Experience with the use of Rituximab for the treatment of rheumatoid arthritis in a tertiary Hospital in Spain: RITAR study

There is evidence supporting that there are no relevant clinical differences between dosing rituximab 1000 mg or 2000 mg per cycle in rheumatoid arthritis (RA) patients in clinical trials, and low-dose cycles seem to have a better safety profile. Our objective was to describe the pattern of use of rituximab in real-life practice conditions. Methods: Rituximab for RA in clinical practice (RITAR) study is a retrospective cohort study from 2005 to 2015. Eligibility criteria were RA adults treated with rituximab for active articular disease. Response duration was the main outcome defined as months elapsed from the date of rituximab first infusion to the date of flare. A multivariable analysis was performed to determine the variables associated with response duration. Results: A total of 114 patients and 409 cycles were described, 93.0% seropositive and 80.7% women. Rituximab was mainly used as second-line biological therapy. On demand retreatment was used in 94.6% of cases versus fixed 6 months retreatment in 5.4%. Median response duration to on demand rituximab cycles was 10 months (interquartile range, 7–13). Multivariable analysis showed that age older than 65 years, number of rituximab cycles, seropositivity, and first- or second-line therapy were associated with longer response duration. The dose administered at each cycle was not significantly associated with response duration. Conclusions: Our experience suggests that 1000 mg rituximab single infusion on demand is a reasonable schedule for long-term treatment of those patients with good response after the first cycles, especially in seropositive patients and when it is applied as a first- or second-line biological therap

The drug logistics process: an innovation experience

Purpose - The purpose of this paper is to present the latest innovations in the drug distribution processes of hospital companies, which are currently dealing with high inventory and storage costs and fragmented organizational responsibilities. Design/methodology/approach - The literature review and the in-depth analysis of a case study support the understanding of the unit dose drug distribution system and the subsequent definition of the practical implications for hospital companies. Findings - Starting from the insights offered by the case study, the analysis shows that the unit dose system allows hospitals to improve the patient care quality and reduce costs. Research limitations/implications - The limitations of the research are those related to the theoretical and exploratory nature of the study, but from a practical point of view, the work provides important indications to the management of healthcare companies, which have to innovate their drug distribution systems. Originality/value - This paper analyzes a new and highly topical issue and provides several insights for the competitive development of a fundamental sector

Coping with demand volatility in retail pharmacies with the aid of big data exploration

Data management tools and analytics have provided managers with the opportunity to contemplate inventory performance as an ongoing activity by no longer examining only data agglomerated from ERP systems, but also, considering internet information derived from customers' online buying behaviour. The realisation of this complex relationship has increased interest in business intelligence through data and text mining of structured, semi-structured and unstructured data, commonly referred to as "big data" to uncover underlying patterns which might explain customer behaviour and improve the response to demand volatility. This paper explores how sales structured data can be used in conjunction with non-structured customer data to improve inventory management either in terms of forecasting or treating some inventory as "top-selling" based on specific customer tendency to acquire more information through the internet. A medical condition is considered - namely pain - by examining 129 weeks of sales data regarding analgesics and information seeking data by customers through Google, online newspapers and YouTube. In order to facilitate our study we consider a VARX model with non-structured data as exogenous to obtain the best estimation and we perform tests against several univariate models in terms of best fit performance and forecasting

Optimizing Vancomycin Dosing in Chronic Kidney Disease by Deriving and Implementing a Web-Based Tool Using a Population Pharmacokinetics Analysis.

Background: Chronic kidney disease (CKD) patients requiring intravenous vancomycin bear considerable risks of adverse outcomes both from the infection and vancomycin therapy itself, necessitating especially precise dosing to avoid sub- and supratherapeutic vancomycin exposure. Methods: In this retrospective study, we performed a population pharmacokinetic analysis to construct a vancomycin dose prediction model for CKD patients who do not require renal replacement therapy. The model was externally validated on an independent cohort of patients to assess its prediction accuracy. The pharmacokinetic parameter estimates and the equations were productized into a Web application (VancApp) subsequently implemented in routine care. The association between VancApp-based dosing and time-to-target concentration attainment, 30-day mortality, and nephrotoxicity were assessed postimplementation. Results: The model constructed from an initial cohort (n = 80) revealed a population clearance and volume of distribution of 1.30 L/h and 1.23 L/kg, respectively. External model validation (n = 112) demonstrated a mean absolute prediction error of 1.25 mg/L. Following 4 months of clinical implementation of VancApp as an optional alternative to usual care [VancApp (n = 22) vs. usual care (n = 21)], patients who had received VancApp-based dosing took a shorter time to reach target concentrations (median: 66 vs. 102 h, p = 0.187) and had fewer 30-day mortalities (14% vs. 24%, p = 0.457) compared to usual care. While statistical significance was not achieved, the clinical significance of these findings appear promising. Conclusion: Clinical implementation of a population pharmacokinetic model for vancomycin in CKD can potentially improve dosing precision in CKD and could serve as a practical means to improve vital clinical outcomes

Impact of a community pharmacist-led medication review on medicines use in patients on polypharmacy - a prospective randomised controlled trial

In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication review, was newly introduced to be delivered independently from the prescriber and reimbursed by the Swiss health insurances. This study aimed at evaluating the impact of this new cognitive service focusing on medicines use and patients' adherence in everyday life.; This randomised controlled trial was conducted in 54 Swiss community pharmacies. Eligible patients used ≥4 prescribed medicines over >3 months. The intervention group received a PMC at study start (T-0) and after 28 weeks (T-28) while the control group received only a PMC at T-28. Primary outcome measure was change in patients' objective adherence, calculated as Medication Possession Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data from the pharmacies and patient information of dosing. Subjective adherence was assessed as secondary outcome by self-report questionnaires (at T-0 and T-28) and telephone interviews (at T-2 and T-16), where participants estimated their overall adherence on a scale from 0-100 %.; A total of 450 patients were randomly allocated to intervention (N = 218, 48.4 %) and control group (N = 232, 51.6 %). Dropout rate was fairly low and comparable for both groups (N Int = 37 (17.0 %), NCont = 41 (17.7 %), p = 0.845). Main addressed drug-related problem (DRP) during PMC at T-0 was insufficient adherence to at least one medicine (N = 69, 26.7 %). At T-28, 1020 chronic therapies fulfilled inclusion criteria for MPR calculation, representing 293 of 372 patients (78.8 %). Mean MPR and adherence to polypharmacy (DPPR) for both groups were equally high (MPRInt = 88.3, SD = 19.03; MPRCont = 87.5, SD = 20.75 (p = 0.811) and DPPRInt = 88.0, SD = 13.31; DPPRCont = 87.5, SD = 20.75 (p = 0.906), respectively). Mean absolute change of subjective adherence between T-0 and T-2 was +1.03 % in the intervention and -0.41 % in the control group (p = 0.058). The number of patients reporting a change of their adherence of more than ±5 points on a scale 0-100 % between T-0 and T-2 was significantly higher in the intervention group (NImprovement = 30; NWorsening = 14) than in the control group (NImprovement = 20; NWorsening = 24; p = 0.028).; Through the PMC pharmacist were able to identify a significant number of DRPs. Participants showed high baseline objective adherence of 87.5 %, providing little potential for improvement. Hence, no significant increase of objective adherence was observed. However, regarding changes in subjective adherence of more than ±5 % the PMC showed a positive effect.; Clinical trial registry database, NCT01739816 ; first entry on November 27, 2012

Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans

Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans.

Inventory Level Improvement in Pharmacy Company Using Probabilistic EOQ Model and Two Echelon Inventory: A Case Study

Abstract. This research is aimed to maintain the inventory level in a two-echelon pharmacy company. The company is a pharmacy company that has 16 branches that operate in Bandung and the surrounding area. The company has a problem with its high inventory cost. To solve the problem, the authors compare two methods that suit the company condition, i.e., the decentralized system using probabilistic EOQ model and the centralization system using the multi-echelon inventory technique. We analyzed sales data and on-hand inventory data acquired from the company information system to perform the study. We limit the scope to the class A items only. We also assume the lead time, setup cost, and holding cost used in this study with the company's owner's consent. To conclude, using the decentralized system, the company will save 31% of their inventory cost, while using the centralization system with the multi-echelon technique, the company will be able to save 61% of their inventory cost. We recommend the company to refer to its competitive strategy before deciding which model it would be implemented. Keywords:  Centralization, Decentralization, Probabilistic Economic Order Quantity (EOQ), Multi-Echelon Inventory, Pharmaceutical Inventory Managemen

Custo de medicamentos produzidos pelo Hospital Universitário, papel da Farmácia Central

The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clinicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.A Farmácia Hospitalar em instituições avançadas e de grande porte evoluiu de uma simples unidade de armazenamento e distribuição, para um centro de manipulação altamente especializado, responsável pelo processamento de centenas de requisições clínicas, muitas delas únicas e não disponíveis de fontes comerciais. Foi perfeitamente natural portanto que em muitos ambientes, um Serviço Industrial fosse gradualmente estabelecido, visando responder a demandas tanto convencionais como extraordinárias da equipe médica. Tal foi o caso do Hospital das Clínicas, onde múltiplas categorias de fármacos são rotineiramente elaboradas nas dependências da Farmácia. Entretanto, imperativos de contenção de gastos determinam que tais atividades sejam reajuizadas sob o prisma de sua eficiência e essencialidade. MÉTODOS: Num estudo prospectivo, a produção do Serviço Industrial da Farmácia Central durante um período de 12 meses foi documentada, e classificada em três modalidades. O Grupo I abrangia medicamentos similares a outros fornecidos comercialmente, no Grupo II foram listadas formulações de composição exclusiva, e finalmente o Grupo III espelhava pedidos especiais voltados para investigações clínicas. RESULTADOS: Os achados das diversas categorias assinalaram que 34,4%, 45,3% e 20,3% dos medicamentos elaborados correspondiam a estes três grupos, respectivamente.Os custos industriais foram calculados para os fármacos do Grupo I e comparados com valores de mercado, chegando-se a uma economia de 63,5%.Quando extrapolada para os outros dois grupos, relativamente aos quais não se contava com preços comerciais diretamente equivalentes, atingiu-se uma estimativa superior a 5 100 000 dólares de economia durante um ano de operação. Mesmo levando-se em conta que tais contas deixaram de lado muitos custos, notavelmente aqueles subordinados à comercialização e distribuição, foi lícito concluir que pelo menos parte da economia citada era verdadeira. CONCLUSÕES: A economia observada, em combinação com a eficiência e confiabilidade com que a Farmácia desempenhou suas obrigações, vieram ao encontro do ponto de vista de que a manufatura interna de drogas foi uma alternativa vantajosa sob o prisma de custos, no contexto descrito