientswithahighprobability ofworseningiftreatmentisdiscontinued.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-161 VANCOMYCINPHARMACOKINETICMONITORINGIN CRITICALLYILLNEONATALPATIENTS

DPascualCarbonell*,JBodegaAzuara,MMartinMarques,HSuñerBarriga,ISacanella Anglès,CDCiuciu,PLópezBroseta,AGarcíaMolina,SCondeGiner,IPloSeco,LCanadell Vilarrasa. HospitalUniversitarioJoanXxiii,PharmacyService,Tarragona,Spain

10.1136/ejhpharm-2024-eahp.265

BackgroundandImportance Vancomycinisabactericidalglycopeptideantibioticwithactivityagainstaerobicandanaerobic gram-positivebacteria.Itsuseinneonatalcriticallyillpatients iswidespread,asitprovidestreatmentfortypicalpathogens affectingthispopulation,whichpresentsanincreasedriskof infection.Doseinthesepatientsisadjustedaccordingtogestationalweeksandpharmacokineticmonitoringisessentialdue toitspotentialnephrotoxicity.

AimandObjectives Assessingpossibleunder-exposuretovancomycinincriticallyillneonatalpatientsafterdosing,asrecommendedbystandardguidelines.

MaterialandMethods Aretrospectiveobservationalstudyina tertiaryhospitalwasconductedfromMarch2021toJune 2023.Criticallyillpatientswhoreceivedvancomycinwith<1 monthoflifeatbaselinewereincluded.Thefollowingdata werecollectedfrommedicalrecords:demographics,diagnosis, microbiologicalcultureresults,renalfunction,vancomycindosingregimen,plasmaconcentration(PC),antimicrobialtreatmentdurationandoccurrenceofnephrotoxicity(determined as50%increaseincreatininevalueversusbaseline).PCis consideredtherapeuticforvancomycinat10–20mg/dLandthe firstpharmacokineticdeterminationwasperformedbefore dose4.

Results Duringthestudyperiod,79pharmacokineticdeterminationswereperformedin34patients,correspondingto45 treatmentswithamediandurationof6days(4,14),of which31(68.9%)wereempirical.Pathogenswereisolatedin 28(62.2%)ofthemicrobiologicalcultures,themainones being: S.epidermidis 11(28.2%), E.faecalis 4(10.3%)and K. pneumoniae 4(10.3%).Mostfrequentdiagnoseswere:catheterinfection17(37.8%),sepsis8(17.8%)andnecrotising enterocolitis8(17.8%).48(60.8%)PCweresub-therapeutic, 29(36.7%)withinrangeand2(2.5%)supratherapeutic.13 (26%)oftheout-of-rangePCachievedthedesiredtargets thankstothepharmacokineticrecommendations.Finally,nephrotoxicitywasobservedin9(13.3%)patients.

ConclusionandRelevance 48(60.8%)criticallyillneonates wereunder-treatedand9(13.3%)hadnephrotoxicitywiththe dosingregimensrecommendedbystandardguidelines.Itis thereforenecessarytoreviewtherecommendeddosingregimensinthisgroupofpatientstoachievetherapeuticPCof vancomycinfromthestartoftreatmentguidedbypharmacokineticmonitoring.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-162 ‘TOERRISHUMAN’– PRESENTINGCASESOF MEDICATIONERRORSFROMREALCLINICAL PRACTICE

1SStoev*, 2SBelcheva, 2TTodorova, 2NVeleva, 2HLebanova. 1MedicalUniversityPleven, PharmaceuticalSciencesandSocialPharmacy,Sofia,Bulgaria; 2MedicalUniversityPleven, PharmaceuticalSciencesandSocialPharmacy,Pleven,Bulgaria

10.1136/ejhpharm-2024-eahp.266

BackgroundandImportance Medicationerrors(ME)arepreventablemistakesorincidentsthatcanoccuratanystageof themedicationuseprocess,whichcancausepatientharmand significantmorbidityandmortality.

AimandObjectives Identificationofthenature,incidence,and potentialpreventativemeasuresofDRPs.Toevaluatetherole ofthepharmacistinMEriskreductionprocessandtoidentifycriticalpointsandoutlinestrategiestoreduceiatrogenic ME.

MaterialandMethods Thecurrentprospectivedirectclinical observationwascarriedoutintheperiodJune-December 2022byanalysingtheelectronicrecordsof1625patientsina specialisedgynaecologicalhospitalwithnationalcoverage.Participantswerealsointerviewedbyaclinicalpharmacisttoverifytheinformationextractedfromtheelectronicrecords.

Results Theaveragenumberofmedicationsperpersonwas five,andthemedianageofthecohortwas36years.In1/3 ofthecases,thetherapyconsistedofbothdrugsandsupplements.Thedesiredtherapeuticoutcomewasachievedin320 oftherecords,whiletreatmentwasdiscontinuedin569.The highestnumberofMEwasobservedintheagegroup>40 years,followedby31–40years.Parenteralproductsaccounted for68%oftheerrors.CategoriesofMEidentifiedwere: administration,prescribing,dispensing,druginteractions, patienterror,andother.Inadequaterecordingofprescription detailsintheelectronichospitalsystemaccountedformostof theidentifiederrors.Misuse,followedbyinappropriatechoice ofdrug/doseordurationoftreatment,andinappropriateroute ofadministrationareamongthemostcommonDRPsidentified.Inonly12%ofcaseswastheerroridentifiedandthe associatedharmpreventedasaresultofaphysician-initiated consultationwiththehospitalpharmacist.Thephysician’ s acceptanceofthepharmacist’ssuggestionswas>80%.

ConclusionandRelevance Althoughhospitale-prescribingsystemsareseenasatooltoreduceprescribingerrors,theabove casesdemonstratethatthesesystemsalonearenotsufficient tosignificantlyreducetheriskofinappropriateprescribing. Hospitalpharmacistscanbeconsideredasavalidcheckpoint toeffectivelyreduceDRP.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TheprojectisfundedbytheEuropeanUnion-NextGenerationEU;procedure ‘Creatinganetworkofresearchuniversities’ fromtheNationalPlanforRecoveryand Resilience,project ‘ResearchUniversity-MedicalUniversity-Pleven ’,contract#BGRRP-2.004–0003-C01.

ConflictofInterest Noconflictofinterest.

4CPS-163 EFFECTIVENESSOFSODIUMZIRCONIUM CYCLOSILICATEINHOSPITALISEDPATIENTSWITH HYPERKALAEMIA

MMora-Cortés,GCano-Martínez,YReyes-DeLaMata,JDiaz-Navarro*. Hospital UniversitarioPuertoReal,HospitalPharmacy,PuertoRealCádiz,Spain

10.1136/ejhpharm-2024-eahp.267

BackgroundandImportance Sodiumzirconiumcyclosilicate (SZC)isusedtocorrecthyperkalaemia(K>5.1mEq/L).SZC shouldbeadministeredtopatientswhohavenotresponded wellorhavebecomeintoleranttoalternativetreatments,such asresins,usinganinitialdoseof10mg/8hfollowedbya maintenancedoseofeither5mgor10mgevery24h.Real clinicaldataofusemightberequiredtooptimisethis treatment.

AimandObjectives TodescribeeffectivenessanduseofSZC forthetreatmentofhyperkalaemiainhospitalisedpatients withaninitialormaintenancestartingdose.

MaterialandMethods Retrospectivedescriptivestudywas designedinhospitalisedpatientswhostartedtreatmentwith SZCbetweenJuly2021andJuly2023.Outcomeswerecollectedfrommedicalrecordsandelectronicprescriptionsoftware:gender,age,initialdoseand/ormaintenancedose,serum potassiumconcentrations(at0,48and72hoursafterstarting SZCtreatment)andprevioususeofexchangeresinslikecalciumpolystyrenesulfonate(CPS).Theeffectivenessendpoint wasdescribedas:percentageofpatientswhoachievedanormalserumpotassiumlevel(3.5–5mEq/L)at48and72h, witheitherinitialormaintenancestartingdose.

Abstracts

Results Therewere35patients(62.2%maleand37.8% female)thatpresentedameanageof69(34–96)years.Initial doseof10mg/8hwereusedin29.7%ofpatients.Maintenancedoseof5mg/24hwereusedasstartingdosein64.9% ofpatientsand10mg/24hin35.1%.Startingserumpotassiumconcentrationmeanwas6.3mEq/L(5.2–9.8).Interms ofuse,CPSwerepreviouslyusedin43.2%ofpatients.About effectivenessresultsat48h,60%ofpatientsreachednormal potassiumconcentrations,72.7%receivedtheinitialstarting dosewhile54.2%didnotreceivedtheinitialstartingdose.At 72h,80%ofpatientsreachednormalpotassiumconcentrations,90.9%receivedtheinitialstartingdosewhile75%did notreceivetheinitialstartingdose.

ConclusionandRelevance SZCtherapydisplayedthatmore than50%ofpatientsachievednormalpotassiumlevelsat48 and72hwithbothregimens.StartingSZCtherapywiththe initialstartingdoseshowedbetterandfastereffectiveness. MorethanhalfofthepatientshadnotpreviouslytriedCPS, themostcost-effectivenessoption.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-164 ANALYSISOFUSTEKINUMABINTENSIFICATIONIN INFLAMMATORYBOWELDISEASEACCORDINGTO LINEOFTREATMENT

ÁGarcíaLópez,AYSalmeronCobos*,MRCantudoCuenca,BSánchezGonzález,MISierra Torres. HospitalUniversitarioVirgenDeLasNieves,Pharmacy,Granada,SPAIN

10.1136/ejhpharm-2024-eahp.268

BackgroundandImportance Ustekinumabhasbeenshownto beeffectiveandsafeinthelongtermininflammatorybowel disease.However,itsuseinadvancedtreatmentstagesisassociatedwithalossofeffectiveness,leadingtointensifiedusage andanassociatedadditionalcost.

AimandObjectives Theobjectiveistoanalysetheposological intensificationofustekinumabinulcerativecolitis(UC)and Crohn’sdisease(CD)inrealclinicalpracticeaccordingtothe lineoftreatmentused.

MaterialandMethods Retrospectiveobservationalstudyin whichallpatientstreatedwithustekinumabinatertiaryhospitalwereincludedduringtheperiodJanuary2017,toSeptember15,2023.

Theanalysedvariablesincluded age,sex,previousanti-TNF therapy,intensifiedpatients,monthsfromthestartofUstekinumabuntilneedingintensificationto6weeksand4weeks, causesofUstekinumabuseinfirstlinetreatment.Thesources usedtoobtaindataweretheelectronicprescriptionapplicationPrisma® andthecomputerisedmedicalrecordsystem Diraya®.

Results Atotalof177patientswereincluded(48.1%women), withameanageof48years(range19–85).Amongthem, 37.3%(n=66)hadbeenpreviouslytreatedwithtwoanti-tnf, eitherexclusivelywithAdalimumab(n=71.40.1%),exclusively withInfliximab(n=20.11.3%)orhadnoprioranti-tnftreatment(n=20,11.3%).

Intensificationoftheregimenwithustekinumabwasnecessaryin54.5%ofthosepreviouslytreatedwithtwoanti-tnf, 49.3%onlyadalimumab,50%onlyinfliximab,45%nopreviousanti-TNF.

Theinitialposologyofustekinumabwas8weeks.The mediannumberofmonthsfortheintensificationof

ustekinumabto6weeksand4weekswas10.5monthsand 19.9months(twoanti-TNF),11.4monthsand20.6months (adalimumab),12.3monthsand20.6months(infliximab)and 19.7monthsand26.5months(nonanti-TNF).

Inourhospital,patientswhohadnotpreviouslyundergone anyanti-TNFtreatmentdidsoduetoneoplasia(46.6%), infections(20%),HLA-DQA1*05(13.3%)ormultiplesclerosis (13.3%).

ConclusionandRelevance ThepercentageofpatientsintensifiedwithustekinumabishigherinthosetreatedwithantiTNFthaninthosenottreated.

Inaddition,patientstreatedwithoneanti-TNFornoantiTNFrequiredmoretimetointensifythanpatientstreated withtwoanti-TNFs.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-165 DETERMINATIONOFPREDICTIVEFACTORSFOR IMMUNE-RELATEDTOXICITYINLUNGCANCER PATIENTSTREATEDWITHIMMUNOTHERAPY

1EZhanZhou, 2MALucenaCampillo, 3XMielgoRubio, 1BSanchezPascual*, 1MPerez Encinas. 1HospitalUniversitarioFundacionAlcorcon,PharmacyService,Alcorcon,Spain; 2HospitalUniversitarioSeveroOchoa,PharmacyService,Leganes,Spain; 3Hospital UniversitarioFundacionAlcorcon,MedicalOncology,Alcorcon,Spain

10.1136/ejhpharm-2024-eahp.269

BackgroundandImportance Immunotherapyhasprovidedbetterresponsesandtoleranceinthetreatmentoflungcancer thanintravenouschemotherapy.However,itcanalsoinduce autoimmuneadverseeffectsthatcouldleadtohospitaladmissionordeathofthepatient.

AimandObjectives Toanalysepossiblefactorsassociatedwith theincidenceofimmune-relatedadverseevents(iRAEs)in lungcancer(LC)patientstreatedwithimmunecheckpoint inhibitors(ICI).

MaterialandMethods Retrospectiveanalysisofpatientswith LCtreatedwithICIbetween2015and2023inatertiary hospital.Thevariablescollectedfromtheclinicalhistory were:age,sex,performancestatus,historyofallergy/autoimmunedisease,treatmentwithcorticosteroidsorantibiotics priortotheICI,occurrenceofiRAEs,typeoftoxicityand severity,laboratoryvariables(haemoglobin,neutrophil count,plateletcount,LDH),dateofprogressionanddeath. TheassociationwasdeterminedusingChi-squaretestsand Fisher ’ sexacttest.Progression-freesurvival(PFS)andoverallsurvival(OS)werecalculatedusingtheKaplan-Meier method

Results Atotalof67patients(74.6%men;meanage68.6 ±9.4years)treatedwithICIwereanalysed.Ofthese,49 developedatleastoneiRAE(73.1%),37.3%fromgrade 3. StatisticallysignificantassociationswerefoundbetweenappearanceofskintoxicityandalteredLDHlevels(p=0.048),and musculoskeletaltoxicityandECOG 2(p=0.037).Historyof allergy/autoimmunediseaseandtreatmentwithcorticosteroids orantibioticsinthe3monthspriortothestartofimmunotherapywereassociatedwiththeappearanceoflivertoxicity (p=0.015inallcases),asthenia(p=0.027;p=0.021; p=0.032)andmusculoskeletaltoxicity(p=0.006;p=0.006); p=0.005).PatientswithiRAEshadlongerPFS(14.8vs.3.3 months)andlongerOS(19.2vs.2.9months).

ConclusionandRelevance Noassociationwasfoundbetween theproposedvariablesandtheappearanceofimmune-related toxicityingeneralbutasignificantrelationwasfound betweenalteredLDHandskintoxicity,andbetween ECOG 2andmusculoskeletaltoxicity.Correlationwasalso foundbetweenahistoryofallergyorautoimmunediseaseand theconsumptionofantibioticsorcorticosteroidswiththe appearanceofhepatic,generalormusculoskeletaltoxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-166 COMPREHENSIVEASSESSMENTOF PHARMACOTHERAPYINTHECOMPLEXCHRONIC PATIENT:COLLABORATIONBETWEENDIFFERENT LEVELSOFCARE

1MMuñoz-García, 1CAcosta-Cano, 1EDelgado*, 1EGomez-Bayona, 1MDMolinaMendoza, 1LQuesada-Muñoz, 2MJZamorano-Serrano, 3ECLópez-Díaz, 3VGrecianoGreciano, 1AÁlvarez-Díaz. 1HospitalUniversitarioRamonYCajal,PharmacyDepartment, Madrid,Spain; 2HospitalUniversitarioRamonYCajal,EmergencyDepartment,Madrid, Spain; 3DirecciónAsistencialEste,PharmacyDepartment,Madrid,Spain

10.1136/ejhpharm-2024-eahp.270

BackgroundandImportance Complexchronicpatients(CCP) havechangingneedsthatrequirecontinuousreassessmentand effectivecoordinationofdifferentlevelsofcare.

AimandObjectives Toanalyseacomprehensivepharmacotherapyassessmentprogramme(CPAP)intheCCPregarding healthresourcesutilisation,optimisationofpharmacotherapy, pharmacotherapeuticandpatientsatisfaction.

MaterialandMethods Prospectiveinterventionstudyinatertiaryhospital´semergencydepartment(ED)between9January 2023to31August2023.Inclusioncriteria:CCPwhoconsultedtheED,signedinformedconsent,andwerenotseriouslyillorinstitutionalised.

ACPAPin<24h/48hintheEDincluded:conciliation, reviewofpharmacotherapyandprescriptionsandissueofa pharmacotherapeuticrecommendationsreport.Thereportwas senttoprimarycare(PC)professionalsatdischarge.Toassess patient’ssatisfaction,afollow-upphonecallwasmade30 daysafterdischarge(score0–10).

Collectedvariableswereage,sex,Charlsonindex,admissionservice,lengthofstay,30-daypost-dischargeEDvisits, mortality,numberofdrugs,numberofrecommendations issuedandaccepted.

Results OnehundredandtenCCPswereincludedintheED, 56males(50.9%),medianage86(35–101),medianCharlson Index:7(2–14).

103(94%)patientswerepolymedicatedand74(67.3%) hyperpolymedicated.Mediannumberofchronicdrugsper patientwas11(3–21).

Eighty-five(77.3%)wereadmitted,meanstay8days,at InternalMedicine37(43.5%).

Seventy-six(83.6%)completedthefollow-upperiod,of which17(15.8%)returnedtotheEDand6(7.9%)were readmitted.Losses:Exitus:18;Palliative:8;Other:8.

IntheED,376recommendationsweremade(mean3.4/ patients)and91(24.2%)wereaccepted.Atdischarge168 (mean2.2/patient)and54(32.1%)wereaccepted.95errors weredetectedbetweentheelectronicprescriptionandthedischargereport,55(57.9%)inthefirstevaluation.

Patientsatisfactionwiththeprojectwas9.4(7–10).

ConclusionandRelevance AhighpercentageofCCPsattendingtheEDwereadmitted.AquarteroftheCCPswerereadmittedorreturnedtotheEDduringthemonthoffollow-up.

Thereisadecreaseinthenumberofrecommendations issuedaftertheCCP’sstayinthehospital,butthereisgreater acceptanceofthedischargerecommendations.

Inmorethanhalfofthepatientstherearediscrepancies betweenthetreatmentdescribedinthedischargereportand theirelectronicprescription,whichisasafetyproblem.

Patientsreportedahighsatisfactionlevelwiththeproject.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-167 USEOFSTANDARD-ANDHIGH-DOSELIPOSOMAL AMPHOTERICINBANDITSRELATIONSHIPWITH HYPOMAGNESAEMIA

RVillaro-Otaño*,AFernández-Ferreiro,MGonzález-Barcia,FCajade-Pascual,MPuenteIglesias,ÁTena-Castro,IZarra-Ferro. ComplejoHospitalarioUniversitarioDeSantiagoDe Compostela,HospitalPharmacistService,SantiagoDeCompostela,Spain 10.1136/ejhpharm-2024-eahp.271

BackgroundandImportance Magnesiumdeficiencyismainly manifestedincardiacandneuromusculardisorders.Hypomagnesaemiahasbeendescribedasafrequentadversereaction associatedwiththeintravenousadministrationofliposomal amphotericinB.

AimandObjectives Tocompareassociatedhypomagnesaemia inpatientswithfungalinfectionreceivingstandard-versus high-doseofliposomalamphotericinB.

MaterialandMethods One-yearretrospectiveobservational studyincludingpatientswhoreceivedliposomalamphotericin Bforatleast5days.Thevariablescollectedwereage,sex, meandose,durationoftreatment,serummagnesiumandneed formagnesiumsupplementation.Patientsweredividedinto twogroups:standarddoses(£ 3mg/kg/day)andhighdoses (>3mg/kg/day).Thechangeinmagnesiumatthebeginning andtheendoftheperiodstudiedineachofthegroupswas analysed.

Results Atotalof31patients(38%women)withameanage of60±13yearswereincluded.Thebaselinemagnesiumvalue ofthepatientswhostartedtreatmentwas1.95±0.34mg/dl, withonlytwopatientsbeingbelowthephysiologicalrange (1.6–2.4mg/dl).

Inthestandarddosegroup,11patients(35%)were includedwithameandoseof1.63±0.84mg/kg/dayanda meandurationof22±10days.Atfivedays,nopatientwas belowthephysiologicalrange, althoughmagnesiumdecreased byanaverageof0.076mg/dl(4%withrespecttobaseline). Thismeantthat45%ofthepatientshadtobesupplemented withintravenousmagnesium.Inthehigh-dosegroup,20 patients(64%)wereinclude d,whoreceivedameandoseof 4.88±0.91mg/kg/dayforameanof17±10days.Onthe fifthday,20%ofthepatientsshowedlevelsbelowthephysiologicalrangeofmagnesium.Furthermore,themean decreaseinthisgroupwas0.195mg/dl(10%),with65% requiringexogenoussupplementation.Therearestatistically significantdifferences(p<0.05)showingthatagreater decreaseinserummagnesiumle velsisassociatedwithhighdoseamphotericin.

ConclusionandRelevance Real-lifedatashowagreater decreaseinserummagnesiumwithhighdosesofliposomal

Abstracts

amphotericinB.Therefore,monitoringandfollow-upofthese patients-whowillrequiremorefrequentmagnesiumsupplementation-isapriority.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-168 EFFECTIVENESS,SAFETYANDADHERENCETO EVOLOCUMABINREALCLINICALPRACTICE

1SGarcíaContreras*, 1MDEdoSolsona, 2MRubioAlmanza, 1MJCuéllarMonreal, 1MMartín-Cerezuela, 1AAlbertMarí, 1NFerrandisSales, 1JLPovedaAndrés. 1Hospital UniversitariIPolitècnicLaFe,DepartmentOfPharmacy,Valencia,Spain; 2Hospital UniversitariIPolitècnicLaFe,DepartmentOfEndocrinology,Valencia,Spain

10.1136/ejhpharm-2024-eahp.272

BackgroundandImportance Evolocumab,aninhibitorofproproteinconvertasesubtilin-kexintype9,representsanalternativetherapeuticoptionforindividualswhoexhibitintolerance tostandardlow-densitylipoproteincholesterol(LDL-C)treatmentsorfailtoattaindesiredLDL-Clevels.

AimandObjectives Thisstudyaimstoassesstheeffectiveness, safetyandadherencetoevolocumabamongpatientswith hypercholesterolemia.

MaterialandMethods Observational,retrospective,andmultidisciplinarystudythatincludedpatientswhostartedtreatment withevolocumabinatertiaryhospitalbetweenJuly2016and August2022.Datavariables(clinicalhistoryanddispensing program)weresex,age,indication,statinstreatment,evolucumabdosage,treatmentduration,LDL-Clevelsatbaseline,3, 6,12and36months,adverseeffects(AEs)andadherence (medicationpossessionrate).SPSS-27statisticalprogram(Wilcoxontest)wasusedtocomparethedecreaseinLCL-Clevels atdifferenttimes.

Results Thestudyenrolled63patients(52.4%women),with anaverageageatinitiationof61.8(SD:11.1)years.Theprimarydiagnosesincludedfamilialhypercholesterolemia (57.1%),establishedcardiovasculardisease(33.3%)orboth (9.5%).63.5%ofpatientswere intoleranttostatins,1.6% hadcontraindications,and34.9%receivedstatinsatmaximumtolerateddoseswithoutachievingtargetLDL-Clevels. Dosagewas140mg/14days,withanaveragetreatment durationof3.0(SD:1.6)yearsandanadherencerateof91.3 (SD:14.9)%.TheaverageLDL-Clevelswas169.9(SD:57.5) mg/dl,84.9(SD:62.6)mg/dl,77.2(SD:47.5)mg/dl,75.7 (SD:39.0)mg/dland84.0(SD:44.5)mg/dlatbasal,3,6, 12and36months,respectively.TheseLDL-Clevelswere significantlyreduced(p<0.01)whencomparedtobasal.Currentlythemajority(85.7%)ofpatientscontinuetheirtreatment,1.6%losttofollow-up,and12.7%discontinueddue todeath(4.8%),AEs(6.3%)andlackofresponse(1.6%). OnlyfourpatientshadAEs(headache;pseudocatarrhal symptoms,haematomas,spasms;anaphylaxis;skinreaction, diarrhoeaandmyopathies),andevolocumabwaswithdrawn inallofthem.

ConclusionandRelevance Evolocumabemergesasacompelling therapeuticoptionforLDL-Creductionandcardiovascular riskmitigation,particularlyforpatientswithstatinintolerance orinadequatestatinresponse.Theresultsobtainedinourreal clinicalpractice(55.4%decreaseinLDL-Clevelsat12 months)weresimilartothoseofthepivotalclinicaltrials.

Furtherresearchiswarrantedtoascertainitsimpactonmajor cardiovasculareventsinreal-worldsettings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-169 EVALUATIONOFANTICHOLINERGICDRUG PRESCRIPTIONUSINGACLINICALDECISIONSUPPORT SYSTEM:APROSPECTIVESTUDYINAGERIATRIC REHABILITATIONCENTRE

1CWasf, 1SHannou*, 2KMajor, 1NPerrottet, 1FSadeghipour, 1PVoirol. 1Chuv, DepartmentOfPharmacy,Lausanne,Switzerland; 2Chuv,ServiceofGeriatricMedicineand GeriatricRehabilitation-DepartmentofMedicine,Lausanne,Switzerland

10.1136/ejhpharm-2024-eahp.273

BackgroundandImportance Anticholinergicdrugsareconsideredaspotentiallyinappropriateinolderadults.Different scalesareavailabletoquantifyanticholinergicburden.Ascore 3isconsideredasincreasingtheriskofsideeffects.Clinicalpharmacistscanplayanimportantroleinreducinganticholinergicdrugprescription,butresourcesarelimited.A clinicaldecisionsupportsystem(CDSS)basedonanticholinergicburdenscalescanhelppharmaciststoidentifypatientsat higherriskofanticholinergicsideeffects.

AimandObjectives Theobjectiveofthisprospectivestudy wastoevaluatetheprescriptionofanticholinergicdrugsina geriatricrehabilitationunit(RU)andtheanticholinergicburdenforeachpatientregardingtheprescriptionathome,at dischargeofacutecare,onadmissioninRUandatdischarge tohome.

MaterialandMethods Allpatients,aged>65years,withat leastoneanticholinergicdrugonadmissioninRUorduringthestaywereeligible.TheCDSSPharmaclass ® was usedtodetectpatientswithanticholinergicdrugs,basedon theCRIDECOanticholinergicburdenscale.Whenthe scorewas 3,thepharmacistevalu atedthesituationand informedthephysician.Ifneeded,hesuggestedpharmaceuticalinterventions.

Results 132patientswereincludedbetweenAprilandMay 2023.Averageanticholinergicscorewas1.83(+/-1.6SD)for theusualhometreatment,2.81(+/-1.78SD),thelastdayin theacuteunit,2.45(+/-1.54SD)onadmissionintheRU and1.81(+/-1.54SD)atdischarge.40%ofthepatientshad ananticholinergicscore 3onadmissionand24%atdischarge.Anticholinergicdrugswereprescribed349timeswith analgesicsbeingthemostprescribed(24%),followedbyantidepressants(16%).Pharmacistinformedtheprescriberabouta score 3for58patientsandrealised45interventionswith anacceptancerateof82%.

ConclusionandRelevance Hospitalisationinacutecareledto anincreaseofanticholinergicdrugprescription.Astayina geriatricrehabilitationunitbeforedischargehelpedreducing thisburden.Sensitivityofgeriatricianregardinginappropriate prescriptionsaswellasfocusedpharmaceuticalinterventions, supportedbyaCDSS,resultinthisscorereduction.This studyrevealstheneedtodeploytheanticholinergicalertof CDSStootherwardsinacutecare.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

CLINICALPHARMACYPRIORITISATIONALGORITHM FORPATIENTSINPSYCHIATRICLONG-TERMCARE:A PILOTSTUDY

1RKnauseder, 2ASonnleitner-Heglmeier*, 3MJeske, 3MMunz, 3MCosta, 4AEWeidmann. 1LeopoldFranzensUniversity,ClinicalPharmacy,Innsbruck,Austria; 2InnsbruckUniversity Hospital,PharmacyDepartment,Innsbruck,Austria; 3InnsbruckUniversityHospital, Pharmacy,Innsbruck,Austria; 4LeopoldFranzensUniversity,DepartmentOfClinical Pharmacy,Innsbruck,Austria

10.1136/ejhpharm-2024-eahp.274

BackgroundandImportance Aprioritisationalgorithmfor long-termpsychiatricpatientscontributestopatientsafetyby identifyingtheindividual’sriskofexperiencingdrug-related problems(DRPs).Todatenosuchalgorithmisapplicableto long-termpsychiatriccare.

AimandObjectives Thispilotstudyaimedtodevelopaclinicalpharmacistprioritisationalgorithmforpsychiatricpatients inalong-termcarefacility.

MaterialandMethods Thisretrospective,mixedmethodsstudy wasconductedinthreephases. PhaseI: Anarrativeliterature reviewtoidentifyavalidatedmethodologicalapproachthat guidesalgorithmdevelopment. PhaseII: Medicationreviews for66long-termpsychiatricinpatientswereconductedbya clinicalpharmacist(ASH)inaspecialistcarefacility. PhaseIII: Anexpertpanelofthreeclinicalpharmacists(MM/MC/AEW) independentlyratedastatisticallyrelevantsamplesizeofall identifieddrugrelatedproblems(DRPs)andtheirintervention ontheircontributiontopatientsafetyusingtheclassification systembyOverhageandLukes.Basedonthesefindingsand non-parametricstatisticalanalysis(Mann-WhitneyUtest,Kruskal-Wallistest),apilotalgorithmforclinicalpharmacistsinterventionsinthispatientpopulationwasdeveloped.Thestudy receivedethicalapprovalfromtheMedicalUniversityInnsbruck[no.1064/2023].

Results Atotalof382DRPswereidentifiedacross66 patients.ThemostcommontypesofDRPswere ‘drug-interaction’ (51,4%/n=196)and ‘adversedrugreaction’ (39,0%/ n=149)withthemostfrequentinterventionsbeing ‘controllingforsymptoms’ (34,6%/n=132)and ‘drugswitch’ (22,6%/ n=86).ThefivedrugclassesmostoftenassociatedwithDRPs wereN05AANTIPSYCHOTICS(36%/n=272),N06AANTIDEPRESSANTS(14,7%/n=110),N05BANXIOLYTICS (13,1%/n=98),N03AANTIEPILEPTICS(5,9%/n=44)and N02AOPIOIDS(3,5%/n=26).Interventionratingwascategorisedasavoiding ‘significant’ or ‘major ’ complicationsin 33,9%(n=126)and12,4%(n=46)ofcases,respectively. DRPsidentifiedtocarrythehighestpatientriskandincluded intheprioritisationalgorithmwere:combinationofsedative agents;concomitantuseofQTintervalprolongingdrugs; cumulativeanticholinergicburden;combinationofacetylsalicylicacidandvalproicacid.

ConclusionandRelevance Thepilotalgorithmproposedinthis studyprovidesameansforclinicalpharmaciststoprioritise patientsatgreatestriskofDRPsinthisuniquepatientpopulation.Whileitisthefirstalgorithmforthispatientpopulation, furtherresearchisneededtoensureinternalandexternal validation.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-171 FIXED-DOSEVERSUSWEIGHT-BASEDDOSING REGIMENOFPEMBROLIZUMAB

ALuaces-Rodríguez*,PFeijoo-Vilanova,LCaeiro-Martínez,EGómez-Costa,AMartínezPradeda,SRotea-Salvo,MDomínguez-Guerra,TCalleja-Chuclá,FBusto-Fernández, IMartín-Herranz. ACoruñaUniversityHospitalComplex,Pharmacy,ACoruña,Spain

10.1136/ejhpharm-2024-eahp.275

BackgroundandImportance PembrolizumabisaPD-1antibody,whichwasfirstapprovedwithadosageregimenof2 mg/kgevery3weeks.In2018,marketingauthorisationwas changedtofixeddosingof200mgevery3weeks.

TheCommissionofPharmacyandTherapeuticsofour regionhastakenthestancethatbasedontheavailableevidencebothregimensmaybeused.

Therefore,ourhospitalhasagreedonaprotocolthat establishestousefixed-doseforpatientswithweight 100 kgandtheweigh-basedfor<100kg.

AimandObjectives EvaluationoftheaccordancetotheprotocolestablishinourhospitalforthedoseofPembrolizumab andtocalculatethefinancialimpactofthisimplementation. MaterialandMethods Retrospectiveobservationalstudyin individualswhostartedpembrolizumabsince1August2022 for1year.

Variablesanalysed wereepidemiological,weigh,cancertype, initialdate,fixed-doseorweight-doseprotocolused,change oftheprotocol.

1081.75C ¼ hasselectedasthevialpriceof100mgof pembrolizumab.

Datawasextractedfromourprescriptionsoftwareforchemotherapy(Oncofarm®).

Results 131patientsinitiatedpembrolizumab,62.60%men, meanage65yearsold.Meanweightwas71.8kgandfour patientsweighted>100kg.Pembrolizumabcancerindications were:melanoma(6.11%),non-small-celllung(57.25%),head andnecksquamous(6.11%),renal(3.05%),colorectal (3.82%),triple-negativebreast(9.92%),endometrial(5.34%), cervical(2.29%),gastric(2.29%)andothers(3.82%).

74.05%(n=98)ofthepatientsinitiatedatthefixed-dose andonly25.95%(n=33)withweigh-baseddose.Therewere fourpatientswithweight>100kgwhichinitiatedwith200 mg.

Ofthepatientsthatinitiatedwithfixed-dose,11.22% (n=11)changedtotheweight-baseddose.Dosewasreduced inameanof24.91%,whichimpliedatotalcostreductionof 29012C ¼ (mean2637C ¼ perpatient)andrepresenteda 14.86%meancostreductionincomparisonwithcontinuing withthefixed-dose.

ConclusionandRelevance Althoughitwasaccordedtouse weight-basedstrategyforthepatients<100kg,thereality wasthanlessthan26%ofthenewpembrolizumabtreatments wereincompliancewithit.

However,itistruethatapproximately10%ofthepatients werechangedtotheweight-basedregimeninorderto decreasetheeconomicalcost.

REFERENCESAND/ORACKNOWLEDGEMENTS

Keytruda:EPAR – Productinformation. ConflictofInterest Noconflictofinterest.

4CPS-172

IMPROVINGPOST-OPERATIVEANALGESIAAND ASSOCIATEDPRESCRIBINGINTHEORTHOPAEDIC SETTING

1MRichardson*, 2GMahoko, 2BFauzia, 3HO’brien. 1OurLadyOfLourdesHospital Drogheda,Pharmacy,Drogheda,IrelandRep; 2OurLadyOfLourdesHospitalDrogheda, Anaesthetics,Drogheda,IrelandRep; 3OurLadyOfLourdesHospitalDrogheda,Geriatrics, Drogheda,IrelandRep

10.1136/ejhpharm-2024-eahp.276

BackgroundandImportance InJanuary2022theHSEissued ‘Guidanceforopioidprescribingforacutenoncancerpain, postoperativepainandpost-procedurepain’

ThreeGuidancedocumentsweredevelopedbyamultidisciplinaryteamcomprisingof:seniorpharmacist,painmanagementCNS,consultantortho-geriatricianandconsultant anaesthetist.

Threekeydocumentsweredeveloped

. Post-OperativeOpioidConversionChart

. AnalgesiaPrescribingGuideline

. OpioidPatientInformationLeaflet

AimandObjectives Theaimoftheprojectwastoimplement therecommendationsoftheHSEGuidelinesto ‘improvequalityandsafetyofopioidprescribingintheacutehospitalsettingandreduceharmfromtheiruse’ .

Theobjectiveswere Avoiduseoflong-actingopioidsinthe port-operativesetting

Appropriateprescribingofpost-operativemedicines.

Materialandmethods Apointprevalencebaselineauditof post-operativeprescribingwasundertakeninJuly2022before theintroductionoftheguidelines.

A2postersoftheguidancedocumentswereprintedand displayedontheorthopaedicwardaccompaniedbyintensive education.

Prescribingwasreauditedusingthesameparametersin November2022.

Results Thedemographicsofthepatientsfortheaudit(n=29) andre-audit(n=28)werecomparable.Hiprelatedinjuries wasthemostprevalenttypeofinjuryforpatientsinboth audits.

Thebaselineauditfoundthehighestincidenceofinappropriateprescribingintheareasof:Opioids,Laxativesand NSAIDs.Thesethreeareasweretargetedforimprovement.

Asummaryofthekeyresultsisdepictedintable1below:

Abstract4CPS-172Table1 Comparisonofprescribingofaudit andre-audit

Akeylearningpointwasthateducationprovisionmustbe continuouswithintensificationatthetimeofteamrotations. Sincecompletionofthisinitialproject,aseparategeneral surgerypost-operativeprescribingguidelinehasbeen developed.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Guidanceforopioidprescribingforacutenoncancerpain,postoperativepain& postprocedurepain,HSE,Jan2022,https://msurgery.ie/wp-content/uploads/2022/ 02/Opioid-guidance-HSE-1.3-CDI-Final.pdf

ConflictofInterest Noconflictofinterest.

4CPS-173 PRESCRIPTIONOFPSYCHOTROPICDRUGSIN PATIENTSWITHHUMANIMMUNODEFICIENCYVIRUS INFECTIONONINTEGRASEINHIBITOR-BASED ANTIRETROVIRALTHERAPY

FBarceló*,EBofillRoig,LHernandezSilveira,APonsMaria,LAnozJimenez,JALuque Mesa. HospitalCanMisses,Pharmacy,Eivissa,Spain

10.1136/ejhpharm-2024-eahp.277

BackgroundandImportance Neuropsychiatricadverseeffects, suchasdepression,anxietyandsleepdisorders,areassociated withintegrasestrandtransferinhibitors(INSTIs).Accordingto astudy,therateofNPAEwithbictegravirishigherthanfirst generationINSTIs.

AimandObjectives Toanalysewhethertheswitchofintegrase inhibitorinpatientswithchronichumanimmunodeficiency virus(HIV)infectiononantiretroviraltreatment(ART)affects theconsumptionofpsychotropicdrugs.

MaterialandMethods Weincludepatientswhoin2019were beingtreatedwithelvitegravir/cobicistat-basedARTandasof 2021,theyeithermaintainedthesametreatment(group1)or switchedtobictegravir-basedARTduringthenext2years (group2).

Theprimaryendpointwastherelativeriskoftakingpsychotropicdrugsafterchangingantiretroviraltreatment.

Thehometreatmentofthesepatientswasreviewedand thosewhohadbeentreatedwithpsychotropicdrugs,suchas anxiolytics,hypnoticsandsedatives,andantidepressants (N05B,N05CandN06AintheATCclassification,respectively)duringthestudyyears,wereselected.

ThedatawereobtainedthroughthePharmaceuticalBenefit Managementprogram(GAIA®)

Results Atotalof122patientswereincluded:34(27.9%) weretreatedwithelvitegravir/cobicistatduringthe4yearsof thestudy(group1)and88(72.1%)switchedtobictegravirin 2021andmaintaineditin2022.(group2).

Whilethepercentageofpatientstreatedwithpsychotropic drugsremainedstableingroup1,thepercentageofpatients takinganypsychotropicdrugincreasedby9%inthegroup thatswitchedtobictegravir.Theantiretroviraltreatment changegrouphada6.5timesgreaterriskoftakingsome typeofpsychotropicdrugthanthecontrolgroup,butthis increaseinriskwasnotstatisticallysignificant(p=0.19).

ConclusionandRelevance Post-operativeanalgesiaandassociatedprescribingcanbeimprovedwithprovisionofclear, accessible,evidencebasedguidelinesandinformationtoprescribersandwardstaff.

Inthegroupofpatientswhowerenottakingpsychotropic drugs,15%startedtakingthemafterswitchingtobictegravir comparedto9%inthecontrolgroup(RR1.6p=0.5).

ConclusionandRelevance Almost40%ofpatientsbeing treatedwithintegraseinhibitorsarebeingtreatedwithsome

psychotropicdrug.Thechangefromelvitegravir/cobicistatto bictegravirseemstobeaccompaniedbyaslightincreasein thetakingofpsychotropicdrugs,althoughitwasnotstatisticallysignificant.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.doi:10.1097/COH.0000000000000705.PMID:34475342.

ConflictofInterest Noconflictofinterest.

4CPS-174 NASALESKETAMINEUSEFORMAYORDEPRESSIVE DISORDER,FROMATHIRD-LEVELHOSPITALTO PERIPHERALMENTALCENTRES

ISanchezMonasterio*,AEzeiza,CSaiz,IZipitria,ALatasa,IBeristain,LMMendarte, ARos,GLiseaga,JMHernandez,SArostegi. UniversityHospitalDonostia,Hospital Pharmacy,SanSebastian,Spain

10.1136/ejhpharm-2024-eahp.278

BackgroundandImportance Esketaminewasrecentlycommercialisedformajordepressivedisorderandinourcommunity isavailablethrougharestrictedprogramduetoitscharacteristicsandprice.Inthisstudy,thepatientsstartedthetreatmentatanacutehospitalandwhentheyreachthe maintenancewerederived toperipheralMentalHealth Centres.

AimandObjectives Studytheeffectivenessandsecurityof Nasalesketamineinanacutehospital.

MaterialandMethods AllpatientsstartingesketaminetreatmentfromDecember2022toJuly2023wereincluded. Efficacyandadverseeffect(AE)datawerecollectedand evaluatedateachdoseadministered,objectivelywiththe MADRS(Montgomery-AlbertdepressionRatingScale).A psychiatristandpsychiatricnurseevaluatesubjectiblyanda pharmacistregisteredit.Thisdatawerecollectedthree times:beforetreatment,duringandattheendofthestudy.

Results 33patientswereincluded;20women,medianage56 years[31–74]andmedianweight72kg[42–110].Five patientsleftthetreatment,threeduetoAEandtwothat werenotevaluatedbyMADRS.

In28patients,thedifferenceoftheMADRSmediansprior totreatmentcomparedtothetwotimesstudiedwassignificant(p=0.00).Beforetreatmentthemedianwas44(IQR35–46.75),attheendofinduction25(IQR20–31.5)andatthe endofthemaintenance23.5(IQR11.5–29.75).

Patientswentfromseveretomoderate-milddepressionin approximately12weeks,twopatientsobtainedremission, MADRS<6result.

TwopatientsdroppedoutduetoseveredissociativeAEs andanotheroneduetolackofefficacyandAEs.Nevertheless,AEsweregenerallymild-moderateandtolerance improvedastreatmentprogressed.MostfrequentAEswere 73%drowsiness,53%dizziness,50%dissociativepictures, 36%transienthypertension,13%gaitinstability.Theseeffects generallysubsidewithintwohoursandinsomepatientsthe toleranceimprovedincreasingthetimebetweennebulisation ’ s morethan5–10min.

ConclusionandRelevance EAprofileandeffectivenessissimilartotheclinicaltrial.Itispossibletomanagethesepatients inperipheralMentalHealthCentresduetothetoleranceof theAEandthegoodresultsofthetreatment,permittingdischargetheacutehospital.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Esketamine[Datasheet].Janssen-CilagInternationalNV.18December2019.

ConflictofInterest Noconflictofinterest.

4CPS-175 EFFECTIVENESSOFIMMUNOTHERAPYASA FUNCTIONOFAGE:META-ANALYSISOFTHE APPROVEDCOMBINATIONSINFIRST-LINE METASTATICNON-SMALL-CELLLUNGCANCERIN PATIENTSWITHOUTMUTATIONS

1AAguadoParedes*, 2EJAlegreDelRey. 1HospitalUniversitarioVirgenMacarena,Clinical Pharmacy,Sevilla,Spain; 2HospitalUniversitarioPuertoReal,ClinicalPharmacy,Cádiz,Spain

10.1136/ejhpharm-2024-eahp.279

BackgroundandImportance Itcouldbehypothesisedthat patientsolderthan65yearsoldmayexperiencedecreased immunefunctionduetothenaturalagingprocess,which couldleadtoamorelimitedresponsetoimmunotherapy comparedtothoseyoungerthan65yearsold.

Theforest-plotanalysisforage-dependentoverallsurvival fromtheclinicaltrialofcemiplimabincombinationwithchemotherapyinlocallyadvancedormetastaticnon-small-cell lungcancer(NSCLC),EMPOWER-Lung3,showedaborderlineinteractionbetweenthesubgroupsyoungerandolder than65yearsold,withap-interaction=0.0895(owncalculation)andHR0.53(0.39–0.72),HR0.81(0.55–1.18), respectively.

AimandObjectives Toverifytheconsistencyofthehypothesis ofanage-relatedeffectivenessbyameta-analysisconsidering allapprovedimmunotherapycombinationsinfirst-line NSCLC.

MaterialandMethods AMEDLINE-PubMedliteraturesearch wasconductedforphaseIIIrandomisedclinicaltrials(RCTs) withsimilarpopulationanddurationofpembrolizumab,atezolizumab±bevacizumab,nivolumab+ipilimumab,durvalumab +tremelimumabandcemiplimab,incombinationwithchemotherapyandnivolumab+ipilimumab.Ameta-analysiswas performedwiththeMetaSurvcalculator.Theprimaryendpointwasoverallsurvival(OS)inpatientsyoungerandolder than,orequalto,65yearsofage.Age-dependentOSdata forimmunotherapycombinationsversusacommoncomparator,platinum-basedchemotherapy,werecompared.Interaction wasconsideredsignificativeifp<0.05anddoubtfulif 0.05£p<0.1.

Results ApooledHRof0.67(95%CI0.58–0.76), p<0.000001wasobtainedinpatientsyoungerthan65years ofage.Heterogeneityamongtrialsestimatevalueswereasfollows:Q14.84,p=0.03812.I253%(CI95%0–79%).

Inthoseolderthan65yearsold,thecombinedHR obtainedwas0.77(95%CI0.70–0.84),p<0.000001.Heterogeneityestimatevalueswereasfollows:Qforheterogeneity 0.81p=0.99733.I20%(CI95%0–0%).

Thecalculatedp-interactionbetweenthecombinedHRsof theunder-65andover-65groupswas0.0551,whichisconsideredadoubtfulinteractioninasubgroupanalysis.

ConclusionandRelevance Asignificantbenefitforimmunotherapy-chemotherapyoverchemotherapyalonewasshownin bothagegroups.Thereissomeconsistencyregardinga greatereffectivenessofimmunotherapyinpatientsunder65 yearsofage,butmoredatawouldbeneededtoconfirmthis possibledifference.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-176 USEANDPERSISTENCEOFGUSELKUMABIN TREATMENTFORRHEUMATICAND DERMATOLOGICALDISEASE

1POrtizFernandez*, 2AHerrerosFernandez, 2PFernandez-VillacañasFernandez, 2PSelvi Sabater, 2MAlmanchelRivadeneyra, 2RAñezCastaño, 2MOntenienteCandela, 2EUrbieta Sanz. 1ReinaSofíaHospital,Pharmacy,Murcia,Spain; 2HospitalGeneralReinaSofia, Pharmacy,Murcia,Spain

10.1136/ejhpharm-2024-eahp.280

BackgroundandImportance Guselkumabisanti-interleukin-23 monoclonalantibodyusedformoderatetoseverepsoriasis (msPs)andpsoriaticarthritis(PsA)inpatientsrefractoryto otherbiologicalagentsinclinicalpractice.

AimandObjectives ToanalysetheprofileofuseandpersistenceofguselkumabinpatientsdiagnosedwithmsPsandPsA.

MaterialandMethods Anobservational,descriptiveandretrospectivestudy(May2019toAugust2023)inwhichwe includedallpatientswhoinitiatedtreatmentwithguselkumab. Dataofsex,age,diagnostic,comorbidities,previousbiological, startdate,lastdispensationdateandthereasonsfortreatment discontinuationwerecollectedfromthemedicalrecordsand prescriptionmedicationsprogram.

Categoricalvariablesweresummarisedaspercentage(N) andasmedianforcontinuousvariables.ThecumulativeprobabilityoftreatmentpersistencewasanalysedbyKaplan-Meier methodandlog-ranktesttocomparethesurvivalalongdiagnostic,lineoftreatmentandcomorbiditiesusingSPSSStatistics,consideringap-value<0.05.

Results Guselkumabwasinitiatedby40patients,57.5%(23) withPsAand42.5%(17)withmsPs.Medianagewas54 years,and57.3%(23)werefemale.Allpatientshadprior exposuretobiologictherapyexceptone,87.5%(35)antiTNF-a(adalimumab,infliximab,etanercept),47.5%(19)antiIL-17(ixekizumab,secukinumab)and30%(12)ustekinumab. Theexposedpatients97.5%(39)hadused1–5biologictherapiesbeforeguselkumabinitiation,40%(16)ofpatients receivedthreeormoretherapies.22.5%(9)ofpatientshad nocomorbidities,35%(14)hadatleastonecomorbidityand 42.5%(17)showedtwoormore.

Thecumulativeprobabilityofguselkumabtreatmentpersistencewas74.8%at1yearand67.3%at2years.Median persistenceofguselkumabwas31.2months(95%CI:21.2–41.2).32.5%(13)discontinuedtreatmentduringthestudy, themaincauseofdiscontinuationwassecondaryfailure (46.1%).Comparinggroups,therewerestatisticaldifferences inguselkumab’spersistenceinmsPsvsPsA(14–36.7months, p=0.059),however,patientswithorwithoutprioranti-IL-17 therapy,withorwithoutcomorbidities,oraccordingtothe numberofpriorbiologicsdidnotshowanystatistical differences.

ConclusionandRelevance Drugsurvivalofguselkumabinthis studyisacceptablebutmainlimitationisshortfollow-uptime insomeofthepatientsduetotheirrecentcoveragebythe SpanishhealthsysteminPsA.Morestudieswithlargersample sizesareneededtoestablishthefactorsthatplayakeyrole inthepersistenceoftreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-177 LONG-ACTINGINTRAMUSCULARANTIRETROVIRALS: WHATREAL-WORLDDATADOWEHAVE?

1SEsteban*, 1ICanamares-Orbis, 1CEsteban-Alba, 1NFont-Tarres, 1LPedraza-Nieto, 1SPrieto-Roman, 2JTroya-Garcia, 2PRyan-Murua, 2GCuevas-Tascon, 2MMatarranz-Del Amo, 1IEscobar-Garcia, 2SRodriguez-Perut. 1HospitalUniversitarioInfantaLeonor, Pharmacy,Madrid,Spain; 2HospitalUniversitarioInfantaLeonor,InternalMedicine,Madrid, Spain

10.1136/ejhpharm-2024-eahp.281

BackgroundandImportance Thenewintramuscularantiretroviraltreatments(IM-ART),cabotegravir-rilpivirine,haverepresentedabreakthroughinreducingstigmaandimproving adherenceamongHIVpatients.However,itisnecessaryto understandhowtheirreal-worlduseimpactspatientoutcomes. AimandObjectives Toassesstheeffectivenessandsafetyof IM-ARTinreal-worldsettingsandinvestigatetheirimpacton analyticalparameters.

MaterialandMethods Aretrospectiveobservationalstudy conductedfromJanuarytoSeptember2023,includingall patientstreatedwithLA-ARTwithatleastthreedoses.Demographicdata(age,gender),tre atment-relatedinformation (previousARTandpresenceofresistancemutations(RM)), clinicaldata(LDL-cholesterol, HDL-cholesterol,creatinine, GOT,GPT,alkalinephosphatase,GGT,totalbilirubin,calcium,andphosphorusbeforeandafterIM-ART),andeffectivenessdata(HIV-RNAcopies(CV),CD4count,andCD4/ CD8ratiobeforeandafterstartingIM-ART)werecollected. Adverseevents(AE)andpainassessedontheVisualAnalog Scale(VAS)duringthefirsttwoadministrationswere recorded.PairedStudent ’st-testandWilcoxonsigned-rank testwereusedforstatisticalanalysisofdifferencesbetween pre-andpost-LA-ARTvariables,dependingonthedistribution.Statisticalanalysiswas performedusingStata/IC16.1 software.

Results Sixty-sixpatients(93.9%men)wereanalysed.Median age:42years(IQR:38–46).50,0%werereceivingtripletherapybeforetheswitch,and27.6%hadatleastoneRM, whichdidnotaffectIM-ART.ThreepatientshadCV>30 copies/mLbeforestartingLA-ART.AllpatientsincludedmaintainedCV<30copies/mLduringthestudyperiod.Statistically significantdifferenceswereobservedinLDL-cholesterol (p=0.0193)andCD4(p=0.0035)betweenpre-andpost-IMARTvalues.

AllpatientsexperiencedatleastoneAE,withinjectionsite reactionsbeingthemostfrequent(98.5%).TheobservedAEs included:generalmalaise(36.7%),asthenia(13.6%),fever (12.1%),diarrhoea(9.1%),headache(7.6%),sleepdisturbances(6.1%),nausea(3.0%),andothers(4.5%).Onepatient discontinuedIM-ARTduetoAE.

DifferencesinpainassessedontheVASwereobserved betweenrilpivirinevscabotegraviradministration[0.9(95% CI:0.3–1.5;p=0.0029)]andbetweenthesecondvsfirst administration:rilpivirine[1.6(95%CI:0.5–2.7;p=0.0042)]; cabotegravir[1.6(95%CI:0.6–2.6;p=0.0032)].

ConclusionandRelevance LA-ARThasdemonstratedeffectivenessandacceptablesafetyinreal-worlddata,consistentwith theresultsoftheATLASandFLAIRstudies.Longer-term studiesareneededtoevaluatetheevolutionofCD4counts, LDLlevelsandpain.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-178

EFFECTOFPCSK9INHIBITORSON HYPERCHOLESTEROLEMIA

AFerrerMachín*,SMartinRodriguez,JVilarRodriguez,MDLAPadronGarcia,MVera Cabrera,JAriasBlaco,MDCVillastrigoGarcia. HospitalPharmacist,PharmacyService, Arrecife,Spain

10.1136/ejhpharm-2024-eahp.282

BackgroundandImportance Patientswithhypercholesterolaemiaareatriskofcardiovascularevents.Somepatientshave toresorttomonoclonalantibodytreatmentstolowertheir bloodcholesterollevels,despitetakingstatinsatfulldoses.

AimandObjectives Theaimofthisstudyistodeterminethe reductionofLDLcholesterol(LDL-c)withPCSK9inhibitors (alirocumabandevolocumab)inpatientswithmixeddyslipidaemia,atheroscleroticcardiovasculardiseaseorfamilial hypercholesterolemia.

MaterialandMethods

Retrospectiveobservationalstudy AdultpatientsundertreatmentwithALIorEVO,withatleast12weeksoffollow-up wereincluded.Patientswithoutcontrollaboratorytestsafter initiationoftherapywereexcluded.

Primaryendpointofthestudywasthepercentagereduction inLDL-cwithrespecttobaseline.

Retrospectivedatacollectionwascarriedoutusingelectronicmedicalrecords(Selene®)andtheanalysisresultssoftware(INFINITY).TheMann-WhitneyUtestwasusedto determinewhetherthereweredifferencesinthepercentage reductionofLDL-cwithrespecttobaselinebetweenpatients treatedwithalirocumabandevolocumab.

AnalyseswereperformedusingSPSS/PCstatisticalsoftware (version24.0forWindows,SPSS,Inc,Chicago,IL).

Results Eighty-eightpatientswereanalysed,ofwhom67% weremaleandthemedianage59±9years.

Ofthe88patients,61%werediagnosedwithmixeddyslipidaemia,31%withfamilialhypercholesterolemia,andthe remainderwithatheroscleroticcardiovasculardisease.Eightyonepercentofthepatientsweretreatedwithalirocumaband theremainderwithevolucumab.

ThebaselineLDL-clevelwas156mg/dL[126–188],total cholesterol238mg/dL[202–266],HDLcholesterol45mg/dL [37–54]andtriglycerides183mg/dL[114–250].Atthe patients‘ lastbloodtest,afteraminimumof12weeksfrom thestartoftreatment,LDL-cwas60mg/dl[37–67],total cholesterol137mg/dl[114–170]andHDLcholesterol48mg/ dl[41–60].

ThemedianpercentreductioninLDL-cfrombaselinein patientsonPCSK9inhibitortreatmentwas45%.Thispercent reductionwas43%whileinpatientsonevolocumabtreatment itwas46%,U=552,z=-0.374,p=0.708.

ConclusionandRelevance TreatmentwithPCSK9inhibitors reducesbasalLDL-cby45%.Nostatisticallysignificantdifferenceswerefoundaccordingtothetreatmentused(alirocumab orevolocumab),p=0.708..

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-179 REAL-LIFEANALYSISOFTHEDEVELOPMENTOFANTIDRUGANTIBODIESINPATIENTSWITH INFLAMMATORYBOWELDISEASEANDTHERAPEUTIC APPROACH

1SGarciaGarcia*, 1MLarrosa-Garcia, 1SClementeBautista, 2XSerraRuiz, 3MFreixas Bermejo, 3OSegarraCanton, 2ECespedesMartinez, 1PMarreroAlvarez, 4MTSanz Martinez, 3ACuevasMoreno, 2NBorruelSainz. 1VallD’hebronBarcelonaHospitalCampus, PharmacyDepartment,Barcelona,Spain; 2VallD’hebronBarcelonaHospitalCampus, Crohn’sAndColitisAttentionUnit-GastroenterologyDepartment,Barcelona,Spain; 3Vall D’hebronBarcelonaHospitalCampus,PediatricGastroenterology-HepatologyAndNutrition Department,Barcelona,Spain; 4VallD’hebronBarcelonaHospitalCampus,Immunology Department,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.283

BackgroundandImportance Lossofresponsetoinfliximab andadalimumabtherapymayoccurduetodevelopmentof neutralisinganti-drugantibodies(ADA),leadingtotreatment failureininflammatoryboweldisease(IBD).

AimandObjectives Toassesstheimmunogenicityofinfliximab andadalimumabinadultsandpaediatricIBDpatients,along withtherapeuticapproachandpotentialfactorscontributing ADAdevelopment.

MaterialandMethods Retrospectiveobservationalstudyin adultandpaediatricIBDpatientstreatedwithinfliximaband adalimumab,betweenJanuary2019toJune2023.

Adalimumab,infliximabandADAconcentrationswere determinedbyenzymeimmunoassays.Concretely,ADAif patientshadinfliximab £3mcg/mlandadalimumab £5mcg/ml concentrations(drug-sensitiveassay).Standarddosageregimen (SD):adalimumab40mg/14days,Infliximab5mg/kg/8 weeks;intensifieddosageinvolvedeithershorteningtheintervalorincreasingdose.

Results 659patientswereincluded.Specifically,399(60.5%) receivedadalimumab:24(6.0%)paediatricsand375(94.0%) adults;and260(39.5%)receivedinfliximab:36(13.8%) paediatricsand224(86.2%)adults.

Adalimumabantibodies(AAA)wereevaluatedin412samplesfrom195(48.9%)patients[10(5.1%)paediatricsand 185(94.9%)adults]andinfliximabantibodies(ATI)wereevaluatedin377samplesfrom150(57.7%)patients[19(12.7%) paediatricsand131(97.3%)adults].

Thirteen(3.3%)patientsdevelopedAAA:allwereadults withCrohn’sdiseaseandmeanageof40.6(12.9)years, including7(53.8%)females.Seven(53.8%)patientshadbeen onadalimumabfor<1year.AtthetimeofAAAdetection, five(38.5%)patientshadadalimumabSD,andsix(46.2%) receivingimmunosuppressants.Eleven(84.6%)patientsdiscontinuedadalimumab,whiletwo(15.4%)withAAAof133ng/ml and107.9ng/mlunderwentadalimumabintensification achievedAAAnegativisation.Pooradherencewassuspectedin five(38.5%)patients.

Twenty-two(8.5%)patientsdevelopedATI:20(90.9%) adultswith45.2(12.8)years,including8(40%)females;and 2(9.9%)paediatricswith15.0(5.7)yearscomprisingone (50%)female.IBDdiagnosed:Crohn’sdiseasein14(63.6%) andulcerativecolitisineight(36.4%)patients.Eleven(50%)

patientshadbeenoninfliximabfor<1year.Atthetimeof ATIdetection,12(54.5%)patientshadinfliximabSD,and12 (54.5%)receivingimmunosuppressants.Thirteen(59.1%) patientsdiscontinuedinfliximab,whileseven(31.8%)with ATI<30ng/mlandtwo(9.1%)with100.6ng/mland171.7ng/ mlunderwentinfliximabintensificationachievedATInegativisation.Pooradherencewasconfirmedinsix(27.3%)patients.

Adalimumabandinfliximabconcentrationswere<1mg/ml inallpatientswithADA.

ConclusionandRelevance AproportionofIBDpatientsdevelopedADA,withahigherincidenceobservedinthosereceivinginfliximab.Enhancingadherencecouldreducetheriskof ADAdevelopment,andintensifyingtreatmentmaybeeffective inachievingADAnegativisation.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-180 SACITUZUMAB-GOVITECANINMETASTATICTRIPLENEGATIVEBREASTCANCER:COMPARISONOFOUR DATATOTHEASCENTTRIALAFTER2YEARSOF EXPERIENCE

LDho*,AMaire,CLevenbruck,JCoussirou,DZerbib,FDeCrozals. InstitutSainte Catherine,Pharmacy,Avignon,France

10.1136/ejhpharm-2024-eahp.284

BackgroundandImportance Sacituzumab-govitecan(SG)isan antibody-drugconjugateusedinmetastatictriple-negative(TN) breastcancer(BC).Adverseevents(AEs)describedinthe physicaldeskreferenceareoftenbasedonanoverselected populationandcanbemoresevereinreal-lifeconditions.

AimandObjectives Aftertwoyearsofpractice,whatarethe mostcommonAEsinourhospitalandwhatdidwedoto preventthem?

MaterialandMethods Wedidaretrospectivestudythat includedallourpatientswithTNBCfromMay2021toJuly 2023,andcomparedourresultstotheAscentTrial(AT).We monitoredtheirgeneralstate,thenumberoftreatmentsand metastaticsitestheyhadbeforethefirstcycle,thetypesand gradesofAEandhowwemanagedthem.

Results Our25patients’ mediumagewas62(AT=54).In ourstudy,themediannumberoflinesbeforeSGwasfour, justlikeintheAT.56%ofourpatientshadaperformance status(ECOG)0(AT=43%),32%wereECOG1(AT= 57%)and12%wereECOG2.

RegardingAEsalone,21outofour25patientsexperiencedthem,mainlyafter15,2weeksoftreatment(aroundthe fifthcycle).Theaveragedose-intensityatthetimeofAEswas 1120±300mg/21days.56%ofourpatientshadneutropenia(AT=63%)butwehadlessgrade3orhigher(G3+) neutropeniacomparedtotheAT(24%versus51%).68%of ourpatientsreceivedgrowthfactors(AT=49%).52%of ourpatientsexperiencedasthenia(AT=45%),44%nausea (AT=57%)and52%diarrhoea(AT=59%)amongwhich 20%wereaG3+(AT=10%).

DosereductionsweremorefrequentinourgroupcomparedtotheAT(60%versus22%).28%hadtoskipatleast onecycleandthreepatientshadtochangelinebecauseof AE.

ConclusionandRelevance Ourstudy ’sAEsweresimilartothe onesdescribedintheAT.However,weobservedmoreG3+ diarrhoeaandlessG3+neutropenia.SinceJune2023,

atropinehasbeenusedassystematicpremedicationtoprevent severediarrhoea.Ourcentrealsoresortstogrowthfactor injectionsmorefrequently.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-181 ELECTRONICPRESCRIBINGINTHENEONATAL INTENSIVECAREUNIT:ANALYSISOFPRESCRIBING ERRORSANDRISKFACTORS

1LCanales*, 1CGarcía-Muñoz, 1JMCaro, 1MFrancisco, 1JMariaDelCarmen, 1FJose Miguel, 2PSalvador, 2PCarmenRosa, 1MMariaTeresa. 1Hospital12DeOctubre,Servicio DeFarmacia,Madrid,Spain; 2Hospital12DeOctubre,ServicioDeNeonatología,Madrid, Spain

10.1136/ejhpharm-2024-eahp.285

BackgroundandImportance Patientsadmittedtoneonatal intensivecareunits(NICU)areuptoeighttimesmoreatrisk ofmedicationerrorsthanpatientsadmittedtoadultintensive careunits.Prescribingerrorsaccountforupto74%ofmedicationerrors.Theimplementationofelectronicprescribinghas beenpostulatedasausefultooltoreduceprescriptionerrors. AimandObjectives Toanalysethemostprevalentprescribing errorswiththee-prescribingsystemandtoanalyserisk factors.

MaterialandMethods Allpatientsbornduringthestudy periodwhowereadmittedtotheNICUforatleast24hours andwithactivepharmacologicaltreatmentwereincludedin thestudy.TheprescriptionsweremadeintheIntelliSpace CriticalCareandAnaesthesia(ICCA®)electronicassistedprescriptionsoftwareintegratedinthemedicalrecordforthe criticallyillpatient.Treatmentreviewwasperformedbya pharmacistonadailybasisanderrorsweregradedaccording tothetaxonomiccriteriaoftheNationalCoordinatingCouncilforMedicationErrorReportingandPrevention. Results 240patientsparticipated(September2021toJune/ 2022).Atotalof13,876prescriptionswerereviewedin158 patients;455errorswerefoundin119patients.

Prescribingerrorswereconcentratedin40drugs/nutritions ofthetotal139thatwereprescribed.Themostfrequent errorwasthediscrepancybetweentheprescriptionandthe associatedfreetextfield(n=96)withmorethanhalfofthese errors(n=106,54.1%)concentratedinenteralnutrition.The fivedrugswiththemosterrorswere:lactobacillusacidofilus (n=45,9.89%),caffeinecitrate(n=40,8.79%),paracetamol (n=35,7.69%),gentamicin(n=25,5.49%)andcholecalciferol (n=16,3.52%).

Intermsofriskfactors,patientswithabirthweight between1000–1500gramswere82%morelikelytohavean errorthanthosewithextremelylowbirthweight(<1000g) (OR=1.81,CI95%1.42–2.89,p<0.05).Prematuritywasalso associatedwithanincreasedriskofprescriptionerrors,the patientsathighestriskwerethosewithgestationalage between28–32weeks,with29.80%higherriskofprescriptionerrorcomparedtogestationalagelessthan28weeks (OR=1.29,CI95%1.02–1.65,p<0.05).

ConclusionandRelevance Prescribingerrorsweremorefrequentinverylowbirthweightandverypretermpatients.It isimportanttoknowwhichdrugsaremoresusceptibletoeprescribingerrorsandinwhichtypeofpatientsinorderto implementadditionalsafetymeasures.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-182 DESCRIPTIONOFACLINICALPHARMACIST INTERVENTIONFOCUSEDONMANAGEMENTOFA CHRONICDISEASEATHOSPITAL:THEEXAMPLEOF CHRONICOBSTRUCTIVEPULMONARYDISEASE(COPD)

1MRigoni*, 2AMaire, 3SDroneau, 1GLeguelinel, 1FDubois. 1UniversityHospitalofNîmes, Pharmacy,Nîmes,France; 2InstitutSainteCatherine,Pharmacy,Avignon,France; 3University HospitalofNîmes,Pneumology,Nîmes,France 10.1136/ejhpharm-2024-eahp.286

BackgroundandImportance COPDiscurrentlythethirdleadingcauseofdeathworldwidewith3.23milliondeathsin 2019.Despiterecommendations,manycarenon-conformities areobservedinCOPDpatients.

AimandObjectives Theaimofthestudywastodescribethe interventionofaclinicalpharmacistfocusedontherespectof COPDmanagementrecommendationsemittedbytheFrench HealthAuthority.

MaterialandMethods Ourstudyisanobservationalstudy conductedbetweenJanuaryandJuly2022.Clinicalpharmacist includedCOPDpatientsandperformedapharmaceutical interviewfocusedonCOPDmanagement.Thisinterview assessedmedicalfollow-upbyapneumologist,smoking,vaccinationagainstpneumococcus,COPDmedication,medication adherenceandproperuseofinhalationdevices.Thenumber ofnon-conformitiestorecommendationsandtheirdistribution werecollectedattheendoftheintervention.Propositions emittedbyclinicalpharmacistwerecollectedandfactorsthat mayhaveanimpactontherecommendationsnon-compliance wereidentified.

Results Atotalof85patientswereincludedinthestudy.The meanagewas70.5years.Atotalof173non-conformities weredetectedon79patients,i.e.,twonon-conformitiesper patient.Atleastonenon-conformitywasobservedin93%of patients.Themostfrequentnon-conformitieswerethemisuse ofinhalationdevices(77.2%)andtheabsenceofvaccination againstpneumococcus(67.1%).Followupbyapneumologist concerned64.7%ofpatients,32.9%ofpatientswereactive smokersand31.2%oftheprescriptionswereconsideredto benon-compliant.Afterinterview,89propositionswereemittedandclinicalpharmacistinterventionallowedtochange COPDmedicationon14.1%ofpatients.Follow-upbya pneumologistincreasessignificantlypneumococcalvaccination coverageandproperuseofinhalerdevices.

ConclusionandRelevance Ourstudyshowsthatclinicalpharmacistcandetectnon-conformitiesandmakerecommendations tooptimiseCOPDmanagementduringpatienthospitalisation. Thiskindofinterventioncouldalsobeusedforpatientssufferingfromotherchronicdiseaseasheartfailure,asthmaor diabetes.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-183 PHARMACISTLEDOPT-OUTCESSATIONTREATMENT PROTOCOLFORCOMBUSTIBLETOBACCOSMOKING

MLefebvre,PLy,MGaume,CBerge-Bouchara,CDuval,CAiriau*. CentreHospitalier

Cholet,Pharmacy,Cholet,France

10.1136/ejhpharm-2024-eahp.287

BackgroundandImportance Inhospitalswherepharmacistsare accountableforobtainingmedicationhistoriesandcompleting medicationreconciliationandmedicationrelatededucationfor allpatients,thepharmacistoffersanearlyuniversalaccess pointtoaddresstobaccouseanddeliveracessation intervention.

AimandObjectives Thisformativestudydescribesthedevelopmentandrefinementofapharmacist-ledinterventionthrough pilottestingtofullimplementation,withinputfrompharmacistsandothers.

MaterialandMethods Adelegationprotocolforhospitalpharmacyinpatientswhosmokedcigarettesgavehospitalpharmaciststheauthoritytoordernicotinereplacementtherapy (NRT)duringhospitalisationandatdischarge.Thesmoking cessationinterventionprotocolwasapprovedbythehospital’ s PharmacyandTherapeuticsCommitteeandMedicalBoard.

Patientstargetedforinterventionwereadults(age18years orolder)admittedtoaparticipatinginpatientunitandservice whowereidentifiedviaanEHRentryonadmissionascurrentlysmokingcigarettes(atanylevelofsmoking),withor withoutotherformsoftobaccouse.

Theprogrammewaspilottestedinphases,withpharmacist feedbackbetweenphases,andthenimplementedhospital-wide. Interviews,surveys,andinformalmechanismsidentifiedways toimproveimplementationandworkflows.

Results Feedbackfrompharmacistsledtochangesthat improvedworkflow,trainingandpatienteducationmaterials, andenhancedadoptionandreach.Refiningimplementation strategiesacrosspilotphasesincreasedprescribedNRTfrom 2%to44%.

ConclusionandRelevance Resultsofthismulti-phased, pharmacistledsmokingcessationinterventionroll-outsuggest thatimprovingimplementationstrategiescanmeaningfully increasetheratesatwhichhospitalisedpatientswhosmoke receiveevidencebasedsmokingcessationtreatment.

Thisprogramme,developedbyamultidisciplinaryteamof stakeholders,capitalisesontheuniqueroleofpharmacists whointeractwithnearlyeveryinpatientatadmission.Iterative inputfrompharmacistswasusedtorefineimplementation strategiesandbetterintegratesmokingcessationintervention intoexistingworkflowstoenhancethereachofNRTand tobaccoquit-linereferralamonginpatients.

Hospitalisationsprovideanidealopportunityforpatientsto makeatobaccoquitattempt,andpharmacistscancapitalise onthisopportunitybyintegratingsmokingcessationtreatment intoexistinginpatientmedicationreconciliationworkflows. Pharmacist-ledimplementationstrategiesdevelopedinthis studymaybeapplicableinotherinpatientsettings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-184

THERAPIESINENDOMETRIALCANCERWITHDNA MISMATCHREPAIRDEFICIENTORMICROSATELLITE INSTABILITY:ASYSTEMATICREVIEW

1CMorenoRamos*, 2MDGil-Sierra, 2MDPBriceño-Casado, 3MReyesMalia, 4ECampos Dávila. 1ServicioAndaluzDeSalud,FarmaciaHospitalaria,Cádiz,Spain; 2Hospital UniversitarioJerezDeLaFrontera,FarmaciaHospitalaria,JerezDeLaFrontera,Spain; 3HospitalInfantaElena,FarmaciaHospitalaria,Huelva,Spain; 4HospitalDeLaLíneaDeLa Concepción,FarmaciaHospitalaria,LaLínea,Spain

10.1136/ejhpharm-2024-eahp.288

BackgroundandImportance Standardtherapyforadvanced endometrialcancer(EC)pre-treatedwithplatinum-basedchemotherapy(PCT)showedlimitedefficacy.DNAmismatch repairdeficient/microsatelliteinstability-high(dMMR/MSI-H) neoplasmsareassociatedwithincreasedPD-1andPD-L1 expression.Thus,immunotherapycouldplayanimportant roleinECwithdMMR/MSI-H.

AimandObjectives ToconductasystematicreviewofscientificevidenceontreatmentsforECwithdMMR/MSI-Hin patientswhopreviouslyreceivedPCT.

MaterialandMethods AliteraturesearchinPubMed® databasewasperformedtoAugust2023.Filter ‘clinicaltrials’ was appliedwiththefollowingsearchstrategy:[microsatellites instabilityORMismatchRepairDeficient]ANDendometrial cancer.PreferredReportingItemsforSystematicreviewsand Meta-Analyses(PRISMA)methodologywasusedinbibliographicreview.Inclusioncriteria:clinicaltrials(CTs)involving patientswithdMMR,orMSI-Hdiagnosedwithadvanced and/ormetastaticECwhohadpreviouslyreceivedPCT.Efficacyendpointsassessedwereoverallsurvival(OS),progression-freesurvival(PFS)andobjectiveresponserate(ORR). Datacollected:publicationdate,studydesign,stage,median patientfollow-up,samplesize,therapies,comparatorarmand efficacydata.

Results Atotalof30searchresultsw ereidentified.Thirteen CTsmettheinclusioncriteria .Thesestudieswerepublished betweenMay2019andFebruary2023.Studydesign:nine non-randomisedphaseII,twonon-randomisedphaseI,one randomisedphaseIIIandonerandomisedphaseIb/II. PatientswithadvancedECwereincludedin23.1%ofCTs, withmetastaticdiseasein23.1%andbothin53.8%.Median follow-uprangedfromsixto42.6months.Samplesizecomprised11to130patients.Therapiesanalysedwere:pembrolizumab,pembrolizumabplu slenvatinib,durvalumab, durvalumabplustremelimumab ,dostarlimab,nivolumaband avelumab.Atotalof11studieshadnocomparatorarm. Pembrolizumabachievedthehighestnumericalefficacy[OS= 40.0months(95%CI25.3-NotReached);PFS=23.5 months(95%CI10.7-NR);ORR=58%(95%CI37–78)]. Dostarlimab[OS=NR;PFS=12.2months(95%CInot available);ORR=43.5%(95%CI34.5–53.4)]anddurvalumab[OS=NR;PFS=8.3months(95%CI2.4-NR);ORR= 47%(95%CI32–63)]presentedthenextbestnumerical efficacy.NoCTscomparedpemb rolizumabwithdostarlimab ordurvalumab.

ConclusionandRelevance Thegreatestnumericalefficacydata wereachievedbypembrolizumab,followedbydostarlimab anddurvalumab.Nevertheless,CTswithadequatecomparisons areneededforreliabledatainterpretation.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-185 ANALYSISOFTHEUSEOFMEDICATIONNOT INCLUDEDINTHEPHARMACOTHERAPEUTICGUIDE OFATERTIARYHOSPITAL

CGonzálezRomero*,MJDeMoraAlfaro,MROrtizNavarro,PMorenoGarcia,HAlabort Ayllón,ETébarMartínez. ComplejoHospitalarioUniversitarioDeAlbacete,Hospital Pharmacy,Albacete,Spain

10.1136/ejhpharm-2024-eahp.289

BackgroundandImportance Interdisciplinarycollaboration,particularlyinvolvingpharmacistsinmedicationreconciliation, canpreventerrors.Medicationdiscrepanciesatcaretransitions arecommonandlinkedtoadverseeventsthat’swhyaddressingcommunicationbarriersbeforeerrorshappeniscrucial.

AimandObjectives Thisstudyaimstoanalysetheprescription ofmedicationnotincludedinthehospital’spharmacotherapeuticguide(MNIG)andthepharmaceuticalinterventions(PI) performed.

Additionally,thisresearchevaluatestheeffectivenessofa qualityindicatoraimedatreducingMNIGprescriptionsinthe cardiologyservicethroughPI.

MaterialandMethods Aprospectivestudywasconducted from20Aprilto31August2023,utilisingtheFarmatools® programtoassessthefollowingvariables:

. ThepercentageofMNIGprescriptions,categorisedby therapeuticgroup(TG)basedonATCcodes.

. ThecauseofMNIGprescriptions,includingreconciliation andnewtreatment.

-Numberofsubstitutionsinthetherapeuticexchangeprogram(TEP)resultingfromPI,includingthepercentageof MNIGreplacedbytherapeuticequivalents(TE),discontinued, notsubstitutable,andincludedinthehospitalguideline.

Results 322MNIGwereprescribed:13%G04C,12%B01A, 11%A10BD,10%C10B,andtheremaining54%,miscellaneousdrugs.

Asforthecauseofprescription:95%isconciliationand 5%isprescriptionofanewtreatment.

OftheMNIGprescribed,53.4%hadTEintheTEP,18% weresubstituted,andtherestwereprovidedbythepatient.A totalof26.4%werenotsubstitutable,and11.18%were includedinthehospitalpharmacotherapeuticguide(HPG)and 9%wererecommendedtobesuspendedonadmission,as indicatedbytheTEP.

TheprescriptionofMNIGisvariableduringthemonths studied,withamedianof4%,maximumof7.5%andminimumof2%,withconcerningthetotalnumberofprescriptions,withoutalineartrend.

ConclusionandRelevance Themultidisciplinaryteamresponsibleforthepatientshouldbeinvolvedinthereductionof MNIGtoavoidmedicationerrors,throughtheuseofHPG andTEP.

Regardingtheanalysisoftheindicator,weconsiderit importanttoperformPItoraiseawarenessamongphysicians ofthecorrectuseofNID,althoughwecannotconfirmthat thepunctualdecreasesinprescriptionsareduetothePIperformed.Inaddition,thepharmacyserviceshouldreviewthe HPGandTEPtoincludethenecessarydrugsandtodisseminatethePETamonghealthprofessionals.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest

Noconflictofinterest.

4CPS-186

IMPLEMENTATIONOFAPATIENTSTRATIFICATION MODELINOUTPATIENTPHARMACYFORIMMUNEMEDIATEDDERMATOLOGICALDISEASES

HSuñer*,PALópezBroseta,ISacanellaAnglès,DPascualCarbonell,CDCiuciu,SJornet Montaña,IPloSeco,MÁRochVentura,MFVueltaArce,LCanadellVilarrasa. Hospital UniversitariJoanXxiii,Pharmacy,Tarragona,Spain

10.1136/ejhpharm-2024-eahp.290

BackgroundandImportance Pharmaceuticalcare(PC)involves pharmacistsengagingwithpatientstoachievesafepharmacotherapeuticgoals,improvinghealthoutcomes.TheSpanish SocietyofHospitalPharmacydevisedtheCMOstratification model(Capacity,Motivation,Opportunity)todetermine patientfollow-upfrequencyandtargetthosewhobenefitmost fromPC.Itassignspatientstoprioritylevels1,2,or3(normally10%,30%and60%ofstratifiedpatientsrespectively) aidingpharmacistsinoptimisingresourcesandtailored interventions.

AimandObjectives Todeterminethecomplexityofpatients withimmunomediateddermatologicaldiseasesinitiatingbiologicaltherapyinourhospital,usingtheCMOmodel,andcomparetheresultswiththeexpectedmodeloutcomes.

MaterialandMethods Across-sectionalstudycompleted betweenMayandSeptember2023ataSpanishTertiaryhospital.Patientsdiagnosedwith immunomediateddermatologicaldiseases,initiatingbiologicaltherapywereincluded.To determinethecomplexitylevel,theCMOmodelwas applied,encompassing23variablesindemographic,sociosanitaryandcognitive,healthc areserviceutilisation,and treatment-relatedcategories.Thepatient‘stotalscorewascalculatedbycombiningthepoint sassignedtoeachvariable. Datawerecollectedfrompatientmedicalrecords,electronic prescriptiondispensingrecords,andclinicalinterviewsin pharmaceuticalcareconsultations.Resultswerecompared withthepercentagedistribut ionproposedforeachcomplexitylevelbythemodel.

Results Atotalof52patientswerestratified,94%adultsand 56%males.Amongthem,88%hadpsoriasis,8%atopicdermatitis,and4%hidradenitis.Variablessuchasactivesmokers (23%),languagebarrier(4%),psychiatrichistory(31%),and reducedqualityoflife(83%)wereidentified.Additionally, 29%had 2chronicdiseases,and73%exhibitedmoderate/ highdiseaseactivity.Regardingtreatment,27%wereonpolypharmacy,42%weretreatment-naive,8%hadariskofsignificantinteractionswiththeirexistingmedication,and10%of non-adherence.

UponapplyingtheCMOmodel,8%(4)fellintopriority 1,48%(25)priority2,and44%(23)priority3.

ConclusionandRelevance Againstexpectationsfromthe CMO,mostpatientswereinlevel2insteadoflevel3,possiblyduetostratificationtiming,occurringduringtreatment initiationorchangeswhenpatients‘ diseasesweremost exacerbated.

ThroughtheCMOapplication,weidentifiedpatientsmost likelytobenefitfromPC,enablingustoreallocateresources formoreregularfollow-up,ensuringcomprehensivepatient support.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-187 DEVELOPMENTOFAPOPULATION PHARMACOKINETICMODELOFCYCLOSPORINE

1DGonzálezAndrés, 2ÁLSalcedoMingoarranz, 1AMAgüíCallejas, 1MEchavarriDeMiguel, 1BRivaDeLaHoz, 1LFernándezRomero, 1BLealPino, 1EAlgarraSánchez, 1PRanz Ortega, 2BGarcíaDíaz, 1MTPozasDelRío. 1NiñoJesúsChildren’sUniversityHospital, Pharmacy,Madrid,Spain; 2SeveroOchoa´SUniversityHospital,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.291

BackgroundandImportance Cyclosporineisanimmunosuppressivedrugwithcomplexpharmacokinetics,anarrowtherapeuticintervalanddose-relatedadverseeffects(nephrotoxicity, hepatotoxicity,andneurotoxicity).

Amiodarone,verapamilandmacrolidesincreasecyclosporine serumconcentrations(CSC),whereasotherdrugssuchasphenytoin,carbamazepineandrifampindecreaseCSC.

Therefore,therapeuticdrugmonitoringofcyclosporineis ofgreatimportanceinroutineclinicalpractice.

AimandObjectives

. Designapopulationpharmacokineticmodelofcyclosporine.

. Analysetheinfluenceoftherecordedcovariates.

MaterialandMethods Retrospectiveobservationalstudythat includedpatientshospitalisedatSeveroOchoaUniversityHospitalandtreatedwithcyclosporinebetweenJanuary2016and April2022.PatientshospitalisedintheICUandoutpatients wereexcluded.

Datarecorded date,timeandvalueoftheCSC,routeof administration,dosesadministered,sex,age,weight,haematocrit,albumin,serumcreatinineandconcomitanttreatment.

Wetestedtheone-andtwo-compartmentalmodelswith fourestimations:firstorder,firstorderwithinteraction,first orderconditionalandfirstorderconditionalwithinteraction. Theinfluenceoftherecordedcovariateswasevaluated,selectingthosethatshowedastatisticallysignificantreductionin theobjectivefunction(OFV).

Results

Patientsincluded 29patients,aged65years-old(28–92), 66,7%female.Meanweightwas75.1kg(42.5–125),serum creatinine1.12mg/dL(0.33–4.41),serumalbumin3.5g/dL (2.3–4.6)andhaematocrit32.6%(13.4–48.5).Noneofthe patientsreceivedtheregistereddrugs.

Theone-compartmentmodelshowedabetterOFVthan thetwo-compartmentmodel(-663,636vs-654,430).However, thegraphicalanalysisshowedabettercorrelationbetweenthe CSCandthosepredicted,thereforetheanalysisofthecovariateswascontinuedwiththetwo-compartmentmodel.

Thevariableswereevaluatedinthetwo-compartment modelandaninfluenceofageandweightonclearancewas observed,withstatisticallyinsignificantdifferences.Nocovariateshowedaneffectonthevolumeofdistribution.

ConclusionandRelevance

. Thetwo-compartmentmodelwithfirstorderconditional estimationwithinteractionsshowedabettergoodnessoffit.

. Thedevelopmentofapharmacokineticmodelofcyclosporine assistsclinicianstoestablishaneffectiveandsafedosing regimen.

. Furtherstudiesareneededtobetteranalysethepopulation pharmacokineticsofcyclosporine.

REFERENCESAND/ORACKNOWLEDGEMENTS

Abstracts

4CPS-188

IMPLEMENTATIONOFTHIOPURINE PHARMACOGENETICSTOIMPROVEPAEDIATRIC SAFETYATATERTIARYHOSPITAL

1VCarrilloLópez*, 2AObradorDeHevia, 1FDoPazoOubiña, 3SNavarroNoguera, 1CMartorellPuigserver, 2IMartínezLópez. 1UniversitaryHospitalSonEspases,Pharmacy, Palma,Spain; 2UniversitaryHospitalSonEspases,Genetic,Palma,Spain; 3Universitary HospitalSonEspases,PediatricOncology,Palma,Spain

10.1136/ejhpharm-2024-eahp.292

BackgroundandImportance Thiopurinesplayacrucialrolein thetreatmentofpaediatricpatientswithacutelymphoidleukaemia(ALL).Althoughthesedrugsareadministeredalmost continuouslyforovertwoyears,theirmaindrawbackliesin theoccurrenceofadverseevents(AEs),particularlyhepatotoxicityandmyelotoxicity,whichcanleadtotreatmentdelays.

ResearchhasestablishedalinkbetweentheseAEsandthe genotypesoftwoenzymesinvolvedinthiopurinemetabolism: thiopurinemethyltransferase(TPMT)andnudix15hydrolase (NUDT15).Currently,recommendationsexistforadjustingthe initialdosagesbasedongenotype.

AimandObjectives

. Determinetheprevalenceofallelesassociatedwiththemost commonenzymeactivitydeficienciesforTPMTand NUDT15inourregion,comparingthemwithliteraturedata.

. Implementananalysisandinformationcircuitenabling individualisedthiopurinedosingbasedonpharmacogenetics forpaediatricALLpatients.

MaterialandMethods Weconductedaliteraturereviewto identifyalleleslinkedtointolerancetostandardthiopurine doses.Consideringtheallelicprevalenceindifferentpopulations,weselectedthreeTPMTallelesandoneNUDT15allele accordingtoours.Thesealleleswereclassifiedasfirst-levelby variousagenciesandconsortiums.Wedesignedprimersfor allelescreeningwithSangersequencingtechnique.

Ourcentre’sdatabasecontained2,194exomeswith informedconsent,whichweanalysedtoestimatealleleprevalenceinourpopulation.Techniques,testrequestprocedures, anddecisionalgorithmsforinitialdosageswereprotocolised basedoncurrentrecommendations.

Results Inatotalof2,194exomes,westudiedmutations rs1800462,rs1800460,andrs1142345forTPMT,and rs116855232forNUDT15.Weidentified36,113,147,and 48cases,respectively.Ourpopulationexhibitedhigher

Abstract4CPS-189Table1

frequenciescomparedtonon-FinnishEuropeans(NFE)inthe GenomeAggregationDatabase,withratesof1.64%vs. 0.24%,5.15%vs.3.82%,6.7%vs.4.23%,and2.18%vs. 0.29%,respectively.

ConclusionandRelevance Ourresultssupportthebenefitof genetictestinginourpopulationduetotheprevalenceof low-activityalleles.

Weanticipateperforming10to15geneticstudiesannually, aligningwiththeALLcaseswetreateachyear.

Theimplementationofanindividualiseddosingcircuit basedonpharmacogeneticsrepresentsasubstantialadvancement.Thisapproachwillenhancethesafetyandefficacyof thiopurinetreatment.

Thismodelcanbereplicatedinhospitalswithgenetic determinationcapabilitiesthroughSangersequencing.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-189 LOCALEXPERIENCEONTHEUSEOFCANNABIDIOL FORTHETREATMENTOFREFRACTORYEPILEPSY: SAFETYANDEFFICACYONA10PATIENTCOHORT

JMSerraLópez-Matencio*,AAlvarezYuste,ERamirezHerraiz,ACalvoGarcia,EAlañon Plaza,MPerezAbanades,SRuizGarcia,AIbañezZurriaga,AArangurenOyarzabal, AMorellBaladron. HospitalDeLaPrincesa,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.293

BackgroundandImportance Cannabidiolisapprovedin Europeasadjunctivetherapyforpreventingseizuresassociated withLennox-GastautSyndrome(LGS),DravetSyndrome(DS), andTuberousSclerosisComplex(TSC)inpatientswithprevioustreatmentrefractoryepilepsy.

AimandObjectives Thisstudyaimstoevaluatetheefficacy andsafetyofcannabidiolinacohortofpatientsfroma medium-sizedhospital.

MaterialandMethods Anobservationalretrospectivestudywas conducted.PatientsdiagnosedwithLGSandDSwhobegan treatmentwithcannabidiolfromOctober2019toSeptember 2023wereincluded.Datacollectedweredemographics(gender,age),drugtherapy(numberofconcomitantdrugs)and clinicaloutcomes(Reduction>50%onseizurerateandcannabidiolsideeffects).

Results Tenpatientswereincludedontheanalyseddataset, withameanageof32.8years,nineofthemhadLGSassociatedepilepsy,andonetoDS.Withamediantreatmentdurationof633daysandacannabidiolmediandoseof10,49mg/ Kg/day,70%ofpatientsreachedaseizurereduction>50%, beingthemajorityofthemoutofdrugrelatedsideeffects.

ConclusionandRelevance Asareal-lifeexperience,ourfindingsconfirmthatthesafetyandefficacyprofilesofcannabidiolshowedbythetrialsGWPCARE3andGWPCARE4 (meanage=15years)1areextendedtoourlocaladultpopulationwithahigheraverageageof32.8years.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.epidyolex-epar-product-information_en.pdf(https://www.ema.europa.eu/en/documents/product-information/epidyolex-epar-product-information_en.pdf)

ConflictofInterest Noconflictofinterest.

4CPS-190 DEVELOPMENTOFTRANSMURALPHARMACEUTICAL CAREINAGENERALHOSPITAL

1,2VVermaut, 2SJabbour, 2SBlondelle*, 3PDuez, 1SPatris, 2,3APardo. 1Facultyof MedicineAndPharmacy-UniversityofMons,DepartmentofClinicalPharmacy,Mons, Belgium; 2ChrHauteSenne,DepartmentofPharmacy,Soignies,Belgium; 3Facultyof MedicineandPharmacy-UniversityofMons,LaboratoryofTherapeuticChemistryand Pharmacognosy,Mons,Belgium

10.1136/ejhpharm-2024-eahp.294

BackgroundandImportance Thetransitionbetweendifferent caresettingsisvulnerabletomedicationerrors.Toavoidthese errors,informationaboutnewmedicationsmustbeshared betweendifferentcareproviders.

ThePACTproject,anintegratedcareproject,proposesto carryoutmedicationreconciliationaccordingtoastructured methodologyusingenvelopes.Athospitaladmission,blue envelopesareused.Theycontainthepatient’smedication schemepreviouslyproducedbythereferencepharmacistina communitypharmacy.Athospitaldischarge,thenewmedicationschemeandthenewprescriptionsareplacedinagreen envelope.Thisenvelopemustbegiventothereferencepharmacistwhomustexplainanychangestothepatient.

Aimandobjectives • Tosetupandevaluatetheimpactof pharmaceuticalinterventionsaimingtoimplementthePACT medicationreconciliationsystemathospitaldischarge.

MaterialandMethods Twoaudits,eachcarriedoutovera periodof10daysinDecember2022,wereconductedin threecareunitsonapre-testgroupandatestgroup.The testgroupwasconstitutedduringtheperiodoftestwhich includedpharmaceuticalinterventions(real-timeinterventions andoutreachvisitstopractitioners).

. Weevaluatedthesimilaritybetweenthetwogroupsinterms ofdemographicandclinicalcharacteristicsandintermsof medicationcharacteristicsusingStudent’stestandtheChiSquaredtest(c2test).

. Theimpactofthepharmaceuticalinterventionswasthen evaluatedbycomparingbetweenthetwogroupstherateof greenenvelopesdeliveredtothepatient.Datawereanalysed using c2test.

Results

. Thetwogroupsweresimilarintermsofdemographicand clinicalcharacteristics.Regardingmedicationcharacteristics, theanalysisconfirmedthesimilaritybetweengroups,except

forthenumberofnewlyprescribedmedicines(p=0.04)and thenumberofmedicinestobestoppedafterhospitalisation (p=0.03).

. Therateofgreenenvelopesdeliveredtothepatientatthe endofhospitalisationwashigherinthetestgroup(78%) comparedtothepre-testgroup(33%)(p<0.001).

ConclusionandRelevance Thisworkhighlightstheimportance ofdevelopingtheroleofintegratedcarepharmacistcoordinatortostrengthenthecommunicationonpatientmedications.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.eahp.eu/24-

4CPS-069

10.1136/ejhpharm-2024-eahp.295

https://pubmed.ncbi.nlm.nih.gov/29248878/ ConflictofInterest Noconflictofinterest.

4CPS-191 PRE-RADIOIODINETHERAPYSURGICALMODALITIES: COMPARISONOFPOST-OPERATIVETHYROGLOBULIN LEVELSINPATIENTSUNDERGOING1-OR2-STEP THYROIDECTOMYFORDIFFERENTIATEDTHYROID CANCER

1FMigeon, 1JFouillet*, 1LRubira, 1CDonzé, 2MCEberlé, 1,3CFersing. 1InstitutRégionalDu CancerDeMontpellierIcm,NuclearMedicineDepartment-RadiopharmacyUnit, Montpellier,France; 2InstitutRégionalDuCancerDeMontpellierIcm,NuclearMedicine Department,Montpellier,France; 3InstitutDesBiomoléculesMaxMousseronIbmm,F9 Team ‘Aminoacids-PeptidesandProteins’,Montpellier,France

10.1136/ejhpharm-2024-eahp.296

BackgroundandImportance Surgicalpracticesinthyroid oncologyrecentlyevolvedtowardsde-escalation,withmore frequent2-stepsurgery(lobectomythentotalisation).Moreover,innon-metastaticthyroidcancerswithlowrisksof recurrence,radioiodinetherapy(RIT)toeliminatepotential residualcancercellshasbecomeoptional,particularlyincases displayinglowpostoperativethyroglobulin(POTg)values.Itis knownthatplasmathyroglobuliniscorrelatedwiththesizeof thepost-thyroidectomyresidue,excludingdistantmetastases. However,itisnotknownwhetherthisresidueisgreaterin thecaseof1-or2-stepsurgery.Indeed,the2-stageapproach mayprovideamoresubstantialresidue,measurablebythe POTgvalue.Cliniciansshouldthereforetakethisnotioninto considerationwhendecidingonadjuvantRIT.

AimandObjectives TocomparePOTgvaluesinpatients undergoing1-or2-stepthyroidectomyforlow-riskthyroid cancer,basedonretrospectivecollectionofbiologicaldata fromoperativeandpathologicalreportsinacohortofRIT patientsatourcentre.

MaterialandMethods Inclusioncriteriaforthisstudywere: non-metastaticpatientswithalow-riskpathologywhohad biologicaltestsperformedbetweensurgeryandRITconsultation,anon-detectableanti-thyroglobulinantibodyassay,a period>28daysbetweensurgeryandbiologicaltests,and TSHlevels<5 mIU/mL.Parametersusefulfordescribingthe patientpopulationandcomparingPOTgvalueswerecompiled inacomputerisedspreadsheetandanalysed.

Results Between15July2016and24February2023,70 patientsfromourcentremettheinclusioncriteria.MeanTSH valuewas1.377±1.336 mIU/mLandmeanPOTgwas0.543 ±1.067ng/mL.Meantimebetweenoperationsforpatients treatedin2-stepswas82±55daysandmeantimebetween operationandbiologicaltestwas68±54days.Twogroups weredefined,including49patientswhounderwent1-stepsurgeryand21patientswhounderwent2-stepsurgery.DifferencebetweenthetwogroupsinmeanTSHvaluesand averagetimebetweenoperationandbiologicaltestwerenot statisticallysignificant(p=0.204and0.97,respectively).No statisticallysignificantdifferencecouldbedemonstrated betweenthemeanPOTginthetwogroups(p=0.622).

ConclusionandRelevance MeanPOTgappearstobeindependentofthesurgicalprocedure,whichisanimportantconsiderationwhendecidingonpostoperativetreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-192 ASTHMAANDRISKOFCARDIOVASCULAREVENTS:A RETROSPECTIVESTUDY

1PGrandaLobato*, 2EVillamañán, 3LDeLasVecillas, 4DLaorden, 2VLCollada, 2CMateos, 2AHoyo, 2LGarcia, 4RÁlvarez-Sala, 2AHerrero. 1HospitalCentralDeLaDefensaGómez

Ulla,Pharmacy,Madrid,Spain; 2HospitalUniversitarioLaPaz,Pharmacy,Madrid,Spain; 3HospitalUniversitarioLaPaz,Allergology,Madrid,Spain; 4HospitalUniversitarioLaPaz, Pneumology,Madrid,Spain

10.1136/ejhpharm-2024-eahp.297

BackgroundandImportance Asthmaisfrequentlyassociated withrespiratoryandnon-respiratorycomorbidities.Non-respiratorycomorbidconditionsincludecardiovasculardisease; indeed,asthmahasbeenlinkedwithincreasedriskofcardiovascularevents,althoughitsprevalencevariesbetweenstudies androbustevidenceofthisrelationshipislimited.

AimandObjectives Theaimofthisstudywastoidentifyand assesscardiovasculardiseaseriskforasthmapatients.

MaterialandMethods Retrospectivecohortstudyinvolving patientsfollowed-upbythesevereasthmaunitofatertiary carehospitalinSpain.Sociodemographicvariablesincluded sexandage.Theclinicalvariableswerecomorbidities(obesity, BMI>30;type2diabetes;arterialhypertension;dyslipidaemia andotherrespiratoryconditions),smokingstatus,asthmaphenotype,biomarkerconcentrations(fractionalexhalednitric oxide[FeNO],totalandspecificserumIgEandbloodeosinophilcount[BEC])andlungfunction.Treatmentwithbiologics forasthma,systemicandinhaledcorticosteroids,inhaledshortactingbeta-agonistsandantihypertensivemedicationwerealso recorded.Patientswithacardiovasculareventpriordiagnosis ofasthmawereexcluded.Historyofcardiovasculareventswas obtainedandoddsratios(ORs)forcardiovasculareventsin asthmaticpatientswereanalysedusingamultiplelogistic regressionmodel.

Results Atotalof206patientswithasthmawereincluded (65.6%female;mean±SDage57±18years).121patients hadallergicasthma,98wereobese,24haddiabetes,65had hypertension,52haddyslipidaemiaand21hadobstructive sleepapnoea.23patients(11%)sufferedacardiovascular event.Ahigherriskofcardiovasculareventwasobservedin thosepatientswithhypertension(OR=2.717,p=0.026),dyslipidaemia(OR=2.717,p=0.026),andchronicobstructivepulmonarydisease(COPD)(OR=5.358,p=0.003).Ahigherrisk

wasalsoobservedinpatientswithFEV1>80%priorbiologic therapy(OR=3.316,p=0.013).

Incontrast,areducedriskofacardiovasculareventwas observedinthosepatientswhohadinhaledcorticosteroids (OR=0.187,p=0.007)orhadaBEC>150cells/mL (OR=0.225,p=0.025).

ConclusionandRelevance Risksofcardiovasculareventswere increasedinasthmapatientswithhypertension,dyslipidaemia orCOPD.Alowerriskofcardiovasculareventswasobserved inpatientsoninhaledcorticosteroidsand,unexpectedly,in thosewithFEV1<80%andBEC>150cells/mL.Nonetheless, theseresultsmustbeinterpretedwithcautionasthedesignof thecurrentstudyissubjecttolimitations.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-193 EFFECTIVENESSANDSAFETYOFINTRAVENOUS USTEKINUMABINTENSIFICATIONINCROHN’S DISEASEWITHLOSSOFRESPONSEORPARTIAL RESPONSETOSUBCUTANEOUSTHERAPY

SHerreroBermejo,ELobatoMatilla,DGómezCostas,BSomozaFernández,PRuizBriones, MFerrisVillanueva,MDPMonteroAntón*,YRiojaDíez,ACarrilloBurdallo,AHerranz Alonso,MSanjurjoSáez. GeneralUniversityHospitalGregorioMarañon,Pharmacy,Madrid, Spain

10.1136/ejhpharm-2024-eahp.298

BackgroundandImportance Ustekinumabisapprovedforadult patientswithmoderately-severeactiveCrohn’sdisease(CD)at ausualdosingscheduleof90mgevery8to12weekssubcutaneously.Somepatientsmayexperienceapartialresponseor secondarylossofresponse.Thereisincreasingevidencefor patientrescuebyshorteningthesubcutaneousadministration interval,butverylittleevidenceforintravenousintensification. AimandObjectives Toevaluatetheeffectivenessandsafetyof treatmentintensificationwithintravenousustekinumabin adultswithCDandlossofresponsetothestandardsubcutaneousregimen.

MaterialandMethods Single-centre,descriptive,retrospective studyincludingCDpatientswhointensifiedustekinumabtreatmenttoreceive130mgintravenouslyevery4–6weeksfrom January2020toAugust2022.

Theclinicalremissionrate(definedasaHarvey-Bradshaw index(HBI)<5)at12,24and52weeksandtheearlyclinicalresponserate(definedasareductioninHBIby 3points orbya30%frombaseline)at12weekswereanalysed.The evolutionofinflammatorylaboratoryparameterssuchasCreactiveprotein(CRP)andfaecalcalprotectin(FC)was assessed.Adverseeffectsdevelopedduringthefollow-up periodwerecollected.

Results Forty-onepatientswereincluded;61.0%weremale, withamedianageatintensificationof44.9years(interquartilerange(IQR):37.8–59.6),amediandiseaseprogressionof 16.6years(IQR:8.1–22.3)andamediantimetointensificationfromustekinumabinitiationof19.6months(IQR:10.8–31.3).ThemostfrequentphenotypeswereL3(53.7%)and B2(43.9%).Perianalinvolvementwaspresentin46.3%of patients.

Ofthetotal,31(75.6%)patientshadabaselineHBI 5, ofwhom18(58.1%)achievedearlyclinicalresponse.Clinical remissionwasachievedby39.0%ofpatientsat12weeksand by58.5%at52weeks.Thepersistencerateat52weekswas

90.2%.Medianlaboratoryparametervaluesimprovedateach timecut-offfrombaseline.

Noseriousadverseeffectswerereportedandnopatient discontinuedtreatmentduetoadverseeffects.Oneepisodeof urinarytractinfectionandoneepisodeofnasopharyngitis weredocumented.

ConclusionandRelevance Intravenousustekinumabat130mg every4–6weeksimprovesCDinflammatoryactivityin patientswithlossofresponseorpartialresponsetothestandardsubcutaneousregimen.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-194 EVOLUTIONOFHOSPITALCLINICALPHARMACY SERVICESINFINLANDDURINGYEARS2017–2022:A FOLLOW-UPSURVEY

1LSchepel*, 2EKunnola, 3KAronpuro, 4MAiraksinen, 5KKvarnström. 1HelsinkiUniversity HospitalAndUniversityOfHelsinki,QualityAndPatientSafetyUnit-HusJointResources AndHusPharmacy,Helsinki,Finland; 2TurkuUniversityHospital,HospitalPharmacy,Turku, Finland; 3HelsinkiUniversityHospital,HusPharmacy,Helsinki,Finland; 4Universityof Helsinki,ClinicalPharmacyGroup-DivisionofPharmacologyAndPharmacotherapy-Faculty ofPharmacy,Helsinki,Finland; 5HelsinkiUniversityHospitalAndUniversityofHelsinki,Hus Pharmacy,Helsinki,Finland

10.1136/ejhpharm-2024-eahp.299

BackgroundandImportance Pharmacists’ involvementin patientcarebecamemorecommonalongwithsystem-based medicationsafetyworkinFinnishhospitalsduring2011–2016.Thefirstnationalsurveywasconductedin2011and repeatedusingthesamemethodin2016.Thisdevelopmentis inlinewithnationalandinternationalpatientsafetypolicy initiativesandEuropeanhospitalpharmacystatements.

AimandObjectives Theaimofthisstudywastoconductthe thirdnationalfollow-upsurveyonhospitalclinicalpharmacy servicesinFinlandin2022andcomparetheresultstothe year2016.

MaterialandMethods Thestudywasconductedin2022asa nationalonlinesurveytargetedtohospitalpharmacies(n=22) andmedicaldispensaries(n=23).Thequestionswereanalysed usingdescriptivestatisticsandqualitativecontentanalysis.

Results Theresponserateofthesurveywas62%(n=29/45). Clinicalpharmacyserviceswereprovidedin83%(n=24/29) oftherespondingunits.Thenumberofclinicalpharmacy staffincreasedbetween2017and2022,andserviceswere providedinmoreversatileenvironments.Inparticular,the serviceshadbecomemorecommonatadmissionandinoutpatientunits,suchasfirstaid,emergencyrooms,andoutpatientclinicswheremedicationreconciliationisessential. Furthermore,insomeunits(25%,n=6/24),serviceswerealso availableintheeveningsandduringweekendsinonerespondingunit.Asin2016,thesystem-basedmedicationsafetywork andthecomprehensivedevelopmentofthemedicationmanagementsystemwerehighlightedalsointhissurvey.Themost increasedtasksweremedicationreviewsandmedicationsafety audits,whereasin2016themostincreasedtaskwasmedicationreconciliation.Surprisingly,pharmacists’ participationin thepatient‘sdischargehaddecreased.Despitetheincreasing prevalenceofautomationtechnologyandpharmacyassistants, logistictaskshadremainedonthesamelevelasin2016.

ConclusionandRelevance Finnishhospitalclinicalpharmacy serviceshaveexpandedinlinewithnationalandinternational

guidelinesandincreasinglyconcentrateonpromotingmedicationsafety.Thefocusiscurrentlyonadmissionandoutpatient units.Inthefuture,moreeffortshouldbeputintodischarge, becauseitwouldbeparticularlycost-effectivebydecreasing drug-relatedreadmissions.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SchepelL, etal. Strategiesforimprovingmedicationsafetyinhospitals:Evolution ofclinicalpharmacyservices. ResSocialAdmPharm.2019Jul;15(7):873–882.

ConflictofInterest Noconflictofinterest.

4CPS-195 CHARACTERISATIONOFINJECTABLEFORMULATIONS ANDOPTIMISATIONOFTHEIRDELIVERYBYENTERAL TUBE:APHYSICOCHEMICALANDPHYSIOLOGICAL APPROACH

YRiojaDiez,CFernándezMartínez-Llamazares,SManriqueRodriguez,MDPMontero Antón*,ACarrilloBurdallo,DGomez,APrietoRomero,SHerreroBermejo,SDelBarrio Buesa,AHerranzAlonso,MSanjurjoSáez. HospitalGeneralUniversitarioGregorio Marañón,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.300

BackgroundandImportance Oraladministrationofinjectables isanalternativeforpatientswithdifficultiestoleratingsolid pharmaceuticalforms.

Duetotheirphysicochemicalcharacteristicsnotadaptedto oraladministration,gastrointestinaladverseeffectscanoccur, especiallyinpatientswithtranspyloricfeedingtube,especially whentheyhaveanosmolarity>500mOsm/LorpH<3.5.

AimandObjectives Theaimofthepresentworkistocharacterisethephysicochemicalpropertiesofinjectableformulations commonlyusedorallyandtheirgastrointestinalabsorptionsite inordertoincreasesafetyintheiradministrationbytranspyloricfeedingtube.

MaterialandMethods Aliteraturesearchwasconductedto establishthegastrointestinalabsorptionsiteoftheactiveprinciples(AP)analysed.

Foreachpreparation,pHandosmolalitywereexperimentallydetermined.ThepHwasmeasuredwithapHmeter (Crison2006,HachLangeEspaña,S.L.U.,Spain).Osmolarity wasdeterminedusingtheFiskeModel210MicroOsmometer (JohnMorrisScientificPtyLtd.,Australia),consideringthe densityoftheactiveprinciplesstudiedtobeequalto1mg/ ml.Allmeasurementswereperformedintriplicate.

Results Ofthe24APsanalysed,pHvalues<3.5werefoundin 21%ofpreparations,whichdiscouragestransyejunaladministration.Inaddition,25%oftheformulasadministeredhad osmolarity>500mOsm/L.

. Ofthe13APsthathavebioavailabilitybytranspyloricroute, onlyeightareadequatelyformulatedforthis,andanother threecouldbedilutedpriortoadministrationtoavoidhigh osmolarities.

. OfthefiveAPsthatcannotbeadministeredviathe transpyloricroute,threeofthemarealsonotadequately formulated.

. OftheremainingsixAPs,whoseabsorptionsitecannotbe objectified,threehavegoodphysicochemicalcharacteristics andwithanothertwothiscouldbeachievedbydilutingwith water.

ConclusionandRelevance MostofAPsstudied,thegastrointestinalabsorptionofthedrugisnotsufficientlycharacterised,

leadingtouncertaintywhenadministeredbytranspyloricfeedingtube.

Manyoftheinjectableshaveahighosmolarityandthereforerequirepriordilution,whilethepHvaluesofsomeof themcanbeanaddedfactorforthedevelopmentofdigestive intolerances.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-196 ASSESSMENTOFORALDRUGTHERAPYREGARDING ABSORPTIONDISORDERSINPATIENTSWITH INTESTINALOSTOMIES – ANOBSERVATIONALSTUDY

MZakhari-Betros*,ISummer,APoier,CFegerl-Stadlober. BarmherzigeBrüderHospital, HospitalPharmacy,Graz,Austria

10.1136/ejhpharm-2024-eahp.301

BackgroundandImportance Aninsufficientabsorptionof orallyadministereddrugsmaythreatentherapygoals.Thus, gastrointestinalalterationsassociatedwithostomyformations maypavethewaytowardsabsorptiondisorders.Although therehadbeenreports,thistopicremainsnotsufficiently studied.1

AimandObjectives Themainpurposeofthisstudywasto assessoralmedicationinpatientswhohadnewlyundergone ileostomyorcolostomyformationinordertoobservewhether surgeryledtopresenceofanydrugresidualsinthepouches, ineffectivenessoftherapyoranyotherindicationsofabsorptiondisturbances.

MaterialandMethods Anobservationalstudywasconducted betweenMarch2022andSeptember2023attheDivisionof VisceralSurgeryatthehospital.Fiftypatientsaged18–80 years,wereenrolled.Oraldrugtherapyofeverypatientwas assessedfollowingostomysurgery.Priorhospitaldischarge,an interviewwasledwiththepatientstocollectadditionaldata regardingclinicalstatus.Atearliest,2–8weeksafterdischarge, thepatientswereinterviewedasecondtimeattheostomy outpatientclinicorbytelephonecall.Bothinterviewswere ledbytwopharmacistsbasedonstandardisedquestionnaires. Results

Sixty-threedifferentagentswereadministered Inthefollowing (table1),findingsregardingdrugcategoryareshown.Table2 presentsadrugmonitoringcarriedouttoproofimpaired absorptionofbupropion.

Abstract4CPS-196Table1

Findingstmax[h](totalnumberofapplieddrugs) 0,5-3(36)3-5(16)>5(10)

Impaireddisintegration/dissolutionCapecitabine Carvedilol

Esomeprazole

Acetylsalicylic acid Aprepitant Bupropion

Ineffectiveness(basedonclinical symptomsand/orlaboratoryparameters) Trimethoprim Loperamide Amlodipine Levothyroxine Tamsulosin

Abstract4CPS-196Table2

Value[ng/ml]Therapeuticrangeofplasmalevels[ng/ml]

Bupropion+

Hydroxybupropion

Pramipexole

353.0850–1500

Bupropion16.0

Hydroxybupropion337.0

ConclusionandRelevance Theresultsofthisstudyconfirm that,contrarytoassumptions,absorptiondisordersmayalso occurindrugtherapywhichseemstobeabsorbedrapidly. Therefore,noabsolutestatementsregardingintestinalabsorptivecapacitycanbedone.Oraldrugtherapyofeverypatient hastobeassessedindividuallybasedonintestinalcondition andapplieddrugproperties.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.DGKPMarioGradischnig,Dr.FelixAigner.MBAFEBSFACS

2.HasaitN, etal.Theileostomypatientandhisdrugtherapy – Drugabsorption problemsofpatientswithanileostomy.Whattodo? Krankenhauspharmazie. 2015; 36(5):229–248.

ConflictofInterest Noconflictofinterest.

4CPS-197 THEKTIA-SCORACSTUDY:SECURINGTHE MEDICATIONMANAGEMENTOFELDERLYPATIENTS BYTHESYSTEMATICEVALUATIONOF ANTICHOLINERGICLOADSCORESVIAACLINICAL DECISIONSUPPORTSYSTEM

1MBassil, 1SDrouot, 1NKunyu*, 1MCChaumais, 1ALeBozec, 2SRaspaud. 1ChuKremlin Bicêtre,DepartmentOfClinicalPharmacy,LeKremlinBicêtre,France; 2ChuKremlinBicêtre, DepartmentOfPharmacy,LeKremlinBicêtre,France

10.1136/ejhpharm-2024-eahp.302

BackgroundandImportance Theuseofanticholinergicdrugs andtheircumulativeeffectsarehighlyprevalentinolderpeopleandareassociatedwithadverseeffectsandoutcomes. However,pharmaceuticalanalysistoassessanticholinergicrisk, remainsachallengeduetoconstrainedhumanresources, insufficientfunctionalitiesofprescriptionassistancesoftware, non-interoperabilityofhospitalinformationsystemsandthe lackofawarenessontheanticholinergicburdenamongelderly patients.

AimandObjectives Thisstudyaimedto1/evaluateandstratify anticholinergicscoresbasedonpatientprofile,admissionunit, andclassofdrugs,2/proposeguidelinesformedicationmanagementand3/securedrugrelatedmanagementbyreducing anticholinergicpatient’ sexposure.

MaterialandMethods Weconductedaretrospectivestudy includingallpatients>65yearsadmittedinourhospital from1April2023to31May2023usingtheCRIDECO AnticholinergicLoadScales(CALS)integratedintheClinical DecisionSupport(CDSS)PharmaClasssoftware3.0 ® . 1

Results 1186patients(n=1316admissions)wereenrolledwith 130patientsre-hospitalised.Around32%ofpatientswith CALS 0wereadmittedtothesurgicaldepartment,13%to ageriatricdepartmentandcardiology-pneumologyeach.In

total,throughouttheirhospitalstay,64%(n=837)ofadmissionshadnochangeintheirCALS(largestgroup),36% (n=469)ofadmissionshadanincreaseandaminorityhada decreaseinscore.Forscore 3, 4and 5,increasewas observedfromadmissiontodischargeof26%,16%and12% respectively.Patientswithincreaseofatleastof1pointof CALSweresignificantlyolder(pval<10-4)andhadincrease lengthofhospitalstay(pval<10-15).Themostcommonprescribeddrugswereanalgesics,anti-epilepticanddiuretics. ConclusionandRelevance FollowingtheCRIDECOrule,30% ofpatients>65yearshadariskofanticholinergicburdenat admission,andthisriskdoesnotdecreaseduringhospitalisations.Athresholdoffivemightbeapotentialcut-offchoice forpharmaceuticalinterventionsinfuturestudiesduetoits significantincreaseforasmallsamplesize.Thisfurthersupportsthefeasibilityandpromisingbenefitsofimplementing newstrategiesforphysicianswithCDSStoimprovemedicationmanagementandtoreducetheanticholinergicburden.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RamosH, etal.CRIDECOAnticholinergicLoadScale:AnUpdatedAnticholinergic BurdenScale.JPersMed. 3févr.2022;12(2):207.

ConflictofInterest Noconflictofinterest.

4CPS-198 EVALUATIONOFPROATEAMINTERVENTION ACCEPTANCERATESTHROUGHANAUTOMATED MEASUREMENTSYSTEM

CDíazRomero*,CFadónHerrera,LOyagueLópez,IMarayMateos,IDeLaFuente Villaverde,SFernándezLastras,MEiroaOsoro,MMuñozVillasur,CRodríguez-Tenreiro Rodríguez,ALozanoBlazquez. HospitalUniversitarioCentralDeAsturias,Hospital Pharmacy,Oviedo,Spain

10.1136/ejhpharm-2024-eahp.303

BackgroundandImportance Programmestooptimiseantibioticsuse(PROA)areconstitutedbymultidisciplinaryteams involvingatleastonephysician,onepharmacistandone microbiologist.Theirpurposeistoimproveclinicaloutcomes relatedtoantibioticuse,reduceadverseeffectsandensure cost-effectivenesstreatmentthrougheducationalclinical interventions.

AimandObjectives Theaimofthisstudyistoevaluatethe acceptanceoftheseinterventionsthroughanautomatedsystem andcomparetheresultswiththoseobtainedmanuallyinthe previousyear.

MaterialandMethods Descriptive,retrospectiveandcross-sectionalstudy,conductedbetweenJanuary-September2023.A softwaretoolwasdevelopedtoanalysewhetherPROAinterventionswereacceptedwithinthefollowing48hours.

Thesystem,bymeansofcomputerprogramming,analyses therecordedinterventionsandassesseswhethertheprescriptionshavebeenmodified.Itonlyfocusesonrecommendations relatedtotreatmentsuspension,sequentialtherapyorantibioticde-escalationandclassifiesthemasrejected,ifprescription continuedunaltered,oracceptedifchangesoccurredaccording withtherecommendation.Subsequently,acomparativeanalysis wasconductedbetweendataobtainedusingthistoolanddata manuallyobtainedpreviouslyfromacross-sectionstudycarriedoutinFebruary2022.Allinformationwascollectedfrom electronicmedicalrecordsandanalysedusingtheRstatistical programme(v.4.2.2).Categoricalvariablesareexpressedas frequencyandpercentage.

Results Atotalof859interventionswereanalysedwithan acceptancerateof83.5%;556involvedtreatmentsuspension, 245antibioticde-escalationand58sequentialtherapy.Acceptanceratesforeachwere86%,80%and74%,respectively.

Abstract4CPS-198Table1 AcceptancerateofPROA interventions:comparativeanalysis

TypeofinterventionFebruary2022 N=(154/192)

January-September2023 N=(717/859)

Treatmentsuspension%(N) 76%(73/96)86%(478/556)

Antibioticde-escalation%(N) 87,2%(68/78)80%(196/245) Sequentialtherapy%(N) 72%(13/18)74%(43/58)

ConclusionandRelevance TheautomatedsystemoffersacomprehensiveviewoftheacceptanceratesofPROAinterventions overtime,contrastingwiththemanualapproachthatonly canbeaffordedforashortperiodoftime.Althoughithas somelimitationsbecauseitdoesnotincludeallintervention types,itallowsaquickanalysisoftheimpactoftheseinterventionsinclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-199 COMPARATIVEEVALUATIONOFENZYME-LINKED IMMUNOSORBENTASSAYVERSUSAPOINT-OF-CARE TECHNIQUEINTHEDETERMINATIONOF ADALIMUMABLEVELS

1FCajade*,FJToja-Camba, 2LRodríguez-Martínez,LArcía-Quintanilla, 3JTomine, 2CFeitosa, 1IZarra-Ferro, 4MBarreiro-DeAcosta, 1JGonzález-López, 1CMondelo-García, 1AFernández-Ferreiro. 1HospitalUniversitarioDeSantiagoDeCompostela,Farmacia Hospitalaria,SantiagoDeCompostela,Spain; 2HealthResearchInstituteOfSantiagoDe CompostelaIdis,ClinicalPharmacologyGroup,SantiagoDeCompostela,Spain; 3Anger University,Pharmacy,Angers,France; 4HospitalUniversitarioDeSantiagoDeCompostela, DigestiveGastroenterologyDepartment,SantiagoDeCompostela,Spain

10.1136/ejhpharm-2024-eahp.304

BackgroundandImportance Therapeuticdrugmonitoringin inflammatoryboweldisease(IBD)isausefultoolforoptimisingbiologictherapy.Theanalysisofadalimumab(ADL)concentrationsinbloodthroughenzyme-linkedimmunosorbent assay(ELISA)requiresaccumulationofsamplestomakeita cost-efficienttechnique,delayingtheresultsforseveraldays. Ontheotherhand,point-of-care(POC)testsfacilitateimmediatedecisionmakingbyprovidingADLconcentrationresults inlessthanhalfanhour.However,itisnecessarytodemonstratetheequivalenceofbothmethodsandtheir interchangeability.

AimandObjectives Theaimofthisstudyistocomparethe referencetechniqueforquantifyingADLlevelsusingELISA withquantificationusingPOCtest.

MaterialandMethods Fromourownbiobankwithserum samplesof200IBDpatientstreatedwithbiologics,thosewith adalimumablevelswereselected.Later,atotalof60patients wererandomlyselected:19forADLsub-therapeuticrange (<5 mg/ml),21forADLtherapeuticrange(5–12 mg/ml)and 20forADLsupra-therapeuticrange(>12 mg/ml).Quantitative sandwichELISAassaywasperformedwithPromonitorADL kitandPOCtestwasperformedwithQuantumBlueassay. CorrelationwasevaluatedwithSpearman’scorrelation

coefficient(rs).ConcordancebetweenthethreedifferenttherapeuticgroupswasassessedthroughweightedCohen’skappa (k )anddifferencesinclassificationforeachgroupwasdeterminedusingMcNemartest.

Results NostatisticallysignificantdifferencesinADLtrough levelswereobservedbetweenELISAandPOC(p=0.3101).

Medianvalueswere10 mg/mL(IQR:3.87–13.25)forthe Promonitorassayand8.85 mg/ml(IQR:3.67–13.62)for QuantumBlueassay.AgoodcorrelationofADLtroughlevels betweenthetwoassays(rs=0.88)andasubstantialagreementinstratifyinginthedifferentgroupsoftherapeutic ranges(K=0.751±0.063)wereobserved.McNemar ’stest revealednosignificantdifferencesamongdifferentrangesclassification(p-value=1).Bland-Altman’sanalysis(figure1)was donetocompletethecomparisonbetweenthemethods, revealingabiasdifferenceof0.4453.

Abstract4CPS-199Figure1

ConclusionandRelevance TheQuantumBluePOCtestrepresentsanalternativetoELISAindeterminingADLconcentrations,allowingresultstobeobtainedinlesstime,which facilitatestherapeuticdecision-makinginpatientswithIBD.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-200 TRIPLETHERAPYFORMETASTATICHORMONESENSITIVEPROSTATECANCERPATIENTSBASEDONA PHARMACOLOGICALTREATMENTALGORITHM

RTamayoBermejo,JCDelRíoValencia,MEspinosaBosch,RSaldaña*. RegionalUniversity HospitalOfMalaga,PharmacyDepartment,Málaga,Spain

10.1136/ejhpharm-2024-eahp.305

BackgroundandImportance Standardtreatmentformetastatic hormone-sensitiveprostatecancer(mHSPC)supplements androgendeprivationtherapy(ADT)withdocetaxel,secondgenerationhormonaltherapy,orradiotherapy.However,the

PEACE-1studydemonstratesthataddingabirateroneplusprednisonetoADTanddocetaxelimprovessurvivalwithamoderateincreaseintoxicity,currentlyofflabel.

AimandObjectives Toevaluateeligibilityforabirateroneplus ADTanddocetaxelindenovometastatichormone-sensitive prostatecancer(mHSPC)basedonapharmacologicaltreatmentalgorithm.

MaterialandMethods Observational,prospective,multidisciplinarystudyincludingallmHSPCpatientsscheduledforfirstlinetreatment(July2022/December2022).Thechoiceoftriplettherapywasbasedoncompliancewithapharmacological treatmentalgorithm,including:age<75years,geriatricassessmentusingtheGeriatric8(G8)scale>14,nofragility impressionbytheoncologist,ECOG0–1,absenceofcomorbiditiessuchasliverdisease,coagulationproblems,and/or activeheartdiseaseinthelast6months;HighRisk(atleast twoofthefollowingcharacteristics):Gleason8–10, 3bone metastasesand/or 1visceralmetastasis;HighVolume (CHAARTEDtrial);andPrognosticGradeGroup(ISSUP 2014-OMS2016)4–5.Othervariables:PSA,comorbidities, polypharmacy,treatment.Progression-freesurvival(PFS)and treatmentduration.Adversereactions(AR).

Results Twenty-ninepatientswereincluded,75.9%werede novomHSPC,44.8%hadhighvolume,ofwhich69.2%met allalgorithmcriteria.Patientstreatedwiththetriplethada medianageof65years,100%hadG8>14,66.6%had ECOG1,77.7%hadmultiplebonemetastases,meanPSAat thestartwas136.32ng/ml,77.7%hadGleason9,88.8%had ISSUP5,onlyonepatienthad>3comorbidities,andthree patientswereonpolypharmacy.Themediantreatmentdurationwas5.97months,andPFShasnotbeenreachedyet, withonlyonepatientprogressingduringdocetaxeltreatment, whiletherestcompletedtheproposedsixcycles.77.7%of patientsexperiencedsomeAR,noneofwhichwereG3–4. ThemostcommonARwasskin-related(44.4%),followedby edema(33.3%),insomnia(22.2%),digestivetoxicity(11.1%), neurotoxicity(11.1%),andelevatedtransaminases(11.1%).

ConclusionandRelevance Choosingtriplettherapybasedona studiedalgorithmhelpsidentifypatientswhocanbenefitmore fromtreatment,focusingonthoseathigherriskandwith worseprognosis,leadingtofavourableoutcomesinefficacy andsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-201 CLINICALEXPERIENCEOFTYROSINE-KINASE INHIBITORSDISCONTINUATIONINCHRONICMYELOID LEUKAEMIA

1BSanchezPascual*, 1ISalvadorLlana, 1CSanzSanchez, 1MPradaBou, 1SHerrera Carranza, 2MDPMartinezBarranco, 1EZhanZou, 1PSanmartinFenollera, 1MPerez Encinas. 1HospitalUniversitarioFundacionAlcorcon,Pharmacy,Alcorcon,Spain; 2Hospital UniversitarioFundacionAlcorcon,Hematology,Alcorcon,Spain

10.1136/ejhpharm-2024-eahp.306

BackgroundandImportance Tyrosine-kinaseinhibitors(TKIs) haveshowntobeeffectiveinchronicmyeloidleukaemia (CML)treatment.Recentclinicaltrialsshowselectedpatients withdeepmolecularresponse(DMR)cansafelydiscontinue treatment.

AimandObjectives DescribingclinicalexperienceofdiscontinuingtreatmentwithTKIsinCMLpatients.

MaterialandMethods AretrospectiveobservationalstudyanalysedTKIsdiscontinuationandmaintenanceofmajormolecularresponse(MMR)afterdiscontinuationinallCMLpatients treatedatourcentrefromthemomenttheystartedTKIsuntil September2023.

Discontinuationprotocolstipulatespatientsmusthavebeen treatedforfivefirstgenerationTKIs)orthree(second

generationTKIs)yearsandmusthaveachieved2yearsof DMR(molecularresponse(MR)=4orgreater).Afterdiscontinuationtheyhavemonthlymonitoringvisitsfor6months (periodwhenmostpatientsloseMMR),afterwardscontrols arespacedoutovertime.IfpatientsloseMMR(MR=3) treatmentshouldrestart.

Variables age,gender,TKI,startdate,response,DMRachievingdate,TKIswitchbeforediscontinuationandcause,discontinuationanddate,withdrawalsyndrome(WS),WStreatment, restartdateandTKI,lastconsultationdate.

Results Sixty-twoCMLpatientsweretreatedwithTKIsand 48.4%(30)discontinued.Medianageofpatientswhodiscontinuedwas57.8years[interquartilerange(IQR):50.1–67.1], 63.3%werefemale.

Wefound73.3%discontinuedwith1st-lineTKIs,26.6% receivedvariousTKIsbeforediscontinuationdueto:toxicity (60%)andsuboptimalresponse(40%).

ForthosewhodiscontinuedmedianTKItreatmentuntil discontinuationwas6.2years[IQR:4.9–12.1],andmedian timewithDMRwas4.9years[IQR:3.3–8.1].Whentheydiscontinued,theyweretreatedwith:imatinib(63.3%),nilotinib (23.3%),dasatinib(6.7%),bosutinib(6.7%).

FivepatientsdevelopedWS:osteomuscularpain(4),panniculitis(1).Onepatientreceivedcorticosteroidsandtwo receivedanalgesics.

63.3%maintaineddiscontinuation,follow-upmedianof3.4 years[IQR:0.9–4.5].

36.7%patientslostMMR,follow-upmedianuntilrestart was5.3months[IQR:4.2–6.9].Sevenpatientsrestartedwith previousTKI,fourchangedtosecondgenerationTKIs.One hadalaterelapseat19.4months.AllpatientsregainedMMR afterrestartingtreatment.

ConclusionandRelevance Ourresultsareinlinewithcurrent literatureshowingcontrolleddiscontinuationisaviableand potentiallylong-termoption.Discontinuationisalreadypart ofthestandardofcareinselectedpatientssinceit’scost-effective,representingsavingsforHealthcareSystemandimproving patient’slifequality.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-202 EVALUATIONOFTHEEXCHANGEOFANTI-CGRP MONOCLONALANTIBODIESFORTHETREATMENTOF CHRONICREFRACTORYMIGRAINE

CMayo*,ALópez-Henares,VColladosArroyo,RFernández-Caballero. Idcsalud Valdemoro-S.A.,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.307

BackgroundandImportance Inclinicalpracticeofchronic migrainetreatment,changesbetweenthedifferentanti-CGRP monoclonalantibodies(mABs)onthemarketaremade,but therearestillnoclinicaltrialstosupporttheeffectivenessof suchaswitch.

AimandObjectives Todeterminethecharacteristicsofthe switchesmadebetweenmABs(fremanezumab,galcanezumab anderenumab)inourhospital,andtoevaluatetheeffectivenessofthesechanges.

MaterialandMethods Descriptiveobservationalandretrospectivestudyinasecond-levelhospitalinwhichpatientsdiagnosedwithrefractorychronicmigrainefromJune2020to September2023andwhohadbeenontreatmentwiththe

threedrugs,wereincluded.Inclusioncriteria:patientsaged >18years,ontreatmentforatleast3monthswithfremanezumab(225mg/month),galcanezumab(120mg/month(initial 240mg)anderenumab(140mg/month).

Demographicvariables(sex,age),efficacyvariables: monthlydayswithheadacheofatleastmoderateintensity (HMD)at0,3and6months,typeofdrugusedandtiming, durationoftreatment(DT(months)),anduseofconcomitant prophylaxis(CP)werecollected.ChangeswithrespecttobaselineHMDwereanalysed,establishingaseffectiveachange greaterthan30%and50%.

Results Eighteenpatientswereincluded,71%female(N=13) andamedianageof44.6(RIQ:42.6–58.4)years.Patients hadameanandstandarddeviation(SD)20.6(SD7.8)days ofbaselineheadache.Atotalof55treatmentswerereviewed: 81%(N=42)receivedPCtogetherwithAcM.Themedian DTwithfremanezumab,galcanezumabanderenumabwas6.7, 10.1and7(SD4.5,7and5)monthsrespectively.Interms ofefficacy,twoandthreepatients(11%/16%)respectively achievedatleasta50%and30%reductioninheadachedays atthefirstchange,andnoneatasecondchangeoftreatment, bothat3and6monthsoftreatment(allwereon fremanezumab).

Abstract4CPS-202Table1

Erenumab55%0%45% Galcanezumab0%89%11% Fremanezumab45%11%44%

ConclusionandRelevance FollowingtheactivetreatmentprotocolsforchronicmigrainewithmABsinourcentreatany giventime,ourpatientsampleshowsthatonlyamaximumof 16%ofpatientscouldberescued,takinga30%decreasein thenumberofheadachedayspermonthasefficacy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-203 DEVELOPMENTANDVALIDATIONOFADATA COLLECTIONTOOLTOEVALUATEPHARMACEUTICAL INTERVENTIONSINANINTENSIVECAREUNIT RAgius*,JVellaSzijj,LMAzzopardi. UniversityofMalta,DepartmentofPharmacy,Msida, Malta

10.1136/ejhpharm-2024-eahp.308

BackgroundandImportance Clinicalpharmacyserviceshave beenrecentlyintroducedinalocalintensivecareunit(ICU) andconsequently,serviceevaluationisanticipated.Thereis theneedforatooltocapturepharmaceuticalinterventionsin ICUandassesstheirimpactonspecificpatientoutcomes.

AimandObjectives Todevelopandvalidateatooltodescribe andclassifydrug-relatedproblems(DRPs)andpharmaceutical interventions(PIs)inICUandevaluatetheclinicalrelevance ofthePIinpreventingapotentialAdverseDrugEvent (pADE).

MaterialandMethods AclassificationsystembasedonPharmaceuticalCareNetworkEurope (PCNE)V9.1wasidentified

tocaptureandresolveDRPsidentifiedinICU.ThePCNE V9.1classificationprovides extensivecategoriesofDRPs. EvaluationofimpactofPIsinpreventingapADEisconductedusinganestablishedscore1 .ThepADEscorereflects thelikelihoodofanADEoccurringintheabsenceofaPI.

Thedevelopeddatacollectiontoolwasvalidatedbyan expertpanelmadeupofthreeclinicalpharmacistspractising inICUandaconsultantintensivist.Theexpertpanel assessedthetoolforfaceandcontentvalidityandpracticality inICUsetting.Subsequently,thetoolwaspilotedinICUfor 10days.

Results Thedatacollectiontoolconsistsofsevensections namelypatientdemographicswithdetailsaboutpertinentlaboratoryresults,descriptionofDRPandPI,classificationof DRPandPI,outcomeofPI,andcategorisationofmedications involved.Thefinalsectionofthetoolrelatestoevaluationof PIinrelationtopreventionofapADEandcontainsfivecategories,zerotohigh,whichcorrespondtotheprobabilityofa pADEoccurringifthepharmacisthadnotintervened.ExamplesfromliteraturearepresentedforeachpADEcategoryto assistwiththeevaluationofPIs.Followingvalidationand pilottesting,foursectionswereamendedtobetteradaptthe tooltoICUsetting.

ConclusionandRelevance Thedevelopmentofsuchadata collectiontoolisimportanttostandardisetheclassificationof DRPsandinterventionsrecommendedbypharmacistsinICU. Thetoolcontributestodatademonstratingvalueofpharmacistinterventionsonpatientoutcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.NesbitTW, etal.Implementationandpharmacoeconomicanalysisofaclinical staffpharmacistpracticemodel. AJHP. 2001;58(9):784–790.DOI:10.1093/ajhp/ 58.9.784

ConflictofInterest Noconflictofinterest.

4CPS-204 MONITORINGOFLINEZOLIDINHAEMODIALYSIS:A CLINICALCASE

1LSopena*, 1MAAllende, 1MArenere, 1INavarro, 2ABWennekers, 1AMerchán, 1MRGarcía, 1EChilet, 1IVarela, 1MMerchante. 1HospitalClínicoUniversitarioLozano Blesa,Pharmacy,Zaragoza,Spain; 2HospitalClínicoUniversitarioLozanoBlesa,Nephrology, Zaragoza,Spain

10.1136/ejhpharm-2024-eahp.309

BackgroundandImportance TheAntimicrobialTherapyGuidelinesrecommendtheconventionaldosageoflinezolid(600 mgevery12hours)forpatientsonhaemodialysis(HD).Linezoliddialyzes40%byHD.

AimandObjectives MonitoringplasmaconcentrationsoflinezolidinapatientonHD.

MaterialandMethods A63-year-oldmanwithahistoryof bypasswithsaphenousveinandstage-4ofchronickidneydiseaseonanHDprogramme,wasadmittedtotheintensive careunit(ICU)forsepticshockduetoanischiorectalabscess.

Enterococcusfaecium sensitivetolinezolid(MIC2)was isolatedfromtheabscesscultureandlinezolidtreatment(600 mgevery12hours)wasstarted.DuringhisstayattheICU, heunderwentdailycontinuoushaemodiafiltration.

Afterthat,hewastransferredtothewardwhereheunderwentthreeconventionalhighflowHDsessionsperweek.

Uponarrivalattheward,wewereaskedtomonitorlinezolidlevelsduetoprobabletoxicityassociatedwithadecrease

inplatelets(196,000/mclatthatmomentvs.441,000/mcl priortolinezolid).

Results After12daysoflinezolidtreatment,atroughlevelof 12.6mcg/mlwasobtained(range2 – 7mcg/ml).Werecommendedtodiscontinuethelinezolidtreatmentandtomeasure thetroughlevelagainthenextdaybeforeandafterHD.The levelsfoundwere6.71and1.26mcg/mlrespectively(HD eliminationrateof81.22%).Thus,weadvisedtorestartwith adosageof600mgevery24hoursthatsamenight.

Duringthefollowingdays,werecommendedtocontinue withthesamedosageguidedbypre-andpost-HDlevels.The plateletcountincreasedprogressivelyafterestablishinglevels withinthetherapeuticrange.

Abstract4CPS-204Table1

ConclusionandRelevance Thisclinicalcasedemonstratesthat theremaybepatientsundergoingHDwhohavetoxiclevels oflinezolidwiththestandarddosage.Inthesecases,thereis aneedtomonitorandadjustthedose.

WehavealsoobservedthattheHDeliminationinthis patientdiffersfromthevaluereportedbytheAntimicrobial TherapyGuidelinesprobablyduetothedifferenttypeofHD membrane.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-205 RESULTSOFANTIBIOTICPROPHYLAXISINACUTE BRONCHOASPIRATIONPNEUMONITIS

1AVarasPerez*, 1MTBrievaHerrero, 2PFriasRuiz. 1HospitalAntequera,PharmacyService, Antequera,Spain; 2GenesisCare,PharmacyService,JerezDeLaFra,Spain

10.1136/ejhpharm-2024-eahp.310

BackgroundandImportance Theuseofantibioticsinacute bronchialaspirationiscommon,althoughthereislittleevidencethatitprovidesbenefits,anditexposespatientsto increasedmicrobiologicalresistanceandtheappearanceofside effectsfromtheuseofantibiotics.

AimandObjectives Comparemortality,changeofventilation modality,ICUadmissionandhospitalstayofpatientswith aspirationwhoreceiveprophylacticantibiotictherapy,with patientswhodonotreceiveantibiotics.

MaterialandMethods Retrospectivedescriptiveobservational studyofpatientswithacutebronchialaspiration(January 2022toMarch/2023).Demographicandclinicaldatawere collectedfromthepatient‘smedicalhistory;andmedicationrelatedinformationfromtheelectronicprescriptionsoftware availableinthehospital.

Results 267patients(50.6%women).Average81.62years. Services:Emergencies(75.7% ),Internal(12.4%).Charlson index6.10(SD2.73).Riskofbronchialaspirationin71 patients(26.6%).231(86.5%)antibiotic,36(13.5%)

withoutantibiotic.Amoxicillin-clavulanicacidwasmost commonlyused(59.2%).Antibi otictreatmentduration6.64 days(SD4.40).Sevencomplicationssecondarytoantibiotics.Antibioticindicatedin28patients(10.5%).30patients (11.2%)changedventilatorymodality,21patients(7.9%) wereadmittedtotheICU.97patients(36.3%)died(days untildeath5.75days),ofwhich75(77.1%)received antibiotics.

ConclusionandRelevance Prophylacticantibioticsduringacute aspirationdonotreducemo rtalityortheneedforICU admission,butratherincreasetheneedtochangeventilation modality.Thehospitalstayinprophylacticantibiotictherapy islongercomparedtopatientswhodonotreceive antibiotics.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-206 PRE-EXPOSUREPROPHYLAXIS,AREWEDOINGIT RIGHT?

MDSLourenço,AMBrito,AAlcobia*,TMendes. HospitalGarciaDeOrta-Epe, PharmaceuticalServices,Almada,Portugal 10.1136/ejhpharm-2024-eahp.311

BackgroundandImportance TheUnitedNationsGeneral Assemblyestablishedthatafastresponsewasrequiredtoend AIDSepidemicsby2030.Pre-exposureprophylaxis(PrEP) involvesreducingtheriskofacquiringHIV.However,amain apprehensionexistswithregardtoriskcompensation,concerningthatPrEPdecreasesthecondomuseandincreasessexually transmittedinfections(STI).Similarly,totheaforementioned goal,by2030,theWHO’sproposeda90%reductioninthe syphilisandgonorrhoeaincidence.RegardingPrEPsincreasing use,itisimportanttoassessourstandpointandhowto improve.

AimandObjectives CharacteriseandassessthePrEPusing populationregardingdemographics,adherence,STIprevalence andHIVinfection.

MaterialandMethods RetrospectivestudyofPrEPprescribed patients,between2017–2022(minimum6-monthperiod intake).Populationcharacteristics,post-exposureprophylaxis history(PEP),PrEPregimen,adherence,therapeuticsuspension andtheircauses,seroconversionandSTIs(chlamydia,syphilis, gonorrhoea,trichomoniasis,Mycoplasmagenitallium),were analysedandconfrontedwithourcountry ’slatestreportof STInotification.

Results Weanalysed392patients(97%male;91.7%malesex withmale),withamediumageof37years,mainlyfromPortugal(52%)andBrazil(33.7%).Only14.3%didPEP,meaningthat85.7%startedPrEPstraightaway.Themajority (91.6%)wereonadailyregimen.TheSTIprevalencewas 73.4%(gonorrhoea46.2%andchlamydia38.3%).TheCovid19pandemichadlittleeffectonadherence,increasingPrEPs use(proportiondayscovered=82.8%).Onlytwopatients testedpositiveforHIV.Suspensionratewas28.1%inwhich 50.5%ofcausesweretraceable(fourpatientsduetoadverse effects).

ConclusionandRelevance PrEPdemonstratedhightolerability andefficacybuthadabigprevalenceofSTIsamongPrEP users.Between2015–2017nationwide,4819casesofchlamydia,gonorrhoea,andsyphiliswerereported,comparingto 463patientsofaregionalhospital,evenacknowledginga

widerperiod.Accessdifficultiesmightbethecauseofhigh suspensionrate,despitefreesupply.Hospitalsareassumingan increasingburdenofcosts,leadingtomonthlysupplyof increasingpatients,investinginHIVpreventionbutpromoting STIs.Wecanengagewithprescriberstostartpharmaceutical appointmentstopromotebehaviouralchangesconcerningSTIs andtoeducatefortheneedofmaintainingPRePadherence. Simultaneously,wecangiveeducationalmaterialsandhealth lectures.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-207 EVALUATIONOFPROSTATICSPECIFICANTIGEN DEPLETIONWITHABIRATERONEASAPRONOSTATIVE FACTORFORSURVIVALINMETASTATICCASTRATIONSENSITIVEPROSTATECANCER

1FCajade*, 1MTourís-Lores, 2APupla-Bartoll, 1ISoto-Baselga, 1BBernárdez-Ferrán, 1SSantana-Martínez, 1LGarcía-Quintanilla, 1ACastro-Balado, 1AMosquera-Torre, 1ELópez-Montero, 1IZarra-Ferro. 1HospitalUniversitarioDeSantiagoDeCompostela, FarmaciaHospitalaria,SantiagoDeCompostela,Spain; 2HospitalGeneralUniversitarioDe Castellón,FarmaciaHospitalaria,Castellón,Spain

10.1136/ejhpharm-2024-eahp.312

BackgroundandImportance Intheliterature,thereisanindicatorofresponsetotreatmentwithenzalutamideandapalutamide,definedasPSA90,forpatientswithmetastatic castration-sensitiveprostatecancer(mCSPC).However,no earlyresponsemarkertoabirateronetreatmentinthesetting ofsynchronousmCSPChasbeendescribed.

AimandObjectives Theaimwastoanalysethedeepprostatic specificantigen(PSA)responseinpatientswithmCSPC treatedwithabiraterone.

MaterialandMethods Retrospectiveanalysisofpatientswith metastaticmCSPCtreatedwithabirateroneaccordingtothe LATITUDEclinicaltrialcriteria(2of3criteria:bonemetastases 3,Gleasonscore 8orpresenceofvisceralmetastases), inourcentrefromSeptember2017toJanuary2023.Data collectedforeachpatientwere:age,PSAatbaseline(PSA0), percentageofPSAdeclineafter14±7dayssincethestartof abirateronetreatment(%PSA),Gleasonscoreatbaseline(GS), typeofmetastases,event(definedasprogressionordeath) andprogression-freesurvival(PFS).Receiveroperatingcharacteristic(ROC)curvewasusedtoevaluatetheoptimalPSA cut-offpointtoidentifyagreaterpossibilityofresponse. Event-timedistributionswereestimatedusingKaplan-Meier methodology.Log-ranktestswereusedtotestfordifferences inevent-timedistributions.Allp-valuesare2-sidedandCIs areatthe95%level,withsignificancepre-definedtobeat the0.05level.

Results Datafrom41patientswereanalysed,ofwhichthere wasnobiochemicalresponseinfiveofthem.Table1shows themedianandstandarddeviationofthevariablesanalysed.

Abstract4CPS-207Table1

Abstracts

FiftypercentofpatientshadaGS=9.Thepercentageof patientswithbone,visceralandlymphnodemetastaseswas 50%,33%and17%,respectively.Acut-offof30%forPSA declinewasestablished.MedianPFSwas10.1months(95% CI:5.3–14.8)inpatientswithPSAdecline<30%and23.9 months(95%CI:11.7–36.1)inpatientswithPSAdecline 30%(p=0.001).

ConclusionandRelevance Thisreal-lifestudyshowsthatan earlydeclineinPSAvalue 30%afterinitiatingabiraterone treatmentmaybeanindicatorofimprovedtreatmentresponse inpatientswithmCSPC.Largerstudiesareneededtoconfirm thishypothesis.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-208 ANALYSISOFTHEIMPLEMENTATIONOFA MULTIDISCIPLINARYPHARMACEUTICALCARE PROJECTFORGERIATRICHAEMATO-ONCOLOGY PATIENTS

1CAlarcon-Payer*, 1MDMSánchezSuárez, 1AMartínRoldán, 2JMPuertaPuerta, 1AJiménezMorales. 1HospitalUniversitarioVirgenDeLasNieves,PharmacyService, Granada,Spain; 2HospitalUniversitarioVirgenDeLasNieves,HematologyService,Granada, Spain

10.1136/ejhpharm-2024-eahp.313

BackgroundandImportance Theelderlyconstitutealargepercentageofpatientswithhaematologicmalignancies.Itisestimatedthatthispercentagewillgrowduetotheageingofthe populationandthenewtherapeutictargetsthatmanageto controlandchronifythedisease.Theypresentcognitive impairment,malnutrition,physicaldependenceandpolymedication,requiringacomprehensiveandmultidisciplinary approach.

AimandObjectives Todesignapharmaceuticalcareprotocol forgeriatrichaemato-oncologypatientsandtoevaluatethe results.

MaterialandMethods ProspectiveobservationalstudyconductedfromJanuary2022toSeptember2023inthePharmaceuticalCareConsultation foroncohaematologicpatients ofatertiaryhospital.Thehaematologistselectedthemost fragilepatientswiththeG8sc aleandwiththehighestnumberofcomorbiditiesevalua tedwiththeCIRS-Gscaleand sentthemtothePharmacyconsultation,wherethepharmacistinchargemadeapreviousevaluationofhomemedication,self-medication,alternativemedicinewiththeaimof detectingdruginteractions,therapeuticduplications,inappropriatelyprescribeddrugsusi ngtheSTART-STOPPcriteria, assessingthepossibledeprescriptionofpolymedication,and lackofadherenceusingtheMorisky-Greentest.Intheevent ofdetectinganyerrorsinmedi cationintake,interactionsof interest.oradversereactions, pharmaceuticalinterventions weremadeinthepatient‘ sclinicalhistoryforconsultation byanyhealthprofessional.

Results Withthisnewprotocol,40patientswereattended, withamedianageof80years,68%menand32%women. Adherencetohaemato-oncologictreatmentwasimprovedby 90%.Thirty-fivepharmaceuticalinterventionswerecarried out:3relatedtothedosageandwayoftakingthetreatment,10withpharmacologicalinteractionsinwhichitwas

necessarytosubstituteadruginthetreatment,fivetherapeuticduplications,eightwiththeuseofherbalproductsand multivitamincomplexesthatinteractedwiththeirtreatment, fourfornotattendingtheirmedicalcheck-upin2yearsand fivehadprescribedmedicationoflittletherapeuticvalueand withahighanticholinergicloadthatwassuspendedfromthe treatment.

ConclusionandRelevance Thehospitalpharmacisthasan importantroleinthepharmaceuticalcareofgeriatrichaemato-oncologypatientsbycreatingmultidisciplinaryworkprotocolsofferingpersonalisedtreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Practicalassessmentandmanagementofvulnerabilitiesinolderpatientsreceiving chemotherapy:ASCOguidelineforgeriatriconcology. JCO.2018.

ConflictofInterest Noconflictofinterest.

4CPS-209 COMPARISONOFTWOPHARMACOKINETIC/ PHARMACODYNAMICINDICESINCRITICALLYILL PATIENTSTREATEDWITHAMIKACIN

1FCajade*, 2IBeltrá-Picó, 2SRuiz-ElJerche, 2AViudez-Martínez, 2ABolea-Lacueva, 3RNalda-Molina, 3ARamón-López, 2PSerrano-Más. 1HospitalUniversitarioDeSantiagoDe Compostela,FarmaciaHospitalaria,SantiagoDeCompostela,Spain; 2HospitalGeneral UniversitarioDeAlicante,FarmaciaHospitalaria,Alicante,Spain; 3UniversidadMiguel Hernández,FacultadDeFarmacia,Elche,Spain

10.1136/ejhpharm-2024-eahp.314

BackgroundandImportance Amikaciniscommonlyusedasan empiricaltreatmentforgram-negativeinfectionsinintensive careunit(ICU)patients.Thepharmacokinetic/pharmacodynamic(PK/PD)indexcommonlyusedistheratiomaximal concentration:minimuminhibitoryconcentration(Cmax/MIC) and,toalesserextent,theratioareaunderthecurvefrom0 to24h:MIC(AUC0– 24/MIC).

AimandObjectives ToevaluatethePK/PDindicesCmax/MIC andAUC0–24/CMIforamikacinincriticallyillpatients.

MaterialandMethods PatientsadmittedtoamedicalICUwith preservedrenalfunction(CKD-EPI>60ml/min)treatedwith empiricalamikacinonce-dailywereincluded.Therapeutic DrugMonitoring(TDM)wascarriedoutafterthefirstdose (sampletiming:CmaxandCpost-8h,at30minutesand8 hoursrespectively,aftera30-minuteinfusion).TargetsforPK/ PDCmax/MICandAUC0–24/MICwere8–10and80,respectively.AnempiricalMICof4mg/Lwasestablishedforthe calculation.ParametricAUCcalculationwasperformedby empiricalBayesianestimationofpharmacokineticparameter. BayesianestimateswereperformedusingPKS® softwarewith asinglecompartmentpharmacokineticmodel.Patientswere classifiedaccordingtothosewhoreachedthetargetornot forbothindices(Cmax/MICandAUC0–24/MIC).

Results Resultsexpressedasmedianandpercentile25–75.

N=48

Age63years Weight83kg Creatinine0.6mg/ dL

Totaldose(mg)1225(1000–1500)1250(1200–1500)

Doseadjustedfortotal weight(mg/kg)

14.7(11.8–18.3)14.7(12.5–17.1)

Doseadjustedforideal weight(mg/kg) 19(15.3–22.8)19(17.6–22.2)

Cmax(mg/L)48.3(45.9–50.9)

Cmin(mg/L)0.19(0.03–0.61)

AUC(mg·h/L)235(191–271)

Cmax/MIC12.1(11.5–12.7)

AUC0–24/MIC58.7(47.7–67.9)

DuetoTDM,100%ofpatientsreachedthetherapeutic objectiveaccordingtotheCmax/MICindex,althoughthepercentagewasreducedto17%whenthePK/PDindexofefficacywasAUC0–24/MICratio(concordanceindex kappa=0.275;p£0.05).ToachievetheAUC0–24/MICtarget, therequireddosewasestimatedtobe1760mg(1300–2270) (p=<0.05).

ConclusionandRelevance NocorrelationbetweenthePK/PD Cmax/CMIandAUC0–24/MICindiceswasobserved.To achievetheAUC0–24/MICtarget,asignificantdoseincrease isnecessarycomparedtothedosesrequiredforCmax/MIC.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-210 HOMEINFUSIONCHEMOTHERAPYTREATMENTFOR PATIENTSWITHMALIGNANTHAEMATOLOGICAL DISORDERS

1CAlarcon-Payer*, 1AMartínRoldán, 1MDMSánchezSuárez, 1AJiménezMorales, 2JMPuertaPuerta. 1HospitalUniversitarioVirgenDeLasNieves,PharmacyService, Granada,Spain; 2HospitalUniversitarioVirgenDeLasNieves,HaematologyService, Granada,Spain

10.1136/ejhpharm-2024-eahp.315

BackgroundandImportance Home-basedchemotherapyis becomingavalidalternativetohospital-basedtreatmentfor patientswithmalignanthaematologicaldisorders.

AimandObjectives Toevaluatethebenefitsofimplementinga homeinfusionchemotherapytreatmentforpatientswith malignanthaematologicaldisorders.

MaterialandMethods Prospectiveobservationalstudyfrom February2016toSeptember2023inatertiaryhospital.The haematologistselectedpatientswithautonomyforself-care andgoodfamilysupport.Thechemotherapyprotocolsadministeredathomewere:ESHAP:Etoposide40mg/m2 IVover2 hdays1to4 – Cytarabine2000mg/m2IVover2honday5 – Cisplatin25mg/m2 in22hcontinuousIVinfusiondays1 to4 – Prednisone60mg/m2 oraldays1to5,DHAOx:Oxaliplatin130mg/m2 IVover2hday1-Cytarabine2000mg/m2/ 12hIVin2hday2 – Dexamethasone40mgoraldays1to4 andEPOCH:Etoposide50mg/m2+Doxorubicine10mg/ m2+Vincristine0,4mg/m2 continuousIVinfusion24hdays 1–4,cyclophosphamide750mg/m2 IVday5,Prednisone 60mg/m2 oraldays1to5.Patientswereinfusedathome usinganelastomericinfuser.Hometreatmentwasprepared individuallybythepharmacist.

Results Homeinfusionchemotherapytreatmentwasperformed in46patients.43,4%withnon-Hodgkin’slymphomareceived ESHAPinsecond-line,withamedianageof51years,and 32,6%withmantlecelllymphomareceivedDHAOXinfirstlinewithamedianageof46yearsand23,9%withaggressive non-Hodgkin’slymphomaweretreatedwithEPOCHinfirstlinewithmedianage42years.Thisallowedanoptimisation ofwaitinglistsby90%,treatingmorepatientsrequiring admissiontotheinpatientwardwithlessdelay.Acceptanceof theprocedureincreasedin92%ofpatients.Theriskofinfectionbynosocomialmicroorganismswasreduced.Asavingof 2500eurosperpatientwasachieved.95%ofpatientssaid theywereverysatisfiedreceivingtheirchemotherapytreatment,beingmorecomfortable.

ConclusionandRelevance HomeInfusionChemotherapyTreatmentforESHAP,DHAOXandEPOCHhasbeenaneffective, safeandfeasibleprocess.Ithasmanagedtoavoidhospitalisationofhaemato-oncologypatientsreceivingIVchemotherapy, savinghospitalstays,reducingnosocomialinfectionsand improvingqualityoflife.

REFERENCESAND/ORACKNOWLEDGEMENTS

1. AmJHealthSystPharm. 2018May1;75(9):246–258.

ConflictofInterest Noconflictofinterest.

4CPS-211 ANALYSISOFTHEPRESCRIPTIONOFVITAMIND SUPPLEMENTSINASOCIALHEALTHCENTRE

1TRicoGutierrez, 1TRicoGutierrez*, 1AAmoros-Paredes, 2FRuiz-Molina, 1RColoma-Peral, 1LMarin-Ventura, 1YPerez-Robres, 1MMoreno-Garcia, 1MVidal-Iglesias, 1AHernandezLopez, 1LGarcia-Lopez. 1LicenciadaEspecialistaEnFarmaciaHospitalaria,Farmacia, Segovia,Spain; 2LicenciadoEspecialistaEnFarmaciaHospitalaria,Farmacia,Segovia,Spain

10.1136/ejhpharm-2024-eahp.316

BackgroundandImportance AccordingtotherecommendationsfortheappropriateuseofvitaminDtestsandsupplementsinthegeneralpopulationpublishedin2021,several bulletinshavebeenpublishedassupporttoolsinroutinepractice,theanalysiscarriedoutbeingvariable.

AimandObjectives StudyoftheconsumptionandprescriptionsofvitaminDsupplementsaloneinasocialhealth centre.

MaterialandMethods Observational,retrospectivestudyofthe consumptionofvitaminDsupplementsandcross-sectional analysisofcurrentprescriptionsforexternalintakeofvitamin D.Allpatientsinstitutionalisedwereincluded.Thevariables collectedwere:age,sex,posologyofvitaminD,levelsand whethertheyhad:bone,kidneyorbothpathologies.Thedata wereobtainedfromtheinpatientmanagementprogramand thecomputerisedclinicalhistory.Fortheanalysis,weusedthe laboratoryanalyticalparametersasareference:deficiency (<10ng/dL),insufficiency(10–30ng/dL),sufficiency(30–100 ng/dL)andtoxicity(>100ng/dL).

Results 300residentswerereviewed,ofwhich43.67%(131/ 300)wereprescribedvitaminD,32menand99women, withameanageof84.4years[52–102].Thedistributionby posologywas:monthlyin70.23%(92/131)residents,biweekly in25.95%(34/131)residents,withtheweeklyregimenand every10daysin1.53%(2/131)residents,respectivelyand every21daysonly0.76%(1/131)residents.Accordingtolaboratorydata,12ofthemhaddeficiency(<10ng/dL),90had insufficiency(10ng/dL-30ng/dL)and27hadsufficiency(30

ng/dL-100ng/dL).Regardingassociatedpathologies:62 (47.33%)residentshadbonepathology,17(12.98%)hadkidneypathology,andbothpathologieswerepresentineight (6.11%)ofthem.39.69%(52/131)residentsdidnotpresent anypathologyrelatedtovitaminDdeficiency.Inrelationto theconsumptionofvitaminD:

ConclusionandRelevance TheexternalsupplyofvitaminDis necessaryincertainpathologies.However,thisconsumption hasincreasedexponentiallyfornoapparentreasonotherthan theresultofthelevelsofvitaminDinthetests.Inviewof theresultsobtained,itwouldbeadvisabletocarryoutperiodicreviewsofvitaminDsupplementationininstitutionalised patients,aswellasconsiderdeprescribingthemifsaidcontributionisunnecessary.

REFERENCESAND/ORACKNOWLEDGEMENTS

3.-chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.euskadi.eus/contenidos/informacion/cevime_infac_2020/es_def/adjuntos/INFAC_Vol_28_1_Vitamina-D.pdf

ConflictofInterest Noconflictofinterest.

4CPS-212 MANAGEMENTOFPOSTCAR-TNEUROTOXICITY USINGANAKINRA:ACASEREPORT

1GMenardi*, 2ACastellino, 1MEBersia, 1GTarasco, 1MAllione, 1DDegioanni, 1MCavallo, 1GPellegrino, 1LInfante, 1EGrande, 1CFruttero. 1AziendaOspedalieraSantaCroceECarle, HospitalPharmacy-AziendaOspedalieraSantaCroceECarle,Cuneo,Italy; 2Azienda OspedalieraSantaCroceECarle,Haematology-AziendaOspedalieraSantaCroceECarle, Cuneo,Italy

10.1136/ejhpharm-2024-eahp.317

BackgroundandImportance Theprognosisforrelapsed/refractory(R/R)Mantlecelllymphoma(MCL),amatureB-celllymphoma,afterthefailureofBrutontyrosinekinaseinhibitors (BTKi)remainsunfavourable.Brexucabtageneautoleucel,an autologousanti-CD19CART-celltherapy,representsthefirst FDA-EMAapprovedCAR-TtreatmentforBTKi-refractoryR/R MCL.Here,wedescribeachallengingcaseofhaematologic toxicityassociatedwithimmuneeffectorcell-associatedsyndrome(ICANS).

AimandObjectives Thepatientisa59-year-oldwithrefractorymantlecelllymphoma,initiallytreatedwithsixalternatingcyclesofR-CHOP(rituximab,cyclophosphamide, doxorubicin,vincristine,andprednisone)andR-DAHP(rituximab,cisplatin,cytarabine,anddexamethasone),followedby autologousstemcelltransplantation.Inthesecond-line,the patientreceivedibrutinib,andinthethird-line,Brexucabtageneautoleucel.

MaterialandMethods Thepatientexperiencedgrade 3cytokinereleasesyndrome(CRS),treatedwithtocilizumabandsteroids,andimmuneeffectorcell-associatedneurotoxicity syndrome(ICANS),withneurologicalsymptomssuchasworsenedhandwriting,significantattentionandorientationdecline,

necessitatingtheadministrationof20mgdexamethasoneand, forrefractoriness,100mganakinraevery6hours.

Results Thecombinedtherapyresultedinrapidimprovement ofthepatient‘stoxicity,leadingtodischargefromtheintensivecareunit.Thetherapywasdefinitivelydiscontinuedafter 5days.PETandCTscansshowedcompleteremissionofthe lymphoma.AstheadoptionofCAR-Ttherapyinhaematology increases,themanagementofsideeffectsbecomescrucial. ICANSisacommontoxicity,particularlyinpatientstreated withaxicabtageneciloleucelandbrexucabtageneceleucel,with amedianonsettimeof6–8days.Inthiscase,ICANSlasted 25days,butthecombinationofdexamethasoneandanakinra provedeffective.Theuseofanakinra,anIL-1receptorantagonistapprovedforrheumatoidarthritis,wasfirstexamined forrefractoryCRS/ICANSinamurinemodelbeforeentering clinicalpracticeatvariousCAR-Tcentres.Theadministration ofanakinra,inconjunctionwithdexamethasone,hasshown benefitsinmanagingsevereICANS.Aphase2study (NCT4205838)aimstogathersolidevidenceforitsapplication.Initialresultsfromthestudy,basedonsevenpatients, showpotentialinreducingsevereICANSandcorticosteroid use.

ConclusionandRelevance Inconclusion,CART-celltherapy offersinnovativetreatmentforB-cellmalignanciesbutintroducesuniquetoxicity.Carefulmonitoringandinterventionsare essentialtoensurepatientsafety.Anakinrashowspromisein ICANSmanagementandreducingcorticosteroiduse.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-213 RESULTSOFANTIBIOTICTREATMENTOFAORTIC ENDOPROSTHESISINFECTIONSINPATIENTSNOT CANDIDATESFORSURGERY

AVarasPerez*,RGarridoFernández,SFernandezEspinola. HospitalAntequera,Pharmacy Service,Antequera,Spain

10.1136/ejhpharm-2024-eahp.318

BackgroundandImportance Aorticendoprosthesisinfection (AIE)complicate0.6–3%oftheseinterventions,withsurgery beingthestandardtreatment.Whensurgeryisnotpossible, conservativetreatmentisanecessitydespitethelackofevidence.Inthisseries,clinicaldataofthepatientsandsurvival areprovided.

AimandObjectives ToknowtheetiologyofEIA,theantibiotictreatmentsreceivedandthemortalityresultsofthese patientswhoarecandidatesforconservativetreatment.

MaterialandMethods Retrospectivestudyofpatientsadmitted forAIEwithconservativetreatmentinourhospital,fromJanuary2014toJuly2023.Clinical(Charlsonindex,timeof firstsymptom,symptoms,antibiotictypeandresponse,death time),epidemiological(ageandsex)andmicrobiologicaldata werecollectedfromtheclinicalhistory.

Results 31patientswereevaluatedwithameanageof72.8 years,90.9%male,andameanCharlsonindexof7.The meantimefromtheinterventiontothefirstsymptomswas 32.7months(4–120months)andfromtheonsetofsymptoms todiagnosisof4.5weeks(1–16weeks).Themostfrequent symptomswerepain(67.3%),fever(54.5%)andconstitutional symptoms(45.45%).Thecausativemicroorganismwasonly identifiedin38.7%(12)ofthepatients,themostfrequent being:E.avium(5),K.pneumoniae(4),E.coli(1)andE.

faecalis(1).Theinitialantibiotictreatmentincludedabeta-lactamin28cases,associatedwithvancomycinin12casesand daptomycininanother12.Maintenancetreatmentsincluded rifampin(n=9),linezolid(n=6),anddalbavancin.(n= 3).15patients(48.4%)diedinthefirst2years:sixfroma septicprocess,sixfromgastrointestinalbleedingduetoaortoentericfistula,andfivefromunrelatedcauses(lungneoplasiaandcerebralhaemorrhage).Themediansurvivaltimewas 18.7months(1–60months).

ConclusionandRelevance Theidentificationofthecausative microorganismoccurredinlessthan40%ofcases,emphasis isrequiredonsaididentificationtocarryouttargetedtreatment.HalfofthepatientswhosufferedAIEdiedwithin2 years.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-214 MONITORINGOFTACROLIMUSINAKIDNEY TRANSPLANTEDCOHORT

1CCarcieri*, 2GSoragna, 3SAllegra, 1SScalpello, 1ABosio, 1ECerutti, 1GFazzina, 3SDe Francia, 4ABo, 2CVitale, 1AGasco. 1MaurizianoHospital,HospitalPharmacy,Turin,Italy; 2MaurizianoHospital,NephrologyAndDialysisDepartment,Turin,Italy; 3UniversityofTurin, ClinicalAndBiologicalSciencesDepartment,Turin,Italy; 4MaurizianoHospital, ManagementControlDepartment,Turin,Italy

10.1136/ejhpharm-2024-eahp.319

BackgroundandImportance Tacrolimus(TAC)isthefirstchoiceimmunosuppressantforpatientsundergoingkidney transplantation.However,ithasconsiderabledruginteractions likelihood,highinter/intra-patientvariabilityandanarrow therapeuticindex.Therefore,constantmonitoringisrequest, toavoidorganrejectionoradverseevents.Fromthisperspective,amultidisciplinaryteamofclinicians,hospitalpharmacists andnurses,providestooutpatients:recognitionandreconciliationofdrugtherapy,therapeuticdrugmonitoring(TDM)of TACconcentrationsinwholeblood,professionalcounselling toverifytherapeuticadherenceandcorrectdrugintake.

AimandObjectives Toexaminetacrolimusplasmaconcentrationvariabilityinacohortoftransplantedpatientsinorderto identifysignificantcorrelationusefulforguidingclinicianin optimisingtherapy.

MaterialandMethods TacrolimusTDMvalueswereanalysed inacohortof160patients(72%male).Atotalof5562 tacrolimusmeasurementsovera4yearsperiodwereevaluated.Inthedescriptivestatistics,continuousandnon-normal variableswereshownasmedianvalues.Statisticaldispersion ofdatameasuredintheinterquartilerange(IQR,quartile1quartile3).TheMann-Whitneytestwasusedtoevaluatethe influenceofsex(maleandfemalepatients)oncreatininelevels,eGFRlevelsandplasmaconcentrationsoftacrolimus(level ofstatisticalsignificancep-value<0,05).AlltestswereperformedwithIBMSPSSStatistics25.0forWindows.

Results Thedistributionanalysisbysexshowsthat73.7% (N=4171)ofthe5662measurementsanalysedwerefrom male.Consideringallthesamples,themedianTACconcentration(mg/ml)was6.60(IQR5,20–8,50).Separatelyevaluating sexesshowthatmedianTACconcentrationwas6.60(IQR 5.30–8.50)and6.50(IQR4.90–8.60)formalesandfemales respectively.TheMann-Whitneytestshowthatsexinfluences tacrolimusplasmaconcentrationwithstatisticalsignificance (p<0.001).Sexinfluencewasstatisticallysignificantalsoon

creatininelevels(mg/dL)(p=0.007)andeGFRlevels(mL/min) (p<0.001).

ConclusionandRelevance Datadisaggregationbysexvariabilitycanbethekeytoimprovepatients’ qualityoflifeandbetterindividualisetreatmentandcare.Themultidisciplinary approachallowstooptimiseprocessesandobtainusefuland reliableresults.Furtheranalysisisneededtofurtherstratify patientsanddeterminecorrelationsusefultoguideclinicians inmonitoringdrugtherapyespeciallyinpolypharmacy patients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-215 ADJUSTMENTOFANTIBIOTICSTHROUGHTHE HEMOFILTER:ACASEREPORT

1MMirandaMagaña, 1ASalamancaCasado*, 2ACaballeroCadenasDeLlano, 1VFaus Felipe, 1MNietoGuindo, 1BTortajadaGoitia. 1HospitalCostaDelSol,ClinicalPharmacist, Marbella,Spain; 2HospitalCostaDelSol,IntensiveCareUnit,Marbella,Spain

10.1136/ejhpharm-2024-eahp.320

BackgroundandImportance

AimandObjectives Inrenalsupporttherapies,theamountof drugeliminatedwilldependonthetherapeuticmodalityused (convection/diffusion)anddosage,thefluidreplacementsite (prefilter/postfilter),aswellasthefiltersurfaceandmaterial, butalsoonintrinsiccharacteristicsofthedrugitself:volume ofdistribution(DV),plasmaproteinbinding(PPB),molecular weight(MW)andpatientcharacteristics.

MaterialandMethods Ourcaseisa67-year-oldwomanadmittedtotheICUforsepticshockofprobableurinaryorigin. Giventheurealevels,metabolicacidosiswithsevereelectrolytedisturbanceandacuteonchronicrenalfailure,extrarenal depurationtherapywasstartedwithcontinuousvenovenous hemodiafiltration(CVVHDF)andempiricalantibiotictreatmentwithertapenem1g/24h.Literaturereviewwasmadeto evaluatetheadjustmentofantibiotictherapyinhemofiltration untilantibiogramresultswereobtained.Themostdialysable drugsarethosewithlowMW,lowDV,highrenalclearance andlowPPB.

Results Amongthecarbapenems,themoststudiedismeropenem.ItpresentslowUPP(2%),PM383.4DaltonandaVD between11–27L,resultinginabetteralternativetoertapenem.Antibiotherapywasmodifiedtomeropenemadjustedto HDFVVC1g/6hin3hextendedperfusionpriorloadingdose of2gtoensureanMIC>40%ofthetimetoachieveboth bacteriostaticandbactericidaleffect.Afterantibiogram,itwas downgradedtoceftriaxone,ahydrophilicmolecule,withhigh UPP(85–95%)andaPM554.58Dalton.Hydrophilicdrugs suchascephalosporinsandpenicillinsgenerallydonotcross cellmembranes,sotheyonlydiffusetotheextracellularspace andtheirDVislowerthanthatoflipophilicdrugs,inadditiontorenalelimination.Ceftriaxone,however,despitebeing ahydrophilicdrug,ispreferentiallyeliminatedthroughbile and,sinceithassuchahighaffinitytoprotein,itishardly dialyzedandthereforedoesnotrequireadjustment.Toensure correctantibioticdosage,itwasdecidedtouseceftriaxone1g/ 12hpriorloadingdoseof3gforreachinglevelsearly, ConclusionandRelevance Theprescriptionoftheappropriate doseofantibioticisfundamentalinthecriticalpatientsinceit allowsavoidingtheestablishmentofexcessivedosesthatcan

causetoxicityoraninsufficientdosecausingtherapeuticfailureorfavouringtheappearanceofmulti-resistances.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-216 EFFICACYANDSAFETYANALYSISOFOBETICHOLIC ACIDINPRIMARYBILIARYCHOLANGITIS:REAL-LIFE DATA

FCajade*,ÁTena-Castro,MTourís-Lores,MPuente-Iglesias,RVillaro-Otaño,IZarra-Ferro. HospitalUniversitarioDeSantiagoDeCompostela,FarmaciaHospitalaria,SantiagoDe Compostela,Spain

10.1136/ejhpharm-2024-eahp.321

BackgroundandImportance Obeticholicacid(OCA)isan orphandrugforpatientswithprimarybiliarycholangitis (PBC),arareautoimmunedisease,whodonotrespond adequatelytotreatmentwithursodeoxycholicacid(UDCA)or donottolerateit.

AimandObjectives Toevaluatetheefficacyandsafetyof OCAinpatientswithPBC.

MaterialandMethods Descriptiveandretrospectivestudy. DatafrompatientswhoreceivedOCAfromJanuary-2021 April-2023wereanalysed.Demographicvariables(sexand age);previoustreatmentwithUDCA;plasmavaluesofliver markers:alkalinephosphatase(ALP),gamma-glutamyltransferase(GGT),totalbilirubin(Bt),aspartateaminotransferase (AST)andalanineaminotransferase(ALT),atthestartof treatmentwithOCA,at6monthsandat12months,were collectedfromtheelectronicmedicalrecordsprogramme. Adverseeffectsdescribedsincethestartoftreatmentwere alsocollected.TreatmentresponsewasdefinedasanALP valuelessthan1.67timestheupperlimitofnormality (ULN),aBtvaluewithinthenormalrangeandadecrease frombaselineALPvalueofatleast15%,accordingtothe pivotaldrugtrial.

Results Thirtypatients(87%women)wereevaluated.The medianagewas66years.Allpatientsexceptone(3%)were ontreatmentwithUDCA.Medianvaluesandpercentile25–75areshown.

Abstract4CPS-216Table1

ALP 333,5(242–453,5)295,5(187–428)252,5(162–332,2)

Bt 0,6(0,5–0,7)0,7(0,5–0,8)0,6(0,4–0,77)

GGT 136(84,5–279,5)82,5(39,5–187,5)56(22,2–113,2)

AST 36,5(33,5–45,7)32,5(29–49,5)35(28–45)

ALT 40,5(28,2–61,5)30,5(23–46)29,5(23–43,7)

AreductionofALP>15%wasachievedin15(50%)and 16patients(53%)at6and12months,respectively.29 patients(97%)hadbilirubininthenormalrangeat6months, andall(100%)at12months.ALP<1.67xULNwasobtained inseven(23%)and11(37%)patientsat6and12months, respectively.Overall,fourpatients(13%)fulfilledthethree pivotaltrialconditionsat6monthsandeightpatients(26%)

at12months.Adversereactionsreportedwere:pruritusin14 patients(47%)andfatigueinone(3%).

ConclusionandRelevance Basedonclinicaltrialendpoints, OCAachievedmodestresultsat6months,whichdoubled1 yearafterinitiationoftreatment.Furtherstudiesareneeded toassesslong-termbenefit.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-217 ACOMPARATIVEEVALUATIONOFTHELONG-TERM EFFECTIVENESSOFGUSELKUMABAND

RISANKIZUMABINTHECLINICALMANAGEMENTOF PLAQUEPSORIASIS

1MRodriguezGoicoechea, 1LGutiérrezLucena*, 1AJMorenoLopez, 2SCanoDominguez, 3CGarridoColmenero, 3FGMorenoSuarez, 3MOcañaCano, 3PAceituno, 4ETejedor Tejada, 1FHornoUreña. 1HospitalaryComplexOfJaén,HospitalPharmacy,Jaén,Spain; 2HospitalaryComplexOfGranada,HospitalPharmacy,Granada,Spain; 3Hospitalary ComplexOfJaén,Dermatology,Jaén,Spain; 4ClinicHospitalOfBarcelona,Hospital Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.322

BackgroundandImportance Anti-interleukin23drugswere approvedinthelast6years.Theabsenceoflong-termcomparisonbetweenalternativessuchasrisankizumaborguselkumabneedstobefulfilled.

AimandObjectives Toevaluatetheeffectivenessthroughindirectcomparisonsofrisankizumabandguselkumabinplaque psoriasislong-termtreatment.

MaterialandMethods Multicentric,retrospectiveandobservationalstudy.Comparisonmadewithplaquepsoriasispatients withactivetreatmentwithrisankizumaborguselkumabto September2023overcoming52weeksoftreatment.Demographic(sex,age)andclinical(psoriasisareaseverityindex (PASI)atbaselineandinsubsequentdermatologycontrols, PASIclearance(PASI90andPASI100))datacollected.ComparisonmadethroughPASI90/PASI100andPASIreduction. Results 110patientsrecruitedforthestudy,with35.5%of thembeingfemaleandwithanaverageageof51.7years.InitialPASIscorewas9.46forthe46patientstreatedwith guselkumab,and8.04forthe64patientstreatedwithrisankizumab.Theresultsareshowninthefollowingtables:

NPASIAveragedweeksPASI90PASI100 46(guselkumab)1,126260,8%56,5% 64(risankizumab)0,886368,75%62,5%

NPASIAveragedweeksPASI90PASI100 23(guselkumab)0,9411469,5%65,2% 30(risankizumab)0,8911063,3%46,6%

NPASIAveragedweeksPASI90PASI100 15(guselkumab)2,6115060%60% 18(risankizumab)0,713672,2%50%

ConclusionandRelevance Bothmoleculesofferhighlypositive long-termresults,particularlyvaluedbypatientswithplaque psoriasis,althoughguselkumabseemstomaintainaslightly greaterfullclearance.

REFERENCESAND/ORACKNOWLEDGEMENTS

Artificialintelligencetoolutilisedtotranslatetexts. ConflictofInterest Noconflictofinterest.

4CPS-218 OPIOIDPRESCRIBINGFORACUTENON-CANCERPAIN, POST-OPERATIVEPAINANDPOST-PROCEDUREPAIN BYSURGICALTEAMSATATERTIARYHOSPITAL:1DAYAUDIT

EMByrne*. CorkUniversityHospital,Pharmacy,Cork,IrelandRep.

10.1136/ejhpharm-2024-eahp.323

BackgroundandImportance InIreland,numbersofprescribed opioidsareincreasingyearly,outofproportiontopopulation increase1.Acutehospitalsareamajorsourceofinitialopioid prescriptionsintocommunities2.TheHealthServiceExecutive(HSE)haspublishedopioidprescribingguidelinesforthe managementofacutenon-cancerpain,post-operativepainand post-procedurepain,specificallyaddressingtheuseofslowreleaseopioids,durationofprescriptionandavoidanceof diversionfollowingdischarge3.

Atourhospital,thereisnostandardisedapproachto opioidprescribinginthispopulation.Abaselinepointprevalencesurvey(PPS)ofopioidprescribinginthispopulationby surgicalteamswasconducted.

AimandObjectives • Tocharacteriseopioidprescribingfor acutenon-cancerpain,post-operativepainandpost-procedure paininatertiaryhealthcaresetting

• Toinformlocalpolicydevelopmentonappropriate opioiduse.

MaterialandMethods ThePPStookplaceonasingledayin May2023.Approvaltoconductthesurveywassoughtfrom thehospitalQualityandPatientSafetyDept.Alladultpatients admittedtoourhospitalunderasurgicalteamwereincluded. Theinpatientmedicationprescriptionrecordandmedical notesforeachpatientwerereviewedbyaclinicalpharmacist. Opioidprescriptiondetailswererecordedonadatacollection formhostedonMicrosoftForms.

Results

. 72%ofstudypopulation(n=205)wereprescribedanopioid; totalof224opioidprescriptions

. Mostcommonindication,43%,wasacutepostoperativepain (97/224)

. 27%(61/224)ofprescriptionswereforslow-release formulations

. 30%(67/224)ofopioidprescriptionswereprescribedfor> 1week

. 97%(218/224)ofopioidprescriptionswerecommenced duringthecurrentadmission

. Figures1&2respectively,summarisetheopioidagentand formulationprescribed.

ConclusionandRelevance This1-daysnapshotaudithaspresentedseveralareasforimprovementatourhospital,specificallytheuseofslow-releaseopioids,treatmentdurationand dischargeprescription.Severalqualityimprovementinitiatives arebeinginitiatedaspartofawideropioidstewardship

programmeinlinewiththeHSENationalClinicalProgramme forAnaesthesia.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.HSEPCRSDataSources.Annualreports.https://www.sspcrs.ie/portal/annualreporting

2.USNationalSurveyonDrugUseandHealth.https://www.samhsa.gov/data/sites/ default/files/cbhsqreports/NSDUHMethodsSummDefs2018/NSDUHMethodsSummDefs2018.htm

3.HSENationalClinicalProgrammeforAnaesthesia.GuidanceforOpioidPrescribing forAcuteNon-cancerPain,Post-operativePainandPost-procedurePain,2022.

ConflictofInterest Noconflictofinterest.

4CPS-219 BEYONDTHEEXPECTED:THEENHANCEDDETECTION OFDRUGRELATEDPROBLEMS,THEMOSTOFA PHARMACEUTICALDECISIONSUPPORTSYSTEM

1APotier*, 2MAde, 1ADony, 1AHuguet, 1TRosier, 1EDivoux, 1DEdith. 1HospitalCenter Luneville,Pharmacy,Luneville,France; 2CentrePsychothérapiqueDeNancy,Pharmacy, Laxou,France

10.1136/ejhpharm-2024-eahp.324

BackgroundandImportance TheEAHPstatementintegrates pharmaceuticalanalysisintoourpracticesmentioningthatall prescriptionsshouldbereviewedandvalidatedassoonaspossiblebyapharmacist.

Howeverthispracticeishighlyvariable.Reviewingallprescriptionsassoonaspossiblebyapharmacistanddetecting drug-relatedproblemsremainsachallenge.

Pharmaceuticaldecisionsupportsystems(PDSS)areassociatedwiththedecreaseofadversedrugeventsandthe improvementofprescribingpractices.

OurPDSSworksonthepatient’sdata,modelledsituations andPharmaclass® (Keenturtle – F)inrealtime.

Aimandobjectives Thisstudyaimstopresentpharmacists’ abilitytodetectdrug-relatedproblems(DRP)inusualcareby usingaPDSS.

MaterialandMethods Anobservationalprospectivestudyhas beenongoingfromNovember2019toJune2023intwo facilities(1600beds).PDSSisappliedinadditiontostandard care.

Uptoamaximumof201modelledsituationswereintegratedinthePDSS.

ADRPresolutionstrategystructurethepharmaceutical analysisofDRPs.Itisthesupportofthehumansupervision ofthePDSS.

Datacollectedarethenumberalertsanalysed,DRPs,PIs andacceptedPIs.

DataanalysisisperformedbyusingPandaslibraryin Python.

Results Thedataarecollectedduring663non-consecutive days.

On14331alerts3157weretechnicalfalsepositives (22.0%)and3821situationsdonotcorrespondtoaDRP (26.7%).

DRPdetectionisperformedfor7,353situationsbythe pharmacistsusingthePDSS(51.3%ofanalysedalerts).

5,062DRP(68.9%ofallDRPdetected)requiredapharmacist’sinterventionthatanalysesthealert.

For2648ofthemapharmacisthadmissedtheidentificationoftheDRPduringhisanalysis.

Inaddition,838PIsweretransmittedforDRPsidentified followingtheoverallanalysisofthesituation.Theselasttwo commentsconstitutethespecificaddedvalueofusingaPDSS.

Another927DRPs(12.6%ofallDRPdetected)had alreadybenefitedfromaPIbyanotherpharmacist.

For1364DRPs(18.5%ofallDRPdetected)thephysician changedthedrugmanagementjustbeforeanalysisofthe alert.

ConclusionandRelevance APDSSisbothefficientandoffers addedvalueinroutinecaretosecurethepatient‘smedication management.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-220 EVALUATIONOFTHEIMPLEMENTATIONOFAPREEXPOSUREPROPHYLAXISPROGRAMME:2YEARS EXPERIENCEINOURREGION

1JGarcia-CalvoNavarro*, 1MLópezLópez-Cepero, 1TGarcíaRuiz, 1HPadillaCastaño, 2JSerraEsteban, 3MRieraJaume, 1ODelgadoSánchez. 1HospitalUniversitariSonEspases, HospitalPharmacy,PalmaDeMallorca,Spain; 2HospitalComarcalD’inca,InternalMedicine, PalmaDeMallorca,Spain; 3HospitalUniversitariSonEspases,InternalMedicine,PalmaDe Mallorca,Spain

10.1136/ejhpharm-2024-eahp.325

BackgroundandImportance HIVremainsasignificantsocial andeconomicproblem.Recently,continuoususeofantiretrovirals(mtricitabina/tenofovir)havebeenusedaspre-exposure prophylaxis(PrEP)withpositiveclinicalandeconomicoutcomes.However,theuseofdrugsinindividualswithoutpathologycanbecontrovertedduetothepotentialexposureto toxiceffects.

AimandObjectives Tostudythesociodemographiccharacteristics,effectiveness,andsafetyofPrEPintheusersofour region.

MaterialandMethods

Retrospectivestudy PeriodAugust2021toSeptember2023. Variables:gender,age,riskbehaviours,sexuallytransmitted infections(STI),chemsex,adherence,serology,sideeffects, discontinuation.

Results 303usersenrolledfromAugust2021toSeptember 2023.Thereare297males,fourtransgenderwomen,one female,andonenon-binary.Users’ agedistributionwas:<25 (2%),25–34(28%),35–44(43%),45–54(20%),55–64(5%), and>65(1%).

58%wereengagedinthreeormoreriskbehaviours.>10 sexualpartnersduringlastyear(93%),nocondom(85%)and asexuallytransmittedinfection(STI)inthelastyear(52%). Approximately37%reporteddruguse,mostlypoppers(80%), cocaine,marijuana,ecstasyandGHB(around35%each), speed(24%),andketamine(14%).326STIswerediagnosed: 51%gonorrhoea,32%chlamydia,and17%syphilis.Only 70%ofusersreportedaperfectadherence.Nonebecame infectedwithHIV.

Regardingsafety,19%experiencedadverseeffects,almost allofwhichweremildandself-limiting.Gastrointestinaldisorders(13%),nausea(6%),andheadache(3%)werethemost commonadverseeffects.27usersdiscontinuedtheprogramme.10ofthemduetorenalimpairment,fourfrom adverseeffects,and13forpersonalreasons.Averageserum creatininedeviationfrombaselineat1,3,6,12,18and24 monthswas0,02±0,2mg/dLforeveryperiod.

ConclusionandRelevance PrEPisaneffectiveandsafestrategy forpreventingHIVinfectioninindividualspractisingrisky behaviors,themajoritybeingyoungadultswithhighereducationorfurtherandemployed.Follow-upprogrammesallow forthedetectionandtreatmentofmultipleSTIstoreduce theirspread,requiringaspecialisedteamtoprovidethenecessarytreatmentandeducation.Interestingly,renalfunctionwas notaffectedatleastinshorttermusewithintwoyearsand despitelowadherence,nouserwasinfectedbyHIV.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-221 EVALUATIONOFTHERELEVANCEOFSTATINS PRESCRIPTIONINTHEELDERLY:TOWARDSA DEPRESCRIPTION?

ADegardin*,MMessager,NKeddari,CFournier. HopitalSaintVincentDePaul,Nord,Lille, France

10.1136/ejhpharm-2024-eahp.326

BackgroundandImportance Statinseffectivenessinreducing cardiovascularriskhasbeendemonstratedinnumerousstudies.However,theassessmentofthebenefit/riskbalancecan favourdeprescription

AimandObjectives Evaluationoftherelevanceofdeprescribingstatinsinpatientsover75yearsold.

MaterialandMethods Thisisaprospectiveobservationalstudy lasting6weeksinpatientsover75yearsofagehospitalised inthedepartmentsofcardiology,pulmonologyandgeriatrics. AdailyanalysisofcomputerisedprescriptionsonHopitalManager ® softwarewasdone.Itledtopharmaceuticalinterventions(PI),oralandwritten,aboutdosagereductionorstatin discontinuationincasesofmisuseorirrelevantprescription. Misusesituationscorrespondtostatinsusewithoutindication foundorwithpresenceofadverseeffects,druginteractions (DI)orcontraindication(CI).Statindiscontinuationwaseither gradualorimmediate.PImonitoringwascontrolledatpatient discharge.

Results Intotal,48patientswereincluded.Averageagewas 83yearsandsexratioM/Fwas0.92.Astatinindicationwas foundandjustifiedfor33patients(68.7%).PIswereformulatedfor15patients(31.3%).Amongthese15patients,nine (18.8%)didnothaveanindicationforastatinprescription. TheproposedPIwasagradualdosereduction(acceptedfor 7/15patients).Of15patients,six(12.5%)hadnostatinindicationandanincreaseinCreatinePhosphoKinase(CPK)levelsattributabletothestatin.Thereby,5/6hadanincrease lowerthanfivetimesnormal(<5N).TheproposedPIwasa progressivedecrease.Only1/6hadCPK>5N.Itledto immediatelystopthestatin.PIwereacceptedforallsix.No CIorDIweredetected.ThetotalacceptancerateforPIsis 13/15i.e86.7%.

ConclusionandRelevance Thisworkconfirmedthemultidisciplinaryinterestinthere-evaluationofstatinindicationandits deprescriptionwhenitnolongerhaditsplaceinpatients therapeuticstrategy.However,thisdecisionmakingismore complicatedamonghospitalprofessionalswhoarenotatthe originoftheinitiation.Strengtheningthecity-hospitallink couldimproveit.Inexistenceofprotocolsisalsoanobstacle todeprescription.Harmonisingpracticeswiththedevelopment ofadeprescribingalgorithmwouldbeanidealtoolto

facilitatepatientcare.Thisalgorithmisthesubjectofaparallelwork.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-222 THEREAL-LIFEOFBENZODIAZEPINESINGERIATRIC DEPARTMENTS:CANTHEPHARMACISTHAVEAN IMPACT?

1CTan*, 1PCarlier, 1RDevaux, 1MPottier, 2ANare, 1LReal. 1CentreHospitalierD’ arras, Pharmacy,Arras,France; 2CentreHospitalierD’arras,Geriatric,Arras,France 10.1136/ejhpharm-2024-eahp.327

BackgroundandImportance Benzodiazepinesandderivatives (BZD)areanti-anxietyorhypnoticdrugs.Theyarefrequently prescribedoveralongperiodoftimeandarerarelyre-evaluated.However,theycancausesideeffects,especiallyamong theelderly.Itisthennecessarytoreassessthetreatment.

Throughhisactivities,thepharmacistmayparticipateatareevaluationoftreatment(pharmaceuticalvalidation,medication reconciliationprocess).

AimandObjectives Thisstudyassessestheimpactofthepharmacistinthere-evaluationofbenzodiazepinestreatments.

MaterialandMethods AnextractionofprescriptionscontainingatleastoneBZDinageriatricwardwasconductedfor4 months.Apharmaceuticalanalysisoftheprescriptioniscarriedout,thenpharmaceuticalinterventionsaremadebymessagetotheprescribersviaourprescriptionsoftwareinorder toproposesubstitutions,dosagereductionsorstoppageof treatmentsbyBZD.

Atthepatient’sdischarge,acomparisonoftheexitprescriptionandtheprescriptionduringthehospitalisationallows ustoknowifthepharmaceuticalinterventionswereaccepted. Somepatientshavehadamedicationreconciliationprocess duringwhichthesameproposalsaremadetothedoctor.

Results Atotalof202BZDwereprescribedtothegeriatric unitover4months,representing169patients.Ofthese, 34.2%wereinitiatedduringhospitalisationand65.8%were hometreatments.

Apharmaceuticalinterventionwasperformedin71%of cases:asubstitutionwasproposedin40%,adosagedecrease in13.3%,are-evaluationofexittreatmentin15%andadiscontinuationin31.7%.

Atotalof55%ofpharmaceuticalinterventionswere acceptedatthedischargeofpatient.

Amongthe169patients,12.4%receivedamedicationreconciliationprocessduringwhichpharmaceuticalinterventions weredone:asubstitutionwasproposedin28.6%ofcases,a dosagedecreasein19%andadiscontinuationin52.4%.In 100%ofcases,theywereaccepted.

ConclusionandRelevance Throughthisstudy,weanalysethat thepharmacisthasapositiveimpactonthere-evaluationof treatments,especiallyduringthemedicationreconciliation processwhereareviewofBZDdrugrelevanceiscarriedout withthegeriatrician.Itwouldbeinterestingtoanalyseifthe presenceofapharmacistonthewardmayimprovethe acceptanceofpharmaceuticalinterventionsandallowmore medicationreconciliationprocessing.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-223

ASTUDYONTHEPERCEPTIONOFELDERLYPATIENTS ONTHEEXPIRATIONDATEANDSTORAGEOF PRESCRIBEDMEDICATION:AQUESTIONNAIRESTUDY

EByun*,SHong,NKim,SBaek,KYeon. VHSMedicalCentre,PharmacyDepartment, Seoul,SouthKorea

10.1136/ejhpharm-2024-eahp.328

BackgroundandImportance Duetotheincreaseintheelderly populationinKorea,thenumberofpowderedmedicinesand long-termrepackagingofprescriptionshasincreased.Asa result,thesafetyofmedicinesisbecomingvulnerable.

AimandObjectives Thisstudyaimstofindouthowelderly patientsperceivetheexpirationdateandstorageofprescriptiondrugsandtoconsiderappropriatepatienteducationfor thesafeuseofdrugs.

MaterialandMethods Across-sectionalstudywasconducted among221elderlyoutpatientsfrom14December2022to21 April2023atVeteransHealthService(VHS)medicalcentre inSeoul,SouthKorea.Thequestionnairewasdividedinto fiveparts.WeusedaChi-squaredtestandFisher ’sexacttest tocompareeachgroupandp<0.05wasconsidered statistically.

Results Asurveyof213peoplewasanalysed,excludingeight whodroppedout.Whenaskedabouttheexpirationdateof theprescribedmedicines,themostpeopleresponded ‘3 months’.Themainstorageplaceformedicineswasthe ‘living room/bedroomdrawer ’ at30.52%.Themainstorageplaces forpowderedmedicineswere28.64%for ‘refrigerator/kimchi refrigerator ’ and26.29%for ‘livingroom/bedroomdrawer.’ Therewere136people(63.85%)whorespondedthatthey wouldgrind3months’ worthofpowderedmedicineatonce, andthemostcommonreasongivenby66people(30.99%) was ‘difficultyingrinding’.Seventy-sevenpeople(36.15%) saidtheywouldcrushthepilleverytimetheytookit,and themostcommonreasonwas ‘riskofdeterioration’ at37 people(17.37%).Therewasnostatisticallysignificantdifferencewhenanalysingtheperceptionofexpirationdateand storageofmedicinesaccordingtodrugmanagersandperceptionofpowderedmedicineaccordingtowhetherornotto prescribepowderedmedicine.

ConclusionandRelevance Elderlypatientsrecognisedtheexpirationdateoforalmedicineswasshorterthanrecommended bytheKoreanPharmaceuticalAssociation.Therewasalsoa lackofawarenessofhowtoproperlystoremedicines.Therefore,inconsiderationofdrugsafety,long-termprescriptions, repackagedprescriptions,andpowderedpreparationsshould beavoidedifpossible.Ifmedicalinstitutionsconductpatient educationforthesafeuseofmedicines,theywillbeableto provideproperpharmacistservicesthatconsiderthesafetyof medicines.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-224 MEDICATIONRECONCILIATIONINASURGERY DEPARTMENT:6-MONTHS’ EXPERIENCE

ALeal*,TCunha,PBarbeita,AMendes,PRocha. CentroHospitalarUniversitárioDeSanto António,PharmaceuticalServices,Porto,Portugal

10.1136/ejhpharm-2024-eahp.329

BackgroundandImportance MedicationReconciliation(MR) allowsustoreducemedicationerrorsthatareverylikelyto occurincaretransitionslikeadmission,transferandclinical discharge.Inourcountry,afewhospitalinstitutionshave MR,althoughtheeffectivenessofthismethodandPharmaceuticalInterventions(PI)inpreventingadversereactions, druginteractionsandprescriptionerrors.isknown.

AimandObjectives EstablishingMRforpatientsatavascular surgerydepartment,inatertiarycareuniversityhospital,to evaluateitsimpactinprescriptionerrorpreventionandto characterisePIanditsacceptanceinourcentre.

MaterialandMethods MRappliedinthefirst48hoursof patientadmissionsbetweenApril2023andSeptember2023.

Inclusioncriteria:age 35years,presenceofcomorbidities andpharmacotherapywith 3drugs.ElaborationofBest PossibleMedicationHistory(BPMH)taking 3sourcesof informationintoaccount,comparisonwithmedicalprescriptionforidentificationandclassificationofdiscrepancies.DiscussionofPIwithprescribers,datarecordingandanalysis usingMicrosoftExcel.

Results Of210patients(77.4%male),16wereexcludedfor interventionrescheduling,suddenclinicaldischargeortransfer betweendepartments.Mediumagewas70.7years[range35; 92]andwefoundamediumof4.7comorbiditiesperpatient ashypertension,dyslipidaemiaanddiabeteswerethemost prevalent.ForBPMHgathering,medicalrecords(28.8%), patientinterview(25.0%)anddrugpackaging(20.2%)were themostusedsourcesofinformation.In202MR,3,010prescriptionlineswereanalysedand77.5%ofthemcontained discrepancies.Ofthose,31.5%wereunintentionalwithpotentialtocauseharmtopatients.Atotalof761PIweremade with89.1%acceptancebyprescribers,mostlyfordrugswith cardiovascular(32.5%),centralnervoussystem(18.8%)and endocrine(13.9%)action.Drugomissionwasthemostfrequentmedicationerror(62.8%),followedbyerroneousdose (16.9%)anderroneousdrug(6.1%).Itwasdetected348 pharmacologicalinteractionsand37adverseeventswithindependentPI,wheneverpatientharmwasconsidered.

ConclusionandRelevance MRallowedustoreduceandpreventamajornumberofmedicationerrors,asalmost90%of PIwereacceptedbyphysicians.Thismethodshouldbeimplementedinmostsusceptiblehospitaldepartments,asaclinical pharmacistpresencebenefitsallofthehealthcareteam,the patientandmedicationsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-225 DEFININGINTERNATIONALCRITICALCARE PHARMACISTASPIRATIONSTOTHEMANAGEMENT OFSEPSIS

1ROakley, 2SGuntschnig*, 1SAl-Mahdi, 1HTrinh, 3MCustodio, 1SKhorshid, 4DLonsdale, 5AGous. 1ST.George’sUniversityHospitalsNHSFoundationTrust,Pharmacy,London,UK; 2TauernklinikumGmbh,ClinicalPharmacy,ZellAmSee,Austria; 3ChesapeakRegional MedicalCenter,Pharmacy,Chesapeake,USA; 4ST.George’sUniversityOfLondon,Clinical Pharmacology,London,UK; 5SefakoMakgathoHealthScienceUniversity,Pharmacy, Garankuwa,SouthAfrica

10.1136/ejhpharm-2024-eahp.330

BackgroundandImportance Clinicalpharmacistinputinintensivecareunit(ICU)patientcarevariesgreatlyamongdifferent countriesandsettings.

AimandObjectives Toidentifyareasofdesiredprofessional contributionanddevelopment,whilstexploringvariability. Thisisenvisagedtosupportleadershipactivitiestoenhance theclinicalpharmacistworkforcebasedonevolvingICU infrastructures.

MaterialandMethods Clinicalpharmacistsinvolvedinthe managementofsepsisintheICUsettingweresurveyedusing semi-structuredinterviewmethods.Institutionalethicalapprovalforthestudywasobtained,whichincludedadataprotectionimpactassessment.Recruitmentvianon-probability convenienceandsnowballsamplingofregisteredpharmacists proficientintheEnglishlanguageoccurredbetween31May 2013and13July2023.Datasaturationdeterminedthesamplesize.RemoteinterviewswereconductedviaZoom.Interviewsweretranscribed,codedandthematicallyanalysedin linewithBraunandClarke’ssix-stageprocess.Asthiswasan exploratorystudy,notheoreticalassumptionswereaddressed. Results Twentyparticipantsfrom14countriesparticipated. Reportedaspirationsvariedbetweenpharmacistsworkingin dedicatedICUrolesbasedatthebedsideandnon-dedicated ICUroleswithlittle/nobedsidecomponent.Overcomingmultifacetedprofessionalbarriersassociatedwithphysical,social, financialandtraining/educationthemesrelativetolocal/ nationalcontextswereconsistentlyreported.Aswereresearch aspirations.Physicalandsocialthemeswereassociatedwith scopeofpracticeandICU/patientrecordaccess.Thisincluded sepsisidentification,initiatingantimicrobials,individualising/ alteringantimicrobialdosingandownershipoftherapeutic drugmonitoring(TDM)activities.Improvingmultidisciplinary teamintegration,stakeholderperceptions,digitalinfrastructures andlegislationwereidentifiedaskeyvehicles.Improvedfinancialincentiveswereinterlinkedwithstakeholderperceptions andmetriccaptureassociatedwithpharmacistcontributions. Whereaseducation/trainingwasdesiredforworkforcestandardisation,increasingscopeofpracticeandimprovingresearch outputs.Includingincreased/improvedTDMpracticessupplementedbypharmacokinetic/pharmacodynamicexpertise, enhancedbypoint-of-caredevicesandmetagenomics.

ConclusionandRelevance ThecontentandvariationinICU clinicalpharmacistaspirationsworldwidereflectsabroader disparityinICUclinicalpharmacistadoption/contribution worldwide,particularlyinEurope.Leadershipandresearch addressingstudyidentifiedthemesisrequiredtoenablepharmaciststomaximisetheirimpactonthecareofseptic patients.ThismustdemonstratethevalueofICUclinical pharmaciststodifferentstakeholderstopromoteadoption, capabilityenhancementandresearchoutputs.

REFERENCESAND/ORACKNOWLEDGEMENTS

4CPS-226 PHARMACEUTICALINTERVENTIONONTHE ADEQUACYOFTHEINDICATIONOFSEMAGLUTIDEIN DIABETESMELLITUS2

CMDominguezSantana,MEBlancoRivas,VVazquezVela,EJAlegreDelRey,JMBorrero Rubio*. HospitalUniversitarioPuertoReal,HospitalPharmacy,PuertoReal,Spain 10.1136/ejhpharm-2024-eahp.331

BackgroundandImportance SemaglutideisaGLP-1analogue approvedforthetreatmentofadultswithpoorlycontrolled type2diabetesmellitus(DMII).Ithasbeenshowntoreduce bloodglucoselevelsandtheriskofhealthcomplications.It

alsoproducesweightloss,aneffectconsideredbeneficialin thistypeofpatient.Thishasledtoinconsistentprescribing, andithasevenbeenusedtoreduceweightinobesenon-diabeticpatients.Asaconsequenceoftheincreaseininappropriateuse,inMarch2023theSpanishAgencyforMedicines andHealthProductsissuedashortagealert.

AimandObjectives Implementationofastrategytoreviewthe suitabilityofsemaglutidetoitstherapeuticindicationand interventionininappropriateprescriptions.

MaterialandMethods Prospectivedescriptivestudyincluding allpatientsonactivetreatmentwithsemaglutide.Aninterventionstrategywasimplementedbyreviewingallmedicalprescriptions,stratifyingpatientsbyhospitalservices,anddrawing uplistsofpatientswhodidnotcomplywiththeauthorised indications.InAugust2023,meetingswereheldwiththedoctorinchargeofeachdepartmenttocommunicatetheneed forreviewandthesuspensionoftreatmentofpatientswho didnotcomplywiththeindication.

Results Sixtypatientswerereviewed,62%male,witha medianageof54years.Activesemaglutideprescriptionsby hospitalserviceswereasfollows:55%Endocrinology,18.3% Cardiology,16.7%Internalmedicine,3.3%Nephrology,3.3% Mentalhealth,1.7%Dermatologyand1.7%Traumatology. 28.3%ofpatientshadDMII,46.7%didnotand25%had pre-DMII.OfthepatientswithoutDMII,100%wereobese. Itwasagreedtosuspendtreatmentforallpatientswhodid notcomplywiththeindication.

ConclusionandRelevance Theprocedurehasprovidedinsight intotheconditionsunderwhichsemaglutideisbeingused.In thecontextofstock-outs,thesuspensionofsemaglutidein patientswithoff-labeluseallowedaccessforpoorlycontrolled diabeticpatients.Theadequacyreviewcanbeextrapolatedto theabuseand/ormisuseofanydrugaspartoftherational medicineusestrategy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

4CPS-227 PHARMACEUTICALREVIEWANDPHARMACEUTICAL INTERVENTIONINANURSINGHOMETOENHANCE THEMEDICATIONMANAGEMENTOFRESIDENTS

1ECastex, 2VFrapart, 3LBertin, 3JSiauve, 3BForget. 1ChuAmiensPicardie,Hospital Pharmacy,Amiens,France; 2ChDeMontreuilSurMer,EhpadLesPléiades,MontreuilSur Mer,France; 3ChDeMontreuilSurMer,HospitalPharmacy,MontreuilSurMer,France

10.1136/ejhpharm-2024-eahp.332

BackgroundandImportance Geriatricsisparticularlyconcerned byiatrogenicmedicationaccidents,especiallyinnursinghomes (NH)whereresidentsareoftenpolypathologicalandcan spendmonthswithouttreatmentrevaluation.

AimandObjectives Enhancethemedicationmanagementof residentsinNH.

MaterialandMethods Pharmaceuticalreview(PR)conducted duringmultidisciplinarymeetings,basedoncomputerisedprescriptions,biologicalandclinicaldatafromtheelectronic patientrecord,andthencomparedtonationalreferences.Subsequently,thepharmaceuticalinterventions(PI)carriedoutare quantifiedandanalysed.

Theanticholinergicscore(AS)wascalculatedforeachresidentusingtwoassessmentscales:theACB(Anticholinergic CognitiveBurden)andCIA(CholinergicDrugBurden)scale.

Results Among71residents,142PIswerecarriedout,witha 58.5%acceptancerate(n=83)ofthephysician,averagingtwo PIsperresident.

MostPIs(33.1%;n=47)concernedunsuitablemedication fortheelderly,witha61.7%acceptancerate.Initially,62 potentiallyinappropriatemedications(PIMs)wereidentified for38residents,averaging0.87PIMsperresident.Afterthe PR:only33PIMsremainingfor25residents,averaging0.47 PIMsperpatient.

AhighASwasfoundfor20residents.Twenty-sixPIs (18.3%)witha42.3%acceptancerate(n=11)wereperformedinattemptstoreducetheseAS:whichresultedina decreasefromfiveresidentswithasignificantACBscoreto three,andfrom15residentswithahighCIAscoreto11.

Seventy-fourPIs(52.1%)wererelatedtonervoussystem drugs.Afteramultidisciplinarydiscussionwithgeriatricians andpsychiatrists,43.2%ofthesePIs(n=32)wereaccepted. SubstitutionwasthemostrecommendedtypeofPI(n=38), resultinginamodestreductioninpsychotropicdrugconsumption(9.7%).

ConclusionandRelevance ThisNHaccommodatesresidents withpsychoticdisorders,behaviouralissues,andintellectual disabilities,whichexplainsthelowacceptancerateofPIs relatedtopsychotropicdrugsandthedifficultyinreducing theAS.BeyondtheacceptanceofPIs,thePRenablesthe coordinatingphysiciantore-evaluatetheoveralltherapeutic managementofresidents,andhelpsmitigatetheunderuse, overuseandmisuseofmedications,whicharequitecommon ingeriatrics.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-228 IMPACTANDACCEPTANCEOFPHARMACEUTICAL INTERVENTIONSFOREARLYMEDICATION RECONCILIATIONINTHEEMERGENCYDEPARTMENT

1ASuárez-Lledó*, 1JMartínezCasanova, 1CPorredónAntelo, 1NMasBauza, 2JJacob Rodríguez, 2PMalchair, 1MBBadíaTahull. 1BellvitgeUniversityHospital,Pharmacy Department,L’hospitaletDeLlobregat,Spain; 2BellvitgeUniversityHospital,Emergency Department,L’hospitaletDeLlobregat,Spain 10.1136/ejhpharm-2024-eahp.333

BackgroundandImportance Emergencydepartments(EDs)are characterisedbyhighcareload,staffrotationandcriticalsituationsthatrequirerapiddecisions.Earlyconciliationinhighriskpatientsmayimprovepatientsafetyduringcare transitions.

AimandObjectives Toestablishaprotocolofearlymedication reconciliationprocessinEDandre-evaluationinpatientswith complexitycriteria(validatedbyHohletal.).Medication reviewbyreferentpharmacistsinEDandtheirinterventions wereevaluatedforacceptancyrateandquality.

MaterialandMethods Aprotocolofmedicationreconciliation wasdevelopedbasedonthe ‘ConsensusdocumentofREDFASTERandSEMES-FARMAgroupforMedicationreconciliationinED’.Reinitiationpriorityofeachpharmacologicgroup wasevaluatedindividually,consideringthebenefitoftheirreconciliationduringEDstayanddefiningthosedrugswhose reconciliationisrecommendedtobedoneinthefirst12 hours.

Thisprotocolwasimplementedinathird-levelhospital with330averagedailyEDassistanceandfivedailyhoursof presentialpharmaceuticalactivity.

EDpharmacistsmadeindividualrecommendations:early reconciliationwasperformedinallpatientsreviewed,and remainingconciliationinterventionswereperformedin patientswithstayslongerthan12hoursandcomplexity criteria.

Results Thechronicmedicationof1,645patientswas reviewedovera2-monthperiod:475recommendationsof earlyreconciliationsweregivenin337patientsandphysicians accepted248(52.32%).Demographicdata:73(13,64)average age,196(58,16%)men.Meantimeofrecommendationsfrom arrivaltoEDwas6.73hours.Timeaverageofreintroduction byphysicianswas10,38h.Withinthefirst12hours,179 drugs(72.18%)wereintroduced.

Fortypharmacologicalgroupswererecommendedtobe reintroduced:insulinandanalogues(A10A)andbetablockers (C07A)werethemostrecommended(N=236),following others:antithrombotic(B01A)(N=37),Calciumchannel blockers(C08C)(N=34),immunosuppressant(L04A)(N=37), antiepileptic(N03A)(N=33),nitrates(C01DA)(N=18).

Atotalof402patientswithstayslongerthan12hours andcomplexitycriteriawerereviewed,leadingto171 recommendations.

Pharmaceuticalinterventionswereanalysedoveraperiod of2monthscomparingbeforeandafterprotocolapplication: varietyofinterventionweresimilar,butquantityincreased afterprotocolimplementation(531vs1043interventions).

Conclusionandrelevance Earlyconciliationledtoearlyreintroductionofprioritydrugs,ensuringsafetyandqualityacross caretransitionsandwithahighrateacceptanceamong physicians.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

4CPS-229 SUSTAINABILITY:APERSON-CENTRED,WHOLE SYSTEMSAPPROACHTOMEDICINESOPTIMISATION

AHogg*,MScott,GFleming,CScullin. NorthernHealthAndSocialCareTrust,Medicines OptimisationInnovationCentre,Antrim,UK

10.1136/ejhpharm-2024-eahp.334

BackgroundandImportance Suboptimalmedicinesuseisa challengeforhealthsystemsglobally,contributingtosuboptimaloutcomes,inefficienciesandsustainabilityissues,including waste.

AimandObjectives TheaimwastoutilisetheClinicalPharmacyTeamtodrivemedicinesoptimisationandsustainability inaHealthandSocialCareTrustthroughthesafe,effective andeconomicuseofmedicines.

MaterialandMethods In2001,aperson-centred,wholesystemsapproachtomedicinesoptimisationwasimplementedin aHealthandSocialCareTrust.Centraltothemodelwasa ward-basedClinicalPharmacyteamdeliveringacomprehensive clinicalpharmacyserviceincludingmedicinesreconciliation, medicinereview,patienteducation,interfacecommunication andextendedrolesfortheClinicalPharmacyteam.Evaluation includedlengthofstay,readmission,medicinesappropriateness usingtheMedicinesAppropriatenessIndexandclinicalsignificanceofpharmacistinterventionsusingtheEadongrading tool.Themodelwasfurtherdevelopedandevaluatedover

twodecadestoincludepharmacistprescribing,post-discharge telephonefollow-upandperson-centredstructuredmedicine reviewandwasextendedtoincludenursingandintermediate caresettings.

Results Initialevaluationdemonstratedsignificantlyimproved medicinesappropriateness,reducedlengthofstay(2days)and readmission(numberneededtotreat=12).Furtherbenefits wereachievedthroughpost-dischargetelephonefollow-up (10%reductioninreadmission)andstructuredmedicine reviews(94.7%interventionsdeemedclinicallysignificantand 92%ofmedicinesstoppedremainedstopped1yearpostreview).

ConclusionandRelevance Thisworkhasdemonstrated improvedmedicinesoptimisationandsustainabilityandhas beenscaledandspreadtootherEuropeancountriesincluding AustriaandPoland.Ithasbeenidentifiedasanexampleof bestpracticetoinformClinicalPharmacyServicesinCentral andEasternEurope1 andworkisongoingtoinnovateand furtherdevelopthemodel.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.UrbańczykK,GuntschnigS,AntoniadisV, etal. Recommendationsforwider adoptionofclinicalpharmacyinCentralandEasternEuropeinordertooptimise pharmacotherapyandimprovepatientoutcomes. Front.Pharmacol 2023;14:1244151.doi:10.3389/fphar.Aug2023.1244151

ConflictofInterest Noconflictofinterest.

4CPS-230 IDENTIFICATIONOFRAREDPYDVARIANTS ASSOCIATEDWITHTOXICITYTOFLUOROPYRIMIDINES INACLINICALPHARMACOGENOMICSPROGRAMME

1JLRevueltaHerrero*, 1XGarcía, 2SSalvador, 2PZapata, 1ITaladriz, 2LLópez, 1AHerranz, 1MSanjurjo. 1HospitalGeneralUniversitarioGregorioMarañón,HospitalPharmacy Department,Madrid,Spain; 2InstitutoDeInvestigaciónSanitariaGregorioMarañónIisgm, PharmacogenomicsUnit,Madrid,Spain

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BackgroundandImportance Dihydropyrimidinedehydrogenase (DPYD)isakeyenzymeinthemetabolismoffluoropyrimidines.PatientswithdeficiencyinDPYDareatgreatriskof severeadverseeventswhentreatedwithfluoropyrimidines(5fluorouracil,capecitabine).Itisrecommendedthatpatientsare screenedforthemostcommonvariantsinthisgenebefore initiatingchemotherapy.However,somepatientsstilldevelop earlyserioustoxicities.

AimandObjectives Wereporttheresultofaclinicalpharmacogenomicsprogrammetargetedtopatientswhodeveloped toxicitywithfluoropyrimidines.Theaimwastoidentifyrare variantsintheDPYDgeneassociatedwithseveretoxicity,and toprovidepatientsandclinicianswithpharmacogenomic counselling.

MaterialandMethods Patientswhosufferedseveretoxicities (grade 3)duringtheirfirstthreecyclesoftreatmentwithfluoropyrimidineswereidentifiedbytheironcologistoroncology pharmacist.Theywereallnegativeforthefourrecommended variants(DPYD*2A,c.2846A>T,c.1679T>G,and c.1236G>A).Amethodologyforsequencingthe23exonsof DPYDwasdevelopedbythePharmacogenomicsUnit,integratedintheHospitalPharmacyDepartment.Thestudywas approvedbythelocalEthicsCommittee.Patientswere informedandgaveconsenttoparticipateintheprogramme. Results Since2017,91patientshavebeenincludedintheprogrammeand32variantsinDPYDwereidentified.Nineof

these32variantswereassociatedwiththedevelopmentof severetoxicityinthesepatients(c.257C>T,c.704G>A, c.775A>G,c.851G>T,c.1977–1984-CTCCAGAA>C, c.2197insA,c.2242+1G>T,c.2324T>Gandc.2087G>A).As aresultoftheprogramme,thecausefortoxicitywasfound in10%(9/91)ofpatients.Theresultsofthetesttogether withadoseadjustmentrecommendationwerecommunicated topatientsandincludedintheirelectronicmedicalrecordto maketheinformationavailablefortheoncologistandtherest oftheclinicalteam.

ConclusionandRelevance ThisprogrammehelpedustoidentifyuncommonvariantsintheDPYDgenethatwereassociatedwithtoxicitytofluoropyrimidinesinaclinicalpractice setting.Thesevariantswillbeincludedinanewtestthatis currentlyunderdevelopment.Webelievethatperformingthis extendedtestbeforeinitiatingtreatmentcanimprovepatient safety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-001 INCIDENCEOFHEPATITISBVIRUSREACTIVATIONIN PSORIASISPATIENTSTREATEDWITHCYTOKINE INHIBITORS:ASYSTEMATICREVIEWANDMETAANALYSIS

1SCShao*, 2MHKuo, 3CWTseng. 1KeelungChangGungMemorialHospital,Department ofPharmacy,Keelung,TaiwanR.O.C; 2DalinTzuChiHospital,DepartmentofPharmacy, Chiayi,TaiwanR.O.C; 3DalinTzuChiHospital,DivisionofGastroenterology-Departmentof InternalMedicine,Chiayi,TaiwanR.O.C

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BackgroundandImportance Thesafetyofcytokineinhibitors inpsoriasispatientswithhepatitisBvirus(HBV)remains uncertainduetotheirexclusionfromclinicaltrials.ObservationalstudieshaverecentlyraisedclinicalconcernsaboutHBV reactivation(HBVr)riskinpsoriasispatientsusingcytokine inhibitors,butacomprehensivesystematicreviewisstill lacking.

AimandObjectives Thisstudyaimedtoevaluatetherisksof HBVrinpsoriasispatientstreatedwithcytokineinhibitors.

MaterialandMethods FollowingthePreferredReportingItems forSystematicReviewsandMeta-Analyses,weconducteda systematicliteraturesearchinPubMed,Embase,WebofScience,andCochraneCentralRegisterofControlledTrialsfor relevantobservationalstudieson5May2023.Weincluded studieswith>5casesandcompleteHBVstatus.Twoindependentreviewersperformedthestudyselectionanddata extraction,andthediscrepanciesbetweenreviewerswouldbe solvedbythefulldiscussion.Arandom-effectsmeta-analysis assessedthepooledincidenceofHBVr.Wealsoconducted subgroupanalysestocompareHBVrincidenceacrossdifferent cytokineinhibitorsandHBsAbstatus.

Results Eightobservationalstudiescomprising181psoriasis patientswereincluded.AmongHBsAg+individualswithout antiviralprophylaxis,thepooledHBVrincidencewas25.3% (95%CI:10.4to49.7%)withamedianonsetat5months (range:3–7months)fromthecytokineinhibitorinitiation.No HBVreventswereobservedinHBsAg+individualswithantiviralprophylaxis.AmongHBsAg /HBcAb+individuals,the pooledHBVrincidencewas5.0%(95%CI:2.3to10.8%) withamedianonsetat12monthsfromthecytokineinhibitor initiation.SubgroupanalysisshowedsimilarpooledHBVr

incidenceforIL-12/23inhibitors(4.0%,95%CI:1.3to 11.8%),IL-17inhibitors(6.6%,95%CI:1.9to20.5%),and IL-23inhibitors(5.0%,95%CI:0.3to47.5%).Nosignificant riskdifferencewasfoundbetweenpatientswithandwithout HBsAb(riskdifference: 0.01%;95%CI 0.16to0.13%).

ConclusionandRelevance ThissystematicreviewandmetaanalysisshedlightontheincidenceofHBVrassociatedwith cytokineinhibitorsinpsoriasispatients.Prophylacticantiviral useiscrucialforpatientswithHBV.PhysiciansandpharmacistsmustensureproperHBVprotectionthroughprophylaxis andmonitoringwhenadministeringcytokineinhibitors,in additiontoadheringtorecommendedHBVvaccination.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-002 PRESCRIBINGTRENDOFFLUOROQUINOLONES FOLLOWINGLATESTEMARECOMMENDATIONS 1APirrone*, 2MAvantaggiato, 2FPanzeri. 1AtsBrianza,PharmaceuticalService,Monza, Italy; 2UniversitàDegliStudiDiMilano,ScuolaDiSpecializzazioneInFarmacologiaE TossicologiaClinica,Milano,Italy

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BackgroundandImportance TheEuropeanMedicinesAgency (EMA),followinga2018European-widereviewtoassessthe riskofseriousanddisablingadversereactions,hasrecommendedthattheuseoffluoroquinolonesshouldberestricted. In2019,theuseoftheseantibioticswassignificantlylimited. However,asubsequentstudy,showedthatthesedrugsarestill prescribedoutsidetherecommendeduses.Forthisreasonthe EMA,inMay2023,issuedareminder.

AimandObjectives Theaimistoanalysetheprescribingtrend offluoroquinolones,followingEMA’sreminder.

MaterialandMethods Analysisofprescription(PR)dispensed throughcommunitypharmacies,relatingtotheactiveingredients(p.a.)classifiedwiththeanatomic,therapeuticand chemicalclassification(ATC)J01MA.Theperiodconsideredis from2017to2022.Theanalyseddatawereinthepharmaceuticalservicedatabase,groupedbyp.a./ATC,patient‘ sage andwasprocessedviaMicrosoftExcel.

Results ThenumberofPRofp.a.analyseddecreasessignificantlystartingfrom2019.Pefloxacinandpipemidicacidare nolongerprescribedfrom2020.Approximately50%ofthe PR,persinglep.a.,areintendedforpatientsaged65orover (302314/601603totalPRin6years).Themostprescribedp. a.arelevofloxacin(273976totalPR)andciprofloxacin (290553totalPR);thenumberofPRofthesetwop.a.,in 2021,decreasedby66%(from74705to25032)and41% (from65980to38916)respectivelycomparedto2017.However,in2022therewasanincreaseof14%(28741PR)for levofloxacinand7%(41785)forciprofloxacin,comparedto thepreviousyear.Intheremainingp.a.,excludingmoxifloxacin,noprescribingincreasewasobservedbetween2021and 2022.

ConclusionandRelevance TherestrictionsintroducedbyEMA aimtoreducetheriskofdisablingandpotentiallyirreversible sideeffectslinkedwithfluoroquinolonesuse,especiallyinthe elderlypopulation.Theresultssuggestthattherestrictions introducedin2019havebeenadoptedeffectively,resultingin adecreaseofprescriptionsupto2021.Theincreaseoflevofloxacin,ciprofloxacinandmoxifloxacinobservedin2022 couldbecausedbyreducedprescribingattention,shortage/

ineffectivenessofotherantimicrobialclasses,orlocalrespiratoryinfectionsoutbreak.TheEMArecallreleasedinMay 2023representsatooltostrengthentheattentionaboutfluoroquinolonesandavoidtheirprescriptionoutsidetherecommendeduses.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-003 IMPROVINGMEDICINESMANAGEMENTOF INPATIENTPARKINSON’SDISEASEPATIENTSBY MAKINGPHARMACYINTERVENTIONS

1MKnipe*, 1EConyard, 2MDonovan. 1OurLadyofLourdesHospital,Pharmacy Department,Drogheda,IrelandRep; 2UniversityCollegeCork,SchoolofPharmacy,Cork, IrelandRep

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BackgroundandImportance HospitaladmissionsofParkinson’ s disease(PD)patientscanresultinmedicationregimendisruptionscausingadverseeffectsforPDpatients.Evidenceshows thatinterventionscanreducemedication-errorsandadministrationofcontraindicatedmedicinesinPDpatients.

AimandObjectives Thestudyaimwastoquantifytheimpact ofapharmacist’sinvolvementinoptimisingmedicinesmanagementofinpatientPDpatients.

MaterialandMethods A2-month ‘baseline’ auditwascompletedpriortointerventionimplementationandmeasured patientdemographics,delayinfirstdosefollowingadmission, medicationerrors(missed/delayeddoses),pharmacistmedicines reviewsandtimeuntilcompletionandpatientoutcome(prevalenceoffalls,delirium,rigidity).Theoutcomeofpatients whowere ‘nilbymouth’ wasalsoassessed.Threeinterventionswereimplementedovera1-monthperiod.Thesewere prioritypharmacistmedicinesreviewsofPDpatients,PDmedicationwardstockoptimisationanddoctor/nursePDmedicine managementeducationsessions.Apost-interventionauditidenticaltothe ‘baseline’ auditwascompletedandbothaudits werecompared.

Results The ‘baseline’ audit(meanage81,24patients,1,611 duedoses)andthepost-interventionaudit(meanage80,30 patients,1,840duedoses)wereanalysed.Medicinereviews increasedfrom79%to97%(p=0.042)andthesewerecompleted38.7hours(p<0.001)soonerpost-admission.Areductioninfirstdosedelaywasseen(13.5vs4.4hours (p<0.001)),alongwithreductionsindelayed(5%to1% (p=0.037))andmisseddoses(8%to2%(p<0.001)).Omitted pre-admissionPDmedicationsreducedfrom16%to2% (p=0.011).Staffeducationcontributedtorecordedduetimes increasingfrom44%to97%(p<0.001).Contraindicated medicineswereadministeredatreducedratesinthepost-interventionaudit.Thelengthofadmissionwasshorterduetothe combinationofinterventions(19vs15days(p=0.475)).

Theseimprovementsresultedinareducedprevalenceoffalls (25%to17%),deliriumepisodes(29%to7%)andrigidity (54%to7%).Patientsweremoreabletointeractwithallied healthprofessionalsinthepost-interventionaudit(46%vs 100%).Improvementsinnon-oralPDmedicinesprescribing occurredin ‘nilbymouth’ patients.

ConclusionandRelevance Thisstudyshowedtheintroduction ofthepharmacist-ledinterventionscanimprovePDinpatient outcomes,byreducingmedicationerrors,decreasingthe

administrationofcontraindicatedmedicinesandpreventing delaysintheadministrationofPDdrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-004 COMPARISONBETWEENBEERS2019CRITERIAAND THEEURO-FORTA2018LISTINTHEIDENTIFICATION OFPOTENTIALLYINAPPROPRIATEMEDICATIONIN ELDERLYPATIENTSINTHEPRIMARYHEALTHCARE CONTEXT

1CDiogo*, 2AMLavrador, 3FFernandez-Llimos. 1HospitalGarciaDeOrta,Pharmaceutical Services,Almada,Portugal; 2FaculdadeDeFarmáciaDaUniversidadeDeCoimbra, FaculdadeDeFarmáciaDaUniversidadeDeCoimbra,Coimbra,Portugal; 3FaculdadeDe FarmáciaDaUniversidadeDoPorto,FaculdadeDeFarmáciaDaUniversidadeDoPorto, Porto,Portugal

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BackgroundandImportance Inappropriateprescriptionisa riskfactorforadversedrugreactionsandhospitalisationsin theelderly.Concernsaboutitsimpactinthisagegrouphave ledtothedevelopmentofvariousstrategiestoaddressthis issue,withafocusontoolsfordetectingpotentiallyinappropriatemedication(PIM),notablytheBeerscriteriaandthe EURO-FORTAlist.

AimandObjectives Tocomparethe2019Beerscriteriawith the2018EURO-FORTAlistandshowtheirapplicabilityon theprimaryhealthcarecontext.

MaterialandMethods Weconductedacross-sectionalobservationalstudyinapopulationofpatientsover65yearsold enrolledinafamilyhealthunitinPortugal.Classificationof alldrugsandactivediagnosesinthefamilyhealthunit accordingtothetoolsunderanalysis.Cross-referencingdrugs identifiedasPIMsaccordingtobothinstrumentswiththe familyhealthunitdatabase,resultingintheidentificationof PIMsforeachpatient,consideringtheirconditions.

Results Twenty-nineofthePIMsaccordingtotheBeerscriteriaarenotPIMsaccordingtotheEURO-FORTAlist;54of thePIMsaccordingtotheEURO-FORTAlistarenotPIMs accordingtotheBeerscriteria;47drugsrecommendedbythe EURO-FORTAlistarePIMsaccordingtotheBeerscriteria. Thestudyincluded2,775patients,59.70%ofwhomwereon polypharmacy.TheprevalenceofPIMswas13.41%according totheBeerscriteriaand35.78%accordingtotheEUROFORTAlist,withahighernumberofPIMsinwomeninboth instruments.ThemostfrequentlyprescribedPIMswerebenzodiazepinesforbothtools,followedbyantipsychoticsand antidepressants.

ConclusionandRelevance ThelevelsofpolypharmacyandprescriptionofPIMsinthepresenceofcertaindiseasesareconsiderableintheelderly,inthecontextofprimaryhealthcare, withbothtoolsbeingusefulinthedetectionofPIMs.However,thereareimportantdifferencesinthedrugstheyinclude, whichmustbeindividuallyanalysedfromapharmacotherapeuticpointofview.Regardingtheintegrationofthesetools intoaclinicaldecisionsupportsystem,itisconcludedthat bothinstrumentsshouldbecomputerisedtogethertotake advantageofthebenefitsofeachoneandtoaddressthe shortcomingsthatbothpresent.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

UTILITYOFTHETHERAPEUTICCOMPLEXITYINDEX ADAPTEDTOCRITICALLYILLPATIENTSASAMETHOD OFSTRATIFICATIONFORPHARMACEUTICALCARE

1LDoménech*, 1GZMariaBlanca, 1GDMariaRosa, 2GSJosepMaria, 1LPilar, 1MQueralt Gorgas. 1VallD´HebronUniversityHospital,PharmacyDepartment,Barcelona,Spain; 2ConsortiumofHealthAndSocialCareofCatalonia,PharmacyDepartment,Barcelona, Spain

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BackgroundandImportance IntensiveCareUnitworkload pharmacistprovidingICUclinicalserviceshasnotbeen optimised.

AimandObjectives Tomeasurethecomplexityofmedication regimensinadultICUandanalysetheutilityofthisindicator asamethodforpatientstratificationinpharmaceuticalcare forcriticallyillpatients.

MaterialandMethods Observational,descriptive,prospective studyconductedatathird-levelhospital.Across-sectional approachwasemployedtoreviewtreatmentregimensand measuretheMRC-ICU(MedicationRegimenComplexity IntensiveCareUnitIndex)forallICUadultpatientsadmitted.

Demographicvariablesand23itemsrelatedtoeach patient’streatmentandclinicalconditionswerecollected,then theseitemswerescoredasdefinedintable2ofGwynnetal. TheMRC-ICUwascalculatedbysummingthetotalscoreof the23items.

Results Seventy-onepatientswereincludedinthestudy(70% bedoccupancy;65%male),withameanageof58±16.6 years.

Amongthese,sixpatients(8%)wereclassifiedasneurocritical,12withrespiratoryfailure,11withtraumaticinjuries,11 withcoronaryconditions,fourpostoperativecardiacpatients, 17post-lungtransplants,fivewithsepticshockandfivewith digestivesemi-criticalconditions.Theaveragenumberofprescribedmedicationsperpatientwas18±7.

Atthetimeofthestudy,themeanlengthofstaywas22 ±24days,andthemeanMRC-ICUwas13±8.Respiratory failureexhibitedthehighestMRC-ICU(median19;IQR10–23),followedbypost-lungtransplantpatients(median17; IQR14–23),septicshock(median12;IQR10–16),post-operativecardiaccases(median10.5;IQR9–12),andneurocritical conditions(median9;IQR5–14).Thedrugscontributing mosttocomplexitywereantibiotics,continuousperfusion sedoanalgesia,andimmunosuppressants.

ConclusionandRelevance Inourstudy,patientsadmittedto theICUduetoAcuteRespiratoryFailureorfollowingLung TransplantationexhibitedMRC-ICU.

Thesepatientsmaybeconsideredascandidatesforprioritisedpharmaceuticalcare.

TooptimiseresourcesItwouldbenecessarytocorrelate thescorewiththeinterventionsperformedbythepharmacist uponadmissiontotheunitandthoseaccumulateduntil discharge.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.GwynnMEetal.Developmentandvalidationofamedicationregimencomplexity scoringtoolforcriticallyillpatients. AmJHealthSystPharm.2019;76(Supplement_2):S34-S40.

ConflictofInterest Noconflictofinterest.

5PSQ-006 FREQUENCYOFCREATININETESTINGANDACUTE KIDNEYINJURYIDENTIFICATIONANDSTAGING

1,2CDaLuzOliveira*, 2,3FDuarte-Ramos, 2FAlvesDaCosta, 4FFernandez-Llimos. 1Hospital VilaFrancadeXira,Pharmacy,VilaFrancadeXira,Portugal; 2IMED-ResearchInstitutefor Medicines,FacultyofPharmacy-UniversidadedeLisboa,Lisboa,Portugal; 3EPIUNITEpidemiologyUnit,LaboratoryforIntegrativeandTranslationalResearchinPopulation HealthITR-UniversidadedoPorto,Porto,Portugal; 4UCIBIO-AppliedMolecularBiosciences Unit-I4HB-InstituteforHealthandBioeconomy,LaboratoryofPharmacology-Facultyof Pharmacy-UniversidadeofPorto,Porto,Portugal

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BackgroundandImportance Criteriatoidentifyandstage acutekidneyinjury(AKI)establishtimeintervalswhenthe serumcreatinine(SCr)shouldincreasetobeconsideredAKI. Theseintervalsrangefrom48hoursto7days(dependingon AKINorKDIGOcriteria).Subsequently,atimelySCrtest shouldbeperformedtoinpatients,preferentiallynolonger than48hours.

AimandObjectives Toevaluatetheimpactofreal-worldSCr testinghospitalpracticefortheidentificationandstagingof AKI.

MaterialandMethods Ahistoricalcohortstudywithdata frommedicalrecordsofpatientsadmittedtohospitalbetween 1June2018and31December2020,wasconducted.AKI stagewascalculatedusingtwocriteria:AKINandKDIGO. Identificationandstagingwerefirstdoneconsideringthetime intervalswhentheSCrincreaseshouldbeidentifiedas describedinthetwocriteria.Then,asecondstagingprocess wasconductedignoringthetimeintervalsandconsideringall thehospitalisationtime.Lengthofstay(LoS)wascalculated byadding1daytothedifferencebetweendischargeand admissiondates.Creatinineclearancewasestimatedusingthe Cockcroft-Gaultequation.Alistofdrugsthatrequiredose adjustmentwhenCrClachieves50mL/minwasobtainedfrom theRenalDrugHandbook3rdedition.

Results Duringthestudyperiod,17,269hospitalisationsand 62,255SCrtestswererecorded.Amongthe17,032hospitalisationswithLoS>48h,46.8%presentedperiods>48hwith noSCrtestsperformed.In3.5%ofhospitalisationsthe patient’sweightwasnotregistered.AnystageofAKIwas identifiedin7.0%andin9.1%ofpatientsusingAKIand KDIGOcriteria,respectively.Whenignoringtimelimitsin bothcriteria,potentialAKIcouldhaveoccurredin1,942 patients(11.2%).Atotalof76differentdrugsrequiringdose adjustmentinpatientswitheGFR £50ml/minwereprescribed in78.5%admissions,and30.3%ofalladmissionsincluded patientsprescribedwiththesedrugsthatreachedeGFR<50 ml/min.

ConclusionandRelevance Ourstudysuggeststhatreal-world SCrtestinghospitalpracticefortheidentificationandstaging ofacutekidneyinjurymaynotbesufficienttoidentifyallthe AKIoccurrences.Organisationalorlegalchangesarenecessary tocontributetotimelyuseofanalyticvaluestooptimisetherapyandthusincreasepatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KDIGOClinicalPracticeGuidelinesForAcuteKidneyInjury. KidneyIntSuppl[Internet]. 2012;2:138.

2. 2.TheRenalDrugHandbook ISBN-13:9781846192982.

3.LagreulaJ, etal.Optimizingpharmacists ’detectionofprescribingerrors:comparisonofon-wardandcentralpharmacyservices. JclinPharmTher. 2021;46:738–43.

ConflictofInterest Noconflictofinterest.

AREVIEWOFMEDICATIONRECONCILIATIONINTHE PERIOPERATIVEPERIOD:VARIABLESTHATLEADTO MEDICATIONERRORS

DJBoardmanGonzález*,LRubioAlonso,SCanalesUgarte,VLafargaLapieza,PHernando Martínez,DBarredaHernández. VirgendelaLuzHospital,PharmacyDepartment,Cuenca, Spain

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BackgroundandImportance Medicationreconciliation(MR) buildsthebridgebetweenthepatients’ currentmedication, andtheirreceivedtreatmentduringhospitalisation.Pharmacists haveanactiveroleinpreventingomissions,duplications,dosingerrors,ordruginteractions;thisisallthemoreevident whenitcomestotheperioperativeperiod,whereacorrect managementonmedicationbecomesimperativetothe patients’ safety.

AimandObjectives Toevaluatewhichpharmacologicalgroups arepronetoleadtomedicationerrorsduringtheperioperativeperiodandtofindapossiblecorrelationbetweensaid errorsandthepatients’ demographicfactorsandprescriptionbasedfactors.

MaterialandMethods Prospectiveobservationalstudyfrom JulytoSeptember2023inasecond-levelhospital.We reviewedpatients’ prescriptionsintraumatology,ophthalmology,urologyandgeneralsurgerywards,andselectedthose withchronicmedicationwithclinicalevidenceontheirreconciliationduringtheperioperativeperiod.Wedividedtheperioperativeperiodintopre-opandpost-op,andanalysed discrepanciesinMR.Variablessuchaspatients’ age,gender, durationofadmissionandnumberofprescribedmedications weretakenintoaccount.Toobtainthisinformation,weused MambrinoXXI® (electronicprescriptionsoftware),andFarmaTools® forpharmaceuticalvalidationprocesses.

Results Fifty-twopatients’ prescriptionswereanalysedanda totalof214medicationswerereviewed.Themedianagefor thisgroupwas67years,where56%weremale.Themedian numberofmedicationsperpatientwasfour(1–13).Thedurationofadmissionhadamedianof5days(2–46days).50% ofadmittedpatients’ MRwassuccessfulonpre-opprocesses, incontrastto42.3%inpost-opprocesses.Whenreviewing thepercentageoferrorsinvariablesincludedinthestudy,we foundthat:Statins(65%pre-op,55%post-op)anddiuretics (50%pre-op,36%post-op)arethemostaffectedgroups. Durationofadmission>5vs.<5days(64,7%vs.65,7%). Numberofprescriptions>4vs.<4(63%vs.70%).

ConclusionandRelevance AlthoughMRintheperioperative periodcanbearigorousprocess;itisamust-haveinany hospitaltoguaranteepatients’ safety.Pharmaceuticalinterventionsarekeytopreventrisksduetomedicationerrors;especiallyinthosepronetoerror.Amoreprecisestatisticalmodel isneededtofigureoutwhichvariablesleadtomedication errorsintheperioperativeperiod.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-008 IMMUNE-MEDIATEDHEPATITISSECONDARYTO TREATMENTWITHPEMBROLIZUMAB.ACASEREPORT CRodriguezMoreta*,RPlaPasán,MDLÁOcañaDeLaRosa,ISánchezLobón,MJHuertas Fernández. HospitalPuertadelMar,HospitalPharmacy,Cádiz,Spain

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BackgroundandImportance Immune-mediatedreactionsplaya majorroleinimmunotherapy,soitisimportanttomonitor patientsandfollow-uptoimprovepatientsafety.

AimandObjectives Todescribeacaseofimmune-mediated hepatitissecondarytotheuseofpembrolizumabandmultidisciplinaryinterventioninitsmanagement.

MaterialandMethods An81-year-oldpatientdiagnosedwith advancedamelanoticnodularmelanoma,withlungandaxillarymetastasis.Dataobtainedfromthedigitalmedicalrecord andfromthechemotherapyelectronicprescriptionprogram. Safetyprofileofpembrolizumabinitstechnicaldatasheet (TDS)andtheliteraturereportedcasesofhepatobiliarydisorderswithpembrolizumabwerereviewed.

Results Thepatientbegantreatmentwithpembrolizumab200 mg/3weeksformetastaticdisease.Priortothethirdinfusion, shereportedregulargeneralcondition,astheniaanddysgeusia, withelevationoftransaminases(aspartate-transaminase:31U/L (1–32);alanine-transaminase:130U/L(0–55))andtotalbilirubin:1.60mg/dL(0.30–1.20),diagnosinggrade4immunemediatedhepatitis.

Specialistcontactedwiththehospitalpharmacisttoconfirm whetheritwasanadverseeffect(AE)secondarytopembrolizumab.ThepharmacistperformedareviewoftheTDSand literaturethatconfirmedtheevent(hepatitisisdescribedasa frequentAE( 1/100to<1/10)).

Treatmentwithpembrolizumabsuspendedandthepatient requiredimmunosuppressivetreatment(pulsesofmethylprednisoloneandmycophenolate-mofetil).AcontrolCT-scan showedadecreaseinthesizeofthemetastases.

After2weeks,thepatientwasasymptomaticandhadgrade 1immune-mediatedhepatitis,sorestartedtreatmentwith immunotherapy,switchingtonivolumab240mgtwiceweekly. Closemonitoringoftransaminaseslevelsandmaintenanceof immunosuppressivetreatmentcontinued.

ThesuspectedAEnotifiedtotheSpanishPharmacovigilance Systemandacausalrelationshipbetweenthedrugandthe AEestablishedaccordingtotheNaranjoAlgorithm,obtaining ascoreof5,whichestablishesaprobablerelationship.

Immune-mediatedhepatitisisanAEalsodescribedwith nivolumab,whichwaswelltoleratedbythepatient,whichdid notoccurwithpembrolizumabdespitehavingasimilarsafety profile.

ConclusionandRelevance Closemonitoringandfollow-upof AEsassociatedwithdrugsisimportant,astheparticipationof thepharmacistinmultidisciplinaryteams,validatingtreatments andcarryingouttheirmonitoring.Allofthiscontributesto animprovementinthemanagementofAEsandinpatient safety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-009 OFF-LABELUSEOFINTRAVENOUS CYCLOPHOSPHAMIDEINSYSTEMICLUPUS ERYTHEMATOSUSPRESENTINGASACUTELUPUS PNEUMONITIS:ACASEREPORT

1AGanforninaAndrades*, 2DGuerraEstévez, 2CPalomoPalomo, 2MMRomeroAlonso, 2JEstaireGutierrez, 2MReyesMalia. 1TomellosoGeneralHospital,Pharmacy,Tomelloso, Spain; 2InfantaElenaHospital,Pharmacy,Huelva,Spain

10.1136/ejhpharm-2024-eahp.344

BackgroundandImportance Systemiclupuserythematosus (SLE)isamultisystemautoimmunediseasewithwide-ranging pleuropulmonarymanifestations.Acutelupuspneumonitis (ALP)isoneofitsuncommoncomplications.Systemicsteroids associatedwithimmunosuppressivetherapy(cyclophosphamide, rituximab,hydroxychloroquineandintravenousimmunoglobulin)arethemainstreamtreatmentofALP.

AimandObjectives TodescribethecaseofapatientwithALP treatedwithintravenouscyclophosphamideaswellastoevaluatetheeffectivenessandsafetyofthistreatment.

MaterialandMethods Wereportthecaseofa67-year-old womanwithamedicalhistoryofbreastcancerandpolymyalgiarheumaticatreatedwithcorticosteroids.Shewas referredtotheemergencydepartmentduetointermittent fever,fatigue,generalisedmyalgiaandarthralgia,milddyspnoeaanddrycoughwithsputumforthepast3weeks.

Multipleandbilaterallungopacitieswerepresentonchest X-raysoshewasdiagnosedwithcommunity-acquiredpneumonia.Thewomanpresenteds lightimprovementdespite empiricalantibioticandantifungalcoverage.Subsequently, laboratoryfindingsshowedleukopeniaandpositiveantidouble-stranded-DNAantibodiessothefinaldiagnosiswas ALPsecondarytoSLE.Systemicsteroidtreatmentwasinitiatedwithahigh-doseofmethylprednisoloneandhydroxychloroquine.Duetotheseverityofthepulmonary involvement,itwasrequestedtostarttreatmentwithintravenouscyclophosphamide.

Results Thepatientreceivedatotalofthreedoses(600mg/ m2)ofintravenouscyclophosphamide.MESNA,ondansetron andoralhydrationwereprescribedassupportivetreatment. Despitethedecreaseininflammatoryanalyticalparameters, thewomanpresentedmodestreductionoflunginjuryand symptoms.Shereportedhigh-grademyalgiaandvomitingafter firstinfusion,whichwassuccessfullytreatedwithparacetamol andmetoclopramide.Sequentialtherapywithoralcyclophosphamidewasconsidered,butbecauseitisnotfundedforALP anditsadverseeffectprofile,treatmentwithmethotrexatewas started.Currently,thepatientcontinuestreatmentwithmethotrexate,hydroxychloroquineandoralsteroids.Computed tomography,performed3monthsafterendingintravenous cyclophosphamide,showedstabilityofthedisease.

ConclusionandRelevance Treatmentwithintravenouscyclophosphamidehasnotshownpromisingresultsinourpatient althoughitssafetyprofileisgood.Becausethetherapeutic alternativesinpatientswithALParelimited,itwouldhave beeninterestingtoverifythatsequentialtherapywithoral cyclophosphamideimprovesthesignsandsymptomsofthe disease,andlong-termadverseeffectscouldalsobeanalysed.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-010 NATIONALSTANDARDISATIONOFPRETERM PARENTERALNUTRITIONINNEONATALUNITS

1,2SFenton*, 2,3BMurphy, 4ADoolan, 5RMccarthy, 2,6AMBrennan. 1CorkUniversity Hospital,PharmacyDepartment,Cork,IrelandRep; 2UniversityCollegeCork,Infant ResearchCentre,Cork,IrelandRep; 3UniversityHospitalWaterford,Paediatrics/Neonatology, Waterford,IrelandRep; 4TheCoombeHospital,Neonatology,Dublin,IrelandRep; 5The NationalMaternityHospital,DepartmentofClinicalNutritionandDietetics,Dublin,Ireland Rep; 6CorkUniversityMaternityHospital,DepartmentofDieteticsandNutrition,Cork, IrelandRep

10.1136/ejhpharm-2024-eahp.345

BackgroundandImportance Parenteralnutrition(PN)isahigh alertmedication,essentialforthesurvivalofinfantsbornpreterm.Europeanexpertguidelinesrecommendthatstandardised parenteralnutrition(SPN)rathertheindividualised(IPN)is usedforthemajorityofinfants,duetoincreasedpatient safetyandresourceefficiency.1 Therehasbeenafailureto implementthispractice,withlargevariationsinthequality andmodelsofPNprovisionandpractices.2,3

Nationally,neonatalunits(NUs)haveintroducedaprecisionSPNsystem,includingtwoexternallycompoundedSPN bagsandaccompanyingclinicaldecisionsupporttool.The SPNsystem,developedover10yearsofmultidisciplinary translationalresearchhasdemonstratedimprovedclinicaland economicoutcomes.4,5 In2018theSPNsystemwasendorsed asthenationalModelofCareforPretermStandardised ParenteralNutritionandanimplementationgroupoversawa nationalrollout,completedmid-2021.

AimandObjectives TodescribethepatternofpretermPN purchasedbyNUsfrombeforeimplementationtothecompletionofnationalroll-out.

MaterialandMethods AretrospectiveanalysisofpretermPN purchasingdatafromNUs(n=13)over6years,2017 –2022.6

Results ThepercentageofpretermSPNpurchasedbyNUs increasednationallyyearonyearfrom56%(3,662/6,522) pre-implementationto95%(4,823/5,074)inthefirstfullyear followinganationalrollout.Thiscorrespondedtoa~90% reductioninIPNpurchasednationally.

ConclusionandRelevance Thisisthefirsttimeacountryhas reportedthislevelofpretermSPNusage,deliveringsafeand equitablecare.Anationalstudyisunderwaytoevaluatethe implementationandeconomicimpact.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RiskinA, etal.ESPGHAN/ESPEN/ESPRguidelinesonpediatricparenteralnutrition: Standardversusindividualizedparenteralnutrition. ClinicalNutrition. 2018. https://www.clinicalnutritionjournal.com/article/S0261-5614(18)31174-9/fulltext

2.LapillonneA, etal.Qualityofnewborncare:adherencetoguidelinesforparenteralnutritioninpreterminfantsinfourEuropeancountries. BMJOpen. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780296/pdf/bmjopen-2013003478.pdf

3.SommerI, etal. Qualityandsafetyofparenteralnutritionfornewbornandpreterminfantsasanon-wardpreparation. EurJHospPharm. 2020.https://www. ncbi.nlm.nih.gov/pmc/articles/PMC7447241/pdf/ejhpharm-2018-001788.pdf

4.BrennanAM, et.al.StandardizedparenteralnutritionforthetransitionPhasein preterminfants:Abagthatfits. Nutrients.2018.https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5852746/pdf/nutrients-10-00170.pdf

5.9thCongressoftheEuropeanAcademyofPaediatricSocieties.2022.https:// www.frontiersin.org/books/9th_Congress_of_the_European_Academy_of_Paediatric_Societies/8754

6.CorrespondencefromnationalPNcompounder,June2023.

ConflictofInterest Noconflictofinterest.

5PSQ-011 TOXICITYOFIMMUNOTHERAPYTREATMENTIN CLINICALPRACTICE

BRodriguezDeCastro*,CRodriguezLage. HMHospitales,Pharmacy,Leon,Spain 10.1136/ejhpharm-2024-eahp.346

BackgroundandImportance Immunotherapyhasbrokennew groundinthetreatmentofoncologicaldisease.However,itis notexemptfromAdverseEvents(AE).

AimandObjectives Toanalyseanddescribethetoxicityprofile ofimmunotherapyinclinicalpractice.

MaterialandMethods Multicentredescriptiveobservational retrospectivestudyofpatientswhoinitiatedimmunotherapy treatment(June2018toJune2023).Clinicaldatawere obtainedfromthecomputerisedclinicalhistories(Doctoris®) andtheeOncology® database.Thefollowingvariableswere collected:demographicdata(sexandage),smokingstatus, comorbidities,historyofautoimmunedisease,oncologicaldiagnosisandstage,treatmentline,treatmentregimenused,numberofadministeredcycles,andtoxicityassessedaccordingto theCTCAEv5(CommonTerminologyCriteriaforAdverse Events)criteriaoftheNCI(NationalCancerInstitute).

Results Duringthestudyperiod,40patients(65%male)initiatedimmunotherapytreatment,medianage67years[39–87]. 35%wereactivesmokersand47%wereformersmokers.The mostfrequentcomorbiditieswerehypertension47%,dyslipidaemia42%,diabetesmellitus27%,andpsychiatricillness 17%.Twopatientshadanautoimmunedisease.

57.5%lungcancer;12.5%renalcancer;12.5%melanoma; 10%bladderurothelialcancer;2.5%gastriccancer;2.5% hepaticcancer,and2.5%pancreaticcancer.63%infirst-line immunotherapytreatment,27%second-line,10%third-line.

20patients(50%)experiencedatleastoneimmune-mediatedAE,mostlyofgrade2(moderate,48%),followedby grade1(mild,35%),andgrade3orhigher(severeandvery severe,12.5%).Corticosteroidswereusedin63%.

In80%ofpatientstreatedwithnivolumab,toxicitywas observed(20%ofwhichweresevere),comparedto50%for durvalumab(non-severe),50%avelumab(non-severe),35% pembrolizumab(10%severe),and16%atezolizumab(nonsevere).

DigestiveAEswerethemostfrequent(29.6%),followedby cutaneousAEs(22.2%),musculoskeletal(arthralgia,weakness) (18.5%),andpulmonaryAEs(14.8%).

ConclusionandRelevance Immunotherapyisbecomingafirstlinetreatmentforseveraltumours.

Ourreal-worldclinicalexperienceshowsthatimmunotherapyhasbeenreasonablywelltolerated,withmostimmunemediatedAEsbeingmoderateormild.

Corticosteroidswerethemostwidelyuseddrugstotreat thistypeoftoxicity.

Severeimmune-mediatedreactionshaverequiredhospitalisationanddiscontinuationoftreatment.

Alargersamplesizeandanextendedstudyperiodare neededtoconfirmthecorrelationbetweentreatmentresponse andtoxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-012 TOOLSOFFEREDBYREGENERATIVEMEDICINEFOR THETREATMENTOFOSTEOARTHRITIS – PLATELET RICHPLASMA(PRP)

1DFerrante, 2ARMarraffa, 3CDeCastris, 1ASerio, 4GMalagnino, 5VGColacicco, 1GMingolla*. 1ASLTaranto,HospitalPharmacy,MartinaFranca,Italy; 2ASLTaranto, Anaesthesia,MartinaFranca,Italy; 3UniversityofSiena,Pharmacy,Siena,Italy; 4ASL Taranto,HealthDirector,MartinaFranca,Italy; 5ASLTaranto,GeneralDirectorofASLTa, MartinaFranca,Italy

10.1136/ejhpharm-2024-eahp.347

BackgroundandImportance Osteoarthritisisthemostcommonformofjointdiseasethatcausespain,functionaldisabilityandworseningofthequalityofworkingandsociallife.

Themaintherapyisanalgesic,withtheadministrationof painkillersasneededandwiththeuseoflocalinfiltrationsof anaestheticcorticosteroidsandhyaluronicacid.Whenineffective,prostheticinterventionisnecessary.

AimandObjectives Adifferentapproachrepresentedbythe useofRegenerativeMedicineprotocolsbymeansofinjection ofautologousPRP,whichinitiatesaprocessoftissueselfrepair.

MaterialandMethods ThePRPprocedureinvolvescentrifugationofthepatient‘swholebloodwithisolationofplateletrichplasmatobeinjectedinasinglesolutionintotheintraarticularcavityfollowedbyaradiofrequencytreatmentthat modulatestheenvironment,makingitmorereceptivetothe biologicalactivatorspresentinthePRP.Thirtypatientswere enrolledbyreferringtotheVASpainscaleandtheWOMAC scaleforjointfunction,withchecksat1and6months.

Results Plateletgranulesrichingrowthfactorshaveanantinociceptiveeffectandinducecellproliferationbymodulatingthe intra-articularenvironmenttopromotechondrogenesis,inhibitingtheproductionofinflammatorymediators.Thisproduced a50%reductioninpainkilleradministrationsinthefirst monthanda98%reductionat6months.Thetreatmenthas replacedultrasound-guidedinfiltrations,reducingtheuseof expensivedrugssuchashyaluronicacid.ThecostoftheKIT dedicatedtothePRPprocedureisC ¼ 700/procedure,theDRG associatedwiththeprocedureisC ¼ 2,100/service,withanet gaincomparedtothedirectcostofthetechnologyof C¼ 1,400.

ConclusionandRelevance Thenoveltyoftheprocedureinthe hospitalunderstudydoesnotallowustocalculatethe advantageoftheautologousremodulationofthejointmicroenvironment,intermsofimpactontheorthopaedicprosthetic intervention.Theadvantageswillbeevaluatedovertimein termsofreductionindirectexpenditureforthepurchaseof drugs,prosthesesandindirectexpenditureforhospitalisations andriskslinkedtoorthopaedicsurgicalpractice.Investingin newtechnologicalmethodssuchasPRPpreservetechnological,financialandsocialresources.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-013 NEWMETHODFORASSESSMENTOF ENVIRONMENTALVIRALCONTAMINATIONOF LIQUIDSPREPAREDINCLOSED-SYSTEMDRUG TRANSFERDEVICES

1ESlutskySmith*, 2MAmichay. 1SimpliviaHealthcare-Ltd.,DesignandDevelopment,Kiryat Shmona,Israel; 2HYLaboratories-Ltd.,VirologyandTissueCultureUnit,Rehovot,Israel

10.1136/ejhpharm-2024-eahp.348

BackgroundandImportance Closedsystemtransferdevices (CSTDs)enablesterilepreparationandadministrationof drugs.

Drugscontaminatedbymicrobesharbourclinicalriskto patients.Drugssuspectedofcontaminationmustbedisposed of,addingeconomicburdentopharmacies.CSTDscanpreventcontaminationbybacteriaandfungi.1 However,a methodfortestingCSTDs’ abilitytopreventviralcontaminationisneeded.

AimandObjectives Theaimwastodevelopamethodfor evaluatingCSTDs’ abilitytopreventviralcontamination,

includingtwocasestudieswithCSTDs,onlyoneofwhich hasbeenpublished.2

MaterialandMethods Casestudieswereperformedwith Chemfort® andPhaSeal™ OptimaCSTDsinsideaglovebox continuouslyaerosolisedwithhumancoronavirusHCoVOC43.WithChemfort®,reconstitutionwassimulatedbytransferringsterilesalinefromIVbagtovialandbacktoIVbag. WithOptima™,boluspreparationwassimulatedbytransferringsterilesalinefromvialtosyringe,andinfusionpreparationwassimulatedbytransferringsterilesalineintoanIV bag.Threerepetitionstimesthreetechnicalreplicateswere performedforeachsimulation.HCoV-OC43RNAinsyringes andIVbagswasquantifiedbyqPCR,includingcalibration samples.Airsamplingverifiedthecontinuedpresenceofviral aerosolsintheglovebox.Fornegativecontrol,liquidtransferswereperformedinthepresenceofsterilemedium aerosols.

Results ViralRNAcouldbequantifiedatconcentrations 5 PFU/ml.

Chemfort®:NoviralRNAtracesweredetectedinanyofthe ninereplicates Optima™:Inbolussimulations,viralRNA traceswereobservedinallninereplicatesandwerewithin thequantifiablerangefor56%ofreplicates.Ininfusionsimulations,viralRNAtraceswereobservedin67%ofreplicates, butwerebelowthequantifiablerange.

ConclusionandRelevance Amethodwasdevelopedfortesting CSTDs’ abilitytopreventviralcontamination.Themethod wasappliedtotwoCSTDsfordifferentsimulatedpharmacy tasks.Themethodcanbeappliedforevaluationofadditional CSTDsandfordirectcomparisonbetweenCSTDbrandsperformingthesametasks.Theknowledgegainedcouldhelp protectvulnerablepatientsfromviralinfection.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.MillsA,YousefM. Drugs&TherapyPerspectives. 2021;37:206–11. 2.AmichayM,ShimonO,RavehE. PharmPract. 2021;19(4):2576.

FundingprovidedbySimpliviaHealthcareLtd. ConflictofInterest Corporatesponsoredresearchorothersubstantiverelationships:

MayaAmichaydeclaresnoconflictofinterest.relatingto thematerialpresentedintheabstract.ElanaSlutskySmithis employedbySimpliviaHealthcareLtd,themanufacturerof Chemfort®

5PSQ-014

ELECTRONICCOMMUNICATIONOFTHE DISCONTINUATIONOFHOMETREATMENT PRESCRIBEDTOPATIENTSINATERTIARYLEVEL HOSPITAL

AMartínRoldán*,MDMSánchezSuarez,RCantudoCuenca,LMartínez-DueñasLópezMarín,AJimenezMorales. VirgendeLasNievesUniversityHospital,PharmacyDepartment, Granada,Spain

10.1136/ejhpharm-2024-eahp.349

BackgroundandImportance Despiteitsapparentbenefits,electronicprescribingsystemsstillfacenumerouschallenges.Withouteffectiveelectroniccommunicationbetweenprescribers andpharmacists,medicationmaybedispensedincorrectly, resultinginpatientharm.

AimandObjectives Todeterminepotentialerrorsintheprescriptionofhomemedication,preventivelysuspendthis

medicationandalerttheprescribingphysiciansothatthe errorcanbesolved.

MaterialandMethods Prospectivecross-sectionalstudyfrom October2022toMay2023inatertiarylevelhospital.Potentialerrorsintheirelectronicprescriptionsweredetectedusing anelectronicprogramlinkedtothepatients‘ homeprescriptions.Errorsandreasonsforsuspensionoftreatmentwere classified:incorrectdosage(1),treatmentcompletedandnot discontinued(2),incorrectlywithdrawntreatment(3),incorrectpresentation(5)andtherapeuticduplicity(6).Theinterventionscarriedoutinwhichthedeadlineformodificationof theinterventionsbytheprescribersexpired(2weeks)were alsotakenintoaccount(4).Treatmentsandmedicalservices involvedwereanalysed.Averagenumberofdaysbetweenthe detectionandnotificationoftheerroranditsresolutionby theprescriberwasalsoevaluated.Thee-prescribingsystem wasusedaswellasamicro-strategydataanalysissystem. Results 340potentialhomeprescribingerrorsweredetected ofwhich190(55.9%)werereal.98(51.58%)werewomen withamedianageof63[20–73].Ofthesepatients81 (42.63%)werepolymedicatedwith10drugsand34(41.97%) hadatleast15ormoredrugsprescribed.Theaveragenumberofdrugsprescribedwas8[4–13].Mostfrequenterrors weredetectedin:semaglutide(28.5%),triptorelin(15%), methotrexate(12.5%),denosumab(9%),aledronic(9%),leuprorelin(5%),dulaglutide(5%),ibandronic(4.7%),risedronic (3%),paliperidone(3%),aripiprazole(2.5%),lanreotide (1.5%)andestradiol(1.3%).Themedicalspecialtieswiththe highestnumberofprescriptionerrorswererheumatology (31%),endocrinology(28.5%),cardiology(10%),oncology (7.3%)andurology(7.3%).Anaverageof7[4–11]dayswas observedbetweenprecautionaryannulmentandcorrectionof theerror.Thecausesofpreventivediscontinuationoftreatmentweretype1(74%),type6(11%),type4(6%),type5 (9%).Aftertheintervention,98treatments(51.57%)werediscontinuedforvariousreasons:1(30.6%),6(21.5%),4 (16.3%),2(15.3%),5(15.3%)and3(1%).

ConclusionandRelevance Electroniccommunicationofdiscontinuationofhometreatmentisanimportantfunctionalitywith potentialtodecreaseadverseeventsduetomedicationerrors andalsotoreducecostsforthehealthcaresystemandfor polymedicatedpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-015 ANALYSISOFTHEOCCURRENCEOFATRIAL FIBRILLATIONWITHTHEADMINISTRATIONOF IBRUTINIB:SHOULDWEBECAREFULWITHTHIS DRUG?

1BSánchezRodríguez, 2DGámezTorres, 1VGonzalezRosa*. 1HospitaldeLaSerraníade Ronda,Pharmacy,Ronda,Spain; 2HospitalUniversitarioTorrecárdenas,Pharmacy,Almería, Spain

10.1136/ejhpharm-2024-eahp.350

BackgroundandImportance IbrutinibisaBruton’styrosine kinase(BTK)inhibitorusedforthetreatmentofchroniclymphocyticleukaemia(CLL).Ibrutinibhasbeenassociatedwith anincreasedincidenceofatrialfibrillation(AF)intrialsrangingfrom5%to16%(1).

AimandObjectives ToanalysetheappearanceofAFandthe timeofitsdebut,aswellasthepossibleriskfactorsin patientsbeingtreatedwithibrutinibinatertiaryhospital.

MaterialandMethods Observational,cross-sectional,retrospective,multicentrestudy.PatientswithCLLtreatedwithibrutinibfromJuly2016toSeptember23foratleast2months wereincluded.Diraya®,FarmaTools® andPrisma® databases wereconsulted.Variableswerecollected:age,sex,cardiovascularriskfactors:arterialhypertension(AHT),diabetesmellitus (DM)andobesity.Durationoftreatmentwithibrutinib,serum creatinineatthestartoftreatment,drugsprescribedafter ibrutinib,appearanceofAF,timetoAFandwhetherhospitalisationwasrequired.

Results Forty-sixpatientswithCLLinthelast7yearswere included(16women,35%);themedianagewas63years [45–88].22patients(48%)hadAHT,eightpatients(17%) hadDMandfivepatients(11%)wereobese.Themeancreatininevaluewas0.97[1.91–0].Anticoagulationwasprescribed tosevenpatients(15%)andreninangiotensinsystemblockers tofivepatients(11%).Thirty-onepatients(67%)continueto betreatedwithibrutinib.Themeandurationoftreatmentin the13patients(28%)whodiscontinuedtreatmentwas546 days.Ofthese,twopatients(4%)developedAFondays21 and594.Inthefirstcase,hospitalisationwasrequiredand treatmentwassuspended.Inthesecond,itwasnotrelatedto ibrutinibbecausetoomuchtimehadelapsedsinceonset,did notrequirehospitalisationandthedrugwasnotdiscontinued. Twopatients(4%)withpreviouschronicAFdidnotdevelop anynewevent.Onepatient(2%)withnoriskfactorsdevelopedventricularextrasystoles.

ConclusionandRelevance Accordingtoourcohort,aconsiderablenumberofcasesappearedaftertreatmentwithibrutinib thatcanbeextrapolatedtotheresultsobtainedinprevious studies1 withoutappearingtoberelatedtocardiovascularrisk factorspriortotreatment.Thoseresponsibleforthesepatients shouldbeawarethatthisisaseriousadverseeffectthat shouldbemonitored.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.https://pubmed.ncbi.nlm.nih.gov/31250562/

ConflictofInterest Noconflictofinterest.

5PSQ-016 ASSESSMENTOFTHEACCREDITATIONAND CONTINUOUSEDUCATIONTESTSFORPHARMACY TECHNICIANSWITHINACYTOTOXICRECONSTITUTION UNIT

1SYounsi*, 1ACau, 1PSaint-Germain, 2AFillatre, 1AAbdaoui, 2YMahboub. 1SaintQuentinHospital,Chemotherapy,Saint-Quentin,France; 2Saint-QuentinHospital,Pharmacy, Saint-Quentin,France

10.1136/ejhpharm-2024-eahp.351

BackgroundandImportance Thenewpreparationgoodpracticesfor2023requireastaffassessment.Wedecidedtoimplementanannual,specificandadaptedtesttoouractivity,with theaimofguaranteeingtheauthorisationofnewpharmacy technicians(PT)andthecontinuouseducation(CE)ofthose alreadypresent.

AimandObjectives Realisationofthe2023annualexaminationfortheaccreditationofnewpharmacytechniciansand thecontinuouseducationofPTsalreadyaccredited.

MaterialandMethods Thetestlasts30minutesandconsists oftwoparts.Thefirstpartismadeupof10multiplechoice questions(MCQ)coveringthecompetenciesofpharmacytechnicians:pharmacology,environment,equipment,hygiene,asepsis,quality,riskmanagement.Thesecondpartconsistsof threevideoscontainingerrorsinthepreparationmethods (choiceofthemolecule,volumetobewithdrawn,dilution) whichhavebeenexportedfromourdigitaldouble-checkvideo system.Apassrateofover75%isrequiredtovalidatethe examination.Belowtherequiredrate,asecondsessionis mandatory.Adebriefingsessionisorganisedwiththeprovisionofadocumentcontainingthequestionsthatposedproblems(withapassratebelow80%)alongwithassociated procedures.

Results InthecontextoftheCE,10PTswerereassessed.The averagepassrateforthetestwas81.5%[75%-85%]withan averageof72.9%forMCQand100%forvideos.Foraccreditation,twoPTswereevaluated.Theoverallaverageofthe testwas70.3%[55%-65%]withanaverageof57.2%for MCQand83.4%forvideosrequiringasecondsession.The overallaverageofthesecondsessionwas90%withanaverageof85.7%forMCQand100%forvideos.Amongthe10 MCQ,sevenhadapassratebelow80%andrequireda reminder.

ConclusionandRelevance Forthepersonnelhavingcarriedout theirCEtheresultsaresatisfactoryandallthestaffhave beenrehabilitatedinthefirstsession.AsforthenewPT,the resultswereinsufficient.Theywererequiredtoreworkall procedures.Thisannualassessmentfrequencycontributesto thesafeguardingofourprocessbykeepingknowledgeup-todateandreinforcinggoodpractices.Asatisfactionsurvey amongPTcanbeconductedtoevolveourevaluation methods.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-017 PHARMACEUTICALINTERVENTIONSINORALAND SUBCUTANEOUSMTXPRESCRIBINGERRORS

LRodríguez-DeFrancisco,JLópez-Hernández,MFernández-González,EHevia-Álvarez, PSuárez-Casillas,SLora*,PBarriga-Rodríguez. HospitalUniversitarioVirgendelRocio, PharmacyDepartment,Sevilla,Spain

10.1136/ejhpharm-2024-eahp.352

BackgroundandImportance Methotrexate(MTX)isacytostaticdrugusedasanimmunomodulatorinnon-oncological diseases,dosedat7–25mgperweekorally/subcutaneouslyin adults.ItiscataloguedbytheISMP(InstituteforSafeMedicationPractices)as ‘high-riskdrugs’,whichincorrectlyused haveahigherlikelihoodofcausingserious-fatalharmto patients.Folicacid(FA)isadministeredtopreventMTX toxicity.

AimandObjectives Toanalysepharmaceuticalinterventions (PIs)onoral/subcutaneousMTXandFAprescriptionsandto assesstheacceptancedegreebythephysicians.

MaterialandMethods Prospectiveobservationalstudy.

Oral/subcutaneousMTXprescriptionsinadultsbetween MarchtoMay2023ofpatientsinathird-levelhospitalarea wereobtained.Filtersappliedtodetecterrorswere:dosageof onetablet(2.5mg)andadministrationfrequencydifferent from7days.Oncepatientswereidentified,MTXandFA

prescriptionswerereviewedandtheresponsiblephysicianwas contacted.TheacceptancedegreeofthePIswasmeasured.

Thefollowingvariableswerecollected:numberofpatients onwhomPIswereperformed,sex,age,diagnosis,number andtypeofPIsidentified.

Results Thirty-sixpatientswitherroneousprescriptionswere detected.67%werefemale.Themedianagewas54years (18–86).

Theassociatedpathologieswereincludedintherheumatologic(n=23,63.9%),dermatologic(n=8,22.2%),andinternal medicine(n=5,13.9%)areas:rheumatologicarthritis(n=8, 22.2%),juvenileidiopathicarthritis(n=3,8.3%),psoriatic spondyloarthritis(n=4,11.1%),polyarthritis(n=1,2.8%), psoriasis(n=6,16.7%)andothers(n=14,38.9%).

OfallthePIsperformed(n=53),thepharmacistrecommendedadjustmentof:MTXdosage(n=11),MTXadministrationfrequency(n=30),FAadministrationfrequency(n=9) andlackofFAprescription(n=3).

TheacceptancedegreeofthePIswereasfollows:MTX dosage(45.5%),MTXadministrationfrequency(80.0%),FA administrationfrequency(55.6%)andlackofFAprescription (66.7%).

ConclusionandRelevance MostofthePIswereabouterrors inprescribingtheMTXadministrationfrequency,dailyinstead ofweekly,implyingahighriskofintoxication.TheacceptancedegreeofthePIswasveryhigh,reinforcingtheroleof thepharmacist.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-018

ANALYSISOFERRORSINTHEMANUALPREPARATION OFSTERILEDRUGSFROMSTOCK

NJiménezRivero,ASalamancaCasado*,BMonteroSalgado,AGómezSánchez, BTortajadaGoitia. CostadelSolUniversityHospital,Pharmacy,Marbella,Spain

10.1136/ejhpharm-2024-eahp.353

BackgroundandImportance Inrecentyears,pharmacyservices haveshiftedtowardscentralisedpreparationofsteriledrugsto ensurecompatibility,stability,andsterility.Qualitycontrols willidentifypreparationerrorspreventingthemfromreaching patients.

AimandObjectives Analyseerrorsdetectedinthemanual preparationofsteriledrugsfromstockduringJanuary2022 toApril2023.

MaterialandMethods Thepreparationofsteriledrugsrequires aseriesofquality/safetycontrolstodetecterrors,preventing themfromreachingpatients.Followingamanualworkmethodology,apharmacytechnicianselectsthemedicines/materials, generatesthelabelsandrecordsquantities,batchesandexpiry datesontheprocessingsheet.Anothertechnicianperformsa doublesafetycheck.Onceprepared,thepharmacistrecords theconformity,afterinspectingthepreparationsheettogether withoneofthepreparationsofeachbatch.

TheincidentsnotedintheelaborationsheetsfromJanuary 2022toApril2023werereviewed.Theerrorswererecorded inaMicrosoftExcelfile,beingclassifiedbasedonthetype andseverity,accordingtopharmacistcriteria:minor(errors onthepreparationsheet,labelsorbatches);andserious (errorsinexpirydateordoseonthelabel,wrongadministrationsystem;wrongdrug/serum,excess/defectdose,presenceof

particles/air,unfinishedpackaging,andunprotectionfrom light).

Results 88errorsweredetected,affecting4.4%ofthebatches produced.44.3%wereconsideredminorerrorsand55.7% wereconsideredserious.Themostfrequenterrorwasthe completionoftheprocessingsheets(26%).Regardinglabelling,themostdetectederrorswererelatedtoexpirydate (15.9%),batch(11.36%),dose/name/colour(2.3%each)and labelhidingthegraduationofthesyringe(1.13%).Other errors:9.1%ofnon-completefinalpackaging;5.68%excess doses,6.81%defectdoses;incorrectserumandinfusionsystems(3.4%each);unprotectedfromlight(3.4%);presenceof particles/air(2.3%)andduplicatebatches(1.13%).

ConclusionandRelevance Theerrorratedetectedislower thanthatreportedintheliterature.Morethanhalfofthem wereconsideredpotentiallyseriousiftheyhadreachedthe patient.

Accordingtoourresultsandtheliterature,thismethodologypresentsalowerrordetection,incorporatingnewtechnologies(comprehensivesoftware,barcodeverification,image capture,gravimetry)couldenhanceerrordetectionandreduce preparationerrors,ultimatelyleadingtoimprovedpatient safety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-019 VALIDATIONPRIORTOTHEDISPENSINGOF MEDICINESASATOOLTOIMPROVETHEQUALITYOF THEPRESCRIPTION

MDCordobaSotomayor,LGutierrezLucena,RContreras*. HospitalUniversitariodeJaen, Pharmacy,Jaen,Spain

10.1136/ejhpharm-2024-eahp.354

BackgroundandImportance Prescriptionvalidationisthediligence,manualorelectronic,bywhichitisauthorised,fora specificpatient,thatcertainmedicines,medicaldevices(PS), enteralnutrition(NE)anddietotherapeuticproducts(PD)can bedispensedfrompublicfunds.

AimandObjectives Theobjectiveofthestudyistoassessthe usefulnessofvalidationasacontroltoolintheprescription, throughtheanalysisoftheincidents/causesofdenialofthis validation,carriedoutbypharmacistsofthevalidationunit (UV)ofthepharmacyservice(SF)inatertiaryhospital MaterialandMethods Thepharmacistsreceiveddailybytelematicmeansintheelectronicvalidationmodule,thevalidation reports(theprescriptiontogetherwiththeclinicalreport), completedbytheprescriber,whichincludethefollowingdata: administrationscheduleanddurationoftreatment,maindiagnosisandindication.Bymeansofvalidation,theconformity oftheprescribedtreatmentisverified,withtheindications authorisedinthetechnicalsheetandthefinancingconditions. Asasupporttool,thelistsofdrugssubmittedtovalidation andtheavailableprotocolswereused.Denialwasmadeif incidentsweredetected

Toclassifythedetectedincidents,thefollowingvariables wererecorded:medication,PS,NEandPD,medicalspecialty oftheprescriber,dateofthereportandreasonforpending data.Accordingtothetypeofincidentdetected,theywere classifiedinto(1)unfundedindication;(2)completionerrors; (3)absenceofcomputerisedvalidationreport;(4)absenceof clinicalreport;and(5)othercauses.

Results Atotalof16,039reportswereanalysedforvalidation, betweenMarchandDecember2022.Thereportsthatregisteredsomeincidencewere1930(12%),remainingpending observationsandnotvalidated.Thereasonsforrefusalwere thefollowing:unfundedindication(58.8%),completionerrors – insufficientorincorrectprescriptiondata – (23.6%),absence ofcomputerisedvalidationreport(13.5%),absenceofclinical report(2.9%)andothercauses-unauthorisedindicationinthe technicalsheet,hospitaldiagnosticmedicationwithoutaspecialistreportandshortages(1.2%).

ConclusionandRelevance Validationispositionedasauseful toolfortheproperuseofmedicinessinceitguaranteesthat theyareusedaccordingtotheindicationsauthorisedinthe technicalsheet.Itrepresentsanimprovementinthequalityof theprescription,because,althoughmostprescriptionsconform totheirfinancedindication,someincidentshavebeendetected thatwereresolvedbypharmacists,thusavoidingerrorsthat affectpatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-020 EVALUATIONOFTHEEFFICACYANDSAFETYOF EPCORITAMAB-BYSPINPATIENTSWITHFOLLICULAR BLYMPHOMA:ACASEREPORT

MMartinez*,PRodriguez,RMoron,JCabeza,GRodriguez. HospitalUniversitarioSan Cecilio,Pharmacy,Granada,Spain

10.1136/ejhpharm-2024-eahp.355

BackgroundandImportance FollicularB-lymphoma(FL)isan indolentlymphoidneoplasmderivedfromgerminalcentre mutatedB-cellswithanodularorfollicularhistologicalpattern.Approximately2–3%ofpatientswilltransformtheir neoplasmtodiffuselargeB-celllymphoma(DLBCL).Epcoritamab-bysp(EPKINLY®)isabispecificIgG1antibodydesigned tosimultaneouslybindtoCD3onT-cellsandCD20onBcells,andinducesT-cell-mediatedkillingofCD20+cells.

AimandObjectives Theaimofthisstudyistoevaluatethe efficacyandsafetyofepcoritamab-byspinapatientwithLF refractorytopreviouslines.

MaterialandMethods Retrospectivestudyofaclinicalcasein whichwefollow-upapatientwithRelapse/RefractoryFL undertreatmentwithepcoritamab-bysp.Administrationwas doneinthelowerabdomenorthighandatadifferentsite eachtimeitwasadministered.Datawereobtainedusingthe digitisedclinicalhistory(Diraya)andtheelectronicchemotherapyorimmunotherapyprescriptionprogramme(Oncofarm).

Results Wepresentthecaseofa57-year-oldwoman,48.8kg and153cm.DiagnosedinAugust2020withstageIVFL withoutBsymptoms.FLwasrefractorytothefirsttwolines oftreatment(1L:R-CHOP,2L:R-ESHAP),aswellastoaclinicaltrialbasedonCAR-Ttherapy.InMay2023,expandeduse ofepcoritamab-byspinmonotherapywithweeklysubcutaneousadministrationinC1withdosestep-up(0.16,0.8,48 mg);every2weeksC4–9(48mg),every4weeksfromC10 toprogression(48mg)wasdecided.Inallimmunotherapy sessionsthepatientwasadmittedfor24hduetoriskof severeadversereactions(CRSorICANS).Inthesecond administration(0.8mg)ofepcoritamab-byspthepatienthada CRS:G1,sointheadministrationofthefirsttargetdose(48 mg)3ªweekofC1,thedosewasreducedto50%(24mg). Evenso,thepatienthadtobetreatedwithIVtocilizumab

(8mg/kg)byCRS:G2andwasadmittedforobservationfor 48h.FromC2onwards,therewerenofurtherincidents. RegardingtheclinicalevolutionoftheLFPET-CTscan,apartialmetabolicresponse(Deauville:4)wasobservedwithrespect tothepreviousstudy.

ConclusionandRelevance Despitetheneedforextendedstudy timetoevaluatetheclinicalbenefitandsafetyinrealclinical practiceofepcoritamab-byspinpatientswithFLorDLBCL, thisimmunotherapyoffersaninnovativemechanismofaction andaninterestingalternativeforpatientswithnon-Hodgkin’ s lymphomarefractorytoconventionaltherapies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-021 EVALUATIONOFTHEPREVALENCEOFMULTIRESISTANTBACTERIAINTHEINTENSIVECAREUNIT AFTERSELECTIVEDECONTAMINATIONOFTHE GASTROINTESTINALTRACT

1MMartinez*, 2AAlberola, 1RMoron, 2AVazquez, 2NChueca, 3EYuste, 1JCabeza, 1MTNieto, 1XDíaz. 1HospitalUniversitarioSanCecilio,Pharmacy,Granada,Spain; 2HospitalUniversitarioSanCecilio,Microbiology,Granada,Spain; 3HospitalUniversitario SanCecilio,Intensivist,Granada,Spain

10.1136/ejhpharm-2024-eahp.356

BackgroundandImportance Oneofthemeasurestoreduce therateofinfectionsbymultidrug-resistantbacteriainIntensiveCareUnit(ICU)servicespromotedinthePneumonia Zero(NZ)programmeisoropharyngealdecontamination (DOF)and/orselectivedigestivedecontamination(SDD).Of thedifferentexistingprotocols,weimplementedtheadministrationofnon-absorbabletopicalantimicrobials(colistin,gentamicinandnystatin)intheoropharynx(paste)and gastrointestinaltract(solution).Bothweredevelopedasmagistralformulas.IntheeventofMRSAisolationoranincrease intheMRSArateinourhospital,vancomycinwouldbe added.

AimandObjectives Theaimwastoassesstheeffectofsucha measureonstudiesoftheprevalenceofmultidrug-resistant bacteriaincriticallyillpatients,andtoseeifthereisselection forresistancemechanisms.

MaterialandMethods AmbispectivestudycomprisingthepreDDS(01/01/2022–30/04/2022)andDDS(01/01/2023–30/04/ 2023)periodsconductedinthe22-bedICU.

FromJuly2022,ICUpatientswithisolationofmultidrugresistantbacteriainbothclinicalorsurveillancesamples,as wellaspatientswithestimatedintubation>72hornon-intubatedpatientswithriskfactorsfordevelopingpneumoniaare administeredDDS/DOF.Inaddition,nasal,pharyngo-tonsillar andperianalexudatesamplesarecollectedformicrobiological surveillanceculturesonadmissionandeveryTuesdaythereafter.Incubateat37°Cfor48h.

Results Inthepre-DDSperiodintheICU,626samplesare receivedforcolonisationstudiesfrom132patients.Excluding repeatisolatesineachpatient,23multidrug-resistantbacteria weredetected.IntheDDSperiod,537samplesarereceived from124patients,detectingninemulti-resistantbacteria. Thereisasignificantdifference(p=0.0138)betweentheproportionofmulti-drugresistantbacteriadetectedinthesurveillancestudiesafterapplyingICUdecontaminationmeasures.

Inthefirstperiod,thefollowingbacteriaweredetected: oneMRSA,oneAcinetobacterbaumannii,eightextended-

spectrumbeta-lactamase(ESBL)-producingenterobacteriaand 13carbapenemase-producinggram-negativebacilli.

Pathogensisolatedinthepost-decontaminationperiodwere: oneMRSA,oneA.baumanniiand8BLEE-producingenterobacteria.Noneoftheisolatesarecarbapenemase-producing.

ConclusionandRelevance TheDDS/DOFprotocolsappliedin theICUofourhospitalhaveshownasignificantdecreasein colonisationbymultidrug-resistantbacteriaincriticallyill patients.AsforMRSA,nodifferencescouldbeseeninthis period,soitwouldbeadvisabletoextendthestudyperiod. However,theroleofthismeasureinthedisappearanceof carbapenemase-producingbacteriashouldbehighlighted.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-022 DRUG-INDUCEDAPLASTICANAEMIA:ANANALYSIS OFTHEFDAADVERSEEVENTREPORTINGSYSTEM (FAERS)

1FPappalardo*, 1MAD’agata, 2MAKhaleel, 2AHayatKhan, 2SMSheikhGhadzi. 1Catania LocalHealthAuthority,DepartmentofPharmacy,Catania,Italy; 2UniversitiSainsMalaysia, DisciplineofClinicalPharmacy-SchoolofPharmaceuticalSciences,PulauPinang,Malaysia 10.1136/ejhpharm-2024-eahp.357

BackgroundandImportance Aplasticanaemia(AA)isarare conditionresultingfromadeficitinhematopoieticstemand progenitorcells,characterisedbyahugesocialandeconomic burden.AAisincludedintheDesignatedMedicalEvent (DME)listdevelopedbytheEuropeanMedicinesAgency (EMA),whichcontainsmedicalconditionsthatareinherently seriousandoftenmedicine-related.

AimandObjectives Inthisanalysis,weaimedtoshedlighton themostfrequentaplasticanaemiaassociateddrugsinreal-life byminingtheFDAAdverseEventReportingSystem(FAERS).

FAERSisoneofthelargestspontaneousreportingdatabases intheworld,usedtoperformsignaldetectionin pharmacovigilance.

MaterialandMethods Adisproportionalityanalysisofthe FAERSwasconductedbyanalysingtheIndividualCaseSafety Reports(ICSRs)fromthefirstquarterof2004(2004Q1)to thethirdquarterof2021(2021Q3).Thereportingodds ratio(ROR)witharelevant95%confidenceinterval(95% CI)asadisproportionalmeasurewascalculated.TheROR wasconsideredstatisticallysignificantwhenthelowerlimitof the95%CIoftheRORexceeded1,withatleastthreecases reported(N 3).

Results Overall,duringtheexaminedperiod(2004Q1–2021 Q3),onatotalofN=11.631.635reports,N=3.413ICSRs containingthepreferredterm ‘aplasticanaemia’ were retrieved.AAaffectedpeoplewithamedianageof49.62 (±25.08)years,mostlyfemale(N=1.645,54.9%).According totheRORvalue,ferrousphosphate594.82(95%CI 184.68–1.915,80),sucrose98.86(95%CI36.89–264.90), aminopyrine82.04(95%CI26.32–255.76),levosimendan 81.41(95%CI54.90–120.73)andmethenolone81.41(95% CI54.90–120.73)wereassociatedwithdisproportionate reporting,resultinginapotentialsignal.RegardingthenumberofICSRs,themostfrequentAA-associateddrugson FAERSwereeculizumabN=431,lymphocyteimmuneglobulin,anti-thymocyteglobulinN=228,eltrombopagN=204, pentamidineN=77andethosuximideN=28.

ConclusionandRelevance Knowingthedrugsassociatedwith aplasticanaemiaisessentialforpromotingappropriateuseof themandimprovingpatientsafetyduringtherapy.Furthermore,healthcareprofessionalsshouldbeawareofthenecessityofstrictlymonitoringpatientstreatedwiththesedrugs andpromptlyrecognisingsignsandsymptomsofdrug-associatedAA.Furtherinvestigationsarerequiredtoconfirmif thesedrugsplayaroleinthedevelopmentofAA.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-023 SAFETYANDTOLERABILITYOFVORICONAZOLE TREATMENT:ARETROSPECTIVEOBSERVATIONAL STUDY

MFalcónCubillo,ALópezGómez,ABGuisadoGil,MMejíasTrueba,MVGilNavarro, PSuárezCasillas,PBarrigaRodríguez,JPQuinteroGarcía,EHeviaÁlvarez,SLora*. HospitalVirgendelRocío,PharmacyDepartment,Seville,Spain

10.1136/ejhpharm-2024-eahp.358

BackgroundandImportance Voriconazoleisanantifungal agentwithconcentration-dependentactivityandhighindividualvariability.Itisgenerallywelltolerated.However,adverse effects(AEs)mayoccur,requiringdosereduction(DR)ordiscontinuationoftreatment.

AimandObjectives Todescribethesafetyandtolerabilityof voriconazoletreatmentinacohortofpatientsadmittedtoa tertiaryhospital.

MaterialandMethods Retrospectiveobservationalcohortstudy thatincludedpatientstreatedwithvoriconazoleduring2022. Variablescollectedwere age,sex,diagnosis,routeofadministration,treatmentstartdate,dateandtypeofAEs,post-AE measures,andtherapeuticdrugmonitoring(TDM).

VoriconazoleAEswereclassifiedasconcentration-dependent ornon-concentration-dependent.

Results Atotalof135patientsweretreatedwithvoriconazole. Themedianagewas64years(4–91).Menrepresented61%. Mostpatientswereimmunocompromised(42%).

Treatmentwasempiricin21%,prophylaxisin10%and targetedtherapyin69%.ThemaindiagnosiswasAspergillus (81%),11%Candidaand8%otherinfections.Itwasadministeredintravenouslyin45%,orallyin30%,and25%were switchedfromintravenoustooral.Themediandurationof treatmentwasninedays.

Voriconazole-relatedAEsoccurredin38patients(28%). ThemediantimetoAEonsetwasfivedays.

Concentration-relatedAEswere hepatotoxicityinsevenpatients (18%),visualdisturbancesin11patients(29%),psychiatric disordersin12patients(31%)suchashallucinations(10)or confusionalsyndrome(2)andneurologicdisturbancesin12 patients(31%)whoexperiencedsomnolence(4),vividdreams (4),tremor(3)ordisorientation(3).Fourpatientsrequired DRand10discontinuedtreatment.

Non-concentration-relatedAEswere dermatologicreactionsin eightpatients(21%),includingphotosensitivity(3),alopecia (2),erythema(4),orwarmsensation(4),anddigestivedisorders(diarrhoea)inonepatient.Twopatientsdiscontinued treatment.

Of38patientswithAEs,22(58%)hadvoriconazole TDM:17hadtherapeuticconcentrations,twoinfratherapeutic andthreesupratherapeutic,ofwhomtwotoleratedtreatment withDRandonediscontinuedvoriconazoleforotherreasons.

ConclusionandRelevance Approximately1in3patientsexperiencedAEs.ThemostcommonAEswerevisualdisturbances andhallucinations.WecannotconfirmthattheseAEswere duetosupratherapeuticconcentrationsas45%hadconcentrationsinthetherapeuticrangebutTDMmaybeaninteresting strategytoimprovetolerabilitytovoriconazole.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-024 ENHANCINGSAFETYANDEFFICIENCYIN CHEMOTHERAPYPREPARATIONAND ADMINISTRATIONINASMALLONCOLOGYHOSPITAL

1,2BDudik*, 1,2EBabiak, 1KKimlikova. 1StElisabethCancerInstitute,PharmacyofSt Elisabeth,Bratislava,Slovakia; 2FacultyofPharmacy-ComeniusUniversityBratislava, DepartmentofPharmacologyandToxicology,Bratislava,Slovakia

10.1136/ejhpharm-2024-eahp.359

BackgroundandImportance Optimisingandstandardisingthe preparationandadministrationofparenteraldrugsinhealthcarefacilitiesmayminimisemedicationerrors,ultimatelyleadingtosafer,moreefficient,andpotentiallycost-effective therapy.

AimandObjectives Ourobjectivewastocreateaninformative manualcontainingdataonthereconstitutionandadministrationofallcytostaticdrugspreparedinourhospitalpharmacy. Thismanualwasdesignedtosurpasstraditionalchemotherapy ordersforpreparationandadministration,aserrorsor unnecessaryorderswereoftencaughtandcorrectedbypharmacists.Ourstudyaimedtoquantifytheimpactofthismanualonpreventingmedicationerrors,costsavings,reductionin nursingtime,andthemitigationofplasticwaste.

MaterialandMethods Weperformedaretrospectiveanalysis ofallchemotherapyordersfromMarchtoAugust2023, focusingonerrorsinpreparationandadministration orders.Ouranalysisincludedcalculationsofthecostsavingsfromavoidingunnecessary infusionbottlesandclosed systemdevices,aswellasreductionsinplasticwasteby weight.Additionally,wecalcu latedthesavednursinghours duringchemotherapyadminist ration,convertingthissaved timeintotheaveragehourlycostofnurses ’ workinour county.

Results Overasix-monthperiod,weprepared6,163doses ofchemotherapy.Ouranalysisrevealedprescriptionerrors in17.86%ofcases,primarilyrelatedtoexcessivedrugdilution,potentiallycompromisingdrugstability,safety,and efficacy.In6.25%ofcases,drugswereneedlesslyordered tobedilutedinmultiplebottles.Theseerrorsresultedin costsavingsofC ¼ 2,712.27andpreventedthegenerationof 34,824.5gramsofplasticwaste.Furthermore,in7.56%of cases,drugswereorderedtobeadministeredoverlonger durationsthannecessary,leadingtothepreventionof445.5 unnecessarynursinghours.Whenrecalculatedtotheaveragehourlycostofnurses ’ work,thisequatedtoC ¼ 10585,08 insavings.

ConclusionandRelevance Ourstudyunderscoresthecritical roleofstandardisingthepreparationandadministrationof parenteraldrugsinhealthcareestablishments,notonlyenhancingsafetyandefficacybutalsoreducingtheoverallcostof treatment,minimisingnursingtime,andmitigatingplastic waste.Thisinvestigationadditionallyhighlightsthe

indispensablecontributionofpharmacistsasintegralmembers oftheoncologyteam.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-025 AUDITONTHECORRECTUSEOFMEDICALDEVICES FORURINARYCATHETERISATION

1CMalat, 1EDollois, 2AFillatre*, 1MLongueville, 1MLefebvre, 2YMahboub. 1SaintQuentinHospital,MedicalDevice,Saint-Quentin,France; 2Saint-QuentinHospital, Pharmacy,Saint-Quentin,France

10.1136/ejhpharm-2024-eahp.360

BackgroundandImportance Urinarycatheterisationisacommonpractice,butcomplexbecauseofalargenumberofmedicaldevices,eachwithitsownparticularities(materials, insertiontime,indications).

AimandObjectives Theaimoftheauditwastoassess nurses ’stheoreticalknowledgeofourhospitalaboutthisprocedureandmedicaldevicesreferenced.Dependingonthe results,assistanceandinformationtoolsonthecorrectuse willbeproposed.

MaterialandMethods Anauditwascarriedoutamongnurses betweenJuneandJuly2023.Theauditincluded15questionsconcerninggeneralitems ofurinarycatheterisation, suchastraceabilityandlegislation.Aspectsrelatingtourinary catheter ’schoiceandinstallationm ethods(closedsystemfitting’ scriteria,hourlydiuresissystem’ scriteriacatheter ’ s materialaccordingtotheinstallationduration)werealso discussed.

Results Theauditincluded81nursesfrom19differentunits.

Obligatorytrackabilityinformationinthepatient’sfilewas knownby35%ofnursesquestioned.

Catheterinsertiontimesdependingonthematerial(PVC, latex,silicone)wereunknownbynurses.

Forclosedsystems(withlatexhydrogel),8%ofnurses gavetherightindicationforthesesystemsand16%thecorrectuseduration.

ForclosedFoleycatheterswithhourlydiuresis,themajority (65%)ofnursesknewtheuseindicationbutnottheduration ofinstallation.

Inaccidentaldisconnectionofaclosedsystembag,49% putanewcollectionbagonthecatheteralreadyinplace ratherthanchangingtheentiresystem.Finally,52%ofnurses thoughttheywerenotsufficientlyinformedabouturinary catheterisationdevices.

ConclusionandRelevance Thisaudithighlightsagoodlevel onurinarycatheterisationgeneralities.However,theuseof closedsystemsandthecorrelationbetweencathetermaterial andinsertiontimeareoftenunknown.

Nurses’sknowledgeofourhospitalpoliciesisthereforeheterogeneous,asnotedinliterature.(1)

Actiontoraiseawarenessofthecorrectuseofurinary deviceshavebeenproposedandareviewofavailablemedical deviceswascarriedout.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.LuyckxF,ValléeMaxime.Sondagesurlessondages:usetcoutumesdesinfirmiers enFrance. ProgrèsenUrologie. 2016;26:739–740.10.1016/j.purol.2016.07.148

ConflictofInterest

THEPOTENTIALOFPHARMACOVIGILANCE DATABASESTOASSESSTOXICOLOGICALRISKOF DIETARYSUPPLEMENTSANDOTHERUNSUPERVISED HEALTHPRODUCTSUSEDBYPATIENTS

BOrsolya*,BMDomián,ARAshraf,ATFittler,RGVida. UniversityofPécsFacultyof Pharmacy,DepartmentofPharmaceuticsandCentralClinicalPharmacy,Pécs,Hungary

10.1136/ejhpharm-2024-eahp.361

BackgroundandImportance Whenexecutingthemedication usereviewormedicationreconciliation,andifthereisasuddennewsymptomorsignoftoxicity,thepotentialroleof healthproductstakenbypatientswithoutthesupervisionof thehealthcareprofessionalsshouldnotbeforgotten.However,thereisnostandardisedapproachtoassesstoxicityof theseproductsineverydaypractice.

AimandObjectives Ouraimwastosearchforandevaluate methodsthatcanbeaddedorstandardisedtoassessillegalor unsupervisedhealthproductsfromtoxicologicalperspective. Wewantedtoknowwhetherthereanydatabasesthatcanbe usedandiftheyareeligibleforthisrolebasedoninformationcontentorapplicability.

MaterialandMethods Inadditiontotheliteraturesearch,we identifiedandreviewedfourOpenAccessdatabases:EudraVigilance;USFDAAdverseEventsReportingSystem(FAERS); USFDACFSANAdverseEventReportingSystem(CAERS); HealthFraudProductDatabase.Fortheinitialscreeningwe choseasamodelsubstancecannabidiol(CBD)(excluding authorisedmedicines)duetoitspopularityandpotential adverseeffects.

Results Weidentified371casesintheEudraVigilancedatabase from2021to2023(2021:126,2022:196,2023:49).Fatal caseswere7.55%ofallcases(n=28).Fromtheconcomitant medicationsusedwithCBD,clobazamwasthemostfrequent (n=16).IntheFAERSdatabasethere276caseswereregisteredfrom2015to2023,with67.4%(n=186)beingsevere and2.5%(n=7)fatal.Thethreemostcommonreactions identifiedwere:Generaldisordersandadministrationsiteconditions(n=117),Nervoussystemdisorders(n=103)andPsychiatricdisorders(n=85).IntheCAERSdatabase163cases werefound(2016–2023)withonefatal.Themostcommon reactionswithMedDRApreferredtermswererelatedtogastrointestinaldisorders(e.g.:diarrhoea,vomiting,nausea).In theHealthFraudProductDatabaseCBDrelatedcaseswere 33intheperiodof2019–2021.

ConclusionandRelevance Theapplicationofopenaccessdatabasescontainingpharmacovigilanceandtoxicovigilancedata aresuitableforassessingthereal-worldtoxicityofdietarysupplementsandidentifyinghighriskproducts.Theincorporation ofourresultsintotheclinicalpracticecanbeacompetency ofaclinicalpharmacist.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-027 VARIABILITYINVANCOMYCINPLASMA CONCENTRATIONINNEUTROPENICPATIENTS

AGarcia*,MAToledoDavia,LTorralbaFernández,CJiménezMéndez,RPrietoGalindo, ADomínguezBarahona,EGómezFernández,PCrespo-Robledo,RLópezÁlvarez,PMoya Gómez. ToledoUniversityHospital,HospitalPharmacy,Toledo,Spain

10.1136/ejhpharm-2024-eahp.362

BackgroundandImportance Therearecurrentlyconflicting resultsinnumerousstudiesontheeffectofneutropeniaon vancomycinplasmaconcentrations.

AimandObjectives Toevaluatetheeffectofneutropeniaon pharmacokineticparametersinpatientstreatedwith vancomycin.

MaterialandMethods Observationalandretrospectivestudyin patientstreatedwithvancomycininatertiarylevelhospital, betweenJulyandJune2023.Theclinicalhistorywasconsultedandthefollowingvariableswerecollected:sex,age, creatinine,neutrophilcountandvancomycintroughlevelsin blood.Neutropenicpatientswereconsiderediftheirlevels werelessthan1.5x10^9neutrophils/Landvancomycinclearance(CLv)wascalculatedbytheMatzkeandMoellering methods.ThedatawereprocessedintheSPSSv.25statistical program:theShapiroWilkstestwasperformedasanormality testandastatisticaltestwascarriedoutaccordingtothe results(Student’st-testorMann-WhitneyU-test).

Results Weanalysed68samplesin37patients;ofwhich17 weremaleandamedianageof65[18–90]years.Patients wereclassifiedintotwogroupsaccordingtothenumberof neutrophils,eight(11%)neutropenicpatientsandthe60 (89%)non-neutropenic.TheShapiroWilksnormalitytest showednormalityinallvariables,howeverthesamplesizeof onegroupmadeitnecessarytouseanon-parametrictest (Mann-WhitneyUtest).Meantroughlevelsinneutropenic patientswere9.6(SD2.96)vs.11(SD7.04)innon-neutropenicpatients(p=0.991).ThemeanCLvbyMatzkeand Moelleringmethodswas107,83(SD39)and88(SD2.34) respectivelyinthegroupofneutropenicpatientsandinnonneutropenicpatientsitwas105.13(SD39.3)and85(SD2.21); p=0.228inbothgroups.

ConclusionandRelevance Althoughnostatisticallysignificant differenceswerefound,probablyduetothesamplesize,it canbeobservedthatthegroupofneutropenicpatientshad lowervancomycintroughlevelsandahigherclearancethan thenon-neutropenicgroup.Furthermore,wecanconclude thatbothmethodsofcalculatingClvaresimilarinboth groupsofpatients.Furtherstudiesareneededtodemonstrate theeffectofneutropeniaonvancomycinlevelsanditsconsequencesontreatmentefficacy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-028 CASEREPORT:ANTITUMORACTIVITYANDTOXICITIES OFENTRECTINIBINAPATIENTWITHAPRIMARY CENTRALNEUROCYTOMA

1MGiraldez, 1LValdeolmillos*, 1EMateo, 1CGarciaPastor, 2MERodriguez-Ruiz. 1Clinica UniversidaddeNavarra,Pharmacy,Pamplona,Spain; 2ClinicaUniversidaddeNavarra, Oncology,Pamplona,Spain

10.1136/ejhpharm-2024-eahp.363

BackgroundandImportance Entrectinibisanoral,CNSactive, potentinhibitoroftyrosineapprovedforuseinpatientswith NTRKgenefusion-positivesolidtumours.Here,wereport theantitumouractivityandsafetyofentrectinibinapatient withcentralneurocytoma,anuncommonneoplasmwithfew drugtreatmentalternatives.

AimandObjectives Tosummarisetheoverallsafetyandreport theantitumouractivityofentrectinibina50year-oldfemale withaprimarycentralneurocytomainitiallytreatedwith

surgeryandradiotherapy.Thepatientbeganentrectinibafter tumourNTRKfusiontestedpositive.

MaterialandMethods Diagnosticandfollow-uptestsandtherapywereobtainedbythereviewofmedicalrecords.

FoundationOne NTRKfusion-positivetumour

Cardiacstressmagneticresonanceimaging(MRI)with adenosine:Subclinicalcardiotoxicity.

Results A50year-oldfemalepatientwithaprimarycentral neurocytoma.Shereceivedsurgeryasprimarytreatmentin July2020.Afterradiographicresponseandprogression shortly,shewastreatedwithadjuvantradiotherapy.

Thetumourwastestedforgeneticmutationsestablishinga NTRKfusion-positive.Entrectinibtreatmentwasauthorised undercompassionateuse.Thepatientstartedtreatment-in March2021atthefull600mgdailydose.

After1monthoftreatment,thepatientdevelopedelectrocardiogramandcardiacMRIalterations.Shewasdiagnosedof subclinicalcardiotoxicitygrade2associatedwithentrectinib, giventhetemporalmatch.Dosewasreducedto400mgdaily andthepatientwasstartedonbisoprolol.InJanuary2022, MRIconfirmedcompleteresponse.However,thepatientwas assessedbytheneurologistandpsychiatristduetogreatercognitiveimpairmentanddelusions.Duloxetinewasstarted.In addition,entrectinibdosewasreducedto200mgdaily.In July2022,entrectinibtreatmentwasstoppedandclosefollow-upwasstarted.Sheexperiencedprogressiveneurologic improvementandlessanxietyanddepressivesymptoms.In September2022,MRIshowedstablediseaseandaftercardiologistandpsychiatricevaluation,duloxetineandbisoprolol wherewithdrawnfromtreatment.InDecember2022,clinical andradiologicstabilitywereobserved.Therefore,entrectinib wasrestartedat200mgdailywithgoodtoleranceuntilat least,today(October2023).

ConclusionandRelevance Entrectinibhasbeenshowntobe activeagainstthosegenefusionsinaprimaryCNSdisease. However,itisstillassociatedwithmoderateadverseevents thatrequiremandatorypharmacovigilanceinourpharmacist dailypractice.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-029 THEOVERRIDINGOFDRUGSAFETYALERTSFIREDBY THECLINICALDECISIONSUPPORTTOOL:EVALUATION OFAPPROPRIATERESPONSESANDALERTFATIGUE SOLUTIONS

AAnsari*,KAlbogami,AFAlwadie,AMAlzahrani,AAlshomrani,AMAlshehri,KAl-Harbi, DAsraf. MinistryofNationalGuard,PharmaceuticalCareServices,Jeddah,SaudiArabia 10.1136/ejhpharm-2024-eahp.364

BackgroundandImportance MostCPOEsoftwarecomewith clinicaldecisionsupport(CDS)thatassistprescribersand notifythemaboutadversedrugreactionsthatplayanimportantroleinreducingmedicationerrorsandenhancingpatient safety.Anexcessivenumberofalertsinarepeatedandnonrelevantmannerleadstoalertfatigueandenforcesphysicians andpharmaciststoalertoverrides.

AimandObjectives Ourprimaryobjectivewastodetermine whichalertsareoverriddenandtheirassociationwithan appropriateaction.Toassesstheappropriateresponsesforred alerts(pDDI,overdose,andallergy).Oursecondobjectivewas todecreasethenumberofunnecessaryredalerts.

MaterialandMethods Thestudywasaretrospectivechart reviewcarriedoutintheinpatientsettingthatincludedall redalertsthatrequiredcommentsandwereoverriddenbya physicianandpharmacist.

Results Inthisretrospectivestudy,wedeterminedwhichalerts areclinicallyirrelevantandneedmodifications.Wefoundthat morethanhalfofthealertswerepDDI,andthedrugallergy alertshadthemostappropriateresponsesbybothprescribers andpharmacistswhencomparedtootheralertclasses(OR= 1.65,OR=1.54,respectively;p<0.05).Fordiminishing theunnecessaryalerts,weprovided14alertrefinementstrategiesandadvisedturningofffouralerts.Applyingthiswill terminate32%ofirrelevantalerts.

ConclusionandRelevance Inthisretrospectivestudy,we describedwhichalertsareclinicallyirrelevantandneedmodifications.Wefoundthatmorethanhalfofthealertswere pDDI,andthedrugallergyalertshadthemostappropriate responsesbybothprescribersandpharmacistswhencompared tootheralertclasses(OR=1.65,OR=1.54,respectively;p <0.05).Weanticipatethatourrecommendationscanleadto consistentandclinicallyrelevantcontentforinterruptive DDIs,andthusdeclinealertfatigueandenhancepatient safety.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SuttonRT,PincockD,BaumgartDC,SadowskiDC,FedorakRN,KroekerKI. NPJ DigitMed. 2020;3:17.10.1038/s41746–020-0221-y

2.HelmonsPJ,SuijkerbuijkBO,NannanPandayPV,KosterinkJG. JAmMedInform Assoc. 2015;22:764–72.10.1093/jamia/ocu010

3.KhreisNA,LauASM,Al-JedaiA,Al-KhaniS,AlruwailiEH. IntJComputCommun Eng. 2019;8:32–9.

4.SimpaoAF,AhumadaLM,DesaiBR, etal.JAmMedInformAssoc. 2015;22:361–9.10.1136/amiajnl-2013–002538

ConflictofInterest Noconflictofinterest.

5PSQ-030 CONCORDANCEOFMEDICATIONPRESCRIPTION RECORDSINTHEHOSPITALISEDSURGICALPATIENT OGuillenMartinez,MRodriguezMorote,MJLucasMayol,CMatosesChirivella,SGutierrez Palomo,ANavarroRuiz*. HospitalGeneralUniversitariodeElche,ServiciodeFarmacia, Elche,Spain

10.1136/ejhpharm-2024-eahp.365

BackgroundandImportance Electronicprescriptionsallow pharmaciststocommunicatewiththerestofthemultidisciplinaryteam,facilitatepharmacotherapeuticmonitoring.

AimandObjectives Assessthereliabilityofelectronicprescriptionbyanalysingconcordance,thepresenceorabsenceofdiscrepancy,bystudyingtheactivemedicationinthese prescriptionsandthepharmacist’sinterviewwiththepatient and/orcaregiver.

MaterialandMethods Retrospectiveobservationalstudycarried outinathird-levelgeneralhospital.Duringaperiodof12 months,allpatientsbelongingtotheTraumatology,Urology andNeurosurgeryServiceinwhomtheresponsiblephysician indicatedmedicationreconciliationbythePharmacyService wereincluded.Demographicvariables(sex,age),pharmacotherapeuticvariables(treatmentlinesreviewed,totalnumber ofdrugs(F)prescribedandnotprescribed,causeofdiscordance(Fprescribedbutthepatientisnotoncurrenttreatment, changesindosage),occasionalconsumption,Fnotprescribed), presenceornotofpolypharmacy(5or>medications),majorityATCclassificationofdiscordantdrugs).

Results 378patientswereanalysed,169men(44.7%)and209 women(55.3%),withameanageof69years[11.8]and71 years[11.6],respectively.Itwasobservedthat60.6%of patientspresentedatleastonediscrepancyinthetreatment reflectedintheelectronicprescription.Thepharmacist reviewed2426prescribedlinesoftreatmentand401discordantdrugsweredetected:98(24.5%)drugsnotprescribed, 187(47%)drugsprescribedbutthatthepatientdoesnot take,75(18.5%)drugswithchangesinthedosageregimen notreflectedintheprescription,41(10%)drugswithoccasionalconsumption.Thepresenceorabsenceofpolypharmacy wasevaluatedstratifiedbysex:110men(65%)and130 women(62%).Inturn,agerangeswereestablished,observing thepresenceofpolypharmacyinthepopulationof61–80 yearswithanaverageofsixdrugsand81–100yearswithan averageofeightdrugs.Finally,itwasstudiedthatthemajority ATCgroupofdrugsthatthepatientdidnottakedespite beingprescribed,wasgroupN,highlightingbenzodiazepines, antidepressantsandantiepileptics.ThemajorityofATCgroup ofdrugsnotprescribedbutthatthepatientdidtakewere groupA,highlightingprotonpumpinhibitors,vitaminD,calciumandmagnesium;andgroupC,mostlystatins,angiotensin IIreceptorantagonists,ACEinhibitorsandbetablockers.

ConclusionandRelevance Inviewoftheresultsobtainedand thehighpercentageofpatients(60.6%)inwhomadiscrepancyisfoundintheelectronicprescription,itwouldbeadvisabletoextrapolatethepharmaceuticalactioncarriedoutin theTraumatology,UrologyandNeurosurgeryservicestoall thehospital’sclinicalservicesinordertoavoidpossiblemedicationerrorsandadverseeffects.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-031 ASSESSINGHEALTHCAREPROFESSIONALS’ VIEWSON DEPRESCRIPTION

1GRomeroCandel*, 1PMMaria, 2GDMercedes, 2CSJuanManuel. 1HospitalHellin, Farmacia,Albacete,Spain; 2HospitaldeHellin,Albacete,Albacete,Spain

10.1136/ejhpharm-2024-eahp.366

BackgroundandImportance Giventhehighprevalenceof potentiallyinappropriatemedication,deprescribingemergesas asafeandstructuredapproachtodrugwithdrawal.Ourgoal wastoassessknowledgeandperceptionregardingdeprescribing,recognisingitssignificanceinenhancingclinicalpractice.

AimandObjectives Themainobjectivewastoassesshealthcareprofessionals’ understandingandattitudestowardsdeprescribing,aimingtoreduceinappropriatemedicationuse. Specificobjectivesencompassevaluatingawarenesslevels,identifyingperceivedbenefits,andassessingfactorsinfluencing deprescribingpractices.

MaterialandMethods Anobservationalcross-sectionalstudy wasconductedusinganadaptedsurveybasedonthePACDP12tool,targetingmedicalandpharmaceuticalprofessionals withinaregionalhealthcarearea.Thesurveycomprised12 questionscategorisedintoattitudes,challenges,andfacilitators associatedwithdeprescribing.Amixedmethodologywasutilised,incorporatingmultiple-choiceandLikert-typequestions tocomprehensivelycaptureparticipants’ perspectives.

Results Thesearchresultspresentasurveyconductedamong 181healthcareprofessionals,primarilyphysicians,toinquire abouttheirknowledgeandopinionsregardingdeprescribing.

Themajorityofrespondents(86.7%)werephysicians,anda majorityworkedinanurbansetting(81%).79%ofrespondentsstatedfamiliaritywiththeterm ‘deprescribing, ’ and 68.5%stronglyagreedonitsbenefitsinthecurrentscenario. Keymotivationsfordeprescribingamedicationincludedmitigatingharmfromadverseeffects(79%)andreducingthe patient‘stherapeuticburden(60%).Asignificantportion (58%)concurredthatdeprescribingshouldbeapriorityin dailypractice.Commonbarrierstodeprescribingwerelimited timeforaddressingdeprescription(73.5%)andresistanceor reluctancefromthepatientortheirfamily(55%).Overall,the majorityofrespondentsagreedthatdeprescribingisbeneficial andshouldbeapriorityindailypractice.

ConclusionandRelevance Healthprofessionalsrecognisethe importanceofdeprescribingandacceptit,althoughtheyface practicalchallenges.Theneedforeducationalprogrammes andstrategiestoovercomebarriersandeffectivelypromote deprescriptionisemphasised.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.BhatDB,SaraswathyGR,SwetaK.DevelopmentandValidationofthePerceptions,Attitudes,andChallengesofPhysiciansTowardsDeprescribing(PACPD-12) Questionnaire. JAmMedDirAssoc.2018Dec;19(12):1135–1136.

ConflictofInterest Noconflictofinterest.

5PSQ-032 USEOFTHE ‘PRECAUTIONARYANNULMENTS’ TOOL BYAHOSPITALPHARMACYSERVICE

MRodriguezJorge,RSerranoGiménez,TBlancoEspeso,MFloridoFrancisco*. HOSPITAL JUANRAMÓNJIMÉNEZ,PHARMACYDEPARTMENT,HUELVA,SPAIN

10.1136/ejhpharm-2024-eahp.367

BackgroundandImportance Themainobjectiveofprecautionaryannulments(PA)istocontributetopatientsafety,preventingdispensingoferroneousmedicationsattheoutpatient pharmacylevel.Thisisanewtoolcarriedoutbybothhospitalandprimarycarepharmacists.

AimandObjectives ToanalysethedifferentPAconductedby hospitalpharmacists,andtoevaluatetheirdegreeofacceptancebydoctors.

MaterialandMethods Thisisaprospectivestudy,carriedout fromMaytoSeptember2023.AllpatientsinwhomaPAwas carriedout,eitherduringahospitaladmissionorbyproactivelyobtainingtheinformationthroughthe ‘Microstrategy ’ database,wereincluded.

Variablescollected age,sex,therapeuticgroupofthedrugand prescribingservice.

ThePAweredistinguishedaccordingtowhethertheywere therapeuticduplications,dosingerrors,orinappropriatemedicationprescription.Finally,thedegreeofacceptancebythe physicianswasmeasured.

Dataobtainedthroughthee-prescriptionmodule,digital medicalrecordandthroughthe ‘Microstrategy ’ database.

Results Atotalof38patientswereincluded(withonePA each).60.5%werewomen(n=23),withamedianageof56 years(IQR=69–41).

Intermsoftherapeuticgroup,thehighestpercentageofPA wasinthegroupofanti-rheumatics(28.9%),followedby anti-ulcers(18.5%),anti-osteoporosis(15.9%)andanti-diabetics(10.5%).Otherdrugscancelledwere:vitamins(5.3%), anti-anginaldrugs(5.3%),anti-anaemics(2.6%),anti-asthmatics (2.6%),antipsychotics(2.6%),antihypertensives(2.6%),

pancreaticdeficiencysubstitutes(2.6%),andmedicaldevices (2.6%).

Theprescriberswere primarycarephysicians(39.5%),rheumatologists(13.2%),gastroenterologists(10.5%),gynaecologists (10.5%),internists(8%),paediatricians(5.3%),rehabilitators (2.6%),cardiologists(2.6%),psychiatrists(2.6%),oncologists (2.6%)andvascularphysicians(2.6%).

Intheanti-rheumaticsgroup(n=11),thedrugdiscontinued inallofthemwasmethotrexate.OfallthePAinthisgroup, sixhadnotyetbeenrenewedbytheprescribingphysician,so thepatientiscurrentlyunabletotakethetreatment.

RegardingthetypeoferrorthatledtothePA,65.8% wereduetodosageerrors;26.3%totherapeuticduplications and7.9%toinappropriateprescribing.

OfallthePAmade,only39.5%wereacceptedbytheprescribingphysician;therestwerediscontinuedbecausethecancellationperiodhadexpiredwithoutresponse.

ConclusionandRelevance AlthoughPAareintendedto improvepatientsafety,itisimportantthattheyarewell reviewedandacceptedbytheprescribingphysician.

OfparticularnotearethePAcarriedoutformethotrexate, adrugconsideredhigh-riskaccordingtoISMP(Institutefor SafeMedicationPractices)Spain.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-033 TEMPORALTRENDSOFATYPICALDRUGACCESSAT ANACADEMICONCOLOGYUNIT:THEVERONA UNIVERSITYHOSPITALEXPERIENCE

FMAtsina*. AziendaOspedalieraUniversitariaVerona,Pharmacy,Verona,Italy

10.1136/ejhpharm-2024-eahp.368

BackgroundandImportance InItaly,patient(pt)accessto oncologicaldrugsisprovidedbytheNHS,followingauthorisationbytheEuropeanMedicinesAgency(EMA)andnegotiationwiththeItalianMedicinesAgency(AIFA)forspecific indications.Regulatorydelaysandtheneedforrapidaccessto innovativedrugs,havepromptedtheutilisationofatypical drugaccesspathways.Atypicaldrugaccesspathwaysare expectedtobeincreasinglyusedinthecontextofaPrecision Oncology.

AimandObjectives Theaimistoevaluatethedistributionof drugtypes.

MaterialandMethods Weexploredtrendsinatypicaldrug accessattheOncologySectionoftheVeronaUniversityand HospitalTrust,byexaminingOncologyandPharmacydatabasesandregionalregistriesofrarediseasesandreviewing AIFAregistryrecords.Dataonatypicaldrugaccesswerealso correlatedwiththeuseofNGS-basedmolecularprofiling.

Results BetweenJanuary2016andDecember2021,atotalof 355atypicaldrugaccessrequestsforthetreatmentofcancer ptswererecorded,withapeakin2017.Thetwomostcommonatypicalaccessschemeswerecompassionate(including namedpatientandearlyaccessprogrammes,61%)andofflabel(21%)use.Thelattersteadilyincreasedovertime(from 8%in2017to39%in2021).Overall,thetypeofdrugs requestedwerealmostequallydistributedbetweenclassical cytotoxicagents(CHT,36%),immuno-oncologydrugs(IO, 29%)andmolecularlytargetedagents(TT,35%).Temporal trendsintheusageofdifferentclassesofdrugsareshownin table1.

Interestingly,TTrequestsdecreasedbetween2016and 2018andstabilisedatapproximately50%oftotalrequests since2019.Among2019and2021,atypicaldrugaccess requeststriggeredbyNGS-basedextendedmolecularprofiling significantlyincreasedfrom2.8%to23.1%(p=0.0007).

Abstract5PSQ-033Table1

ConclusionandRelevance Atrendtowardsincreasedoff-label useofTTwasidentified,especiallyfrom2019.Since2019, NGS-informedrequestshavesignificantlyincreasedtoconstitutealmost1/4ofallatypicaldrugaccessrequests,clearly identifyingatrendtowardsimplementationofPrecision Oncologyinclinicalpractice.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-034 COMPARISONOFTOXICITYINCLINICALPRACTICEOF ANTI-PD-1/PD-L1ANTIBODIESINMONOTHERAPYIN NON-SMALL-CELLLUNGCANCER

1IPatier*, 2ACCercos-Lleti. 1HospitalUniversitariodeSanJorge,Pharmacy,Huesca,Spain; 2HospitalClínicoUniversitario,Pharmacy,Valencia,Spain

10.1136/ejhpharm-2024-eahp.369

BackgroundandImportance Theleadingcauseofcancerrelateddeathremainslungcancer.AntiPD-1/PD-L1antibodies exhibituniqueimmune-relatedadverseevents(IrAEs).The assessmentandcomparisonofdifferentsafetyprofilesinreal clinicalpracticeatourcentresarenecessary.

AimandObjectives Evaluationandcomparisonofthesafetyin routineclinicalpracticeofanti-PD-1/PD-L1monoclonalantibodies(nivolumab,pembrolizumabandatezolizumab)usedas monotherapyinthetreatmentofnon-smallcell-lungcancer (NSCLC).

MaterialandMethods Retrospectiveobservationalstudythat includedpatientswithNSCLCtreatedwithanti-PD-1/PD-L1 for7yearsinathird-levelhospital.Demographic,clinical, treatment,andsafetyvariableswerecollected.Datawere obtainedfromtheelectronicmedicalrecord.Adverseeffect (AE)incidenceswerecalculatedandcomparedbetween subgroups.

Results 44patientswereincluded,18withpembrolizumab,17 withatezolizumaband9withnivolumab.84.1%weremen withstageIVin88.6%ofthecases.70.5%hadanECOG Performancestatusbetween0–1.Allhadnegativemutations fortargetedtherapiesand75%hadrecordsofdetermination ofPD-L1expression,with61.9%beinghighexpressors ( 50%).Themediandurationoftreatmentwas108(49.5–223.7)days.Regardingthetoxicityanalysis,68.2%hada recordofsomeAE,70.7%grade1–2and38.6%immune related.Regardingthedifferentdrugs,pembrolizumab

presentedmorecasesofAEingeneralandahigherincidence ofIrAE(44.4%)comparedwithatezolizumab(29.4%).Dueto toxicity,theadministrationofimmunotherapywasdelayedin 46.6%ofthepatients,26.6%suspendedtreatment,and 16.7%requiredhospitaladmissiontomanagethetoxicity.No statisticallysignificantdifferenceswereobservedbetweenthe differentsubgroups.

ConclusionandRelevance TheincidenceofAEintreatment withanti-PD-1/PD-L1wassimilartothatavailableintheliterature(68.2%).Approximately30%weregrade3–4andwe observedafrequencyofpneumonitisgreaterthan15%.The differentantibodiespresentasimilarincidenceofAE,butatezolizumabseemstohavealessimmunerelatedsafetyprofile statisticallynon-significantthantheotheralternatives.Itis essentialtoincreasethesamplesizeandfollow-uptimeto confirmthesefindings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-035 SACITUZUMAB-GOVITECANINMETASTATICTRIPLENEGATIVEBREASTCANCER:AMULTICENTRE EFFECTIVENESSANDSAFETYSTUDY

1SLora*, 2IMCarrión-Madroñal, 3MENaranjo-Llamas, 3SArtacho-Criado, 1EPrado-Mel. 1HospitalUniversitarioVirgendelRocío,PharmacyDepartment,Seville,Spain; 2Hospital UniversitarioVirgenMacarena,PharmacyDepartment,Sevilla,Spain; 3HospitalUniversitario VirgendeValme,PharmacyDepartment,Sevilla,Spain

10.1136/ejhpharm-2024-eahp.370

BackgroundandImportance Sacituzumab-govitecan(SG)isa newantibody-drugconjugateapprovedforunresectable/metastatictriplenegativebreastcancer(TNBC),availablefromthe endof2022intheSpanishpublichealthsystem,sothereis stilllittlepublishedreal-lifedata.

AimandObjectives Toanalysetheeffectivenessandsafetyof SGinTNBCofpatientsfromthethreemainhospitalsofa city.

MaterialandMethods Retrospective,observational,andmulticentrestudywasconducted,includingallpatientstreatedwith SGuntilJuly2023.Datawereobtainedfromtheelectronic medicalrecordandprescriptionsoftware.SPSS-Statisticsv.21® wasusedforprocessing.Variablescollected:sex,age,body massindex(BMI),hormonereceptor(HR)andhumanepidermalgrowthreceptor-2(HER2)status,primarygranulocyte-colony-stimulatingfactor(G-CSF)prophylaxis,locationof metastases,breast-cancer-gene(BRCA)mutationalstatus,Eastern-Cooperative-Oncology-Group(ECOG)score,durationof treatment,objectiveresponserate(ORR)accordingto RECIST-v1.1criteria,progression-freesurvival(PFS),overall survival(OS),causeoftreatmentdiscontinuation,previous chemotherapy(CT)lines,andadverseeffects(AEs)according toCommonTerminologyCriteriaforAdverseEvents-v5 (CTCAE).

Results Thirty-sixpatientswereincluded(100%female); medianage52.5[Interquartilerange(IQR)=64.3–46.8]. MeanBMI25.8[standarddeviation(SD)=4.9].97%HR-negativeand100%HER2-negative.30.6%receivedprimaryprophylaxiswithG-CSF.Lungmetastaseswerethemostfrequent (63.9%),followedbybone(36%),hepatic(30.5%)andganglionic(25%).61.1%BRCA-negative,5.6%BRCA2and 33.3%notavailable.Mostofthepatientshadabaseline ECOG0–1(75%).Todate,14patientswerestillon

treatment.ORRis25%(22.2%partialresponseand2.8% completeresponse),stablediseasein22.2%andprogression intherest.MedianPFSwas4months(IC95%:2.9–5.3); MedianOSnotreached.47.2%ofpatientsdiscontinuedtreatmentduetodiseaseprogressionand13.9%exits.Median totalofSGcyclesreceivedwas4(IQR=8.1–2.4)anda medianof2(IQR=3–1)previousCT-linesinmetastatic-stage.

97.2%ofthepatientshadsomeAEduringtreatment. Mostfrequentwere:asthenia(80.5%(G3–4:2.8%)),anaemia (61%(G3–4:8.3%)),neutropenia(50%(G3–4:16.7%)),diarrhoea(44.4%(G3–4:11.1%)),alopecia(44.4%(G3–4:5.5%)). 69.4%hadsomereductionordelayofdosebecauseoftoxicityandnopatientdiscontinuedtreatmentduetoanAE. ConclusionandRelevance MedianPFSwaslowerthaninthe pivotalASCENTtrial.Althoughthemajoritypresentedsome AE,innocasedidtheseforcetreatmentdiscontinuation.Furtherstudieswithalargersamplesizeandlongerfollow-up periodareneededtoconfirmthesereal-liferesults.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-036 ANALYSISOFPHARMACEUTICALINTERVENTIONSON ANTIMICROBIALPRESCRIPTIONSINTHEPOSTOPERATIVERESUSCITATIONUNIT

LAmaro*,RCastillejo,CMoya,LMoñino. HospitalUniversitarioVirgenMacarena,Hospital Pharmacy,Seville,Spain

10.1136/ejhpharm-2024-eahp.371

BackgroundandImportance Multidrug-resistantmicroorganisms representoneofthegreatestchallengesinmedicinetoday. TheAntibioticStewardshipProgramme(ASP)reviewsantimicrobialprescribingandmakesrecommendationstoprescribers toachieverationaluseofantibioticsandreducetheriskof resistancedevelopment.

AimandObjectives Toanalysetheinterventionscarriedouton antimicrobialtreatmentbytheASPinpatientsadmittedtoa postoperativeresuscitationunit(PRU)andtoevaluatethe degreeofacceptanceofthem.

MaterialandMethods Retrospectiveandobservationalstudyof theinterventionsperformedbytheASPthroughdailymultidisciplinarymeetingsfromJanuary2022toJuly2023ina third-levelhospital.Antifungalsandbroad-spectrumantibiotics consideredas ‘restricted’ inourhospitalwerereviewed.These includedcarbapenems,linezolid,daptomycin,caspofungin,voriconazole,etc.

Datacollected patientdemographics,diagnosis(typeofinfection),treatment(empirical,prophylacticortargeted),restricted antibioticsprescribedandtheirappropriateness,recommendationsmadeandrateofacceptance.

Results 62patients(53.2%men)wereincluded.130restricted antibioticswerereviewed.Themostreviewedantimicrobials were,infirstplace,meropenem(46.9%),followedbycaspofungin(24.6%)andlinezolid(15.4%).

75.6%oftheantibioticprescriptionswereempirical,22.1% targetedand2.3%prophylactic.Themostcommontypesof infectionswereintra-abdominal(56.9%),respiratory(20.9%), urinary(10.5%),bacteremia(3.5%),skinandsofttissueinfections(2.3%);andlessfrequentlyosteoarticularinfections (1,2%),febrileneutropenia(1.2%)andcandidemia(1.2%).

51.2%prescriptionswereconsideredappropriateand 48.8%inappropriate.

51interventionsweremade.Thetypeofrecommendations madewerede-escalate(45.1%),discontinuation(25.5%), adjustdose(11.8%),requestsupplementarytest(11.8%)and changetheantibiotic(5.8%).

86.7%oftheinterventionswereacceptedbythe prescribers.

ConclusionandRelevance Ourstudyhighlightsthecritical needtotakemeasurestopromotetheproperuseofantibioticstopreventthespreadofantibioticresistance.Thehigh percentageofacceptedinterventionsindicatesasignificant levelofconfidenceintheASPinourhospital.Nevertheless, thereisstillroomforimprovementinthisregard.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-037 PERIPHERALBLOODBIOMARKERSDYNAMICS PREDICTCLINICALRESPONSETOPEMBROLIZUMAB PLUSCHEMOTHERAPYINPATIENTSWITHNONSQUAMOUSMETASTATICNON-SMALL-CELLLUNG CANCER

SLora*,RJiménez-Galán,EPrado-Mel,MDVega-Coca,MAPérez-Moreno,LAbdel-Kader Martín. HospitalUniversitarioVirgendelRocío,PharmacyDepartment,Seville,Spain

10.1136/ejhpharm-2024-eahp.372

BackgroundandImportance Heterogeneityinresponseto immunotherapyinpatientswithadvancednon-small-celllung cancer(NSCLC)highlightstheneedtoidentifypredictivebiomarkers.Peripheralbloodbiomarkershavebeenassociated withtheprognosisinadvancedNSCLCtreatedwith immunotherapy.

AimandObjectives Toanalysethecorrelationbetweenthe responsetopembrolizumabpluschemotherapyandperipheral bloodbiomarkerdynamicsinpatientswithnon-squamous metastaticNSCLC.

MaterialandMethods Retrospectiveandobservationalstudy includingallpatientstreatedwithpembrolizumabpluspemetrexedplusplatinum-basedchemotherapyfromJanuary2020 toDecember2021.Variablescollected:sex,age,baselineEasternCooperativeOncologyGroup(ECOG)scale,andlymphocyte,neutrophilandeosinophilabsolutecounts(ALC,ANC andAEC,respectively)atthreetimepoints:baseline(before treatment),week4oftreatmentandfirstcomputerisedtomography(CT)scan.Neutrophil-to-lymphocyteratio(NLR)was calculatedforeachtimepoint.Patientswereclassifiedasresponders(partialresponseorstabledisease)ornon-responders (progressionatfirstCTscan).StatisticalanalysiswasperformedwithsoftwareSPSS24.0.

Results

Sixtypatientswereincluded 76.7%weremalewithamedian ageof62years.88.3%presentedbaselineECOG<2and 76.7%ofpatientswerecategorisedasresponders(23.3%nonresponders).BaselineNLRwassimilarbetweenrespondersand non-responders.MedianNLRatweek4wassignificantly higherinnon-responders(3.3vs1.99;p=0.04).MedianNLR atfirstCTscanwasalsosignificantlyhigherinnon-responders (3.5vs1.9;p=0.01).Amongresponders,therewasasignificantdecrease(p<0.01)betweenbaselineNRLandattimeof firstCT,whilenon-significantchangeswerefoundinthenonrespondergroup.ANCwassimilaratbaselineandfirstCT amongrespondersandnon-responders.However,therewere significantdifferencesatweek4(p=0.036).RegardingALC,

significantdifferenceswereonlyfoundbetweenbothgroups atfirstCT(p=0.015).Finally,forAEC,wedidnotfindsignificantdifferencesatanyofthemeasuredtimepoints.

ConclusionandRelevance OurresultssuggestthatNLR behavesasapredictivebiomarkerofresponsetoimmunotherapy.ANCshowedsignificantdifferencesamongresponders andnon-respondersatweek4,andALCatthefirstevaluation.AECdidnotshowcorrelationwithresponse.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-038 REAL-WORLDSAFETYOFIBRUTINIBINCLINICAL PRACTICEINPATIENTSWITHCHRONICLYMPHOCYTIC LEUKAEMIA

MValeraRubio,JCordero-Ramos,LMoñinoDomínguez*,AAguado-Paredes. Hospital UniversitarioVirgenMacarena,HospitalPharmacy,Sevilla,Spain

10.1136/ejhpharm-2024-eahp.373

BackgroundandImportance Ibrutinibwaswell-toleratedin clinicaltrials.However,thereislimiteddataonthesafetyof Ibrutinib-treatedpatientswithchroniclymphocyticleukaemia (CLL)inroutineclinicalpractice.

AimandObjectives TodescribethesafetyofibrutinibinCLL patientsinareal-worldsetting.

MaterialandMethods Retrospectivestudyinathird-levelhospital.AllCLLpatientstreatedwithibrutinib(July2016to June2022)wereincluded.Collectedvariables:age,sex,mutations,Binetstageatbaseline,Bsymptomsatbaseline,baseline ECOG,comorbidities,lineoftherapy,startingdose,discontinuationoftreatmentandreason.Presenceofhigh-riskcytogeneticswasdetermined:17pdeletion,TP53mutation,11q deletion,immunoglobulinheavychainmutationalstatus (IGHV).Safetyvariables:adverseeventsobservedandtheir severityaccordingtoCommonTerminologyCriteriafor AdverseEventsv.5.0.Informationwastakenfrommedical recordsandtheOutpatientDispensingsoftware.SPSS® was usedfordataanalysis.

Results 47patientswereincluded,68%male,mean(±SD)age of69.2±11years.91.5%were>50yearsold.19.2%patients hadTP53alteration,59.5%unmutatedIGHV,8.5%11qdeletion,and8.5%17pdeletion.Binetstagingclassificationwas: A(42.6%),B(19.1%),C(21.3%)andundeterminedin17%. 42.6%ofpatientshadBsymptomsatbaseline.51%of patientspresentedECOG1atinitiationand40.4%presented ECOG0.61.7%ofpatientshadtwoormorecomorbidities: hypertension(63.8%patients),diabetesmellitus(19.15%),dyslipidaemia(19.2%)andatrialfibrillation(12.8%).66%of patientsstartedasafirst-linetreatment.Allreceiveddosesof 420mgandfourhaddosereductionsduetotoxicityandone duetointolerance.Intermsofsafety,14.9%patientshadto discontinueduetotheoccurrenceofadversereactions.80.8% patientsexperiencedG1-typeadversereactions,themostfrequentbeingasthenia(39.5%),arthralgias(26.6%)andhaematomas(21.5%).34%ofpatientshadG2reactions,most frequentlyhaemorrhagesandanaemia(18.7%),neutropenia (15.5%)andatrialfibrillation(12.5%).10.6%patientshadG3 reactions,thesebeingpneumonitis,neutropenia,uveitis,rectorrhagiaandacardiovascularevent.Medianfollow-upuntilprogressionwas55.8±3.8months.MedianPFSwasnotreached. ConclusionandRelevance Overall,resultsareconsistentwith thosereportedinclinicaltrialsandotherreal-worldstudies.

Inaddition,noincreasedriskofseriousadverseeventswas observed.Furtherfollow-upisneededtoconfirmlong-term safety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-039 IMPACTOFTAILOREDSCREENINGINTERVALSON

THEBURDENOFDRUG-DRUGINTERACTIONALERTS:

ANINTERRUPTEDTIMESERIESANALYSIS

1GvandeSijpe*, 1KWalgraeve, 1EvanLaer, 1CQuintens, 2CMachiels, 1LvanderLinden, 1ISpriet. 1UniversityHospitalsLeuven,PharmacyDepartment,Leuven,Belgium; 2Nexuzhealth,ITDepartment,Hasselt,Belgium

10.1136/ejhpharm-2024-eahp.374

BackgroundandImportance Usingfixedaswellasbroad screeningintervalsfordrug-druginteraction(DDI)alertsleads toanexcessoffalsepositivealerts,contributingtoalert fatigueamongprescribers.

AimandObjectives WeaimedtoinvestigatetheeffectoftailoredscreeningintervalsontheoccurrenceofDDIalerts.

MaterialandMethods Aninterruptedtimeseriesanalysiswas performedtoevaluatetheeffectofapragmaticintervention onthedailypercentageofDDIalerts.Thestudyperiodconsistedof100randomlyselecteddaysbetweenApril2021and December2022.Afixedscreeningintervalof7daysbefore andafterprescribingadrughadbeenusedtoscreenfor DDIs,untilimplementationoftheintervention.Theinterventioncomprisedembeddingtailoredscreeningintervalsfor27 selectedDDIsintothehospitalinformationsystem.Thedaily percentageofDDIalertswasdefinedastheratioofthenumberofDDIalertstothenumberofnewprescriptionsperday.

Results Duringthestudyperiod,ameanof5731(±2909) dailynewprescriptionswascreated.DailyDDIalerts decreasedfromanaverageof8.6%(±2.2)inthepre-interventionperiodto6.6%(±1.4)inthepost-interventionperiod. Asignificantimmediateabsolutereductionof4.5%(95%CI: -6.2;-2.8%,p<0.0001)inthenumberofprescriptionswitha DDIalertwasobserved,whichtranslatedtoapproximately 258(0.045*5731)falsepositiveDDIalertsavoidedperday. Conclusionandrelevance Definingandimplementingtailored screeningintervalswasfeasibleandeffectiveinreducingthe burdenofDDIalerts.

Referencesand/orAcknowledgements ConflictofInterest Noconflictofinterest.

5PSQ-040 VOLUNTARYMEDICATIONERRORSREPORTING SYSTEMINANORTHOPAEDICSURGERYAND TRAUMATOLOGYUNIT

1ACouso*, 1EMartinezDiaz, 1APérezPlasencia, 1SGarciaRodicio, 1NRamónRigau, 2DNoriegoMuñoz, 2JSugrañesEscribano, 1MBrugueraTeixidor, 1CSubiranaBatlle, 1ADordàBenito. 1HospitalUniversitariDr.JosepTrueta,PharmacyDepartment,Girona, Spain; 2HospitalUniversitariDr.JosepTrueta,OrthopaedicSurgeryDepartment,Girona, Spain

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BackgroundandImportance Medicationerrors(ME)areincidentsthatcanoccuratanystageofmedicationusein patient‘scareprocess.Voluntaryincidentreportinghasproven tobeausefultooltoidentifycontributingfactorsand

establishimprovementactions.Surgicalpatientshaveoneof thehighestratesofMEsbecauseoftheirvulnerableprofile andtheirmultiplecaretransitions.

AimandObjectives ToanalysethevoluntaryMEnotifications madeintheOrthopedicsurgeryandTraumatologyunitofa tertiarylevelhospitalwithelectronicprescription,validation andadministrationsystem,toidentifythemostimportantcontributingfactorsandtodescribeimprovementactions.

MaterialandMethods MEreportedintheOrthopedicsurgery andTraumatologyunitwereanalysedmonthlybyHospital SafeMedicationUseCommitteefromFebruary2022toJune 2023.Notificationswereclassifiedaccordingtothreefactors: causality(prescription,administration,reconciliation,monitoring,transfers,labeling,dispensing,similarityofpackagingand/ orname),severity(potentialcircumstancetoproduceME, incidentthatdoesnotreachthepatient,incidentwithout harmandadverseevents)andnotifyingpersonnel(physicians, nursesorpharmacists).Contributingfactorswerealsoidentifiedandimprovementactionswereproposed.

Results Atotalof83MEvoluntaryreportswereanalysed. 74.6%ofthemwereprescriptionerrors,6%wererelatedto administrationand4.8%wererelatedtoreconciliationand monitoring.Intermsofseverity,47.8%wereharmlessincidents,26.5%werepotentialME-causingcircumstances,19.3% wereincidentsthatdidnotreachthepatientand7.2%were adverseeventsthatdidcauseharm.Thereportingpersonnel weremostlynurses(58%)andpharmacists(25%).Themain contributingfactorsidentifiedweredailyreviewelectronicprescriptionsfailure,lackofreconciliationofthepatient‘sregular medicationandvariabilityinpaediatricpatientprescriptions. Improvementactionsimplementedwereaspecificprotocolfor themanagementofpaediatrictraumapatients,amultidisciplinarystudyofprescriptionerrorsandaninformativesessionin theOrthopaedicsurgeryandtraumatologyunitwherewe explainthereportedMEandspecificrecommendationswere giventoavoidthem.

ConclusionandRelevance TheanalysisofthereportedME hasallowedustoidentifythecontributingfactorsandto establishrecommendationstomodifythem.Furtherstudiesof prescriptionerrorswillallowustomonitortheimpactofthe implementedactions.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-041 IMPACTOFINTRODUCINGPREFILLEDATROPINE SYRINGESINOCULARSURGERY:PROACTIVE ASSESSMENTOFDRUGCOSTSANDMEDICATION SAFETY

1MSuominen*, 2YJeon, 1NKoskinen, 1RLatvakoski, 1HRuutiainen, 1KKvarnström, 1SKuitunen. 1HUS,HUSPharmacy,Helsinki,Finland; 2HUS,HeadandNeckCentre, Helsinki,Finland

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BackgroundandImportance Intravenousatropineinjectionis usedtotreatacutebradycardiaduringocularsurgery.Ithas beenobservedthatasignificantamountofampoule-drawn atropineinjectionswereunusedandwastedyearlyinalarge ocularsurgeryunit.Somepotentialmedicationsafetyrisks havealsobeenrecognised.Althoughready-to-useprefilled atropinesyringesarerecommendedtoimprovemedication

safetyofintravenousdrugs,theyarestillrarelyusedinour country.

AimandObjectives Theaimofourprojectwastocompare thedrugcostsandmedicationsafetyrisksassociatedwiththe useofatropineampoulesandatropineprefilledsyringesto treatacutebradycardiainocularsurgery.

MaterialandMethods First,theeffectsofprefilledsyringeson drugcostswereinvestigatedbyaliteraturesearchandby gatheringdatafromothersurgicalunitsthatalreadyusedprefilledsyringes.Atropin-relateddrugcostsofothersurgical unitswerecalculatedbeforeandaftertransitiontoprefilled syringes.Afterthat,aFailureModeandEffectsAnalysis ‘FMEA’ conductedbyaninterprofessionalexpertgroupwas usedtoevaluaterisksassociatedwiththemedicationmanagementanduseprocessofbothatropineproducts.

Results Theintroductionofprefilledsyringeshaddecreased thecostsofatropineinjectionsinothersurgicalunitsmore than50%inaveragewhencomparedtoatropineampoules. Thesavingsweobservedresultedmainlyfromwastageminimisation,becausetheshelflifeofampoule-drawnatropine injectionislimited.Ourliteraturesearchsupportedthisobservation.TheFMEAanalysisidentifiedmoremedicationsafety risksrelatedtotheuseofatropineampoules(n=14,riskprofilenumber ‘RPN’ 297)whencomparedtotheprefilled syringes(n=7,RPN74).Themostsignificantdifferencecame fromtherisksrelatedtopreparationofatropineinjection(i.e. limitedshelflife)andlook-alike,sound-alike ‘LASA’-risksassociatedwiththeuseofatropineampoules.

ConclusionandRelevance Basedoncostanalysisandproactive riskassessmentbyFMEAthetransitiontoprefilledsyringes appearstodecreasecostsandincreasemedicationsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-042 FOCUSONMEDICATIONERRORSONHIGH-RISK MEDICATIONSINAHOSPITAL’SELECTRONIC INCIDENTREPORTINGSYSTEM

1YAndersson*, 2JMezori, 3SREikeland, 2AGGranås. 1HospitalPharmaciesEnterpriseSouth-EasternNorway,HospitalPharmaciesEnterprise,Oslo,Norway; 2UniversityofOslo, DepartmentofPharmacy,Oslo,Norway; 3HospitalPharmaciesEnterprise-South-Eastern Norway,HospitalPharmacyKalnes,Kalnes,Norway

10.1136/ejhpharm-2024-eahp.377

BackgroundandImportance High-riskmedications,i.e.anticoagulants,digoxin,gentamicin,insulin,potassium,opioidsand low-dosemethotrexate,haveanincreasedriskofcausing patientharmwhenusedincorrectly.

Barcodemedicationadministration(BCMA)systemscan reducetheriskofmedicationerrorsbyfocusingonthefive R’sinmedicationmanagement,i.e.,therightpatient,theright drug,therightdose,therightroute,andtherighttime.

AimandObjectives Theaimswere1)toanalyseandquantify medicationerrorsinanelectronicreportingsystemhandling adverseeventsinahospitalwithBMCA,and2)toquantify theextentofhigh-riskmedicationsthatlackedabarcodeat medicineunitlevel.

MaterialandMethods Weanalysedmedicationerrorsreported byhospitalemployeesinthehospital’selectronicincident reportingsystemthathandlesadverseevents.Wehaveread andcategorisedtheerrorscarefullyintermsoftype,frequencyandwhereindrughandlingtheerrorshadoccurred.

Results Hospitalstaffreported1,777medicationerrorsand nearly30%(n=467)wereassociatedwithhigh-riskmedications.Mosterrorsoccurredduringprescribing(n=133,28%) anddrugadministration(n=189,40%).Anticoagulantsand opioidsweremostfrequentlyreported.Thisalsocorresponds withthat14%(n=41)ofthe293differenthigh-riskmedicationpackageslackedbarcodesatmedicineunitlevel,mostof whichwereanticoagulantsandopioids.

ConclusionandRelevance Assigningabarcodetoallhigh-risk medicationpackages,sohigh-riskmedicationscanbescanned, canpreventfuturemedicationerrors.Labellingbarcodesat medicinesunitlevelonanticoagulantsandopioidsshouldbe prioritised.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-043 DESCRIPTIVESTUDYOFMARKETEDMEDICINES CONTAININGASPARTAME

JAHernandezRamos*,ACastroFrontiñan,AGonzalezGomez,MCJimenezLeon,FMayo Olveira,VGarciaEnriquez,FHuecasJimenez,PDelPalacioGarcia,CEVaquerFerrer, JMFerrariPiquero. HospitalUniversitario12deOctubre,Pharmacy,Madrid,Spain 10.1136/ejhpharm-2024-eahp.378

BackgroundandImportance Recently,theInternationalAgency forResearchonCancer(IARC)hasclassifiedaspartameas possiblycarcinogenictohumans.Furthermore,theJoint ExpertCommitteeonFoodAdditives(JECFA)administeredby theFoodandAgricultureOrganizationoftheUnitedNations inpartnershipwiththeWorldHealthOrganizationhas acceptedadailyintakeof40mg/kgbodyweightassafety threshold.

AimandObjectives Theprimaryobjectivewastocomparethe maximumdailyintakeofaspartame(MDIa)foreveryoral medicinemarketedinourcountrywiththesafetythreshold establishedbytheJECFA.MDIawasdefinedasthedaily amountofaspartametakenifusingthemaximumdoseofthe correspondingdrugaccordingtoitslabeldosage recommendations.

Secondaryobjectivesincludeddescribingthemainfeatures ofthesemedicinesandanalysingtheirassociationwithMDIa. MaterialandMethods Bibliographicunicentricstudycarried outinatertiaryhospital.

Collectedvariablesincludedmedicinename,dosageform, authorisedindicationandmilligramsofaspartameperunitin solidformsorpermillilitreinliquidforms.Datawere expressedasamount(percentage)forqualitativevariablesand median(interquartilerange)forquantitativevariables.DifferenceofmedianswasassessedthroughMann-WhitneyUtest. Results 370medicinesdeclaredcontainingaspartame.Accordingtotheirrespectiveauthorisedindications,222(60.0%) wereconsideredmedicationforchronicuseand148(40.0%) acutecaredrugs.Regardingdosageform,283(76.5%)were fastdisintegratingtablets,68(18.4%)oralsolutions/suspensionsorpowdersfororalsolution/suspensionand19(5.1%) other.

Mediandoseofaspartamewas3.0mg/unit(1.3–8.0)for solidforms,and12.5mg/mL(5.0–30.0)forliquidforms.For thetotalpopulationofstudy,MDIawas9.0mgperunitor mL(3.0–20.8)andtheabsolutelargestobservationwas420.0 mg/mL.Specifically,medianMDIaforsolidformswas8.0 mg/unit(2.1–11.2)andforliquidformswas75.0mg/mL

(30.0–90.0);thedifferencebetweenthesemedianswasstatisticallysignificant(p<0.001).

ConclusionandRelevance AllmedicinesmarketedinourcountrycontainingaspartameremainunderthethresholdestablishedbytheJECFAformostadultpopulation.However, sinceliquidformscontainconsiderableamounts,theirsuitabilityaschronictreatmentsshouldbereconsideredforchildren orothervery-lowweightpatientsduringmedicationreview, especiallyifpolymedicated.

TheseresultsshouldbecomparabletotherestofEuropean countries.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-044 SAFETYOFPEMBROLIZUMAB+/-CHEMOTHERAPYIN FIRST-LINEMETASTATICNON-SMALL-CELLLUNG CARCINOMAINREAL-WORLDPRACTICE

MCardenasSierra*,FJGoikoleaUgarte,AGomezDeSeguraSarobe,INuñezCeruelo, GMironElorriaga,MPalaciosFilardo,AMartinTorrente,YVisedaTorrellas,LTorioAlvarez, OIbarraBarrueta. HospitalGaldakaoUsansolo,PharmacyService,Galdakao,Spain

10.1136/ejhpharm-2024-eahp.379

BackgroundandImportance Cancerpatientswithcomorbidities areusuallyexcludedfromclinicaltrials.Real-lifeobservational studiesareofparticularinteresttoelucidatethesafetyof thesenewtherapies.

Safetyofpembrolizumab+/-chemotherapyinmetastatic non-small-celllungcarcinoma(NSCLC)wasassessedinKEYNOTE-024,189and407pivotaltrials.

AimandObjectives Toassessthesafetyofpembrolizumab+/platinum-basedchemotherapyinfirst-linetreatmentofmetastaticNSCLCinreal-worldpractice.

MaterialandMethods Observational,retrospective,singlecentrestudyincluding130adultpatientswithstageIV NSCLCtreatedinfirst-linefrom1December2017to31 December2022,withoutEGFRorALKmutations,autoimmunediseasesorbrainmetastases,andperformancestatus0–1.

PatientswithPD-L1 50%receivedpembrolizumab200 mgor2mg/kgIVevery3weeks.Thosewithnon-squamous histologyandPD-L1<50%receivedpembrolizumab+cisplatinIV75mg/m2orcarboplatinIV6AUCpluspemetrexedIV500mg/m2every3weeksfor4cyclesplus maintenancewithpembrolizumab+pemetrexed.Squamous cellsandPD-L1<50%receivedpembrolizumab+IVcarboplatin6AUCandIVpaclitaxel200mg/m2every3weeksfor 4cyclesplusmaintenancewithpembrolizumab.Treatments wereprolongeduntilprogressionortoxicityforamaximum of2years.

Adatabasewascreatedtorecordadverseevents(AEs) obtainedfromelectronicmedicalrecordsandaccordingto CommonTerminologyCriteriaforAdverseEvents(CTCAE) Version5.0.

Results Intotal,491AEofanygradeand78ofgrade3–4 wererecorded.10patientsdiscontinuedtreatmentduetotoxicity.AEswithincidence>15%were(anygrade – grade3–4):anaemia(36–11),anorexia(51–2),asthenia(96–10),nausea(43–3),diarrhoea(25-2),constipation(20–0),mucositis (21–2),neurotoxicity(22–1).Immune-mediatedAEswere(any grade – grade3–4):hepatotoxicity(7–3),nephritis(3–1),myocarditis(1–1),duodenojejunitis(1–1),pneumonitis(1–0).

ConclusionandRelevance Mostpatientssufferedmorethan oneAE.Evenso,nodeathswererelatedtotoxicity(there werenograde5AEs).Thesixgrade3–4immune-mediated AEsshouldbehighlighted.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-045 ANALYSISOFAPHARMACEUTICALINTERVENTIONIN POLYMEDICATEDPATIENTSWITHDEMENTIAANDIN TREATMENTWITHHIGHANTICHOLINERGICACTIVITY DRUGS

MCSánchezArgaiz,MGallegoGalisteo,ATrujillanoRuiz,AJVillaRubio,ECamposDavila*. HospitalNuevoLaLíneadeLaConcepción,HospitalPharmacy,LaLíneadeLa Concepción,Spain

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BackgroundandImportance Medicineswithanticholinergic propertiesarefrequentlyprescribedinolderpopulationsfor differentmedicalconditionsincreasingtheriskofcognitive andfunctionaldisorders.Patientswithdementiaintreatment withacetylcholinesteraseinhibitors(donepezil,rivastigmine, galantamine)arealsomorevulnerabletothesedrug-related problems,notonlybecauseoftheadverseimpactofthe cumulativeanticholinergiceffectbutalsobecausetheeffects ofanticholinergicsandacetylcholinesteraseinhibitors(AChEi) opposeeachotherandmayresultinadiminishedtherapeutic effect.

AimandObjectives Toanalysethepharmaceuticalintervention carriedoutinpolymedicatedpatientswithdementiaandtakinghighanticholinergicactivitydrugs.

MaterialandMethods Observational,descriptiveandprospectivestudyinwhichthepharmaceuticalinterventionsperformedbetweenJunetoAugust2023infiveprimaryhealthcarecentres.Polymedicatedpatients( 5drugs)withdementiaandAChEidrugsandconcomitanttreatmentwithhigh anticholinergicburdenwereselected.Theclinicianreceiveda reviewofthepotentialdruginteractionwithclinicalevidence andalistofpatientseligiblefordeprescription.Afterone monthwereviewedifthepharmaceuticalinterventionwas acceptedornotwithanypatientprescriptionchange:reduced doseofanticholinergicdrug,suspensionorsubstitutionofany drug.

Results Duringthestudyperiod,49polymedicatedoutpatients wereincluded,29%men,79(75–96)yearsmedianage.

Medianprescribeddrugs12(10–22).AccordingtotheATC classification,thehighanticholinergicactivitydrugprescribed were:21%(10)Antimuscarinicoveractivebladder,4%(2) Antimuscarinicspasmolytic,8%(4)Antihistamines,8%(4) Antipsychotropic,41%(20)Tricyclicantidepressants,18%(9) Selectiveserotoninreuptakeinhibitor.Acceptanceofpharmaceuticalinterventionwithanychangeinprescription:43% (21).14(66%)anticholinergicdrugsweresuspended,2(10%) reducedoseofanticholinergicdrug,2(10%)increasedoseof AChEidrugsoraddedmemantine,3(14%)changethehigh anticholinergicactivitydrug.

ConclusionandRelevance Thisstudyhighlightstheneedand importancetoreviewthechronicmedicationandtomeasure theanticholinergicburdeninoldpatientsaboveallindementiadiagnosis.Mostguidesrecommendtheavoidanceofthe combinationofanticholinergicdrugandacetylcholinesterase inhibitorsdrugsifitispossibleandthisstudygivesusan

ideaofthebenefitofhavingapharmacistaspartofthemultidisciplinaryteamreviewingpolymedicatedpatientstoprioritiseinterventionsinpatientsathighestriskofsuffering adversedrugevents.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-046 SYNDROMEOFINAPPROPRIATESECRETIONOF ANTIDIURETICHORMONEINDUCEDBYALPRAZOLAM: ACASEREPORT

1XTaci*, 2LCamuffo, 2SFaoro, 3FCeccato, 1NRealdon, 2FVenturini. 1UniversitàDegli StudidiPadova,SchoolofSpecialisationinHospitalPharmacy,Padua,Italy; 2Azienda OspedaleUniversitàPadova,HospitalPharmacy,Padua,Italy; 3AziendaOspedaleUniversità Padova,DepartmentofEndocrinology,Padua,Italy

10.1136/ejhpharm-2024-eahp.381

BackgroundandImportance Thecorrelationbetweenpsychotropicdrugsandiatrogenicsyndromeofinappropriateantidiuretichormonesecretion(SIADH)hasbeenwelldocumented. Inregardstoanxiolyticsandhypnoticdrugs,however,a recentexpertconsensusfindsonlylow-levelevidencesupportingtherelationshipbetweenbenzodiazepinesandSIADH.In thisreportwepresentacaseofpatientwithdiagnosedalprazolam-inducedSIADH.

AimandObjectives A67year-oldwomanwasdiagnosedwith SIADHpossiblyinducedbyalprazolambenzodiazepine.The patient,withalonghistoryofanxietysyndrome,wastreated withalprazolam0.25mg3timesdailyformorethan10 years.ThepatientalsosufferedfromHashimoto’sthyroiditis, pulmonaryarterialhypertension,paroxysmalatrialfibrillation, mitralvalvuloplasty,Gilbert’ssyndromeandunderwentpolypharmacytreatmentwithfurosemide25mg,rivaroxaban20 mg,bisoprolol5mg,ramipril5mg,amlodipine20mg,atorvastatin10mgandcholecalciferol10.000UI/ml.

MaterialandMethods In2020,thepatientattendedthe emergencydepartmentaftersyncopeanddiarrhoea.Blood testsrevealedsodiumlevelsof126mmol/L.Furosemide wasimmediatelysuspendedand sodiumwithinulinsupplementationwasinitiated.Thesubsequentfollow-uptests excludedhypocorticismorthyroiddysfunction;copeptin andsodiumandpotassiumexcretionlevelswereallin range;allotherpossiblecauseswereexcluded.Duetothe anxietysyndrome,benzodiaze pinetherapywasnotdiscontinuedbutalprazolamwasreplacedwithbromazepam1.25 mgtwicedaily.

Results Sincelastcheck-ups,thepatienthasbeenpresenting stablemildhyponatremia(around130mmol/L)andiscontinuingdailyoralsodiumandinulinsupplementation.Periodic electrolytetestsandmonitoringforsymptomssuchasconfusion,psychomotorretardation,nauseaorvomitingarerecommendedateveryvisit.

ConclusionandRelevance Thepatientpresentedinthiscase reportwasdiagnosedwithanalprazolam-inducedSIADHafter differentialdiagnosis.Riskfactorsknowntopotentiallycause SIADH,suchasage>=60years,femalegender,polypharmacyandmedicalcomorbidities,allpresentinthedescribed patient,hadtobetakenintoconsiderationfordiagnosis.Benzodiazepine-inducedSIADHcouldbeconsideredincaseof hyponatraemicpatientspresentingunderlyingriskfactorsand intheabsenceofotherclinicalcauses.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PinkhasovA, etal.ManagementofSIADH-relatedhyponatremiaduetopsychotropicmedications-AnexpertconsensusfromtheAssociationofMedicineand Psychiatry. JPsychosomRes.2021;151:110654.

ConflictofInterest Noconflictofinterest.

5PSQ-047 THEPERCEIVEDIMPACTONPATIENTSAFETYAND QUALITYOFCAREOFPHARMACEUTICALTECHNICAL ASSISTANTSONNURSINGWARDS:AQUALITATIVE STUDY

1,2,3MDeGraef*, 1BSerraes, 1VVanRompay, 4,5NEDijkstra, 4,6ERHeerdink, 2,3TDilles. 1ClinicalNursingandAlliedHealthResearchandDevelopmentGroupCnuah-Rd,Nursing andParamedicalDepartment-VitazHospitalAndHealthCare,9100Sint-Niklaas,Belgium; 2NuPhaCBe,NurseandPharmaceuticalCareInternationalExpertConsortium,Antwerp, Belgium; 3DepartmentofNursingScienceandMidwifery-CentreforResearchand InnovationinCareCric,FacultyofMedicineandHealthSciences-UniversityofAntwerp, Antwerp,Belgium; 4ResearchGroupInnovationsinHealthcareProcessesinPharmacology, UniversityofAppliedSciencesUtrecht,Utrecht,TheNetherlands; 5NuPhaCNL,Nurseand PharmaceuticalCareInternationalExpertConsortium,Utrecht,Belgium; 6Divisionof PharmacoepidemiologyandClinicalPharmacology,UtrechtInstituteforPharmaceutical Sciences-UtrechtUniversity,Utrecht,TheNetherlands

10.1136/ejhpharm-2024-eahp.382

BackgroundandImportance Staffshortageschallengeshospital nursestomaintainhigh-qualitymedicinemanagement.Tosupportnurses,pharmaceuticaltechnicalassistants(PTAs)have beenintroducedonhospitalwardstodispensemedication. However,evidenceislackingregardingtheimpactofPTAson thequalityofcareandpatientsafety.

AimandObjectives Thisstudyexplorednurses’,PTAs’ and pharmacists’ experiencesandperceptionsregardingtheimplementationofPTAstosupportmedicationdispensationonhospitalwards.Theprocessofimplementation,roledevelopment, andimpactonsafetyandqualityofcarewereinvestigatedto determinecriticalsuccessfactorsandopportunities.

MaterialandMethods Semi-structuredinterviewswithinvolved healthcareprofessionalswereconducted(December2022to March2023),audiorecorded,andtranscribedverbatim.Thematicanalysiswasperformed.

Results Twenty-eightinterviewswereconductedwithnine nurses,sevenheadnurses,10PTAsandtwopharmacistson internal,surgicalandgeriatrichospitalwards.Threemain themesemerged:patientsafetyandqualityofcare,organisationofcare,androledevelopmentandcollaboration.ImplementationofPTAsonhospitalwardswasperceivedtoa lowerriskofmedicationerrorswithoutcompromisingcare quality.SuccessfulimplementationrequiresaclearroledescriptionofPTAsanduniformcommunicationprocedureto improvemedicationsafetyandcarequality,hospitalwards mustbestructurallyallocatedtothesamePTAs,forthemto becomepartoftheteam.Beingpartoftheteamisconsidered animportantaspecttoensureanoptimalcooperationbetween nursesandPTAs.Nursesindicatedthatcollaborationwith PTAschallengedthemintheirroleofsupervisingcareand co-workingintheteam,butitresultedalsoinreducedworkloadforpharmaceuticalcaretasks.PTAsperceivedtheir implementationonhospitalwardsasawelcomeexpansionof theirrole.

ConclusionandRelevance Allparticipantswereconvincedthat implementationofPTAsonhospitalwardshadapositive effectonnurses’ workload,patientsafetyandqualityofcare. Organisationalbarriersmentionedwerelimited,yet,willhelp

tofurtheroptimiseprocessesandoutcomes.InotherEuropeancountries,PTAsareallowedtoperformmoretaskson hospitalwards.

CriticalsuccessfactorsfortheimplementationincludededicatedassignmentofPTAstohospitalwards,clearroledescriptionandmutualexpectationsinthecollaborationand communicationbetweenPTAsandnurses.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-048 COST-SAVINGIMPACTOFUSINGNUSINERSENBY CLINICALTRIALSFORSPINALMUSCULARATROPHY

1MChoviTrull*, 1OBallestaLópez, 1JEMegíasVericat, 1TPalanquesPastor, 2IPitarch Castellano. 1HospitalUniversitariiPolitècnicLaFe,ServiciodeFarmacia,Valencia,Spain; 2HospitalUniversitariiPolitècnicLaFe,ServiciodeNeurología,Valencia,Spain

10.1136/ejhpharm-2024-eahp.383

BackgroundandImportance Nusinersenisanantisenseoligonucleotidethatincreasestheproductionoffull-length,functionalsurvivalofmotorneuron(SMN)protein.Itwasthe firstdiseasemodifyingtherapyapprovedforSpinalMuscular Atrophy5q(SMA).SMAisaprogressiveneuromuscularrare disease,howeverthecostofavailabletreatmentsimpliesa higheconomicburdenforthesanitarysystem.

AimandObjectives Toanalysetheeconomicadvantageof treatingSMAinclinicaltrials(CT)withnusinersenprovided bythesponsor.

MaterialandMethods Retrospective,observational,singlecentre,multidisciplinaryeconomicstudycalculatingthecostsavingimpactoftheuseofintrathecalnusinerseninCT betweenFebruary2021andSeptember2023.

ClinicaldatawasextractedfromFarmis-Oncofarm® and pkEnsayos®,whereaseconomicdata[LaboratoryPurchase Price(LPP)withoutValue-AddedTax(VAT)]wasobtained fromOrion-Logis®

Thevariablesanalysedwere age,anthropometricdata(basal weight),diagnosis,pharmacotherapeuticdata(cyclesreceived andadministrations)andconsumptiondata(preparationsand avoidedcosts).Theresultswereexpressedas:percentage,and medianwithinterquartilerange(IQR).

Results TwoactiveCTforSMAusingnusinersenwereselected tobeincluded:aphaseII/IIItrial,andthephaseIIIextension.SevenpatientsweretreatedwithnusinerseninbothCT: 5paediatricpatients(71.4%)and2adults(28.6%).The medianpaediatricageandweightwere2.8years[IQR2.5–7.4]and10.0kg[IQR6.5–23.0],respectively.Theadults’ medianageandweightwererespectively34.8years(31.4y 38.1)and78.5kg(48.0y109.0).

Atotalof53drugpreparationsweremade,withamedian ofnineperpatient[IQR5–9],thatresultedinatotalconsumptionof1,394mg(178mgperpatient[IQR162–240]). Theglobalcost-savingwas5,148,443.7C ¼ ,thatrepresents annuallyaneconomicimpactof2,067,648.1C ¼ .

ThemediantreatmentcostavoidedperCTandpatient were2,574,221.9C ¼ (2,415,410.5y2,733,033.3)and 598,312.7C ¼ [IQR3,871.3-88,639.2],respectively.

ConclusionandRelevance SMAisconsideredoneofthe world’smostexpensivetreatmentdisease,andnusinersenis

thestandardofcare.ThepromotiontoparticipateinSMA CTallowsaccesstoinnovativetreatmentsforpatientsand hospitalswiththeaimofreducingthelargeunderlyingbudgetaryburden.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-049 MEDICATIONPRESCRIBINGERRORSPROSPECTIVE OBSERVATIONALSTUDYINANINTENSIVECAREUNIT 1APérezPlasencia, 1MVilaCurrius, 2POrtizBallujera, 1ADordaBenito, 1ENoguePujadas, 2NSamperSanchez, 1MBrugueraTeixidor*, 1CSubiranaBatlle, 3NVilanovaAnducas, 1RAguilarSalmerón. 1HospitalUniversitariDr.JosepTrueta,PharmacyDepartment,Girona, Spain; 2HospitalUniversitariDr.JosepTrueta,IntensiveCareUnit,Girona,Spain; 3Hospital UniversitariDr.JosepTrueta,InternalMedicineDepartment,Girona,Spain

10.1136/ejhpharm-2024-eahp.384

BackgroundandImportance Prescribingerrors(PE)arean importantcauseofmedication-relatedadverseeventsinIntensiveCareUnits(ICU)butlimiteddataareavailableinICU withelectronicprescribingandadministration(ePA)systems. AimandObjectives TodeterminetherateofPEinanICU withePAsystem,toclassifyincidenttypesandtoidentifycriticalpointswheremeasuresshouldbeimplementedtoimprove patientsafety.

MaterialandMethods Prospective,observationalandcross-sectionalstudyinanICUwithePAsystemduringfiveworking days(november2021).TheinclusioncriteriawereICUinpatientswithanelectronicprescription.Prescriptionswererecollectedandanalysedbyamultidisciplinaryteamcomprisedof apharmacist,anICUphysician,anurseandthepersonin chargeofthehospital’sMedicationErrorsCommittee.PE werereportedtothehospital’spatientsafety-relatedincident notificationsystem.

Results 30patientprescriptions,with441medicationsprescribed,wererevisedduringthestudyperiod.Thepatients’ averageagewas60.7±(SD=13.2)yearsandeachprescriptionhadanaverageof14.7medications.PEwerereportedin 31casesandtwosituationswiththecapacitytocauseerrors weredetected.TherateofPEwas1.03errorsperpatient, 0.07perprescribedmedicationand53%ofpatientprescriptionswerePEfree.ThemostcommontypesofPEwere wrongdose(33.3%),excessiveduration(29.0%),drugnot indicatedbyclinicalsituation(12.9%)andnoadministration prescribedmedication(12.9%).Resultswerecommunicatedto staffphysiciansandresidentswithrecommendationstominimisethem:enteralnutritionadjustmentifapropofoltreatmentinitiatedormodified,useavailableprotocolsinePA system,reviewandeliminatenon-activetreatmentsandbe especiallycarefulwithcaretransitions.

ConclusionandRelevance Thisstudyhasmadeitpossibleto identifytheweakpointsofmedicationprescriptioninour ICU.TherealisationofperiodicPEstudiesallowsustoestablishtheimpactoftheimplementedactionsandtodefinenew objectivestoimprovepatientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

Abstracts

5PSQ-050 ISITPOSSIBLETOIMPROVETHEHIPOPOTASEMIC MANAGEMENTINTHEHOSPITAL?

MBrugueraTeixidor*,CSubiranaBatlle,QLópezNoguera,AVelezDeMendizabalArregui, SGarciaRodicio,NSunyerEsquerra,ENoguéPujadas,XLarreaUrtaran. Hospital UniversitariDr.JosepTrueta,PharmacyDepartment,Girona,Spain

10.1136/ejhpharm-2024-eahp.385

BackgroundandImportance Potassiummetabolismdisorders arethemostfrequentelectrolytealterationinclinicalpractice. Earlydetectionofhypokalaemiacouldpreventfuture complications.

AimandObjectives Toknowtheprevalenceofhypokalaemia disordersinadultsadmittedinathird-levelhospital.Evaluate theaetiologyandthecorrectivetreatmentduringthefollowing24hours.Toidentifyimprovementactions.

MaterialandMethods Descriptiveobservationalstudyof threecross-sectionscarried outduringDecember2022.In eachsection,alltheanalyticaldeterminationsthatincluded potassiumdeterminationwereselected,andthemedical recordsofpatientswithhypokalaemia(K<3.5mEq/L) werereviewed.

Theseverityofthealterationandthecorrectivetreatment weredeterminedwithin24hoursaftertheanalytical determination.

Hypokalaemiawasclassifiedaccordingtoseverityas:mild (3–3.49mEq/L),moderate(2.51–2.99mEq/L)orsevere(£2.5 mEq/L).Possiblecauseswereconsidered:hypomagnesemia, pharmacological,idiopathicorinsufficientintake(nothingby mouthwithoutpotassiumsupplement).

Results Ineachsection,wereidentified116,116and112 (344intotal)patientswithpotassiumdetermination.The patientsadmittedeachdaywere327,323and321,respectively.45/344(13%;95%CI[9.5–16.6])hadhypokalaemia (40mild,4moderateand1severe).

21/45patientshadapharmacologicalcause(46.7%;95% CI[32.1–61.2]),furosemidebeingprescribedin15ofthem. 11/45patientspresentedhypomagnesemiaasaprobableaetiology(24.4%;95%CI[11.9–37]).Itwasidentifiedasapossibleidiopathiccausein9/45patients(20%;95%CI[8.3–31]) andin4/45(8.9%;95%CI[6–17.2])insufficientsupplyof potassiumwasobserved(patientsonanabsolutedietwithout supplementation).

18/45patientsdidnotreceivecorrectivetreatment(40%; 95%CI[25.7–54.3]).

ConclusionandRelevance Hypokalaemiaoccursin13%of dailylaboratoryanalysisinthehospital,themaincausebeing pharmacological.Inthefirst24hours,40%ofpatientsdo notreceivecorrectivetreatment.

Theestablishmentofasystematisedcomputerisedextraction ofpatientswithalterationsinpotassiumlevelswoulddetect unidentifiedalterations.Itcouldbepossibletoestablishcorrectivetreatmentearlier,andthisfactcouldbeabletobenefit morethan5,000patientsannuallyinoursetting.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-051 EFFECTIVENESSANDSAFETYOFNIRMATRELVIR/ RITONAVIRINOLDERPATIENTSATANURSING HOMEWITHCOVID-19

MDMolinaMendoza,JCorcueraCatalá,MGuerreroPeña,EDelgado*,JMateos-Nozal, EGómezBayona,EGemenoLópez,MMuñozGarcía,ACruzJentoft,AMÁlvarezDíaz. HospitalRamónyCajal,FarmaciaHospitalaria,Madrid,Spain

10.1136/ejhpharm-2024-eahp.386

BackgroundandImportance Theuseoftheantiviraldrugnirmatrelvir/ritonavirinnursinghomepatientswithCOVID-19 hasreduceditsmaincomplications,althoughduetocomorbidityandpolypharmacythereareoftenproblemswith interactions.

AimandObjectives Toevaluatetheeffectivenessandsafetyof nirmatrelvir/ritonavirinnursinghomepatientswithCOVID19infection.

MaterialandMethods RetrospectiveobservationalstudyincludingallnursinghomepatientsattendedbyaGeriatricsLiaison UnitfromahospitalinMadridbetweenMay2022andJuly 2023andtreatedwithnirmatrelvir/ritonavir.Wecollectedthe numberofreferralstotheemergencydepartment,hospitalisationsandmortalityduetoCOVID-19amonthaftertreatment withnirmatrelvir/ritonavirandinteractionsandadverseevents detectedassociatedwiththedrug.

Sociodemographic,clinicalandpharmacologicalvariables werecollectedfromtheelectronicmedicalrecord.

Results Atotalof111patients(76.6%women)withamedian ageof89.5years(68–102)andaCharlsonindexof2(0–5) pointswereincluded,from18differentnursinghomes.Overall,58.6%(65)haddementia,40.5%(45)Barthel £40and 33.3%(37)impairedrenalfunctionreceivingreduceddosesof nirmatrelvir/ritonavir.

Clinically,96.4%(107)hadmildsymptoms(cough,fever, myalgia,diarrhoea)and0.9%(1)wereasymptomaticand 53.2%ofthem(59)previouslyreceivedfourdosesofvaccine. Nosymptomswererecordedin2.7%(3)ofthepatients.

Atotalof283interactionsofnirmatrelvir/ritonavirwith62 differentchronicdrugsweredetected:trazodone(8.8%), metamizole(8.1%),quetiapine(7.4%),amlodipine(7.4%), mirtazapine(6%),atorvastatin(4.6%)werethemostfrequent. Weobservedatleastoneinteractionin93.8%ofthepatients, withameannumberof2.6interactionsperpatient.Eightytwointeractionsweresevererequiringdiscontinuation,180 weremoderateofwhich81requiredmonitoringand99 requireddrugadjustmentincludingchangeofdose,frequency, regimenorsubstitutionwithanotherdrug.

Onemonthaftertreatmentwithnirmatrelvir/ritonavir, 2.7%(3)ofpatientswerereferredtotheemergencydepartmentforCovid-19ofwhom66.7%(2)requiredhospital admission,whilejustonepatientpresentedpotentialadverse reactiontotreatment(dysgeusia)andnopatientdiedduring thismonthduetoCOVID-19.

ConclusionandRelevance Nirmartrelvir/ritonaviriseffective andsafeforthetreatmentofCovid-19innursinghome patientsbutrequiresareviewofclinicalhistoryanddrug interactionstoadjustchronictreatmentsduringadministration.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

ANALYSISOFPOTENTIALPROGNOSTICFACTORSOF EFFICACYINTISAGENLECLEUCELTREATMENTINA COHORTOFPATIENTSWITHDIFFUSELARGEB-CELL LYMPHOMA

FChinotti*,CLauriaPantano,ATrenta,MAnghilieri,FGuidoni,GCavalleris,FZelante, VLadisa. IstitutoNazionaledeiTumori,HospitalPharmacy,Milano,Italy

10.1136/ejhpharm-2024-eahp.387

BackgroundandImportance InthecontextofB-cellnonHodgkinlymphomas,theuseofCART-celltherapyoffered newtreatmentpossibilities.Theevolutionofthesetherapies canimprovethetreatmentarsenalandpatients’ lifeexpectancy.However,somepatientsexperiencetreatmentfailure:the identificationofpredictorscanbecrucialforacost-effective useofthistherapy.

AimandObjectives Thepurposeofthisanalysiswastoevaluatethecorrelationbetweensomepossiblepredictivefactors andoutcomeaftertisagenlecleucelinfusioninpatientswith diffuseB-celllymphoma.Aretrospectiveobservationalstudy wasconductedonacohortof35patientstreatedwithtisagenlecleucelfromclinicalpracticeinanItalianOncologic InstitutefromDecember2019toAugust2023.Patientswere evaluatedbasedontheirresponsetothetherapyintermsof overallresponserateoveran18-monthperiodfollowinginfusion.Theanalysedfactorsincludedage,gender,development ofcytokinereleasesyndromeanditsgrade,tocilizumab administration,steroidadministration,lymphocytecountatthe timeofleukapheresis,lymphocytecountatday14andday 30post-infusion,c-reactiveproteinatday0,peakofc-reactiveproteinwithin14dayspost-infusion,ferritinatday0, peakferritinwithin14days,previoustherapylines,previous autologousmarrowtransplantation,diseasestage,bridgetherapyreceived.

MaterialandMethods Factorsthatcouldinfluenceresponse wereanalysedbystratifiedanalysisdividingpatientsintoresponders(completeremission,partialremission)andnon-responders(deathandprogression)at18months;Mann-Whitney UtestforcontinuousvariablesandFisher ’sexacttestforcategoricalvariableswereused.Univariatelogisticregressionwas usedtoassesstheindependentcontributionofeachfactoron theprobabilityofresponsetotherapy.Statisticalsignificance wasconsideredforavalueofp<0.05.

Results Elevatedbaselinelevelsofc-reactiveproteinandferritinincreasetheriskoftherapyfailure.Higherferritinpeaks within14daysalsoincreasetheriskoffailure.Higherlymphocyteexpansionatday30isassociatedwithabetter response;previousautologousmarrowtransplantationcorrelateswithabetterresponse.

ConclusionandRelevance Thepatient‘sinflammatorystatus beforetherapyshouldbecarefullyevaluated:elevatedlevelsof inflammatorymarkersareassociatedwiththerapyfailure.Previousautologousmarrowtransplantationcorrelateswithabetterresponse;theanalysisoffactorsthatcanpredictthe possibilityoftreatmentfailureisimportant.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-053 EFFECTIVENESSANDSAFETYOFGALCANEZUMAB. REAL-LIFERESULTS

SGarcíaLastra*,ECrespoRodriguez,PAndreuMargullon,ARomeroGarcia,IZapico Garcia,AIPlanoSánchez,CCarrilesFernandez,NPerezDomínguez,JAValduezaBeneitez, NGonzalezSanchez. HospitalSanAgustín,Pharmacy,Avilés,Spain

10.1136/ejhpharm-2024-eahp.388

BackgroundandImportance Galcanezumabisamonoclonal antibodythatbindsthecalcitoningene-relatedpeptide,indicatedformigraineprophylaxis.

AimandObjectives Toassesstheeffectivenessandsafetyof galcanezumabsixmonthsafterinitiationoftreatment.

MaterialandMethods Aretrospectiveobservationalstudy includingpatientstreatedwithgalcanezumab,fromSeptember 2020toAugust2023wasconducted.Collectedvariablescomprisedage,sex,typeofmigraine,mediannumberofmigraine dayspermonth(MDM),HIT-6score,galcanezumabtreatment duration,andadverseeffects.Treatmentwithgalcanezumab wasconsideredeffectiveifareductionofatleast50%in MDMorareductionofmorethan5pointsontheHIT-6 scalewasachievedat6monthsoftreatment.Fortheassessmentofdrugsafety,adverseeffectsreportedbythepatient wereconsidered.

Results Atotalof32caseswerereviewed(medianage49 years;25women[71.4%]),75%(n=24)ofpatientshad chronicmigrainewithoutaura,9.4%(n=3)hadchronic migrainewithaura,and15.6%(n=5)hadhigh-frequencyepisodicmigraine.ThechangeinMDMbeforeandaftersix monthsoftreatmentwas15versus5,andtheHIT-6index was69versus57.Mediandurationofgalcanezumabtreatment was19months.Attheendofthestudyperiod,84.6%of patientscontinuedwiththetreatment,while15.4%discontinueditduetosideeffectsorineffectiveness.Regardingthe typeofadverseeffects,twopatientsreporteddizziness(7.7%), andonereportedintenseitching(3.8%).Theobservedfrequenciesarehigherthanthosereportedinpivotalclinicaltrials,withanincidenceof1.2%fordizzinessanditching.The adverseeffectsreportedwereinallcases,mildormoderate, andthediscontinuationrateawedtothisreasonwaslessthan 4%.

ConclusionandRelevance Treatmentwithgalcanezumabhas provedtobeeffectiveandsafeinmostpatients.Despite adequatemonitoringatsixmonthsfromtheinitiationof monoclonalantibodytreatment,furtherandlonger-termstudieswouldbenecessarytoestablishtheutilityofthisdrug,its impactonqualityoflife,anditslong-termsafety.

Referencesand/orAcknowledgements ConflictofInterest Noconflictofinterest.

5PSQ-054 EVALUATIONOFANAPPLICATIONTOHELPFORTHE ADEQUACYOFTHEDOSAGEOFANTIBIOTICSIN RENALFAILURE

1QMoreno*, 1PAlonso, 1NSala, 2SCervera. 1HospitalSantJoandeDéu.FundacióAlthaia, Pharmacy,Manresa,Spain; 2HospitalSantJoandeDéu.FundacióAlthaia,Information Systems,Manresa,Spain

10.1136/ejhpharm-2024-eahp.389

BackgroundandImportance Duetotheagingofthepopulation,therearemoreandmorepatientswithchronicrenal failurewhorequireprolongedhospitalisation.Therearealso manypatientswho,duringahospitaladmission,seetheir renalfunctionworsenandarethereforecandidatesforadosageadjustmentofcertaindrugs.

Forthisreasonwedesignedwithinourdrugprescription system,amoduletoguaranteesafetyintheprescriptionof drugsthatrequireadjustmentaccordingtoglomerularfiltrationrate(GFR).

AimandObjectives Toimprovethesafetyofprescribingantibioticsrequiringrenaladjustmentduringhospitaladmission.

MaterialandMethods Inthedrugprescriptionsystemwecan indicatetherecommendeddosageaccordingtotheGFRintervalofeachdrug.

IffromacertainGFR,itsprescriptionisnotrecommended,theprogramwarnsyouandadvisesagainstitsuse.

DifferentGFRintervalscanbeaddedandifnecessarya differentdoseofthesamedrugcanbeassociated.Thus, whentheprogramalertsthatthedrugrequiresachangeof dose,theprogramproposesitautomatically,whichentailsagilityatthetimeofmakingtheprescription.

Withintheprescriptionprogram,thevalueofthepatient‘ s lastGFRcanbedisplayedwiththedateoftheanalysis.Itis withthisvaluethattheprogrammakestheproposalto changethedosage.

Ifdosageadjustmentisnotnecessaryaccordingtoclinical criteria,theconventionalregimencanalsobeprescribed.

Results Duringthe4yearsafterimplantation,28,701dosage adjustmentshavebeenmadeaccordingtorenalfunction.Of these,6,081(21%)correspondtoantibiotics.

Ofthetotaldosageschanged,1,410(23%)correspondto piperacillin-tazobactam,1,138(18.7%)tociprofloxacin,822 (13.5%)toamoxicillin-clavulanicacid,380(6.2%)tomeropenem,330(5.4%)tolevofloxacin,183(3%)tofosfomycin, 176(3%)tocefepime,163(2.6%)toimipenem,160(2.6%) tocefazolin,141(2.3%)tovancomycinand139(2.2%)to ceftriaxone.

Theremaining1,039(17%)antibioticscarrytheremaining 1,039(17%)prescriptions.

ConclusionandRelevance Thisapplicationhashelpedusto improvetheadequacyofthedosageofantibioticsincaseof renalfailure.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-055 EFFICACYANDSAFETYOFDALBAVANCININGRAMPOSITIVEINFECTIONSTREATMENT

LAmaro*,CMoya,RCastillejo. HospitalUniversitarioVirgenMacarena,HospitalPharmacy, Seville,Spain

10.1136/ejhpharm-2024-eahp.390

BackgroundandImportance Dalbavancinisasemi-synthetic lipoglycopeptidewithactivityagainstgram-positives,including methicillin-resistantStaphylococcusaureus,indicatedforskin andsofttissueinfections.Unlikeotherglycopeptides,ithasan extremelylonghalf-life,allowingforweeklyorbiweekly dosing.

AimandObjectives Theaimofthestudywastoevaluatethe effectivenessandsafetyofdalbavanciningram-positiveinfectiontreatmentinpatientsatatertiary-levelhospital.

MaterialandMethods Retrospective,single-centrestudy. PatientsreceivingdalbavancinfromSeptember2021toAugust 2023wereincluded.Clinicalandanalyticaldatawere obtainedfrommedicalrecords.Variablescollected:gender, age,antibioticallergies,typeofinfection,causativemicroorganism,previousantibiotictherapy.Regardingtreatment:dosage,duration,diagnosis,concomitantantibiotics,clinicaland microbiologicalresolution,adversereactions(ARs)anddiscontinuationduetothem.Clinicalresolutionwasdefinedas absenceofinfectionsigns,andmicrobiologicalresolutionas obtaininganegativeculture.

Results 35patientswereincluded,withmeanage(±SD)of 70(±11.54)years,60.7%male.Onlyonehadantibiotic allergy(amoxicillin-clavulanate).Allpatientshadreceivedprior antibiotictreatmentbeforedalbavancin,exceptone,average duration(±SD)of20(±8.5)days.

Dalbavancinwasprescribedastargetedtreatmentexceptfor twoempiriccases.Theindicationswere:endocarditis60.0%; prostheticinfection20.0%;pacemakerinfection8.6%;and theremaining11.4%includedosteomyelitis,septicpseudoarthritis,mycoticaneurysm,andmediastinitis(1each).

Causativemicroorganisms Staphylococcusepidermidis28.6%, Viridans-groupStreptococcus20.0%,Methicillin-sensitiveS. aureus14.3%,Enterococcusspp.11.4%(3E.faeciumand1E. faecalis),Clostridiumspp.11.4%,Methicillin-resistantS.aureus 5.7%,Abiotrophiaspp.2.9%.

Dosageregimen 48.6%(17)weeklyregimen(initialdose1000 mg,maintenance500mg);34.3%(12)biweeklytreatment (initialdose1500mg,maintenance1000mg);and17.1%(6) singledoseof1500mg.Meanduration(±SD)was4.32 (±3.38)weeks.Onepatientreceivedconcomitantantibiotic treatmentduetoapolymicrobialinfection.

Reasonsforusingdalbavancinwastofacilitatedischarge andavoidprolongedhospitalstaysin27/35patients,three failedtopreviousantibiotics,andfivehadARstoprevious antibiotics.

Clinicalandmicrobiologicalremissionwasachievedin 85.7%.NopatientexperiencedARstothedrug.

ConclusionandRelevance Inourexperience,dalbavancinis effectiveandsafeingram-positiveinfectionsrequiringprolongedtreatments,suchasendocarditis.Itspharmacokinetic characteristicsenableoutpatient-typeadministrationthat reducespatient‘shospitalstay,resultinginincreasedpatient safetyandqualityoflife,aswellassignificantcostsavingsin hospitalexpenses.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-056 VACCINATIONCOVERAGEAGAINSTPENUMOCOCCUS FORPEOPLELIVINGWITHHIVBEFOREANDAFTER THECOVID-19PANDEMIC

1MVélez-Díaz-Pallarés, 1ACFernándezChávez, 2PGuijarroMartínez*, 1JMAranaz-Andrés, 2AMÁlvarezDíaz. 1HospitalRamonyCajal,ServiciodeMedicinaPreventivaySalud Pública-HospitalUniversitarioRamónyCajal-Irycis,Madrid,Spain; 2HospitalRamony Cajal,PharmacyDepartment-HospitalUniversitarioRamónyCajal-Irycis,Madrid,Spain

10.1136/ejhpharm-2024-eahp.391

BackgroundandImportance ImmunisationisthebestpreventionagainstpneumococcaldiseasesinpeoplelivingwithHIV (PLHIV).From2010to2022,therecommendedvaccination schedulewassequential:13vconjugatevaccinefollowedby the23vpolysaccharidevaccine.

AimandObjectives Theaimofthestudywastodescribeand comparevaccinecoverageagainstpneumococcusbeforeand aftertheCOVID-19pandemicin(PLHIV).

MaterialandMethods Thesamplewasobtainedfrompatients whoattendedthePharmacyDepartmentofatertiaryhospital intheyears2019and2022toreceivetheirantiretroviral drugs.VaccinationdatawereobtainedfromtheSISPALdatabaseoftheCommunityofMadrid.Vaccinationcoverage between2019and2022wasestimatedandcomparedusing bivariatelogisticregression.

Results Intotal,PLHIVwere2,978and3,169in2019and 2022respectively.Themedianagewas47(37–53)and46 (35–53)respectively.Menweremoreprevalent,with81.5% in2019and81.9%in2022.62.7%and68.5%receivedthe sequentialanti-pneumococcalregimenin2019and2022, respectively(OR1.2995%;CI:1.13–1.48;p<0.05).29.6% (2019)and22.6%(2022)ofthepatientsdidnotcomplete thesequentialvaccineregimen,and7.7%(2019)and8.9% (2022)didnotreceiveanyvaccineinbothyears.

ConclusionandRelevance Vaccinecoverageinpeopleliving withHIVagainstpneumococcusincreasedin2022compared to2019,priortotheCOVID-19pandemic.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-057 ANTICHOLINERGICBURDENASSESSMENTIN INSTITUTIONALISEDPATIENTS

MFloridoFrancisco*,RSanchezDelMoral,ICorrienteGordón. HospitalJuanRamón Jiménez,Farmacia,Huelva,Spain

10.1136/ejhpharm-2024-eahp.392

BackgroundandImportance Pluripathology,polymedication, dependenceandfrailtyarecommonsituationsininstitutionalisedpopulations.Duetothesecircumstancesisveryimportant

tomonitordrugsafetyinthesepatients,especiallytheriskof anticholinergiceffectsthatcansignificantlyaffectqualityof life.

AimandObjectives Toidentifythedrugsthataddanticholinergicburden(AB)prescribedinnursinghomeresidents,as wellastoquantifytheoverallAB.

MaterialandMethods Cross-sectionalstudycarriedoutin nursinghomeresidentsattachedtoahospitalpharmacyservice.AllpatientsinstitutionalisedinSeptember2023were included.Variablescollected:Age,sexandnumberofdrugs prescribed.

TheAnticholinergicBurdenCalculatorwasusedtoidentify drugswithABaccordingtothe10scalesincludedinthecalculator.Theanticholinergicrisk(AR)obtainedwasquantified withtheAnticholinergicCognitiveBurdenScale(ACB),which classifiesthepatientwithahigh(>3),medium(2)andlow (1)riskofpresentinganticholinergicadverseeffects.

Subsequently,patientswerecategorisedintofourgroups accordingtothenumberofdrugsprescribed(1–5,6–10,11–15and>15)andtheABwasquantifiedaccordingtoACBof eachgroup.

Datasources electronicmedicalsourcesandelectronicprescribingsoftware.MicrosoftExcel2020® wasusedtoprocessthe data.

Results Eighty-twopatientswereincluded,male69.5% (n=57),meanage74.5±8.5years,withameanof9.0±4.3 prescribedmedicationsperresident.

AccordingtoACB32.9%(n=27)hadlow,4.9%(n=4) mediumand24.4%(n=20)highriskofmanifestinganticholinergicadverseeffects;37.8%(n=31)ofpatientshadnoAR.

ThemostprescribeddrugswithABwere:furosemide7.1% (n=15),tamsulosin6.2%(n=13),tramadol6.2%(n=13)and metformin5.2%(n=11);thedrugswiththehighestABwere: oxybutynin0.5%(n=1),paroxetine0.9%(n=2)andolanzapine1.4%(n=3).

ThemeanABfoundaccordingtothenumberofdrugsprescribedwas:0.2±0.4forthe1–5group(n=16,19.5%),1.5 ±1.7in6–10(n=39,47.6%),1.4±1.2in11–15 (n=20,24.4%)and3.3±1.6inpatientswith>15(n=7,8.5%) drugsprescribed.

ConclusionandRelevance Inourstudyahighpercentageof patientsshowedAR,howeverthemostprescribeddrugshad lowAB.Ontheotherhand,ABwashigherasthenumberof drugsprescribedincreased.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.anticholinergicscales.es/

ConflictofInterest Noconflictofinterest.

5PSQ-058 EFFICACYEVALUATIONOFANTI-PCSK9DRUGSFOR THETREATMENTOFPRIMARY HYPERCHOLESTEROLAEMIAORMIXED DYSLIPIDAEMIA

LSilva*,GBabaglioni,EFesta,DPaganotti,TETesta. AsstSpedaliCiviliofBrescia,Hospital Pharmacy,Brescia,Italy

10.1136/ejhpharm-2024-eahp.393

BackgroundandImportance Theanti-PCSK9monoclonalantibodiesalirocumabandevolocumabwereauthorisedin2015 forthetreatmentofprimaryhypercholesterolaemia(heterozygousHeFHornon-familynoFH)ormixeddyslipidaemia

(MD).Theyhavebeenstudiedinstatin-intolerantpatients,in combinationwithastatinorasmonotherapyandhavebeen showntoreduceLDLcholesterolby50–70%overall.1

AimandObjectives Theanalysisaimedtoevaluate,bycheckingAIFAmonitoringregisters,theefficacyofalirocumaband evolocumabandthetherapeuticadherenceinpatientswho completedthetreatmentforprimaryhypercholesterolaemiaor mixeddyslipidaemia.

MaterialandMethods TheC-LDLandC-HDLvaluesatthe beginningandattheendoftreatmentwerecomparedastherapyefficacyindicators.Inaddition,comorbiditiesandconcomitanttherapieswereanalysed.Thedatareportedrefertothe overallaveragedurationoftreatmentforeachpatient.

Results Ofthe37patients(meanage63years,36–81),28 receivedalirocumabandninereceivedevolocumab.Theaveragedurationoftreatmentwas34.7months(4.6–73,9)and 76%hadatleasttwocomorbidities.Also,83,8%ofpatients weretakingezetimibe,19%rosuvastatinand13,5%atorvastatin.57%ofthesamplewaseligiblefornoFH,32%forMD and11%forHeFH.ThemeanC-LDLreductionfrombaselineaftertherapywithalirocumabwas39,9%whilewithevolocumabitwas42,8%.AnaverageC-HDLincreaseof13% occurredinboththerapies.

ConclusionandRelevance Anti-PCSK9areeffectiveinreducing C-LDLlevels:a40%reductionwasreportedforalirocumab 75mgoveranaverageof35,5monthsoftreatment(2–62,3), 41%foralirocumab150mgover35,2months(10,8–64,9) and42,5%forevolocumabover34,7months(8–73,9).These valuesarelowerthanthoseoftheregistrativeclinicalstudies althoughtheyrefertoshortertreatmentperiods(2–3months). Thesedatasuggestthatinadditiontoefficacy,itisimportant tomonitorpatients‘ adherenceandtolerability:intheformer case,76%ofpatientschangedtherapyafteranaverageof 355monthsandinthelattercase,13.5%discontinuedtherapyduetotheoccurrenceofadversereactionsafteranaverageof17,7months.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.JoelSchmitz,IoannaGouni-Berthold.Anti-PCSK9Antibodies:ANewErainthe TreatmentofDyslipidemia. CurrPharmDes.2017;23(10):1484–1494.

ConflictofInterest Noconflictofinterest.

5PSQ-059 STUDYOFTHEUSEOFCEFTAZIDIME/AVIBACTAMIN AFIRST-LEVELHOSPITAL

1MGDíazLópez*, 1MSánchezValera, 1DGamezTorres, 2ELRománMárquez, 1MTGómez Sánchez, 1IAlférezGarcía. 1HospitalUniversitarioTorrecárdenas,ServiciodeFarmacia, Almería,Spain; 2HospitalTorrecárdenas,FarmaciaHospitalaria,Almería,Spain 10.1136/ejhpharm-2024-eahp.394

BackgroundandImportance Ceftazidime/avibactamisacombinationantibiotictreatmentconsideredtobeofrestricteduse duetoitsnoveltyandlowresistance.Itsuseisjustifiedasa targetedtherapyinthepresenceofmulti-resistantgram-negativeaerobicbacteriaaccordingtotheantibioticoptimisation programmeprotocol.

AimandObjectives Toanalysetheuseandprescribingservices ofceftazidime/avibactamininpatientsduring365days.

MaterialandMethods Aretrospectiveanddescriptiveobservationalstudyoftheuseofceftazidime/avibactamduringa24monthperiodintheHospitalUniversitarioTorrecárdenaswas carriedout,analysing46patients.Datawereextractedfrom

theclinicaldatabaseoftheAndalusianHealthSystem(Diraya), thedatabaseofthelaboratoriesofAlmeria(Modulab)andthe locationofthetreatmentwasconsultedintheDominion –Unidosisdatabase.

Results Thegroupanalysedconsistedof46patientsofwhom 16died,andofthetotalof30survivors,fourwerestillin hospitalatthetimeofthestudy.

Thegroupconsistedof26%womenand74%men.Mortalityinfemaleswas33%comparedto35%inmales.Total mortalitywas37%.

Ofthetotal,48%receivedatargetedtreatmentfora multi-resistantbacterium,with10%prescribedbytheinfectiousdiseaseserviceand38%byotherservices.Only28% weretargetedtreatmentsformulti-resistantgram-resistant bacteria.

Incontrast,52%ofthetotalreceivedceftazidime/avibactam asempiricaltreatment.In37%oftheempiricalcasesthebacteriawerefoundtobenon-resistant.

Ofthe48%oftargetedtreatments:

20%ofgram-positive

1Staphylococcuspetrasii

5StaphylococcusepidermidisMRSA

2StaphylococcushaemoliticumMRSA

1StaphylococcusaureusMRSA

28%ofgram-negative

7PseudomonaaeruginosamR

1EscherichiacoliOXA-48

1KlebsiellapneumoniaeBLEA

1EnterococcusfaeciumVanR

3Stenotrophomonasmaltophila

ConclusionandRelevance Thedatarevealedbythestudydo notconformtothecentreprotocolhighlightingitsuseas empiricalandtargetedtreatmentforgram-positives.Ceftazidime/avibactamisconsideredtobeofextremelyrestricteduse limitedbyantibiogramsorsepsiscodesinthepresenceof multidrug-resistantgram-positivebacteria.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-060 REAL-LIFEDATAONTHEEFFECTIVENESSANDSAFETY OFCABOTEGRAVIR/RILPIVIRINEINATHIRD-LEVEL HOSPITAL

1MVélez-Díaz-Pallarés, 1SSánchez-IzquierdoYarnoz, 1PGuijarroMartínez*, 1BMontero Llorente, 1MÁParroMartín, 2AMorenoZamora, 2SDelCampoTerrón, 2SMartín Colmenarejo, 2MAÁmezSegovia, 2SMorenoGuillén, 1AMÁlvarezDíaz. 1HospitalRamony Cajal,PharmacyDepartment-HospitalUniversitarioRamónyCajal-Irycis,Madrid,Spain; 2HospitalRamonyCajal,InfectiousDiseaseDepartment-HospitalUniversitarioRamóny Cajal-Irycis,Madrid,Spain

10.1136/ejhpharm-2024-eahp.395

BackgroundandImportance Thecombinationofcabotegravir andrilpivirine(C/R)isthefirstcommercialisedlong-acting injectablefortreatingHIV-1.Real-lifedatainSpainisstill scarce.

AimandObjectives Toanalysetheeffectivenessandsafetyof patientstreatedwithC/Rinatertiaryhospital.

MaterialandMethods Adescriptiveobservationalstudyof patientstreatedwithC/Rfrom1February2023(dateof inclusionintheHospitalDrugGuide)until31August2023 inatertiaryhospital.Allpatientsonanoralregimenand withanundetectableviralload(VL)wereincluded.Those

thatcamefromthepivotaltrialswereexcluded.Effectiveness wasmeasuredasthepercentageofpatientswhoremained withundetectableVLon24September2023.Tomeasure safety,theadversereactions(AR)recordedintheelectronic medicalrecordswerereviewed.

Results Onehundredandseventy-fivepatientswereincluded: 156cis-men(89%),18cis-women(10%)andonetranswoman(1%),withamedianageof45years(IQR=36–57). Themostcommonpriortreatmentswerebictegravir/emtricitabine/tenofoviralafenamide(48%)anddolutegravir/lamivudine (23%).Onehundredandthirty-sevenpatientshadatleastone analysissincethefirstadministration,15hadtwo,andthe resthadnoanalysissincethefirstadministrationofC/R. Onlytwopatients(1.1%)haddetectableVLintheirfirst analysis(log1.64and1.74),butinboth,anewanalysiswas doneat29and7days,respectively,andagainhadundetectableVL.

ThemostprevalentARwaspainattheadministrationsite (53.0%),followedbydiarrhoea(2.2%),fatigue(1.7%),pyrexia(1.7%),headache(1.7%),andinduration(0.6%).The restofthepatients(39.1%)didnotpresentanyAR.Two patients(1.1%)discontinuedtreatmentduetoAR,onedueto painatthesiteofadministrationandanotherduetofatigue andweightloss[DS1].ThedurationofARhadamedianof 2days,andallofthemresolvedwithin7daysof administration.

ConclusionandRelevance Theintramuscularassociationof cabotegravirandrilpivirineeffectivelymaintainsVLsupressed anditissafe.Themostreportedadversereactionispainat theinjectionsite.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-061 CURRENTPRACTICEOFPAEDIATRICOFF-LABEL PRESCRIPTIONSINAPAEDIATRICHOSPITAL

1NMontiGuarnieri*, 1EAndresciani, 1AMFGarzone, 1SGuglielmi, 1FMura, 1LCollevecchio, 2CPolidori, 1APompilio. 1AziendaOspedalieroUniversitariadelleMarche, SodFarmacia,Ancona,Italy; 2UniversitàdegliStudidiCamerino,ScuoladiScienzedel FarmacoeProdottidellaSalute,Camerino,Italy

10.1136/ejhpharm-2024-eahp.396

BackgroundandImportance Dataconcerningdrugs’ dose,efficacyandsafetyinpaediatricareverylimitedandthisgapof knowledgeinducestheoff-label(OL)druguse.Astudy showedthat60%ofpaediatricprescriptionswereOLandthe mainOL-drugclasseswereantibacterials/antiasthmatics/analgesics.Overthelast30yearstheDrug-Agencyhasapproved lawstoensureanappropriateuseofOL-medications(Law 648/96,Law94/98,Law326/03,Law7/9/2017).

AimandObjectives Theaimofthisworkwastoevaluatethe paediatricOL-druguseandsafetyinourhospitalinthelast2 yearsaccordingtotheLaw94/98andtheLaw326/03.

MaterialandMethods WeanalysedOL-prescriptionsevaluated bytheHospital-OL-Committee(HOLC)(composedbyaHospital-Pharmacist/Pharmacologist/Clinician)fromJanuary-2021/ December-2022.Wecalculatedhowmanypaediatricpatients wereinvolved,whichOL-drugwasthemostprescribedand forwhattypeofdisease(ifrarediseaseaccordingtothe national-rare-disease-database),howmanypatientspresented anAdverse-Drug-Reaction(ADR).WeconsideredOLallthe Intravenous-Immunoglobulins(IgIv)thatwerenotprescribed

accordingtoourregional ‘Operative-Procedure-for-the-appropriate-use-of-IgIv’

Results TheHOLCevaluated258OLprescriptionsaccording totheLaw94/98and69(27%)administeredto49paediatric patients(twopatientsreceivedtwoOL-drugs).25different OL-drugswereusedtotreat33conditions(20rarediseases); sevendrugs(28%)didnothavethepaediatriclicense.The mostprescribedOLdrug(second-levelATC)wasJ06Immune-Serum-and-Immunoglobulins(20%)representedby IgIvtotreatIdiopathic-Dermatomyositis/Giant-cell-Hepatitis withAutoimmune-Haemolytic-Anemia/Chronic-Polyradiculoneuritis(withorwithoutanti-MOGantibodies)/AutoimmuneEncephalitis/Rasmussen-Syndrome/Opsoclone-Myoclone-SyndromefollowedbyL01-Cytostatic(17,5%)representedby bevacizumabtotreatgliomaandL04-immunosuppressant (17,5%)representedbyadalimumabtotreatBechet-Syndrome/ Systemic-Vasculitis.Inthesameperiodsixpatientsreceived OLdrugsaccordingtotheLaw326/03and4(67%)were paediatric.ThreeOL-drugswereusedtotreattworareconditions:twopatientsreceivedivacaftor/tezacaftor/elexacaftor+ivaacaftortotreatcystic-fibrosisandtwofenfluraminetotreat Dravet-Syndrome.FourADRsreferredtofourOLtherapies werereportedinfourpaediatricpatientsinducedbyPonatinib, IgIv,Arsenic-Trioxide,Rituximab.

ConclusionandRelevance ThepaediatricOLdruguseina commonpracticeandoverthelast30yearsseveralstrategies wereadoptedtoguaranteeanearlyandsafeaccesstopaediatricOL-medications.Forexampleinourhospital,since2007, alldrugsincludedintheHospital-Therapeutic-Formularycan beprescribed(withouttheHOLC ’sevaluation)iftheyareonlabelforindicationbutoff-labelforage/dosage/frequency.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-062 SAFETYEVALUATIONOFPEMBROLIZUMABIN MONOTHERAPY

1AAlmanchelRivadeneyra*, 2JGonzalezBartolome, 2MICastilloMedrano, 2RFernández Galán, 2LCFernándezLisón. 1Pharmacist,HospitalPharmacy,Cáceres,Spain; 2HospitalSan PedrodeAlcantara,Farmacia,Caceres,Spain

10.1136/ejhpharm-2024-eahp.397

BackgroundandImportance Checkpointinhibitionimmunotherapy(ICIs)havesubstantiallyimprovedtheprognosisfor patientswithmanyadvancedmalignancies.Despiteimportant clinicalbenefits,ICIsareassociatedwithauniquespectrumof sideeffectsknownasimmune-relatedadverseevents(irAEs). IrAEsincludedermatologic,gastrointestinal,hepatic,endocrine, andotherlesscommoninflammatoryevents.Therefore, promptrecognitionandmanagementofirAEsisimportant.

AimandObjectives Todescribetheoccurrenceofadverse events(AEs)duringtreatmentwithpembrolizumabmonotherapy,regardlessofindication,inroutineclinicalpractice.

MaterialandMethods Weconductedaretrospective,observationalstudythatincludedallpatientstreatedwithpembrolizumabfromSeptember2022toSeptember2023atourcentre. Thevariablescollectedwere age,sex,previousimmunological disease,numberofcyclesreceived,AEanddegreeoftoxicity, aswellasdelaysduetotoxicity.Thecomputerisedclinical historywasusedforthispurpose.AdverseeventswereclassifiedaccordingtotheNationalCancerInstitute(NCI)

CommonTerminologyCriteriaforAdverseEvents(CTCAE) classification.

Results Datawerecollectedfrom44patients(54.54%male) withameanageof71years±10.9SD.

29.54%diagnosedwithlungadenocarcinoma,27.27%with melanoma,11.36%withrenalcellcarcinoma,13.63%with non-small-cellepidermoidlungcancer,epidermoidcarcinoma, 2.27%withHodgkin’sLymphoma,2.27%withgastriccancer and2.27%withmalignantmesothelioma.Meantreatment duration42.65weeks±13.1SD.

22patients(50%)presentedsomeAE,beinggrade1: 59.45%,grade2:18.91%andgrade3–4:21.6%.Grade3–4 AEswere:threecasesofskintoxicity(37.5%),twocasesof neurotoxicity(25%),onecaseofarthralgias(12.5%),onecase oflimitingdiarrhoea(12.5%)andonecaseofhepatitis (12.5%).

Toxicityledtotemporarydiscontinuationoftreatmentin sixpatientsanddefinitivediscontinuationinthreepatients. ConclusionandRelevance Treatmentwithpembrolizumab monotherapyprovedsafe.Itwasgenerallywelltoleratedand AEswereasexpectedaccordingtotechnicalsheet,withno newtoxicityprofilesnoted.Cutaneousimmune-relatedadverse events(irAEs)wasthemostcommongrade 3adverseevents. Only8/44patientshadgrade3–4AE,beinglimitingin3/44 patients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-063 ADJUVANTEANALGESICSINTERACTIONS:HOWTO MANAGEPAININPATIENTSRECEIVINGORAL THERAPYFORBREASTCANCERTREATMENT

ASilva*,ATinoco,CFerraz,VGoncalves. HospitaldeBragaEPE,HospitalPharmacy, Braga,Portugal

10.1136/ejhpharm-2024-eahp.398

BackgroundandImportance Painisanunpleasantsensoryand emotionalexperienceassociated,orsimilartothatassociated, withactualorpotentialtissuedamage.Thisisadominant symptomincancerpatientsandaffectstheirday-to-daylife.

TheWorldHealthOrganizationpublishedananalgesiaimplementationmodelconsistingofthreelevels.Thismodel includesadjuvantanalgesics,whicharedrugsmarketedfor indicationsotherthanpain,veryusefulwhenassociatedwith opioidtherapy.

AimandObjectives Theaimofthestudywastocollectand analysethedruginteractionsthatexistintheconcomitantuse ofadjuvantanalgesicsusedtocontrolpaininpatientswith breastcancerundergoingoraltherapy,inahospitalinstitution.

MaterialandMethods Alistofadjuvantanalgesicsandoral medicationsusedinthetreatmentofbreastcancerwasdrawn up.

Theadjuvantanalgesicsstudiedwerecarbamazepine,gabapentin,oxcarbazepine,pregabalin,amitriptyline,duloxetine, venlafaxine,dexamethasone,methylprednisoloneandprednisolone.Theoralbreastcancerdrugswereabemaciclib,capecitabine,everolimus,lapatinib,olaparib,palbociclib,ribociclib, tucatinibandvinorelbine.

CancerDrugsInteraction,Drugs.comandLexicomp® were consultedandtheinteractionswerecollected,evaluatedand dividedintofourgroups:1)severeinteraction,2)moderate

interaction,3)weakinteractionsand4)noknown interactions.

Tableswerecreatedandanalgesicadjuvantsinteractionrates werecalculated.

Results

Thefollowingresultswereobtained 1)Severeinteraction:carbamazepine(77,8%),oxcarbazepine(55.6%),dexamethasone (33.3%),amitriptyline(11.1%)andvenlafaxine(11.1%).

2)Moderateinteraction:dexamethasone(55.6%),methylprednisolone(33.33%),oxcarbazepine(33.33%),prednisolone (33.33%)andvenlafaxine(33.33%),amitriptyline(11.1%), carbamazepine(11.1%)andduloxetine(11.1%).

3)Weakinteractions:amitriptyline(22.2%)andvenlafaxine (22.2%)andmethylprednisolone(11.1%)andprednisolone (11.1%).

4)Noknowninteractions:gabapentin(100%),pregabalin (100%),duloxetine(88.9%)amitriptyline

(55.6%),methylprednisolone(55.6%),prednisolone(55.6%) venlafaxine(33.3%),carbamazepine(11.1%),dexamethasone (11.1%)andoxcarbazepine(11.1%).

ConclusionandRelevance Thestudyconcludesthatthereare manyserious,moderateandweakinteractionstobetaken intoaccountwhentreatingpaininpatientsundergoingoral therapyforbreastcancer.Dependingonthedegreeofinteraction,thepharmacistmaysuggestreplacingorcloselymonitoringthesepatients.

Thesedatareinforcetheimportanceofthepharmacistas anelementofthehealthcareteam,providinginformationin decision-makingprocessandimprovingpatienttherapeutic outcomes.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://cancer-druginteractions.org/checker

2.https://www.drugs.com/drug_interactions.html

3.https://www.uptodate.com/drug-interactions

ConflictofInterest Noconflictofinterest.

5PSQ-064 ANALYSISOFPHARMACEUTICALINTERVENTIONSON DIRECTACTINGORALANTICOAGULANTSINA TERTIARYCAREHOSPITAL

SMagantoGarrido,MMonteroLázaro,SFernándezPeña,MECárdabaGarcía, MDLMHernandoVerdugo,PBlancoGarcia*,CGuitianBermejo,CGonzálezGonzález, AFijóPrieto,MTSánchezSánchez. HospitalClínicoUniversitariodeValladolid,Farmacia Hospitalaria,Valladolid,Spain

10.1136/ejhpharm-2024-eahp.399

BackgroundandImportance Directactingoralanticoagulants (DOACs)areagroupofdrugsusedforthepreventionof strokeandsystemicembolisminpatientswithatrialfibrillation.Astheyareconsideredhigh-riskdrugs,itisimportant thatthedosageiscorrectlyadjusted.

AimandObjectives Toanalysepharmaceuticalinterventions (PI)onDOACinelectronicprescribingtohospitalisedpatients inatertiaryhospitalandtheirdegreeofacceptancebyprescribers.Todetecterroneousdosageadjustmentsand,by meansofapharmacotherapeuticrecommendation,toadapt theprescriptiontothepatient‘sprofileinordertoreducethe riskofadverseeffectsassociatedwithDOAC.

MaterialandMethods Observational,retrospectivestudy.All patientswhowereprescribedaDOAC(apixaban,rivaroxaban, edoxabananddabigatran)duringtheiradmissionbetween1

January2022and31December2022wereincluded.Thevariablescollected,fromthe ‘UnidosisManagement’ moduleof theFarmaToolssoftwareapplication(v.3.0),were:dateofprescription,age,sex,creatinineclearance,drug,regimen,PIperformedandacceptancebytheprescriber.

Results Atotalof892DOACsprescriptionswereevaluated. Interventionwasnecessaryin53patients(5.94%).The DOACsinvolvedwere:29apixaban(55%),14rivaroxaban (26%),nineedoxaban(17%)andonedabigatran(2%).The medianageofpatientsundergoingPIwas85years(75–95), with34men(64%).ThePIperformedwere:

-adjustmentforpoorrenalfunctionin31patients(59%)

-adjustmentforpatientweightin11patients(20%).

-unjustifiedduplicationofanticoagulationtherapywith DOACandlow-molecular-weightheparin(LMWH)innine patients(17%).

-modificationofthedoseoftheDOACprescribedon admissionduetopoortreatmentreconciliationinonepatient (2%).

-doseincreaseduetounder-dosinginonepatient(2%).

Twenty-sixinterventionswereaccepted(49%).

ConclusionandRelevance MostDOACprescriptionsare appropriatetothepatient‘ssituation.

Incasesoferror,themostfrequentinterventionisdose adjustmentduetopoorrenalfunction,followedbyweight andsimultaneousprescriptionofDOACandLMWH.

TheoveralllevelofacceptanceofthePIishigh.

Periodicweightandrenalfunctioncontrolsareidentifiedas pointsforimprovementinordertoassesspossibledose adjustmentsandimprovetheeffectivenessoftreatment.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-065 INTESTINALPERFORATIONAFTERCRSANDICANSIN ACAR-TTREATEDPATIENT:ACLINICALCASEREPORT 1GMenardi*, 1GTarasco, 2ACastellino, 1MViglione, 1MEBersia, 1MAllione, 1DDegioanni, 1SGastaldi, 1LInfante, 1EGrande, 1CFruttero. 1AziendaOspedalieraSanta CroceeCarle,HospitalPharmacy-AziendaOspedalieraSantaCroceeCarle,Cuneo,Italy; 2AziendaOspedalieraSantaCroceeCarle,Haematology-AziendaOspedalieraSantaCroce eCarle,Cuneo,Italy

10.1136/ejhpharm-2024-eahp.400

BackgroundandImportance Brexucabtageneautoleucel,an autologousanti-CD19CART-celltherapywithachimeric antigenreceptor(CAR),representsthefirstFDA-EMA approvedCAR-Tforrelapsed/refractorymantlecelllymphoma (MCL).WhileCART-celltherapyisaninnovation,italso comeswithuniquetoxicities.

AimandObjectives Here,wedescribethecaseofapatient withrelapsed-refractorymantlecelllymphomatreatedwith brexucabtageneautoleucelwhoexperiencedCytokineRelease Syndrome(CRS),ImmuneEffectorCell-AssociatedNeurotoxicitySyndrome(ICANS),evaluatedwithaNaranjoscalescore of5–8,andintestinalperforationinthedaysfollowingtherapy.ThisabstracthasbeenwritteninordertosharetheclinicaldifficultiesofCAR-Tpatientmanagementandtohighlight thepotentialroleofanti-IL6medicinesinthissingular adversedrugreaction.

MaterialandMethods Thepatientreceivedtocilizumaband dexamethasoneforCRS,effectivelymanagingitbutfacedsubstantialICANSsymptoms.Anakinraandhigh-dose

dexamethasoneledtonotableimprovement.Onday+34, acuteabdominalsymptomsemerged,leadingtoaCTscan revealingdiverticulitiscomplications,necessitatingexploratory laparotomyandcolonicresection.Remarkably,histological analysisshowednolymphomaorextensiveCART-cellinfiltrationbutrevealedneutrophilicinflammationandCytomegalovirus(CMV)presence,treatedwithantivirals.

Results WiththeincreasingadoptionofCAR-Ttherapyin haematology,theaccuratemanagementofsideeffectsbecomes crucial.Asearchinourcountry ’spharmacovigilancedatabase didnotrevealotherreportsofintestinalperforationpossibly relatedtotocilizumabinpatientstreatedwithbrexucabtagene autoleucelapartfromthiscase,evaluatedwithascoreof1–4 ontheNaranjoscale.Clinical-dataandpost-marketingsurveillancehavereportedanincreasedriskofgastrointestinalperforationinpatientstreatedwithaxicabtageneciloleucel,but therehavebeennoreportsofintestinalperforationassociated withbrexucabtageneautoleucel.However,thesettingremains similar:patientsundergolymphodepletingchemotherapyand receiveahighdoseofIL-6receptorinhibitorand corticosteroids.

ConclusionandRelevance IntestinalperforationinCAR-T treatedpatientsismentionedintheESMO-guidelinesforthe managementofImmuneEffectorCell-AssociatedHypersensitivity(ICAH)andacorrelationbetweentocilizumabandintestinalperforationshasbeensuggested(5–8Naranjoscale score),asobservedinclinicaltrialsandpost-marketinganalysis amongpatientswithrheumatoidarthritis.ThiscaseunderscorestheimportanceofmeticulousmonitoringandunderstandingCAR-Ttherapyintricaciesandtoxicitymanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-066 SURVIVALANALYSISOFREGORAFENIBINPATIENTS WITHCOLORECTALCANCER.FIRSTRESULTSOF REGORAFENIBUSEINREALCLINICALPRACTICE

CJiménezMéndez*,MAToledoDavia,LTorralbaFernández,RPrietoGalindo,AGarcia Perez,RLópezÁlvarez,ADominguezBarahona,ARRubioSalvador,PMoyaGomez. Pharmacist,HospitalPharmacy,Toledo,Spain

10.1136/ejhpharm-2024-eahp.401

BackgroundandImportance InSpain,Regorafenibwasmarketedin2013;theresultsofitsuseinreal-worldclinical practicemustbeanalysed.Regorafenibasmonotherapyis indicatedforthetreatmentofmetastaticcolorectalcancer.

AimandObjectives Toevaluatetheresultsoftheuseofregorafenibinpatientswithcolorectalcancer.Tocomparethese resultswiththoseobtainedinpivotalclinicaltrials.

MaterialandMethods Anobservationalandretrospectivestudy (March2015toJuly2023)wascarriedoutinallpatients withregorafenib.Demographicvariables(age,sex)andclinical variableswerecollected:ECOGatbaseline,previoustreatment,KRASmutationalstatusandadversedrugreaction.The Kaplan-Meiermethodwasusedtocalculateoverallsurvival (OS)andprogression-freesurvival(PFS).Datawereanalysed withtheSPSSv.21statisticalprogram.

Results Weanalysed44patientswithamedianageof61[46–84]years;30men(68.2%).Baselinecharacteristics:100% presentedmetastases(hepatic(18.1%),pulmonary(11.4%)or both(70.5%)).21patientswithECOG0,17withECOG1, 6withECOG2.97.7%ofthepatientshadreceivedprevious

chemotherapytreatment.KRASmutationalstatuswasdeterminedin75%ofpatients,42%ofwhomhadmutatedKRAS.

Someadversereactionswerereportedin68%ofthe patients,andtreatmentwassuspendedin13%.Themost reportedadversereactionwasasthenia(N=12),followedby hand-footsyndrome(N=6)andanorexia(N=6);arterial hypertension,aphoniaandskintoxicitywerealsoreportedas adversereactions.

Survivalanalysisresults medianPFSwas3.9months(95%CI 2.9–4.9)vs.1.9monthsinthepivotaltrial,with30events (70%).MedianOSwasnotreached,withonlynineevents (20%).

ConclusionandRelevance Inourcohort,medianOScouldnot becalculated,whichcouldbejustifiedbyasmallsamplesize orduetoinsufficientfollow-uptime.PFSresultsarecomparablewiththoseobtainedinthepivotaltrial(CORRECT). Morestudiesareneededtobetteranalysethereal-liferesults ofregorafenib,aswellasalargernumberofpatientstobe analysed.Itwouldbeessentialtoconsidertheuseofregorafenibinpatientswithearlierstagesandtoanalyseitspotential benefit.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-067 DRUGUTILISATIONPROFILESOFADVANCED THERAPYMEDICINALPRODUCTS:AREAL-WORLD

EVIDENCESTUDY

1MSerino*, 2MGaldo, 3UTrama, 1SMucherino, 1EMenditto, 1VOrlando. 1CIRFF-Center ofPharmacoeconomicsandDrugUtilisationResearch-Naples-Italy,Departmentof Pharmacy-UniversityofNaplesFedericoIi-Italy,Naples,Italy; 2AziendaOspedaliera ‘OspedalideiColli’,UosdGestioneClinicadelFarmaco – Responsible,Naples,Italy; 3RegionalPharmaceuticalUnit,U.O.D.06PoliticadelFarmacoEDispositivi,Naples,Italy

10.1136/ejhpharm-2024-eahp.402

BackgroundandImportance Advancedtherapymedicinalproducts(ATMPs)representtheforefrontofhealthcareinnovation.

DespitetheapprovalofthefirstATMPinItalyin2016,there iscurrentlyalackofscientificevidenceconcerningtheutilisationpatternsofATMPs.

AimandObjectives StudyaimwastoevaluatethedrugutilisationpatternsamongpatientsreceivingATMPtreatmentsin Italy.

MaterialandMethods Retrospectivestudyusingdatasourced fromtheMonitoringRegistriesoftheItalianMedicine Agency,specificallytheDrugProductRegistry(DPR)containinginformationondispensedtreatmentsandclinicaldatafor patientsutilisingATMPsinCampaniaRegion(~6million, 10%ofthenationalpopulation)andresidentstreatedinadifferentItalianRegion.Finalcohortincludedindividualswho receivedatleastoneprescriptionforATMPdrugsintheItalianmarketbetween2016and2023.Weanalysedprescription patternsfocusingontheindextreatment,diagnoses,treatment interruptions,mortalityratesandadverseevents.

Results Intotal,92patientsinitiatedATMPtreatments between1January2016and1September2023.21.6% receivedvoretigeneneparvovec,25%onasemnogeneabeparvovec,22.8%tisagenlecleuceland21.7%axicabtageneciloleucel. Theoveralloccurrenceofadverseeventswaslow(1.1%),primarilyassociatedwithautologoushumancornealepithelial cellstreatments.Theoverallmortalityratewas12%,affecting onlytwodrugs:28.6%tisagenlecleuceland25.0%

axicabtageneciloleucel.Notably,nearly90%ofsubjectscompletedtheirtreatmentwithoutexperiencingadverseeventsor mortality.

ConclusionandRelevance ThisstudyhighlightsthelowoccurrenceofadverseeventsandmortalityassociatedwithATMPs, emphasisingtheirpotentialasapromisingfrontierfortreating severediseaseslackingtherapeuticalternativesinreal-world scenarios.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-068 THEHOSPITALPHARMACIST‘SINTERVENTIONSIN THEPOST-MARKETINGPHARMACOVIGILANCEOF ANTI-ASTHMATICBIOLOGICS:AREAL-LIFEANALYSIS 1MSantonocito*, 1CBotto, 1GCancellieri, 1EDeLuca, 2PPolidori. 1UniversitàdegliStudidi Palermo,Ssfo-ScuoladiSpecializzazioneinFarmaciaOspedaliera,Palermo,Italy; 2Ospedali RiunitiVillaSofia – Cervello,UOCFarmacia,Palermo,Italy

10.1136/ejhpharm-2024-eahp.403

BackgroundandImportance Pharmacovigilanceisanimportant toolformonitoringdrugpost-marketingsafety.HospitalPharmacist(HP)playsaprimaryroleintheidentificationofsuspectedAdverseDrugReaction(ADRs)duetohisdirect contactwiththepatient.Infact,throughtheapplicationof indirectpharmacovigilancetoolsinareal-lifecontext,canlead totheidentificationofhiddenorunderestimatedADRs.

AimandObjectives Theaimofthestudywastoevaluatethe increaseofsuspectedADRsreportstobiologicaldrugsforthe treatmentofsevererefractoryhypereosinophilicasthma(omalizumab,dupilumab,mepolizumabandbenralizumab)obtained followingtheinterventionsofHP.

MaterialandMethods A7-months(October2022toMay 2023)post-marketingsafetystudywasconducted.Thedata werecollectedviaaquestionnaireconsistingoftwosections: generaldata(sex,age,comorbidities,drugstakenandstartof therapy)andlistreportingthemostcommonsideeffects wherethepatientcanindicateoneormoresuspectedADRs amongthosereportedand/orenteranysideeffectthatis potentiallylinkedtothedrug.Thequestionnairewasillustratedandgiventothepatientsatthetimeofdispensing. Thedatawerealsocomparedwiththeclinicaltrialsandall adversereactionsreportedbypatientswereenteredintothe pharmacovigilancenetwork.

Results InitiallytherewerenoreportsofADRsforanyofthe drugsconsidered.FollowingtheHP ’sinterventions,55%(55/ 100)ofpatientsreportedoneormoreadversereactions (Mepolizumab65%,26/40;dupilumab54.5%,12/22;omalizumab53.3%,8/15;benralizumab39.1%,9/23)bringingthe numberofreportsto122(76mepolizumab;14dupilumab; 16omalizumab;16benralizumab).Thestudyalsohighlighted ADRsnotreportedinthetrials;formepolizumabwerefound diffusepetechiae,haemorrhagicperiodandfrequenturination problemswithrecurrentcystitis(3.5%;1/26)whilefordupilumabwasfoundahigherincidenceofherpeticdevelopment andalopecia(4.5%;1/22).Ahigherpercentageofpyrexia wasfoundforbenralizumabcomparedtotrials(3%;12/320 vs13%;3/26).

ConclusionandRelevance Thedataanalysisconfirmedthe importanceoftheHProleinpharmacovigilance.Theinvestigationinareal-worldcontextcharacterisedbyahighheterogenicityofpatientcharacteristics(age,comorbidity,adherence)

ledtoanimprovementintheincidenceofADRsreportsand tothehighlightingofsideeffectsnotdetectedduringtheclinicaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-069 COMPARISONOFRENALGLOMERULARFILTRATION ESTIMATIONFORMULASINVANCOMYCIN PHARMACOKINETICMONITORING

1TESalinasMuñoz*, 1MDMAlañonPardo, 2MCGonzalezEscribano, 2CNavarroCamacho, 2CNotarioDongil, 2NAndresNavarro. 1HospitallaManchaCentro,Pharmacy,Alcazarde SanJuan,Spain; 2HospitallaManchaCentro,Pharmacy,AlcázardeSanJuan,Spain

10.1136/ejhpharm-2024-eahp.404

BackgroundandImportance Thisretrospectivestudyaimedto assesstheutilityofrenalglomerularfiltrationrate(GFR)estimationformulas,includingCockcroft-Gault(CG),Modification ofDietinRenalDisease(MDRD-4),andChronicKidneyDiseaseEpidemiology(CKD-EPI),inthepharmacokineticmonitoringofvancomycin.

AimandObjectives ThestudyaimedtoevaluatethecorrelationbetweenestimatedGFRusingdifferentformulasandthe actualclearanceofvancomycininpatients,providingvaluable insightsforpharmacokineticmonitoringanddosing adjustments.

MaterialandMethods Retrospectivestudy(October2022to March2023)onpatientsmonitoredbytheClinicalPharmacokineticsUnitduringvancomycintreatment.Inclusion criteria:age 18, twovancomycintroughplasmaconcentrations(Cmin),andstableserumcreatinine(+/-0.5 mg/dL)duringmonitoring.Rec ordedvariables:gender,age, weight(kg),height(cm),serumcreatininemg/dL),estimatedglomerularfiltrationrate(eGFR)(mL/min)using variousformulas,observed vancomycinCmin(mcg/mL), andpredictedCmin(mcg/mL)basedonBayesianadjustment(software:Mw-Pharm++ ® ).Linearregressionanalysedtherelationshipbetween initialestimatedvancomycin plasmaclearance(Clp)us ingeGFRdataandpatient ‘ s actualClpobtainedthroughBa yesianestimation(consideringmonitoredvancomycinconcentrations).

Results Atotalof34patientswererecruited(65.70%males, meanage±standarddeviati on:68.06±16.89years).The meanestimatedglomerularfiltrationrate(GFR)valueswere: 84.44±49.87mL/min,116.23±52.95mL/min,91.53± 28.22mL/minfortheCG,MDRD-4,andCKD-EPIformulas, respectively.ThemeanobservedvancomycinCmininthe secondanalyticaldeterminationwas16.13±6.56mcg/mL. ThemeanpredictedCminvalueswere17.15±8.08mcg/ mL,14.03±8.26mcg/mL,and14.57±7.56mcg/mLfor theCG,MDRD-4,andCKD-EPIformulas,respectively. Basedonthecoefficientsofdeterminationcalculatedfrom theregressionlines,83%,76%,and86%ofthevariations foundintheactualvancomycinclearancecanbeexplained byvariationsintheestimatedclearanceusingGFRdata obtainedwiththeCG,MDRD-4,andCKD-EPIformulas, respectively.

ConclusionandRelevance Inthisstudy,theCockcroft-Gault andCKD-EPIformulasexhibitedbettercorrelationwithactual vancomycinclearancecomparedtoMDRD-4.Thefindings suggestapotentialriskofoverdosingwhenusingMDRD-4.

AlthoughinitialvancomycindosingbasedonestimatedGFR formulasprovidesareasonableapproach,pharmacokinetic monitoringofplasmaconcentrationsremainsasaferapproach forantibioticdosing.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-070 DUPILUMABISAMONOCLONALANTIBODYUSED FORTHETREATMENTOFATOPICDERMATITIS.THIS STUDYEVALUATESTHEEFFECTIVENESSAND PERSISTENCE.DUPILUMABPRESENTSGOOD EFFECTIVENESSANDPERSISTENCE

VEsteve*,MJCompany,EVicente,ARiera,SGarcia,MDBelles,RFerrando. Castellon UniversityGeneralHospital,HospitalPharmacy,Castellon,Spain

10.1136/ejhpharm-2024-eahp.405

BackgroundandImportance Atopicdermatitis(AD)isarelapsinginflammatoryskindiseasecharacterisedbysevereitching, skinlesionsanddysregulationoftheimmunesystem.Dupilumabisananti-IL-4/13monoclonalantibodyapprovedforthe treatmentofmoderatetosevereAD.

AimandObjectives Toevaluatetheeffectivenessandpersistenceofdupilumabinmoderate-severeAD.

MaterialandMethods Observationalandretrospectivestudyof patientsontreatmentwithdupilumabformoderate-severeAD fromMarch2020toSeptember2023inatertiaryhospital. Variablescollected:age,sex,previoususeoftopical(Ct)and systemic(Ci)corticosteroids,topicaltacrolimus,antihistamine andcyclosporine,dosage,anddurationoftreatment.The effectivenessvariablesaretheEASI(EczemaAreaandSeverity Index)andIGA(InvestigatorGlobalAssessment)scalesin weeks16,24and52.Treatmentwasconsideredeffective whentheEASIhadbeenreducedby50%(EASI50)andwhen theIGAhadbeenreducedby<2points.Datawereobtained fromtheelectronicmedicalrecord(Abucasis®).Quantitative variablesweredescribedasmean(minimumandmaximum) andqualitativevariablesaspercentages.

Results Atotalof39patientswereincluded,meanage30.7 years(4–64),58.9%ofthepatientsweremale.100%ofthe patientshavewornCtand30%continuetowearthem.69% havetakenCi,31%tacrolimus,79%antihistamines,66% cyclosporine.56%ofpatientsareonthe300mgevery2 weeksregimen.Themediantreatmenttimewithdupilumabin theincludedpatientswas21.7months(0.9–68.4).Atweek 16,89.6%(n=33)oftheincludedpatientsreachedEASI50, atweek24EASI50wasreachedby93%(n=32)andat week52itwasreachedby100%(n=25).63%(n=33)of thepatientsachievedanIGAof0–1atweek16,81%at week24andatweek52thepercentagewas100%(n=27) achievinganIGAof0–1.10%ofpatientshadtreatmentfailurewithDupilumab,7%switchedtotralokinumaband3%to upadacitinib.

ConclusionandRelevance Dupilumabtreatmentshowsgood persistenceandeffectivenessinAD,althoughfurtherstudies oflongerdurationareneededtoestablishtheusefulnessof dupilumabinlong-termclinicalpracticeconditions.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-071 MULTIDISCIPLINARYMANAGEMENTOFDRESS SYNDROME:ACASEREPORT

YMenguianoRomero*,MCorralesPaz,ÁOcañaDeLaRosa,MERodríguezMateos, MJHuertasFernández,MVManzanoMartín. PuertadelMarUniversityHospital,Hospital Pharmacy,Cádiz,Spain

10.1136/ejhpharm-2024-eahp.406

BackgroundandImportance DressSyndrome(DS)isavery rarebutpotentiallylife-threateningdrug-inducedhypersensitivitysyndrome.Itischaracterisedbyanextensiveskinrash associatedwithvisceralorganinvolvement,lymphadenopathy, eosinophiliaandatypicallymphocytosis.

DrugsmostfrequentlyassociatedwithDSareallopurinol anddapsone.Otherlessfrequentlyassociatedarebeta-lactam antibiotics.

AimandObjectives Describethecaseofapatientwithsurgicallyremovedsquamouscellcarcinoma(SCC)whodevelops surgicalwoundinfectionandthemultidisciplinaryintervention foritsmanagement.

MaterialandMethods Weconductedaretrospectivedescriptive studyinapatientintreatmentwithantibioticswhodeveloped DS.DatawereobtainedfromDiraya(digitalclinicalhistory).

LiteraturereviewwasperformedinUptoDate.

Results Thecaseofa70year-oldfemalepatientdiagnosed withSCCispresented.Noepisodesofallergytobeta-lactam antibioticswaspreviouslydescribed.Patientunderwentsurgical treatmenton1February2023.Bacterialgrowthwasisolated andceftazidimewasstartedaccordingtotheantibiogram.On 16February2023purulentmaterialwascollectedafteropeningtheduramater.A literaturereviewoftheavailableevidenceforsuspectedinfectionmeningealwithrecentsurgery wasperformed.Treatmentwithceftazidimeorcarbapenemics wasrecommended. Pseudomonaaeruginosa resistancetoceftazidimewasisolatedon23February2023andantibiotherapy wasmodifiedtomeropenem.

Afterseveraldaysoftreatment,atorpidclinicalcoursewas observedwithelevationofC-reactiveprotein,deteriorationof renalfunction,transaminasesincreased,leucocytosis,eosinophiliaandappearanceoferythematousmacules.Anatypical DSwasdiagnosed(3/7diagnosticcriteriascore). WeperformedareviewofthepossiblecausesthatcouldbeassociatedwithDS,aswellasamedicationreview.Technicalsheets ofceftazidimeandmeropenemwerereviewed.InbothDSis describedwithanunknownfrequency.Naranjoalgorithms establishthecausalityrelationshipbetweenthetwo(scoreof 2).TheSpanishPharmacovigilanceCentrewasnotified.Multiorganfailurecompatiblewithsepsiswasobservedandthe patientdiedthreedayslater.

ConclusionandRelevance DSshouldbeconsideredinpatients witheosinophilia,skinrashesandinternalorganinvolvement whenassociatedwithrecentbeta-lactamantibioticstreatment intheabsenceofothercauses.EarlydetectionofDSisessentialtoavoidafataloutcome.

Thepharmacist’scollaborationinmultidisciplinaryteams andthemonitoringofpossibleadverseeventsassociatedwith drugsisessential.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-072 TREATMENTWITHGALCANEZUMABINREAL-WORLD DATA:SAFETY

1RDíazPerales*, 1ALinaresAlarcón, 1BLópezBautís, 1ALunaHiguera, 2RSaldañaSoria. 1HospitalRegionalUniversitariodeMálaga,UnidaddeGestiónClínicadeFarmacia, Málaga,Spain; 2HospitalMaternoInfantildeMálaga,UnidaddeGestiónClínicade Farmacia,Málaga,Spain

10.1136/ejhpharm-2024-eahp.407

BackgroundandImportance Galcanezumabisarecombinant humanisedmonoclonalantibodythatbindstocalcitoningenerelatedpeptide(CGRP).Itisusedfortheprophylaxisof chronicmigraineinadultsduetoIthasdemonstratedits safetyandeffectivenessinreducingthefrequencyofepisodes andimprovingpatientfunctionalityintheEVOLVE-1, EVOLVE-2andREGAINstudies.However,thereisnoevidenceonitseffectiveness,toleranceandcausesoftreatment limitationinareal-worlddata.

AimandObjectives Todescribethefrequencyofdiscontinuationsoftreatmentwithgalcanezumabandevaluatethecauses responsibleforthesesuspensionsinourpatientcohort.

MaterialandMethods Observational,retrospectiveanddescriptivestudydevelopedwithpatientsdiagnosedwithmigraine whohavereceivedtreatmentwithgalcanezumabandithas alreadybeensuspendedatthetimeofthestudy(September 2023)underfollow-upbythepharmacyserviceofatertiary hospital(years2020–2023).Variablescollected:demographic (sexandage)andclinical(durationoftreatmentwithgalcanezumab,diagnosis,monthlymigraineepisodes,previoustreatments,ratereasonsfordiscontinuation:loweffectiveness, definedbyareductionbelow50%inmigraineattacks,intoleranceandpersonaldecision).

Results 110patientswerestudied,allofthemwithadiagnosis ofchronicmigraine.76.5%women.Meanage:44.7years (22–75).

Meannumberofpreviousmigraineepisodesover8 months.Allofourpatientshadreceivedprevioustreatment withthreeormoretreatments(betablockers,antiepileptics, antidepressantsandbotulinumtoxin)withoutsatisfactory experience.

17patientsdiscontinuedtreatmentwithgalcanezumabin ourhospitalduringthestudyperiod(15.5%).Suspension rates:64.7%loweffectiveness;29.4%intolerance(localreaction:twopatients;weightgain:one;constipationandgeneraliseditching:one);5.9%personaldecision(upcoming pregnancy).

ConclusionandRelevance Galcanezumabhashadalowdropoutrateinourpatients,makingusconsideritasafedrugin ourcohort.

Thepercentageofsuspensionsduetodrugintolerancehas beenverylow,comparedtothepivotaltrialsinwhichitrepresentedthemostfrequentcause(mainlylocalreactionsto theinjection).

Inroutineclinicalpractice,wecontinuetomonitorside effectsofourpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-073 RISKSCOREFORDRUGDISCREPANCYAND ADHERENCEINCLINICALTRIALPATIENTS

ETejedorTejada*,JPeraltaAlvarez,BGomezPerez,STenaMestre,SBalsellsVives,MDe RibaSoler,MBoillosFernandez,ATorrentRodriguez,TLizondoLopez,DSoyMuner. HospitalClinicBarcelona,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.408

BackgroundandImportance Themainchallengeinclinicaltrials(CT)istodetectpooradherencetooraltreatmentswhich mayinfluenceontreatmenteffectiveness.Therefore,atoolis neededtohelpusstratifypatientsaccordingtotheriskof non-compliance.

AimandObjectives Toassessadherenceinpatientswithoral experimentaltreatmentandvalidateapredefinedscoreto detectpatientswithpoorornon-adherence.

MaterialandMethods Anexperimental,prospective,singlecentrestudywasconducted,withmainlyonco-haematologic patients,inaclinicaltrialsunitofatertiaryhospital.Ascoringwasdesignedtodetectnon-adherence.Patientswerestratifiedbasedondemographicinformation(age,native),clinical data(pathology,status)andtrialcharacteristics(phase,protocol,complexity).Allriskvariableswereatthesameleveland eachreceiveda1-pointscore.Risklevelofnon-adherence wasconsideredhigh(4–7),medium(3)andlow(1–2).

Patientswerecontactedbytelephonetodetectcompliancediscrepancies,patientconcerns/questionsinreferencetothereal adherence.ThesoftwareusedwereSAP(clinicalhistory),Fundanet(clinicaltrialplatform),Excel(datacollectionform).

TheprojectwasapprovedbyHospital’sEthicsCommittee.

Results Thirty-fivepatientswererecruitedfrom1Julyto20 September2023.Themeanageofthepatientswas63.4 years.Themeannon-adherencescorewas2.2(±0.92).Nine outof35(25.7%)ofthepatientswereontreatmentwith morethanonedrugatthesameCTand80%wereontreatmentwithotherdrugsoutsidetheclinicaltrial.75%ofthe patientswereaccompaniedbyanotherperson(familyorpartner)whenstartingtreatmentatthepharmacy´sclinicaltrial unit.TheCTphaseswiththehighestrecruitmentwere:II (29.3%)andIII(27.4%).In95%ofpatientsnoconcernson drugadministrationweredetected,witha ‘real’ adherence rateof92%.

ConclusionandRelevance Clinicaltrialpatientsincludedin thisstudyshowedgoodadherencetotheexperimentaltreatment.However,alargersamplesizemightbeneededtoverifytheseresults.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.GillaniSW,GulamSM,ThomasD,GebreighziabherFB,Al-SalloumJ, etal .Role andServicesofaPharmacistinthePreventionofMedicationErrors:ASystematicReview. CurrDrugSaf. 2021; 16 (3):322–328.doi:10.2174/ 1574886315666201002124713.PMID:33006539.

ConflictofInterest Noconflictofinterest.

5PSQ-074 PHARMACEUTICALINTERVENTIONSINPAIN MANAGEMENT

1MCuyBueno*, 1MGilabertSotoca, 1MBardollCucala, 1JRiusPerera, 1SMCanoMarron, 1MMartínezSogues, 2MNevotBlanc, 1IManguesBafalluy, 1JASchoenenbergerArnaiz. 1HospitalUniversitariArnaudeVilanova,Pharmacy,Lleida,Spain; 2HospitalUniversitari SantaMaría,Pharmacy,Lleida,Spain

10.1136/ejhpharm-2024-eahp.409

BackgroundandImportance Hospitalpainprotocolisacrucial elementinimprovingpatient’squalityoflife,aseffectivepain managementnotonlyalleviatessufferingbutalsopromotes recovery.

Theinvolvementofthepharmacistthroughpharmaceutical interventions(PIs)facilitatestheimplementationofthepain protocol.

AimandObjectives TodescribeandanalysePIsassociated withanalgesicmedicationsinaccordancewiththeinstitutional painprotocolforpatientsadmittedtoasecondarylevel hospital.

MaterialandMethods Anobservational,descriptiveandretrospectivestudythatanalysePIsconductedwiththeComputerizedPhysicianOrderEntry(CPOE)Silicon® duringthe validationofprescriptionscontaininganalgesicsinhospitalised patientsfromJanuarytoDecember2022.

Results 455PIswererecordedwith64%oftheminvolving surgicalpatients.ThemostcommontypeofPIsweredose modification(272/455;59,8%);drugsuspension(138/455; 30,3%);drugchanges(14/455;3,1%);frequencyadjustments (13/455;2,9%);reconciliationuponadmission(11/455; 2,4%);routeofadministrationorpharmaceuticalformmodification(4/455;0,9%)andincompletemedicalorder(3/455; 0,6%).

MedicationsmostfrequentlyinvolvedinPIsweredexketoprofen(116/455;25,5%),metamizole(113/455;24,8%),tramadol(94/455;20,7%)andacetaminophen(87/455;19,1%).

AmongdexketoprofenPIs,39,7%(46/116)wereattributed tocontraindications.PIsrelatedtoexcessivedosagewere accountedfor57,5%(65/113)ofallmetamizoleinterventions, 72,3%(68/94)oftramadolinterventionsand70,1%(61/87) ofacetaminopheninterventions.Furthermore,therewere34 IPdetectinginteractionsofwhichmetamizolewasimplicated in79,4%(27/34)ofthecases.

Thelevelofacceptanceamongdoctorswasasfollows: 61,8%overallwithindividualacceptanceratesof79,3%(69/ 87)foracetaminophen,68,1%(77/113)formetamizole, 55,3%(52/94)fortramadoland53,4%(62/116)for dexketoprofen.

ConclusionandRelevance DosemodificationwasthemostfrequentPIs,mainlyduetoexcessivedosage.

ThedrugsthatreceivedthemostPIsweredexketoprofen andmetamizole.

ThedegreeofacceptanceofPIswashigh,whichsupports theintegrationofthepharmacistinthemultidisciplinaryteam andimprovesthesafetyofthepatient’sanalgesictreatment.

Thisstudyprovidesusefulinformationtodetectareasfor improvementintheimplementationofpainprotocolsandthe importanceofinterdisciplinarycollaboration.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-075 ADHERENCETOLOCALANTIBIOTICPRESCRIBING GUIDELINESWITHIN48HOURSOFINPATIENT ADMISSION

1MHeislerova*, 2PPaterova, 1MNovosadova, 1PRozsivalova, 3HDrábková. 1University Hospital,HospitalPharmacy,HradecKrálové,CzechRepublic; 2UniversityHospital,Clinical Microbiology,HradecKrálové,CzechRepublic; 3UniversityHospital,QualityManagement, HradecKrálové,CzechRepublic

10.1136/ejhpharm-2024-eahp.410

BackgroundandImportance Optimisationofantibiotic(ATB) administrationisvitalforimprovinginfectiontreatmenteffectiveness.AnATBstewardshipprogrammecanhelpclinicians rationaliseATBprescribing.Thereisnosimpleandeffective tool.Lastyearweconductedanadherenceauditwiththe localguidelines(LG).

AimandObjectives Thisstudyaimedtoreviewtheadherence ofclinicianstoLGintermsofATBprescribingand administration.

MaterialandMethods Single-centreprospectiveauditforprescribedATBtreatmentinatleast50inpatientsadmittedto theuniversityhospitalwithATBinitiationwithinthefirst48 hoursofadmission.AdherencetoLGforATBwasassessed usingtheadoptedaudittool.1 Thepatientselectionwasgeneratedfromthehospital’ selectronicprescribingsystembased onemergencydepartmentadmissionandsubsequenthospitalisationandATCcodeforATBprescribedwithin48hours. Adherencewasassessedasfullc ompliancewithLG.Partial adherencewasattributedwhenminordeviationfromLG occurred.Nonadherencewasdefinedasanincorrectchoice ofATB.

Results Duringtheauditedperiod,therewere1,842new admissionsandATBwereinitiatedwithin48hoursin478 inpatients(26%).Atotalof74patientswith117ATBagents wereauditedand77indicationsfornewlyprescribedATB therapywerefound.For46indications(59.7%)ATBwas giveninanindicationthatisincludedinavailableLG.The overalladherencetoATBLGwasobservedin33indications (i.e.71.7%of46).Partialadherencewasfoundin11indications(23.9%).Non-adherencewasshownintwoindications (4.3%).TheseinvolvedATBforsurgicalprophylaxis.Outof 117ATB,therewas72%adherencewithLG.Incorrect administrationofATBwerethemostcommonreasonsfor partialadherence(21%).

ConclusionandRelevance Wefoundthatadherencein72%of prescribedATBagentswithrecommendedpracticesisconsideredasatisfactoryoutcome.Theauditresultswerepresented tomanagementandshallberepeatedinfuture.

REFERENCESAND/ORACKNOWLEDGEMENTS

1. HoodG,etal.Measuringappropriateantibioticprescribinginacutehospitals: developmentofanationalaudittoolthroughadelphiconsensus.Antibiotics (Basel). 2019Apr29;8(2):49.

ThisstudywassupportedbyCharlesUniversitygrantSVV 260665.

ConflictofInterest Noconflictofinterest.

5PSQ-076 EFFICACYANDSAFETYOFNIVOLUMAB

MONOTHERAPYVSNIVOLUMABPLUSIPILIMUMABIN RENALCELLCARCINOMAINCLINICALPRACTICE MDZambranoCroche,ARojasAlbarrán*,ÁGilGarcía,MGrageraGómez,HVelázquez Vázquez. UniversityHospitalComplexofBadajoz,PharmacyDepartment,Badajoz,Spain 10.1136/ejhpharm-2024-eahp.411

BackgroundandImportance Nivolumabisindicatedfor advancedrenalcellcarcinoma(RCC)bothasmonotherapy (second-line)andincombinationwithipilimumab(first-line). Itisnotknownthebenefittoaddipilimumabtonivolumab, alsoitmustbeentakenthepossibleworsesecurityprofile.

AimandObjectives Theaimofthisstudyistodeterminethe efficacyandsecurityofnivolumabplusipilimumabvsnivolumabmonotherapyintheclinicalpractice.

MaterialandMethods Thisisadescriptive,observationaland retrospectivestudy(January2016toSeptember2023)of30 patientstreatedwithnivolumabornivolumabplusipilimumab inathird-levelhospital.Thedatawereobtainedfromthe electronicmedicalrecordsofthepatientsandtheFarmaTools Managementprogramme.DatawereprocessedbyMicrosoft ExcelandSPSSsoftware.

Results Inthisstudy30patientswereincludedintotal,11 treatedwithdualtherapyand19withmonotherapy.Patient demographicsanddiseasecharacteristicsaredescribedintable 1.Medianprogression-freesurvivalwas4.9months(95%CI: 0–10.8)fornivolumaband10.7months(95%CI:0–26.5) forthecombinationtherapy.However,whenwecompared thetwotreatmentsusingthelog-ranktest,thep-valuewas 0.799.Themedianoverallsurvivalwas43.4months(95% CI:0–97.4)fornivolumab,butitwasnotreachedforthe combinationtreatment.Themostprevalentadversereactions inthemonotherapyvsdualtherapygroup,respectively,were hepatic(5.3%vs45.5%),endocrine(36.8vs63.6)andskin (57.9vs36.4).Itshouldbenotedthatonepatientwiththe combinationtherapyhadmyositis,myocarditis,andhepatitis. Thispatientultimatelydied.

Abstract5PSQ-076Table1

CharacteristicNivolumabplus Ipilimumab(n=11) Nivolumab (n=19)

Age,median(range),years62(44–74)57(37–83) Male6(54.5)16(84.2)

Histology

ClearcellRCR10(90.9)13(68.4)

PapillaryRCR0(0)3(15.8)

Notspecified1(9.1)3(15.8)

ECOG(EasternCooperativeOncologyGroup) performancestatus

05(45.5)11(57.9)

15(45.5)3(15.8)

Notspecified1(9.1)5(26.3)

Lungmetastases8(72.7)16(84.2)

Livermetastases2(18.2)6(31.6)

NOTE:DataareNo.(%).

ConclusionandRelevance Nodifferenceswereobservedin efficacy,butthereweredifferencesinsafety.However,our studyislimitedsinceitinvolvesfewpatients.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-077 ADEQUATENUTRITIONALTHERAPYINCRITICAL PATIENTSWITHCORONAVIRUSDISEASE(COVID-19) SArnaizDiez,MUbeiraIglesias,LIzquierdoAcosta,OÁlamoGonzález,MPEspinosa Gomez,MDLÁMachínMorón,EBrionesCuesta,IGutierrezFernández,ZRodriguez Fernandez*,MGuemesGarcía. BurgosUniversityHospital,Pharmacy,Burgos,Spain 10.1136/ejhpharm-2024-eahp.412

BackgroundandImportance Thecriticalpatientisbydefinitionapatientatnutritionalriskforpresentingahypermetabolicstatewhichleadstoarapidprocessofmalnutrition. Nutrometabolictreatmentinthistypeofpatientisafundamentalpartofabetterclinicalevolution.

AimandObjectives Todescribehowtheparenteralnutrition prescriptionwasadaptedtothenutritionguidelinesinpatients withCOVID-19diseaseincriticalcareunits(ICU).

MaterialandMethods Retrospectiveobservationalstudyof patientswithtotalparenteralnutrition(TPN)incriticalcare unitsbetweenMarchandMay2020.

DatafromtheElectronicMedicalRecordandtheTPN prescriptionwererecorded:age,sex,weight,daysofadmissiontotheICU,TPNindication,durationofTPNtherapy, co-administrationofEnteralNutrition(EN)(ifapplicable), totalenergyintakeanddailyprescribedproteinandcomplicationsfromTPN.

Energyandproteinrequirementswerecalculatedbasedon theASPEN ‘GuidelinesfortheProvisionandAssessmentof NutritionSupportTherapyintheAdultCriticallyIllPatient’ andthehospital’sCOVID-19NutritionProtocol:11–14Kcal/ Kg/dayforobesepatientsand25Kcal/Kg/dayfornon-obese patients.1.5g/Kg/dayofproteinwascalculatedforallpatients.

Theagreementwiththeguidelineswasacceptedifthepercentageoftotalenergyandproteinrequirementswaswithin 80–120%.

Results ThirteenpatientswithTPNwereidentified(table1).

Abstract5PSQ-077Table1

Mediannumberofdaysinthecriticalunitwas38days (12–73).MediannumberofdayswithTPNwas13(2–53). MedianpercentageofdayswithTPN(comparedtothetotal daysspentinthecriticalcareunit)was36.8%(7.1–72.6). Mediancalculatedenergyrequirementswere1,800Kcal/day (1150–2137),andmedianproteinrequirementsperdaywere 130.5gramsofprotein(105–163.5).Atotalof28prescriptionswererecorded.MediantotalKcalprescribedperday was1,827Kcal(1035–2475),andmedianproteinintakewas 100grams(57–147.5).18(64.3%)totaldailyKcalprescriptionsand9(32%)oftheproteinprescriptionswereadapted totheguidelines.

ConclusionandRelevance Wefoundlowadaptationofthe prescriptionstotheguidelinesinrelationtogramsofprotein (kidneyinvolvementcouldberesponsible),althoughthetotal energyrequirementswereadapted.Thehighrateofcatheter bacteraemiawasstriking.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-078 HYPOPHOSPHATEMIAAFTERFERRIC CARBOXYMALTOSEADMINISTRATIONINACOHORT OFELDERLYPATIENTSWITHHIPFRACTURE

1HGenestalVicente, 1PLalueza-Broto*, 1CRaventos-Aymar, 1JCJuarez-Gimenez, 1AGArevalo-Bernabe, 1MQGorgas-Torner, 2NRial-Lorenzo, 2ISanz-Perez, 2JMestre-Torres, 2MUrquizu-Padilla. 1VallHebronUniversityHospitalCampus,PharmacyDepartment, Barcelona,Spain; 2VallHebronUniversityHospitalCampus,InternalMedicineDepartmentOrthogeriatricUnit,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.413

BackgroundandImportance Hypophosphatemiaafterintravenousferriccarboxymatose(FCM)isawell-documented adversereaction.However,thereisscantevidenceaboutits prevalenceamongelderlypatientswithhipfracture,acomplexpolymedicatedpluripathologicpopulationexposedto theseformulationsinperioperativecare.

AimandObjectives Theaimofthisstudywastoidentifythe incidenceofhypophosphatemiainpatientsover65yearsold treatedwithFCMinthecontextofhipsurgery.

MaterialandMethods Observationalretrospectivestudy includingallpatientsadmittedtotheOrthogeriatricUnitof atertiaryhospitalfromJune2023toAugust2023forhip fractureandtreatedwithFCM.Analyticaltreatment-related datawerecollectedfromelectronicmedicalrecords.For descriptiveanalysis,categoricalvariablesarepresentedas countsandpercentages.Continuousvariablesasmediansand interquartilerange.

Results 65patientswereincluded(51/65[78.5%]women,88 ±7yearsold),withamedianhospitalstayof13days.The totaldosesusedwere500mg(69.2%ofpatients),1g (24.6%)orhigher.Onthegathereddataareshownelevated parathormoneandlowcholecalciferollevels,andanaltered glomerularfiltrationrate.Ofthepatientsincluded,28had bothpre-andpost-ironadministrationphosphatelevelsmeasured.Amongthem,21(75%)experiencedaphosphatelevel reductionwithameanchangeof-36.4[19.1–51.4]%from theirinitiallevelstothesecondmeasurement,mirroringthe overalltrendshowninthetable1.Withinthisgroup,5out of28patients(17.9%)hadinitialphosphatelevelsbelow2.5 mg/dL.Afterironadministration,thisincreasedupto12 (42.9%).Noneofthemshowedanyrelevantclinicalsigns associated.

Abstract5PSQ-078Table1

VariableNMedian[P25-P75]

Beforeironadministration:

Phosphate(mg/dL)453.5[2.8–4.1]

Hemoglobin(g/dL)4610.3[9.1–11.4]

Parathormone(pg/mL)3586.4[59.2–103.5]

Cholecalciferol(ng/mL)3723.2[13.6–33.9]

Glomerularfiltrationrate(ml/min/1.73m2)4656[32–77.8]

Afterironadministration:

Daysbetweenironadministrationandphosphate determination

426.5[3.0–9.8]

Phosphate(mg/dL)422.6[1.9–2.9]

ConclusionandRelevance Bloodphosphatelevelstendto decreasenotablyafterFCMadministration,suggestinga potentialcorrelation.However,hyperparathyroidismandvitaminDdeficiencyarecommoninthispopulationandmay

alsoinfluencethisoutcome.Phosphatemiamonitoringand phosphatesupplementationaremeasuresthatneedtobeconsideredtoreducepossibleclinicalconsequences,especiallyin elderlypatientswithadditionalriskfactors.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-079 PHARMACEUTICALINTERVENTIONSINAHEALTH MANAGEMENTAREA

MDPSáezCarballo,YDomínguezRivas,ABMorilloMora,VGonzalezRosa*,MZaragoza Rascón,JMGonzález-MiretMartín. HospitalSerraniaRonda,ServiciodeFarmacia,Ronda, Spain

10.1136/ejhpharm-2024-eahp.414

BackgroundandImportance Drugtherapyrepresentsamajor portionofhealthcarespending.Drugutilisationresearchcontributestooptimisingdrugpoliciesinarationaldruguse context.

AimandObjectives ToanalyseandinterveneonactiveprescriptionsofmedicinessubjecttoRationalUseofMedicines (RUM)strategiesestablishedbytheAndalusianPublicHealth Systembasedontheavailablescientificevidence.

MaterialandMethods Adescriptivestudyoftheinterventions carriedoutontwolistsofpatientswithactiveprescriptions providedbyourHealthSystemfromJanuarytoJune2023 wasconducted.GroupA:patientswithtwoormoreproton pumpinhibitors(PPIs)andGroupB:patientswith bisphosphonatesprescribedformorethan5years,giventhat theoptimaldurationoftrea tmentinosteoporosishasnot beenestablishedinthetechni caldatasheet,indicatingthe needforperiodicreevaluati on,especiallyaftermorethan5 years.

Theinterventionscarriedoutbythepharmacistwereto informtheprescribingphysiciansbycorporateemailtoreevaluatethetreatmentandcarryoutPrecautionaryOverrides (PO).ThemainobjectiveofPOistocontributetopatient safetybyavoidingthedispensingofprescribedmedications whenthereisamanifesterrorintheprescription,inappropriateness,safetyalertoranyotherreasonthatmeansariskto thepatient.

Results 155patientswerereviewedfromJanuarytoJune 2023:17inGroupAand138inGroupB.100%ofprescriptionswerecommunicatedtoprescribingphysicians.We proceededtocarryout35PO(22.5%).InGroupA:13PO (76.5%)duetotherapeuticduplication,four(23.5%)patients werenotevaluableduetomedicalcancellationpriortothe review.GroupB:22PO(15.9%)duetolackofadherenceto treatment.Inthisgroup,itwasfoundthat31patients (22.4%)didnothaveanindicationfortheuseofbisphosphonatesrecordedintheirclinicalhistory.27PO(77.1%)were acceptedbytheprescribingphysicians,sixinGroupAand27 inGroupB.

ConclusionandRelevance TheanalysisaimedatactiveprescriptionssusceptibletointerventionisessentialtomeetRUM objectives,toguaranteeasustainableandqualityPublicHealth System,withthepharmacisthavingakeyroleinachieving them.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-080 CLINICALINTERVENTIONSINPATIENTSUNDERGOING ANTI-PARKINSONIANTREATMENT:THEIMPORTANCE

OFCORRECTRECONCILIATION

EParadelaGarcía,ICorriente,MFloridoFrancisco*,RSerrano. JuanRamonJimenez UniversityHospital,HospitalPharmacy,Huelva,Spain

10.1136/ejhpharm-2024-eahp.415

BackgroundandImportance Thepurposeoftheanti-Parkinsonianpharmacologicaltreatmentistooptimisedopaminelevels andcontrolofdiseasesymptoms.Therefore,itisessentialto implementacorrectreconciliationprocedureathospitalisation toavoidadverseeffectsassociatedwiththemedication.12

AimandObjectives Todescribetheinterventionsperformedin hospitalisedpatientsundergoinganti-Parkinsoniantreatment, byhospitalpharmacistsintheareaofpharmaceuticalvalidation,andtoevaluatetheiracceptancedegreebyclinicians. MaterialandMethods Thiswasaprospective,single-centre andinterventionalstudy,conductedfromSeptember2022to September2023.Thestudyincludedallthehospitalised patientsshowingadiscordancebetweentheirdomiciliaryantiParkinsoniantreatmentandathospitalisation.Demographic (sex,age),clinical[clinicaljudgements(CJ)andinpatientclinicalservice]andpharmacotherapeutic[numberofchronicmedicinesandpolymedication( 6drugs)]variableswerecollected. Interventionswerereportedtoclinicianviae-prescribingsoftware.Theywereclassifiedinto:adequacy(detectionofprescribingerror/therapyreconciliationerror),initiation(usual treatmentnotprescribed),posologymodification(dosage increase/decrease,frequency/schedulemodification),suspension (duplicity/unnecessarymedication).Patientlistsanddatawere collectedthroughmedicalrecordsande-prescribingsoftware, andprocessedusingLibreOfficespreadsheet-7.5.1.2®

Results Thestudyincluded34patients(64.7%male;35.3% female;medianage76years;IQR=84–71).Mostfrequent CJ:urinaryinfection(11.8%),surgicalintervention(11.8%) anddeteriorationofgeneralcondition(8.8%).Inpatientclinicalservices:InternalMedicine(47.1%),Gastroenterology (17.6%),Urology(5.9%),Cardiology(5.9%),Pneumology (5.9%)andTraumatology(5.9%).Themediannumberof activemedicationswas11(IQR=11–8).Polymedicatedpatients raisedupto85.3%.Thenumberofinterventionsperformed was60(n=12 ‘notaccepted’ becauseofdischarge/non-acceptancebytheclinician).Withregardtothoseaccepted(n=48), 8.3%relatedtoadequacy(4.2%detectionofprescribingerror, 4.2%therapyreconciliationerror),4.2%relatedtoinitiation (usualtreatmentnotprescribed),58.3%relatedtoposology modification(27.1%dosageincrease/decrease,31.2%frequency/schedulemodification)and29.2%tosuspension(2.1% duplicityand27.1%prescriptionofunnecessarymedication). Mostinterventionsaffectedlevodopa/carbidopatreatmentbut othermedicationsrepresentedareducedpercentage(10%) (safinamide,levodopa/benserazideorrasagiline).

ConclusionandRelevance ThesupervisionofParkinsonian patientsathospitalisationisapharmaceuticaldailywork.This studyshowedthatthereconciliationprocedurehasahigh degreeofacceptance,improvingthequalityandsafetyofthe therapy.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://neurologia.com/articulo/2022217/eng

2.https://pubmed.ncbi.nlm.nih.gov/24389262/

ConflictofInterest Noconflictofinterest.

5PSQ-081 SATISFACTIONOFPHYSICIANSANDHOSPITAL PHARMACISTSOFAHYPERSENSITIVITY DOCUMENTATIONTOOLWITHDE-LABELINGFEATURE INCLINICALPRACTICE

1VShiwa*, 2SVanLaere, 1WVandendooren, 3SCMWuyts, 4KGentens, 1KMuylle, 5MGrosber, 1PCornu. 1VrijeUniversiteitBrussel,DepartmentofPharmaceuticaland PharmacologicalSciences,Brussels,Belgium; 2UniversitairZiekenhuisBrussel,Departmentof ClinicalSciences,Brussels,Belgium; 3VrijeUniversiteitBrussel,PharmacyDepartment –UniversitairZiekenhuisBrussel,Brussels,Belgium; 4UniversitairZiekenhuisBrussel, DepartmentofMedicalInformatics,Brussels,Belgium; 5VrijeUniversiteitBrussel, DepartmentofDermatology – UniversitairZiekenhuisBrussel,Brussels,Belgium 10.1136/ejhpharm-2024-eahp.416

BackgroundandImportance Poordocumentationofdrug hypersensitivitiesinpatientrecordscanleadtoallergicreactions.Developingtoolsforaccuratehypersensitivitydocumentationcanpreventprescriptionerrors.However,thereisno consensusonhowhypersensitivitiesshouldberoutinelydocumentedelectronically.Wedevelopedanewstructuredand codedhypersensitivitydocumentationtoolwithasemi-automaticde-labellingfeatureincollaborationwithend-users1 and implementeditinouruniversityhospitalinMay2022.

AimandObjectives Toevaluatethesatisfactionofphysicians andhospitalpharmacistswiththenewhypersensitivitydocumentationtoolafterimplementationinclinicalpractice.

MaterialandMethods Anelectronicsurveywassenttophysiciansandhospitalpharmaciststoevaluatethetool’ssatisfactioninclinicalpractice.DatacollectedbetweenApriland September2023includeddemographics,usersatisfaction, experiencewiththetool,andsuggestionsforimprovement. TheSystemUsabilityScale(SUS)wasusedtoevaluatesatisfaction.Closed-endedresponseswereanalysedusingdescriptive statisticsandinferentialanalysis(Mann-WhitneyUtest).

Results Surveywascompletedby286physicians(47%)and ninehospitalpharmacists(90%),ofwhich167(57%) reportedusingthetool.Reasonsfornon-useincludedtool unawareness(52%),preferenceforfreetextdocumentation (28%),notime(14%)andnopatientswithdrugallergies (14%).ThemedianSUSscoreofuserswas60(IQR=20), translatinginanadjectiveratingof ‘OK’.Hospitalpharmacists hadasignificantlyhighermedianSUSscore(75,IQR=25) thanphysicians(55,IQR=18),correspondingtoadjectiveratings ‘Good’ and ‘OK’,respectively(Z=2.838,p=0.005).Only 81participants(28%)indicatedbeingfamiliarwithinactivating hypersensitivities.About35%ofphysiciansreportedprescribingmedicationstowhichpatientshaveanallergy.Physicians expressedconcernaboutdocumentationburdenandwanted allergyalertswhenprescribing.

ConclusionandRelevance Trainingphysicianscouldincrease awarenessaboutdrughypersensitivitiesanduseofthedocumentationtool.Althoughusersconsideredthenewtoolrelativelygoodinclinicalpractice,itsefficiencycanstillbe improved.Bridgingthegapbetweenminimaldocumentation requirementsforanalertsystemandphysicians’ timeconstraintstodocumentiscrucial.Involvinghospitalpharmacists couldreducethetimeburdenforphysiciansandimprove accuratedocumentationofhypersensitivities.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.MuylleK, etal.Usabilityofgraphicaluserinterfaceswithsemiautomaticdelabelingfeaturetoimprovedrugallergydocumentation. JACIinPractice. 2023Feb;11 (2):519–526.e3.

ConflictofInterest Noconflictofinterest.

5PSQ-082 THIRD-GENERATIONHOSPITAL-EXCLUSIVE CEPHALOSPORINS:DIFFERENTSAFETYPROFILES?

1BAbreuFaria*, 1SBarroso, 2JPFernandes, 2MSilva, 1ACarvalho. 1HospitaldeBraga, UnidadedeFarmacovigilânciadeBraga,Braga,Portugal; 2Infarmed – AutoridadeNacional doMedicamentoeProdutosdeSaúde-I.P.,DireçãodeGestãodoRiscodeMedicamentos, Lisboa,Portugal

10.1136/ejhpharm-2024-eahp.417

BackgroundandImportance Third-generationcephalosporins areclinicallyrelevantduetotheirbroadspectrumofactivity againstgram-negative,gram-positive,andPseudomonasaeruginosabacteria.Monitoringthesafetyprofileofthesemedicinal productsinareal-worldsettingisofparamountimportance, aimingtoprotectbothindividualandcollectivehealth.Toour knowledge,nostudywiththeaimofcomparingthesafety profilesofthesemedicinalproductshasbeenconductedinthe Portuguesecontext.

AimandObjectives Assessthereportsofsuspectedadverse drugreactions(ADRs)receivedbythePortugueseNational PharmacovigilanceSystemconcerningthird-generationhospitalexclusivecephalosporins,withtheaimofcomparingthesafety profileofthesemedicinalproducts.

MaterialandMethods Aretrospectivestudywasconducted usingdatafromthePortalRAMbetween1January2013, and31March2023.IndividualCaseSafetyReports(ICSRs) wereselectediftheyidentifiedonlyonethird-generationhospital-exclusivecephalosporinasthesuspectdrug,namelycefotaxime(CEFO),ceftriaxone(CEF),ceftazidime(CEFT),or ceftazidime+avibactam(CEFT/AV).Demographicdataofthe patient,ADRcategory(MedDRAPreferredTerms(PT)), Important/DesignatedMedicalEvent(IMEandDME)terms, andcaseoutcomeswereanalysed.

Results Thesearchreturned269ICSRsofinterest.,withthe majorityrelatedtoCEF(84.8%).Forallthecephalosporins understudy,therewasapredominanceofmalepatients, withamedianageover50years,exceptforCEFO(15.0 ±10.0).MostICSRswereclassifiedassevere(CEFO: 80.0%;CEF:88.2%;CEFT:82.4%;CEFT/AV:64.3%). RegardingthenumberofICSRscontainingIMEterms, CEFT/AVhadthehighestpercentageat64.3%,while25.4% ofCEFICSRscontainedaDMEterm.ThehighestpercentageofICSRswithPTtermsrelatedtooff-labeluseandlack ofefficacybelongedtoCEFT,with11.8%and23.5%, respectively.Inallcephalosporins,themajorityofICSRs evolvedtowardsrecovery.

ConclusionandRelevance Ourresultsappeartoindicatethat therearenosignificantdifferencesinthesafetyprofileof thesemedicinalproducts.However,furtherstudiesareneeded. Theimplementationofactivepharmacovigilanceprotocolsat thehospitallevelmaycontributetoasaferandmorerational useofthesedrugs,minimisingtheimpactofADRsonPublic Health,bothintermsofeconomicburdenonhealthcaresystemsandmorbidityandmortalityforcitizens.

5PSQ-083 MARIBAVIR-INDUCEDTOXICEPIDERMALNECROLYSIS INALIVERTRANSPLANTPATIENT:ACASEREPORT

1CGuzmánCordero*, 2CGuijarroSánchez, 1BAparicioCastellano, 1LGarcíaMartínez. 1HospitalUniversitarioReinaSofía,PharmacyService,Córdoba,Spain; 2Hospital UniversitarioReinaSofía,DermatologyService,Córdoba,Spain

10.1136/ejhpharm-2024-eahp.418

BackgroundandImportance Cytomegalovirus(CMV)infection posesasignificantthreattotransplantrecipients,1 oftennecessitatingantiviraltreatment.Ganciclovirandvalganciclovirhave beenmainstays,butCMVresistanceinover20%ofcases requiresalternativeslikefoscarnetorcidofovir.2 Maribavir,a novelCMVUL97proteinkinaseinhibitor,hasemergedasan effectiveoption.3 Here,weunveilapreviouslyunreported adverseeffect(AE)associatedwithmaribavir.

AimandObjectives Ouraimistoreportacaseoftoxicepidermalnecrolysis(TEN)linkedtomaribavirintake.

MaterialandMethods InMarch2021,amaleliver-transplantedpatientwithCMV-relatedretinalnecrosisdeveloped severepancytopeniaduringvalganciclovirtreatment,subsequentlyreceivingfoscarnetinmultiplehospitalisations.InMay 2023,maribavirwasinitiated,markingthefirstsuchcasein ourhospital.Withinamonth,thepatientwasreadmittedwith painfulskinlesionsandmucositisinoralandgenitalmucosa. TENdiagnosewasassumed,evidencedbytensebullae,extensiveepidermaldetachment(60%ofBodySurfaceArea),anda clearlypositiveNikolskysign.HewastransferredtotheICU 3dayslaterandtreatedwitha5-day-courseof125mgintravenousmethylprednisoloneand2g/kgimmunoglobulin.

Results Thepatient’soverallstatusimproved,withreduced lesionsandepidermaldetachment.After10days,onlyscarring remained.ThisAEwasclassifiedasprobablecausalitydueto maribavir,withascoreof6ontheNaranjoScale.4 TheSpanishSystemforPharmacovigilanceofHumanDrugswas informedofthiseventbythePharmacyService.

ConclusionandRelevance TEN,alife-threateningdrug-associatedAE,mustbeconsideredwhenprescribing.Whileantibioticscause25%ofTENcases,antiviralsrarelyinduceit.5 This AEisespeciallynoteworthysincemaribavir,marketedin November2022,haslimitedexposuretopatientsinSpain. Early-phasepharmacovigilanceiscrucialfordetectingunreportedAEs.Establishingmultidisciplinaryteamscomprising physiciansandpharmacistsisessentialtoensuredrugsafety, mitigatingsevereAEs.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RazonableRR. ClinTransplant. 2019;33:e13512.DOI:10.1111/ctr.13512

2.ChemalyRF, etal ClinInfectDis. 2019;68(8):1420–1426.DOI:10.1093/cid/ ciy696

3.Livtencitytechnicaldatasheet. EMA.2022.

4.NaranjoCA, etal ClinPharmacolTher. 1981;30:239245.DOI:10.1038/ clpt.1981.154

5.LeeEY, etal JAMADermatol.2023;4:384–392.DOI:10.1001/ jamadermatol.2022.6378

ConflictofInterest Noconflictofinterest.

5PSQ-084 EROSIVEBALANITISASAPOSSIBLEADVERSEEFFECT TOTREATMENTWITHTOFACITINIB.ACASEREPORT ISánchezLobón*,RPlaPasán,CRodríguezMoreta,MVManzanoMartín,MJHuertas Fernández. PuertadelMarUniversityHospital,Pharmacy,Cádiz,Spain

10.1136/ejhpharm-2024-eahp.419

BackgroundandImportance Tofacitinibisaselectiveinhibitor oftheJanuskinasefamilyindicatedforthetreatmentofvariousrheumatologicalpathologiessuchasrheumatoidarthritis (RA)andpsoriaticarthritis.Accordingtothetechnicaldata sheet(TDS),mostfrequentlyreportedadverseeffects(AE) duringthefirst3monthsofclinicalstudieswereheadache, upperrespiratorytractinfectionsandviralrespiratorytract infectionsupper.Pharmacovigilancecollectsinformationand analysesandnotifiescasesofsuspectedadversedrugreactions topreventthemoccurringinthefuture.

AimandObjectives Describethecausalrelationshipina patientwhosuffersfromerosivebalanitisaftertheadministrationoftofacitinib,besidesthemultidisciplinaryinterventionin itsmanagement.

MaterialandMethods Retrospectiveandmultidisciplinary study,whichdescribesthecaseofa66-year-oldpatientdiagnosedwithRAsince2007andwho,in2019,afternumerous failureswithdisease-modifyingdrugs(DMARDs),begantreatmentwithtofacitinib5mgevery12hours.Datawere obtainedfromDiraya® digitalmedicalrecord.Safetyprofile oftofacitinibwasreviewedinitsTDSandtheNaranjoAlgorithmwasappliedtoestablishthedrug-adversereactioncausal relationship.

Results InJanuary2022,thepatientwasreferredfromprimarycaretothedermatologyclinicduetoerythemainglans areathathadbeendevelopingforamonth,reportingthathe hadanoutbreakwiththesamecharacteristic ’spreviousyear. Followingthisevent,theprecautionarysuspensionoftofacitinibwasagreedwithrheumatologyteam.Specialistscontact theHospitalPharmacyServicetoconfirmwhetheritisanAE secondarytotofacitinib.Afterthis,thepharmacistperformed areviewoftheTDSandliteratureconfirmingthattherewas noevidenceoferosivebalanitisasanAEoftofacinib.The suspectedAEwasreportedtotheSpanishPharmacovigilance Systemandacausalrelationshipwasestablishedbetweenthe drugandtheAEaccordingtotheNaranjoAlgorithm,obtainingascoreof1thatestablishedapossiblerelationship betweenthedrugofinterestandtheAE.Aftertopicalcures for2-months,treatmentwithtofacitinibwasrestartedinMay 2022withoutreportingnewincidents.

ConclusionandRelevance Multidisciplinaryparticipationinthe detection,notificationandactions,toestablishthecausalrelationshipofAEassociatedwithdrugs,contributestoimproving patientsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-085 SAFETYASSESSMENTOFJANUSKINASEINHIBITORS INCLINICALPRACTICE

IDeLaFuenteVillaverde*,VGarcíaJiménez,SFernándezLastras,LOyagueLópez,MEiroa Osoro,CRodríguez-TenreiroRodríguez,MMuñozVillasur,CDíazRomero,CFadón Herrera,ALozanoBlázquez. CentralUniversityHospitalofAsturias,HospitalPharmacy, Oviedo,Spain

10.1136/ejhpharm-2024-eahp.420

BackgroundandImportance Januskinaseinhibitors(JAKi) tofacitinib,baricitinib,upadacitinibandfilgotinibareimmunosuppressantsindicatedforthetreatmentofchronicinflammatorydisorders.Concernregardingtheirsafetyhasrecently arisensincepublicationofnewdatainrecentyears.

AimandObjectives Toassessthesafetyoftofacitinib,baricitinib,upadacitinibandfilgotinibforthetreatmentofchronic inflammatorydisordersinrealclinicalpractice.Tocompareit withtheclinicaltrials(CT)results.

MaterialandMethods Observationalrestrospectivestudy includingallpatientstreatedwithJAKifromJanuary2019to August2023inatertiaryhospital.Datawereobtainedby reviewofelectronicmedicalrecordsandlaboratorydatabase. Variablesstudiedwere:patientdemographics,prescribingunits, adversereactions(AR),treatmentdurationandmotiveof interruption.

Results 271(74,5%women)patientswereincludedinthis study,withamedianageof55(18–92)years.243hadrheumatologydisorders,21digestivedisorders,3dermatologydisordersand4bothrheumatologyanddigestivedisorders.122 (45%)patientssufferedsomekindoftoxicityduringtreatment withJAKi.ThemostfrequentlyregisteredARbydrugare showninthetable1:

In43(15.9%)patientstreatmentwasstoppedduetotoxicity(16baricitinib,19tofacitinib,twoupadacitinib,onefilgotinib).ThemostfrequentARthatledtointerruptionwere gastrointestinaldisorderswithtofacitinibandinfectionswith baricitinib.

Treatmenthadtobestoppedinfivepatientsbecauseof neoplasmdiagnosis(threebaricitinib,twotofacitinib).Two patientsdiedduringperiodofstudy(onetofacitinib,one baricitinib).

Dosereductionbecauseoftoxicitywasrequiredinone patienttreatedwithtofacitinibandin12treatedwith baricitinib.

ConclusionandRelevance Ingeneralterms,fortofacitiniband baricitinib,ourstudycarriedoutinreal-worldclinicalpractice showsatoxicityprofilesimilartotheonedescribedinCT. AllARaredescribedintheliterature.

Infectionsandhypercholesterolaemiaareamongthemost frequentARinourstudyandinCT.

AlthoughmostoftheARweretolerable,therewereseveral casesofsevereARledtotreatmentinterruption.

IncontrasttorecentCTresults,nomajoradversecardiovasculareventswereregisteredinourstudy.

Abiggersampleisneededtomakeconclusionsaboutupadacitinibandfilgotinibsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-086 ADMINISTRATIONOFTYROSINEKINASEINHIBITOR DRUGSINPATIENTSWITHENTERALFEEDINGTUBES

APérezFácila,JJSaizMolina*. HospitalGenerallaManchaCentro,FarmaciaHospitalaria, AlcázardeSanJuanCiudadReal,Spain

10.1136/ejhpharm-2024-eahp.421

BackgroundandImportance Swallowingproblemsarecommon inpaediatricpatients,elderlypatientsandsomepathologies.A commonnursingpracticeistheadministrationofenteral nutrition(EN)formulastogetherwithdrugsthroughfeeding tubes.Inrecentyears,thenumberoftyrosinekinaseinhibitor (TKI)drugsforthetreatmentofoncohaematologicalpathologieshasgrownenormously.

AimandObjectives ToidentifyalternativestooraladministrationofTKIsinpatientswithswallowingproblems.

MaterialandMethods Aliteraturereviewwasperformedin August2023ontheconditionsforhandlingandadministrationoftheTKIsusedinourhospitalinpatientswithswallowingproblems.Therespectivetechnicaldatasheetsand

clinicalpracticeguidelineswerereviewed,aswellasspecific articles.

Variables possibilityofadministrationbyfeedingtubes,manipulativetechniqueofthedosageform,dissolutionmedium, needtoprepareamagistralformulainthePharmacyService, specialadministrationconditionsandcompatibilitywithEN. Results 31TKIdrugswereidentifiedinourhospital.Of these,informationwasavailablefor24.

Ofthedrugswithinformation(possibilityofadministration byfeedingtubes:22;alternativedosageformexists:1;no alternativeexists:1).Bymanipulativetechnique(crushand dissolve:15;dispersewithoutcrushing:7),dissolutionmedium (10–20mlofwater:6;>20mlofwater:5;acidand>20ml: 2;>40°Cand10–20mlofwater:3;>40°Cand>20ml:1; others:5).4drugsrequirethepreparationofamagistralformulainthePharmacyService.Specialadministrationconditions(photoprotection:3;1:>8Frfeedingtubes:1).14ITKs arecompatiblewithEN;intheremainingcases,separate administrationisrecommended(1hourbeforeor2hours later).

ConclusionandRelevance Despitenumeroussourcesofinformation,thereisa20%ofTKIwithoutevidence.Furthermore, compatibilitywithENadministrationisbasedonanalogywith oralformsofadministration.

REFERENCESAND/ORACKNOWLEDGEMENTS Noconflictofinterest.

ConflictofInterest Noconflictofinterest.

5PSQ-087 ANALYSISOFEFFECTIVENESSANDSAFETYOF TRALOKINUMABINMODERATE-SEVEREATOPIC DERMATITIS

1AYSalmeronCobos, 2MÁUrbanoFernández, 1SCanoDomínguez, 3MRodríguez Goicoechea, 1MRCantudoCuenca, 1AJimenezMorales*. 1HospitalUniversitarioVirgende LasNieves,Pharmacy,Granada,Spain; 2HospitalUniversitarioSanCecilio,Pharmacy, Granada,Spain; 3HospitalUniversitariodeJaén,Pharmacy,Jaén,Spain

10.1136/ejhpharm-2024-eahp.422

BackgroundandImportance Atopicdermatitis(AD)isa chronicinflammatoryskindiseasecharacterisedbyseverepruritus,eczemaandxerosis.Asystemictreatmentoptionfor moderate-severeADistralokinumab,ahumanmonoclonal antibodytargetingIL-13.

AimandObjectives Theaimofthestudyistoevaluatethe effectivenessandsafetyoftralokinumabinpatientswithmoderate-severeADinthreetertiaryhospitals.

MaterialandMethods Observational,retrospective,multicentredstudyofpatientstreatedwithtralokinumabfromApril 2022toSeptember2023.Variablescollected:age,sex,previoustreatments,initiationanddurationoftreatment,adverse effects(AE)andtheseverityofADwasanalysedusingthe scales: EczemaAreaandSeverityIndex (EASI)and BodySurfaceArea (BSA).

Effectivenesswasevaluatedassessingthenumberofpatients withareductionofatleast50%or75%inthevaluesof EASI(EASI50andEASI75,respectively)andnumberof patientswithareductioninBSA,duringweek16approximately.Sourcesofinformation:applicationofelectronicprescriptionPrisma® andcomputerisedclinicalhistoryDiraya® Results Weincluded39patients,ofwhom32(18women,14 men)hadreachedweek16oftreatmentorhigher,withan averageageof37.63years(range16–66years)andwitha

medianfollow-upof26.6weeks.Allreceivedprevioustreatmentwithtopicalcorticosteroidsandcyclosporine,11had receivedtreatmentwithdupilumaband6withJAKinhibitors.

ThebasalmediumofEASIwas27.05andaftertheassessmentcarriedout,33%(13/39)achievedEASI50and23%(9/ 39)EASI75.Withamediandermatologistassessmentof20 weeks,thenumberofpatientsremainingonEASI50was11 andonEASI759.ThebasalmedianofBSAwas21,where3 (8%)patientssufferedanincreaseand17(44%)reducedit, reaching7ofthemtovaluesof0–1.15patients(38%)discontinuedtreatment,14duetolackofefficacyand1dueto AE.

FourpatientswithADwerereported:syncope,respiratory infection,headacheandconjunctivitistogetherwithgeneralised xerosis,whosepatienthadtodiscontinuetreatment.

ConclusionandRelevance Tralokinumabisaninnovativealternativeinpatientswithmoderate-severeADrefractorytoother therapies.Moredataonlong-termefficacyandsafetyare needed.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-088 ADHERENCETOANTIRETROVIRALTHERAPYINHIV PATIENTS

YDominguezRivas,VGonzalezRosa*,ABMorilloMora,MZaragozaRascón, JMGonzález-MiretMartín. HospitalSerraniaRonda,ServiciodeFarmacia,Ronda,Spain

10.1136/ejhpharm-2024-eahp.423

BackgroundandImportance Thegoalofantiretroviraltherapy (ART)isvirologicalsuppressionsincesubtherapeuticlevelsof antiretroviralscanleadtodevelopmentofresistance.Acorrect adherencetreatmentiscrucialtoachievethatissue.

AimandObjectives Toidentifythedegreeofadherenceto ARTinHIV-positivepatientsandanalysewhetheritisrelated tovirologicalresultsandthetypeofARTused.

MaterialandMethods Retrospectiveobservationalstudyof HIVpatientsattendedatourPharmacyOutpatientUnitduringtheyear2022.Thefollowingvariableswerecollected: sex,age,viralload(VL),typeofART(drugs,numberoftablets),excludingthoseintreatmentlessof6months.

Adherencewasestimatedwiththeindirectmethodofthe medicationpossessionratio(MPR),definedasthepercentage ofdayscoveredwiththedispensedmedicationcomparedto totaldayswiththeprescribedmedicationx100.GoodadherencewasdefinedasanMPR95–100%,intermediateadherence:MPR80–95%andpooradherence:MPR<80%. Results 53patientswereeligibleforthestudy(69.8%men withameanageof49.2±10.3yearsand50.9±9.4yearsin women),ofwhich84.9%receivedtripletherapy,11.3%doubletherapyand3.8%monotherapy.

Theoverallmeanadherencewas95.1±7.2%(95.7%in womenand94.9%inmen),ofwhich67.9%hadgoodadherence(52±10.2years),22.6%intermediateadherence(47±7.9 years)and9.4%pooradherence(42±5.9years).

VLwasundetectablein84.9%ofcases(meanadherence 95.9%)andunknownin9.4%duringthestudyyear.Only threepatients(5.7%)weredetectable,twowithgoodadherenceandonewithintermediateadherence.

Regardingthenumberofdailytablets,adherencewasgood inpatientswhotook1,2and3tabletsdaily(95.3±7.3%)

andintermediateinthosewhotook4tabletsdaily(90.7 ±8.7%).

ConclusionandRelevance Mostpatientsinourstudyhave goodadherenceanditishigherinolderpatientsandtheless tabletsdailytheytake.Norelationshipwasfoundbetween patientgenderandadherence.ThecasesofdetectableVL werenotassociatedwithpooradherencetoART,whichcould beduetopatientresistanceorlimitationsoftheadherence measurementmethod.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-089 OUTCOMEOFMOLNUPIRAVIRTREATMENTINRENAL TRANSPLANTPATIENTSWITHCOVID-19

1MHeislerova*, 2MMatyskováKubišová, 2APokorná, 3R Šafránek, 4PMoučka, 5IGuňka, 6MNovosadova, 6,7PRozsivalova, 4SDusilovaSulkova. 1UniversityHospital,Hospital Pharmacy,Prague,CzechRepublic; 2UniversityHospital,DepartmentofNephrologyand InterdisciplinaryTransplantationCentre,HradecKrálové,CzechRepublic; 3University Hospital,DepartmentofNephrologyand,InterdisciplinaryTransplantationCentre,Czech Republic; 4UniversityHospital,DepartmentofNephrology,HradecKrálové,CzechRepublic; 5UniversityHospital,DepartmentofSurgeryAndInterdisciplinaryTransplantationCentre, HradecKrálové,CzechRepublic; 6UniversityHospital,HospitalPharmacy,HradecKrálové, CzechRepublic; 7FacultyofPharmacy,SocialandClinicalPharmacy,HradecKrálové,Czech Republic

10.1136/ejhpharm-2024-eahp.424

BackgroundandImportance AccordingtotheglobalrecommendationsforCOVID-19therapy,adultpatientsatriskof severedisease(includingpatientsafterorgantransplantation) shouldbetreatedwithantivirals:preferablynirmatrelvir/ritonavir(Paxlovid)orremdesivir(Veklury).Alternativechoiceis unlicenseduseofmolnupiravir(Lagevrio).

AimandObjectives OurstudyfocusedonevaluatingtheeffectivenessandsafetyofmolnupiravirinpatientswithCOVID19aftersuccessfulkidneytransplantation(KTx).

MaterialandMethods Acohortof93patients(62males)was retrospectivelyevaluated,with89.0%ofpatientshavinghada firstKTx(theremainderhavinghadasecondKTx)and 39.0%withdiabetesmellitus.Themeanageofthepatientsat thetimeofmolnupiravirtherapywas56years(SD12.9)and theyreceivedmolnupiravirwithmeanof2.24days(SD1.67) sinceconfirmationofSARS-2-positivity.Immunosuppressive therapywasadjusteduniformlyaccordingtothesiteprotocol andprednisonewasincreasedforamaximumoftwotothree weeks.Thesafetyoftheproposedprocedureconcerninggraft functionandriskofrejectionwasevaluatedbasedonthe trendincreatininemiaandurinaryprotein/creatinineindex. NonparametricWilcoxontestwasused.

Results Themedianserumcreatininevalueinthestudypopulationwas127 mmol/l(IQR52)beforeCOVID-19.Outpatient follow-upwaswithin1monthafterquarantinewithmedian 124 mmol/lpost-diseasecreatinine(IQR53,2).Thedifference inmediancreatininevaluesbeforeandaftermolnupiravirtherapywasnotstatisticallysignificant(p=0.8175).COVID-19 relatedhospitalisationoccurredin5.4%patients,onepatient inthecohortdiedduetoCOVID-19disease.Short-termdiscontinuationormodificationofimmunosuppressiondidnot induceanyrejectionepisode.

ConclusionandRelevance Ourexperiencedemonstratesthat earlyinitiationofmolnupiravirmaybeaneffectiveandsafe therapyforCOVID-19diseaseinpatientsafterkidney

transplantation(whereitisauthorisedintheCzechRepublic untiltheendof2023).Moreover,comparedtoPaxlovid,its useisnotlimitedbydrug-druginteractionsandthuscanbe administeredwithcalcineurininhibitors.

REFERENCESAND/ORACKNOWLEDGEMENTS

SupportedbyprojectsoftheMinistryofHealthofthe CzechRepublic – RVO;FNHK,00179906andtheCOOPERATIOprogramme,INDIscientificareaandSVV260665. ConflictofInterest Noconflictofinterest.

5PSQ-090 CAPSAICIN8%PATCHINTREATMENTOF PERIPHERALNEUROPATHICPAIN

1SAsenjoSegovia*, 2MSarobeCarricas, 2NLarreaGoñi. 1ServicioNavarrodeSaludOsasunbidea,Pharmacy,Pamplona,Spain; 2Hun-ServicioNavarrodeSalud-Osasunbidea, Pharmacy,Pamplona,Spain

10.1136/ejhpharm-2024-eahp.425

BackgroundandImportance TheInternationalAssociationfor theStudyofPaindefinesneuropathicpainaspaincausedby alesionordiseaseofthesomatosensorynervoussystem,centralorperipheral.

Capsaicin8%cutaneouspatchisindicatedforthetreatmentofperipheralneuropathicpain(PNP)inadultseither aloneorincombinationwithothermedicinalproductsforthe treatmentofpain.

AimandObjectives Thisstudyaimedtoevaluatetheclinical efficacyandtolerabilityofcapsaicinpatchinPNPinausual clinicalpracticeatathird-levelhospital.

MaterialandMethods RetrospectiveobservationalstudyconductedbetweenJanuary2019andDecember2022ofpatients withPNPwhounderwenttreatmentinthehospital.Allof themsignedinformedconsent.Datawerecollectedfromclinicalhistoryandpharmacyprogram.

Therapeuticefficacywasevaluatedthroughpainintensity, usingtheVisualAnalogueScale(VAS),atbaselineandaweek aftertreatment.Patientswereconsideredasrespondersto therapyifVASdecreases 3.

Patientswereincludedinoneofthefollowinggroups accordingtothelocalisationpain:Back,Hip,Knee,Feet, Upperlimbs(hands,arms).

Endpointsincludeddemographicandclinicalcharacteristics (age,sex),therapeuticoutcomes(changeinbasalpainintensity),adverseevents(AEs),sitereactions.

Results 686patientswereincludedinthestudy(65%women, medianage60.5years).Localisationareaapplicationwere: Knee(21.6%),Back(8.5%),Hip(6.6%)Upperlimbs/feet (19.7%).

ThemedianVASbaselinescore(6,9)decreasedaweek aftertreatment(5.7).

Amedianpercentageofpatients(42.4%,n=291)improved VASscaleand42%(n=122)ofthemwereconsideredresponderstotreatment(decreasebaselineVAS 3).

Adverseevents(mildtomoderateinintensity)were:erythema(13,1%),burningsensation(29,8%)andpruritus(21.4%). Nosevereadverseeventswereobserved.

ConclusionandRelevance Capsaicinpatchuseinperipheral neuropathicpainseemstobeeffective,decreasingpainintensityintreatedconditions.

Treatmentwasgenerallywelltolerated adverseeventswere transientandself-limiting.

Abstracts

Morestudiesareneededtoevaluatethelong-termeffectivenessandsafetyofcapsaicin8%cutaneouspatch.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-091 SUITABILITYOFTERIPARATIDEANDLEVELOF ACCEPTANCEOFPHARMACOTHERAPEUTIC RECOMMENDATIONSINANAREAOFHEALTH MANAGEMENT

AYSalmeronCobos*,ARodríguezDelgado,MIArchillaAmat,MRCantudoCuenca, AJiménezMorales. HospitalUniversitarioVirgendeLasNieves,Pharmacy,Granada,Spain 10.1136/ejhpharm-2024-eahp.426

BackgroundandImportance Theuseofteriparatidetreatment hasresultedinanincreaseofgreateconomicimpactatthe hospitallevelinrecentyears.

AimandObjectives Toanalysetheappropriatenessoftheprescriptionofteriparatideinthetreatmentofosteoporosisin theOrthopedicSurgeryandTraumatologyServiceandtoevaluatethedegreeofacceptancebythephysicianoftheinterventionsperformed.

MaterialandMethods Aprospective,single-centreintervention studyhasbeencarriedoutbetweenMarch-April2023.Adult patientswithanactiveprescriptionofteraparatidefromthe OrthopedicSurgeryandTraumatologyServicewhoselastdispensationwasinJanuary2023wereincluded.Thevariables collectedwere:age,sex,treatmentduration,dosingregimen, previousfractureandtypeoffracture,previoustreatment, contraindications,osteoporosis.

Informationsources electronicprescriptionapplicationPrisma®, computerisedmedicalrecordsDiraya® anddispensingdata usingMicroStrategysoftware.

Incaseofinadequacyoftreatment,individualisedletters werepreparedforeachpatientandsenttotheresponsible medicalspecialistsalongwithrecommendationsforteriparatide treatment.Thedegreeofacceptanceoftheinterventionswas measuredbythepercentageofpatientswithsuspensionor modificationoftreatmentafterpharmaceuticalintervention.

Results Atotalof43patients(76.74%women)withamedian ageof76.5years(range30–92years)wereincluded.18.60% (n=8)ofpatientshadtreatmenterrors,ofwhich62.5% (n=5)duetodosingregimen>2years,12.5%(n=1)dueto anerrorintheregimenand25%(n=2)duetocontraindications.Inaddition,13wereprescriptionswithapreviousnonvertebralfracture,where84.61%(n=11)werefirst-lineteriparatidetreatments,whenitisnotrecommended.Thedegree ofacceptancebythespecialistsaftertheinterventionwas 62.5%.Theprescriber ’smodificationsweresuspensionofteriparatidetreatmentfor>2yearsandinitiationofbisphosphonates,modificationoftheregimenerror,andreplacementof drugsthathadcontraindicationswithfirst-linedrugs.

ConclusionandRelevance Althoughtherearenotmanyerrors inthetreatmentinactiveprescriptionsofteriparatide,the interventionscarriedoutwerepartlyacceptedbyphysicians, buttheycontinuebeingprescribedasfirst-linetreatments whenitisnotrecommended.Inaddition,prescriptionerrors werereducedandmedicationsafetyincreased,reflectingthe importanceoftheroleofthepharmacistatthehospitallevel.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-092 ALTEREDPHARMACOKINETICSPARAMETERSOF VANCOMYCININPATIENTSWITHHAEMATOLOGIC MALIGNANCYWITHFEBRILENEUTROPENIA,A BAYESIANSOFTWAREESTIMATION

1AAnsari*, 1AAlzahrani, 2YAAlzahrani, 1SKarim, 1AAlazmi. 1MinistryofNationalGuard, PharmaceuticalCareServices,Jeddah,SaudiArabia; 2EastJeddahHospital-Ministryof Health-Jeddah-SaudiArabi,DepartmentofPharmacy-,Jeddah,SaudiArabia

10.1136/ejhpharm-2024-eahp.427

BackgroundandImportance Thepharmacokineticsofvancomycinvarysignificantlybetweenspecificgroupsofpatients, suchaspatientswithhaematologicalmalignancywithfebrile neutropenia.Recentevidencesuggeststhattheuseofthe usualstandarddoseofantibioticsinpatientswithfebrileneutropeniamaynotofferadequateexposureduetopharmacokineticvariability.

AimandObjectives Toassesstheeffectoffebrileneutropenia ontheAUC0–24hoursasakeyparameterforvancomycin monitoring,aswellastodeterminewhichvancomycinpharmacokineticsparametersareaffectedbythepresenceoffebrile neutropeniausingBayesiansoftwarePrecisePKinhaematologicalmalignancywithfebrileneutropenia.

ToevaluatethedifferenceinestimatedAUC0–24between febrileneutropeniaandnon-febrileneutropeniaamongpatients withhaematologicalmalignancies.

MaterialandMethods ThestudyincludedadultpatientsadmittedbetweenJanuary2017andDecember2020,whoreceived vancomycinwithmeasuredsteady-statetroughconcentrations beforethefourthdose.Ofthe297patientstreated,217met theinclusioncriteria.Pharmacokineticparametersforboth neutropenicandnon-neutropenicpatientswereestimatedusing theprecisePKBayesianplatform.

Results TheresultshowedthatAUC0–24waslowerinfebrile neutropenicpatientsp<0.05(403vs.461mg·h/L)compared tonon-febrileneutropeniapatients.Also,therewasasignificantdifference(p<0.05)invancomycinclearance,thevolumeofdistributionatasteadystate,thevolumeof distributionfortheperipheralcompartment,thehalf-lifefor theeliminationphase,andthefirst-orderrateconstantforthe eliminationprocessinfebrileneutropeniagroupcomparedto non-febrileneutropenicpatients.

ConclusionandRelevance Febrileneutropeniahasasignificant effectonthepharmacokineticsparametersofvancomycinand AUC0–24,whichmayrequirespecificconsiderationduringthe treatmentinitiation.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.LinesJ, etal.Int.J.Clin.Pharm. 2021;43:263–269.

2.MarkoR,HajjarJ, etal.Can.J.Hosp.Pharm. 2021;74:334–343.

3.CockcroftDW,GaultMH.1976;16:31–41.

4.ZimmerAJ, etal.J.Oncol.Pract. 2019.

5.SimeFB, etal.2014;58:3533–3537.

ConflictofInterest Noconflictofinterest.

5PSQ-093 DOESEXPOSURETOANTIBIOTICSPRIORTO TREATMENTWITHIMMUNECHECKPOINTINHIBITORS AFFECTTHEIREFFECTIVENESS?

JJSaizMolina*,CNotarioDongil,CNavarroCamacho,TEDeSalinasMuñoz,MDMAlañon Pardo,NAndresNavarro. LaManchaCentroHospital,HospitalPharmacy,AlcázardeSan Juan,Spain

10.1136/ejhpharm-2024-eahp.428

BackgroundandImportance Takingantibioticsweeksbefore immunotherapyaltersthegutmicrobiota.Itisthereforequestionablewhethertheuseofantibioticspriortoimmunotherapyisassociatedwithdecreasedeffectivenessincancer patients.

AimandObjectives Toevaluatetheinfluenceoftheuseof antibiotictherapyontheeffectivenessofimmunotherapytreatmentincancerpatients.

MaterialandMethods Observational,retrospective,68-month, retrospectivestudy(January2018toAugust2023)inpatients diagnosedwithrenalcell,non-small-celllungandheadand neckcancers.

Thedifferenceineffectivenesswasmeasuredbycomparing themedianprogression-freesurvival(mPFS)andmedianoverallsurvival(mOS)ofpatientswhoreceivedantibiotictherapy 2monthspriortothestartofimmunotherapyandthosewho didnotreceiveantibiotictherapy.

Variables age,sex, EasternCooperativeOncologyGroup (ECOG)scale,immunotherapyreceived,numberofprevious lines,antibioticprescription2monthspriortothestartof immunotherapyanddurationoftreatment.

Datasource computerisedmedicalrecordsandelectronicprescribingprogramme.

Results Atotalof138patients(71.0%male;medianage67 years)wereanalysed.Ofthepatients,42.0%receivedantibiotictherapy2monthspriortothestartofimmunotherapy.

Thegroupreceivingantibiotherapy(56.8%male;median age68years):ECOG<1(89%),byimmunotherapy(pembrolizumab:58%;atezolizumab:23%;nivolumab:19%),numberofpreviouslines(2[1–3]median).mPFSwas5.1(3.2–7.1) monthsandmOSwas16.4(12.7–22.5)months.

Theantibiotic-naivegroup(81%male;medianage65 years):ECOG<1(91%),byimmunotherapy(pembrolizumab:54%;atezolizumab:28%;nivolumab:18%),numberof priorlines(2[1–3]median).mPFSwas5.6(4.6–9.5)months andmOSwas17.8(12.6–21.8)months.

ThedifferencesinbothgroupsonmPFSandmOSwere notstatisticallysignificant(p=0.57)and(p=0.78),respectively.

ConclusionandRelevance Despitelimitationsinsamplesize, ourstudyrevealsthattheuseofantibiotictherapy2-months priortothestartofimmunotherapydoesnotmakeadifferencetotheeffectivenessofimmunotherapy.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.Noconflictofinterest.

ConflictofInterest Noconflictofinterest.

5PSQ-094 INCIDENCEOFHYPERSENSITIVITYREACTIONSIN PACLITAXELINFUSIONSFOLLOWINGTHE DISCONTINUATIONOFRANITIDINE JJSaizMolina*,MDCGonzalezEscribano,APerezFacila,TEDeSalinasMuñoz,CNavarro Camacho,CNotarioDongil. LaManchaCentroHospital,HospitalPharmacy,AlcázardeSan Juan,Spain

10.1136/ejhpharm-2024-eahp.429

BackgroundandImportance Currentliteraturesupportsthat theuseofH2antihistaminesinpaclitaxel-containingregimens isnotessential,althoughpublicationsarescarce.1

AimandObjectives Todeterminetheincidenceofhypersensitivityreactions(HRs)duringpaclitaxelinfusionafterthewithdrawalofranitidinefromthemarket.

MaterialandMethods Observational,retrospectiveanddescriptivestudyinwhichpatientsundergoingchemotherapywith paclitaxel-containingschemesforadjuvant(ABC)andneoadjuvant(NBC)breastcancer,cervicalcancer(CC),ovarian(OC) andendometrial(EC)wereincluded.Thestudyperiodwas from2February2022(cessationofmarketingofranitidine) to31August2023.

HRswereanalysedaftermodificationofthepremedication protocol,whichincludedthesametreatmentguidelines, excludingranitidine.

Variables age,sex,typeofneoplasm,lineoftreatment,treatmentschedule,administrationtime,premedication,HRsand measureadopted.

Datasource computerisedmedicalrecordsandelectronicprescribingprogramme.

Results Atotalof493administrationsofpaclitaxelwere infusedto68patients(100%female)withamedianageof 64years[31–89].20%correspondedwithABC,29%OC, 14%CC,11%ECand26%NBC.Sixty-sevenpercentof patientswerefirst-line.

SixHRswereobservedduringthefirstorsecondcycle. Three(50%)wererelatedtopaclitaxeladministration,onein ABC(paclitaxel80mg/m2 weeklyover1hour),oneinOC (paclitaxel175mg/m2 over3hours)andoneinEC(paclitaxel175mg/m2over3hours).Theremainingthreewere relatedtotheadministrationofcarboplatininpatientson OC.

HRsappearedinpatientsaged43–67years.Onerequired discontinuationoftreatment,therestweregivenpremedicationthedaybeforethecycleandincreasedinfusiontime. ConclusionandRelevance Theuseofpremedicationprotocols withoutH2antihistaminesappearstobeasafepractice.Our studyhaslimitationsintermsofsamplesize.However,itis importanttoknowtheroleofthesedrugsanditisnecessary toinvolvethepharmacistinthedevelopmentofhospitalprotocolstoidentifypatientstobenefitfromthesedrugs.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.GelderblomH,ZwavelingJ.NoneedforH2-antagonistsinpremedicationregimensforpaclitaxelinfusions:lessismore. BrJCancer. 2021;124(10):1613–4. Noconflictofinterest. ConflictofInterest Noconflictofinterest.

5PSQ-095 HOSPITALPHARMACISTSENGAGEMENTIN PHARMACOVIGILANCEPRACTICESDURINGCOVID-19 INTHENORTHMACEDONIA

1BLazarova, 2MKovaceva, 3MSimonovskaCrcareka, 4AKapedanovskaNestorovska, 4ZNaumovska*. 1ClinicalHospitalStip,ClinicalHospital,Stip,RepublicofNorthMacedonia; 2PharmaceuticalChamberofMacedonia,PharmaceuticalChamberofMacedonia,Skopje, RepublicofNorthMacedonia; 3FacultyofPharmacy-UniversityStCyrilandMethodius-, PharmaceuticalTehnology,Skopje,RepublicofNorthMacedonia; 4FacultyofPharmacyUniversityStCyrilandMethodius-,PharmaceuticalChemistry,Skopje,RepublicofNorth Macedonia

10.1136/ejhpharm-2024-eahp.430

BackgroundandImportance Pharmacistsareacknowledgedas safetyleadersworldwide,sincetheyhavehighimpactof patients’ safety,anditwasconfirmedduringCOVID-19pandemic.IntheRepublicofNorthMacedoniahospitalpharmacists(HPs)werenationallyrecognisedasakeyfactorfor implementationofgoodpharmacovigilance(PV)practicesand since2017theyareengagedinPVworkinggroupin

MacedonianRegulatoryAgency(MALMED),activelyworking onrisingtheawarenessandimprovementofAdverseEvents (AEs)reporting.

AimandObjectives Thequestionnaire-basedresearchaimedto evaluatethecurtailroleofHPsinimplementationofgood PVpracticesduringCOVID-19pandemicinoverloaded hospitals.

MaterialandMethods Non-Interventional,questionnaire-based studyevaluatingtheknowledge,attitudesandengagementHPs forpharmacovigilanceduringCOVID-19pandemicwasperformedamongHPsintheRepublicofNorthMacedoniain July2022.Obtaineddatawerecomputedandassessedusing statisticalsoftwareSTATGRAPHICSCenturionXVIevaluation (StatPointtechnologiesInc.,USA).

Results Thesurveywascompletedby35(representingalmost 50%)ofHPsinourcountry.Theaverageageofrespondents was45.4±12.9years,morethan40%haveover20years workingexperienceasHPsandalmost70%areworkingin publichospitals.Although83%ofHPsconfirmedthathave reportedanadverseevent(AE)duringtheirworkingpractice andareexperiencedinimplementationofgoodPVpractices, only13%ofHPsstronglyagreedand39.1%agreed,that receivedtheinformationforAEsassociatedtoCOVID-19 treatmentandalmostthesamepercentageofHPsreported theAEstotheAgency.LowlevelofreportingbyHPs (17.4%)wasobservedalsoforoff-labeluseofdrugsduring thepandemic.Additionally,only17.4%ofHPswereconsultedfortheprocedureofadverseeventreportingtothe Agencybyotherhealthcareprofessionalssuggestingthatthey arestillnotrecognisedassafetyleadersinhospitals.

ConclusionandRelevance AlthoughHPsarenationallyrecognisedasstakeholdersintheimprovementofgoodPVpractices,theywerenotfullyengagedinAEsidentificationand reportingduringCOVID-19andappreciationoftheirPV expertiseinhospitalshavetobeimproved.AppropriatePV educationalongsidewithutilisationofcontemporarysoftware opportunitiesissuitableapproachforimprovementofAEs reporting,medicinessafetyandpublichealth.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-096 DESCRIPTIONOFINMMUNOGLOBULINREPLACEMENT THERAPYINMULTIPLEMYELOMAPATIENTSWITH ANTI-BCMACART

1MGiraldez*, 1EMateo, 1CGarciaPastor, 2AUrrutia, 1MSerrano, 1EMolins. 1Clinica UniversidadDeNavarra,Pharmacy,Pamplona,Spain; 2ClinicaUniversidadDeNavarra, ClinicalTrialsUnit,Pamplona,Spain 10.1136/ejhpharm-2024-eahp.431

BackgroundandImportance MultipleMyeloma(MM)isa plasmacellneoplasm.Thereductionanddysfunctionalityof normalplasmacellstogetherwithtreatmentwithanti-BCMA CAR-Tleadstoadeficitinhumoralimmunitythatmanifests ashypogammaglobulinemiaandanincreaseininfectionsrisk, whichleadtotheneedtoadministerreplacementtherapy withintravenouspolyclonalimmunoglobulins(IgRT).

AimandObjectives Theprimaryobjectiveofthisstudyisto describetheuseofimmunoglobulinsinpatientswhohave receivedanti-BCMACAR-Ttherapy(ide-cel,cilta-cel, ARI0002)forthetreatmentofMMinaclinicaltrialoras compassionateuse.

MaterialandMethods Thisisasingle-centre,observational, descriptiveandretrospectivestudytodescribetheuseof immunoglobulinsinpatientswhohadhypogammaglobulinemia,definedasIgGlevels<400mg/dL,oranyIgGlevel alongwithinfectiouseventsthatrequiretreatmentwithimmunoglobulins.Aninstitutionalreviewboard(IRB)approvedthe study.

Results 47patientsreceivedananti-BCMACAR-T,withIdeCelbeingtheCARTin70.21%(n=33)ofthem.PlasmaIgG levelsdecreasedprogressivelyovertime(mediannadirmonth 7=208mg/dL(range100–465)presentingarecoveryaround theeighthmonthpost-infusion.Ofthese47patients,22 (58.64%)received,atleastonce,IgRT.Inthese22patients, themediantimeuntilthestartoftreatmentwithIgRTwas 123days(range:69to799).Therateofinfectiousevents andfebrileneutropeniagrade3–4was68.18%(15/22)in patientswhoreceivedIgRTand56%(14/25)inpatientswho didnotreceiveIgRT(p=0.391).

ConclusionandRelevance Theseresultsrevealaperiodof hypogammaglobulinemiaafteranti-BCMACART-celltherapy. TheroleandwhentobeginIgRTneedsfurtherexploration, asinthisstudyhasnotimprovedtherateofgrade3–4infectiouseventsinpatientswhoreceivedit.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-097 ANAPPROACHTOTHEUSEOFMACHINELEARNING TOOLSFORTHEPREDICTIONOFADVERSEEVENTSIN CANCERPATIENTSONIMMUNOTHERAPY

1AParadelaCarreiro, 1LOteroMillan, 1MAlfonsínLara*, 1EYRomeroVentosa, 2CVeiga García, 3MJVillanuevaSilva, 1AMRegueiraArcay, 1IAgraBlanco, 4ARomeroRendón, 1NMartínezLópezDeCastro. 1HospitalÁlvaroCunqueiro,HospitalPharmacy,Vigo,Spain; 2FundaciónBiomédicaGaliciaSur,SeniorResearcher,Vigo,Spain; 3HospitalÁlvaro Cunqueiro,Oncology,Vigo,Spain; 4FundaciónBiomédicaGaliciaSur,ResearchFellow, Vigo,Spain

10.1136/ejhpharm-2024-eahp.432

BackgroundandImportance TheFDAAdverseReportingSystem(FAERS)isatooltovoluntaryreportadverseevents (AE),Thesedatacanbedownloadedandusedtoapply ‘Machinelearning’(ML)techniques.Thebibliographyislimited,althoughithasalreadybeenthesubjectofasystematic review(Kimetal,2022).FAERSdatasetcouldbeusefulto elaboratepotentialpredictivemodelling.

AimandObjectives TotestatoolofMLtodevelopapotentialpredictivemodelofAEcausedbyimmunecheckpoint inhibitors(ICI),usingFAERSdataset.

TocontrastandexplaintheMLresultswithareference model(RM),obtainedthroughconventionalprocessingdata (spreadsheet).

MaterialandMethods AllFAERSrecordsfrom2022were downloaded,selectingthoseofthegroupICIsgroupnotified as ‘mainsuspecteddrug’ (inclusioncriteria).Collectedvariables fromFAERSdatasetwere:AE,age,drugandsex.TheML decisiontreeclassificationalgorithmJ48implementedinthe Wekaapplication(version3.8.6)wasusedtoelaboratethe MLmodel.TheRMwasbuiltusingaspreadsheettotabulate andanalysethedata(pivottablesanddescriptivestatistics). Results 1,702,222notificationsweredownloadedand86,053 recordswereselectedaccordingtoinclusioncriteria.TheJ48 algorithmappliedtoasubsetincluding ‘adverseeffect’ , ‘ sex ’

and ‘drug’,allowedustoestimate,foreachAEthemost likelyresponsibleICIdrug.ThemetricsoftheMLmodel obtainedweresatisfactoryandcompatiblewiththeRManalysis.TheJ48algorithmproducedacomplextree(tobe expectedgiventhelargenumberofAE).Theapplicationof J48onanothersubsetthatincludes ‘adverseeffect’ , ‘ age ’ and ‘drug’,hadalowerpredictivecapacity,duetothelowerconsistencyofthedata(ageisonlyrecordedasyoungerorolder than65years)andthatthereisahigherproportionofmissingvalues.TheRMallowstheresultsobtainedwithMLto beeasilyexplainedandunderstood.

ConclusionandRelevance TheresultsoftheJ48algorithm wereusefulfortheassociationbetweenAE,sexanddrug. DespitetheinherentlimitationsofvoluntaryAEreporting, thisstudywillserveasastartingpointforapplyingMLtechniquesinanyothergroup,usingFAERSdata.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Kim, etal. 2022.10.1097/MD.0000000000029387

ConflictofInterest Noconflictofinterest.

5PSQ-098

PATIENTSWITHHEARTFAILUREWITHREDUCED EJECTIONFRACTION:OPTIMISATIONOFACCESSTO THERAPYINACCORDANCEWITHEUROPEAN GUIDELINES

1ECusumano*, 1AListro, 2IUomo, 2MPastorello. 1UniversitàDegliStudiDiPalermo, ScuolaDiSpecializzazioneInFarmaciaOspedaliera,Palermo,Italy; 2AspPalermo, DipartimentoInteraziendaleFarmaceutico,Palermo,Italy

10.1136/ejhpharm-2024-eahp.433

BackgroundandImportance The2021ESCguidelinesrecommendsacubril/valsartanastheprimarytreatmentforheartfailurewithreducedejectionfraction(HFrEF)overACE inhibitors.Until2023,eligibilityforsacubitril/valsartantreatmentrequired6monthsoffirst-linetherapy(FLT).The updateissuedbytheItalianDrugAgency(AIFA)on4March 2023alignedeligibilitycriteriawithEuropeanguidelines,followingearlyaccessafteronly1monthofFLT.

AimandObjectives Thisstudyaimstoassesstheimpactof theAIFAupdateontheclinicalmanagementofHFrEF patientsandtoestimatehowmanypatientscouldhave accessedthistherapyifthecurrentcriteriahadbeenadopted byAIFAin2022.

MaterialandMethods OurPharmaceuticalDepartmenthasthe roleofauthorisingsacubitril/valsartanprescriptionsaftermonitoringtheirprescriptiveappropriateness.Systematicmonitoring wasconductedonall682requestsofauthorisationfornaïve patients,receivedbetweenJanuary2022andJune2023. Therewerenoinclusioncriteria.Adatabasewasestablished todocumentthepharmacotherapyhistoryandtimingof administration(i.e.,toverifytheFLT,essentialeligibilitycriterionforsacubitril/valsartantreatment).Adataanalysiswas performedtocomparetheperiods:

01/01/2022–03/03/2023(pre-update),thatisbeforethe introductionoftheneweligibilitycriteria;4/03/2023–30/06/ 2023(post-update),whichissubjecttocurrentlegislation.

Results Comparativedataanalysisshowsanincreaseinthe flowofrequests:465over14months(pre-update)and217 injustthreemonths(post-update).Post-update,earlyaccess authorisationshavebeen97.7%(212/217).Pre-update,78 patientsweredeniedmedicationduetoineligibility;under

currentcriteria,anestimated63%ofthesepatientswould havebeeneligiblefortherapy.Conversely,ifAIFAhadnot updatedeligibilitycriteria,approximately27%ofauthorised prescriptions(57/112)fromMarchonwardswouldhavebeen disregarded.

ConclusionandRelevance Inconclusion,post-update,aconsiderablenumberofhigh-riskpatientsobtainedearlyaccessto therapy.Theseresultshighlighttheimportanceofquickly adaptingtonewguidelines.Thisallowsforthetreatmentofa largerpatientpopulation,reducingtheclinicalrisksassociated withhospitalisationandmortality.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.McDonaghTA, etal.ESCGuidelinesforthediagnosisandtreatmentofacute andchronicheartfailure. EurHeartJ.2021Sep21;42(36):3599–3726.DetermineAIFA223/2017e54/2023.

ConflictofInterest Noconflictofinterest.

5PSQ-099 DRUG-RELATEDPROBLEMSASSOCIATEDWITHTHE TREATMENTOFPOLYCYSTICOVARYSYNDROME

TTodorva*,YDobreva,NVeleva,SStoev,HLebanova. MedicalUniversityPleven, PharmaceuticalSciencesandSocialPharmacy,Pleven,Bulgaria

10.1136/ejhpharm-2024-eahp.434

BackgroundandImportance Polycysticovarysyndrome(PCOS) isaseverepublichealthproblemandamajordeterminantof variousreproductive,metabolic,andpsychologicaloutcomes. ThepharmacologicalmanagementofPCOSiscomplexand shouldbeindividualisedbasedonthemultifactorialmanifestationofthediseaseintheindividualpatientandherreproductivedesires.

AimandObjectives Toidentifythemostcommondrug-related problems(DRPs)byreviewingandanalysingdatafromthe scientificliteratureandPCOStreatmentguidelines.

MaterialandMethods Areviewofinternationalscientificdatabases,projects,initiativestoimprovethetherapeuticmanagementofPCOSandnormativeregulationsinthefieldof pharmaceuticalpracticewascarriedout.Bothcomparativeand criticalcontentanalysisoftherapeuticguidelinesandgood practiceinitiativesforthetreatmentofPCOS,aswellasgeneralresearchmethods(historical,internetreferenceandcontentreview,theoreticaldeductiveanalysismethod)wereused. Results DRPsrelatedtothelackofsufficientefficacydatato supportdruguse,aswellasinadequatetherapyselectionto addressthecomplexphenotypeofPCOS,andDRPsrelated tosafetyandtolerabilityconcerns(mainlyassociatedwithmetforminandletrozoletreatment)areamongthemainissues identified.ThesafetyprofileoforalcontraceptivesastheprimarytherapeuticapproachforPCOStreatmentisalsoa sourceofDRPs.Thepossibilitythatthechoiceoftherapeutic approachmaynotbetailoredtospecificpatientcharacteristics,usuallythroughtheselectionofsubeffectivedosesand dosageforms,remainsacriticalconcerninthecontextof PCOSpharmacotherapy.Drugmisuse,off-labelprescribingor prescribingofrepurposeddrugs,andDRPduetothelong durationoftherapyrequiredareothermajorgroupofconcernsrelatedtothemanagementofPCOS.

ConclusionandRelevance Theimplementationofcomplex pharmaceuticalcareinterventionsbyhospitalpharmaciststailoredtothespecificneedsofpatientswithPCOSandthe addressingoftheidentifiedDRPswillleadtobettercontrol

Abstracts

ofdisease-relatedsymptoms,betteroverallhealthoutcomes, higherqualityoflife,andgreaterpatientsatisfactioncompared tostandarddiseasecontrolapproaches.

REFERENCESAND/ORACKNOWLEDGEMENTS

TheprojectwasfundedbytheEuropeanUnion-NextGenerationEU;procedure ‘Creatinganetworkofresearchuniversities’ fromtheNationalPlanforRecoveryandResilience, project ‘ResearchUniversity-MedicalUniversity-Pleven’ ,contract#BG-RRP-2.004–0003-C01. ConflictofInterest Noconflictofinterest.

5PSQ-100 SURVEYOFPATIENTINVOLVEMENTINADVERSE DRUGREACTIONMONITORING:THEIRINFORMATION SOURCESANDNEEDS

1NJarernsiripornkul*, 1WSrisuriyachanchai, 2ARCox. 1FacultyofPharmaceuticalSciences, DivisionofClinicalPharmacy,KhonKaen,Thailand; 2SchoolofPharmacy-,Collegeof MedicalAndDentalSciences-UniversityofBirmingham,Birmingham,UK

10.1136/ejhpharm-2024-eahp.435

BackgroundandImportance Adversedrugreactions(ADRs) haveresultedinasignificantproportionofmorbidityandmortality.Patientshaveaccesstoseveralsourcesofinformation aboutadversedrugreactions(ADRs),whichcontributeto improvingmedicationsafety.Therehavebeenfewpublished studiesonsourcesofADRinformationusedandtheinformation neededbypatients.

AimandObjectives Toexplorepatients‘ useofinformation sourcesandtheirinformationneedsinthemonitoringprocess ofadversedrugreactions(ADRs)andtoevaluatefactors relatedtobothinformationsourcesandinformationneeds.

MaterialandMethods Across-sectionalsurvey,usingaselfadministeredquestionnaire,wasdistributedtopatientsthrough purposivesampling,whowerevisitingoutpatientdepartments oftwouniversityhospitalsfromJanuarytoJuly2020.Patients aged18andoverwereaskedabouttheirinformationsources andneedsabouttheexperiencedADRs.

Results Ofthetotal617questionnairesdistributed,479were completed(77.6%).Respondentswereaskedaboutsourcesof informationusedtoconfirmADRsymptoms.Ofthetotal 476respondents,316(66.4%)claimedthattheyconsulted theirphysicianstoconfirmADRs,194(40.8%)reliedontheir ownexperiences,and66(13.9%)consultedpharmacists.The toptwoinformationthatpatientsneededinADRidentificationwerehealthcareprofessionaladvice(75.0%)andADR informationdocuments(48.1%).ThemajorneededinformationregardingADRmanagementincludedthetreatmentof ADRsymptoms(33.9%)andswitchingtootherdrugs (32.9%).MajorinformationneedsrelatedtoADRprevention wererecordingahistoryofdrugallergies(40.6%)andADR surveillanceanddetectionmethods(29.0%).Patientswith bachelor ’sdegreeorhighereducationallevelsweremorelikely tousemedicinelabelsasasourceofADRinformation(p= 0.047).Patientsagedlessthan60years(p=0.018)and patientshavingthreeunderlyingdiseasesorless(p=0.043) weremorelikelytorequiretheADRinformation.

ConclusionandRelevance Healthcareprofessionals(HCPs)are theprimarysourcesofinformationforpatients.Younger patientsandlessunderlyingdiseaseswerefoundtobeassociatedwithagreaterneedforinformation.Therefore,HCPs

shouldensurethatpatientsreceivesufficientADRinformation particularlyolderpatientstoenhancemedicationsafety.

REFERENCESAND/ORACKNOWLEDGEMENTS

WethanktheRoyalGoldenJubileePh.D.ProgrammeFund forsupportingthisresearch.

ConflictofInterest Noconflictofinterest.

5PSQ-101 MEDICALDEVICESINCIDENTREPORTS:ANITALIAN EXPERIENCE

GGuarnieri*,CZero,MDall’aglio,GMangoni,LCervi. AsstGrandeOspedale MetropolitanoNiguarda,Pharmacy,Milan,Italy

10.1136/ejhpharm-2024-eahp.436

BackgroundandImportance DispovigilanceistheItalianMinistryofHealth’sdatabasethatsupportstheNationalVigilance DeviceNetworksinceOctober2022.Itisanessentialtoolin thereportingsystemforserious,non-seriousincidentsand safetyactionsrelatedtomedicalandinvitrodiagnosticdevices(MDsandIVDs).

TheNationalClassificationofMedicalDevices(CND) groupsMDsintohomogeneouscategoriesofproductsforsimilardiagnosticand/ortherapeuticintervention.

TheEuropeanMedicalDeviceNomenclature(EMDN), Regulations2017/745and2017/746,isbasedontheItalian CND.TheRegulationsalsoclassifyMDsintodifferentclasses accordingtoriskmanagement.

AimandObjectives ThepurposewastoinvestigateMDs involvedinincidentsoccurredatanItalianhospital,toproviderealworldevidence.

MaterialandMethods Thisstudywasperformedonincident reportscollectedthroughDispovigilancebetweenJanuary 2022andSeptember2023.CND,riskclass(I,IIA,IIB,III) andreporterwereanalysed.

Results Atotalof42reportswerecollected;ofthese,17 (40%)during2022and25(60%)inthefirstninemonthsof 2023.AccordingtoCND,themostfrequentlyreportedDMs belongedto ‘C,CardiocirculatorySystemDevices’ (20cases, 23%); ‘P,ImplantableProstheticandOsteosynthesisDevices’ (8cases,19%)and ‘A,DevicesforAdministration,Withdrawal andCollection’ (7cases,16%).Basedontheclassofrisk,1 MDreferredtoclassI,15toclassIIA,13toclassIIB,13to classIII.Mostaccidentswerereportedbyclinicians(25cases), followedbypharmacists(7cases)andnurses(7cases).

ConclusionandRelevance Theanalysisshowsanincreasing reportingtrendin2023comparedto2022,probablydueto theadventofDispovigilance,althoughunderreportingisstill presentespeciallyforlow-riskdevices.Mostreportsreferto mediumandhigh-riskdevices.

BasedonCND,CandParefrequentlynotified;thereason couldbethegreaterattentiononthesehigh-riskdevices. Accordingtoourresults,cliniciansarethepredominant reporters,togetherwithpharmacistsandotherhealthcareprofessionalssincetheyaredirectlyinvolvedinthemanagement anduseofDMs.

Thisstudyhighlightstheessentialroleofvigilanceofmedicaldevices.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-102

ANALYSISOFREPEATEDEMERGENCYDEPARTMENT VISITSANDTHEIRRELATIONSHIPTOMEDICATION

MJCanalejoFuentes*,CPuivecinoMoreno,YCastellanosClemente,JPedreiraBouzas, MGarciaGil. FuenlabradaUniversityHospital,PharmacyUnit,Fuenlabrada,Spain

10.1136/ejhpharm-2024-eahp.437

BackgroundandImportance Analysingthereasonsofrepeated EmergencyDepartment(ED)visitscouldhelpestablishapharmacotherapeuticfollow-upconsultation,inordertoreducethe numberofre-consultations

AimandObjectives Analysethepercentageofrepeatedvisits toEDinrelationtopharmaceutically-approvedpatients’ medicationorpatients’ medicationthathavereceivedathorough pharmacotherapyrevision(approved/thoroughlychecked patients).

MaterialandMethods Anobservational,retrospectivestudy developedinasecond-levelhospitalfromSeptemberto December2022.Allpatientsapprovedandthoroughly checkedbyPharmacyteamfromEDwereincluded,meaning allthosewhoappearedinatleastoneofEmergencyPharmacyActivity(EPA)forms.Themainvariableconsideredwas thepercentageofpatientsthatcamebacktoED,counting 2 EPAregistrations,comparedtothetotalamountofapproved/ thoroughlycheckedpatientsinthatperiod.Othervariables consideredwerethepercentageofpatientscomingbackwith thesameissue,themainissuestherepeatavisit,thepercentageofrepeatedvisitsrelatedtopharmacotherapyandthe mainpharmacotherapeuticrelatedgroups(ATCcode).Data wereacquiredfromtheelectronicclinicalhistory.Datawere statisticallyevaluatedthroughasoftwaredescriptivefrequency analysis.

Results Duringthestudyperiod,673patientswereincluded. Fromthem,50.52%werewomen(medianage:72yearsold).

ThenumberofpatientsthatvisitedEDagainwas11.44% (77/673).Thetotalamountofrepeatedvisitswas83.Several patients[46.75%(36/77)]camebackduetosameissue.The mainissuestorevisitwererespiratoryinfection[11.68%(9/ 77)],unbalancedheartfailureandurinarytractinfection[both 10.38%(8/77)],andCOPDflare-ups[7.8%(6/77)].The repeatedvisitsrelatedtomedicationwere57.83%(48/83)of cases.Themainpharmacotherapeuticgroupsrelatedtothe EDwere:cardiovascular-system[35.41%(17/48)],anti-infectivegroup[20.83%(10/48)]andrespiratory-system[12.5%(6/ 48)].

ConclusionandRelevance Fromtheapproved/thoroughly checkedpatientsthatcametoED,1/10camebackatleast onceand.Inoverhalfofthecases,repeatedvisitswere relatedtomedication,andspecificallytoissueswherecardiovascularoranti-infectiousmedicationwereinvolved.Tolearn abouttherepeatedvisitstoEDandhowtheyarerelatedto pharmacotherapycouldhelpselectpatientswhocouldbenefit fromanoutpatientpharmacotherapeuticappointmentafter beingdischarged,aimingtoreducetheamountofrepeated EDvisitsrelatedtomedication.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-103 VANCOMYCIN-INDUCEDRENALTOXICITYTHROUGH THERAPEUTICDRUGMONITORINGINDAILY PRACTICE

1AMagdalenaPérez, 1JPeñaHernández, 1ASantosFagundo*, 1JEsquivelNegrin, 2CFrias Ruiz, 1PJoyCarmona, 1AMartínLópez, 1ETévarAfonso, 2MCarreteroPérez, 1FJMerino Alonso. 1NuestraSeñoraDeCandelariaUniversityHospital,HospitalPharmacy,SantaCruz DeTenerife,Spain; 2NuestraSeñoraDeCandelariaUniversityHospital,ClinicalAnalysis, SantaCruzDeTenerife,Spain

10.1136/ejhpharm-2024-eahp.438

BackgroundandImportance Vancomycinisusedinthetreatmentofresistantgram-positivemicroorganisminfections.Due toanarrowtherapeuticrange,itsuseislimitedbyitsnephrotoxicity,whichrangesfrom5–43%accordingtotheliterature. Therefore,it’simportanttoidentifypatientswhomaybenefit frompharmacokineticmonitoring.Thedurationoftreatment andahighminimumconcentrationofvancomycinarefactors associatedwithnephrotoxicity.

AimandObjectives Todeterminetheincidenceofnephrotoxicityassociatedwiththeuseofvancomycininmonitored patientsandidentifyfactorsrelatedtoitsoccurrence.

MaterialandMethods Retrospective,observationalstudyin patientswhounderwentpharmacokineticmonitoringbetween 2022andJanuary2023,inathird-levelhospital.Demographicdataandinformationrelatedtoantibiotictreatment werecollected,includingdurationandindication,initialdose andfrequencyofadministration,minimumsteady-stateconcentrationofvancomycin,andrenalfunctiondata:baselinecreatinine,creatinineatthestartofantibiotictreatment,andattwo daystoassessthedevelopmentofAcuteKidneyInjury(AKI), definedbytheKidneyDisease:ImprovingGlobalOutcomes (KDIGO)guidelinesasanincreaseincreatinineby0.3mg/dL comparedtotheinitialvalueaftertwoconsecutivedaysof treatment.

ThesedatawereanalysedwithJamovisoftware.

Results 93patients,71%men,meanage62(18–92).

8.6%ofthepatientsmetthecriteriaforAKIsecondaryto vancomycin.

Factorsassociatedwithnephrotoxicity ageequaltoorgreater than65years(p=0,04),beingfemale(p=<0,001)andhaving aBMIequaltoorgreaterthan30kg/m2(p=0,03).

Therewasnoobservedhigherincidenceofnephrotoxicity basedontheuseofhighdosesorthelocationofthe infection.

ConclusionandRelevance Inourstudy,weobservedan advancedage,beingfemale,aBMIover30kg/m2andahigh minimumconcentrationofvancomycinasfactorsassociated withnephrotoxicity.GiventheincidenceofAKIsecondaryto vancomycintreatment,it’simportanttorecognisethefactors associatedwithitsoccurrenceinordertoidentifypatients whomaybenefitfrompharmacokineticmonitoring,thusoptimisingtreatmentandlimitingnephrotoxicity.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549902/pdf/ijgm-15-7685.pdf

2.https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/bcp.15429

3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10296058/pdf/ofad264.pdf

4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10296058/pdf/ofad264.pdf

5.https://www.ilaphar.org/incidencia-de-nefrotoxicidad-en-pacientes-monitorizadosen-tratamiento-con-vancomicina/ 6.https://rdu.unc.edu.ar/bitstream/handle/11086/18090/13904%20tesis%202020% 20Suarez%20Alejandra%20TIF%20Farma%20Hospitalaria.pdf?sequence=1 7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520844/ 8.https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/bcp.14834 9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9691676/pdf/fphar-13-1041152.pdf

ConflictofInterest Noconflictofinterest.

5PSQ-104 REAL-WORLDEVIDENCE:ISIBRUTINIBASSAFEAS EVIDENCETELLS?

LSoriano,MOliver*,SRedondo-Capafons,MGómez-Valent. ParcTaulíHospital Universitari.InstitutD’investigacióIInnovacióParcTaulíI3pt,Pharmacy,Sabadell,Spain 10.1136/ejhpharm-2024-eahp.439

BackgroundandImportance IbrutinibisaBrutontyrosine-kinaseinhibitorusedinfirstandsubsequentlinesoftreatmentof chroniclymphocythicleukaemia(CLL).Ibrutinibhasdemonstrateditsefficacyandsafetyinmanystudiespublishedto date.Thereisalsoexperienceavailableaboutthistopicin real-worldpractice.However,thesafety ’sevidenceisdifferentbetweenbothscenarios.Becausetheuseofibrutinibmay varyamongdifferentcountriesandhospitalsinthesame country,wequestionwhethersafety ’sinformationinour patientsisaccordingtoreal-worldevidence.

AimandObjectives Toanalysethesafetyprofileofibrutinib inCLLall-linesoftreatment,andthemanagementofits toxicity.

Secondaryendpoints todetermineibrutinib’styperesponses. MaterialandMethods Observational,descriptive,single-centre, retrospectiveandlongitudinalstudy.Inclusioncriteria:patients CLLdiagnosedwhostartedsingle-agentibrutinibtreatment fromJanuary2016toDecember2022,aged 18years-old. Patientstreatedinclinicaltrialsandcompassionateusecontexts,wereexcluded.Quantitativevariableswillbedescribed withmeansormedians(ranges);qualitativevariableswith absoluteandrelativefrequencies.

Results Sixtypatientswereincluded,35%receivedibrutinibin first-linesetting.642adverseevents(AEs)weredescribed, average:10,7(2–32)AEs/patient.MostcommonAEsofany gradewerehaematologicaltoxicity(18,1%)mainlyanaemia andneutropenia,andinfections(15.9%).Asspecialinterest EAs,itwasfoundarterialhypertension(3.7%),atrialfibrillation(1.2%)andheartfailure(0.8%).Mostfrequentgrade 3 AEswere:infections(27%)especiallyrespiratoryinfections, haematologicaltoxicity(16%)andarterialhypertension(13%). Fivepatientsdiedduringibrutinibtreatment.Temporaryinterruptionsoccurredin68%patients,mostlybecauseAEs(69%) andsurgicalprocedures/diagnosticstests.27%ofpatients neededdosereductionsfortoxicitymanagement.Anypatient requiredasecondreductionforitsmanagement.Mainreasons fortreatmentendwereAEs(32%),diseaseprogression(19%) anddeath(19%).Treatmentresponsewasevaluatedin51 patients:completeresponse(56%),partialresponse(20%)and stablediseaseprogression(7%).

ConclusionandRelevance DespitetheelevatednumberofAEs detected,noneofspecialofinterest.notpreviouslydescribed havebeenfound.Safetyprofileshownbyibrutinibinour treatedpopulationiscomparabletothatdescribedinprevious publishedstudies.Surprisingly,completeresponsefrequency detectedishigherthanreportedinotherstudies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-105 PATTERNSOFUSEANDAPPROPRIATENESSOF ANTICOAGULATIONINATRIALFIBRILLATION:AN OBSERVATIONALSTUDYAMONGGERIATRIC INPATIENTS

1JHias, 1EVanderstuyft, 1KWalgraeve*, 2LHellemans, 3LVanAelst, 4JTournoy, 1LVanDer Linden. 1UniversityHospitalsLeuven,HospitalPharmacy,Leuven,Belgium; 2KULeuven, DepartmentofPharmaceuticalandPharmacologicalSciences,Leuven,Belgium; 3University HospitalsLeuven,Cardiology,Leuven,Belgium; 4UniversityHospitalsLeuven,Geriatric Medicine,Leuven,Belgium

10.1136/ejhpharm-2024-eahp.440

BackgroundandImportance Atrialfibrillation(AF)isacommonarrhythmia,affectingnearlyhalfofallgeriatricpatients. AFposesasignificantischemicstrokerisk,makingeffective anticoagulationessential.Directoralanticoagulants(DOACs) haveemergedaseffectivestroke-preventionagents,yetunderutilisationremainsaconcern,especiallyingeriatricpatients. Toimprovepharmacotherapy,includinganticoagulation,aclinicalpharmacyprogramwasimplementedonthegeriatric units.

AimandObjectives Onthatbackground,wesoughttocharacteriseanticoagulantutilisationpatternsandinappropriateness amonggeriatricAFinpatients.

MaterialandMethods Anobservationalstudywasperformed attheacutegeriatricunitsof anacademichospital.Thefirst 90AFpatientsfor2020,2021and2022,whoreceivedat leastoneoralanticoagulant,wereincluded.Anticoagulantuse atdischargeandtherapyappropriatenesswereassessed. Determinantsforunderdosingwereevaluatedusingmultivariablelogisticregression.Tempor alassociationsforappropriateness(yesorno)andanticoagulantclass(VitaminK antagonist(VKA)vs.DOAC)wereassessedusingFisher ’ s exactanalysis.

Results Meanagewas86.5(±5.3)yearswithmedian CHA2DS2-VAScscore5[4–6].Atdischarge,256(94.8%) patientsusedaDOAC,9(3.3%)usedaVKA,1(0.4%)a DOAC-antiplateletcombination,andin4(1.5%)anticoagulant usewasdiscontinued.Apixabanwasmostcommonlyprescribed(40.7%)andamajorityofpatients(64.4%)receiveda reducedDOACdose.Thirty-nine(14.4%)patientsreceived inappropriatetherapyandfor23/39(59.0%)nodeviation rationalewasdocumented.Theyear ‘2022’ (oddsratio0.104; 95%confidenceinterval,0.012–0.878)wastheonlydeterminantforunderdosing.Therewasnotemporalassociation regardingappropriateness(P=0.533)oranticoagulantclass (P=0.479).

ConclusionandRelevance Amajorityreceivedanticoagulation atdischarge,mostlyreducedDOACdoses.Onlyaminority wasmanagedinappropriately.Thereassuringfindingsoverthe 3-yearperiodmightbeexplainedbythesuccessoftheclinical pharmacyprogramme.Inconclusion,onabackgroundofsaid pharmacyservices,mostAFpatientsweretreatedaccordingto currentguidelines.However,deviationfromclinicalguidelines stilloccurredconsistently,frequentlywithoutadocumented rationaleandlargelyexplainedbyunderdosinginthecontext ofahighbleedingrisk.Accordingly,moretrialdataonthe mostappropriateanticoagulationstrategyareurgentlyneeded ingeriatricAFpatientswith(very)highbleedingrisks.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-106 FALL-INCREASINGRISKDRUGS(FRIDS)ANDFALLRELATEDFRACTURES

1SMachado*, 1CFerro, 2OTkachuk, 2TOsorio, 1PSadio. 1UnidadeLocalDeSaudeDo BaixoAlentejo,HospitalPharmacy,Beja,Portugal; 2UnidadeLocalDeSaudeDoBaixo Alentejo,Orthopaedics,Beja,Portugal

10.1136/ejhpharm-2024-eahp.441

BackgroundandImportance Fallsareamajorpublichealth issue,oftenresultingfrominteractingrisks,beingfall-riskincreasingdrugs(FRIDs)useoneoftheprominentriskfactors.Fallscarryahighriskoffunctionaldependence,hospitalisation,institutionalisationandmortality.STOPPfallswasbuilt throughaDelphiprocessofexpertsandresultedinalistof FRIDs.1 Consensuswasreachedforanticholinergics,diuretics, alpha-blockersusedasantihypertensives,opioids,antidepressants,antipsychotics,antiepileptics,benzodiazepinesandbenzodiazepine-relateddrugs,centrally-actingantihypertensives, alpha-blockersforprostatehyperplasia,antihistaminesandvasodilatorsusedincardiacdiseasesandoveractivebladderand urgeincontinence.

AimandObjectives CharacteriseFRIDsprescriptionprofilein fall-causedadmissionsinanOrthopaedicsservice.

MaterialandMethods Allpatientsaged65yearsorover, admittedtoOrthopaedicsservice,withadiagnosisoffracture duetoafallbetween1January2023and30June2023 wereincluded.Sociodemographicdataandmedicationhistory wereobtainedusingelectronicmedicalrecord.

Results Thestudyincluded154patients,mostlywomen (78%).Theaverageagewas83years.Themajorityofthe patients(49%)usedtotake5–9medications,41%0–4medicationsand10%morethan10medications.Werefound222 FRIDsprescriptions,whichcorrespondsto1.44FRIDsprescribed/patient.ThemostcommonFRIDsprescribedwere antidepressants(25%),diuretics(21%)andbenzodiazepines (21%).

ConclusionandRelevance BesidesthenumberofFRIDs/patient islowerthaninotherstudies(1.44vs2.6),2,3 themostcommonprescribeddrugclassesaremuchthesame.Regarding ageandgender,resultsaresimilartotheSpanishstudy.A limitationisthatonlydataaboutFRIDs’ numberwasassessed, regardlessofthedefineddailydosageofeachdrug.Thislater hypothesiscouldhavedeliveredbetterunderstandingof whetherdrugdosageaffectsfallrisk.ItisimportanttopromoteFRIDsdesprescription.Therefore,theupfrontuseand disseminationofdesprescribingtoolsasSTOPFallsamong healthcareprofessionalsshouldbeencouragedalongsidewitha multifactorialstrategytoreducefalls.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SeppalaLJ, etal. STOPPFall:aDelphistudybytheEuGMStaskandfinishgroup onfall-risk-increasingdrugs. AgeandAgeing. 2021;4:1189–1199.

2.Correa-PérezA, etal. PS-050|Prevalenceofpolypharmacyandfallriskincreased drugsatdischargeinfallrelatedhipfractureelderlypatients. EuropeanJournalof HospitalPharmacy. 2017;24:A249.

3.MilosV, etal. Fallrisk-increasingdrugsandfalls:across-sectionalstudyamong elderlypatientsinprimarycare. BMCGeriatrics. 2012;14:40.

ConflictofInterest Noconflictofinterest.

5PSQ-107 COMPLIANCEOFFLUOROQUINOLONES PRESCRIPTIONS:AHOSPITALACQUIREDRESISTANCE?

AOlivan*,AAutellet,IMerhari,MCarrot,GBaroux,GMaquin. ChuMontpellier, PharmacySaint-Eloi/GuiDeChauliac,34090Montpellier,France

10.1136/ejhpharm-2024-eahp.442

BackgroundandImportance InEurope,theannualdeathtoll fromantibiotic-resistantbacteriahasrisenfrom25,000to 35,0001.In2020,Francereporteda16%resistancerateto fluoroquinolone(FQ)inhospital2.FQarenolongerrecommendedasfirst-linetreatmentandarerestrictedtosomeurinary,pulmonary,intra-abdominal,softtissueinfections,and bacteraemiacases.

AimandObjectives Thisstudyaimstoassessthecompliance ofFQprescriptionswithguidelinesprovidedbythelocal healthcareproductsafetycommission,SummariesofProduct Characteristics,andtheFrenchSocietyofInfectiousPathology (SPLIF).

MaterialandMethods Thestudy(1December2022-to1 May2023)wasconductedacrossthefollowingspecialties: hepatogastroenterology,vascularmedicine,homehospitalisation,neurology,ophthalmology,dermatology,haematology,and intensivecaredepartments.

UsingtheDxCare® prescriptionsoftware,ciprofloxacin, ofloxacin,levofloxacin,andmoxifloxacinwereanalysed,focusingontheconformityof:indication,dosage,duration,documentation,theintervalbetweentwoFQ,andpharmaceutical validation.

Results 197prescriptionswereextracted.100%werevalidated.41%(81)werecompliant.Compliancerateswere85% (168)forindicationsand94%(185)fordosage.59%ofprescriptions(117)werefirstline,33%(65)secondline,5%(9) thirdline,and2%(3)fourthline.70%(137)adheredtothe recommendedtreatmentdurationand83%(164)respected theminimum6-monthintervalbetweentwoFQ.47%(92)of prescriptionsweredocumented,34%(67)wereprobabilistic, and19%(39)wereprophylaxis,ofwhich13(30%)were compliant.

85%ofstrainsweresensitivetoFQ,with16%sensitiveat higherdoses,and3%exhibitingresistance.

Amongthe59%non-compliantprescriptions(116),indicationswereprincipally:5%maleurinarytract(10),6%skin andsofttissue(12),9%(17)forbothpulmonaryandfemale urinarytract.

ConclusionandRelevance Consideringthehighrateofnoncompliantprescriptions(59%),thereisaneedtoreviewinternalguidelinesoftheprincipalnon-compliantinfections,tobe moreintuitive.Wecouldproduceaninformationalnoteto physiciansandpharmaciststoemphasisetheneedtoadhere tostrictindicationsandtodocumentinfections,sinceless thanhalfweredocumented.Thiswasa6-monthstudyin selecthospitaldepartments,itcouldhavebeenextendedto theuniversityhospitalcentrein2022.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-108

EFFICACYANDSAFETYOFINFLIXIMABINNF-KB ESSENTIALMODULATORDELETEDEXON5AUTOINFLAMMATORYSYNDROME:ACASEREPORT

JBersali*,CReygner,NGosse-Boeuf,JJost,EMarcellaud. CHULimoges,UnitéDe PharmacieClinique-PharmacieUsageIntérieur,87042Limoges,France

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BackgroundandImportance TheNF-KBessentialmodulator deletedexon5auto-inflammatorysyndrome(NEMO-NDAS) isanX-linkedauto-inflammatorydiseasebelongingtothesystemicauto-inflammatorydiseases(SAIDs).NEMO-NDAS affectstheskin(ectodermaldysplasia)andtheimmunesystem. AfewcaseshavebeenreportedinFrance.

AimandObjectives Theobjectiveofthiscasereportwasto describetheuseofinfliximabanditssafetyinNEMONDAS.

MaterialandMethods Wereporta9-month-oldbabywhoinitiallypresentedalong-lastingfeverandapanniculitis.No infectiousnorautoimmunecauseswerefound,andtheinterferonsignaturewaslow.Acorticosteroidtreatmentwas started.Furthergeneticanalysesshowedananomalyofthe NEMOgenecompatiblewithaNEMO-NDAS.Severalpathwaysaremodified,includingtheinterferonpathway,which wasincreased.Norecommendationsnorrelevantliteraturefor specifictreatmentwasfound.

Results Anti-TNF-alphasuchasadalimumaborinfliximab couldbeusedtodownregulatethisinterferonpathway. Infliximabwasintroducedatadoseof5mg/kgevery15days foramonthandahalf,theneverymonth.Afterthefirst injection,nofever,infectionnorcutaneousmanifestationwere reportedbytheparents.Thepatientseemedtosufferless. Followingthesecondinjection,thecorticosteroidtreatment wasdecreasedandstoppedovera15-dayperiod.

Onemonthaftertheintroductionofinfliximab,thepatient presentedatotalapyrexiaandnoclinicalsignsofinfection. Onclinicalexamination,ahypertrophyofthelymphaticsystemwasfound(bilateralpainlessmobileaxillaryadenopathies, anteriorcervicalandsupra-clavicularadenopathies).Inspiteof this,thepatientwasconsideredtobeinclinicalandbiological remission(C-reactiveprotein=1mg/L,sedimentationrate< 2mminthefirsthour,amyloidAserum<6,4mg/L,transcriptomicsignatureofnegativeinterferongamma).Infliximab iscurrentlybeingcontinued.

ConclusionandRelevance Infliximabwasusedsuccessfullyin ourcaseandledtoremissionin1monthwithgoodtolerance andnoadverseeffect.Infliximabseemstobeawell-tolerated treatmentoptionforNEMO-NDASininfants.

Introductionofinfliximaballowedatotalremissionin1 monthwithoutanyadverseeffectonthepatient.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-109 HAEMOASSIST:ADIGITALBRIDGEBETWEEN HAEMOPHILIAPATIENTSANDPHARMACISTS

NBlazquez-Ramos*,JARomeroGarrido,CBilbaoGómez-Martino,CSobrinoJimenez, CJimenezNunez,MEIbañezRonco,LCarrascoCuesta,SMallonGonzalez,VLCollada Sánchez,ABAranconPardo,AHerreroAmbrosio. HospitalUniversitarioLaPaz,Hospital Pharmacy,Madrid,Spain

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BackgroundandImportance Patientswithseverehaemophilia willneedregularparenteraltreatmentthroughouttheirlives torestoretheirhaemostasis.

Thesepatientsreachahighdegreeofautonomyandtheir follow-upcanbeachallengeforhealthcareprofessionals.

In2020ourPharmacyService(PS)offeredamobileapplication(Haemoassist®)to315patientssothattheycould recordtheirpharmacologicaladministrations,specifying whetherforprophylacticpurposesortotreatactivebleeding. AimandObjectives Compareappusagedataobtainedin 2022,withthedatapublishedin2020,toknowifweare achieving:

-Increasethenumberofpatientsusingtheapp.

-Improvethequalityofthedataenteredintheapp. MaterialandMethods

. Countthenumberofpatientswhousedtheappin2022.

. Westudiedthedegreeofconcordancebetweentheadherence offeredbytheapp(reportedadministereddoses/prescribed doses)andthatcalculatedfromthePS(dispenseddoses/ prescribeddoses).

. Checkwhetherallpatientswho,accordingtothedata collectedinthehospital’smedicalrecord,hadbledandwere usingtheapp,hadreportedthesebleedsintheapp.

Wecomparedthese2022datawiththosepublishedin2020. Results 190patientsusedtheapponsomeoccasionduring 2022comparedto169patientsin2020.

In2022,themedianadherenceachievedbythe190patients, accordingtotheapp,was8%andtheInterquartileRange (IR):0–57%andaccordingtotheSFdispensationswas92%(IR: 77-99%).Thedegreeofconcordancebetweenthetwocalculationmethodswas18%.In2020,concordancewas9%.

Ofthe190patientsusingtheappin2022,accordingto thehospital’smedicalrecords,153ofthemhadableeding episode,butonly74reportedtheirbleedsintheapp.The 48%ofpatientsreportedtheirbleedsintheappin2022versus54%in2020.

ConclusionandRelevance Thenumberofpatientsusingthe apphasbeenincreasing.Thequalityofpatient-reporteddata isslowlyimproving.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.NuriaBlazquez-Ramos,Romero-GarridoJoséA,LuisGonzalezDelVall,Hortensia DelaCorte-Rodriguez,AliciaHerrero-Ambrosio,CarlosRodriguez-MerchanE. Developmentofatelematicpharmaceuticalcareapp(Haemoassist)formultidisciplinaryfollow-upofpatientswithcongenitalcoagulopathies. ExpertReviewof Hematology.2023;16:3:213–226.DOI:10.1080/17474086.2023.2162497

ConflictofInterest Noconflictofinterest.

5PSQ-110 DESENSITISATIONTOMONOCLONALANTIBODIESIN ONCOHAEMATOLOGICALPATIENTS

1SGonzalezSuarez, 2CCremadesArtacho, 3RMMuñozCano, 3SGelisCaparros, 1IMonge Escartín, 2CLópezCabezas, 2TLizondo*, 4LCarolaMagnano, 5ARodríguezHernández, 6MPascalCapdevilla, 2DSoyMuner. 1HospitalClinicBarcelona,HospitalPharmacy. DesensitisationWorkingGroup,Barcelona,Spain; 2HospitalClinicBarcelona,Hospital Pharmacy,Barcelona,Spain; 3HospitalClinicBarcelona.Idibaps.UniversityofBarcelona., AllergologyDepartment.ClinicalRespiratoryInstitute.DesensitisationWorkingGroup, Barcelona,Spain; 4HospitalClinicBarcelona,HematologyDepartment.Desensitisation WorkingGroup,Barcelona,Spain; 5HospitalClinicBarcelona,OncologyDepartment. DesensitisationWorkingGroup,Barcelona,Spain; 6HospitalClinicBarcelona,Immunology Deparment.DesensitisationWorkingGroup,Barcelona,Spain

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BackgroundandImportance Theincreaseduseofmonoclonal antibodies(mAb)forcancertreatmenthasbeenassociated withahigherincidenceofhypersensitivityreactions(HR). Drugdesensitisationisaprocedurethat,byinducingtemporarytolerance,allowspatientswhohavedevelopedadrug HRtosafelyreceiveit.Thistechniqueisperformedaccording topreviouslypublishedstudiesandplaysasignificantrolefor patientswithHR,enablingtreatmentcontinuation.

AimandObjectives Toconductadescriptiveanalysisofthe useofmAbasadesensitisationprotocolandtoevaluatetheir effectivenessinaseriesofcases.

MaterialandMethods Alloncological-haematologicalpatients, whounderwentdesensitisationusinga3-concentrationprotocolduetoHRtomAbinaUniversityHospitalbetween 2019and2022,wereincluded.Clinicalinformationwasretrospectivelycollectedfrommedicalrecords(SAP®,Genomi®), includingoncohaematologiccancertype,mAbdesensitised, timeandseverityofthereaction,allergologystudyresults (skintestand/orBasophilActivationTest(BAT)),suspected underlyingmechanism(InmunoglobulinE(IgE)mediatedor non-IgEmediated),breakthroughreactionsduringanyofthe desensitisationandfinaloutcome.

Results Thirty-sixpatientsreceivedmAbdesensitisationregimens,withatotalof357desensitisationsofeightdifferent drugs[rituximab(123),cetuximab(87),daratumumab(68), trastuzumab(45),brentuximab(13),Obinutuzumab(9),isatuximab(9),trastuzumabentamsine(3)].Eachpatientreceivedan averageof10administrations(1–52)indesensitisationregimen.Twenty-eightpatientshadhaematologicalpathologies (77%),mostofthemtreatedwithrituximab.Seventeenoutof 36(47%)patientsdesensitisedexperiencedareactionatfirst contactwiththedrug.Halfofallpatients(18)sufferedmoderatetosevereHR;andonlyfivepatientshadaconfirmed IgE-mediatedHR,confirmedbyskintestsorBAT.86%of thepatientsdidnotexperienceanyreaction(breakthrough reactions)duringthedesensitisation.Theremainingexperiencedsomemildreactionduringatleastoneofthedesensitisations,butafteradjustingtheinfusionregimentheytolerated treatmentadequately.All(100%)ofthedesensitisationswere successful;patientswereabletoreceivethemedicationthey werebeingtreatedwithoutexperiencinganyadversereactions thatrequirediscontinuation.

ConclusionandRelevance Thehighsuccessofdesensitisations tomAbinourhospitalhighlightstheimportanceofthistechniquepreventingswitchingtoothertreatmentsthatmightbe moreexpensiveandlesseffective.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-111 SODIUM-GLUCOSECOTRANSPORTER2INHIBITORS AFTERHEARTTRANSPLANTATION

1NMasBauza*, 1CPorredon-Antelo, 1DMoisés-Minchola-Lavado, 1MSantos-Puig, 2EGarcía-Romero, 2JGonzález-Costello, 2LHerrador-Galindo, 2LTriguero-Llonch, 3NSabéFernández, 1LSantulario-Verdú. 1HospitalUniversitariDeBellvitge,Pharmacy,HospitaletDe Llobregat-Barcelona,Spain; 2HospitalUniversitariDeBellvitge,Cardiology,HospitaletDe Llobregat-Barcelona,Spain; 3HospitalUniversitariDeBellvitge,InternalMedicine,Hospitalet DeLlobregat-Barcelona,Spain

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BackgroundandImportance Sodium-glucosecotransporter2 inhibitors(SGTL2i)arewidelyusedtomanagediabetes

mellitus(DM)andheartfailure(HF).Recently,safetystudies havebeenpublishedontheiruseinrenalrecipients,however, noevidenceexistsinhearttransplantrecipients(HTR).

AimandObjectives Toevaluatesafety,tolerabilityandeffectivenessofSGTL2iinHTR.

MaterialandMethods Retrospectivedescriptivecohortstudy conductedinatertiaryhospital.Alladultsundergoingheart transplantation(HT)fromJanuary2016toJuly2023 treatedwithSGLT2iwereincluded.Demographic,clinical andpharmacologicaldatawe rerecorded.Outcomemeasures:BodyMassIndex(BMI)andHbA1cevolution,numberofhospitalisationsinpatientswithHFandadverse events(AE).

Results Among154HTR,28patientswereonSGLT2i, 21.4%women,62.1[50.9 – 63.4]yearsold),9(32.1%)with dapagliflozinand19(67.9%)withempagliflozin.

SGLT2iindicationwere:75%DM,21%HFand4%DM +HF.Atotalof22(78.6%)patientswereDM,81,8%of whomwereonacombinedantihyperglycemictherapy.Seven (25%)patientsdevelopedDMafterHT.Mediantimefrom HTtoSGTL2iinitiationwas20[4–40]months.

Threepatients(10.7%)reportedAEwhileonSGLT2i:two sufferedurinarytractinfectionsandonecephalicinstability. Moreover,twopatientsdiscontinuedSGTL2i,oneafter4 monthsduetointoleranceandtheotherafter11months becauseofHbA1cnormalisation.At6monthsafterinitiation ofISGLT2,areductioninHbA1cof0.2[-1,9 – 0.3]points wasobserved.ItwasalsonotedareductioninBMIof1.4[2,4 – 0,8]points.InpatientswithHF,noHFhospitalisations occurredafterinitiation.

ConclusionandRelevance OurresultsshowthatSGTL2iare well-toleratedinHTR.Althoughthesedataareconsistent withfindingsinrenalrecipients 1,furtherinvestigationis needed.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KanbayM,DemirayA,AfsarB,KarakusKE,OrtizA,HornumM, etal.Sodiumglucosecotransporter2inhibitorsfordiabetesmellituscontrolafterkidneytransplantation:Reviewofthecurrentevidence. Nephrology(Carlton).2021;26 (12):1007–17.

ConflictofInterest Noconflictofinterest.

5PSQ-112 ASURVEYOFHOMESTORAGETEMPERATUREOFINUSEINSULINSANDANALYSISOFTHEIRSTABILITIES UNDERTHESIMULATEDHIGHESTHOME TEMPERATURE

1KKangwantat, 2STheeramonkong, 1SKaniknun, 1NKunathikom, 1JPongwecharak*. 1FacultyofPharmacy-ThammasatUniversity,PharmaceuticalCare,Pathumtani,Thailand; 2FacultyofPharmacy-ThammasatUniversity,PharmaceuticalScience,Pathumtani,Thailand

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BackgroundandImportance Insulinsremainessentialforpeoplelivingwithdiabetesworldwide.Asabiologicalproduct,it issusceptibletoheat,lightandsheerconditions.Littleis knownaboutactualhouseholdstoragetemperatureofinsulins, especiallyinthesettingwhereroomtemperatureisfarbeyond 25°C,underwhichinsulinstabilitymightbecompromised. AimandObjectives Todeterminehomestoragetemperatureof in-usehumaninsulinsamongambulatorytype2diabetes (T2D)peopleandtosubsequentlytestinsulinstabilityunder thesimulatedmaximumstoragetemperatureidentified.

MaterialandMethods PeoplewithT2Dwhocollectedprescribedinsulinsfromahospitaldispensaryandreceivedaselfassemblypenwitheitherregularinsulin(RI),isophane(NPH) orpremixedRI/NPHinsulins,weregivenatemperatureloggertotracktheirhomestoragetemperatureofinsulinsfor5–7days(N=47).Themaximumoutoftherecommended rangetemperatureidentifiedwassimulatedinlaboratory wheretheinsulinswerekeptfor4weeks.Thepercentages labelamountoftheinsulinsimitateddailyusewerethenanalysedataweeklyinterval,followingthe42nd ed.UnitedState Pharmacopoeia.Theacceptablerangewas95-105%with referencetostandard.Descriptivestatisticswereusedto presenttherecordedtemperature.

Results Majority(81%)ofthepatientskeepinginsulinina refrigeratorhadtemperatureoutsidethe2to8°Crange. Roomtemperaturestoragewastotallyabove30°C(maximum 43.6 °C).Atthesimulatedisothermal42±2°C,RI,NPHand premixedRI/NPHinsulinshadpercentagelabelamountsin theacceptablerangeat2,3and4weeks,respectively.

ConclusionandRelevance Actualhomestoragetemperaturesof theinsulinswereoutoftheappropriateranges.Thesewere similartoBrauneatal.1 Underthesimulated42±2°C,in-use humaninsulinsretainedacceptablecontent,withregularinsulinbeingstableuptoweek2;NPHandthepremixedinsulin uptoweek3andweek4,respectively.Theresultswerein linewiththeKenyastudy2 buttheysetthemaximumtemperatureat37 °C.Pharmacistsshouldbeawareoftruehousehold storagetemperatureofinsulinproductsandtakeintoaccount thenumberofdaysittakesforoneinsulincartridgetobe finishedagainstwiththeprobablestabilityduration.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://doi.org/10.1089/dia.2019.0046 2.https://doi.org/10.1371/journal.pone.0245372

ConflictofInterest Noconflictofinterest.

5PSQ-113 ROOTCAUSEANALYSIS:STATEGYFORA SUSTAINABLEANTIBLASTICTHERAPYMANAGEMENT SYSTEM

1EDeLuca*, 2DMadonia, 1GCancellieri, 1CBotto, 1MSantonocito, 3SGambino, 3PPolidori. 1UniversitàDegliStudiDiPalermo,Ssfo – ScuolaDiSpecializzazioneInFarmacia Ospedaliera,Palermopa,Italy; 2UniversitàDegliStudiDiMessina,Ssfo-ScuolaDi SpecializzazioneInFarmaciaOspedaliera,Messina,Italy; 3OspedaliRiuniti ‘VillaSofiaCervello’,UocFarmacia,Palermopa,Italy

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BackgroundandImportance Thecostofunusedantiblastic therapies(UAT)hasaconsiderableimpactonaGeneralHospital(GH)budget.Inordertooptimiseresourcesallocation/ limitwaste,itispossibletoanalysetheprocessthatgoes fromthephysicianrequestforpatientcaretovalidationcarriedoutbytheHospitalPharmacist,topreparation/distribution/therapyadministrationfordetectingweakpointsandturn towardsamoresustainablecompanymodusoperandi.

AimandObjectives ObjectiveofthestudywastoanalyseantiblasticdrugmanagementprocessinaGH,bymeansofRoot CauseAnalysis,detectingweaklinkseconomicconsequences andpromotingcorporateawarenessworkontheissue.

MaterialandMethods TheanalysiscoveredtheperiodDecember2022toMay2023.Accordingtodatacollected,anExcel filewasdrawnup(showingprotocolname/dosage/department/

non-administrationreason);itwasalsospecifiedwhethertherapywasreusedforanotherpatientordisposedofand,ifso, howmuchthischoicehasimpactedonGH’sexpenditure, makinganestimateofthemonetaryvaluecostsincurredfor drug/preparation.Anauditcomposedofphysicians/pharmacists/nursesmettoinvestigatenon-administrationcausesfor findingasustainablecompanypolicy.

Results Of12,150therapiessetup,97wereUAT;ofthese, 26/97werere-usedand71/97disposedof,foraneconomic lossofapproximately33,961.82Euros,consideringanestimateof150Eurosforset-upcosts(personnel-resources employed).RootCauseAnalysisshowedthatthemainreasons fornon-administrationwere:prescribingerrors7.22%(7/97), inabilitytoreachGH20.6%(20/97),AdverseDrugReactions (ADRs)44.33%(43/97),illnessnotADRsrelated14.43%(14/ 97),otherfactors[anti-Covidtestpositivity,therapyrefusal, falls,etc]13.40%(13/97).

ConclusionandRelevance Foreachnon-administrationreason correctiveactionswereidentified.Itwouldbedesirablefor PhysiciantoconfirmtherapytoCompoundingAntiblasticUnit (CAU)onlywhenknowsreallythatpatientcanreceiveit,followingthevisit/assessmentofclinicalanalyses,todirecttherapiessettinguponlytowardspatientswhoaretrulyeligible forconditions/availability/therapeuticreconciliation.Ideal wouldbethetimelycommunicationtoCAUofanyUATso thatitcanbeassessed,accordingtodrug’stechnicaldata sheet,whetherdrugcanbereusedonthesamedayorwithin thestabilitytime.Finally,itwouldbeusefulhavingsoftware alert/constraintsystemforcyclesexceedingnumberspermitted, establishedatthetimeofprotocolcoding.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-114 HEADANDNECKERYTHEMAASSOCIATEDWITHTHE USEOFDUPILUMABINPATIENTSWITHATOPIC DERMATITIS

IBaenaBocero,NRevillaCuesta,SArnaizDiez,MTEsteban,LSanchezLuque,JBAgueda Fernandez,AMiguelDominguez,EBrionesCuesta,ZRodriguezFernandez*,MGüemes García. Hospital,Pharmacy,Burgos,Spain

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BackgroundandImportance Adversereaction(erythemaon headandneck)notdescribedinthetechnicaldatasheet.

AimandObjectives Describingtheresolutionoferythemaassociatedwithdupilumabbyextendingthedosinginterval.

MaterialandMethods Descriptive,retrospectivestudyofaseriesofcasespresentingerythemaasanadversereactionassociatedwiththeuseofdupilumab.Patientswithatopic dermatitisontreatmentwithdupilumabinJanuary2023were selected.Bytelephoneinterview,electronicmedicalrecords andoutpatientdispensingmodule,thefollowinginformation wascollected:sex,age,dateoftreatmentinitiation,dateof erythemaonset,otheradversereactions,dosage,extensionof dupilumabdosinginterval,dateofchangeofdosage,resolutionornotoferythemaandotheradverseeffectsafterdosing adjustment,influenceofalcoholconsumptiononerythema.

Results Atthetimeofthestudy,44patientswerereceiving dupilumab,threepatientsdevelopederythema(6.81%),mainly ontheirheadandneck.Allthreewerewomen,receiving300 mg/2weeksatthetimeoferythemaonset.Twoofthe patientsreportedtheresolutionoferythemaonemonthafter

spacingdupilumabto300mg/3weeks.Oneofthemdebuted withfacialerythemaayearafterstartingwithdupilumab,the dosespacingwasmadethesamemonthastheappearanceof erythema.Theotheronepresentederythemaonemonthafter thestartofdupilumab,startingthedosingschedule5months aftertheonsetoferythema.Thethirdpatientreportederythemaonemonthafterthestartofdupilumab.Threemonths aftertheonsetoferythema,shediscontinuedtreatmentdue toprimaryinefficacy.Onemonthafterdiscontinuationof dupilumab,theerythemacompletelysubsided.Allthree patientsalsoexperiencedocularadverseeffects(dryness,irritationand/orconjunctivitisepisodes),whichresolvedcompletely withdosageadjustmentordiscontinuationofdupilumab.A possibletriggerfordupilumab-associatederythemaisalcohol consumption.Twoofthethreepatientsconfirmedworsening oferythemaafteralcoholconsumption.

ConclusionandRelevance Headandneckerythemaappearsto beassociatedwiththeuseofdupilumab,asanadverseeffect notdescribedinthedatasheet.Extensionoftheexperimental dosingintervalto300mg/3weeksordiscontinuationofdupilumabpartiallyorcompletelyresolvestheerythemainthe patientsinthiscaseseries.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-115 EVALUATIONOFHYPOTHYROIDISMASSOCIATED WITHAPALUTAMIDEANDENZALUTAMIDE TREATMENTINMETASTATICPROSTATECANCER USINGTHEEUROPEANADVERSEEFFECTDATABASE (EUDRAVIGILANCE)

FCajade*,MTourisLores,ISoto-Baselga,BBernardez-Ferrán,SSantana-Martínez,IZarraFerro. HospitalUniversitarioDeSantiagoDeCompostela,FarmaciaHospitalaria,Santiago DeCompostela,Spain

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BackgroundandImportance Hypothyroidismisalimitingand underestimatedadverseeffectofmetastaticprostatecancer treatments,theimpactofwhichinelderlypatientsismore significant.Apalutamideandenzalutamidearedrugswithsimilarchemicalstructure,butdifferintermsofadverseeffect profile.Hypothyroidismisdescribedasacommonadverse reactionforapalutamide,buthasnotbeenevaluatedinpivotaltrialsofenzalutamide.

AimandObjectives Tocomparetheincidenceofhypothyroidismwithapalutamideandenzalutamidebyanalysingspontaneousreal-lifereportsobtainedfromEudraVigilancedatabase.

MaterialandMethods Spontaneousnotificationsconcerning theevaluateddrugswereobtainedfromEudraVigilance,the EuropeanMedicinesAgency ’sdatabaseforsuspectedadverse drugreactions.Foreachdrug-eventcombination,thefollowingwerecalculatedasmeasuresofdisproportionality:the proportionalreportingratio(PRR),the95%confidence interval(CI95%),theChi-square( c2 )andthenumberof reportedcases.Amongallrepor tedadversereactions,only thoseclassifiedashypothyroidism(event)wereconsidered.

Theanalysisperiodswere2019–2023forapalutamideand 2013–2023forenzalutamide(fromthedateofauthorisation). Forthegenerationofanalertsignal,thefollowing3criteria mustbemet:PRR 2, c2 4andthenumberofnewcases reported 3(1).

Results Intheperiodstudied,forbothdrugs,atotalof 26.077adversereactionreportswerecollected.Ofthese, 4.274(16%)wereforapalutamideand21.803(84%)for enzalutamide,ofwhich74(1.7%)and14(0.06%)correspondedtohypothyroidism,respectively.Thevaluesofthe disproportionalitymeasuresofapalutamidewithrespectto enzalutamidecalculatedwere:PRR=26.96(15.24–47.69), c2=295.32andnumberofhypothyroidismcasesforapalutamide=74.Accordingtothesevalues,whenallthreecriteria aremet,ahypothyroidismalertforapalutamidewouldbe generated.

Abstract5PSQ-115Figure1

ConclusionandRelevance Ouranalysisperformedonthe EudraVigilancereal-lifedatabaseconfirmsthehighincidence ofhypothyroidisminpatientstreatedwithapalutamide, accordingtotheSPARTANandTITANpivotaltrials,comparedtoenzalutamide.Ontheotherhand,amuchlowerincidenceofhypothyroidismisevidentforenzalutamide.The importanceofmonitoringforsignsofhypothyroidismin patientstreatedwithapalutamideishighlighted.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.RothmanKJ.Thereportingoddsratioanditsadvantagesovertheproportional reportingratio. PharmacoepidemiolDrugSaf.2004Aug;13(8):519–23.

ConflictofInterest Noconflictofinterest.

5PSQ-116 REAL-WORLDPERSISTENCEWITHGUSELKUMAB AMONGADULTSWITHPSORIATICARTHRITIS

CMontero-Vilchez,MIArchillaAmat,MRCantudo-Cuenca,MISierraTorres,LMartínez DueñasLópezMarín,AJimenezMorales*. HospitalUniversitarioVirgenDeLasNieves, Pharmacy,Granada,Spain

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BackgroundandImportance Guselkumabisamonoclonalantibodythatselectivelybindstointerleukin23proteinwitha labelindicationinplaquepsoriasisandpsoriaticarthritis (PsA).Littleinformationaboutreal-worldpersistencewith guselkumabtherapyforPsAisknown.

AimandObjectives Theaimwastoevaluatepersistencewith guselkumabtherapyinPsA.

MaterialandMethods Retrospectiveobservationalstudywas conductedinatertiarylevelhospital.Patientswhostarted treatmentwithguselkumabbetween01/05/2020–01/09/2023 wereincluded.Thosewithlessthan9months’ treatment durationwereexcluded.Thevariablescollectedweresex,age, underlyingpathologyandcomorbidities,previoustreatments, andstart-enddateoftreatment.Dataanalysiswasperformed usingSPSS® version24statisticalsoftware.Adescriptiveanalysisofthedatawasperformed,comparativestatisticaltests,as wellasaKaplan-Meiersurvivalanalysis.

Results Amongthe69patientsinthedatabasewhoinitiated guselkumabduringthestudyperiod,50metthestudyinclusioncriteria.Themean(SD)agewas53.3(12.7)yearsand 58%werefemale.44%(22/50)hadbeentreatedwithfouror

morePsAdrugsbeforeguselkumaband74%usedanantiTNFdrug.

Themediandrugsurvival(SD)was20.6(2.7)months. 52%ofpatientsexperiencedtheevent(discontinuationof treatment)within30monthsoftreatment.Persistencewas 69.3%(ES:0.07)at1yearoftreatmentanditdecreasedto 43.7%(ES:0.08)at2yearsoftreatment.

Therewerenostatisticaldifferencesbetweenpatientswho hadbeentreatedwithmoreorlessthanfourprevioustreatmentsnorpatientswithandwithoutcomorbidities.However, wefoundsomedifferencesbetweenpatientswithprevious anti-TNFtreatmentsandtheoneswhodidn’tusethem. 30.8%ofpatientswithoutAnti-TNFdiscontinuedtreatmentvs 59.5%whousedAnti-TNFbefore(p=0,075),meandrugsurvivalinthefirstgroup(noanti-TNF)(SD)was26.0(2.0)vs 16.4(1.8)inthesecondgroup(p=0.02).Thereasonfor theseresultsmaybebecauseguselkumabisusedininitial stagesofthediseaseduetocontraindicationstoanti-TNF. ConclusionandRelevance Asinclinicaltrialsandanotherrealworldstudy,highpersistencerateswereobservedwithguselkumabduringthefirstyear.Furtherreal-worldresearch shouldbeconductedtocorrelatethedifferencesfound betweenpatientswithpreviousanti-TNFtreatment,asno suchdifferenceswerefoundinclinicaltrials.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-117 TRACEABILITYOFIMPLANTABLEMEDICALDEVICES/ PATIENTINFORMATION:WHEREDOWESTAND?

1KLefevre*, 2MPoulard, 1AFerre, 1,3JClouet, 1FRondeau, 1,3FNativel. 1ChuNantes, Pharmacy,Nantes,France; 2ChuNantes,Quality-RisksandEvaluationDepartment,Nantes, France; 3UFROfPharmaceuticalandBiologicalSciences,Pharmacy,Nantes,France

10.1136/ejhpharm-2024-eahp.452

BackgroundandImportance Healthtraceabilityofimplantable medicaldevices(IMD)isamajorpublichealthissue.Inthe eventofmateriovigilance,thisinformationcanbeusedto tracepatientswhohavereceivedanIMD.Legalinformation relatingtoIMDisincludedinthepatientfileandmustbe transmittedtothepatientonanimplantcard(ArticleR5212–42,FrenchPublicHealthCode).

AimandObjectives ToassessthecomplianceofthistraceabilityinourfacilitytocomplywiththenewversionoftheContractfortheImprovementofQualityandEfficiencyofCare (CAQES).

MaterialandMethods TenIMDrepresentativeofthefacility ’ s activity,withdifferentmanagementandfinancingmodeswere selectedand50interventionswereanalysed.Twenty-seven itemswereevaluateddividedintofourareas:traceabilityby pharmacy(9),byuserservice(6),traceabilityofpatientinformationintheelectronicpatientrecord(EPR – 9)andtransmissiontothepatients(3).Thisretrospectiveanalysiswas comparedtoasimilarauditconductedin2020.

Results Complianceratesare86%forpharmacytraceability, 84%forservicetraceability,52%forpatientinformation traceabilityintheEPRand96%forinformationtransmission tothepatient.Thereisalossofinformationobserved betweentraceabilityinbusinesssoftwareandinformation recordedastransmittedtothepatient,especiallyforIMD denomination,manufacturername,lotandserialnumbers. Practicesvarydependingonsurgicalspecialties.Themain

non-compliancesconcerntheprovisionoftheimplantcard, theUniqueDeviceIdentifier(UDI),andtheIndividualHealthcareIdentifiers(IHI)number,whicharenottracked.Since 2020,practiceshaveimproved,especiallyintermsofpatient informationtraceability,whichhasincreasedby43%.

ConclusionandRelevance Despitethepositiveresultsforpharmacyandservicetraceability,thetargetsetbyCAQESfor 2022–2024(>75%)isnotmetforallcriteria.Improvement areasincludeUDItraceabilityuponreceiptanduse,integrationoftheIHInumberintothebusinesssoftware,andharmonisingprocessesacrossdifferentoperatingrooms. Improvementavenuesforpatientinformationtraceability involvestandardisingliaisonlettersbetweensurgicalspecialties, interoperabilityofbusinesssoftware,andtraceabilityofthe deliveryoftheoperativereportandimplantcardtothe patient,alltomaintainahighlevelofcarequality.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-118 NON-ACTIVEPRESCRIPTIONSINAMBULATORY PATIENTS:ANALYSISANDEFFECTINCONSULTATION WAITINGTIME

SFernándezLastras*,IDeLaFuenteVillaverde,COralloLuna,MEiroaOsoro,LOyague López,CRodríguez-TenreiroRodríguez,MMuñozVillasur,CFadónHerrera,CDíaz Romero,ALozanoBlazquez. HospitalUniversitarioCentralDeAsturias,PharmacyService, Oviedo,Spain

10.1136/ejhpharm-2024-eahp.453

BackgroundandImportance Theoptimisationoftimewithin theHospitalOutpatientPharmacyhasbecomeanurgentchallengeinlightoftheremarkablesurgeinactivityoverrecent years.Asubstantialnumberofpatientsarrivewithoutan activeprescription,renderingitimpossibletodispensetheir medicationspromptly,consequentlyresultinginconsultation delaysandpatientinconvenience.

AimandObjectives Theprimaryaimofthisstudyistodelineatethechiefcausesofnon-activeprescriptionsatthepoint ofdispensationandtoassesstheirimpactonpatientwaiting timeswhenattendingtheHospitalOutpatientPharmacy.

MaterialandMethods BetweenJanuary2022andSeptember 2023,weconductedaprospectiveregistrationofpatientslackingactiveprescriptionsandsubsequentlyselectedarandom sampleforanalysis.Thisinvestigationencompassedanassessmentoftheclinicalservicetowhichpatientswereaffiliated, thereasonsunderpinningprescriptionunavailability,andthe temporaldiscrepancybetweenthescheduledappointmenttime andtheactualconsultationconclusiontime.Itisessentialto emphasisethatweconsideredtheappointmenttimeasthe momentofconsultationentry,assumingzerodelays.Data weremeticulouslygatheredfromtheelectronicprescribing software.

Results Ourstudyencompassedacohortof81patients. Amongthepatientswhopresentedwithnon-activeprescriptions,theimplicatedClinicalServicescomprisedNephrology (21.0%),Rheumatology(21.0%),Neurology(16.0%),Pulmonology(11.1%),InternalMedicine(9.9%),Urology(7.4%), Dermatology(3.7%),Gastroenterology(3.7%),Endocrinology andNutrition(2.5%),Allergy(1.2%),Haematology(1.2%), andPaediatrics(1.2%).

Therationalesbehindnon-activeprescriptionsweremultifarious:failuretorenewprescriptionsduringtheprevious

consultation(63.0%),prescriptionswithinadequatevalidity untilthesubsequentconsultation(21.0%),prescriptionerrors (8.6%),patientnon-attendanceattheprecedingconsultation (4.9%),absenceofapatientconsultationwithinthelastyear (1.2%),andreschedulingofthepreviousconsultation(1.2%).

Withinoursampledcohort,themedianconsultationwaitingtimeamountedto36minutes,withanextremedelay reachingupto3hours.

ConclusionandRelevance Asevidencedbythisinvestigation, theabsenceofanactiveprescriptionatthedispensationjunctureexertsanadverseinfluenceontheday-to-dayoperations oftheHospitalOutpatientPharmacy.Itisourassertionthat enhancedtrainingandmorerobustcommunicationwiththe implicatedclinicalservicescouldproveinvaluableinproactivelyaddressingthispredicament.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-119 REVIEWOFREAL-WORLDMANAGEMENTOF NATALIZUMABTREATMENTINMULTIPLESCLEROSIS: ADOUBLE-EDGEDWEAPON

AGilGarcia,ARojasAlbarrán*,MGrageraGomez,MDZambranoCroche,HVelazquez Vazquez,ANavarroRuiz,LTorresZaragoza. UniversityHospitalComplexofBadajoz, HospitalPharmacy,Badajoz,Spain

10.1136/ejhpharm-2024-eahp.454

BackgroundandImportance Weknowthatnatalizumabisan effectivetreatmentinpatientswithrelapsing-remittingmultiple sclerosiswithhighactivity.Moredoubtsariseregardingits safetywhichwillleadtohavingtocloselymonitorthe patient.

AimandObjectives Toevaluatethesafetyoftreatmentwith natalizumabforrelapsing-remittingmultiplesclerosis(RRMS), specificallyJohnCunninghamvirus(JCV)infectionthatcan causeProgressiveMultifocalLeukoencephalopathy(PML).Also evaluateeffectivenessbycountingoutbreaksduringtreatment andtimeintreatment.

MaterialandMethods Retrospectiveobservationalstudysince theapprovalofthedrug.AllpatientswithRRMSundertreatmentwithnatalizumabwereincludedandthevariablessex, age,previousandsubsequenttreatments,positiveJCVserology atanytime,durationoftreatment,relapsesandnumberof them,andreasonfordiscontinuingtreatmentwerecollected. DatawasextractedfromFarmaTools® softwaredatabaseand theelectronicmedical.

Results Atotalof75patientswereanalysed,47(63%)of themwomen.Meanageatthetimeofinitiationoftreatment of41years(28–69),mediannumberofpreviouslinesof1 (0–5),beingusedasfirstlinein15patients(20%),second linein42patients(56%).Thepatientsanalysedwereon treatmentforanaverageof2.6years,thereasonsforsuspensionbeing:PositiveJCVserology39(52%),adverseeffects11 (15%),outbreakssix(8%),progressiveworseningfive(7%), unknowncausethree(4%)and2(3%)discontinueddueto pregnancy.Nine(12%)arestillreceivingtreatment.Sixteen patients(21%)hadanoutbreakduringthetimeontreatment.

ConclusionandRelevance Alargeproportionofthepatients analysedmanagetoreachthe2-yeartreatmentperiod,after whichtheriskofJCVinfectionincreases.Atthatpoint,the majorityofpatientsdiscontinuetreatment.Thedrugiswell tolerated,withlittlesuspensionoftreatmentduetoadverse

effects,andisusuallychronicfatigue(alsoassociatedwiththe disease).Effectivedrug,withonly16patientshavinganoutbreakduringtreatment.Withthesedata,wecanconcludethat inourpatientsithasbeenaneffectivetreatment,usedonce thepatienthashighactivitytostopit.Regardingsafety,JCV wouldbethemaindrawback,requiringclosemonitoringfor possibleinfection.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

5PSQ-120 PEMBROLIZUMABIMMUNE-MEDIATEDTOXICITY RConde*,CSoares,PBarbeita,TCunha,PRocha. CentroHospitalarUniversitárioDe SantoAntónio,ServiçosFarmacêuticos,Porto,Portugal

10.1136/ejhpharm-2024-eahp.455

BackgroundandImportance Checkpointinhibitors(ICI)are increasinglyusedinvariouscancers.Whiletheyofferclinical benefits,theyalsointroducedrugmanagementchallengesdue totheiradverseeffects(AE).Anotableconcernisthepotentialforsevereimmune-mediatedtoxicities,whichcanposesignificantriskstopatients.Thepresentedcaseisuniqueasit underscoresthesevererepercussionsofimmune-mediatedtoxicityfrompembrolizumab.

AimandObjectives Thisreportsacaseofa70smalewith clearcellrenalcellcarcinoma(ccRCC)whodevelopedsevere immune-mediatedtoxicityfollowingtreatmentwithpembrolizumab.Thepatienthadahistoryofsomecomorbidities.The initialpresentationwasincidentaldetectionofccRCCposttrauma.Hissubsequenttreatment,adversereactions,andoutcomesformthecruxofthiscase.

MaterialandMethods Thepatientwasinhis70s,caucasian male,1.64m,58kg,non-smoker,andnon-alcoholic.His medicalhistoryincludedtype2diabetes,hypertension,nephrolithiasis,benignprostatichyperplasia,pacemakerimplantdue tobradycardia.Dailymedication:metformin,amlodipine,perindopril/indapamide,acetylsalicylicacid,dutasteride,afluzosin, lactulose,sodiumpicosulfate.Firstlinetreatmentwithintravenouspembrolizumab400mg(6/6weeks)andaxitinib5mg twicedaily.

Results Daysafterthefirstcycleoftreatment,thepatient presentedtotheemergencys ervice(ES)withswallowing difficulties,imbalance,andmusclepain.AprobablediagnosisofG3polymyositiswithsuspectedpembrolizumabinducedmyopathywasmade.Despitesuspendingtheoncologytreatmentandinitiatinghig h-dosecorticosteroidtherapy,thepatient ‘ sconditiondeteriorated.Hedeveloped myocarditisleadingtosevereglobaldysfunctionofleftventricularsystolicfunction.Subsequenttreatmentsincluding humanimmunoglobulinandabataceptwereunsuccessful, andthepatientunfortunatelysuccumbedtocardiorespiratoryarresttwoweekslater.

ConclusionandRelevance Thiscasereportbringsattentionto thesevereimmune-mediatedtoxicity,emphasisingthechallengesinitsmanagement.WhileacuteAEcanoftenbemanagedwithsymptom-basedapproachesandhigh-dose corticosteroids,1 thiscasedemonstratesthatthesemeasures maysometimesbeinsufficient.Creatingstructuredprotocols andconductingin-depthresearchisimperative.Medicalprofessionalsshouldremainvigilanttosuchadverseeffects.This caseunderlinestheimportanceofriskassessmentandcontinuousmonitoringofpatientsonimmunotherapies.

Abstracts

REFERENCESAND/ORACKNOWLEDGEMENTS

1.JohnsonD, etal.Immune-checkpointinhibitors:long-termimplicationsoftoxicity. NatureReviewsClinicalOncology. 2022;19(4):254–267.

Thiscasehasneverbeenreported/publishedbefore. ConflictofInterest Noconflictofinterest.

5PSQ-121 AREVIEWOFTHEEXPOSURETOPOTENTIALLY HARMFULEXCIPIENTSTHROUGHORALLIQUID FORMSINPAEDIATRICINPATIENTSINFRANCE

MBobillot*,VDelannoy,ATrouillard,JMKinwoski,ISoulairol. CHUDeNimes-France, Pharmacy,Nimes,France

10.1136/ejhpharm-2024-eahp.456

BackgroundandImportance Despitegrowinginterestsforthe useofexcipientswithdescribedtoxicities(excipientsofinterest.,EOI)inchildrenandneonates,eventodaythelackof paediatricdatamakesitdifficulttoestablishpreciserecommendationsaboutquantitativelevelsofEOIincommercialised paediatricformulations.

AimandObjectives Theprimaryobjectiveofthisworkisto identifytheEOIpresentinoralliquidformsusedinpaediatricdepartments.Thesecondaryendpointistoquantifythe EOIexposureforoften-prescribedmolecules(originatorformulationsandgenericbrands)usedinrecommendedposology ranges,fordifferentagecategories.

MaterialandMethods AreviewofmedicationsusedinFrench hospitalshasallowedestablishingalistoforalliquidforms usedforpaediatricsandneonatologyinpatients.Theformulationofeachmedicationhasbeenexaminedusingthesummariesofproductcharacteristics(SmPC).Tenofthemost prescribedmoleculeshavebeenselectedconcerningprinceps andgenericsformulationsforatotalof31formulations.EOI exposurehasbeencalculatedandSTEPDatabaseandEuropeanMédicineAgency(EMA)recommendationswereusedto evaluatetheexposurelevels.

Results Theanalysisinvolved219formulationsincluding 123activemoleculesand140excipients.Sixteenexcipients werepresentinabove10%oftheformulationsandnineof themarerecognisedasEOI(ethanol,propyleneglycol,glycerol,sodiumbenzoate,methyl andpropylparaben,aspartame,sorbitol,saccharose).Atotalof95%ofallstudied formulationsinvolveatleastoneEOI.TheamountsofEOI foundinthe10studiedmoleculesoutcometherecommendedlevelsfor45%ofthe31formulations.Arateof 73%ofthedrugswithneonatalogymarketingauthorisation includeatleastoneexcipientnotrecommendedinthisage category.

ConclusionandRelevance Pediatricandneonatesinpatients arereceivingawiderangeofharmfulexcipients,among othersthroughtheadminist rationoforalliquidforms. Althoughspecificstudiestendtoenlargetheknowledge aboutspecificuseandtoxicityoftheexcipientsinpaediatrics,toolittleremains,especiallyinpreterm.WhenEOIcannotbeavoided,quantitativeinformationabouttheiramount indrugformulationsshouldbe easilyknowntohelpphysiciansandpharmacisttoselectthemostappropriatedrugs andanticipatepossibleadverseeffectsoradaptdrugs posology.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-122 SEQUENTIALCHANGEOFDOSINGINTERVALOF PALIPERIDONEPALMITATEBASEDONPLASMA CONCENTRATIONMONITORING

FFuentesHidalgo*,GMartínezOrea,CGarcíaGonzález,ACampelloMoñino,JMDel MoralSánchez,ARuízGómez,NCanoCuenca,ACandelaFajardo,EArroyoDomingo, RBonillaPeñarrubia. HospitalDeLaVegaBaja,PharmacyDepartment,OrihuelaAlicanteComunidadValenciana,Spain

10.1136/ejhpharm-2024-eahp.457

BackgroundandImportance Paliperidoneisanantipsychotic usedforthetreatmentofschizophrenia.Toincreaseadherence totreatmentandthusreducetheriskofrelapse,itwasformulatedasanextended-releaseinjectable.Thereare3types offormulations:monthly,quarterlyandsemi-annually.Monitoringofpaliperidoneplasmaconcentrationscanhelptooptimisetreatment,aspatientswhodonotrequiredose adjustmentsmaybenefitfromthelongertherapeuticinterval formulations(quarterlyandsemi-annual)

AimandObjectives Toanalysetherelationshipbetweenthe changeofpresentationofpaliperidonepalmitateanditspharmacokineticmonitoring

MaterialandMethods Retrospectiveobservationalstudyin whichallpatientswhoseplasmaconcentrationsofpaliperidone weredeterminedfromJanuarytoJuly2023wereincluded. Patientsontreatmentwithoralpaliperidonewereexcluded. Thevariablescollectedwere sex,age,currentplasmaconcentrationsofpaliperidonepalmitate,typeofpaliperidonepalmitateformulationusedincurrenttreatment,initiationof paliperidonepalmitate,presenceofpreviouscontrolsof anothertypeofpaliperidonepalmitateformulation,previous plasmaconcentrationsofpaliperidonepalmitate.

Results Sixty-ninepatientswereincluded,69.6%malewitha medianageof50years(20–72).

Ofthepatients,42.0%hadplasmapaliperidonepalmitate concentrationswithinthetherapeuticrange.Ofthepatients, 36.3%wereonpaliperidonepalmitatemonthly,42.0%were onpaliperidonepalmitatequarterly,and21.7%wereonpaliperidonepalmitatesemi-annually.

Achangeofpaliperidonepalmitatepresentationhad occurredin87.0%ofthepatients.Ofthese,only43.3%had pharmacokineticmonitoringpriortothechangeofpresentation.Ofthesepatients,46.2%hadplasmaconcentrationsin rangeinthecontrolwiththepreviouspresentationofpaliperidonepalmitate.

ConclusionandRelevance Althoughthepharmacokineticdeterminationofplasmaconcentrationsofpaliperidonepalmitate allowsindividualisingthetreatmenttoeachpatient,thedecisiontoswitchfromoneformulationofinjectablepaliperidone palmitatetoanotherwithadifferentdosingintervalwasnot basedontheplasmaconcentrationsofthedruginour population.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-123 SIMULATIONOFADISCHARGECONTROL:AN EFFECTIVETOOLFORQUALIFYINGSTAFF

GLafci*,JBodet,AChaibi,EPoutrain,PBarreau,AVillain,MAbele,ISakji,GMarliot. CentreOscarLambret,Pharmacy,Lille,France

10.1136/ejhpharm-2024-eahp.458

BackgroundandImportance Thepreparationofchemotherapy (CT)atourcentrerepresentsamajoractivity(42,000preparationsperyear).Oneoftheriskieststagesisdischargecontrol(DC).Toensurethesafetyofthisstage,inlinewith nationalguidelinesonstafftraining,wedecidedtosetupa DCsimulation.

AimandObjectives Thisworkaimedtocreateasimulationto ensurethattheoreticaltraininginDCwasunderstoodand implemented;itwasdesignedtoenableinitialqualification andperiodicreassessmentofpharmaceuticalstaff.

MaterialandMethods Atheoreticalevaluation(TE)anda practicalevaluation(PE)werecreated.TheDCmostfrequent andriskiesterrorsweredefinedduringaFailureModes, EffectsandCriticalityAnalysis(FMECA).Thecriticality definedwasusedtoestablishwhethertheerrorwas eliminatory.

FortheTEa28-itemquestionnairewascreated(13eliminatoryquestions).

ForthePE,asimulationofDCincluding20dummyCT preparations(4compliantand16non-compliant)reflecting ourcentre’sactivitywasdesigned.Tenresponseswere eliminatory.

Theevaluationswerecarriedoutunderreal-lifeconditions. Thevalidationthresholdwas100%ofcorrectanswersto eliminatoryquestions.

Results Sincethetoolwascreated,12pharmaceuticalstaff havebeenassessed.

TheaveragescorefortheTEwas17/20(minimum15.2/ 20andmaximum19.8/20).Ofthefivemostfrequenterrors, twocorrespondedtorarecases(specificpaediatricprotocols), twotoproductionspecificities(CTforweekendsandthe operatingroom),andonetoalackofknowledgeofthecircuit.AllTEswerevalidated.

TheaveragescoreforthePEwas17.6/20(minimum14.5/ 20andmaximum19.5/20).Oneerror,correspondingtoa specificitylinkedtothedeviceused,recurredregularly.Two personwhomadeeliminatoryerrors(solventerror,expired andleakypouch)hadtobereformedandreassessed.

ConclusionandRelevance Implementingthissimulation allowedforanexhaustiveandentertainingevaluationofthe individualsauthorisedforDC.Reviewingtheerrorsmadeduringtheassessmentenabledustorevisetheinitialtrainingand emphasisethecriticalpoints.Asaresult,wedecidedtocarry outaunitaryrelease,integratedintoourmanagementsoftware (CHIMIO®),apop-uplistingallthecriticalpointstobe monitored.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-124 THETREATMENTOFPRESSUREULCERSWITH BACTERIABINDINGMEDICATIONASAVALID THERAPEUTICOPPORTUNITY

* SAmbrosini,EZanetti,FGuarneri,CLazzari,IRestivo,TETesta. AsstSpedaliCiviliDi Brescia,HospitalPharmacy,Brescia,Italy

10.1136/ejhpharm-2024-eahp.459

BackgroundandImportance Thepressureulcer(PU),tissue lesionconsequenceofhighorprolongedconstantpressure overtime,representsthethirdmostcostlydiseaseforthe healthcaresystem,causingover60,000deathseachyear¹.

Theuse,duringtheSars-Cov-2pandemic,ofthebacteria bindingmedication(BBM)toreducePU,wasthestarting pointthatallowedthespreadofBBMinmanyhospital departments,asapossibletherapeuticalternativetoiodoform gauze(IG).BBM,consistingoffabricsaturatedwithdialkylcarbamoylchloride(DACC),isabletocapturebacteriaandfungi thankstoaphysicalmechanism(hydrophobicinteraction) insteadofIGthatcontrolthewoundmicroenvironmentin theshorttermwithanhighriskofpossibletoxicitydueto thesystemicabsorptionofiodine.

AimandObjectives Consideringtheincr easedincidenceof PUrelatedtocareservices,theHospitalPharmacy,assisted bywoundcarespecialists(WCS),hasmonitoredinthe periodfrom2020to2023theprescriptiveappropriateness andtheconsumptionofBBMindifferentdepartmentsin ordertodemonstratethegreatersafetyandeffectiveness thantheIG.

MaterialandMethods SinceSeptember2020theHospital PharmacyhasselectedsomepilotwardsinwhichaWCS operate,andsubsequentlyequippedthemwithBBM.AcosteffectivenessanalysiswasconductedbycomparingIGand BBM.

Afterreviewingtheexcellentperformanceofthedevicein thefirstselecteddepartments,thePharmacy,thecliniciansand WCShavecollaboratedtoidentifyinwhichclinicalsituations itwaspossibletoreplaceIGwithBBMandwhentoprefer othertherapeuticchoices.

Results Theperformedanalysisshowedthat,inthesingleservice,thecostofBBMis3%higherthanIG,butinprolonged treatmenttheuseofBBMisadvantageous.BBM,compared toIG,canbeleftinplaceforupto7daysreducingcare costs(MDandWCSservice)andthefrequencyofwound manipulation,limitingclinicalcomplicationsandeliminating theriskofsystemiciodineabsorptioncausedbytheIG.

ConclusionandRelevance

PUsrequirelong-termtreatment BBMrepresentacost-effective alternativeandthePharmacyhasdecidedtointroducedefinitivelytheBBMintothehospitalformularyandtodismissIG.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.AfzaliBorojenyL, etal.IntJPrevMed.2020Oct5;11:171.

ConflictofInterest Noconflictofinterest.

Abstracts

ANALYSISOFINTRODUCINGPROBIOTICSFORTHE PREVENTIONOFNECROTISINGENTEROCOLITISIN PREMATURENEONATESINANEONATALUNIT

1CJMorenoPerez*, 1MGLopezRamos, 2RDelRíoFlorentino, 2MIriondoSanz, 1RFarre Riba. 1SantJoanDeDeu,Pharmacy,EspluguesDeLlobregat,Spain; 2SantJoanDeDeu, Neonatology,EspluguesDeLlobregat,Spain

10.1136/ejhpharm-2024-eahp.460

BackgroundandImportance NecrotisingEnterocolitis(NEC)is alife-threateningintestinalinflammatorydiseasethatprimarily affectspreterminfants.Riskfactorsincludeprematurity,low birthweight,andalteredintestinalmicrobiota.Gastrointestinal colonisationbyprobioticstrainscanavoidtheovergrowthof potentialpathogens.

AimandObjectives EvaluatetheuseofaprobioticcombinationaimingtoreducetheincidenceofNECinalevelIV neonatalunit.

MaterialandMethods InApril2022,oraladministrationofa combinationofprobioticbacteria(Bifidobacteriuminfantis, Bifidobacteriumlactis and Streptococcustermophilus, Proprems ®) wasstartedaimingatdecreasingNECincidencein ourunit.Thisprobioticcombinationisrecommendedbythe mostrecentEuropeanGuidelines.

Neonatesofgestationalage(GA) £ 32weeks,andGA £ 34,8weekswithbirthweight £ 1500gwereselectedto receiveprobiotic(1oralsachet/day,startedinthefirst72hof life),becauseoftheirhighrisk.Theyreceivedituntilpostmenstrualage(PMA)of34weeksand35,8weeks respectively.

WeconductedaretrospectiveobservationalreviewofmedicalrecordsfromApril2022–March2023,collecting:GA, weight,daysoflifeatstart,treatmentdurationandbreaks, PMAatremovalandNECepisodes.

Results 50outof55patientsmetcriteriatoreceiveprobiotic (27boys/23girls).MedianGAwas29,4weeks(range:23–34,7),medianbirthweightwas1kg(0,5–1,85)and2daysof lifeatstart,with37patientsstartingprobioticwithlessthan 72hoflife.Medianoftreatmentdurationwas24days(2–71).Asforremoval,itwascorrectin35patients(11patients laterthanindicated).

Treatmentwassafeandwell-toleratedinallpatients.No episodesofsepsisbytheprobioticstrainswererecordedduringthisperiod.

NECincidenceontargetpopulationwas11,6%,withseven casesin2022,decreasedcomparedto16%in2020.Between April-Decemberof2022therewerefourepisodesofNEC, twoofwhichhavereceivedprobiotic.

ConclusionandRelevance Themaindeviationsintheuseof theprobioticaccordingtoestablishedcriteriawerebothlate initiationandremoval.

Theselectedformulationwassafeandwell-tolerated.

Inthestudyperiod,areductionofNECincidencewas observedassociatedtodifferentmeasuresandamongthem, theuseofprobiotic.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.https://pubmed.ncbi.nlm.nih.gov/32332478/ 2.https://pubmed.ncbi.nlm.nih.gov/33058137/

ConflictofInterest Noconflictofinterest.

5PSQ-126 THEANALYSISOFINTERACTIONSANDPOTENTIALLY INAPPROPRIATEMEDICATIONSINHOSPITALISED SENIORS

1AVicena*, 2SKosirova, 1HKomjathy. 1GeneralHospitalKomarno,HospitalPharmacy, Komarno,Slovakia; 2FacultyofPharmacyCommeniusUniversity,Departmentof PharmacologyandToxicology,Bratislava,Slovakia

10.1136/ejhpharm-2024-eahp.461

BackgroundandImportance Inourcountryshouldbeplaced greateremphasistothehealthcareoftheelderlypatients.It isnecessarytomonitorthedrug-use,suggestedtousethe PIMwiselyorpreventtheiruse,monitorthepossibleinteractionsbetweendrugs.

AimandObjectives Tofollowthepharmacotherapyofthe patientsovertheage65yearshospitalisedintheinpatient departmentofgeriatricdepartmentforahalfyear(September-December2018).Further,toanalyseinteractions betweendrugs,tomonitorandquantifythePIMs,follow thenumberofhospitalisationsandfindcorrelationsbetween thesevalues.

MaterialandMethods Retrospectiveanalysisofthemedical recordsof127patientsinageover65yearshospitalisedin theinpatientdepartmentofgeriatricdepartment,whowere admittedatleastontheday.Possibledruginteractionswere evaluatedbyprogramLexicomp®.PIMswereevaluated accordingtotheEU(7)-PIMlist.Resultswerestatistically analysed.

Results Inthestudygrouptheaverageagewas83[69–95;80]years.Eachpatientused6[0 –15;5]drugs/day.We identified425possibleinteractions,3[0 –13;0]interactions/ patient.Only26patientsdidnothaveanydruginteractions. Thegreatestvalueofuseddrugsinonepatientwas16. NumberofPIM/patient/daywas1[0 –5;1].Thethreemost frequentlyusedPIMwerepantoprazole,alprazolam,digoxin. ThedifferenceinthenumberofPI Mwasstatisticallysignificant(p<0.05)inpatientswith/w ithoutinteractionintherapy. Therewasconfirmedamodera terelationshipbetweenthe numberofuseddrugsandthenumberofPIM( =0.611, R2=0.915,p<0.01).Inthestudygrouppatientswerehospitalised2[1–13;1]timesintheperiod.Therewasfoundthat thenumberofhospitalisationsdidnotcorrelatewiththe numberofuseddrugs( =0.054,R2=0.0178,NS),orthe numberofPIMs( =-0.002,R2=0.1249,NS),buthadaweak relationshipwiththenumber ofpotentialinteractions ( =0.19,R2=0.5086;p<0.05).

ConclusionandRelevance Intheobservedgroupofhospitalisedelderlypatientsonepersontookonaverage6drugs/ day.Therewasfoundthatifinthepatient ’ streatmentmore potentialinteractionsarepresent,thereisagreaterlikelihoodofhospitalisation(p<0.05).Further,ifapatienttakes moredrugs,thereisagreaterpossibilitytotakeaPIM (p<0.01).

REFERENCESAND/ORACKNOWLEDGEMENTS

1.Rodríguez-PerezA, etal.ValidationoftheLESS-CHRONcriteria:reliabilitystudy ofatoolfordeprescribinginpatientswithmultimorbidity. EJHPharm.DOI: 10.1136/ejhpharm-2017-001476

ConflictofInterest Noconflictofinterest.

5PSQ-127

MEDICATION-RELATEDFALLSINANURSINGHOME: IDENTIFICATIONANDHOSPITALPHARMACY INTERVENTIONS

ADrozdzVergara*,AValladolidWalsh,ASanzArrufat,CGonzálezRomero,ETébar Martínez,HAlabortAyllón. ComplejoHospitalarioUniversitarioDeAlbacete,Pharmacy Department,Albacete,Spain

10.1136/ejhpharm-2024-eahp.462

BackgroundandImportance Medicationuseisamodifiable riskfactorandhasahighprevalenceinolderpeople,where polypharmacyiscommon.Forthisreason,medicationreview isoneofthekeycomponentsofmultifactorialfallprevention interventions.

AimandObjectives Theobjectiveofthisstudyistodetermine iffallsinanursinghomearerelatedtopharmacologicaltreatmentaswellastoevaluateifapharmacistcanimprovetreatmentthroughpharmacologicalrecommendations.

MaterialandMethods Studydesign:non-comparativeinterventionstudy.Inclusioncrit eria:patientsinwhomfalls wererecordedinanursinghomewith201residents between22/05/2023 – 03/09/2023.Arecordofincidents, fallsandinjurieswasprepa redandcoordinatedfromthe NursingUnitinwhichthefollowingdatawerecollected: demographicdataofthereside nt,typeoffall,description ofthefall,conditionoftheresidentafterthefall,comorbiditiesandusualmedication. Thetreatmentofallpatients inwhomfallswererecordedwasreviewedbythepharmacist,assessingwhethertheyw erecausedbydrugswitha highriskofcausingfalls. Pharmacologicalrecommendationsweremadebythehospitalpharmacistaimedatpreventingfalls.

Results Duringthestudyperiod40fallswererecorded, correspondingto25patients,48%weremenwitha medianageof84years(72.5 – 95.5).Atotalof67.5% wereidentifiedasrelatedtodrugtreatment.Thehospital pharmacistcarriedout27pharmacologicalinterventions thatincluded:graduallyreducingthedoseofsedativehypnoticsuntildiscontinuation(33.3%),optimisationofantihypertensivetreatment(25.9%),prescribingcapillary glycaemiacontrols,assessingtheadjustmentofbasalinsulin units(7.4%)andreducingtheanticholinergicburdenof treatment(7.4%).

ConclusionandRelevance Fallsrelatedtodrugtreatmentare commonininstitutionalisedpa tientsandcanbeidentified bythehospitalpharmacist.Hospitalpharmacistscanalso contributetooptimisingpatienttreatmentthroughpharmacologicalinterventions,whichwerewellacceptedinour case.

Theimprovementmeasuresthatweintendtodevelopare theimplementationofafallnotificationprotocoltothePharmacyServicetoidentifythosecausedbypharmacological treatmentandrecommendchangesinthemedicalteamofthe geriatriccentresassignedtoourPharmacyService(1,000 residents).

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

5PSQ-128 COST-EFFECTIVENESSOFPHARMACEUTICAL PREOPERATIVECONSULTATIONS:AFIVE-YEAR ANALYSIS

DGomez*,ARibed,ÁGiménez,SHerrero,YRioja,BTorroba,AHerranz. HospitalGeneral UniversitarioGregorioMarañon,HospitalPharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.463

BackgroundandImportance 2.5%ofoperationsarecancelled becauseofpreoperativemedicationerrors.Pharmaceuticalpreoperativeconsultationsareaneffectivetoolindetectionand preventionoftheseerrors,butcost-effectivenessoftheir implementationhasnotbeenevaluated.

AimandObjectives Todeterminethecost-effectivenessofthe implementationofapharmaceuticalpreoperativeconsultation toreviewthecorrectmedicationmanagementofpatients undergoingsurgery.

MaterialandMethods Aretrospective,single-centerstudywas conductedtoanalyzeallmedicationerrorspreventedbya pharmacistduringapreoperativecareconsultationsincetheir implementationin2016until12/2020.Thepharmacistreconciledmedicationandreviewedtheirappropriatepreoperative management.Recommendationsweremadebasedonaninstitutionalprotocol.

Toassesstheeconomicimpactofpreventedmedication errors,ateamofpharmacistsandanesthesiologistsassigned eacherroraprobabilityofresultinginapatient-impacting adverseevent(p).FollowingNebitetalmethodology,values of0,0.01,0.1,0.4,or0.6wereassignedtoeacherror,with 0.6beingthemaximumprobabilityasaconservativemeasure.

AcostofC ¼ 6,924peradverseeventwasestablishedbased ondatafromtheSpanishMinistryofHealthin2005and adjustedfortheconsumerpriceindexin2020.Thecostof eachpreventederrorwascalculatedasC ¼ 6,924xp.The annualcostofahospitalpharmacyspecialistinSpainwas C¼ 45,494in2020.

Asensitivityanalysiswasconducted,recalculatingthe resultsiftheaveragecostofanadverseeventwas20%higher (C ¼ 8,309)orlower(C ¼ 5,539).

Results Theconsultationwasattendedby3,105patients (meanage67.0years)and1,179medicationerrorswereprevented.Sixwereclassifiedasp=0,224asp=0.01,346as p=0.1,497asp=0.4,and106asp=0.6,correspondingto 299.2preventedadverseevents.

Inmonetaryterms,thesavingsassociatedwiththesepreventedadverseeventswereC ¼ 2,076,785over5years,while thecostofemployingapharmacistwasC ¼ 227,470.Thenet savingswereC ¼ 1,849,315,andtheeurosaved/investedratio was9.1/1.Applyingthesensitivityanalysis,thisratiowould rangefrom7.3/1to10.9/1.

ConclusionandRelevance TheimplementationofaPharmaceuticalPreoperativeCareconsultationwascost-effectivefor thehealthcaresystem,withacostsavingsrangingfrom7.3 and10.9eurospereuroinvested.

Referencesand/orAcknowledgements ConflictofInterest Noconflictofinterest.

6ER-001

HEALTHCARERESOURCEUTILISATIONANDCOSTSOF INTRAVITREALRANIBIZUMABORAFLIBERCEPTVS. DEXAMETHASONEFORDIABETICMACULAREDEMA INTAIWAN

1HYChen*, 2SCShao. 1LinkouChangGungMemorialHospital,DepartmentofPharmacy, Taoyuan,TaiwanR.O.C; 2KeelungChangGungMemorialHospital,Departmentof Pharmacy,Keelung,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.464

BackgroundandImportance Treatmentoptionsfordiabetic macularedema(DME)includeintravitrealanti-vascularendothelialgrowthfactor(anti-VEGF)drugsanddexamethasone implant(DEX-implant),bothwiththeirowntreatmentpros andcons.Todate,fewstudieshaveexaminedthehealthcare resourceutilisationandmedicalcostsassociatedwiththese twodrugclassesforDMEtreatment.

AimandObjectives TocompareDME-relatedhealthcareutilisationandmedicalcostsofpatientswithDMEreceiving intravitrealanti-VEGFdrugsorDEX-implantinclinical practice.

MaterialandMethods Weconductedaretrospectivecohort studybyanalysingthelargestmulti-institutionalelectronic medicalrecordsdatabaseinTaiwan.Weincludedadult patientswithDMEnewlyreceivingintravitrealanti-VEGF drugs(ranibizumabandaflibercept),andDEX-implantduring 2017–2021.Toensurethehomogeneouscomparisons,we applythe1:1propensityscorematchingapproachtocontrol thepotentialconfounders.Theprimaryoutcomewasthe1yearDME-relatedhealthcareutilisationanddirectmedicalcost perpatientwithDMEthatwasreimbursedbyTaiwan’ s NationalHealthInsurance.Weusedthemean±standard deviationtopresentdescriptivestatisticsandappliedt-teststo determinestatisticaldifferencesbetweenthetwotreatment groupsforcontinuousoutcomes.

Results Weincludedatotalof214patientswithDMEnewly receivingintravitrealanti-VEGFdrugs(n=107)andDEXimplant(n=107).Themeanage(67.0±9.0vs.67.0±12.8 years)andHbA1c(7.6±1.1vs.7.7±1.3%)andeGFRlevels (70.5±26.7vs.70.1±22.0mL/min/1.73m2)weresimilarfor thetwotreatmentgroups.Theaverageoutpatientmedicalcost perpersonforeyecarewaslowerfortheDEX-implantgroup (NTD81,838±54,752vs.105,109±62,481;p=0.004),comparedtotheanti-VEGFdruggroupduringthe1-yearfollowupperiod.Theaverageintravitrealinjectionsperpersonfor eyecarewerelowerfortheDEX-implantgroup(1.8±1.4vs. 3.9±2.6;p<0.001),comparedtotheanti-VEGFgroup,during the1-yearfollow-upperiod.However,patientswithDEXimplantreceivedmorepneumotonometry(3.3±3.7vs.2.0 ±2.6;p=0.004),comparedtotheanti-VEGFdruggroup,duringthe1-yearfollow-upperiod.

ConclusionandRelevance Comparedtotheanti-VEGFdrug group,DMEpatientswithintravitrealDEX-implantwereassociatedwithloweraveragedirectoutpatientmedicalcostsfor eyecareandlowernumberofintravitrealinjectionsduring thefirstyearoftreatmentinTaiwan.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-002 POSITIVEPREDICTIVEVALUESOFANAPHYLAXIS DIAGNOSISINCLAIMSDATA:AMULTIINSTITUTIONALSTUDYINTAIWAN

1SCShao*, 2SCLiao. 1KeelungChangGungMemorialHospital,DepartmentofPharmacy, Keelung,TaiwanR.O.C; 2KeelungChangGungMemorialHospital,Departmentof EmergencyMedicine,Keelung,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.465

BackgroundandImportance Real-worlddatasourcescanfacilitateessentialunderstandingoftheepidemiologicalfeaturesof anaphylaxis.However,theaccuracyofcase-identifyingdefinitionsbasedondiagnosiscodesforanaphylaxisinhealthcare databasesremainsunderstudied.

AimandObjectives ToevaluatetheaccuracyofInternational ClassificationofDiseases,TenthRevision,ClinicalModification(ICD-10-CM)codestoidentifyanaphylaxisinclaimsdata fromthelargesthealthcaresysteminTaiwan.

MaterialandMethods Weconductedacross-sectionalstudy analysingclaimsdatafromthelargestmulti-institutional healthcaresysteminTaiwanfrom2017to2021.We includedpatientswithincide ntanaphylaxisidentifiedby eitherICD-10-CMcodesforanaphylaxis(Group1)or ICD-10-CMcodesforsevere allergicordrugadverse eventsandadditionalmodifiercodesforacuteallergy events(e.g.,epinephrine,intramuscularorintravascular injection)(Group2).Werandomlyselected20%ofthe casestodeterminethepositivepredictivevalue(PPV)of anaphylaxiscase-identifyingdefinitionsinGroups1and2 afterindependentreviewofel ectronicmedicalrecordsby twophysicians.Theclinicalc riteriaforanaphylaxis,proposedattheSecondNationalIns tituteofAllergyandInfectiousDisease/FoodAllergyandAnaphylaxisNetwork, servedasthegoldstandardto confirmanaphylaxisdiagnosis(Groups1and2).

Results Fromtheoriginalcohort(n=2,176),werandomly selected433patients(20%)witheitheradiagnosisofanaphylaxis(Group1),oradiagnosisofsevereallergicanddrug adverseeventswithadditionalmodifiercodesforacuteallergy events(Group2).InGroup1,wejudged135/170patientsas trueanaphylaxiscases(medianage:47years;female:46.5%), givingaPPVof79.4%(95%CI:73.3–85.5).InGroup2,we judged47/263patientsastrueanaphylaxiscases(medianage: 48years;female:54.0%),givingaPPVof17.9%(95%CI: 13.3–22.5).Theunderlyingcausesforfalse-positiveanaphylaxisidentificationinGroup2wereurticaria(76.7%)and angioedema(23.4%).

ConclusionandRelevance AcceptablePPVswereobserved whenanaphylaxiscaseswereidentifiedbyICD-10-CMcodes foranaphylaxis,butnotbyICD-10-CMcodesforsevereallergicordrugadverseeventwithadditionalmodifiercodesfor acuteallergyevents.Ourmulti-institutionalfindingscould serveasafundamentalreferenceforfurtherstudiesofanaphylaxisbasedonreal-worldhealthcaredatabases.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-003 ASSESSMENTOFOVERALLSURVIVALANDSAFETYIN NEWLYAPPROVEDONCOHAEMATOLOGICDRUGS

1ABPousadaFonseca*, 2HMartínezBarros, 3JPedreiraBouzas. 1HospitalUniversitarioDe Móstoles,HospitalPharmacy,Móstoles,Spain; 2HospitalUniversitarioRamónYCajal, HospitalPharmacy,Madrid,Spain; 3HospitalUniversitarioDeFuenlabrada,Hospital Pharmacy,Fuenlabrada,Spain

10.1136/ejhpharm-2024-eahp.466

BackgroundandImportance TobeincludedontheWorld HealthOrganization(WHO)ModelListofEssentialMedicines,cancerdrugsshouldincreaseoverallsurvival(OS)byat least4–6months.

AimandObjectives ToevaluateOSbenefitandsafetyofoncohaematologicaldrugsapprovedbytheEuropeanMedicines Agency(EMA)from2017to2020.

MaterialandMethods Thisretrospectiveobservationalstudy identifiedthefirstindicationofnewoncohaematologicaldrugs approvedbytheEMAbetween2017and2020.ThefollowingvariableswerecollectedusingtheEuropeanPublicAssessmentReports:drug,primaryendpoint,HazardRatio(HR)of OSwithconfidenceintervals,OSbenefitinmonths(if medianswerereached)andtotalgrade3or4adverseevents (AE)forbothdrugandcomparator.AStudent’st-testwas conductedtocompareAE.

Results Atotalof49indicationswereidentified.Theprimary endpointusedwassurrogatein41indications(83.7%): Responseratein20(40.8%);progression-freesurvivalin15 (30.6%);disease-freesurvivalintwo(4.1%);metastasis-free survivalintwo(4.1%);andinvasivedisease-freesurvivalin oneindication(2.0%).Onedrug(2.0%)wasapprovedwitha pharmacokineticequivalenceoutcome.

Intheremainingeightindications(16.3%),theprimary endpointwasOSwithamedianHRof0.71[IQI0.59–0.77] andamedianintervalwidth(upperminuslowerinterval)of 0.36[IQI0.29–0.42].Infouradditionalindications(8.2%), therewasbenefitforOSasasecondaryendpoint.

Globally,OSbenefitswerereportedin12indications (24.5%)(8asprimaryandfourassecondaryendpoint),but medianOShadnotbeenreachedintwo.Medianbenefitwas 4.1months[IQI3.6–16.7],withsixindications(6/10)demonstratingbenefitsequaltoorexceeding4months.

Regardingsafety,themeanofseriousAE( grade3)in the49indicationswas63.6%intheexperimentalgroupsand 52.2%inthecontrolgroups,withadifferenceof11.4% (95%CI:0.74–22.1).

ConclusionandRelevance OSwastheprimaryendpointin1 in6approvedindications.WhileHRvalueswereacceptable, considerableintervalwidthswerenoted.

Approximatelyone-quarterofindicationsdemonstratedOS benefitandsixapprovedindicationsmetthelowerlimitfor inclusionintheWHOModelListofEssentialMedicines.

DespitemodestOSoutcomes,statisticallysignificant increasesinAEwereobserved.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-004 VISIONRELATEDQUALITYOFLIFEINPATIENTSWITH DIABETICMACULAROEDEMAANDAGE-RELATED MACULARDEGENERATIONTREATEDWITHANTIVASCULARGROWTHFACTORTHERAPYOR DEXAMETHASONE

1GMercadal*, 2PVentayol, 3JISerrano, 4SHerrera. 1HospitalMateuOrfila,Pharmacy, Mahon,Spain; 2HospitalUniversitariSonEspases,Pharmacy,PalmaDeMallorca,Spain; 3HospitalUniversitariSonLlatzer,Pharmacy,PalmaDeMallorca,Spain; 4HospitalDelMar, Imim-Bibliopro,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.467

BackgroundandImportance Age-relatedmaculardegeneration (AMD)anddiabeticmacularoedema(DME)standasthe foremostcausesofvisualimpairmentamongtheelderlyin developednations,oftenresultinginseverelossofvisualfunctionorblindness.Visualimpairmentsignificantlyhindersindividuals’ abilitytocarryoutdailyactivitiesandcompromises theirmobility.

AimandObjectives Theprimarygoalofthisstudywasto assesstheimpactofintravitrealanti-vascularendothelial growthfactortherapies(anti-VEGF)suchasaflibercept,ranibizumab,orbevacizumab,aswellasdexamethasone,onthe improvementofvision-relatedqualityoflife(VQoL)in patientswithAMDorDME.

MaterialandMethods Thisstudyencompassedpatientswith AMDorDMEwhoreceivedtreatmentwithintravitrealantiVEGFagentsordexamethasone.Therecruitmentperiod extendedfromNovember2022toAugust2023,withafollow-upperiodof6monthsaftertheinitiationorchangeof treatment.Follow-upandevaluationwerefacilitatedthrougha remotetoolthatgatheredpatient-reportedoutcome questionnaires.

Twoquestionnaireswereemployed

. SpanishLowVisionQualityofLifeQuestionnaire(SLVQOL): Comprising25items,thisquestionnaireexploredfour distinctdimensions distancevision,mobilityand illumination,adaptation,readingandprecisionwork,and dailylifeactivities.

. NationalEyeInstituteVisualFunctioningQuestionnaire25 (NEIVFQ-25):Thisquestionnairefeatured25questions, assessing12aspectsincludinggeneralhealth,generalvision, ocularpain,nearvisionactivities,distancevisionactivities, socialfunctioning,vision-specificroledifficulties,visionspecificmentalhealth,dependencyduetovision,driving, peripheralvision,andcolourvision.Statisticalanalysis includedpairedt-testsusingSTATAsoftwaretocompare means.

Results Atotalof54patientswereenrolled,47%being femaleandameanageof66.9years.Amongthem,72.3% hadage-relatedmaculardegeneration,27.7%haddiabetic macularoedema,and92.6%receivedtreatmentwithantiVEGFdrugs(including74%aflibercept,3.8%bevacizumab, and14.8%ranibizumab),while7.4%weretreatedwith dexamethasone.

Fromthebaselinevisittothe6-monthfollow-up,an improvementinVQoLscorewasobserved,althoughitdid notachievestatisticalsignificance:

SLVQOLfrom97,31points+28,43to101,57+31,6 (p=0.6)

NEIVFQ-25from66,47points+18,32to68,57+23,91 (p=0.74)

ConclusionandRelevance Inourstudy,theutilisationofantiVEGFtherapiesordexamethasoneledtoanenhancementin VQoLscoreatthe6-monthmark,albeitnotreachingstatisticalsignificance.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-005 DRUGWASTAGE:AHIDDENCOSTOFCANCERCARE

ABPousadaFonseca*,DGarcíaMartinez,MJVázquezCastillo,YMateosMateos, IGonzalezGarcía,MRMengualBarroso,AGonzalezFuentes,FFernandezFraga,BRubio Cebrián,MMañesSevilla,MSeguraBedmar. HospitalUniversitarioDeMóstoles,Hospital Pharmacy,Móstoles,Spain

10.1136/ejhpharm-2024-eahp.468

BackgroundandImportance Ourcountry ’slegislationbansthe returnofdispenseddrugstoPharmacyServices,potentially leadingtoincreasedcostsfortheNationalHealthSystem.

AimandObjectives Toestimatethecostofpillwastagedueto dosemodificationsanddiscontinuationfororalanticancer drugs.

MaterialandMethods Retrospectiveeconomicevaluationcarriedoutinanintermediatecomplexityhospital.Usingthe electronicmedicalrecord,dispensationsoforalanticancer drugsbetweenJuly2022andJuly2023wereidentified.

Thefollowingvariableswerecollected drug,dateofdispensing, tabletsdispensed,datethepatientneedstoreturntothepharmacy,treatmentinterruptionandcause,dateofinterruption andleftovertablets.

Thelaboratories’ salespriceswereusedtocalculatethe costs.Wecalculatedthepotentialnumberofdispensations thatthewastagecouldhavecoveredbydividingthetotalwastagebythemedianpriceperdispensation.

Dosemodificationswerenottakenintoaccountindrugs whichhadpillstrengthsdivisibleateachdose-reductionlevel.

Unmarketeddrugsinourcountrywereexcluded. Results 1239dispensationswereidentified.Themostdispenseddrugswereenzalutamide40mgwith308dispensations(25%)ribociclib200mgwith219(18%),niraparib100 mgwith143(12%)andlenvatinib10mgwith66(5%).The mediannumberofdaysforwhichmedicationwasdispensed was30[IQI28–35].Themedianpriceperdispensingwas C¼ 3,173[IQI1,866–4,445]andthetotalannualexpenditure wasC ¼ 3,759,172.

63(5%)dispensationswereinterrupted.Themostfrequent causeswerediseaseprogressionfor33drugs(52%)andtoxicityfor19(30%).Themedianpriceperdispensingwas C¼ 3,173[IQI1,155–4,445]andthetotalpricewasC ¼ 186,327.

In34oftheinterruptions(54%)patientshadtablets remaining.ThemedianwastageperpatientwasC ¼ 1,393[IQI 645–2,503]andthetotalwastagewasC ¼ 56,459(1.5%ofthe annualexpenditureand30.3%ofthediscontinued treatments).

Seventeendispensations(1.4%)couldhavebeencovered withthetotalcostofpillwastage.

ConclusionandRelevance Althoughfewtreatmentswerediscontinued,significanteconomicwastageoccurredduetodrug prices.Tominimiseit,ithasbeensuggestedthatcompanies refundmoneyforunusedtabletsandmanufactureappropriate pillstrengths¹.Additionally,hospitalpharmacistscouldbe empoweredtodecideonthereturnofmedications.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.https://pubmed.ncbi.nlm.nih.gov/37471095/

ConflictofInterest Noconflictofinterest.

6ER-006 LABOURPRODUCTIVITYGROWTHINPATIENTSWITH IMMUNE-MEDIATEDINFLAMMATORYDISEASES UNDERGOINGBIOLOGICALORJANUSKINASE INHIBITORTREATMENT

1GMercadal*, 2PVentayol, 2MGomez, 3MAMaestre, 3MBello, 4FFernandez, 5JISerrano, 6SHerrera, 7FMateu. 1HospitalMateuOrfila,Pharmacy,Mahon,Spain; 2Hospital UniversitariSonEspases,Pharmacy,PalmaDeMallorca,Spain; 3HospitalManacor, Pharmacy,Manacor,Spain; 4HospitalInca,Pharmacy,Inca,Spain; 5HospitalUniversitariSon Llatzer,Pharmacy,PalmaDeMallorca,Spain; 6HospitalDelMar,Biblopro,Barcelona,Spain; 7MongoDb,DigitalHealthandInnovation,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.469

BackgroundandImportance Workdisabilityisamajorhealth problemwithconsiderablesocialandeconomicimplications, especiallyevidentinpatientswithimmune-mediatedinflammatorydiseases(IMIDs).Amongthepharmacologicaltreatments forIMIDs,biologicaltherapiesandJanuskinaseinhibitors (JAKi)standout.Consideringtheimpactofboththetreatmentandthediseaseonthepatient‘sworklifeiscrucialto makinginformedtreatmentdecisions.Evidence-basedanalyses comparingthesafety,efficacyandcostsofbiologictherapies andJAKiforIMIDsareessentialtoassisthealthcareprofessionalsandpolicymakers

AimandObjectives Thisstudyaimstoevaluatethelabour productivityimpactofbiologictherapiesandJAKiinpatients withrheumatic(rheumatoidarthritis,psoriaticarthritis,ankylosingspondylitis),dermatological(psoriasis,urticarial,atopic dermatitis),andgastrointestinalautoimmuneconditions (Crohn’sdiseaseandulcerativecolitis).Theassessmentwill employtheWorkRoleFunctioningQuestionnaire(WRFQ), designedtomeasureworkdisabilityandtheperceivedinfluenceofhealthconditionsonjobperformance.

MaterialandMethods Acohortof138patientsdiagnosed withImmune-MediatedInflammatoryDiseases(IMIDs)was selectedfromfiveSpanishpublichospitals.Thestudyspanned fromApril2021toAugust2022,withaone-yearfollow-up afterinitiatingorswitchingtobiologictherapyorJAKinhibitors(JAKi).RemotedatacollectionutilisedtheWork-related FatigueQuestionnaire(WRFQ),comprising27itemsinfive subscales.Comparativeanalysisemployedapairedt-testwith STATA17.0

Results Oftheparticipants,53.4%werefemale,andthemean agewas50.5years(range:18–90).Overthe12-monthfollow-up,notableimprovementsinworkperformancewere observed,indicatedbyscoreincreases:

Workschedulingdemandsfrom65points+34,63to84,49 +26,16(p=0.013)

Outputdemandsfrom67,08points+35,48to86,25+22,95 (p=0.001)

Physicaldemandsfrom51,8points+38,06to78,33+31,06 (p=0.0093)

Mentaldemandsfrom73,26points+32,46to85,6+22,51 (p=0.0694)

Socialdemandsfrom77,77points+31,57to91,66+ 19,24(p=0.054)

Globalscorefromfrom68,34+32,68to84,66+4,46 (p=0.026)

ConclusionandRelevance Thisstudyunderscoresasignificant improvementinworkperformanceamongpatientsutilising biologicdrugsorJAKitherapies.Thispositiveoutcomeserves toreinforcethevalueandcost-effectivenessofthesetreatments,therebymitigatingtheirsubstantialimpactonhealthcarebudgets.Thefindingsholdrelevanceforhealthcare professionalsandpolicymakersalike,guidingthemtoward moreinformeddecisionsregardingIMIDsmanagement.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-007 REDUCINGOURMEDICINES’ CARBONFOOTPRINTBY TACKLINGNITROUSOXIDEWASTE

LStevenson*. King’sCollegeHospitalNHSFoundationTrust,Pharmacy,London,UK

10.1136/ejhpharm-2024-eahp.470

BackgroundandImportance ThereisafocusontheNHS becominggreenerunderpinnedbytheNHSGreenPlanand closingthegaptonetzero.Oneofthebiggestcontributors totheNHScarbonfootprintismedicines,accountingfor 25%.Nitrousoxideconfersthelargestcarbonfootprintof theanaestheticgaseswithintheacutesectoraccountingforat least75%ofthetotalfootprint.

Itiscrucialweworktoreduceourcarbonfootprint – the climatecrisisisahealthcrisis,anditisourdutyashealth careprofessionalstoacttoprotectourpatientsandplanet.

AimandObjectives Ourprojectaimedtotacklethelargest causeofanaestheticemissions,nitrousoxide.Nitrousoxideis abiggerproblemthanmostgasesduetofrequencyofuse andrelianceindentalandpaediatricprocedures.Ourgoal wastoreduceourcarbonfootprintofthesegasesbytackling waste.

MaterialandMethods Wecarriedoutaclinicalauditacross allclinicalareasthatareservedbypipednitrousoxide,1605 litreswereusedweeklyonaverage(83,460litresperyear). Wewereabletocompareourclinicalauditdatawiththe totalgasboughtintothetrust(915,000litresperyear).Figure2showsclinicaluseof5%,andtherefore95%waste.

Results Inestablishingasolutiontotheproblemweknewthe mainsourceofwasteofnitrousoxidewasfromthepiped supply.Therefore,ourplanwastocompletelydecommission areasthathadzeroclinicalusageandconvertanaestheticgas machinestotakeportablecylindersinallotherareas.Convertingtosmaller,portablecylinderswecouldprovidea leanersupplywithnochangeinpatientcareorexperience.

ConclusionandRelevance Fromswitchingtoaleanersupply ofmedicalgases,wehavesavedover250tonnesofCO2e sincebeginningourproject,aswellasover£20,000.The projectcontinueswithaimstoreducetolessthan100tonnes ofCO2 emissionsperyearfromournitrousoxidefootprint.

REFERENCESAND/ORACKNOWLEDGEMENTS 1.GreenerNHS»Areasoffocus(england.nhs.uk).

2.Nitrousoxidecouldbeharmingpeopleasmuchastheplanet – ThePharmaceuticalJournal(pharmaceutical-journal.com 3.NHSEngland»Puttinganaestheticemissionstobed:commitmentondesflurane.

ConflictofInterest Noconflictofinterest.

6ER-008 QUALITY,GAPSANDOPPORTUNITIESIN SMARTPHONEAPPLICATIONSFORPULMONARY HYPERTENSION:ANEVALUATIONFROMHOSPITAL PHARMACISTS’ ANDPATIENTS’ PERSPECTIVES

1HRodríguezRamallo, 2NBáezGutiérrez, 3BBrownArreola, 3EMMendozaZambrano, 1PSuárezCasillas*, 1SLoraEscobar, 4BAparicioCastellano, 4CGuzmanCordero, 3ROtero Candelera. 1HospitalUniversitarioVirgenDelRocío,Pharmacy,Sevilla,Spain; 2Hospital UniversitarioPuertaDelMar,Pharmacy,Cádiz,Spain; 3HospitalUniversitarioVirgenDel Rocío,Pneumology,Sevilla,Spain; 4HospitalUniversitarioReinaSofia,Pharmacy,Córdoba, Spain

10.1136/ejhpharm-2024-eahp.471

BackgroundandImportance Hospitalpharmacistsandpatients facechallengesinidentifyinghigh-quality,functionalsmartphoneapplications(apps)foraidingpulmonaryhypertension (PH)management.Athorough,user-centredevaluationis requiredduetotheseapp’sroleinmedicationmanagement andpatienteducation.

AimandObjectives ToevaluatethequalityandutilityofPHfocusedappsfromtheperspectivesofhospitalpharmacists andpatients.

MaterialandMethods Anobservationalstudywasconducted onfreelyavailableappsintendedforPHpatientsandhealthcareprovidersonAndroidandiOSplatforms.Variablessuch asplatform(Android/iOS),lastupdatedate,intendedpurpose andstakeholderinvolvementwerecollected.TheMobile ApplicationRatingScale(MARS)frameworkwasusedfor qualityassessment,andMann-WhitneyUtestswereappliedto comparemeanMARSscoresbasedonspecificvariables (healthcareprofessionalparticipation,pharmaceuticalindustry involvement,ortargetpopulation).

Results Ourevaluationencompassed20PH-specificapplicationsacrosstwoplatforms:Android(9),iOS(7),andboth (4).Ofthese,11targetedhealthcareprofessionalsand9were designedforpatientsorgeneralpopulationuse.Elevenapps wereupdatedwithinthepastyear.

Only10appsweredevelopedwithhealthcareprofessional input,andnoneinvolvedPHpatients.Fiveapplicationswere pharmaceutical-industry-developed,and8benefitedfrompharmaceuticalfunding.

Despiteauniversalemphasisonthefewappsidentifiedon disseminatingPHgeneralinformation,noneofferedfeatures forpatientself-managementlikeadverseeffectmonitoringor medicationtracking.Likewise,theylackedfunctionalitiescrucialforhospitalpharmacists,suchasdruginteractionchecks orallowingdirectcommunicationwithpatients.

QualityassessmentviatheMARSscaleyieldedamedian scoreof3.4(1.8–3.9),indicatingacceptablequality.Analyses foundnosignificantimpactofhealthcareprofessionalparticipation,pharmaceuticalindustryinvolvement,ortargetpopulationontheapp´squality.

ConclusionandRelevance WhilethefewexistingPHapps offereducationalfeaturesforpatientsandhealthcareprovidersofacceptablequality,theyneglectthespecialisedneeds ofhospitalpharmacistsandPHpatients.Ourfindingsaccentuatetheimperativeforfocused ,collaborativedevelopment

ofappstobetterservethese specificstakeholdersinPH management.

Whilethisdevelopmenthasthepotentialtoimprove patientcare,thispropositionwarrantsempiricalvalidation. Therefore,itisadvisabletoconductstudiesincontrolledsettingstogeneraterobustevidenceregardingtheefficacyof thesetools.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-009 PRESCRIBINGPATTERNSANDEFFECTIVENESSOF RANIBIZUMABANDAFLIBERCEPTINPATIENTSWITH CENTRALRETINALVEINOCCLUSION:A RETROSPECTIVECOHORTSTUDYINTAIWAN CCLiu*,SCShao. KeelungChangGungMemorialHospital,DepartmentofPharmacy, Keelung,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.472

BackgroundandImportance Intravitrealinjectionsofranibizumabandafliberceptareestablishedinitialtherapiesformanagingmacularoedemaarisingfromcentralretinalveinocclusion (CRVO).However,thereisalackofextensivestudiesevaluatingtheprescribingpatternsandtherapeuticeffectivenessof thesetwodrugs.

AimandObjectives Toscrutinisethepatients’ characteristics, particularlyfocusingontheinitialseverityoftheCRVO,and toevaluatetheeffectivenessofranibizumabandafliberceptin patientswithCRVOeyes.

MaterialandMethods Weperformedaretrospectiveexaminationofelectronichealthrecordsdatafromthreehospitalsin NorthernTaiwan.WeincludedadultpatientswithCRVOwho initiatedeitherintravitrealranibizumaborafliberceptfrom 2017to2021.Centralretinalthickness(CRT)andvisual acuity(VA)wereevaluatedbeforethetreatmentandthrough afollow-upperiodlastingupto2years.Forstatisticalanalyses,VAwastranscribedintoLogMAR(logarithmoftheminimumangleofresolution)VAvalues.Independentt-testand pairedt-testanalyseswereemployedtoassessthedifference ofbaselineCRTandLogMARVAbetweenranibizumaband afliberceptandchangesofCRTandLogMARVAaftertreatments,respectively.

Results Thestudycohortconsistedof220patients(average age:65.6±13.8years;55.9%male)andincluded127eyes intravitreallytreatedwithranibizumaband93eyestreated withaflibercept.Aflibercept-treatedeyesdisplayedamarkedly higherinitialCRT(577.7 mmvs.510.8 mm,p=0.006),but nosignificantdifferencesininitialLogMARVAwereseen (0.92vs.0.87,p=0.29),comparedtothosewithranibizumab. BothmedicationsledtoconsiderablereductionsinCRTafter 1-year(ranibizumab:510.8vs.343.5 mm,p<0.001;aflibercept:577.7vs.346.5 mm,p<0.001)and2-yeartreatments (ranibizumab:510.8vs.310.6 mm,p<0.001;aflibercept: 577.7vs.298.5 mm,p<0.001).Nevertheless,neitherdrug contributedtonoteworthyimprovementsinLogMARVAafter 1-year(ranibizumab:0.87vs.0.92,p=0.51;aflibercept:0.92 vs.0.92,p=0.90)or2-yeartreatments(ranibizumab:0.87vs. 0.92,p=0.49;aflibercept:0.92vs.0.93,p=0.91).

ConclusionandRelevance Bothintravitrealranibizumaband afliberceptforCRVOproducedsignificantreductionsinCRT andremainedtheVAintheroutinecarefromTaiwan.Our datasuggestthatupcomingcomparativestudiesbetweenthese treatmentsshouldconsidertheobservedbaselinedifferencesin CRT.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-010 INVESTIGATINGNEEDANDAPPROPRIATENESSFOR PHARMACIST-LEDVACCINATIONSERVICESWITHINA HEALTHCARESYSTEM

TAttard*,FWirth,LMAzzopardi. UniversityofMalta,DepartmentofPharmacy,Msida, Malta

10.1136/ejhpharm-2024-eahp.473

BackgroundandImportance Pharmacist-ledvaccinationservices areanopportunitytoimprovepatientaccesstovaccination andimproveuptake.

AimandObjectives Toassessdriversforpharmacist-ledvaccinationservicesandtounderstandpatientexpectationsand pharmacist-preparednessforpharmacist-ledvaccination services.

MaterialandMethods Twoself-administeredquestionnaires weredevelopedandvalidated;oneforpharmacistsandthe otherforgeneralpublic.Thepharmacistquestionnaireevaluatedknowledgeandskillsonthepreparationandadministrationofvaccinesandserviceprovision.Thepatient questionnaireevaluatedvaccineeducationandadministration bypharmacists.Thequestionnairesweredistributedelectronically(n=40pharmacists;n=140patients)andphysicallyfrom 2communitypharmaciesandsnowballsampling(n=22pharmacists;n=23patients).

Results Pharmacistquestionnaire(N=62):45female,17male, 23–69years,where19pharmacistsprefertoadministervaccinestotheadultgroupoverthepaediatricgroup(n=3). Pharmacistsareawareoferrorsduringpreparationand administrationofvaccines(n=31),aswellascontraindications (n=45),thecurrentnationalguidelines(n=42)andtheprocedureofvaccinestorage(n=58).Communitypharmacists agreedthatitisfeasibletocarryoutvaccinationservicesat thepharmacy(n=47),someofwhomstatedthatthepremises requirefurthermodifications(n=28).Pharmacistscommented ontheimportanceofpropertrainingfortheservicetobe carriedoutefficiently.

Patientquestionnaire(N=163):97female,66male,18–70 +years,where102patientsapproachpharmacistswithconcernsonvaryingaspectsincludingsideeffects,generalinformation,concerns,usesandotherinformationregarding vaccines,71reportedthattheyweresatisfiedwiththepharmacist’sresponses,and146trustthepharmacisttoadminister theinfluenzavaccine.Seventy-fivepatientsarewillingtopay C¼ 5fortheserviceprovidedbypharmacists,and37patients arenotwillingtopay.

ConclusionandRelevance Thedriversthatcontributetothe implementationofpharmacist-ledvaccinationservicesinclude

patientexpectationsandthelevelofpreparednessamong pharmacists.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-011 ANASSESSMENTOFPHARMACISTS’ CONFIDENCE ANDBEHAVIOURSINDISPENSINGOPIOID MEDICATIONS

JEClark*,BDorman,LHarris,AKolbrick,JLamberti,CPiazza. UniversityofSouthFlorida, TanejaCollegeofPharmacy,Tampa,USA

10.1136/ejhpharm-2024-eahp.474

BackgroundandImportance Opioidprescribinghasbeenassociatedwithwhatisdescribedasan ‘opioidcrisis’ inthe UnitedStates.Pharmacistsareinuniquepositionstooffer beneficialservicestopromotethesafeuseofopioidmedicines.Lowconfidence,knowledge,andtraininghavebeen associatedwithbarriersinprovidingopioiddispensing services.1

AimandObjectives Theprimaryaimwastoinvestigatethe associationbetweencommunitypharmacists’ confidenceand practicebehavioursinthedispensingofopioidmedications.

MaterialandMethods AmodifiedversionoftheOpioidTherapyProviderSurveywassent178communitypharmacists betweenAprilandSeptember2023toassesstheirconfidence andbehavioursindispensingopioidmedicines.Participants confidencewasassessedwithtenstatementsaroundcounsellingandadvice,dispensing,abuseperception,communication withproviders,andpracticeprotocolsthatweremeasured usingSpearman’sstatisticalcorrelation.

Results Thestudyresponsewas28%.Staffpharmacists accountedfor35%andpharmacymanagers32%ofthe respondents.Thirty-fivepercentofthepharmacistshadbeen inpracticeformorethan7years.Forty-sevenpercent(47%) ofthepharmacistsdispensedover30opioidmedicinesper week.Ninety-one(91%)percentoftherespondentsfeltconfidentindispensingopioidsintheirpractice.Therewasa strong,positivecorrelationbetweenpharmacists’ comfort when:(1)followingarecommendedopioiddispensingprotocol(rs =.593, p <.001),(2)counsellingpatientsonside effects(rs =.480, p =.0o5,(3)informationprovidedby painspecialists(rs =.515, p =.002).and(4)havingaconsistentpracticeapproachindispensingopioids(rs =.604, p <.001).

ConclusionandRelevance Mostcommunitypharmacistsappear tofeelconfidentindispensingopioidmedicines.Thereisa stronglevelofconfidenceamongcommunitypharmacistsin counsellingpatientsonopioidsideeffects,overdose,andantidotes.Pharmacistsaremostcomfortableindispensingopioids whentherearemanagementapproveddispensingprotocols andmedicalinformationisprovidedbytheprescribingpain specialist.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.PearsonAC,MomanRN,MoeschlerSM, et.al.Providerconfidenceinopioidprescribingandchronicpainmanagement:resultsoftheOpioidTherapyProvider Survey. J.PainResearch 2017;10:1395–1400.

ConflictofInterest Noconflictofinterest.

6ER-012 EVALUATIONOFTHEEFFECTOFCLOSEDSYSTEM TRANSFERDEVICESYRINGEADAPTORCONNECTION INTHEISOLATORONCYTOTOXICRESIDUE CONTAMINATIONDURINGINTRAVENOUS ADMINISTRATION

LKnowles*. UniversityofManchester,FacultyofMedicalandHumanSciences,Manchester, UK

10.1136/ejhpharm-2024-eahp.475

BackgroundandImportance TheEuropeanBiosafetyNetwork recommendsthatcytotoxicdrugsurfacecontaminationin pharmacyandpatientwardsnotexceed0.1ng/cm2.Among othermitigations,closedsystemtransferdevices(CSTDs)are recommendedinseveralguidancesintheUS,Europe,andUK forreductionofsurfacecontamination.IntheUK,CSTDsare notpartofstandardcytotoxicpreparationproceduresinisolators,buttheNHSrecommendstheuseofCSTDsyringe adaptors(SAs)withsyringesusedforintravenousadministration.AtUniversityHospitalsBirmingham,standardpracticeis toconnectLuercapsintheisolatorandremovethemfor administration.

AimandObjectives Theaimwastodetermineiftheaddition ofaCSTDSAintheisolatorreducescytotoxicresiduecontaminationduringintravenousbolusadministration.

MaterialandMethods Surfacecontaminationofsyringes,gauze padsplacedattheadministrationsite,andnurses’ gloveswere comparedbetweentwoprocedures:connectingAMDhubcaps intheisolatorandremovalinthewardvs.connectingTevadaptorSALocks(SALs)intheisolatorduringpreparation.

Inanegativepressureisolator,25cyclophosphamide syringeswerepreparedwithhubcapsand25withSALs. Syringeswerewipedwith50%methanolpriortoremoval fromtheisolator.Intheward,syringeswereswabbed.Gauze padsplacedunderconnectionsitesforbolusadministration werecollected.Followingadministration,nurses’ gloveswere swabbed.Cyclophosphamideonswabsandgauzepadswas quantifiedbyLC/MS.

Results

WhenSALsreplacedhubcaps mediancyclophosphamidecontaminationdecreasedfrom8.29ngto0.62ngonsyringes, from384.82ngto0.01ngongauzepads,andfrom1.11ng to0.00ngongloves.Whenhubcapswereused,12/25 syringes,19/25gauzepads,and2/25glovesexceededtherecommendedlimitof0.1ng/cm2,whilewithSAL,nosamples exceededthislimit.

ConclusionandRelevance AdditionofTevadaptorSALsto syringesintheisolatorreducedcytotoxicresidueonsyringe surfaces,nurses’ gloves,andonconnect/disconnect,compared totheadditionofstandardhubcaps.Thus,TevadaptorSALs arebeneficialinreducingcytotoxicdrugexposuretonurses administeringIVsyringesandmayreducetheriskofmutagenicadverseevents.

REFERENCESAND/ORACKNOWLEDGEMENTS

PartialfundingprovidedbyB.BraunMedicalandSimplivia HealthcareLtd.

ConflictofInterest Conflictofinterest.

Corporatesponsoredresearchorothersubstantive relationships:

Theauthorhasnoconflictofinterest.todeclare.Elana SlutskySmith,whoassistedwiththesubmissionprocess,is

employedbySimpliviaHealthcare,Ltd.,themanufacturerof theTevadaptorCSTD.

6ER-013 ENHANCINGPATIENT-CENTREEDCARETHROUGH PREDICTIVEMODELLINGOFPATIENT-REPORTED OUTCOMESINHOSPITALPHARMACYSETTING

1SHerrera, 2GMercadal*, 3PVentayol, 4JSerrano, 5MAMaestre, 6FFernandez, 7LAnoz, 8FMateu. 1InstitutoDeInvestigacionesMédicasHospitalDelMar,CiberEpidemiologíaY

SaludPúblicaCiberesp-Spain,Barcelona,Spain; 2HospitalMateuOrfila,Pharmacy,Mahon, Spain; 3HospitalUniversitariSonEspases,Pharmacy,PalmaDeMallorca,Spain; 4Hospital UniversitariSonLlatzer,Pharmacy,PalmaDeMallorca,Spain; 5HospitalManacor, Pharmacy,Manacor,Spain; 6HospitalInca,Pharmacy,Inca,Spain; 7HospitalCanMisses, Pharmacy,Ibiza,Spain; 8Mongodb,DigitalHealthandInnovation,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.476

BackgroundandImportance Patient-reportedOutcomes(PROs) haveestablishedthemselvesaskeytoolsformeasuringthe realimpactofmedicalinterventionsfromthepatient‘ sperspective.However,tomaximisetheirusefulness,itiscrucial toanticipateandunderstandtheseoutcomes.Machinelearning isemergingasapowerfulsolutiontopredictPROsandoptimisehealthcare.

AimandObjectives Thisstudypresentsanovelpredictive modelbasedontheRandomForestalgorithmforthepredictionofPROscoresfromsociodemographicvariablesandmedicationregistriesobtainedinhospitalpharmacypractice.

MaterialandMethods Datafrom400Spanishchronicpatients (includingpsoriasis,asthma,HIVandmigraineamongothers) fromtheNAVETAtelemedicineprogramwereanalysed.Sociodemographicvariableswereincludedaswellasthedrugsdispensedbyhospitalpharmacies.Usingthesevariables,a RandomForestmodelpredictedthePROvalues.Predictions wereevaluatedusinganadhocmetricbasedonthemean squarederror(MSE).Themaximumallowableerrorwastaken as25%ofthetotalresponserangeofeachPRO(e.g.0–100). Predictionswerethenratedas ‘excellent’ iftheMSEwas within25%ofthisreferencevalue, ‘good’ within50%, ‘moderate’ within75%and ‘outofrange’ incaseofexceeding 76%ofthereferencevalue.Thismethodprovidesaweighted assessmentofthequalityofthepredictionsmadebyour model.

Results TheRandomForestmodeldemonstratedoutstanding predictiveabilitywithanR2of0.93,effectivelycapturingthe variabilityofthePROmeasurements.TheMSEwas0.07, indicatinggoodaccuracy.Basedonthepredictionqualityrating,oursystemranked40%ofthequestionnairesas ‘excellent’ or ‘good’,includingtheWRFQ(WorkRoleFunctioning Questionnaire),HIVSI(HIVSymptomIndex),MOS30HIV (MedicalOutcomesStudy-shortform30items)andDLQI (DermatologyLifeQualityIndex),suggestingagoodperformanceofthemodelinpredictingPROsscores.

ConclusionandRelevance TheresultsindicatethatHospital PharmacyrecordsobtainedfromtheNAVETAcohortsignificantlypredictpatienthealthoutcomes.TheuseofthispredictivemodelintelemedicinesystemssuchasNAVETAwould improvepatientcarebyhelpingtoquicklyidentifyneedsand tailortreatments,leadingtoaccurate,patient-centredcarein thecontextofhospitalpharmacy.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-014 ASSESSINGADHERENCETOESC/ERSGUIDELINESFOR VASOREACTIVITYTESTINGANDPRESCRIPTIONOF CALCIUMCHANNELBLOCKERSINPULMONARY HYPERTENSIONPATIENTS

1HRodriguez-Ramallo, 2NBáezGutiérrez, 3BAparicioCastellano, 3CGuzmanCordero, 1LESantiago. 1HospitalUniversitarioVirgenDelRocio,Pharmacy,Seville,Spain; 2Hopital PuertaDelMar,Pharmacy,Cádiz,Spain; 3HospitalReinaSofía,Pharmacy,Córdoba,Spain

10.1136/ejhpharm-2024-eahp.477

BackgroundandImportance TheESC/ERSGuidelinesfor treatingpulmonaryhypertension(PH)recommendvasoreactivitytesting(VT)duringrightheartcatheterisationforpatients withidiopathic/hereditable/drug-associatedPH(IPH/HPH/ DAPH)andsubsequenttreatmentwithcalciumchannelblockersinthosewithapositiveresult.

AimandObjectives Toevaluatetheconsistencyinconducting VTinpatientswithIPH/HPH/DAPHandtoascertainwhether positivetestoutcomesleadtotheinitiationofcalciumchannel blockertherapy.

MaterialandMethods Wecarriedamulticentrecross-sectional observationalstudyinthreehospitalsincludingadultstreated between2006and2023.Wereviewedclinicalchartsforall patientswithaPHtype-IdiagnosistoidentifyIPH/HPH/ DAPHpatients.Forthesepatientswereviewedcatheterisation datatofindVT;Ifapositiveresultwasfound,prescription ambulatorydatawasreviewedinsearchforprescriptionsof calciumchannelblockers.

Weestimatedthenumberofpatientswhocouldpotentially benefitfromcalciumchannelblockers,basedontheassumptionthat10%ofpatientswillexhibitapositiveVTtest.

Results Thestudyencompassed176Type-IPHpatientsacross threetertiaryhospitals,including125women(71.0%)witha medianageof58(IQR:24).Underlyingaetiologieswerecongenitalheartdisease38.6%(68),ConnectiveTissueDisease 27.8%(49),PortopulmonaryHypertension6.8%(12),HIV 3.4%(6),IPH15.3%(27),and1.1%DAPH(2).

VTwasreviewedforasubsetof29patients(27IPHand twoDAPH).Ofthese,12underwentVTwithfivereturning positiveresultsandconsequentlyreceivingprescriptionsfor calciumchannelblockers.Fortheremaining17patients,four hadmissingcatheterisationdata,and13underwentcatheterisationbutwerenottestedforvasoreactivity.Iftheaforementionedrateremainsconsistent,anestimated1–2patients couldbenefitfromcalciumchannelblockers.

ConclusionandRelevance VTwasnotconsistentlycarriedout inIPH/HPH/ADPHpatients;asubsetofpatientscouldbenefit fromhighdosecalciumchannelblockers.Forthosepatients withapositiveresult,calciumchannelblockerswere adequatelyprescribed.

Hospitalpharmacistscouldplayaroleinreviewingnew prescriptionsofPH-specifictherapyinordertoidentify patientsnottestedforvasoreactivity.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-015 RETRACTEDPHARMACOLOGYARTICLES:ACROSSSECTIONALSTUDYUSINGTHERETRACTIONWATCH DATABASE

1HRodriguez-Ramallo, 2NBáez-Gutiérrez, 3BAparicioCastellano*. 1HospitalUniversitario VirgenDelRocio,Pharmacy,Seville,Spain; 2HospitalPuertaDelMar,Pharmacy,Cádiz, Spain; 3HospitalUniversitarioReinaSofia,Pharmacy,Córdoba,Spain

10.1136/ejhpharm-2024-eahp.478

BackgroundandImportance Retractionsinscientificliterature canprofoundlyimpacthealthcareprofessionals,potentially misleadinghospitalpharmacistsandaffectingpatientsafety.

AimandObjectives Thisstudyaimedtoprovideafocused examinationofarticleretractionsinpharmacologicalresearch.

MaterialandMethods Across-sectionalobservationalstudy wascarriedoutusingdatafromtherecentlyreleased(10/09/ 2023) ‘RetractionWatchDatabase’*whichcompilesdatafrom retractedscientificarticlessincetheearly70s.Weincluded datafromretractedarticlescategorisedas ‘Medicine-Pharmacology ’ involvingEuropeanresearchers.Weexcludeddata fromarticlereinstatements.

Westudiedvariablessuchas:typeofstudy,dateofarticle publication,dateofarticleretraction,andreasonsfor retraction.

Timetoretractionwascalculatedasdateofarticleretraction – dateofarticlepublication.Asmostarticleshadseveral reasonsforretraction,theywerepresentedinaheatmatof pairwisecombinations.

Results Atotalof516articleswereretractedwithinthestudy period.Retractedarticleswereoriginalstudies61.2%(316),

reviews27.1%(140),Reviewandmeta-analysis3.9%(20) andothers7.8%(40).

Abstract6ER-015Table1

YearperiodArticlepublication N(%) Articleretraction N(%)

1975–199963(12.2)6(1.2)

2000–200494(18.2)12(2.3)

2005–2009116(22.5)22(4.3)

2010–2014138(26.7)174(33.7)

2015–201966(12.8)138(26.74)

2020–202339(7.6)164(31.8)

Themediantimetoretractionwas2135(IQR:3680)days. ConclusionandRelevance Thisstudyrevealedasignificant numberofretractedpharmacologyarticles,oftenwithsubstantialtimelagsfrompublicationtoretractionforseveralsignificantreasons.Hospitalpharmacistsmustbeawareofthis issue,asitinfluencesclinicaldecision-making.Discernmentin citingarticlesisimperativetominimiseassociatedrisks.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.TheRetractionWatchDatabase[Internet].NewYork:TheCenterforScientific Integrity.2018.ISSN:2692-465X.[Cited(20/09/2023)].Availablefrom:http:// retractiondatabase.org/

ConflictofInterest Noconflictofinterest.

Abstract6ER-015Figure1

6ER-016 REAL-WORLDEFFECTIVENESSOFALECTINIBASFIRSTLINETREATMENTINNON-SMALL-CELLLUNGCANCER PATIENTS:EVIDENCEFROMTAIWAN

MhHung*,KChang,HyChen. LinkouChangGungMemorialHospital,DepartmentOf Pharmacy,Taoyuan,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.479

BackgroundandImportance Alectinibhadbeenapprovedfor treatmentofanaplasticlymphomakinase(ALK)-positivenonsmallcelllungcancer(NSCLC).However,real-worldevidence ofalectinibasfirst-lineforAsianpopulationwasstilllimited.

AimandObjectives Ourstudywasaimedtoestimatetheclinicalbenefitsandpotentialprognosticfactorsofalectinibfor ALK-positiveNSCLCtreatment.

MaterialandMethods Weconductedaretrospectivecohort studybyanalysingamulti-institutionalelectronicmedical recordsdatainTaiwan.WeincludedNSCLCpatientsnewly receivingalectinibasfirst-lineALKtyrosinekinaseinhibitors (TKIs)from1January2019to31December2021.Wefurtherexcludedthepatientswithpreviouschemotherapy.The studyoutcomesincludedoverallsurvival(OS)andtreatment duration.Wefollowthepatientsfrominitiatingalectinibto theoccurrenceofinterest.outcomes,death,lossoffollowup orendofdata(31March2023),whichevercamefirst.Prognosticfactorsforoutcomesincludedpatients’ demographics(e. g.,sexandage),Charlsoncomorbidityindex(CCI),brain metastasis,genemutationstatus,stageandEasternCooperativeOncologyGroup(ECOG).Uni-variableCoxregression modelwasappliedtoidentifypotentialprognosticfactors.

Results Weincludedatotalof109NSCLCpatientswith newlyreceivingalectinibasafirst-lineALK-TKIswitha medianageof62.0years(range:50.0–71.0),ofwhom48.6% werefemale.Among17.9monthsfollow-up,medianOSwas non-reach.Brainmetastasiswasinsignificantlyassociatedwith worsenOS(HR:1.57,95%CI:0.69–3.60).Moreover,we foundelderlypatients(HR:2.57,1.32–5.01),ECOG>2 (HR:5.05,2.52–10.1)andCCI>5(HR:2.50,1.31–4.78) weresignificantlyrelatedtobetterOS.

ConclusionandRelevance Betterpatients‘ performancewas associatedwithbetterOSinNSCLCpatientswithalectinibas first-lineALK-TKI.Futurereal-worldstudieswithlargesample sizeandlongerfollow-uptimearesuggestedtoconfirmour findings.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-017 FACTORSPREDICTIVEOFCLINICALOUTCOMEIN ADVANCEDNON-SMALL-CELLLUNGCANCER PATIENTSRECEIVINGOSIMERTINIBTREATMENT:A REAL-WORLDEXPERIENCE

TYYeh*,KChang,HYChen. LinkouChangGungMemorialHospital,Pharmacy,Taoyuan City,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.480

BackgroundandImportance Osimertinib,athird-generation irreversibletyrosinekinaseinhibitorofbothactivatingEGFR mutationsandresistance-associatedT790Mpointmutation, wasapprovedfortreatingadvancednon-smallcelllungcancer (NSCLC).

AimandObjectives Theaimofthisstudywastoinvestigate thefactorspredictiveofclinicaloutcomeinadvancedNSCLC patientsreceivingosimertinibtreatment.

MaterialandMethods Weconductedaretrospectivestudy usingamulti-institutionalelectronicmedicalrecordsdatabase inTaiwan.WeincludedadvancedNSCLCpatientsnewly receivingosimertinibassecond-lineorbeyondsystemictherapybetweenJanuary2020andDecember2020.Theclinical outcomesweremedianprogression-freesurvival(PFS)based ontheResponseEvaluationCriteriainSolidTumors (RECIST),overallsurvival(OS).WeappliedKaplan-Meier methodstoestimatemedianPFSandOS.Uni-variableand multi-variableCoxregressionmodelswereappliedtoidentify theprognosticfactors.

Results Weincluded286osimertinibnaiveuserswitha medianageof66.8(IQR:58.8–73.1)years,ofwhom61.5% werefemaleand99.7%werestage4.ThemedianPFSand OSwere12.0monthsandnon-reach,respectively.Moreover, ECOGperformance(HR:1.82,95%CI:1.06–3.13),exon19 deletion(HR:0.57,95%CI:0.41–0.80),andlivermetastasis (HR:1.88,1.24 – 2.85)weresignificantlyrelatedtoPFSin themulti-variableanalysis.Inaddition,weanalysedthe patientswith ΔCTvalueofEGFRmutation.Wefoundthat thepatientswithhighervalueof ΔCTbetweenT790Mand L858RmutationhadsignificantlyworseOS(HR:1.46,95% CI:1.08–1.96)andPFS(HR:1.47,95%CI:1.15–1.81).

ConclusionandRelevance OsimertinibwasaneffectivetreatmentoptionforadvancedNSCLCpatientsinreal-worldexperience.Tumourburdenlivermetastasis,ECOGperformance andamutationinexon19deletionwereindependentpredictivefactorsforprogression-freesurvival.Moreover, ΔCT betweenT790MandL858Rmutationwasalsoapredictive factorwhileusingosimertinib.Futurereal-worldstudieswith largesamplesizearesuggestedtoconfirmourfindings.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-018 THEEFFECTIVENESSOFADRENERGICALPHA ANTAGONISTSONREDUCINGRE-CATHETERISATION RATESINADULTSWITHURINARYCATHETERS:A SYSTEMATICREVIEWANDMETA-ANALYSIS

YTChen*,CKai-Cheng,CHui-Yu. ChangGungMedicalHospital,PharmacyDepartment, TaoyuanCity,TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.481

BackgroundandImportance Hospitalisedpatientsoftenrequire indwellingurinarycathetersduetourinaryretention,surgery, orotherreasons,andcatheterisationmayincreasetheriskof catheter-associatedurinarytractinfection(CAUTI)anddeath. Alpha-blockerscanreducemuscletensionandrelievedysuria inpatientswithbenignprostatichyperplasia(BPH).However, thereisconsiderableuncertaintyaboutwhetheralpha-blockers aidincatheterremoval.

AimandObjectives Toassesstheeffectivenessofalpha-blockersonsuccessfulresumptionofmicturitionafterremovalofa short-termurinarycatheterinadults.

MaterialandMethods WesearchedPubMed,Embaseand Cochranedatabasesfrom1983toJuly2023forallrandomisedcontrolledtrials(RCTs).Nolanguageorotherrestrictionswereimposedonthesearches.Tworeviewauthors independentlyscreenedthetitlesandabstractsofeachtrial

beforeobtainingthefulltextforallpotentiallyeligibletrials andassessedtheincludedtrialsforriskofbias.Arandomeffectsmeta-analysiswasappliedtopooleventrateswith 95%confidenceintervals(CIs).Wemadeappropriateclinical treatmentrecommendationsbyGRADEEvidencetoDecision (EtD)frameworks.

Results Atotalof33RCTswereincludedwith14studiesin thenon-surgicalgroupandallpatientswithBPH.Therewas highqualityevidencetosuggestthattherateofsuccessful trialwithoutcatheter(TWOC)favouredalpha-blockersover placebo(oddsratio[OR],2.2;95%CI:1.6–3.0).Therewas moderatequalityevidencetoreducetheriskofrequiringrecatheterisation(OR:0.5;95%CI:0.3–0.7).Therewaslow qualityevidencetoreducetheincidenceofrecurrenturinary retention(OR:0.2;95%CI:0.1–0.7).In19studieswith BPHandnon-BPHpatientsundergoingsurgery,therewas moderatequalityevidencetoreducetheriskofpostoperative urinaryretention(POUR)regardlessofgynaecologicalsurgery. ConclusionandRelevance Westronglyrecommendpatients withahistoryofBPHorsuspectedwithBPHtoacceptprophylacticalpha-blockersbeforecatheterremoval.Surgical patientsaremoderatelyrecommendedusingalpha-blockersto preventPOUR.Asforotherpatients,wemustevaluatemany factorssuchasage,gender,medicalhistory,riskofadverse effects,previousurinarycatheterexperienceandindicationsof indwellingurinarycathetersbeforealpha-blockersapplication.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-019 TREATMENTBEYONDPROGRESSIONWITH PEMBROLIZUMABINADVANCEDNON-SMALL-CELL LUNGCANCER

YCLIU*. LinkouChangGungMemorialHospital,DepartmentofPharmacy,Taoyuan, TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.482

BackgroundandImportance Whilepembrolizumabbecamea newstandardofcareinadvancednon-small-celllungcancer (aNSCLC),limitedstudiesprovedtheeffectivenessofcontinuinguseofpembrolizumabafterdiseaseprogression.

AimandObjectives Weaimedtoevaluatetheeffectivenessof treatmentbeyondprogression(TBP)ofpembrolizumabin aNSCLCpatients.

MaterialandMethods Thismulticentrestudyretrospectively analysedelectronicmedicalrecordsfromdatabasesoftwo medicalcentresandtwolocalhospitals.Patientsconfirmed aNSCLCwhoreceivedpembrolizumab(monotherapyorcombinationtherapy)andexperiencedprogressiondiseasebetween 2016andDecember2021wereenrolled.Thefirstdateof diseaseprogressionafterpembrolizumabusedwasdefinedas theindexdate.Wedefinedpatientswithatleastonepembrolizumabwithin60daysasTBPgroup,otherpatientswere definedasswitchedgroup.Wefollowedeachpatientuntil death,lossoffollow-upandendofJune2023.Theprimary outcomewasoverallsurvival(OS),andthebaselinecharacteristicwouldbeadjustedbyinverseprobabilitytreatment weightingmethod.Wealsoevaluatedprognosticfactors, includingprogressionpattern,metastaticsitesandbaseline characteristicsbyusingaCoxregressionmodel.

Results Atotalof307aNSCLCwereincluded.Amongall, 141(45.9%)continuedreceivingpembrolizumabbeyond

progression,while166patients(54.1%)switchedtoother treatments.Overall,medianagewas63.3y/o,73.3%were male,90.6%werewithECOGperformance0–1and61.3% hadhighprogrammeddeathligand-1(PD-L1)expression ( 50%).Withmedian6.2(2.0–13.1)monthsfollow-uptime, theTBPgrouphadalongerOSthantheswitchedgroup (medianOS:11.1vs.4.5months,P<0.01).

ConclusionandRelevance WhiletheTBPgroupwasassociated withbetterOS,additionalstudiesareneededtofurthervalidateourfindings.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-020 WOULDCHATGPTPASSTHERESIDENTINTERNAL PHARMACISTEXAM?

1CGonzález*, 2JNietoDeVicente, 2MTorregoEllacuría, 3GHernandoLlorente, 3PPastor Vara, 3MFernández-VázquezCrespo, 3JCorazónVillanueva, 2LLlorenteSanz, 2MLuaces, 3MTBenítezGiménez. 1HospitalClinicoSanCarlos-Idissc,HospitalPharmacy,Madrid, Spain; 2Idissc,InnovationUnit,Madrid,Spain; 3HospitalClínicoSanCarlos-Idissc,Hospital Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.483

BackgroundandImportance AssessingChatGPT’sperformance intheHealthTrainingexamforPharmacyspecialisation(FIR) holdssignificanceingaugingAI’sroleinhealthcareeducation.

AimandObjectives ToassessChatGPT’sabilitytorespondto andpotentiallypasstheHealthTrainingexamforPharmacy specialisation(FIR).

MaterialandMethods Amultidisciplinaryteamconsistingof hospitalpharmacists,physiciansandbiomedicalengineers selectedanexamversionforthe2022session.Onequestion wasexcludedduetothepresenceofanimage.Abriefintroduction,providingcontextabouttheFIRexamanditscontents,wasaddedatthebeginningoftheconversation.

ChatGPT’sperformance,definedasthepercentageofcorrect answers,wasevaluatedthroughthreedifferentapproaches:

1.Twosetsof50randomlyselectedquestionsweremanually inputintotheOpenAIwebinterfaceduringthesame conversation.

2.Atotalof209questions,includingbothquestionsandtheir fourpossibleanswersweresolvedbytheApplication ProgrammingInterface(API)forPythonfromaspreadsheet.

3.Open-endedquestionslackingpredefinedpossibleanswers wereextractedbyAPIforPython,followedbythe applicationofNaturalLanguageProcessing(NLP).NLP assessedthesimilaritybetweenAPI-generatedresponsesand actualresponses,providingamoreaccurateevaluationof ChatGPT’shuman-likeperformanceinamultiple-choice exam.Thesimilaritymetriccomparedfeaturevectorsof sentencesandgeneratedavaluerepresentingthedegreeof similarity,withamaximumvalueof1signifyingaperfect matchandthusacorrectanswer.

Correctanswersreceivedavalueof3points,whileincorrectonessubtractincurredadeductionof1point.Inthe 2022call,aminimumscoreof97pointswasnecessarytobe eligibleforallocationofFIRpositions.

Results Usingthemanualinclusionmethod,weachieved60% and66%accuracyin50randomlyselectedquestions(score equivalentto280and328points,respectively).Thesecond methodyieldedasuccessasuccessrateof45.5to49.0%,

equatingto164–192points.Inthethirdmethod,valuesof 50.2–52.6%(200–220points)wereobtained.

ConclusionandRelevance Thefindingsdemonstrate ChatGPT’svariableabilitytoprovidecorrectresponsesto FIRquestionsdependingonthemethodologyemployed.

Regardlessoftheapproach,ChatGPTconsistentlyachieved theminimumscorerequiredforparticipationintheallocation ofFIRpositions.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-021 OPIOID-SPARINGSTRATEGIESFORDISCHARGE ANALGESIAPRESCRIBINGINNON-COMPLEX SURGERIES – AMISSEDOPPORTUNITY

1GRoberts*, 1NScarfo, 1KFigueroa, 1MGeekie, 2AMoore, 3CHall, 4JKoerber. 1Flinders MedicalCentre,SaPharmacy,BedfordPark,Australia; 2UniversityofSouthAustralia,School ofPharmacyandMedicalSciences,Adelaide,Australia; 3FlindersMedicalCentre,AcutePain Service,BedfordPark,Australia; 4FlindersMedicalCentre,DeptAnaesthesia,BedfordPark, Australia

10.1136/ejhpharm-2024-eahp.484

BackgroundandImportance Opioidsareanintegralelement ofpost-operativemanagementformoderatetostrongpain. Despitetheireffectivenesstheyareassociatedwitharangeof adverseeffectsandexcessiveopioidprescribinghascontributedtoawidespreadinternationalcrisisofaddictionand overdose,includingacrossEuropeandinAustralia.Even minorsurgeriescanserveasaninitialeventforopioid-naive patientstobecomepersistentopioidusers.InAustralia, opioid-relatedharmandassociateddeathshaverisenalong withopioidprescribing.

Guidelinesrecommendparacetamolandnonsteroidalantiinflammatorydrugs(NSAIDs)toreducetheopioidanalgesics use.NSAIDsinparticularworksynergisticallywithopioids, providingopioid-sparingeffects.Usageinthefinal24hours ofhospitaladmissionguidesdecision-makingaroundprescribingofdischargeanalgesia.

AimandObjectives Weretrospectivelyassessedanalgesiause patternsinopioid-naivepatientsundergoingnon-complexsurgery(length-of-stay1–4dayspost-operatively).Wehadaparticularfocusonintermediaryanalgesiause(NSAIDsand tramadol)andpossibleNSAIDscontra-indicationstoshorttermuse.

MaterialandMethods Patientsundergoingsurgeryundergeneralsurgicalteamswithapost-operativelength-of-stayof1–4 dayswereretrospectivelyidentifiedusingcasemixcodes.Use ofopiods,non-steroidalanti-inflammatories,tramadolandparacetamolinthefinal24hoursofadmissionwerequantified alongwithpossiblecontra-indicationsforuseanddischarge prescribing.

Results Of1015patientsassessedtherewere555(55.7%) whowereeligibleforNSAIDsand/ortramadolandnotprescribedthisasaninpatientoption,although310(55.9%)of thesepatientsstillreceivedopioids.

Inthefinal24hofadmission759patientswithnocontraindicationtoNSAIDsortramadoldidnotreceivethesemedicationsbut314(41.4%)stillreceiveddischargeopioids.

79(7.8%)patientsrequirednoopioidanalgesiainthefinal 24hoursbutwerestillprescribedopioidatdischarge.

Afurther122(12.0%)werenotprescribedinpatientparacetamol31(25%)butreceiveddischargeopioids.

ConclusionandRelevance Thereisanabundanceofmissed opportunityforopioid-sparingstrategiestobeemployedin thiscohort.Thesepoorprescribingpatternswerelargely drivenbyengrainedcultureand/orjuniorprescriberunawarenessofoptions.Furtherworkisunderwaytodefinepost-dischargeanalgesiausepatternsinordertoinformdevelopment ofclinicaldecisionsupporttoaddressthisissue.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-022 KNOWLEDGE,ATTITUDEANDPRACTICEABOUT PHARMACEUTICALSINTHEENVIRONMENTAMONG HOSPITALPHARMACISTSINSPAIN

1SDomingo-Echaburu*, 2AZuriñe, 3JFRangel-Mayoral, 3ARojas-Albarrán, 4,5GOrive, 6ULertxundi. 1OsakidetzaBasqueHealthService-DebagoienaIntegratedHealth Organisation,PharmacyService,Arrasate-Mondragón,Spain; 2BioarabaHealthResearch Institute,BioarabaHealthResearchInstitute,Vitoria-Gasteiz,Spain; 3ComplejoHospitalario UniversitarioDeBadajozChub,PharmacyService,Badajoz,Spain; 4BioarabaHealth ResearchInstitute,NanobiocelResearchGroup,Vitoria-Gasteiz,Spain; 5NanobiocelGroupLaboratoryofPharmaceutics-SchoolofPharmacy,UniversityofTheBasqueCountryUpv/ Ehu,Vitoria-Gasteiz,Spain; 6BioarabaHealthResearchInstitute-OsakidetzaBasqueHealth Service-ArabaMentalHealthNetwork-ArabaPsychiatricHospital,PharmacyService, Vitoria-Gasteiz,Spain

10.1136/ejhpharm-2024-eahp.485

BackgroundandImportance Healthcareprofessionalsneedto bemoreawareofthenegativeenvironmentalimpactofpharmaceuticals.Hospitalpharmacists,inparticular,playanessentialroleinthelifecycleofdrugs.Theircontributiontotackle theproblemisgoingtobepivotal.Sofar,scantinformation isavailableaboutthelevelofknowledge,attitudeandpractice abouttheissueamonghospitalpharmacists.

AimandObjectives Toevaluatetheknowledge,attitudeand practiceabouttheissueofpharmaceuticalsintheenvironment (PiE)amonghospitalpharmacistsinSpain.

MaterialandMethods Aself-administeredon-linequestionnaire (MicrosoftForms)consistingof18questionsaboutknowledge, 10aboutattitude,2aboutpracticeand3otherswassentvia e-mailtoallmembersoftheSpanishSocietyofHospitalPharmacists(n=4451).Thescaleusedforknowledgequestions wasvariable.Theattitudescale,previouslyvalidated,isan agreementscale(being0 ‘totallydisagree’ and10 ‘totally agree ’).Descriptivestatisticswereperformed.

Results 149hospitalpharmacists(3.4%)answeredthesurvey. (75.2%women,meanage43.7years).92professionals (61.7%)didnotknowtheconcept ‘emergingpollutants’,and 85participants(57.0%),hadnotheardof ‘OneHealth’.Only 19(12.7%)knewabouttheEnvironmentalRiskAssessment reportsoftheEuropeanMedicinesAgency,andthemajority (n=98;66.2%)responded ‘donottoknow/noanswer ’ to thequestionaboutthemostfamousecotoxicologicaldisaster inAsianvulturescausedbyveterinarydiclofenac.111(74.5%) knewnothingaboutthedestinyoftheirhospitalwastewaters and58(38.9%)admittedtohavingdoubtsaboutpharmaceuticalwastemanagementintheirsetting.Onthecontrary,130 (87.2%)correctlyidentifiedmetereddoseinhalers(MDIs)havingahighercarbonfootprint.Acquiringknowledgeabout drugpollutionwasconsideredverypositive(meanscore 8.61).Only17responders(11.4%)admittedtoconsidering environmentalaspectstodevelophospitalformularies.

ConclusionandRelevance Thisstudyshowsthatthereisroom forimprovementintheknowledgeaboutPiEamonghospital

pharmacistsinSpain.Thereisahighlevelofknowledge aboutMDIscarbonfootprint,andtheattitudetowardsthe issueispositive,butenvironmentalcriteriaarenotconsidered todevelophospitalformularies.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-023 AMULTI-SECTORSIMULATEDEXPERIENTIAL PRACTICEEVENTFORYEAR1PHARMACYSTUDENTS

1RO’hare*, 2NO’boyle, 3ELavery, 4MSmyth. 1CraigavonAreaHospital,Pharmacy, Portadown,UK; 2SouthEasternTrust,Pharmacy,Belfast,UK; 3WesternHealthandSocial CareTrust,Pharmacy,Londonderry,UK; 4NorthernHealthandSocialCareTrust,Pharmacy, Coleraine,UK

10.1136/ejhpharm-2024-eahp.486

BackgroundandImportance Simulation-basededucationcomplementstraditionalteaching,improvingstudents’ knowledge, understanding,aswellassupportingthedevelopmentofstudents’ teamwork,decision-making,andconsultationskills1,2,as wellassupportingprofessionalidentityformation3.Year1studentsacrossthecountryparticipatedinapre-placementworkshopandasimulatedmulti-sectorexperientialevent.

AimandObjectives ToevaluateYear1pharmacystudents’ and participatingstaff ’ experiencesofasimulatedmulti-sector ExperientialEventdesignedtodevelopclinicalandconsultationskills.

MaterialandMethods Theyear1ExperientialEventwas deliveredinbothUniversitiesinthecountryinMarch2022. Staff(n=16)andstudents(n=222)wereinvitedtocomplete apost-EventevaluationonMicrosoftFormstoinform ongoingimprovementoftheEvent.

Ethicalapprovalwasnotrequiredasthisformedpartof thereviewofthemodule

Results Seventy-fivepercentofstaffresponded(n=12)with 42%(n=5)respondentsbelievingthatstudentswerecompetentconductingmedicationhistory,counsellingandsimpleprescribingdecisions.Seventy-sevenpercentofstudents(171/222) responded;85%(n=145)and81%(n=139)respectively believedthatthemedicationhistoryandconsultationchecklists developedinthepre-placementworkshoppreparedthemfor ‘real’ patientconsultations.StudentswereconfidentinconductingBPandpeakflowexaminations(73%,n=125)andin prescribingmedication(83%,n=142).Eighty-sixpercent (n=147)ofrespondentsbelievedthattheeventhadmade themfeelmorelikeapharmacist.

ConclusionandRelevance Year1respondentsshowedan appreciationfortheexperientialevent,believingthatit improvedtheirclinicalandconsultationskills.Themajority ofstudentrespondentsbelievedthattheeventsupported theirprofessionalidentityformation.Staffrespondentsagreed thatstudentsdevelopedcorec linicalskillsbuttoalesser extentthanstudentparticipants,believingcurriculumredesignwillfacilitate enhancedstudentengagementwiththe event.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.KorayemGB, etal. Simulation-BasedEducationImplementationinPharmacyCurriculum:AReviewoftheCurrentStatus. AdvancesinMedicalEducationPractice. 2022;13:649–660.

2.McMillanA,BarrickmanA.Implementationofaskillspracticaltofirst-yearpharmacystudents. CurrentsinPharmacyTeachingandLearning. 2017;9(6):1111–1116.

3.QuinnG,LucasB,SilcockJ.ProfessionalIdentityFormationinPharmacyStudents DuringanEarlyPreregistrationTrainingPlacement. AmericanJournalofPharmaceuticalEducation. 2020;84(8):1132–1139.

ConflictofInterest Noconflictofinterest.

6ER-024 LYELL’SSYNDROMEINCAR-TTREATEDPATIENTS:A CASESTUDY

1CLauriaPantano*, 2FZelante, 2BRe, 2ATrenta, 2FChinotti, 2MAnghileri, 2FGuidoni, 2GCavalleris, 2VLadisa. 1IrccsIstitutoTumori,Farmacia,Milano,Italy; 2IstitutoNazionale DeiTumoriMilano,Farmacia,Milano,Italy

10.1136/ejhpharm-2024-eahp.487

BackgroundandImportance Lyell’ssyndrome-atoxicepidermalnecrolysis-isarareandpotentiallylife-threateningdiseasethataffectstheskinandmucousmembranes.Thedrugs commonlyimplicatedintoxicepidermalnecrolysis(TEN) includenon-steroidalanti-inflammatorydrugs,chemotherapy, antibioticsandanticonvulsants.

AimandObjectives Thiscasereportexplorespotentialtriggers ofLyell’ssyndromein39-year-oldwomandiagnosedwith relapseanddiffuserefractorylargecellBlymphoma(DLBCL) whounderwentThirdLineTherapywithAxicabtageneciloleucel.Aftertheinfusion,CRS(cytokinereleasesyndrome)was reported,whichprogressedfromgrade1toG2within3 days.ThiswascomplicatedbytheonsetofICANS(immuneeffectorcell-associatedneurotoxicitysyndrome)progressedto G3within3days.Subsequently,theHLH/MASframework (HemophagocyticLymphohistiocytosis/MacrophageActivation Syndrome)wasreported.Tocontrolherpersistenthighfever andtoreducetheriskofconvulsions,wassomministratedlevetiracetam.Despiteanti-cytokinetherapiesandsteroidswere continued,after6daysToxicepidermolysisaffected90%of thebodysurfacearea,confirmedbyhistologicalexamination oftheskinrhomboid,consistentwithTEN/Lyellsyndrome. Levetiracetamwasdiscontinued.

MaterialandMethods MedicalrecordsandNationalPharmacovigilanceNetworkwereusedtocollectdata.

Results Thepatientwasadmittedtotheintensivecareunitfor 32days,receivingtreatmentscomparabletothosegivento patientswithsevereburns.Drugsadministered:ruxolitinib, methylprednisolone,daptomycin,amine,piperacillin/tazobactam,tocilizumab,entanercept,anakinra,andhigh-dosefluids. ThepharmacistprovidedcriticalsupporttoCAR-Tteam,playingakeyroleinthemanagementofdrugselectionandoccasionallyresorttooff-labeluseofmedicines.Asterileparaffin tullegrasdressingledtore-epithelialisationanddisappearance oftheblisters.DLBCLprogressionledtodeath9months later.

ConclusionandRelevance Theco-administrationofseveral drugs,thelackofavailabledataonadversedrugreactions (ADRs)inresponsetoCAR-T,andthetemporalrelationship betweenlevetiracetamandonsetofADRleadtotheconclusionthatametaboliteofanticonvulsants,identifiedintheliteratureasapotentialtrigger,wasresponsiblefortheADR. Thedecisiontouseanti-TNF-alphawascriticalinthemanagementofthesyndrome.AcomparableADRwassubsequently reportedinEudravigilance,raisinguncertaintyaboutthe potentialinvolvementoflevetiracetamasatriggerofthe ADR.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-025 ANTIMICROBIALACTIVITYOFSUBCRITICALCO2 EXTRACTOBTAINEDFROMUNDERGROUNDFERULA ASAFOETIDAL

UDatkhayev,KZhakipbekov*,NRakhymbayev,SMombekov,MAshirov,ADaulbayeva, NZhumabayev. AsfendiyarovKazakhNationalMedicalUniversity,SchoolofPharmacy, Almaty,Kazakhstan

10.1136/ejhpharm-2024-eahp.488

BackgroundandImportance Literaturereviewshowedthatvariousextractsof Ferulaasafoetida L.havewoundhealing,antiinflammatory,antinociceptive,antimicrobial,antitumour,antidiabeticeffects.However,thereisalackofstudiesregarding CO2 extractsof Ferulaasafoetida L.Thisraisestheneedfor phytochemicalandantimicrobialstudyofthisextract.

AimandObjectives Thepossibilityofcreatingtoconsideran antimicrobialpreparationbasedonCO2 extractof Ferulaasafoetida L.usedinpharmacypractice.

MaterialandMethods Determinationoftheconstituentsofthe CO2 extractof Ferulaasafoetida L.wasdonebyGC-MSand identifiedbycomparingtheobtainedspectrawiththeexisting NISTlibrary.

Results GC-MSanalysisoftheCO2 extractof Ferulaasafoetida L.showedthatsomecomponentsofsulfurcompounds (34.69%)wereinratherhighconcentrations.Inthecourseof thestudies,theminimuminhibitoryconcentrations(MIC)of theCO2 extractof Ferulaasafoetida L.weredeterminedby themethodofserialdilutionsinliquidnutrientmedium:

Staphylococcusaureus 7.81 mg/ml, Bacillussubtilis 31.25 mg/ ml, Escherichiacoli,Klebsiellapneumoniae,Salmonellaenterica 15.63 mg/ml,Candidaalbicans,Aspergillusniger 62.5 mg/ ml. Inthesecondmethod,theCO2 extractof Ferulaasafoetida L.ismoreactivethanthecomparisondrugamoxicillin against Staphylococcusaureus andsporebacterium Bacillus subtilis by1.2-fold, Escherichiacoli by1.5-foldand Salmonellaenterica by1.4-fold.Andalsothisextractshowedfungicidalactivityagainst Candidaalbicans 1.5timesmorethan fluconazole.

ConclusionandRelevance Thewiderangeofantimicrobial propertiesoftheCO2 extractof Ferulaasafoetida L.isassociatedwiththepresenceofsulfurcompoundsinitschemical composition.Asaresultofcomparingtheantimicrobialactivityofthisextractwithliteraturedata,wefoundthattheantimicrobialactivityofCO2-extractof Ferulaasafoetida L.is higherthanthatofpolarextractsofthisplant,andthatof essentialoilsitishigheragainst Escherichiacoli and Bacillus subtilis.Inviewoftheabove,theCO2-extractof Ferulaasafoetida L.canbeusedinpharmaceuticalpracticeasamedicinalherbalremedywithantimicrobialaction.

REFERENCESAND/ORACKNOWLEDGEMENTS

TheauthorswouldliketothankthestaffofmicrobiologicallaboratoriesoftheScientificCentreforAnti-Infectious Drugsfortheirsupportinthiswork. ConflictofInterest Noconflictofinterest.

6ER-026 THEIMPORTANCEOFPHARMACYDEPARTMENT CLINICALTRIALSUNITINTERVENTIONINA REFERENCECENTREFORTHETREATMENTOF PARAMYLOIDOSIS

DPinto*,AOliveira,SFontes,DMonteiro,MCruz,TCunha,PBarbeita,AMatos, PRocha. CentroHospitalarUniversitárioDeSantoAntónio,PharmacyDepartment,Porto, Portugal

10.1136/ejhpharm-2024-eahp.489

BackgroundandImportance Asareferencecentreforthe treatmentoffamilialparamylo idosis,ourhospitalreceives patientsfromalloverthecountry.1 Theemergenceofnew therapeuticoptionsisessentialtoensuretreatmentand reducetheimpactthatthediseasehasonindividualsand families.

ClinicalTrials(CT)usingnewmoleculessuchastafamidis, inotersenandpatisiranrepresentsignificantadvancesinthe treatmentofpatientswithHereditaryTransthyretinAmyloidosis(hATTR),insteadoflivertransplant.2

AimandObjectives DescribingtheactivityofthePharmacy DepartmentClinicalTrialsUnit(PDCTU)inareferencecentre fortheinvestigationandtreatmentofhATTR,between2006 and2023.

MaterialandMethods RetrospectiveanalysisoftheparticipationofthePDCTUofourhospitalintheclinicalinvestigationofhATTR.Forthisanalysis,thenumberofCTstarted eachyear,thenumberofongoingCTandthenumberof patientsincludedinCTassociatedwithhATTRwere evaluated.

Results Since2006,ourPDCTUhasparticipatedin21CT.It hasmadeasignificantcontributiontotheapprovalofemergingtherapies,someofwhichhavealreadybeengrantedMarketingAuthorisation,asisthecaseoftransthyretin(TTR) stabilisersandTTRlevelreducingagents.

Intotal,since2006,327patientshavetakenpartin hATTR-relatedCT,64ofwhomarestilltakingpartinaset of6CT,allofthemofphase3.

EachtrialassociatedwithhATTRhadanaverageparticipationofeightpatients,anaveragewellabovetheaverageof patients/trial(twopatients/trial)atourcentre.

ConclusionandRelevance Since2015therehasbeenagrowingtrendintheinclusionofhospitalinnewCT.Thecentre isevaluatingvariousinvestigationaltherapiesforthetreatment ofhATTR,includingagentsthatstabiliseTTR,antibodies, antisenseoligonucleotidesandRNAitherapies.

ThepharmacistsatthePDCTU,contributetothedevelopmentandapprovalofnewtherapeutics,guidelinesand protocols.Sincetheyareresponsiblefortheentireinvestigationalproductcircuit,theyensurethattrialsarewell conducted.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.SNS – PortaldoSNS. ParamiloidoseemPortugalenomundo.https://www.sns. gov.pt/noticias/2021/04/29/paramiloidose-em-portugal-e-no-mundo/ 2.DispenzieriA.Clinicalandgeneticprofileofpatientsenrolledinthetransthyretin amyloidosisoutcomessurvey(THAOS):14-yearupdate. OrphanetJournalofRare Diseases. 2022;17 https://doi.org/10.1186/s13023-022-02359-w

ConflictofInterest Noconflictofinterest.

ECONOMICBENEFITANDCLINICALADVANTAGES WITHTHEINCLUSIONOFPATIENTSINCLINICAL TRIALSRELATEDTOPARAMYLOIDOSIS

DPinto*,AOliveira,AFontes,DMonteiro,MCruz,TCunha,PBarbeita,AMatos, PRocha. CentroHospitalarUniversitárioDeSantoAntónio,PharmacyDepartment,Porto, Portugal

10.1136/ejhpharm-2024-eahp.490

BackgroundandImportance Accesstoinnovativemedicines requiresextensiveandcarefulpharmaco-economicevaluation.

TheinclusionofpatientsinClinicalTrials(CT)allows earlyaccesstonewexperimentalmedicinesandconsiderable economicsavingforthehealthcaresystem.

AimandObjectives Evaluatetheeconomicbenefitofincluding patientswithhereditarytransthyretinamyloidosis(hATTR)in clinicaltrialsbetween2018and2023.

MaterialandMethods Retrospectiveanalysisofparamyloidosisrelatedclinicaltrialstakingplaceatthecentresince2018. Thedatacollectedwerethenumberofparamyloidosis-related CT,thenumberofpatientsincludedthetimeofparticipation intheCTandtheaveragepriceofconventionaltreatment.

Results AtourClinicalTrialsUnittherearecurrently6Paramyloidosis-relatedCTunderway,involvingatotalof65 patients.

Ineconomicterms,patientparticipationonongoingCT relatedtoParamyloidosishasledtoacumulativesavingof 15,667,487.98C ¼ ,comparedtothecostsofconventionaltherapy(tafamidis1,inotersen2 andpatisiran3).

Thedistributionofannualsavingswas:

. 2019:644.396,70C ¼

. 2020:2.447.335,64C ¼

. 2021:4.465.670,09C ¼

. 2022:4.206.997,00C ¼

. Augustof2023:3.903.088,55C ¼

ConclusionandRelevance ParticipationinCTallowsearly accesstonewexperimentaltherapiesandcontributestothe developmentofnewdrugsand/ornewtherapeuticindications. InParamyloidosis,newagentslikeTTRstabilisers,subcutaneousantisenseoligonucleotidesandiRNAtherapiesarepotentialnewalternatives.4

ByparticipatinginCT,centresobtainanextrasourceof funding.TheparticipationofpatientsinCTalsoallowsfora reductionincosts,throughthepreservationoffinancial resourcesandmedication.

ThesavingsgeneratedbytheparticipationinCThelpto providebettercareandanefficiencyhealthcaresystem.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.EuropeanMedicinesAgency – Vyndaqel® Publicassessmentreport.Availableat: https://www.ema.europa.eu/en/documents/product-information/vyndaqel-epar-product-information_pt.pdf

2.EuropeanMedicinesAgency – Tegsedi® Publicassessmentreport.Availableat: https://www.ema.europa.eu/en/documents/product-information/tegsedi-epar-product-information_pt.pdf

3.EuropeanMedicinesAgency – Onpattro® Publicassessmentreport.Availableat: https://www.ema.europa.eu/en/documents/product-information/onpattro-epar-product-information_pt.pdf

4.GertzMA,MauermannML,GroganM,CoelhoT.Advancesinthetreatmentof hereditarytransthyretinamyloidosis:Areview. BrainandBehavior. 2019;9(9). https://doi.org/10.1002/brb3.1371

ConflictofInterest Noconflictofinterest.

6ER-028 REAL-WORLDTREATMENTPATTERNAND EFFECTIVENESSOFPIRFENIDONEANDNINTEDANIB INPATIENTSWITHIDIOPATHICPULMONARY FIBROSIS:AMULTI-INSTITUTIONALSTUDYINTAIWAN KChang*,HYChen. LinkouChangGungMemorialHospital,Pharmacy,Taoyuan,Taiwan R.O.C

10.1136/ejhpharm-2024-eahp.491

BackgroundandImportance Pirfenidoneandnintedanibhave beenprovensurvivalbenefitsandbeencurrentlyapprovedfor idiopathicpulmonaryfibrosis(IPF).However,real-worldcomparisonofeffectivenessbetweentwoantifibroticsremainslimitedinAsia.

AimandObjectives Ourstudywasaimedtoassess:(1)factors associatedwiththechoiceofpirfenidoneversusnintedanib; (2)dosemodificationduringtreatment;(3)overallsurvival (OS).

MaterialandMethods Weconductedaretrospectivecohort studybyusingthelargestmulti-institutionalelectronicmedicalrecordsinTaiwan.WeincludedIPFpatientsnewlyreceivingpirfenidoneornintedanibduring2018–2020.We followedupincludedpatientstodeath,lossoffollow-upor December2022.Theclinicalfactorsincludedage,sex,lung function,biochemicaldata,comorbiditiesandco-medications. Multiplelogisticregressionan alysiswasusedtoassessfactors associatedwithdrugchoice.Dosemodificationwasassessed every3monthsbyusingdoseintensityinfollow-upperiod basedonas-treatedanalysis. InOSanalysis,weappliedprobabilityoftreatmentweighting(IPTW)andCoxregression modeltoenhancethecomparabilityofstudysubjectsand estimatehazardratio(HR)betweentwotreatmentgroups, respectively.

Results Atotalof86patientsreceivingpirfenidoneand142 patientsreceivingnintedanib.MeanageandForcedvital capacity(FVC)were70.711.3yearsand68.817.4%,respectively.Theuseofnintedanibwaspositivelyassociatedwith thepatientswithchronickidneydisease(CKD)(oddsratio: 2.1,95%CI:1.06 – 4.18).Dosereductionratewassimilar betweentwogroups(59.3%vs.65.4%,P=0.34).Aftera medianof25.5monthsfollow-up,nintedanibuserswereassociatedwithworsenOSthanpirfenidoneusers(adjustedHR: 2.07,95%CI:1.24 – 3.45).

ConclusionandRelevance OurstudyshowedCKDpatients werelikelyprescribednintedanib.Pirfenidoneusershadassociationofbetterall-causemortalitythannintedanibusers.Furtherstudiesaresuggestedtoconfirmourfindings.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-029 ASYSTEMATICREVIEWOFCOMBINEDPOLY(ADPRIBOSE)POLYMERASEINHIBITORANDANDROGEN RECEPTORANTAGONISTSINMETASTATIC CASTRATION-RESISTANTPROSTATECANCER YHWang,KCChang,HYChen. ChangGungMedicalFoundation,Pharmacy,TaoyuanCity, TaiwanR.O.C

10.1136/ejhpharm-2024-eahp.492

BackgroundandImportance Accordingtolatestpracticeguideline,concurrentadministrationofpoly(ADP-ribose)polymeraseinhibitors(PARPi)andandrogendeprivationtherapy (ADT)mayhavesynergisticefficacyformetastaticcastrationresistantprostatecancer(mCRPC)patients.However,the effectivenessofPARPiandADTwashighlydependedon mCRPCpatients’ heterogeneousgenestatus.Tomovetoward precisionmedicineinmCRPCtreatment,highlevelofevidencesummarisingnewestclinicaltrialswasunmetneed.

AimandObjectives ToconductasystematicreviewandmetaanalysistoestimateeffectivenessofPARPinhibitorscombined withADTversusstandardADTinthemCRPCpatientswith homologousrecombinationrepair(HRR)positiveand negative.

MaterialandMethods WesearchedPubMed,Embaseand Cochranedatabasesfrom2009toSeptember2023forall randomisedclinicaltrials.Nolanguageorotherrestrictions wereimposedonthesearches.Tworeviewauthorsindependentlyscreenedthetitlesandabstractsofeachtrialbefore obtainingthefulltextforallpotentiallyeligibletrialsand assessedtheincludedtrialsforriskofbias.Theoutcomes includedprogressionfreesurvivalandoverallsurvivalamong allpatients,HRR+andHRR-.Afixed-effectsmeta-analysis wasappliedtopoolhazardratio(HR)with95%confidence intervals(CIs).

Results Atotaloffivestudieswithatotalof1207PARPiand 1206placebopatientswereincluded.Comparedtostandard ADT,thePARPiplusADTwasassociatedwitha38%PFS improvement(HR:0.62;95%CI:0.54–0.72)andOSprolong (HR:0.85,0.73–0.99)intheoverallpatients.AmongHRR+ patients,thepooledPFSandOSwere0.65(0.52–0.81)and 0.66(0.45–0.95),respectively.AmongHRR-patients,the pooledPFSandOSwere0.74(0.59–0.92)and0.89(0.70–1.14),respectively.

Conclusionandrelevance Basedoncurrentevidence,wesuggestthatthecombinationofPARPiandADTinpatientswith mCRPCtosignificantlyimprovedbothprogression-freesurvivalandoverallsurvivalrates,especiallyforHRR+patients. Ashospitalpharmacists,weplayanauxiliaryroleinshared decision-makingsystem.Wecanuseskillofevidence-based medicinetointegrateandexplainevidenceandprovide patientswithmorepreciselyandeffectivelytherapeutic strategies.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-030 EVALUATIONOFAGROUP-BASEDONLINEINFORMED CONSENTCONVERSATION(ECONSENT)IN PARTICIPANTSFROMAVACCINATIONCLINICAL TRIAL:AMIXEDMETHODSTUDY

1NTan*, 2MLafeber, 1RSablerolles, 3LVisser, 4DPostma, 5AGoorhuis, 1HVanDerKuy. 1ErasmusMc,HospitalPharmacy,Rotterdam,TheNetherlands; 2ErasmusMc,Internal Medicine,Rotterdam,TheNetherlands; 3LeidenUmc,InfectiousDiseases,Leiden,The Netherlands; 4UmcGroningen,InternalMedicineandInfectiousDiseases,Groningen,The Netherlands; 5AmsterdamUmc,InfectiousDiseases,Amsterdam,TheNetherlands

10.1136/ejhpharm-2024-eahp.493

BackgroundandImportance Useofdigitalconsent(eConsent) hasexpandedinthelastfewyearsinEuropeespeciallyduring thepandemic.Slowrecruitmentrateandlimitationinreaching outtoparticipantsfromdifferentbackgroundsarethe

challengesoftenfacedinclinicalresearch.Giventhebenefits ofeConsentandgroupcounsellingreportedintheliterature, groupeConsentwasimplementedinstudyrecruitmentforthe SWITCH-ONtrial.

AimandObjectives WeaimtoexploretheexperienceofparticipantswhoattendedgroupeConsentfortheSWITCH-ON studyandevaluateitspotentialforfutureuse.

MaterialandMethods SWITCH-ONstudyaimstoanalysethe immunogenicityofhealthypopulationfollowingbivalent COVID-19boostervaccination.434healthcareworkersaged between18and65weresuccessfullyrecruitedandweresent aquestionnaireabouttheirexperiencewithgroupeConsent aftertheirinformedconsentsession.Outof399completed questionnairesreceived(responserate92%),39participants didnotjoingroupeConsent.Theremaining360responses wereincludedinthefinalanalysis.Quantitativeandqualitative datawerereportedusingdescriptivestatisticalanalysisand thematicanalysisrespectively.

Results ParticipantsfoundgroupeConsentefficient,usefulto hearquestionsfromothersandbeinginagroupcreateda senseoftogetherness.However,limitedprivacy,barriersto askquestionsinagroupandpeerpressurecanlimittheuse ofgroupeConsent.165(46%)participantsthoughtthatgroup eConsentwasalsosuitabletorecruitparticipantswithdisease orconditionswhile87(24%)reportedlimitationswiththis method.Theremainingparticipantssuggestedthatapplicability ofgroupeConsentdependedonthediseasesorconditionsof thestudypopulationandone-to-oneconversationshould alwaysbeavailable.Participantswhohadexperienceboth one-to-oneandgroupeConsentshareddifferentpreferred consentformatsforfuturestudies.

ConclusionandRelevance GroupeConsentcanbeaneffective toolforresearchrecruitmentwithfurtheroptimisationsto overcomethelimitationsraisedbyparticipants.Usingwebinars toprovidegeneralinformationaboutthestudy,followedbyan individualsessionforeachparticipantwillretainthebenefits ofgroupeConsentandminimisethelimitationsitposed.This proposedsettingwilladdresstheprivacyquestionsandmakes groupeConsenteasiertobeimplementedinmanystudy populations.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-031 EXCLUSIONOFPEOPLELIVINGWITHHIVFROM ONCOHAEMATOLOGICALCLINICALTRIALSWITH IMMUNECHECKPOINTINHIBITORS

SRodríguezTierno*,HMartínezBarros,JFernándezFradejas,MVélezDíaz-Pallarés, AMÁlvarezDíaz. Irycis,Pharmacy,Madrid,Spain

10.1136/ejhpharm-2024-eahp.494

BackgroundandImportance Previousresearchhighlightedthat peoplelivingwithHIV(PLWHIV)arefrequentlyexcluded fromclinicaltrials(CT)aimedatcancertreatmentwith immunecheckpointinhibitors(ICI),evenifHIViswellcontrolled.Scientificsocietiesandregulatorshaveissuedrecommendationstocorrectthis,andreal-lifeevidencesupportsthat theuseofICIinPLWHIVappearstobesafe.Thereisno recentdataonwhetherthistrendhaschanged.

AimandObjectives TodeterminewhetherHIVinfectionisan exclusioncriterioninoncohaematologicalCTinvolvingICI availableatourcentre.

MaterialandMethods Observational,single-centre,retrospectivestudy,whichincludedalloncohaematologicalCTwhose experimentalinterventioninvolvedtheuseofICIinitiatedin atertiaryhospitalfromJanuary2018toDecember2022.

Expansionstudieswereexcluded.Thefollowingvariables werecollected:neoplasm,locations(unicentre/multicentre; national/international),ICI,intervention(monotherapy/combination),control(yes/no),phase,clinicalcontext(adjuvant/neoadjuvant/locallyadvanced/metastatic/haematologicalmalignancy withcurativeintent/haematologicalmalignancywithpalliative intent),intention(curative/palliative),inclusioncriteriafor PLWHIV(explicitlyexcluded/conditionalinclusion/notmentioned)and,amongconditionalinclusion,conditionsestablished(viralload/antiretroviraltreatment/lymphocytecount).

Datawereextractedfromclinicaltrials.gov,theEUClinical TrialsRegisterandtheSpanishCTRegister.

Results Onehundredandtwenty-sixCTswereidentified,of which123(97.6%)involvedsolidtumours.Themost studiedneoplasmswerelungcancer(n=17;13.5%),basket trials(n=16;12.7%)andmelanoma(n=14;11.1%).CTs weremainlyinternational(n= 114;90.5%)andmulticentre (n=125;99.2%).TheinterventionconsistedofICIcombinedwithotheragents(n=89;70.6%),ICImonotherapy (n=25;19.8%),andICIdualtherapy(n=22;17.5%). PembrolizumabwasthemostfrequentlystudiedICI (n=34;27.0%),followedbyatezolizumab(n=22;17.5%) andnivolumab(n=20;15.9%).Seventy(55.6%)CTwere controlled.Sixty-threewerephaseII(n=63;50.0%),III (51;40.5%),andI(n=12;9.5%).Mostwereconductedin themetastaticsetting(n= 98;77.8%)andwithpalliative intent(n=103;81.7%).PLWHIVwereexplicitlyexcluded from91(72.2%),24(19.0%)didnotmentionHIVinfectionamongtheirinclusion/ex clusioncriteria,and11 (8.7%)allowedtheinclusionofPLWHIVifcertainconditionsweremetregardingvira lload(n=6;54.5%),antiretroviraltreatment(n=8;72.7%),lymphocytecount(n=6; 54.5%),and3(27.3%)statedadequateHIVcontrol,withoutfurtherdetail.

ConclusionandRelevance PLWHIVarefrequentlyexcluded fromoncohaematologicalCTstestingICI.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-032 ADJUSTEDINDIRECTCOMPARISONOFCEMIPLIMAB INCOMBINATIONWITHCHEMOTHERAPYVS IMMUNOTHERAPYALONEINTHEFIRST-LINE TREATMENTOFMETASTATICNON-SMALL-CELLLUNG CANCERINPATIENTSWITHPD-L1 50%

1AAguadoParedes*, 2EJAlegreDelRey. 1ClinicalPharmacist,HospitalUniversitarioVirgen Macarena,Sevilla,Spain; 2HospitalUniversitarioPuertoReal,ClinicalPharmacy,Cádiz, Spain

10.1136/ejhpharm-2024-eahp.495

BackgroundandImportance Cemiplimabwithchemotherapyis licensedforthetreatmentoffirstlineadultpatientswith locallyadvancedNSCLCwhoarenotcandidatesforchemoradiation,ormetastatic,expressingPD-L1 1%.Cemiplimab alonehasthesameindicationinpatientsexpressingPDL1 50%.Pembrolizumabandatezolizumabarealsoindicated inmetastaticstageinpatientswithPD-L1 50%.

AimandObjectives Toknowwhethercemiplimabincombinationwithchemotherapy(ct)andmono-immunotherapycanbe declaredequivalenttherapeuticalternatives(ETA).

MaterialandMethods Aliteraturesearchwasperformedin MEDLINE-PubMedforphaseIIIrandomisedclinicaltrials (CT)withsimilarpopulationandduration.Anadjustedindirect comparison(IC)wasperformedusingBucher ’smethod(ITC calculator).Theprimaryendpointwasoverallsurvivalin patientswithPD-L1 50%.Therapeuticalternativeswerecomparedwithcemiplimabmonotherapy.Thedeltavalue(D), maximumclinicallyirrelevantdifference,wastakenasthe valuefromtheESMO-MCBSGuidelinestoconsidersubstantialbenefit,HR0.70anditsinverse1.43.Todeclarethem asETA,theGENESIS-GHEMAguidelineswereapplied.

Results DatafromCTagainstacommoncomparator,platinum-basedchemotherapy,wereincluded.Thestudieswere similar,althoughtheCTofcemiplimab-chemotherapyand cemiplimabincludedpatientswithstageIIIB,IIICandIV, whiletheotherCTonlyincludedstageIV;furthermore,the CTofcemiplimabexcludednever-smokers(lessthan100cigarettesthroughlife),andthesmallamountofnever-smokers includedonothermonotherapytrialsshoweduncertainbenefits.Thefollowingresultswereobtained:HR(cemiplimabvs cemiplimab+ct)0.93[95%CI0.52–1.68]p0.81;HR(cemiplimabvspembrolizumab)0.95[95%CI0.58–1.55]p0.84;HR (cemiplimabvsatezolizumab)0.97[95%CI0.59–1.60]p0.89.

AccordingtotheETAguidelines,cemiplimab+ct,atezolizumab,pembrolizumabandcemiplimabshowed ‘probableclinical equivalence’.Clinicallyrelevantdifferencesbetweenthemcannotbediscarded,sincetheconfidenceintervalsexceedthe equivalencemargins,butthisoccursatbothextremes,and theycanbeconsideredasalternativeswithsimilareffectiveness.Cemiplimab+ctpresentsacomparativehandicapon safetybecauseofthetoxicityofchemotherapy.

ConclusionandRelevance Inthissetting,atezolizumab,cemiplimabandpembrolizumabmonotherapiescanbepositioned asETA;theirselectionshouldbebasedoneconomiccomparisons.Amongthenever-smokersubpopulation,thecomparative effectivenessbetweenimmune-chemotherapyandmono-immunotherapyshouldbeassessed.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-033 ADJUSTEDINDIRECTCOMPARISONOFCEMIPLIMAB INCOMBINATIONWITHCHEMOTHERAPYVS IMMUNOTHERAPYALONEINTHEFIRST-LINE TREATMENTOFMETASTATICNON-SMALL-CELLLUNG CANCERINPATIENTSWITHPD-L1 1%

1AAguadoParedes*, 2EJAlegreDelRey. 1HospitalUniversitarioVirgenMacarena,Clinical Pharmacy,Sevilla,Spain; 2HospitalUniversitarioPuertoReal,ClinicalPharmacy,Cádiz,Spain

10.1136/ejhpharm-2024-eahp.496

BackgroundandImportance Cemiplimab,pembrolizumab,atezolizumab±bevacizumab,nivolumab+ipilimumabanddurvalumab+tremelimumabincombinationwithchemotherapy, andnivolumab+ipilimumab,arelicensedforthetreatment of1LadultpatientswithmetastaticNSCLCexpressingPDL1 1%.

AimandObjectives Toknowifthecombinationsofimmunotherapyandchemotherapy(ct)canbedeclaredequivalent therapeuticalternatives(ETA).

MaterialandMethods PhaseIIIrandomisedclinicaltrials(CT) withsimilarcharacteristicsweresearchedinMEDLINEPubmed.Anadjustedindirectcomparison(IC)wasperformed usingBucher ’smethod(ITCcalculator).OverallsurvivaloutcomesinpatientswithPD-L1 1%weretakenastheprimary endpoint.Allthecombinationswerecomparedwithcemiplimab-ct.Deltavalue(D),maximumclinicallyirrelevantdifference,wastakenasthevaluefromtheESMO-MCBS Guidelinestoconsidersubstantialbenefit,HR=0.70andits inverse1.43.TodeclarethemasETA,theGENESIS-GHEMA guidelineswereapplied.

Results DatafromCTagainstacommoncomparatorwere included.Thestudiesweresimilar,althoughthecemiplimabchemotherapyCTincludedpatientswithstageIIIB,IIICand IV,whiletheotherCTincludedonlystageIV;furthermore, sometrialsincludedonlypatientswithsquamousornon-squamoushistologyandothersboth.Thefollowingresultswere obtained:HR(cemiplimab-ctvspembrolizumab-ctnon-squamoushistology)0.82[95%CI0.55 – 1.22]p0.34;HR (cemiplimab-ctvspembrolizumab-ctsquamous)0.81[95%CI 0.56 – 1.18]p0.27;HR(cemiplimab-ctvsatezolizumab ±bevacizumab-ctnon-squamous)0.72[95%CI0.50 – 1.04]p 0.08;HR(cemiplimab-ctvsnivolumab-ipilimumab)0.67[95% CI0.48 – 0.94]p0.02;HR(cemiplimab-ctvsnivolumab-ipilimumab-ct)0.74[95%CI0.51 – 0.94]p0.12;HR(cemiplimab-ctvsdurvalumab-tremelimumab-ct)0.68[95%CI0.47 –0.98]p0.04.

ConclusionandRelevance AccordingtotheETAguidelines, combinationsofatezolizumab±bevacizumab,nivolumab-ipilimumabandpembrolizumabincombinationwithchemotherapyshowedtypeCpositioning ‘probableclinicalequivalence’ . Nivolumab-ipilimumabanddurvalumab-tremelimumab-chemotherapyshowedtypeFpositioning ‘probablyrelevant difference’

Therearenostatisticallysignificantdifferencesbetween cemiplimab-chemotherapyandtheotherapprovedcombinationswiththeexceptionofdurvalumab-tremelimumab-chemotherapyandnivolumab-ipilimumabinfavourofcemiplimabchemotherapy.Combinationsofimmunotherapyandchemotherapydonotmeetstrictcriteriafor(ETA)asthereisuncertaintyastowhethertheremaybeclinicallyrelevant differences.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-034 EFFICACYOFNEOADJUVANTTREATMENTWITH IMMUNECHECKPOINTINHIBITORSINNON-SMALLCELLLUNGCANCERINEARLYSTAGES:A SYSTEMATICREVIEW

EPérez*,DJBoardmanGonzález,IMartínNiño,GPicazoSanchiz,LRubioAlonso, DBarredaHernandez. HospitalVirgenDeLaLuz,Pharmacy,Cuenca,Spain 10.1136/ejhpharm-2024-eahp.497

BackgroundandImportance Immunecheckpointinhibitors (ICIs)arecurrentlypartofthestandardtreatmentofnonsmall-celllungcancer(NSCLC)inthecontextofadjuvant therapy.However,itsuseinneoadjuvanttherapy(NAT), althoughrelativelymorerecent,hasencouragingpotential.

AimandObjectives ToevaluatetheefficacyofICIs-based NATintheearlystagesoflungcancer.

MaterialandMethods Asystematicreviewwascarriedout throughMedline,forarticlespublisheduntilAugust2023.

ThemethodsusedwerebasedthePreferredReporting ItemsforSystematicReviewsandMeta-Analyses(PRISMA). Wesearchedforphase-2/3randomisedclinicaltrials(RCTs) thatevaluatedtheefficacyofNATwithICIsbothinmonotherapyandincombinationwithchemotherapyNSCLCin stagesI-III.

Tworeviewersindependentlyassessedtheeligibilityofeach study.Toevaluatetheirquality,theGradesscalewasused. Results 10studiesmettheinclusioncriteria:twowerephase 3,sixusedPD-1inhibitorsandfourusedPD-L1inhibitors. Moreover,threestudiescontinuedadjuvanttreatmentwith ICIs.

NADIM trialstudiednivolumab+chemotherapybeforesurgeryandobtainedaprogression-freesurvival(PFS)of77.1% andapCRrateof63.4%.Subsequently,in NADIMII, patientswererandomisedtoreceivenivolumab+chemotherapy orchemotherapyalone,showingabetterpCRrate(36.2%vs 6.8%)andbetterPFSwithnivolumab.

In CheckMate816,nivolumab+chemotherapyresultedina highermedianevent-freesupervenience(EFS)thanchemotherapyalone(31.6vs.20.8months)aswellasahigherpCR rate.

TheNEOSTARstudyshowedahigherpCRrateofthenivolumab+ipilimumabcombinationcomparedtonivolumabmonotherapyOtherstudies,suchas Shueetal.usingatezolizumab +chemotherapy,or LCMC3,alsosupportedtheefficacyof neoadjuvantimmunotherapy(NAIT),withimprovementsin responserates.

KEYNOTE671 evaluatedpembrolizumab+chemotherapy showingbetterEFSandRCpinthepembrolizumabgroup comparedtoplacebouse.

Finally, PRINCESS and IONESCO studiedtheuseofatezolizumabanddurvalumab,respectively,anddidnotprovide favourableresults.

ConclusionandRelevance Thesestudiessupporttheuseof NAITinpatientswithresectableNSCLC,withpromising resultsintermsofsurvivalandpCR.Currently,nivolumabis usedinresectablelungcanceraccordingtoCheckMate816.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-035 EXAMININGTHEPERCEPTIONSOFPHARMACISTSOF JOBSATISFACTION,ACHIEVEMENTS,AND PREPAREDNESS

1BMukhalalati*, 2SElshami, 3AAwaisu, 2RAbidi, 2LAl-Ghazal, 2TAl-Hathal, 2MBasil, 2NFakhr, 2OYakti, 2AEl-Awaisi, 2DStewart, 4FMraiche, 2MDiab. 1QatarUniversity, CollegeofPharmacy,Doha,Qatar; 2QatarUniversity,ClinicalPharmacyandPractice Department-CollegeofPharmacy-ClinicalPharmacyandPracticeDepartment-Health Cluster,Doha,Qatar; 3ClinicalPharmacyandPracticeDepartment-CollegeofPharmacyClinicalPharmacyandPracticeDepartment-HealthCluster,QatarUniversity,Doha,Qatar; 4QatarUniversity,PharmaceuticalSciencesDepartment-CollegeofPharmacy-Clinical PharmacyandPracticeDepartment-HealthCluster-,Doha,Qatar

10.1136/ejhpharm-2024-eahp.498

BackgroundandImportance Thereisascarcityofresearch thatholisticallyexplorespharmacists’ employmentexperience andtheirprofessionalperformance.Ithasbeenshownthat jobsatisfactionislinkedtoprofessionals’ productivityand educationalpreparedness.

AimandObjectives ThisstudyaimedtoexploretheprofessionalexperiencesofpharmacistswhograduatedfromtheCollegeofPharmacy(CPH)throughanexaminationoftheir perceptionsofjobsatisfaction,achievementsintheworkplace, andpreparednesstopractice.

MaterialandMethods Aconvergentmixed-methodsdesign wasutilisedatwhichtheHerzbergMotivation-Hygienetheory wasapplied.Thisstudyinvolvedtheadministrationofapretestedquestionnaireamongallpharmacistswhograduated fromtheCPH(n=214)andtheconductionofsevenfocus groupsofwhichtheparticipantswereselectedfromaheterogeneouspurposivesample(n=87).

Results Onehundredandthirty-sixpharmacistscompletedthe questionnaire(responserate=63.6%),and40pharmacistsparticipatedintheFGs.Thepharmacistsdemonstratedagood levelofjobsatisfaction(medianscore=30(IQR=12),[outof 48]).Examplesofjobsatisfactionanddissatisfactionsources weretherecognition,andthelimitedopportunitiesforprofessionalgrowth,respectively.Theyalsodemonstratedgoodsatisfaction(medianscore=20(IQR=21),[outof56])withtheir abilitytoattainseveralachievements(e.g.,developingpharmacy-relatedservices)whichallowedforcareersuccess.Moreover,thepharmacistsindicatedafairlevelofagreementabout theadequacyoftheirpreparednesstopractice(e.g.,being careproviders)(mean=37(SD=7.5),[outof52]);however, certainaspectswarrantedfurtherimprovement(e.g.,non-clinicalknowledge).

ConclusionandRelevance Overall,thepharmacistshadpositive perceptionsoftheirprofessionalexperiences.However,reinforcementsareneededthroughoutthelearningexperienceto supportthepharmacists’ interestsindifferentpharmacycareer prospects.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-036 EVALUATIONOFTHEEFFICACYOFNEOADJUVANT TREATMENTWITHIMMUNOTHERAPYINEARLYSTAGEBREASTCANCER:ASYSTEMATICREVIEW EPérez*,VLafargaLapieza,LRubioAlonso,GPicazoSanchiz,IMartínNiño,DBarreda Hernández. HospitalVirgenDeLaLuz,Pharmacy,Cuenca,Spain

10.1136/ejhpharm-2024-eahp.499

BackgroundandImportance Immunotherapyisusedin advancedcancers,butitsuseinearlystagesisanewareaof study.Neoadjuvanttherapy(NAT)withimmunecheckpoint inhibitors(ICIs)couldbeadvantageous,stimulatingthe immuneresponsebeforesurgery.

AimandObjectives ToevaluatetheefficacyofICIs-based NATintheearlystagesofbreastcancer(BC).

MaterialandMethods ThisstudyfollowedthePreferred ReportingItemsforSystematicReviewsandMeta-Analyses (PRISMA)methodology.Pubmedwasconsultedtoidentifyall clinicaltrialspublishedbetweenJanuary2018-August2023 thatincludedpatientswithresectableearly-stageBC,who weretreatedwithICIsinmonotherapyorcombinedwithchemotherapypriortosurgery.

Onlythosereportingefficacydata,suchaspathological completeresponse(pCR)anddisease-freesurvivalwere included,alongsidephase-2andphase-3trials.Articleselection anddataextractionwascarriedoutbypeerreviewandthe evaluationofdiscrepancieswasdonebyathirdparty.

Results Sevenstudiesmettheinclusioncriteria:fourincluded patientswithtriple-negativehistology,oneincludedbothtriple-negativeandhormonereceptor(HR)positive/humanepidermalgrowthfactor2(HER-2)negativereceptors.One includedHER-2positivepatientsandanotherincluded patientswithLuminalB-like(LumB-like)molecularhistology.

3studiesusedPD-1inhibitorsand4usedPD-L1inhibitors.Additionally,3studiescontinuedadjuvanttreatmentwith ICIs.IntheGeparNuevotrial,durvalumabimprovedsurvival despiteamodestincreaseinpCR.

InKeynote-522,chemotherapy+pembrolizumabresultedin increasedpCRandevent-freesurvivalinpatientswithtriplenegativebreastcancer(TNBC).

TheI-SPY2studyexploredmultipletreatmentsinhigh-risk BC,showingbenefitsofpembrolizumabinpatientswithdifferentmolecularsubtypes(HER-2negative,HRpositive/HER2negativeandTNBC)

InIMpassion031,chemotherapy+atezolizumabincreasedthe pCRrateinTNBCpatients.Theseresultswereconsistent withNeoTRIP.

ForHER-2positiveBC,NeoPATHsuggestedthatimmunotherapy-chemotherapycombinationcouldbebeneficial,especiallyinHRnegativeandPD-L1positivepatients.

IntheGIADA-trialevaluatingnivolumabinLumB-likeBC, thehypothesisforpCRratewasnotmet.

ConclusionandRelevance Althoughimmunotherapyshows promisingadvancesinNAT,especiallyinTNBC,sinceitis themostimmunogenicsubtype,moreresearchisneededto betterunderstanditsmechanismsandfindpredictivebiomarkersofresponse.Currently,pembrolizumabisusedin TNBCaccordingtoKeynote-522.

REFERENCESAND/ORACKNOWLEDGEMENTS ConflictofInterest Noconflictofinterest.

6ER-037 PHARMACO-UTILISATIONOFIBRUTINIBINCLL:A SINGLECENTRESTUDY

GFaitelli*,AUcciero,APisterna. HospitalPharmacy-AouMaggioreDellaCarità-Novara, HospitalPharmacy,Novara,Italy

10.1136/ejhpharm-2024-eahp.500

BackgroundandImportance Chroniclymphocyticleukaemia (CLL)isaB-cellneoplasmcharacterisedbytheclonalexpansionofmatureBlymphocytes.Ibrutinib,anirreversibleinhibitorofBrutontyrosinekinase,isprescribedforCLLtreatment atallstages.Beinganoraltreatment,strictadherenceis closelylinkedtoclinicaloutcomes.

AimandObjectives Thestudyaimstomeasureibrutinibadherenceandpersistenceinreal-worldCLLpatients,andanalyse theircorrelationwithpatientdemographics,clinicalfactors, andgeneticsinaNorthernItalianUniversityHospital.

MaterialandMethods ThisretrospectivestudyincludedCLL patientsaged18orolderwhoreceivedibrutinibmonotherapy foratleast6months(observedbetween2016and30/06/ 2023).Prescriptiondatacamefromelectronicprescribingsoftware,andclinicalinformationwassourcedfromAIFARegistries.Adherencewasassessedusingtheratioofreceivedto prescribeddailydoses(RDD/PDD),andpersistencewasdeterminedbytheaveragedurationoftherapybeforediscontinuation(indays).PatientswithaRDD/PDDratio 0.9were consideredadherent.

Results Amongthe42subjectsinthisstudy,theaverageibrutinibadherenceratewas0.75(rangingfrom0.45to1).There werenonotabledifferencesinadherenceratesbasedondemographicorclinicalcharacteristics.Interestingly,amajorityof patients(57%)withunfavourablecytogeneticshadanRDD/ PDDratiobelow0.9.Amongpatientswhoexperienced adversereactions,86%belongedtothelowadherencegroup, whilesevensubjectswithdiseaseprogressionwereevenlysplit betweenthetwoadherencegroups.Outofthe20patients whodiscontinuedtreatment,onlyonehadafavourablecytogeneticprofile(IGHV-mutated;noTP53mutationordel(17p)). Theaveragetimetodiscontinuationwasshorterforsubjects whoexperiencedtoxicity(976days)comparedtothosewho haddiseaseprogression(1312days).

ConclusionandRelevance InpatientswithCLLtreatedwith ibrutinib,meanadherencewaslowerthanratesseeninclinical trials.Apparently,demographicandclinicalcharacteristicsdid notinfluencetreatmentadherence.However,aloweradherenceratewasobservedinhigher-riskgroups,andnearlyall patientswhodiscontinuedtreatmentexhibitedanunfavourable cytogeneticprofile.It’sworthnotingthattheconnection betweenhigh-riskcytogeneticsandpooradherencehasnot beenexploredinliterature,highlightingtheneedtoinvestigatethisrelationshipinalargerpatientsample.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

6ER-038 ELABORATIONOFACOMPETENCYFRAMEWORKFOR PATIENTSUNDERGOINGPERCUTANEOUSCLOSURE OFPATENTFORAMENOVALEORATRIALSEPTAL DEFECT

1NGuillon*, 1FLindenberg, 2PGuérin, 2JPlessis, 3AFresselinat, 2SQuéric, 3AAitgougam, 4XIriart, 1,5JClouet, 1DFeldman, 1,5FNativel. 1NantesUniversité-ChuNantes,Pharmacie, Nantes,France; 2NantesUniversité-ChuNantes,ServiceCardiologieInterventionnelle, Nantes,France; 3ChuBordeaux,Pharmacie,Bordeaux,France; 4ChuBordeaux,Service CardiologieInterventionnelle,Bordeaux,France; 5NantesUniversité,UfrDesSciences PharmaceutiquesEtBiologiques,Nantes,France

10.1136/ejhpharm-2024-eahp.501

BackgroundandImportance Patentforamenovale(PFO)and atrialseptaldefect(ASD)arehe artdiseasescharacterisedby persistentcommunicationbetw eenthetwoatria.PercutaneousclosureofPFOorASDisrequireddependingonthe patientandisperformedbyinter ventionalcardiologists.It requirestheuseofanoccluderwhichisanimplantablemedicaldevice(IMD).Itensuresacompleteclosureofthe interatrialshunt.Aftertheintervention,thereisstillarisk associatedwiththeprocedureanddrugtreatments.These patientshaveashorthospitalstay.Caregiversdonotnecessarilyhavethetimetoteachtheirpatientstheskillstheyneed tolivesafelywiththeirprosthesisintheirdailyliveswhen theyreturnhome.

AimandObjectives Theaimofthisprojectistoelaboratea competencyframeworkforpatientsundergoingpercutaneous closureofPFOandASD.Thiswillserveasasupportforthe developmentofeducationaltools.

MaterialandMethods Multicentremeetingswithhealthcare professionals(pharmacists,interventionalcardiologists,qualified nurses)fromtwouniversityhospitalcentresandonepatient wereheldtodevelopacompetencyframework.Aninformationsheetandaninterviewguidewerethenproducedtohelp

patientsacquiretheskillsconsideredapriorityinthemanagementoftheirdisease.Interviewswereconductedwith19 patientsovera3-monthperiodtoevaluatetheinterviewguide andthefirstversionofaninformationsheet.

Results Thecompetencyframeworkincludes89skillsfor patientswithFOPand92forpatientswithCIA.Allpatients surveyedweresatisfiedwiththeinterviewsandthefirstversionoftheinformationsheet.Mostpatientspreferredtohave theinterviewbeforetheintervention,asitreassuredthemand gavethemconfidencefortherestoftheirtreatment.

ConclusionandRelevance Thiscompetencyframeworkcould serveasasupportforthedevelopmentoftherapeuticpatient educationprogrammesforthesepatients.Hospitalpharmacists, whoareresponsiblefortheproperuseofhealthcareproducts includingdrugsandmedicaldevices,couldplayabeneficial roleintheseprogrammes.

REFERENCESAND/ORACKNOWLEDGEMENTS

Theauthorswarmlythankthepatientforherparticipation inthisworkinggroup.

ConflictofInterest Noconflictofinterest.

6ER-039 PAINMANAGEMENT:OPIOIDUSEINHOSPITALS

DNMARatnata,RBenko*,ZEngi,DCsupor,RViola,MCsatordai,MMatuz. UniversityOf Szeged,ClinicalPharmacy,Szeged,Hungary

10.1136/ejhpharm-2024-eahp.502

BackgroundandImportance Adequatepaincontrolisabasic andunquestionablehumanright.Opioidsarethemostpotent pharmacologicaltreatmentforavarietyofpains.Opioduseis alwaysofinterest.duetotheirpotentialoveruseandabuse andthecontrarylimitedaccesstothem.Hospitalcaredata onopioidutilisationisscarceintheliteratureandnodatais availableforourcountry.

AimandObjectives Thereforeweaimedtoanalyseopioidutilisationinhospitalsnationwidebetween2015and2021.

MaterialandMethods Populationbaseddrugutilisationsales datawereobtainedonanalgesics(ATCcode:N02A).UtilisationscaleandtrendswerecalculatedbasedontheWHO definedAnatomicalTherapeuticChemicalClassification/ DefinedDailyDose(ATC/DDD)methodology.Aggregatedutilisationdatawerestandardisedfor100patient-days(i.e.DDD per100patient-days).Nationalandregionallevelanalyses wereperformed.

Results Totalopioidvaluesrangedbetween8.12to8.86 DDDsper100patient-daysinvariousstudyyears.Oral administrationofopioidanalgesicswasdominantwithrelative shareof53.9%in2015and60.1%in2021.Tramadol,fentanyl,morphine,andnalbufinewerethemostusedopioid analgesicsin2015with62.9%,22%,6.8%and2.5%relative sharewhilein2021thetopagentsweretramadol(42.3% share),fentanyl(25.9%)andthentwotramadolcombinations onthe3rdand4thplaceintheranking.Largeinterregional differencesweredetected(5.7vs17.2DDDper100patientdays)withmaximum/minimumratioof3.03inthefinalyear ofanalysis.

ConclusionandRelevance Trendsofopioidutilisationin nationalhospitalshasnotchangedovertime,withthedominantuseofweakoralopioids.Regionaldisparitiesare substantial.

REFERENCESAND/ORACKNOWLEDGEMENTS

Acknowledgment ITM-NKFIA-TKP2021-EGA-32. ConflictofInterest Noconflictofinterest.

6ER-040 ATOOLPROPOSALFORIDENTIFYINGTHERISKOF POLYPHARMACYINNURSINGHOMESFORELDERLY PEOPLE

IBarralJuez*,IGonzalezGarcia,AMartiarenaAyestaran,SMartinezArrechea, MPBachillerCacho. Osakidetza-OsiDonostialdea,PharmacyService,Donostia,Spain 10.1136/ejhpharm-2024-eahp.503

BackgroundandImportance Thenewmodelofpharmaceutical careinnursinghomesconsistsofcreatingdrugdepositslinked tohospitalpharmacyserviceswherehospitalpharmacistshave theresponsibilitytoprovidepharmaceuticalcare.Besides,polypharmacyiscommonlydefinedasthenumberofmedications takenconcurrentlyusingstandardcut-offs,butseveralstudies havehighlightedtheneedformultidimensionalassessment.

AimandObjectives Theaimofthisstudyistoidentifypolymedicatedresidentsatrisk.Forthisgoal,itisproposedto designascorebasedonmedicationindicators.

MaterialandMethods Ascoreisdesignedbasedondemographicdataandhazardousdrugsforelderlypeople:age,sex, numberoftotalandchronicprescriptions(Np,Npc),number ofprescriptionsfor:protonpumpinhibitors(PPI),cardiovasculardrugs(CRZ),vitaminKantagonists(VKA),oralanticoagulants(ACOD),plateletantiaggregant[IGG1](PAA), neuroleptics(NLP),benzodiazepines(BZD),antidementiadrugs (DEM),antidepressants(DEP),opioids(OPI),drugswithhigh andlowanticholinergiceffect(Aca,Acb)andconcomitantuse ofNLP,BZD,DEPandDEM(POKER).Theweightofeach indicatorisadjustedaccordingtobibliographyandexpert opinion.

Results Thetoolisappliedforapopulationof3,010people from25centres.Morethan90%ofthepopulationobtainsa resultlessthan0.6(2,731people),9.5%ofthepopulation obtainsaresultmorethan0.6(288people)and1.3%more than0.9(39people).

Apracticalexample:twopeoplewiththesamenumberof totalprescriptions(15)andchronicprescriptions(12)butwith differencesinthenumberofprescriptionspergroup,havea differentscore:>0.9thefirstoneand<0.5theotherone.

ConclusionandRelevance Thistoolcouldgiveusascorethat allowstodistinguishtheriskassociatedwithpolypharmacy basedontheamountofprescriptionsandprescriptedhazardousdrugs.Inthefuture,itwillbenecessarytodesignastudy thatcollectseventsprospectively,soeachindicatorcouldbe assignedaweightcorrespondingtoitsrisk.

REFERENCESAND/ORACKNOWLEDGEMENTS

1.CarrE,FedermanA,DzahiniO,DobsonRJ,BendayanR.Amultidimensional measureofpolypharmacyforolderadultsusingtheHealthandRetirementStudy. SciRep.2021Apr22;11(1):8783.doi:10.1038/s41598-021-86331-x.PMID: 33888728;PMCID:PMC8062687.

ConflictofInterest Noconflictofinterest.

6ER-041 ROLEOFCHECKPOINTINHIBITORSPOST-ALLOGENEIC HAEMATOPOIETICSTEMCELLTRANSPLANTATIONIN ACUTEMYELOIDLEUKAEMIA

RRomeroDomínguez*,RCots. ClínicaTresTorres,Pharmacy,Barcelona,Spain

10.1136/ejhpharm-2024-eahp.504

BackgroundandImportance Immunecheckpointinhibitors (ICI)post-allogeneichaematopoieticstemcelltransplantation hasemergedasapromisingstrategyinthetreatmentofacute myeloidleukaemia(AML).AMLisatypeofbloodcancer characterisedbyanuncontrolledproliferationofimmature myeloidcellsinthebonemarrow.Allogeneichaematopoietic transplantationisatreatmentforAMLinhigh-riskcasesorin casesofrecurrenceafterintensivechemotherapy,butitcan leadtocomplicationssuchasgraft-versus-hostdisease (GVHD)anddiseaserelapse.

AimandObjectives Theaimwastoknowthecurrentsituation ofICIpostallogeneichaematopoieticstemcelltransplantation. MaterialandMethods Aqualitativesystematicreviewhasbeen developed.

WesystematicallysearchedinPubMed,GoogleScholarand Scopus.Articleswasappliedtothefollowingreview, ‘Immune checkpointinhibitors’ AND/OR ‘LMA’ , ‘Immunecheckpoint inhibitors’ AND/OR ‘posthematopoieticallogeneictransplantation’ , ‘LMA’ AND/OR ‘posthematopoieticallogeneic transplantation’ .

Inclusioncriteria articlespublishedinthelast5yearsand articlesthatprovidedconclusiveresultsontheuseofICI. Exclusioncriteria articlesthat,meetingtheinclusioncriteria, wereinconclusiveduetolackofdata,reproducibilityorno significantdifferencesbetweentreatments.

Results Ninety-fourarticlesthatcouldbeanalysedtofulfill thepurposesofthisworkhavebeenfound,ofwhichnine mettheinclusionandexclusioncriteria.

Variousstudieshavehighlightedtheimportanceofimmune checkpointinhibitorsinthepost-allogeneichaematopoietic transplant,whichofferanewtherapeuticalternativeinthe treatmentofAML,theirabilitytoimprovetheimmune responseagainstleukaemiccellsandregulatetheGVHD responseoffershopeforbettersurvivalandqualityoflifeof AMLpatientsundergoingpost-allogeneichaematopoietic transplantation.

ConclusionandRelevance ImmunotherapybasedonICIin combinationwithintensivechemotherapy,hypomethylating agents,orothertargetedtherapiesisgaininginterestinthe treatmentofhaematologicmalignanciessuchasAML.However,theresultsobtainedfromclinicaltrialsaremodestand limitedbyboththetypeofdesignandthephaseofthe trial.Theprospectivestudyofresponsestothistypeof treatmentsaccordingtodifferentbiologicalprofilescould providestrategiestoidentifythosepatientswhomaybenefit fromICI.

Morestudiesareneededtodetermineitslong-termefficacy andtoestablishclearguidelinesforitsclinicaluse.

REFERENCESAND/ORACKNOWLEDGEMENTS

ConflictofInterest Noconflictofinterest.

Abstracts

6ER-042

THEDISASTERPREPAREDNESSANDMANAGEMENT OFHEALTHCAREPRACTITIONERS:ASYSTEMATIC REVIEWOFTHEASSESSMENTINSTRUMENTS

1SElshami, 1MIzham, 1AAwaisu, 1BMukhalalati*, 1OYakti, 2MSherbash. 1Qatar University,ClinicalPharmacyAndPracticeDepartment-CollegeofPharmacy-HealthCluster, Doha,Qatar; 2QatarUniversity,PublicHealthDepartment-CollegeofHealthSciencesHealthCluster,Doha,Qatar

10.1136/ejhpharm-2024-eahp.505

BackgroundandImportance Disastershavebeentraditionally consideredasoneofthemainthreatstohealthcaredelivery worldwide,withnocountrybeingimmunetothem.The deliveryofhealthcareservicesduringdisastersistheresponsibilityofhealthcarepractitioners(HCPs),whoshouldideally bepreparedtomanagedisasters.Therefore,itisimportantto accuratelyassessthedisasterpreparednessandmanagementof HCPs.

AimandObjectives Theaimofthissystematicreviewisto identifyandevaluatethepsychometricpropertiesofdisaster preparednessandmanagementinstrumentsthatweredevelopedforassessingthedisasterpreparednessandmanagement ofHCPs.

MaterialandMethods Asystematicreviewsearchstrategywas utilisedtoidentifytherelevantoriginalresearcharticles,utilisingPubMed,ProQuestPublicHealth,andCINAHLdatabases. Thekeyconceptsusedwere:disasters,healthpersonnel,preparedness,management,andquestionnaire.Theidentified instrumentsintheincludedarticlesweresummarisedaccordingtotheirmeasurementscope/context,psychometricproperties,andstrengthsandlimitations.Dataaboutthevalidityand reliabilityoftheincludedinstrumentsweresummarised accordingtocontentvalidity,responseprocess,internalstructure,relationtoothervariables,andconsequencevalidity.

Results Thereviewedarticlespossessedminimalqualityfor validityandreliabilityevidence.Mostretrievedinstruments haveundergoneminorpsychometricevaluations,predominantlyemphasisingthe ‘content’ and ‘internalstructure’ validities.ThemostusedinstrumentwastheEmergency PreparednessInformationQuestionnaire(EPIQ),whilethe mostvalidandreliableinstrumentsweretheProvider ResponsetoEmergencyPandemic(PREP)andtheKoreanversionoftheDisasterPreparednessEvaluationTool(DPET). Thekeydomainsmeasuredintheincludedinstrumentswere knowledge,training,andwillingnesstoreporttoworkduring disasters.

ConclusionandRelevance Thefindingsofthisreviewhighlightedthesacristyofadequatelyvalidatedassessmentinstrumentsthatcanbeemployedtoassessdisastermanagement andpreparednessofHCPs.Thiscallsforfuturecollaborative researchinitiativestodesignandadequatelyvalidatedisaster managementandpreparednessinstrumentsinordertoevaluateandultimatelyimprovedisastermanagementandpreparednessofHCPs.

REFERENCESAND/ORACKNOWLEDGEMENTS

ThisstudywasfundedbytheQatarNationalResearch Fund,EarlyCareerResearcherAward:ECRA03-001-3-001 ConflictofInterest Noconflictofinterest.

6ER-043 DEVELOPINGANDVALIDATINGADISASTER MANAGEMENTASSESSMENTTOOLFORHEALTHCARE PRACTITIONERS

1BMukhalalati*, 2SElshami, 2IMohamed, 2AAwaisu, 3MElhassan, 3ARHanan. 1Qatar University,CollegeofPharmacy,Doha,Qatar; 2QatarUniversity,ClinicalPharmacyAnd PracticeDepartment-CollegeofPharmacy-HealthCluster,Doha,Qatar; 3QatarUniversity, PublicHealthDepartment-CollegeofHealthSciences-HealthCluster,Doha,Qatar

10.1136/ejhpharm-2024-eahp.506

BackgroundandImportance Overthepastfivedecades,disastershavebecomemorefrequent,makingitcrucialforhealthcarepractitioners,includingpharmacists,tobewell-prepared fordisastermanagement.However,thereisasacristyof adequatelydevelopedandtestedassessmenttoolsthatcanbe employedtoexaminedisasterpreparednessamongstHCPs fromdifferenthealthcaredisciplinesandindifferentdisaster situations.

AimandObjectives TodevelopandevaluatetheDisasterManagementAssessmentToolforHealthCarePractitioners (DMAT_HCP).

MaterialandMethods DMAT_HCPwasdevelopedbasedon thefourstagesofthe ‘disastermanagementframework’ anda literaturereviewofsimilarpreviouslyvalidatedtools.Content validitywasassessedthroughtworoundsofreviewbynine andfiveexperts,whereasfacevaliditywasassessedby11 HCPs.DMAT_HCPwastestedon107HCPsfromdifferent healthdisciplinesandsettingstoevaluatethestructural(factor analysis)andconstruct(convergentanddivergent)validitiesas wellasinternalconsistencyreliability.Statisticalanalysiswas performedusingStata17software.

Results DMAT_HCPcomprisedfiveLikertscalesthatassess theperceptionsofHCPsforknowledge,attitude,practice, willingnesstocontinuepracticingduties,andorganisationbasedmanagementduringdisastersituations.Thecontentvalidityindicesindicatedthatallscalesdemonstratedsatisfactory relevanceandclarity,yetfurtherimprovementsweremadefollowingthereviewofHCPs.Factoranalysesrevealedmodels thatallitemsineachscaleloadedsignificantlyontheir respectivefactorsanddemonstratedagoodfittodata.EvaluationofconstructvalidityandreliabilityofDMAT_HCP revealedthateachscaleitemcanadequatelymeasuretheconstructstheyaredesignedtomeasure,andhadexcellentinternalconsistency,respectively.

ConclusionandRelevance Thisstudyestablishedthat DMAT_HCPisaconceptuallyandmethodologicallyvalidand reliabletoolthatisrelevanttovarioushealthdisciplinesin respondingtothechallengesofdisasters.Thisuseofthistool willallowstakeholderstohighlightkeyareasforimprovement andinnovation,optimisetrainingprogrammes,resourceallocation,andstrategicplanningtobetterpreparehealthcareprofessionalsfordisasters.

REFERENCESAND/ORACKNOWLEDGEMENTS

ThisstudywasfundedbytheQatarNationalResearch Fund(QNRF),EarlyCareerResearcherAward(ECRA): ECRA03-001-3-001

ConflictofInterest Noconflictofinterest.

Thenumbernexttotheauthorindicatesthepagenumber,nottheabstractnumber.

AbadLechaE,4CPS-050

AbadSazatornilMR,4CPS-004

AbdaouiA,5PSQ-016

Abdel-KaderMartínL,5PSQ-037

Abdullah-KoolmeesH,3PC-018

AbeleM,5PSQ-123

AbidiR,6ER-035

AbreuFariaB,5PSQ-082

AceitunoP,4CPS-217

Achaques-RodriguezM,4CPS-058

AckermannD,3PC-015

AcostaGarcíaHL,2SPD-012

Acosta-CanoC,4CPS-166

AcramelA,3PC-033

AdeM,4CPS-219

AgiusR,4CPS-203

AgraBlancoI,5PSQ-097

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AgüíCallejasAM,4CPS-187

AguadoA,4CPS-055

AguadoParedesA,4CPS-175,6ER-032,6ER-033

Aguado-ParedesA,5PSQ-038

AguedaFernandezJB,5PSQ-114

AguilarSalmerónR,5PSQ-049

AguileraV,3PC-005

Aguilera-OrtegaA,3PC-009

AguilóLafargaI,4CPS-004

AgulloM,1ISG-005

Agullo-PerezAD,2SPD-007

AibarAbadMP,4CPS-114,4CPS-133

AimarD,2SPD-010

AinaS,4CPS-120

AiraksinenM,4CPS-194

AiriauC,4CPS-183

AitgougamA,6ER-038

AkkermanO,4CPS-059

Al-GhazalL,6ER-035

Al-HarbiK,5PSQ-029

Al-HathalT,6ER-035

Al-MahdiS,4CPS-225

ÁlamoGonzálezO,5PSQ-077

AlabortAyllónH,4CPS-185,5PSQ-127

AlañonPardoMDM,4CPS-108,5PSQ-069,5PSQ093

AlañonPlazaE,4CPS-189

AlarcónPayerC,4CPS-027,4CPS-028

Alarcon-PayerC,4CPS-208,4CPS-210

AlazmiA,5PSQ-092

AlbanellM,2SPD-002

AlberdiLemaC,4CPS-064

AlberolaA,5PSQ-021

AlbertMaríA,4CPS-168

Albiñana-PérezS,2SPD-018

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AlcaceraLopezMA,4CPS-133

AlcaláR,4CPS-085

AlcobiaA,1ISG-024,4CPS-206

AldeaGarciaDeVicuñaA,4CPS-049

AlegreDelReyEJ,4CPS-106,4CPS-175,4CPS-226, 6ER-032,6ER-033

Alegre-SanchoJJ,4CPS-005

AleksandraDukic-OttADO,NP-004

AlfaroLaraER,4CPS-123

AlférezGarcíaI,5PSQ-059

AlfonsínLaraM,5PSQ-097

AlfonsinLaraM,3PC-008

AlgarraSánchezE,4CPS-187

AliceS,2SPD-015

AliotoD,1ISG-001

AllegraS,4CPS-214

AllendeBandrésMA,4CPS-114

AllendeBandresMA,4CPS-133

AllendeMA,4CPS-204

AllioneM,4CPS-212,5PSQ-065

AllwoodM,3PC-007

AlmanchelRivadeneyraA,4CPS-159,5PSQ-062

AlmanchelRivadeneyraM,4CPS-176

AlonsoCastañéMD,4CPS-019

AlonsoCastroV,1ISG-001

AlonsoP,5PSQ-054

Alonso-ZazoFJ,4CPS-058

AlshehriAM,5PSQ-029

AlshomraniA,5PSQ-029

ÁlvarezDíazAM,5PSQ-051,5PSQ-056,5PSQ-060, 6ER-031

ÁlvarezYusteA,4CPS-138

AlvarezYusteA,4CPS-189

Alvarez-AtienzaS,4CPS-002

Álvarez-DíazA,4CPS-166

Álvarez-SalaR,4CPS-095,4CPS-192

Alvarez-VayoC,NP-007

AlvesDaCostaF,5PSQ-006

AlwadieAF,5PSQ-029

AlzahraniA,5PSQ-092

AlzahraniAM,5PSQ-029

AlzahraniYA,5PSQ-092

AmaroL,4CPS-054,4CPS-055,4CPS-139,5PSQ036,5PSQ-055

AmaroR,4CPS-064

Amat-DiazM,4CPS-060

AmbrosiniS,5PSQ-124

ÁmezSegoviaMA,5PSQ-060

AmichayM,5PSQ-013

AmorGarciaMA,4CPS-066,4CPS-084

AmorMÁ,2SPD-001

Amoros-ParedesA,4CPS-211

AnaAD,4CPS-156

AnaMargaridaS,1ISG-024

AnastasiA,2SPD-017

AndersenA,1ISG-002

AndersenO,1ISG-002

AnderssonY,4CPS-063,5PSQ-042

AndreozziV,4CPS-033

AndresNavarroN,4CPS-108,5PSQ-069,5PSQ-093

AndrescianiE,5PSQ-061

AndreuMargullonP,5PSQ-053

AñezCastañoR,4CPS-176

AngeliniD,2SPD-020

AnghileriM,6ER-024

AnghilieriM,5PSQ-052

AnguitaDomingoD,4CPS-061

AnnaSantamäkiAS,NP-003

AnozJimenezL,4CPS-173

AnozL,6ER-013

AnsariA,5PSQ-029,5PSQ-092

AntignacM,3PC-023

AntonMartinezM,4CPS-119

AntonelosN,4CPS-040

AntúnezRetamalR,2SPD-013

AparicioCarmenaA,3PC-017

AparicioCastellanoB,5PSQ-083,6ER-008,6ER-014, 6ER-015

ApezteguiaFernandezC,4CPS-066

ApezteguiaFernandezCA,4CPS-084

Apezteguia-FernándezCA,2SPD-001

Aragón-DíezÁ,4CPS-127

Aranaz-AndrésJM,5PSQ-056

AranconPardoAB,5PSQ-109

Aranda-GarciaA,4CPS-014

ArangurenOyarzabalA,4CPS-044,4CPS-137,4CPS138,4CPS-189

AraújoA,4CPS-033

ArchillaAmatMI,4CPS-018,5PSQ-091,5PSQ-116

Arcía-QuintanillaL,4CPS-199

ArenalesCaceresP,4CPS-094

ArenasJimenezM,4CPS-018

ArenereM,4CPS-204

ArenereMendozaM,4CPS-114

Arevalo-BernabeAG,5PSQ-078

ArgandoñaMJ,3PC-046

Arguedas-ChacónS,2SPD-003

AriasBlacoJ,4CPS-178

ArnaizDiezS,5PSQ-077,5PSQ-114

AronpuroK,4CPS-194

ArostegiS,4CPS-174

ArriaC,1ISG-020

ArroyoDomingoE,5PSQ-122

Artacho-CriadoS,5PSQ-035

ArtimeRodríguez-HermidaF,4CPS-073

AsenjoSegoviaS,5PSQ-090

AsensiDiezR,2SPD-004

AsensioA,3PC-046

AshirovM,6ER-025

Ashiru-OredopeD,NP-009

AshrafAR,5PSQ-026

AsingerN,3PC-031

AsrafD,5PSQ-029

AtsinaFM,5PSQ-033

AttardPizzutoM,2SPD-017

AttardT,6ER-010

AuletS,2SPD-016

AutelletA,5PSQ-107

AuvrayD,4CPS-088

AvantaggiatoM,5PSQ-002

AwaisuA,6ER-035,6ER-042,6ER-043

AyalaAlvarezCanalJ,4CPS-131,4CPS-144

AznarDeLaRieraMB,4CPS-020

AznartePadialMP,4CPS-056

AzzopardiLM,4CPS-203,6ER-010

BabaglioniG,5PSQ-058

BabiakE,5PSQ-024

BabinM,2SPD-019

BachillerCachoMP,6ER-040

Bačić VrcaV,4CPS-039

BácskayI,4CPS-035,4CPS-036

BadíaTahullMB,4CPS-228

BadalCogulMB,3PC-025

BadracimN,4CPS-155

BaekS,4CPS-223

BaenaBoceroI,5PSQ-114

BáezGutiérrezN,6ER-008,6ER-014

Báez-GutiérrezN,6ER-015

BagagliniG,1ISG-006

BalaGalaA,2SPD-013

BalázsKarvalyGellért,NP-011

BallardiniG,1ISG-007,4CPS-092,4CPS-093

BallestaLópezO,4CPS-070,5PSQ-048

Ballesta-LópezO,4CPS-031

BallottaA,1ISG-007

BalsellsVivesS,5PSQ-073

BaltazarF,3PC-024

BalukuP,4CPS-035

BarbeitaP,4CPS-224,5PSQ-120,6ER-026,6ER-027

BarbosaCM,3PC-024

BarbosaR,3PC-024

BarcelóF,4CPS-173

BarceloSansoF,4CPS-077,4CPS-082

BardollCucalaM,4CPS-041,4CPS-042,5PSQ-074

BarouxG,4CPS-088,4CPS-099,5PSQ-107

BarralJuezI,6ER-040

BarreauP,5PSQ-123

BarredaHernándezD,5PSQ-007,6ER-036

BarredaHernandezD,6ER-034

Barreiro-DeAcostaM,4CPS-199

BarrerasRuízN,4CPS-001

BarrigaRodríguezP,4CPS-025,5PSQ-023

Barriga-RodríguezP,5PSQ-017

BarrosoS,5PSQ-082

BarusseauA,NP-008

BasilM,6ER-035

BassilM,4CPS-197

BastidaC,4CPS-003

BatistaR,1ISG-010,3PC-028,4CPS-125

BautistaSanzMP,4CPS-084

BautistaSanzP,4CPS-066

Bautista-SanzP,2SPD-001

BeaMascatoB,3PC-008

BeatrizEC,4CPS-156

BécaresMartínezFJ,4CPS-001

BeckerML,4CPS-102

BelchevaS,4CPS-162

BellésMD,4CPS-112

BellesMD,5PSQ-070

BelloCalvoR,4CPS-004

BelloM,6ER-006

BelloW,3PC-003

Beltrá-PicóI,4CPS-209

BenhiaC,3PC-028

BenítezGiménezMT,3PC-017,6ER-020

BenitoÁBPousada,4CPS-104

BenitoZazoN,4CPS-070

Benkő R,4CPS-036

BenkoR,6ER-039

BennieM,NP-009

Berczi-KunE,4CPS-035

Berge-BoucharaC,4CPS-183

BeristainI,4CPS-174

BerlanaD,3PC-037

Bernabeu-MartínezMÁ,4CPS-097

Bernabeu-MartinezMA,4CPS-011

Bernardez-FerránB,5PSQ-115

Bernárdez-FerránB,4CPS-207

BernikierE,3PC-038

BersaliJ,5PSQ-108

BersiaME,4CPS-212,5PSQ-065

BertinL,4CPS-227

BertranDeLisBartolomeB,4CPS-006

Beso-MorenoP,2SPD-007

BiasiV,1ISG-006

BilbaoGómez-MartinoC,5PSQ-109

BirkenauB,4CPS-012

BlancAL,4CPS-081

BlancaRV,2SPD-001

BlanchetB,4CPS-125

BlancoEspesoT,5PSQ-032

BlancoGarciaP,4CPS-050,4CPS-119,5PSQ-064

BlancoRivasME,4CPS-226

Blanco-CastañoMA,4CPS-079

Blazquez-RamosN,5PSQ-109

BlondelleS,4CPS-190

BoA,4CPS-214

BoardmanGonzálezDJ,5PSQ-007,6ER-034 BobillotM,5PSQ-121

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Bocos-BaeloA,4CPS-043,4CPS-046,4CPS-098

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BoillosFernandezM,5PSQ-073

BoivinPN,3PC-006

Bolea-LacuevaA,4CPS-209 BolhuisM,4CPS-059

BonR,3PC-007

BonagaSerranoB,4CPS-133

BonanniG,1ISG-006

BonhommeM,3PC-041

BoniM,4CPS-120

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ByrneEM,4CPS-218

ByunE,4CPS-223

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CandelaMR,4CPS-060

CanoCuencaN,5PSQ-122

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CarlierP,4CPS-222

CarmenRosaP,4CPS-181

CaroJM,4CPS-181

CarolaMagnanoL,5PSQ-110

Carrascal-MozoC,3PC-021

CarrascoCorralT,3PC-022

CarrascoCuestaL,5PSQ-109

CarreraSánchezM,4CPS-104,4CPS-107

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Carrión-MadroñalIM,5PSQ-035

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CarrotM,5PSQ-107

Cartín-RamírezA,2SPD-003

CarvalhoA,5PSQ-082

CarvalhoC,1ISG-018

CarvalhoLiliana,NP-001

CasalisC,3PC-019

CasasFernándezX,4CPS-010

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CasiniG,4CPS-017,4CPS-034

CastanhaA,4CPS-033

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CastellanaE,3PC-019

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Castera-MelchorE,4CPS-085

CastexE,4CPS-227

CastillejoR,5PSQ-036,5PSQ-055

CastillloMedranoM,4CPS-159

CastilloMedranoMI,5PSQ-062

Castillo-LopezGA,2SPD-007

CastroFrontiñanA,4CPS-006,5PSQ-043

CastroQuirogaA,4CPS-009

CastroSalinasP,4CPS-087

CastroVidaMA,4CPS-103,4CPS-106,4CPS-149

Castro-BaladoA,4CPS-207

Castro-RodríguezM,4CPS-121

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CaviR,2SPD-015

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CellaM,4CPS-092

CeppiMG,4CPS-074

Cercos-LletiAC,5PSQ-034

CeruttiE,4CPS-214

CerveraS,5PSQ-054

CerviL,5PSQ-101

CespedesMartinezE,4CPS-179

CestinoD,2SPD-020

CestinoE,2SPD-020

ChabonnierBeaupelF,3PC-023

ChaeHW,4CPS-157

ChagasCristina,NP-001

ChaguacedaC,3PC-005

ChaibiA,5PSQ-123

ChangK,6ER-016,6ER-017,6ER-028

ChangKC,6ER-029

CharquesTralleroV,4CPS-087

ChasseigneV,1ISG-014

ChatzidimitriouG,4CPS-040

ChatzigeorgiouN,4CPS-040

ChaumaisMC,4CPS-197

Chavarri-GilE,NP-007

ChenHY,6ER-001,6ER-016,6ER-017,6ER-028, 6ER-029

ChenYT,6ER-018

ChiappettaMR,3PC-019 ChiariF,4CPS-096

ChiletE,4CPS-204

ChiletRodrigoE,4CPS-133

ChinottiF,5PSQ-052,6ER-024

ChoEJ,4CPS-157

ChoYS,4CPS-157

ChoviTrullM,5PSQ-048

ChristensenLWS,1ISG-002 ChuecaN,5PSQ-021

Cia-BarrioMA,4CPS-011

CiuciuCD,4CPS-161,4CPS-186 CiudadGutierrezP,4CPS-032 ClapeauE,3PC-011

ClarkJE,6ER-011

ClementeBautistaS,3PC-037,4CPS-179 ClementeMartíL,2SPD-013 ClimenteMartíM,4CPS-116 Climente-MartiM,4CPS-005 ClouetJ,5PSQ-117,6ER-038 CodonalDemetrioA,3PC-022 CoisA,4CPS-120

ColaciccoVG,1ISG-003,1ISG-004,5PSQ-012 ColinM,3PC-038

ColladaSánchezVL,4CPS-095,5PSQ-109

ColladaVL,4CPS-192

ColladoBorellR,2SPD-005,4CPS-153 ColladoMohedanoA,4CPS-137

ColladosArroyoV,4CPS-202 CollevecchioL,5PSQ-061

Coloma-PeralR,4CPS-211

Colomer-AguilarC,4CPS-060

ComaPunsetM,4CPS-073

CompanyMJ,5PSQ-070

CondeGinerS,4CPS-161

CondeR,5PSQ-120

ConstanzeRémiCR,NP-004

ContrerasColladoR,4CPS-140

ContrerasR,5PSQ-019

ConyardE,5PSQ-003

CorazónVillanuevaJ,3PC-017,6ER-020

CorazonVillanuevaJ,3PC-035

CorcueraCataláJ,5PSQ-051

CorderoJ,4CPS-055

CorderoRamosJ,4CPS-054

Cordero-RamosJ,5PSQ-038

CórdobaSotomayorMD,4CPS-140

CordobaSotomayorMD,5PSQ-019

CormierN,3PC-011

CornejoS,4CPS-085

CornuP,5PSQ-081

CorominasH,4CPS-109,4CPS-113

CorralAlaejosA,4CPS-019

CorralesKrohnertS,3PC-022

CorralesM,4CPS-115

CorralesPazM,4CPS-019,5PSQ-071

CorralesPérezL,4CPS-104

CorralesPerezL,4CPS-107

CorreaA,3PC-016

CorreaV,2SPD-016

CorridoniS,4CPS-134

CorrienteGordónI,5PSQ-057

CorrienteI,5PSQ-080

CortesPalaciosAP,4CPS-151

CosemansL,4CPS-110

CosinMunillaL,4CPS-101

CostaI,4CPS-033

CostaM,4CPS-170

CostantiniA,4CPS-134

CotsR,6ER-041

CottrezK,4CPS-117

CousoA,4CPS-069,5PSQ-040

CousoCruzA,4CPS-026

CoussirouJ,4CPS-180

CovadongaPM,4CPS-156

CoxAR,5PSQ-100

CraverHospitalLS,4CPS-042

CremadesArtachoC,5PSQ-110

CrespiCifreMA,3PC-025

CrespoA,1ISG-009

CrespoBernabeuJM,4CPS-089

CrespoRodriguezE,5PSQ-053

Crespo-RobledoP,5PSQ-027

CrisCercósA,4CPS-065

CrosC,3PC-033

Cruañes-MontferrerJ,2SPD-007 CruzJentoftA,5PSQ-051 CruzJP,1ISG-018,4CPS-033 CruzM,6ER-026,6ER-027 CruzSánchezA,3PC-027 Cruz-CruzT,4CPS-062 CsatordaiM,6ER-039

CsuporD,6ER-039

CuadrosMartínezCM,4CPS-105

CuéllarMonrealMJ,4CPS-168

Cubo-RomanoMP,2SPD-001

CuevasMorenoA,4CPS-179

Cuevas-TasconG,4CPS-177

CulterS,4CPS-075

CunhaT,4CPS-224,5PSQ-120,6ER-026,6ER-027

CustodioM,4CPS-225

CusumanoE,5PSQ-098

CuyBuenoM,4CPS-042,5PSQ-074

CuyM,4CPS-041

CuzziF,3PC-019

CzernekM,3PC-003

D’agataMA,4CPS-015,5PSQ-022

DaLuzOliveiraC,5PSQ-006

Dall’aglioM,5PSQ-101

DamienT,1ISG-019

DanielMG,4CPS-158

DarocasL,4CPS-112

DatkhayevU,6ER-025

DaulbayevaA,6ER-025

DaviesM,4CPS-063

DeCastrisC,1ISG-003,1ISG-004,5PSQ-012

DeCastroAvedilloC,4CPS-010,4CPS-067,4CPS131,4CPS-144

DeCastroJulveM,3PC-034

DeCrozalsF,4CPS-180

DeDiegoPeñaA,3PC-035

DeDiosA,4CPS-091

DeFranciaS,4CPS-214

DeGraefM,5PSQ-047

DeGregoriJ,1ISG-005

DeLaFuenteVillaverdeI,4CPS-122,4CPS-198, 5PSQ-085,5PSQ-118

DeLaTorreOrtizM,3PC-017,3PC-035

DeLasVecillasL,4CPS-095,4CPS-192

DeLosSantosGilI,4CPS-044

DeLucaA,1ISG-020,3PC-043

DeLucaE,1ISG-017,4CPS-071,4CPS-124,4CPS152,5PSQ-068,5PSQ-113

DeMendizabalArreguiAVelez,5PSQ-050

DeMiguelGazteluM,3PC-020

DeMoraAlfaroMJ,4CPS-185

DePacoMartinF,3PC-025

DeRibaSolerM,5PSQ-073

deRijdtT,4CPS-110

DeSalinasMuñozTE,5PSQ-093,5PSQ-094

DeWeerd-SlotM,4CPS-102

DeenenMJ,4CPS-013

DegardinA,4CPS-221

DegioanniD,4CPS-212,5PSQ-065

DegrassatTheasA,1ISG-010

DeguiE,1ISG-022

DekkerJ,3PC-004

DelBarrioBuesaS,4CPS-195

DelCampoTerrónS,5PSQ-060

DelEstalJimenezJ,3PC-034

DelMoralSánchezJM,5PSQ-122

DelPalacioGarciaP,5PSQ-043

DelRíoFlorentinoR,5PSQ-125

DelRíoValenciaJC,3PC-026,4CPS-147,4CPS-200

DelRioValenciaJC,4CPS-051

DelamotteM,3PC-036

DelandeE,2SPD-010

DelannoyV,5PSQ-121

DelgadoE,4CPS-166,5PSQ-051

DelgadoRodriguezJ,3PC-034

DelgadoSánchezO,4CPS-220

DepreuxN,3PC-005

DesmarisR,3PC-033

DeusterS,3PC-010

DevauxR,4CPS-222

DhoL,4CPS-180

DiabCaceresL,4CPS-006

DiabM,6ER-035

DiazLopezMG,3PC-002

DíazLópezMG,5PSQ-059

DíazPeralesR,5PSQ-072

DiazRomeroC,4CPS-122

DíazRomeroC,4CPS-198,5PSQ-085,5PSQ-118

DiazRuizP,4CPS-072

DíazRuízP,4CPS-129

DíazX,5PSQ-021

Díaz-CalderónHorcadaCI,4CPS-004

Díaz-GonzálezM,4CPS-097

Díaz-MadrizJP,2SPD-003

Diaz-NavarroJ,4CPS-079,4CPS-130,4CPS-163

Diaz-TorneC,4CPS-109,4CPS-113

DíezVallejoC,4CPS-026

DiezVallejoC,4CPS-069,4CPS-073

DijkstraNE,5PSQ-047

DillesT,5PSQ-047

DimasF,4CPS-033

DineenAlana,NP-012

DiogoC,1ISG-024,5PSQ-004

DivouxE,4CPS-219

DoPazoOubiñaF,4CPS-188

DobrevaY,5PSQ-099

DogbetenTS,3PC-029,3PC-030

DolloisE,5PSQ-025

Dolz-BubiE,NP-007

DoménechL,5PSQ-005

DomenechMoralesL,4CPS-135

DomiánBM,5PSQ-026

Domingo-EchaburuS,6ER-022

DominguezA,1ISG-009

DomínguezA,4CPS-076

DomínguezBarahonaA,5PSQ-027

DominguezBarahonaA,5PSQ-066

DominguezChaferJ,3PC-017

DominguezChaferJA,3PC-035

DomínguezRivasY,5PSQ-079

DominguezRivasY,5PSQ-088

DominguezSantanaCM,4CPS-045,4CPS-106, 4CPS-226

Dominguez-CanteroM,4CPS-079

Domínguez-GuerraM,4CPS-171

DonosoRengifoC,4CPS-158

DonovanM,5PSQ-003

DonyA,4CPS-219

DonzéC,3PC-013,3PC-040,4CPS-069

DoolanA,5PSQ-010

DoradoBouixL,4CPS-043

DordàBenitoA,4CPS-069,4CPS-073,5PSQ-040

DordaBenitoA,5PSQ-049

DormanB,6ER-011

Dorst-MooimanK,3PC-004

Douwes-DraaijerP,4CPS-013

DrábkováH,5PSQ-075

DrechselT,4CPS-016

DrobnyM,NP-010

DroneauS,4CPS-182

DrouotS,4CPS-197

DrozdzVergaraA,5PSQ-127

DuarteMH,1ISG-024

Duarte-RamosF,5PSQ-006

DuboisF,4CPS-182

DudikB,5PSQ-024

DuezP,4CPS-190

DufosseM,2SPD-019

DupontA,4CPS-117

DuqueJJ,3PC-016

DuqueTebarP,4CPS-138 DusabeG,1ISG-005

DusilovaSulkovaS,5PSQ-089 DuvalC,4CPS-183

EberléMC,4CPS-069

EchavarriDeMiguelM,4CPS-030,4CPS-187

EdithD,4CPS-219

EdoSolsonaMD,4CPS-168

EgbertsT,3PC-004

EguiluzSolanaM,4CPS-029

EikelandSR,5PSQ-042

EiroaOsoroM,4CPS-122,4CPS-198,5PSQ-085, 5PSQ-118

ElMershatiS,1ISG-022

El-AwaisiA,6ER-035

ElenaGL,4CPS-156

ElhassanM,6ER-043

ElsabakhawiM,4CPS-142

ElshamiS,6ER-035,6ER-042,6ER-043

EngiZ,6ER-039

EnriquezOlivarL,4CPS-111

ErdozainS,4CPS-009,4CPS-049

ErmerA,4CPS-047

EscalupL,3PC-033

EscobarHernándezL,4CPS-070

EscobarRodríguezI,3PC-032

Escobar-GarciaI,4CPS-177

Escribano-ValencianoI,4CPS-062

EscuderoSánchezG,4CPS-044,4CPS-137

EscuderoVilaplanaV,2SPD-005,4CPS-153 EspinosaBoschM,4CPS-051,4CPS-147,4CPS-200 EspinosaGomezMP,5PSQ-077

EspinosaMalpartidaM,4CPS-032

EsquivelJ,1ISG-009

EsquivelNegrinJ,4CPS-072,5PSQ-103

EsquivelNegrínJ,4CPS-129

EstaireGutierrezJ,5PSQ-009

EstebanMT,5PSQ-114

EstebanS,4CPS-177

Esteban-AlbaC,4CPS-177

EstelrichM,4CPS-083

EsteveV,5PSQ-070

EstradaL,2SPD-016,3PC-005,4CPS-043,4CPS046,4CPS-098

Estrada-SantiagoA,2SPD-001

EvaF,3PC-042

EvansA,NP-009

EzeizaA,4CPS-174

FadónHerreraC,4CPS-198,5PSQ-085,5PSQ-118

FadonHerreraC,4CPS-122

FaioniEM,1ISG-007

FaitelliG,6ER-037

FakhrN,6ER-035

FalcãoFátima,NP-001

FalcónCubilloM,5PSQ-023

FalcónM,4CPS-025

FalconioLM,1ISG-011

FaoroS,5PSQ-046

FarinhaHelena,NP-001

FarreRibaR,5PSQ-125

FasanoF,1ISG-003,1ISG-004

FasanoG,1ISG-003,1ISG-004

FausFelipeV,4CPS-215

FauziaB,4CPS-172

FayePA,3PC-038

FayetPerezA,4CPS-073

FazzinaG,4CPS-214

Fegerl-StadloberC,4CPS-196

Feijoo-VilanovaP,2SPD-018,4CPS-171

FeitosaC,4CPS-199

FeldmanD,2SPD-014,6ER-038

FeliuA,4CPS-109,4CPS-113

FeliuMasN,4CPS-046

FelloniS,3PC-019

FenatC,2SPD-014

FentonS,5PSQ-010

FernánderMartinezV,4CPS-020

FernandesJP,5PSQ-082

FernándezAlonsoE,4CPS-114

FernandezAlonsoE,4CPS-133

FernándezAvilésF,4CPS-064

FernándezCañabateS,4CPS-019

FernándezChávezAC,5PSQ-056

FernándezCuervaC,2SPD-004

FernandezDeGamarraMartinezE,4CPS-151

FernándezDeLaFuenteMA,4CPS-111

FernandezEspinolaS,4CPS-213

FernandezF,6ER-006,6ER-013

FernándezFradejasJ,6ER-031

FernandezFragaF,6ER-005

FernándezGalánR,4CPS-159,5PSQ-062

FernandezGinesFD,3PC-002

FernándezGonzálezM,2SPD-012,4CPS-123

FernandezLastrasS,4CPS-122

FernándezLastrasS,4CPS-198,5PSQ-085,5PSQ118

FernándezLisónLC,5PSQ-062

FernándezMÁUrbano,5PSQ-087

FernándezMartínezC,4CPS-020

FernándezMartínez-LlamazaresC,4CPS-195

FernandezMolinaS,4CPS-135

FernándezPeñaS,5PSQ-064

FernándezRomeroL,4CPS-030,4CPS-187

FernàndezS,2SPD-016

FernándezVázquezA,4CPS-010,4CPS-067

FernandezVazquezA,4CPS-131,4CPS-144

FernándezValenciaL,4CPS-104,4CPS-107

Fernández-CaballeroR,4CPS-202

Fernández-FernándezN,4CPS-121

Fernández-FerreiroA,4CPS-167,4CPS-199

Fernandez-FragaF,4CPS-058

Fernández-GonzálezM,5PSQ-017

Fernandez-LlamazaresCM,NP-007

Fernandez-LlimosF,3PC-024,5PSQ-004,5PSQ-006

Fernández-VázquezCrespoM,3PC-017,3PC-035, 6ER-020

Fernandez-VillacañasFernandezP,4CPS-176

FernandoPB,4CPS-156

FerràndezMartíD,4CPS-087

FerraioliA,1ISG-006

FerrandisSalesN,4CPS-168

FerrandoR,4CPS-112,5PSQ-070

FerranteD,1ISG-003,1ISG-004,5PSQ-012

FerrariPiqueroJM,4CPS-006,4CPS-141,5PSQ-043 FerrazC,5PSQ-063

FerreA,5PSQ-117

FerrerMachínA,4CPS-178

FerrerSolerFM,4CPS-105

FerrisVillanuevaM,4CPS-193

FerroC,5PSQ-106

FersingC,3PC-013,3PC-040,4CPS-069

FestaE,5PSQ-058

FétalLuisa,NP-001

FélixJ,4CPS-033

FésüsA,4CPS-035,4CPS-036

FeyeuxH,1ISG-005

FigueroaK,6ER-021

FijóPrietoA,4CPS-050,4CPS-119,5PSQ-064

FillatreA,4CPS-117,5PSQ-016,5PSQ-025

FilosoI,1ISG-011

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MadigandB,3PC-006

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MaestreMA,6ER-006,6ER-013

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MandyB,2SPD-010

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ManriqueRodriguezS,4CPS-195

ManzanequeA,4CPS-038

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MarMM,4CPS-070

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MarayI,4CPS-122

MarayMateosI,4CPS-198

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MariaDelCarmenJ,4CPS-181

MariaPM,5PSQ-031

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Marin-VenturaL,4CPS-211

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MarliotG,5PSQ-123

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Marqués-MiñanaM,4CPS-031

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MartínColmenarejoS,5PSQ-060

MartínLópezA,4CPS-129,5PSQ-103

MartínMÁParro,5PSQ-060

MartínMartínMI,4CPS-159

MartínNiñoI,6ER-034,6ER-036

MartínRodríguezM,4CPS-141

MartínRoldánA,4CPS-023,4CPS-024,4CPS-027, 4CPS-028,4CPS-208,4CPS-210,5PSQ-014 MartínSanzA,4CPS-067

MartínSigueroA,4CPS-158

Martín-ÁvilaG,4CPS-090

Martín-CerezuelaM,4CPS-168

Martín-HerranzI,2SPD-018,4CPS-171

Martín-ZaragozaL,4CPS-090

MartínezA,4CPS-112

MartínezBarrosH,6ER-003,6ER-031 MartínezCasanovaJ,4CPS-228

MartínezDíazE,4CPS-026

MartínezDeLaTorreF,4CPS-006,4CPS-141

MartínezDiazE,4CPS-069

MartínezDueñasLópezMarínL,5PSQ-116

MartínezGonzálezJ,4CPS-087

MartínezLópezDeCastroN,5PSQ-097

MartínezLópezI,4CPS-188

MartínezMI,2SPD-016

MartínezOreaG,5PSQ-122

MartínezSoguesM,5PSQ-074

MartínezToledoV,4CPS-116

Martínez-DueñasLópez-MarínL,4CPS-023,4CPS-024, 5PSQ-014

Martínez-EscuderoA,4CPS-055

Martínez-PradedaA,2SPD-018,4CPS-171

MartiarenaAyestaranA,6ER-040

MartignoniI,4CPS-068

MartinClavoS,4CPS-051

MartinJA,1ISG-009

MartinJimenezM,4CPS-153 MartinLopezA,4CPS-072

MartinM,4CPS-064

MartinMarquesM,4CPS-161

MartinMiraMDLM,4CPS-103

MartinRodriguezD,4CPS-066 MartinRodriguezS,4CPS-178

MartinRoldanA,4CPS-037 MartinTorrenteA,5PSQ-044 Martin-LozanoS,4CPS-002

Martin-MiraMM,4CPS-149

Martin-ZaragozaL,4CPS-127

MartinezAlbadalejoP,4CPS-116

MartinezArrecheaS,6ER-040

MartinezBarrancoMDP,4CPS-201

MartinezCastroB,4CPS-041

MartinezDiazE,5PSQ-040

MartinezM,5PSQ-020,5PSQ-021

MartinezOreaA,4CPS-146

MartinezPerezS,4CPS-089

MartinezSuarezA,4CPS-054

MartinezValeroA,4CPS-089

Martinez-CabanesM,4CPS-060

Martinez-DueñasL,4CPS-037

Martinez-MolinaC,4CPS-109,4CPS-113

Martinez-PinnaM,1ISG-009

MartorellPuigserverC,4CPS-188

MasBauzaN,4CPS-228,5PSQ-111

MasipM,4CPS-076,4CPS-091

MassarrahSanchezT,4CPS-153

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Matarranz-DelAmoM,4CPS-177

MateoE,5PSQ-028,5PSQ-096

MateosC,4CPS-095,4CPS-192

MateosMateosY,4CPS-104,4CPS-107,6ER-005 Mateos-NozalJ,5PSQ-051

MateuF,6ER-006,6ER-013

MatillaGarcíaE,4CPS-066

MatillaGarciaE,4CPS-084

Matilla-GarcíaE,2SPD-001 MatosA,6ER-026,6ER-027

MatosesChirivellaC,1ISG-023,5PSQ-030 MatuzM,4CPS-036,6ER-039

MatyskováKubišováM,5PSQ-089

MayoC,4CPS-202

MayoOlveiraF,4CPS-006,4CPS-141,5PSQ-043 MccarthyR,5PSQ-010

MecaCasasnovasN,4CPS-057

MedinaM,3PC-039,3PC-041

MegíasVericatJE,5PSQ-048

MegiasVericatJE,4CPS-070

MegualBarrosoMR,4CPS-104

MejíasTruebaM,4CPS-025,4CPS-123,5PSQ-023 Mejias-TruebaM,NP-007 MelgarejoOrtuñoA,4CPS-066

Melgarejo-OrtuñoA,2SPD-001,4CPS-084

MenardiG,4CPS-212,5PSQ-065

MendarteLM,4CPS-174

MendesA,4CPS-224

MendesT,4CPS-206

MéndezPérezMC,4CPS-094

MendiolaGarcíaS,4CPS-087

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MendozaZambranoEM,6ER-008

Mendoza-OteroF,4CPS-097

MañesSevillaM,4CPS-078,6ER-005 MengatoD,1ISG-012

MengualBarrosoMR,4CPS-107,6ER-005 MenguianoRomeroY,5PSQ-071

MenguianoY,4CPS-115

MensaM,3PC-042

MercadalG,6ER-004,6ER-006,6ER-013

MercedesGD,5PSQ-031

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MerchanFloresA,4CPS-133

MerchanteM,4CPS-204

MerhariI,5PSQ-107

MerienneC,3PC-039,3PC-041

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MerinoV,4CPS-139

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MesaO,1ISG-009

MessagerM,4CPS-221

Mestre-TorresJ,5PSQ-078

MetzC,3PC-023

Meyer-MassettiC,4CPS-081

MezoriJ,5PSQ-042

MezzaM,1ISG-012

MichalsenV,3PC-029

MielgoRubioX,4CPS-165

MigeonF,4CPS-069

MiguelDominguezA,5PSQ-114

MinTehM,4CPS-110

MingoarranzÁLSalcedo,4CPS-001,4CPS-187

MingollaG,1ISG-003,1ISG-004,5PSQ-012

MirCrosM,4CPS-041,4CPS-042

MirallesAndreuG,1ISG-023,1ISG-025,4CPS-086

MirandaDelCerroA,3PC-022

MirandaMagañaM,4CPS-215

MirandaMarínA,4CPS-004

MiretC,2SPD-016

MironElorriagaG,5PSQ-044

MiscioM,1ISG-012

MistrettaI,1ISG-017,4CPS-071

MoguezE,1ISG-021

MohamedI,6ER-043

Moine-PicardC,4CPS-125

Moisés-Minchola-LavadoD,5PSQ-111

MoisanA,3PC-045

MolasG,4CPS-038

MolinaMendozaMD,5PSQ-051

Molina-GarcíaT,4CPS-008,4CPS-121,4CPS-127

Molina-GarciaT,4CPS-090,4CPS-101

Molina-MendozaMD,4CPS-166

MolinsE,5PSQ-096

MombekovS,6ER-025

MoncassinP,3PC-038

Mondelo-GarcíaC,4CPS-199

MonforteGasqueMP,4CPS-114

MongeEscartínI,5PSQ-110

MongeI,2SPD-002

MoñinoDomínguezL,5PSQ-038

MoñinoL,5PSQ-036

MonjeA,4CPS-053

MonjeMontoyaP,3PC-032

MonteBoquetE,4CPS-136

Monte-SerranoJ,2SPD-007

Montecatine-AlonsoE,NP-007

MonteiroD,6ER-026,6ER-027

MonteroAntónMDP,2SPD-005,4CPS-193,4CPS195

MonteroLázaroM,4CPS-050,4CPS-119,5PSQ-064

MonteroLlorenteB,5PSQ-060

MonteroSalgadoB,4CPS-029,5PSQ-018

Montero-AntonMP,4CPS-002

Montero-VilchezC,4CPS-150,5PSQ-116

MontiGuarnieriN,5PSQ-061

MontiI,1ISG-011

MontoroRonsanoBJ,2SPD-006

MooreA,6ER-021

MoraRodriguezB,4CPS-051

MorónMDLÁMachín,5PSQ-077

Mora-CortésM,4CPS-163

MoralesA,3PC-005,4CPS-046

MoralesPortilloA,4CPS-041

MoranteHernándezM,4CPS-052

MoratallaRolaníaA,2SPD-009

MorellBaladrónA,4CPS-044,4CPS-137,4CPS-138

MorellBaladronA,4CPS-189

MorenoÁMVillalba,4CPS-123

MorenoDiazR,4CPS-066,4CPS-084

MorenoGarciaP,4CPS-185

MorenoGuillénS,5PSQ-060

MorenoLopezAJ,4CPS-217

MorenoPerezCJ,5PSQ-125

MorenoQ,5PSQ-054

MorenoRamosC,4CPS-184

MorenoSuarezFG,4CPS-217

MorenoZamoraA,5PSQ-060

Moreno-DíazR,2SPD-001

Moreno-GarciaM,4CPS-211

MorielSánchezC,4CPS-001

MorilloMoraAB,5PSQ-079,5PSQ-088

MoronR,5PSQ-020,5PSQ-021

MoronaMinguezI,4CPS-107

Mosquera-TorreA,4CPS-207

MossburgerK,2SPD-011

MoučkaP,5PSQ-089

MoyaC,5PSQ-036,5PSQ-055

MoyaGómezP,5PSQ-027

MoyaGomezP,5PSQ-066

MoyaMangasC,4CPS-139

Moya-MartinezA,4CPS-011

MraicheF,6ER-035

MucherinoS,4CPS-118,5PSQ-067

MukhalalatiB,6ER-035,6ER-042,6ER-043

MulrooneyMaria,NP-012

MuñozCanoRM,5PSQ-110

MuñozCastilloI,4CPS-051

MuñozGarcíaM,5PSQ-051

MuñozVillasurM,4CPS-122,4CPS-198,5PSQ-085, 5PSQ-118

Muñoz-GarcíaM,4CPS-166 MunzM,4CPS-170 MuraF,5PSQ-061

MurciaLópezAC,4CPS-052

MurgadellaSanchoA,4CPS-160 MurphyB,5PSQ-010

MuylleK,5PSQ-081

NagyEE,4CPS-145,4CPS-148 NájeraPérezMD,4CPS-146

Nalda-MolinaR,4CPS-209 NansMM,1ISG-005

Naranjo-LlamasME,5PSQ-035

NareA,4CPS-222

NarhC,NP-009

NativelF,5PSQ-117,6ER-038

NaumovskaZ,5PSQ-095

NavarroCamachoC,5PSQ-069,5PSQ-093,5PSQ094

NavarroI,4CPS-204

NavarroNogueraS,4CPS-188

NavarroPardoI,4CPS-114

NavarroRuizA,1ISG-023,1ISG-025,4CPS-052, 4CPS-086,5PSQ-030,5PSQ-119

NavasN,3PC-009

NevotBlancM,5PSQ-074

NicolasJ,4CPS-038

NicolásPicóJ,4CPS-057 NietoDeVicenteJ,6ER-020 NietoGuindoM,4CPS-215 NietoMT,5PSQ-021 NietoRuizA,4CPS-135 NievesSedanoM,1ISG-001 NoguéPujadasE,5PSQ-050 NoguePujadasE,5PSQ-049 Noguera-JuradoC,4CPS-038 NoriaÀCastelló,4CPS-026

NoriegoMuñozD,5PSQ-040 NotarioDongilC,5PSQ-069,5PSQ-093,5PSQ-094 NovosadovaM,5PSQ-075,5PSQ-089 NuñezCerueloI,5PSQ-044 Nuñez-MartinezPC,2SPD-007 NurmAnette,NP-005

O’boyleN,6ER-023

O’brienH,4CPS-172

O’hareR,6ER-023

OakleyR,4CPS-225

ObradorDeHeviaA,4CPS-188

OcañaCanoM,4CPS-217

OjedaGilS,4CPS-094

OjedaS,4CPS-053,4CPS-076,4CPS-091,4CPS-113

OkerekeU,NP-009

OlariagaO,3PC-046

OlcinaFornerN,1ISG-023,1ISG-025

OlivaOlivaA,4CPS-111

OlivanA,5PSQ-107

OliveiraA,6ER-026,6ER-027

OliverCervelloM,3PC-034

OliverM,5PSQ-104

OliverasPérezM,4CPS-069

OliverioS,NP-006

OlivierE,3PC-011

OlmoMartinezM,4CPS-073

OlrandoV,4CPS-118

OmodeoSalèE,4CPS-092,4CPS-093

OmodeoSale’ E,1ISG-007

OntenienteCandelaM,4CPS-176

Onteniente-GonzálezA,4CPS-008,4CPS-090,4CPS127

OralloLunaC,5PSQ-118

OriveG,6ER-022

OrlandoV,5PSQ-067

OrsiC,1ISG-020,3PC-043

OrsolyaB,5PSQ-026

OrsucciC,NP-006

OrtegaDeLaCruzC,3PC-026

OrtegaValínL,4CPS-010

OrtegaValinL,4CPS-144

OrtíJuanC,4CPS-026

OrtizBallujeraP,5PSQ-049

OrtizDeUrbinaGonzálezJJ,4CPS-010,4CPS-067

OrtizDeUrbinaGonzalezJJ,4CPS-131,4CPS-144

OrtizFernandezP,4CPS-014,4CPS-176

OrtizNavarroMR,4CPS-185

OrtnerHadžiabdić M,4CPS-039

OrtuñoRuizY,4CPS-026

OsmanR,NP-009

OsorioT,5PSQ-106

OsunaMDLRGarcia,4CPS-133

OteroCandeleraR,6ER-008

OteroLópezMJ,4CPS-111

OteroMillanL,3PC-008,5PSQ-097

OttN,3PC-003,3PC-010

OyaAlvarezDeMoralesB,4CPS-140

OyagueL,4CPS-122

OyagueLópezL,4CPS-198,5PSQ-085,5PSQ-118

OzcoidiIdioateD,4CPS-144

OzcoidiIdoateD,4CPS-010,4CPS-067,4CPS-131

OzolinaL,3PC-007

PadillaCastañoH,4CPS-220

PadillaLópezAM,3PC-027

PadronGarciaMDLA,4CPS-178

PagèsN,4CPS-076,4CPS-091

PaganottiD,4CPS-096,5PSQ-058

PailletC,3PC-039,3PC-041

PalaciosFilardoM,5PSQ-044

PalanquesPastorT,4CPS-070,5PSQ-048

Palanques-PastorT,4CPS-136

PalomoPalomoC,5PSQ-009

PaniM,NP-006

PanzeriF,5PSQ-002

PapandreouV,4CPS-040

PapastergiouJ,4CPS-142

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ParadelaCarreiroA,5PSQ-097

ParadelaGarcíaE,5PSQ-080

PardoA,4CPS-190

PardoPastorJ,4CPS-057

ParedesBernaldoQuirosML,4CPS-019

ParienteJunqueraA,4CPS-050,4CPS-119

ParkHS,4CPS-109,4CPS-113

ParkS,4CPS-157

PascalCapdevillaM,5PSQ-110

PascualCarbonellD,4CPS-161,4CPS-186

PastorVaraP,3PC-017,3PC-035,6ER-020

PastorelloM,5PSQ-098

PasutE,NP-006

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PaulD,1ISG-008

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PérezAbánadesM,4CPS-137,4CPS-138

PerezAbanadesM,4CPS-189

PérezBlancoJL,2SPD-012

PerezDomínguezN,5PSQ-053

PérezE,6ER-034,6ER-036

PerezEncinasM,4CPS-165,4CPS-201

PérezFácilaA,5PSQ-086

PerezFacilaA,5PSQ-094

PerezPlasenciaA,4CPS-069

PérezPlasenciaA,5PSQ-040,5PSQ-049

Pérez-MorenoMA,5PSQ-037

Perez-RobresY,4CPS-211

PericA,4CPS-128

Peris-RiberaJE,4CPS-031

PerniaLopezMS,3PC-047

PerniolaMA,1ISG-004

PerpinyàGombauM,4CPS-073

PerrinG,1ISG-010

PerrottaN,4CPS-017,4CPS-034

PerrottetN,4CPS-169

PersoonsV,3PC-045

Petan-RanguinF,4CPS-088

PetitA,2SPD-019

PetitjeanB,3PC-023

PettiR,1ISG-016,NP-006

PiazzaC,6ER-011

PicazoSanchizG,6ER-034,6ER-036

PichlerH,4CPS-012

PilarL,5PSQ-005

PinedaE,2SPD-002

PinedaSánchezA,4CPS-020

PinoGarcíaJ,3PC-034

PinoRamosA,4CPS-009,4CPS-049

PintoD,6ER-026,6ER-027

PiredduS,NP-006

PirotF,3PC-039,3PC-041

PirroneA,5PSQ-002

PisciottaA,1ISG-013

PisternaA,4CPS-120,6ER-037

PitarchCastellanoI,5PSQ-048

PitardM,1ISG-014

PizarroGómezC,4CPS-153

PlaPasánR,5PSQ-008,5PSQ-084

PlanA,2SPD-010

PlanoSánchezAI,5PSQ-053

PlazaA,4CPS-053,4CPS-076

PlazaDiazA,4CPS-094

PlessisJ,6ER-038

PloSecoI,4CPS-161,4CPS-186

PoggioL,1ISG-013

PoierA,4CPS-196

PokornáA,5PSQ-089

Polache-VengudJ,4CPS-097

PolidoriC,5PSQ-061

PolidoriP,1ISG-017,4CPS-071,4CPS-124,4CPS152,5PSQ-068,5PSQ-113

PolitoG,4CPS-017,4CPS-034

PoloDuránJ,4CPS-116

PoloMontaneroP,3PC-027

PompilioA,5PSQ-061

PongwecharakJ,5PSQ-112

PonsMariaA,4CPS-077,4CPS-082,4CPS-173

Poquet-JornetJ,2SPD-007,4CPS-011,4CPS-097

PorredónAnteloC,4CPS-228

Porredon-AnteloC,5PSQ-111

PostmaD,6ER-030

PotierA,4CPS-219

PotterC,4CPS-142

PottierM,4CPS-222

PoulardM,5PSQ-117

PousadaFonsecaA,4CPS-078

PousadaFonsecaAB,4CPS-001,6ER-003,6ER-005

PoutrainE,5PSQ-123

PovedaAndrésJL,4CPS-154,4CPS-168

PovedaAndresJL,4CPS-070

Poveda-AndrésJL,4CPS-031

PoxleitnerP,4CPS-047

PozasDelRíoMT,4CPS-030,4CPS-187

PradaBouM,4CPS-201

Prado-MelE,5PSQ-035,5PSQ-037

PratsP,3PC-016

PratsRieraM,4CPS-082

PrietoGalindoR,5PSQ-027,5PSQ-066

PrietoRománS,3PC-032

PrietoRomeroA,2SPD-005,3PC-047,4CPS-141, 4CPS-153,4CPS-195

Prieto-CastelloM,4CPS-011

Prieto-RomanS,4CPS-177

ProliEM,4CPS-017,4CPS-034

Prot-LabartheS,2SPD-014 ProyVegaB,4CPS-108

PueblaGarcíaV,3PC-017

PueblaGarciaV,3PC-035

PueblaVillaescusaA,4CPS-160

Puente-IglesiasM,4CPS-167,4CPS-216 PuertaPuertaJM,4CPS-208,4CPS-210 PuertasSanjuanA,4CPS-135

PuértolasR,4CPS-112

PuivecinoMorenoC,4CPS-100,5PSQ-102 Pupla-BartollA,4CPS-207 PyperC,NP-009

QuentinM,1ISG-019

QueraltGorgasM,5PSQ-005

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TanN,6ER-030

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VillacortaP,3PC-016

VillainA,5PSQ-123

VillalobosMT,4CPS-038

Villalobos-MadrizJA,2SPD-003

VillamañánE,4CPS-095,4CPS-192

VillanuevaBuenoC,2SPD-005

VillanuevaSilvaMJ,5PSQ-097

Villaro-OtañoR,4CPS-167,4CPS-216

VillastrigoGarciaMDC,4CPS-178

ViñasSaguéL,4CPS-026

ViñasSagueL,4CPS-069

VinuesaHernandoJM,4CPS-133

ViolaR,6ER-039

VisedaTorrellasY,5PSQ-044 VisserL,6ER-030

VitaleC,4CPS-214

Viudez-MartínezA,4CPS-209 VlachouM,4CPS-040

VoirolP,4CPS-169

VolpiP,1ISG-016 VoyerCondeS,3PC-022

VueltaArceMF,4CPS-186

WalgraeveK,5PSQ-039,5PSQ-105

WalkerK,3PC-007

WallaceA,3PC-007

WallsAB,1ISG-002

WangYH,6ER-029

WasfC,4CPS-169

WeidmannA,4CPS-016

WeidmannAE,4CPS-170 WeirD,4CPS-021

WennekersAB,4CPS-204

WernerS,3PC-010

WernliU,4CPS-081

WilkinsonA,3PC-007

WirthF,6ER-010 WuytsSCM,5PSQ-081

YaktiO,6ER-035,6ER-042

Yankova-KomsalovaL,2SPD-007 YbáñezGarcíaL,3PC-017 YbañezGarciaL,3PC-035

YehTY,6ER-017

YeonK,4CPS-223

YerroYanguasA,4CPS-009

YoonS,4CPS-157

YounsiS,5PSQ-016

YusteÁM,3PC-016

YusteE,5PSQ-021

Zakhari-BetrosM,4CPS-196

ZambranoCrocheMD,4CPS-132,5PSQ-076,5PSQ119

Zamorano-SerranoMJ,4CPS-166

ZanettiE,5PSQ-124

ZapataP,4CPS-230

ZapicoGarciaI,5PSQ-053

ZaragozaRascónM,5PSQ-079,5PSQ-088

Zarra-FerroI,4CPS-167,4CPS-199,4CPS-207,4CPS216,5PSQ-115

ZavaletaE,2SPD-003

ZelanteF,5PSQ-052,6ER-024

ZerbibD,4CPS-180

ZeroC,5PSQ-101

ZhakipbekovK,6ER-025

ZhanZhouE,4CPS-165

ZhanZouE,4CPS-201

ZhumabayevN,6ER-025

ZipitriaI,4CPS-174

ZitelliS,1ISG-007,4CPS-092,4CPS-093

ZuriñeA,6ER-022

ZuritaB,4CPS-083

ZwavelingJ,2SPD-008