Farmaceutisch onderzoek

879 artikelen

30 mrt 2020

Geschiktheid van orale posaconazolsuspensie in immuungecompromitteerde kinderen

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1703
  • Auteur(s):
    András Vermes

Geschiktheid van orale posaconazolsuspensie in immuungecompromitteerde kinderen

25 mrt 2020

Voorkeuren van patiënten en apothekers bij het afhandelen van geneesmiddelinteracties

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2020;5:a1721
  • Auteur(s):
    Mette Heringa abc*, Annemieke Floor-Schreudering ab, Hans Wouters d, Peter A.G.M. de Smet e en Marcel L. Bouvy ab

Voorkeuren van patiënten en apothekers bij het afhandelen van geneesmiddelinteracties

Preferences of patients and pharmacists with regard to the management of drug-drug interactions: a choice-based conjoint analysis

Background

For the management of drug-drug interactions (DDI), a risk-benefit assessment should be combined with the patient’s perspective.

Objective

To investigate patients’ and pharmacists’ preferences regarding DDI management.

Design and methods

We conducted an online choice-based conjoint survey among patients and pharmacists. The choice task was about the management of a fictitious DDI: the combination of a cardiovascular drug and an antibiotic for pneumonia leading to a risk for developing muscle problems. Respondents answered twelve choice sets of two DDI-management options. The options were only described by their five characteristics (attributes) regarding risk for adverse events, benefit, and practical consequences. Each of the five attributes could have two different levels (e.g. low or high risk), which were varied over the 12 choice tasks. Data were analysed by latent class analysis in order to identify potential classes (subgroups) of respondents with similar preference patterns.

Results

The survey was completed by 298 patients and 178 pharmacists. The latent class model for both patients and pharmacists resulted in three classes. The first class of patients attached most importance to fewer adverse events (class probability 41%), the second class attached most importance to avoiding a medication switch (20%), and the third class attached most importance to blood sampling (39%). For pharmacists, the first class attached most importance to curing pneumonia (31%), the second class to avoiding a medication switch (31%), and the third class to avoiding blood sampling (38%).

Conclusion

Among patients and pharmacists diverging preferences regarding DDI management were observed. Some subgroups of respondents attached most value to risk or benefit while others attached more value to practical considerations. Awareness of existing variability in preferences among and between pharmacists and patients can contribute to shared decision making in DDI management.

19 mrt 2020

Vergelijking tussen factor VIII gemeten met een activiteitsassay en met massaspectrometrie bij patiënten met hemofilie A

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2020;5:a1716
  • Auteur(s):
    Anouk Donners a*, Erik van Maarseveen a, Yrea Weetink a, Mohsin El Amrani ab, Kathelijn Fischer c, Karin Rademaker a, Toine Egberts ad, Albert Huisman b en Ruben Musson b

Vergelijking tussen factor VIII gemeten met een activiteitsassay en met massaspectrometrie bij patiënten met hemofilie A

Comparison between coagulation factor VIII quantified with one-stage activity assay and mass spectrometry in haemophilia A patients

Background

Haemophilia A is a hereditary bleeding disorder caused by a factor VIII (FVIII) deficiency. As biomarker, FVIII activity is used to classify disease severity and to monitor treatment. The one-stage clotting assay (OSA) is used to measure FVIII activity but OSA’s limitations may result in misclassification of disease severity or suboptimal monitoring of treatment. Measurement of FVIII plasma concentration with LC-MS/MS might overcome these challenges.

Objective

To investigate the association between FVIII activity and concentration as well as determinants for discrepancies.

Design and methods

In this cross-sectional study, all haemophilia A patients receiving standard of care were eligible for inclusion. Within the activity categories of < 1%, 1-5%, > 5-40%, > 40-150%, and > 150-600% we randomly selected 15 till 20 plasma samples, and compared FVIII concentration (LC-MS/MS) to FVIII activity (OSA) with linear regression and Bland-Altman analysis. Potential determinants were analysed with linear regression.

Results

87 samples were included. Bland-Altman analysis demonstrated an overall mean difference of –1% with a standard deviation (SD) of 64% between the two methods. Discrepancies were associated with the presence of anti-FVIII antibodies (133%, 95% confidence interval [95%CI] = 81-185, n = 5) and exogenous FVIII products (–37%, 95%CI = –65- –9, n = 58), e.g. plasma-derived and B-domain modified FVIII.

Conclusion

Despite almost no discrepancy overall, the variability between FVIII activity and FVIII concentration was large. Anti-FVIII antibodies or use of exogenous FVIII products might result in differences of potential clinical impact. More research is needed to determine the value of FVIII concentration in addition to activity.

10 mrt 2020

Beslisregels voor geneesmiddelen bij ouderen zijn toepasbaar en leiden tot wijzigingen in voorschriften van risicomedicatie

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1701
  • Auteur(s):
    Sander D. Borgsteede

Beslisregels voor geneesmiddelen bij ouderen zijn toepasbaar en leiden tot wijzigingen in voorschriften van risicomedicatie

02 mrt 2020

Betrouwbaarheid van twee testen voor gammahydroxyboterzuur; prospectief onderzoek naar de DrugCheck GHB Single Test en Viva-E GHB immunoassay

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2020;5:a1720
  • Auteur(s):
    T.A. Smits a*, F.M.J. Gresnigt b, B.D. van Groen c, E.J.F. Franssen a en M.E. Attema-de Jonge d

Betrouwbaarheid van twee testen voor gammahydroxyboterzuur; prospectief onderzoek naar de DrugCheck GHB Single Test en Viva-E GHB immunoassay

Prospective investigation of the performance of 2 gamma-hydroxybutyric acid tests: DrugCheck GHB Single Test and Viva-E GHB immunoassay

Objective and design

Since results are quickly available, a point-of-care test for GHB in urine can be of great diagnostic value. The objective of this prospective study was to determine the performance of the new DrugCheck GHB Single Test and the Viva-E GHB immunoassay for urine samples from emergency department patients.

Methods

Patients presented to the emergency department of OLVG hospital in Amsterdam with a Glasgow Coma Scale < 15 and a potential intoxication with drugs of abuse were included. Urine of these patients was tested for presence of GHB using the DrugCheck GHB Single Test and the Viva-E GHB immunoassay (cutoff for a positive result: 10 or 50 mg/L GHB). Results were compared for agreement with a validated gas chromatography method. Possible cross-reactivity with ethanol was investigated by analyzing ethanol concentrations in patients’ urine and serum. Furthermore, the diagnostic performance of emergency medicine physicians for possible GHB-intoxicated patients was assessed.

Results

A total of 375 patients were prospectively included. The specificity and sensitivity of the DrugCheck GHB Single Test were 90% and 73%, respectively. Results improved using a cutoff value of 50 mg/L to a specificity of 97% and a sensitivity of 75%. Serum and urine ethanol levels in the false positive group were significantly higher compared to the true negative group (P < 0.05). Using the Viva-E GHB immunoassay the specificity was 99% and the sensitivity was 94% (cutoff value 50 mg/L and excluding samples with ethanol levels ≥ 2 g/L). The specificity and sensitivity of the physicians were 93% and 66%, respectively.

Conclusion

The DrugCheck GHB Single Test shows a sufficient specificity of > 90%, but a poor sensitivity and is therefore not suitable for use in clinical practice. In contrast, the Viva-E GHB immunoassay showed acceptable results when using a cutoff value of 50 mg/L in case samples with ethanol levels ≥ 2 g/L were excluded.

27 feb 2020

SEH-bezoek als gevolg van intoxicaties

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1702
  • Auteur(s):
    András Vermes

SEH-bezoek als gevolg van intoxicaties

25 feb 2020

Een landelijke inventarisatie naar geprotocolleerde zorg voor het gebruik van antidepressiva, antihypertensiva en tocolytica tijdens zwangerschap en lactatie

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2020;5:a1719
  • Auteur(s):
    N. Huijgen, MSc a, drs. L. de Vries b, dr. T.W. de Vries c, prof. dr. E.P. van Puijenbroek bd en dr. P.G.J. ter Horst e*

Een landelijke inventarisatie naar geprotocolleerde zorg voor het gebruik van antidepressiva, antihypertensiva en tocolytica tijdens zwangerschap en lactatie

National inventory of protocoled care for the use of antidepressants, antihypertensives and tocolytics during pregnancy and lactation

Objective

To gain insight into medical guidelines for perinatal use of antidepressants, tocolytics and antihypertensive drugs in Dutch hospitals.

Design

Observational inventory study.

Methods

We contacted the departments of gynaecology, and paediatrics of the Dutch hospitals either by mail, e-mail, or searched for specific guidelines on the websites of the according hospitals. These included guidelines regarding antidepressants, antihypertensives and drugs used during delivery (tocolytics and uterotonics) during the perinatal period. Those guidelines were analysed and categorised based on user advices just before delivery, during the lactation period and precautions for the neonate after maternal use of the aforementioned drug categories.

Results

We received local guidelines of 53 Dutch hospitals, among which are five university hospitals. We found information on the use of antidepressants (50 SSRIs; 16 TCAs), antihypertensive drugs (21), and drugs used during partus (tocolytics and uterotonic drugs, 21 in total). The guidelines of all drug categories differed in number of controls, kind of controls, length of postpartum hospital stay, and whether or not to use antidepressants during pregnancy and lactation.

Conclusion

There is a large heterogeneity in advices given to pregnant women and health care workers about the safe use of antidepressants, antihypertensive drugs and tocolytics. We believe there is a need for a national guideline that comprises all aspects of perinatal use of drugs.

21 feb 2020

Geneesmiddelen als oorzaak van heropname na ontslag uit het ziekenhuis: verschil in inzicht tussen patiënt en zorgverlener

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1700
  • Auteur(s):
    Sander D. Borgsteede

Geneesmiddelen als oorzaak van heropname na ontslag uit het ziekenhuis: verschil in inzicht tussen patiënt en zorgverlener

13 feb 2020

Chronisch gebruik van protonpompremmers en verlaagde ijzerstatus bij patiënten met een niertransplantaat

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1696
  • Auteur(s):
    André Wieringa

Chronisch gebruik van protonpompremmers en verlaagde ijzerstatus bij patiënten met een niertransplantaat

04 feb 2020

Verbeterde overleving door triple-therapie in BRAF-V600E-gemuteerde colorectale kanker

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1695
  • Auteur(s):
    André Wieringa

Verbeterde overleving door triple-therapie in BRAF-V600E-gemuteerde colorectale kanker

30 jan 2020

De effectiviteit van medicatiebeoordeling op het aantal geneesmiddelgerelateerde problemen bij cardiologische polikliniekpatiënten

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1698
  • Auteur(s):
    Bob Wilffert

De effectiviteit van medicatiebeoordeling op het aantal geneesmiddelgerelateerde problemen bij cardiologische polikliniekpatiënten

24 jan 2020

Dankbetuiging 2019

  • Rubriek:
    Redactioneel
  • Identificatie:
    2020;5:e1699
  • Auteur(s):
    Redactiebureau NPFO

Dankbetuiging 2019

15 jan 2020

Invloed van het genotype van P-glycoproteïne op de werkzaamheid van paroxetine

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1697
  • Auteur(s):
    Bob Wilffert

Invloed van het genotype van P-glycoproteïne op de werkzaamheid van paroxetine

07 jan 2020

Hoeveel wordt verspild als patiënten stoppen met orale oncolytica of biologicals?

  • Rubriek:
    Referaat
  • Identificatie:
    2020;5:e1692
  • Auteur(s):
    Lonneke Timmers

Hoeveel wordt verspild als patiënten stoppen met orale oncolytica of biologicals?

23 dec 2019

Het positieve effect van klinische beslisregels getoond op het moment van voorschrijven

  • Rubriek:
    Oorspronkelijk artikel
  • Identificatie:
    2019;4:a1717
  • Auteur(s):
    Matthijs L. Becker ab*, Fatih Baypinar a, Marieke Pereboom ab, Soufiane Lilih c, Hylke Jan Kingma ab en Ruud T.M. van der Hoeven ab

Het positieve effect van klinische beslisregels getoond op het moment van voorschrijven

The positive effect of clinical decision support shown at the time of prescribing

BACKGROUND

Clinical decision support system (CDSS) should help healthcare providers to make better decisions. For optimal performance, a CDSS uses algorithms taking various factors in consideration. For pharmacy practice, a CDSS often generates a patient list that is reviewed by a pharmacist and the physician is contacted in case of a clinically relevant signal. In our hospital we implemented five algorithms that alert the physician directly at the time of prescribing to treat the patient in line with the guidelines.

OBJECTIVE

To evaluate the effect of implementation of algorithms for medication surveillance shown directly to the physician at the time of prescribing.

DESIGN

Prospective intervention study.

METHODS

We analyzed the change in treatments in line with the guidelines and the percentage of correct follow-up after the advice was shown. We examined the implementation of five algorithms. These were the algorithms for gastric protection, methotrexate, vitamin D, hyponatremia and therapeutic drug monitoring of aminoglycosides and vancomycin.

RESULTS

For all algorithms the percentage of treatments in line with the guidelines increased significantly. The percentage of increase varied from 11 to 36% and in three of the five CDSSs the percentage was above 80% after implementation. For the algorithm gastric protection, the advice was accepted in 45% of all signals versus 4.3% in case of the classical drug-drug interaction signals.

CONCLUSION

Algorithms for medication surveillance that are shown to the physician at the time of prescribing increase the compliance with the guidelines.

20 dec 2019

VKA-beleid in het DOAC-tijdperk: fenprocoumon ten opzichte van acenocoumarol

  • Rubriek:
    Korte bijdrage
  • Identificatie:
    2019;4:a1718
  • Auteur(s):
    Dr. Maarten J. Beinema a*, dr. Henk J. Adriaansen b, prof. dr. Hugo ten Cate c, dr. Laura M. Faber d, dr. Angelique T.M. van Holten-Verzantvoort e, dr. Melchior C. Nierman f, dr. R.W.L.M. Niessen g en em. prof. dr. J.R.B.J. Brouwers h

VKA-beleid in het DOAC-tijdperk: fenprocoumon ten opzichte van acenocoumarol

VKA policy in the DOAC era: phenprocoumon versus acenocoumarol

Background and objective

Vitamin K antagonists (VKAs) are still used for the prevention of thromboembolic events. In Europe acenocoumarol and phenprocoumon are frequently prescribed. In the Netherlands acenocoumarol is the most prescribed VKA.

Design and methods

This article describes the differences between these two drugs: acenocoumarol and phenprocoumon.

Results and conclusion

Phenprocoumon is characterized by an extremely long half-life (160 hours), which leads to a better time in therapeutic range. Phenprocoumon dosing however, is more difficult and requires more often vitamin K interventions. Due to pharmacogenetic differences between these two anticoagulants, phenprocoumon is probably less sensitive to drug-drug interactions.