Farmacología

URI permanente para esta comunidadhttps://hdl.handle.net/11441/11024

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Impact of Frailty on Outcomes of First-Line Pembrolizumab Monotherapy in a Real-World Population with Advanced Non-Small Cell Lung Cancer
(MDPI, 2023) Jiménez Galán, Rocío; Prado-Mel, Elena; Álvarez de Sotomayor Paz, María; Abdel-Kader Martín, Laila; Universidad de Sevilla. Departamento de Farmacología
ICIs have been able to improve overall survival in advanced-stage lung cancer. The benefit of this therapy is limited in patients with poor ECOG PS. However, this scale is imprecise and can be influenced by different factors, such as frailty. Cancer patients have a high risk of frailty independently of age. In this observational, single-center, retrospective study, we investigated the effect of frailty on the effectiveness of pembrolizumab in first-line use in a cohort of 101 patients with metastatic NSCLC. Frailty was determined using a frailty score system developed by Sakakida et al. Univariate and multivariate analysis was performed to determine the prognostic role of frailty on OS and PFS. Median OS was significantly higher in patients with low frailty compared with intermediate and high frailty (23.8 vs. 7.0 and 1.8 months, respectively; p < 0.001). Median PFS was also significantly higher in patients with low frailty compared with intermediate and high frailty (10.5 vs. 3.9 and 1.6 months; p < 000.1, respectively). Frailty was the only variable that showed significant differences in OS and PFS. Multivariate analysis confirms frailty as an independent predictor of OS and PFS. Frailty assessment could help to select which patients are candidates for ICIs in NSCLC.
Prevalence of Polypharmacy and Association to Pharmacotherapy Complexity in Older HIV-Positive Patients. The Sevihlla Study
(eSciPub LLC, 2019) Morillo Verdugo, Ramón Alejandro; Robustillo Cortés, María de las Aguas; Abdel-Kader Martín, Laila; Álvarez de Sotomayor Paz, María; Lozano de León Naranjo, Fernando; Almeida González, Carmen V.; Universidad de Sevilla. Departamento de Farmacología
Background: Increased life expectancy of older HIV-positive patients has been associated to a parallel increase in age-related comorbidities. Objectives: To ascertain the prevalence of polypharmacy and its association to pharmacotherapy complexity, as measured by the Medication Regimen Complexity Index, in older HIV-positive patients; to calculate the median value of pharmacotherapy complexity; to identify polypharmacy and multimorbidity patterns; and to address adherence to antiretroviral and concomitant drugs. Methods: A cross-sectional, observational study was conducted in patients over 50 years of age receiving active antiretroviral drugs during 2014 at outpatient pharmacy services of a tertiary hospital in Spain. Data collected from the electronic medical record included demographic, clinical and comorbidity related endpoints. The primary endpoint was the proportion of patients with polypharmacy and major polypharmacy. Polypharmacy was defined as treatment with six or more drugs (including antiretroviral). Major polypharmacy (more than 11 drugs) was also considered. Patients was categorized according to their polypharmacy pattern. Three patterns were applied based on age of participants: cardiovascular, depression-anxiety, and chronic obstructive pulmonary (COPD) disease patterns. A patient was classified into a pattern when at least three drugs of the treatment were in the same pattern. Antiretroviral treatment adherence was measured using the SMAQ questionnaire and hospital dispensing records. Adherence to concomitant medication was measured using the Morisky-Green questionnaire and electronic pharmacy dispensing records. Pharmacotherapy complexity index, as assessed by MRCI, was also considered. Patients were classified as low MRCI (less than 14 points) or high MRCI (more than 14 points). Results: The study sample consisted of 223 patients (86.5% men), with a median age of 53.0 years. More than 80.0% of the patients were viro-inmunological controlled. Prevalence of polypharmacy was 56.1%. The median value of pharmacotherapy complexity was 11.0. The main contribution to this value was from the concomitant medication. The polypharmacy pattern mainly calculated was cardiovascular (60.0%) and the multimorbidity pattern was cardiometabolic (73.8%). Presence of polypharmacy was associated to greater pharmacotherapy complexity (p<0,001). Adequate adherence to the antiretroviral and to concomitant medication was found in 83.6% and 37.9% of patients respectively. Conclusions: More than a half of the older HIV-positive patients received six or more different drugs with a significant pharmacotherapy complexity showing adequate adherence to antiretroviral but not to concomitant drugs. Cardiovascular conditions were most common in terms of prescriptions and comorbidities.
The challenge of aging and pharmacoterapeutic complexity in the HIV + patient
(Grupo Aula Medica S.L., 2018) Morillo Verdugo, Ramón Alejandro; Ramos Blanco, José Ramón; Abdel-Kader Martín, Laila; Álvarez de Sotomayor Paz, María; Universidad de Sevilla. Departamento de Farmacología
Objective: To describe the current knowledge and management of aging and pharmacotherapeutic complexity in HIV + patients. Method: A review of literature was carried out, including articles, originals or reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms «Polypharmacy»/«Polifarmacia», «Aging»/«Envejecimiento», «Frailty»/«Fragilidad», «Complejidad Farmacotera péutica»/«Medication Regimen Complexity» and «HIV»/«VIH» were combined. The review was carried out independently by two authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An aging of the population and an increase in associated comorbidities have been identified, especially over 50 years-old. Immunological changes similar to those that are generated in a non-infected elderly population have been described. These conditions influencing the prescription of antiretroviral treatment, according to studies identified. In parallel, polypharmacy is increasingly present, being defined exclusively by the concomitant use of five drugs. Pharmacotherapeutic complexity, through the Medication Regimen Complexity Index, has begun to analyse and relate to health outcomes. There has been a need to know and apply concepts already known in non-HIV-aged population, such as deprescription, potentially inappropriate medication, cholinergic risk, although few results are available. Conclusions: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new concepts that help pharmacotherapeutic optimization in this population.

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Examinando Farmacología por Autor "Abdel-Kader Martín, Laila"