Nederlands Platform voor Farmaceutisch Onderzoek

Het Nederlands Platform voor Farmaceutisch Onderzoek (NPFO) presenteert onderzoek in de farmaceutische wetenschappen, zoals medicatieveiligheid, patiëntenzorg, formulering, (bio)analyse, (klinische) farmacologie en casuïstiek.

Dankbetuiging

Rubriek: Redactionele mededeling
Identificatie: 2017;2:e1631
Datum: 20 januari 2017

Medisch-farmaceutische beslisregels en nierfunctiemeting in de openbare apotheek: wat levert het op?

Mette Heringa abc*, Caroline H. van de Steeg-van Gompel a en Marcel L. Bouvy ab

Lees abstract

Clinical decision rules and measuring renal function in community pharmacy: what do we get out of it?

OBJECTIVE

To investigate the frequency and management of drug therapy alerts about drug use in patients with (potential) renal impairment, to investigate the contribution of point-of-care testing (PoCT) of renal function in community pharmacy to the availability of information on renal function, and to investigate pharmacists’ experiences with drug therapy alerts and PoCT.

DESIGN AND METHODS

A clinical decision support system with clinical decision rules for eleven drugs (seven antibiotics, sotalol, digoxin, allopurinol and spironolactone) and PoCT of renal function were implemented in community pharmacies. The clinical decision rules generated an alert when dose adjustment was advised based on a registered impaired renal function, and when information on the renal function was lacking for patients over 70 years of age with a prescription for one of the selected drugs. Data registered in the clinical decision support system regarding generated alerts, renal functions and alert management were analysed retrospectively. In addition, the participating pharmacists filled out a questionnaire about their experiences.

RESULTS

336 pharmacists managed 27.307 alerts for 21.494 patients, leading to 362 dose adjustments and 65 drug replacements. For 16.208 of these patients, renal function has been registered in the clinical decision support system, including over 400 PoCT measurements. Based on PoCT, 25 cases of impaired renal function have been registered, leading to two therapy adjustments. The participating pharmacists were positive about the project.

CONCLUSION

Advanced clinical decision rules on renal function led to over 400 therapy adjustments. PoCT is a potentially useful source of information on renal function in a limited number of cases, when this information is urgently needed and not available from other sources.

Rubriek: Oorspronkelijk artikel
Identificatie: 2017;2:a1638
Datum: 9 januari 2017

Levensbedreigende bijwerking na toevoegen van DPP-4-remmer sitagliptine aan enalapril

Carina Bethlehem a*, Vincent G. Haver b en Krijn Dekens c

Lees abstract

Life-threatening side effect after adding sitagliptin to enalapril

INTRODUCTION

Angioedema is localised subcutaneous or submucosal oedema due to extravasation of fluid with a predominance for occurring in the face or airway. Because of the sudden onset with possibility of rapid progression it can be life-threatening.

DESCRIPTION

We describe the case of a patient with life-threatening angioedema after adding the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin to enalapril. Angioedema persisted for multiple days despite treatment with H1 and H2 antihistamines and glucocorticoids. Absence of response to this therapy in combination with the history and course of the disease make a bradykinin-mediated etiology of the angioedema likely.

DISCUSSION

Inhibiting angiotensin-converting enzyme and DPP-4 inhibits two important routes to eliminate bradykinin, which can explain the development of angioedema in our patient. There are some case reports of angioedema caused by the combination of a DPP-4 inhibitor and ACE inhibition, although structured clinical evidence is weak.

CONCLUSION

We recommend to avoid the combination of DDP-4 inhibitors and ACE inhibitors in patients with previously known angioedema. Alertness to the risk of developing angioedema can prevent under-reporting of this potentially life-threatening side effect.

Rubriek: Casuïstische mededeling
Identificatie: 2017;2:a1637
Datum: 9 januari 2017

Therapeutic drug monitoring van tumornecrosefactorantagonisten bij reumatoïde artritis

Bartholomeus J.F. van den Bemt a* en Alfons A. den Broeder b

Lees abstract

Therapeutic drug monitoring of tumour necrosis factor inhibitors in rheumatoid arthritis

Therapeutic drug monitoring (TDM) of tumour necrosis factor inhibitors (TNFi) is being proposed as a useful tool for the clinician to further personalize anti-TNF treatment for patients with rheumatoid arthritis (RA). As (1) there are large interindividual differences between the pharmacokinetics of these drugs, as (2) there is an association between TNFi drug levels and clinical response on population level and as (3) dose-dependent infections and the high costs of these drugs demand for an as low as possible dosage, clinical scenarios have been proposed in which measurement of drug levels is expected to be valuable for predicting either effectiveness of a new treatment, or for identifying patients eligible for dose tapering. However, although several cross-sectional population-based studies are available, there is insufficient or contradicting evidence in RA patients that TDM-based therapies complementary to usual clinical treat-to-target care is superior to usual care with respect to better health outcomes or financial advantages.

Rubriek: Overzichtsartikel
Identificatie: 2017;2:a1630
Datum: 9 januari 2017

Zero-residual syringe als verpakkingsmateriaal voor bevacizumab als intravitreale injectie – Antwoord van de auteurs

Maartje S. Jacobs a*, Wietske L. Hemminga b, Herman J. Woerdenbag c, Marjan Bouma a en Jan Reindert Moes a

Rubriek: Correspondentie
Identificatie: 2017;2:c1604
Datum: 9 januari 2017

Zero-residual syringe als verpakkingsmateriaal voor bevacizumab als intravitreale injectie – Reactie

M. Pereboom a*, M.L. Becker a, S.L. Verweij a, R.T.M. van der Hoeven a en I.J. Mulder a

Rubriek: Correspondentie
Identificatie: 2017;2:c1603
Datum: 9 januari 2017

Het risico op hypoglykemieën bij sulfonylureumderivaten ten opzichte van metformine in relatie tot nierfunctie en metabolietgroep

Judith van Dalem abc, Martijn C.G.J. Brouwers d, Coen D.A. Stehouwer e, André Krings b, Hubert G.M. Leufkens f, Johanna H.M. Driessen acf, Frank de Vries af* en Andrea M. Burden acf

Lees abstract

Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group

OBJECTIVE

To determine whether treatment with sulphonylureas (SUs) only in patients with renal impairment is associated with a higher risk of hypoglycaemia compared to metformin-only users.

DESIGN

Retrospective population based cohort study.

METHODS

We conducted this study using data from the Clinical Practice Research Datalink database (2004-2012). New users (N = 120,803) with at least one prescription for a non-insulin antidiabetic agent and aged over 18 were included. Associations between SU dose, renal impairment, different SUs used, and risk of hypoglycaemia were determined using Cox proportional hazard models. Adjustments were made for age, sex, life style, comorbidities and drug use.

RESULTS

The risk of hypoglycaemia in current SU-only users was significantly increased compared with current metformin-only users (adjusted hazard ratio [HRadj] 2.50; 95% confidence interval [CI95] 2.23-2.82). The risk in current SU-only users was further increased in patients with an eGFR <30 (mL/min)/(1.73m2) (HRadj 4.96; CI95 3.76-6.55). The risk of hypoglycaemia was also significantly higher in patients with a high SU dose (HRadj 3.12; CI95 2.68-3.62) and with current glibenclamide use (HRadj 7.48; CI95 4.89-11.44). Results for gliclazide, the currently recommend SU of first choice, showed a similar risk of hypoglycaemia compared to other SUs.

CONCLUSION

SU treatment in patients with an eGFR <30 (mL/min)/(1.73m2) should be considered with caution, especially the use of glibenclamide. In contrast with several guidelines, gliclazide does not seem to be superior to glimepiride, glipizide and tolbutamide.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1636
Datum: 12 december 2016

Ciprofloxacine als QTc-verlenger in de G-Standaard: afhandeling van het interactiesignaal in de praktijk

Evelien Woldman a, Florine Berger b, Patricia van den Bemt c, Ruud van der Hoeven d en Matthijs Becker d*

Lees abstract

Ciprofloxacin as a QTc prolonging drug in the G-Standaard: processing of the interaction signal in practice

OBJECTIVE

To analyse the effect of the introduction of an interaction signal when ordering ciprofloxacin concomitantly with another QTc prolonging drug on the number of stopped orders and the number of ECGs measured. Ciprofloxacin has been added to the G-Standaard as a QTc prolonging drug with a known risk of torsade de pointes (TdP).

DESIGN

Observational retrospective cohort study.

METHODS

All inpatient orders for ciprofloxacin, concomitantly prescribed with another QTc prolonging drug in the Spaarne Hospital (Haarlem/Hoofddorp) were selected. The study included a period before introduction of ciprofloxacin as QTc prolonging drug (March 29 until June 1, 2015), and a period thereafter (June 1 until November 14, 2015). We compared how often prescribers stopped an order for a QTc prolonging drug and how often ECGs were measured before and after start of the QTc prolonging drug–drug combination.

RESULTS

Ciprofloxacin generated 4.2 QTc interaction signals per day, which was an increase of 22.3% for the total number of QTc interaction signals. In 9.4% of the QTc interaction signals with ciprofloxacin, one or more of the QTc prolonging drugs were stopped. The number of ECGs taken within seven days before and three days after start of the combination with ciprofloxacin increased by respectively 8.7% (P = 0.008) and 7.0% (P = 0.021).

CONCLUSION

The introduction of the QTc interaction signal for ciprofloxacin has a clear effect in the Spaarne hospital.

Rubriek: Oorspronkelijk artikel
Identificatie: 2016;1:a1633
Datum: 12 december 2016

Variatie in indicaties voor gebruik van antidepressiva

Rogier Klok

Rubriek: Referaat
Identificatie: 2016;1:e1628
Datum: 29 november 2016

Het glas van farmacogenetica is eerder half vol dan half leeg

Rogier Klok

Rubriek: Referaat
Identificatie: 2016;1:e1627
Datum: 29 november 2016

Patiëntervaringen en therapietrouw bij langdurig gebruik van capecitabine

Jacqueline Hugtenburg

Rubriek: Referaat
Identificatie: 2016;1:e1626
Datum: 18 november 2016

Statinegebruik en fysiek functioneren bij ouderen

Jacqueline Hugtenburg

Rubriek: Referaat
Identificatie: 2016;1:e1625
Datum: 18 november 2016

Contact

Arjan Polderman
Redacteur / secretaris

(070) 373 73 14 a.k.s.polderman@pw.nl