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.

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

Substitutie van parkinsonmiddelen omgeven met problemen

R. Beekman a, P. Vermeulen b en A.A. van Dooren b*

Lees abstract

Substitution of Parkinson disease medication surrounded with problems

OBJECTIVE

To get an insight in the extent of substitution of Parkinson disease medication in the Netherlands, and to see whether such substitutions lead to drug-related problems. In addition, we investigated the exchange of information between healthcare providers and patients in case of such a substitution.

DESIGN AND METHODS

Questionnaires among pharmacists and patients, and interviews with patients, pharmacists, neurologists and health insurance companies.

RESULTS

64 out of 123 responding patients (52%) mentioned that they had experienced substitution. Reasons for pharmacists to substitute are the so-called ‘preference policy’, logistic and financial considerations, and unfamiliarity or disagreement with the KNMP substitution guideline. About half of patients who were confronted with substitution had subsequently experienced adverse reactions. One out of three patients had been asked for their permission to substitute. Similar percentages were given by pharmacists. The neurologists were less often informed. 16 of the 71 responding pharmacists decided to substitute, also when ‘medical need’ was mentioned.

CONCLUSION

Substitution of Parkinson disease medication often takes place ignoring medical guidelines, governmental rules and practices such as informing patients and consulting professionals. Some pharmacists feel ‘squeezed’ between the policy of health insurance companies, negative financial consequences if they deviate from this policy, availability problems of many drug products, and the KNMP guideline stating that substitution of Parkinson disease medication should be avoided.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1634
Datum: 15 november 2016

Effect van therapietrouw op exacerbaties is moeilijk te schatten met beschikbare real life data voor astma en COPD

Lucas Goossens a*, Jetty Overbeek b, Maurice Driessen c en Maureen Rutten-van Mölken a

Lees abstract

Effect of medication compliance on exacerbations is hard to estimate with available real life data for asthma and COPD

BACKGROUND

Effectiveness of long-acting bronchodilators and inhaled corticosteroids has been established in clinical trials. Their effectiveness in real life is not well documented.

OBJECTIVE

To investigate to what extent it is possible to estimate the effect of medication compliance on the risk of asthma and COPD exacerbations, using data from community pharmacies and GP practices.

DESIGN AND METHODS

A cohort of 2294 asthma patients and 1559 COPD patients (≥ 18 years old) was compiled from linked databases of the PHARMO Institute. They were followed 1-4 years. Two measures of compliance were applied: (1) ‘actual use’ on a certain day, defined as the availability of medication on that day; (2) ‘long-term compliance’, which was assumed if there was actual use on at least 80% of the study period. Cox proportional hazards models were used to estimate associations of compliance and exacerbations, with and without adjustment for patients’ baseline characteristics (age, body mass index, gender, smoking history, disease severity). The adjusted analysis was applied on a subset of patients.

RESULTS

Without statistical adjustments, compliance was associated with a shorter time to exacerbations. After adjustment for baseline characteristics, the associations disappeared, but no protective effect was found. The same results were found in the subset when no adjustment was applied.

CONCLUSION

Registrations should be improved in order to enable the estimation of the real life effect of medication compliance on the risk of exacerbations in asthma and COPD patients.

Rubriek: Oorspronkelijk artikel
Identificatie: 2016;1:a1632
Datum: 11 november 2016

Anti-Xa-activiteit van therapeutisch nadroparine bij verminderde nierfunctie en behandeling conform richtlijn Nederlandse federatie voor Nefrologie: vergelijking met standaarddosis bij normale nierfunctie

A.L. van Ojik a*, M. Hemmelder b, M. Hoogendoorn b, R. Folkeringa c, R. Smit de, H.J. Derijks df, R.J. van Marum gh, S.H. Hofma c en E.N. van Roon ai

Lees abstract

Anti-Xa activity of therapeutic nadroparin in patients with renal impairment treated according to the Dutch Federation of Nephrology guideline: comparison with standard dosing in patients with normal renal function

OBJECTIVE

To determine equivalence of the mean anti-Xa activity (aXa) in patients with eGFR < 60 mL/min treated with a reduced therapeutic dose of nadroparin using the dosage guideline of the Dutch Federation of Nephrology (NfN) and patients with eGFR > 60 mL/min receiving a standard therapeutic dose of nadroparin.

DESIGN

Prospective, observational, multicentre, cohort study.

METHODS

In three general teaching hospitals, patients were included between July 2014 and April 2016 if they met inclusion criteria: age > 18 years, therapeutic dose of nadroparin, subcutaneous administration for at least three days and written informed consent. Exclusion criteria were: dialysis, participation in another study and use of anti-Xa inhibitors other than nadroparin or four-factor prothrombin complex concentrate within seven days before the start or during the study. After at least three adjusted doses on the third day of therapy a blood sample was drawn four hours after administration of nadroparin (therapeutic range: 0.6-1.0 IU/mL).

RESULTS

97 patients with eGFR < 60 mL/min and 100 patients with eGFR > 60 mL/min were included. The mean aXa was 0.63 IU/mL respectively 0.62 IU/mL (P for equivalence = 0.015). In the group with renal impairment 52%, 12% respectively 37% of the patients achieved sub-, supra- and therapeutic aXa, compared with 47%, 7% respectively 46% in the group with normal renal function (P = 0.30).

CONCLUSION

This study shows that in patients with renal impairment a dosage reduction of therapeutic nadroparin using the dosage guideline of the NfN results in aXa that is equivalent with standard dose treatment in patients with normal renal function.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1631
Datum: 7 november 2016

Ziekte van Parkinson, levodopagebruik en het risico op melanoom

Hazel Hummels a, Lotte Sebek b, Wijnand Rutgers c, Petra Harms d, Ithamar Brinkman e* en Marianne Luinstra f

Lees abstract

Parkinson’s disease, levodopa use and the risk of melanoma

BACKGROUND

Changes in melanin concentration in the melanocytes of the skin play an important role in the genesis of skin cancer, while in Parkinson’s disease a reduction occurs of the amount of neuromelanin (the form of melanin in the substantia nigra). Melanin thus plays a role in both illnesses, but the exact connection between both diseases is still unknown.

OBJECTIVE

To define the risk of developing malignant melanoma as a possible side effect of levodopa use in patients with Parkinson’s disease.

DESIGN AND METHODS

Literature review using PubMed.

RESULTS

We found no evidence of a significantly increased risk of developing melanoma due to levodopa use. However, there is a bi-directional relationship between Parkinson’s disease and malignant melanoma.

CONCLUSION

Based on this literature study we suggest to alert Parkinson patients to the increased risk of melanoma.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1635
Datum: 27 oktober 2016

Anti-Xa-bloedspiegels bij patiënten met verminderde nierfunctie – Antwoord van de auteurs

R. Smit a*, R.J. van Marum bc, N.C.V. Péquériaux d, A.A.M.J. Hollander e, M.W.P. Bleeker f, W.A.J.J. Hermens a en H.J. Derijks ag

Rubriek: Correspondentie
Identificatie: 2016;1:c1602
Datum: 25 oktober 2016

Anti-Xa-bloedspiegels bij patiënten met verminderde nierfunctie – Reactie

E. Boerrigter a, A.T.M. Wasylewicz b, R.J.E. Grouls c en C.H.M. Kerskes d*

Rubriek: Correspondentie
Identificatie: 2016;1:c1601
Datum: 25 oktober 2016

Postoperatieve pijnbestrijding in Nederlandse ziekenhuizen

E.S. Koster a* en E.H.H. Wiltink b

Lees abstract

Postoperative pain management in Dutch hospitals

OBJECTIVE

To assess procedures regarding postoperative pain management in Dutch hospitals. Many postoperative patients experience pain. Inadequate pain control hampers patient recovery and may prolong hospital admission.

DESIGN AND METHODS

Structured questionnaires were used to describe the procedures in the participating hospitals. Furthermore, data on executed pain measurements and pain control were collected for both admitted and recently discharged patients.

RESULTS

Data were collected in 30 Dutch hospitals. All 30 hospitals had a protocol describing pain management. Postoperative pain was included most often (n = 28). In 28 hospitals the protocol described treatment of pain and in 25 hospitals pain measurement was described. We included 160 admitted and 155 recently discharged patients. For 94% of the admitted patients and 88% of the discharged patients, pain measurements were recorded during their hospital admission. For approximately half of the patients, three pain measurements per day were conducted. In both groups, for 74% a pain treatment strategy was described.

CONCLUSION

All hospitals had a guideline describing procedures for postoperative pain management. Most of the time patients have been treated according to the pain protocol.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1629
Datum: 11 oktober 2016

Ervaringen met farmaceutische anamnese in de polikliniek: een oriënterend onderzoek

L. Ariaans-Silkens a*, M.G.J. Meevis-Hendriks b en E.A. van Dijk c

Lees abstract

Experiences with pharmaceutical consultation prior to outpatient visit: a pilot study

OBJECTIVE

To assess the feasibility and appropriateness of a pharmaceutical consultation prior to an outpatient visit for performing medication reconciliation and identifying potential drug-related problems (DRPs), and to identify factors that indicate when physicians consider a follow-up pharmaceutical consultation desirable.

DESIGN AND METHODS

In this pilot study, adult patients who used medication were invited for a pharmaceutical consultation by a pharmacy technician prior to their visit to the outpatient clinic of internal medicine. The pharmacy technician performed medication reconciliation based on electronically generated pharmacy dispensing data. A checklist was used to identify potential DRPs. The physician was asked for which patients a follow-up pharmaceutical consultation was considered desirable.

RESULTS

The pharmaceutical consultation took about 15 minutes, half of which was preparation. Electronically generated pharmacy dispensing data were accurate for only 29% of all patients. Per patient, 2.9 medication records had to be adjusted. 31% of consulted patients reported a DRP with the current medication. Nearly 10% reported intentional noncompliance. Physicians indicated repeating the pharmaceutical consultation was desirable for 26% of all consulted patients. Physicians were more likely to consider follow-up desirable if they were not oncology specialists, if available consultation time was 10 minutes or less, and if patients were over 75 years old and used three or more medicines.

CONCLUSION

A pharmaceutical consultation by a pharmacy technician prior to an outpatient visit provides useful information on current medication use and DRPs, but the required time limits routine implementation. Future research is needed to identify risk patients that will benefit most from a pharmaceutical consultation.

Rubriek: Oorspronkelijk artikel
Identificatie: 2016;1:a1628
Datum: 3 oktober 2016

Het gebruik van incretines en het risico op alvleesklierkanker: een populatiegebaseerde cohortstudie

Lotte M. Knapen a, Nielka P. van Erp b, Hubert G.M. Leufkens c, Sander Croes a, Frank de Vries acde* en Johanna H.M. Driessen acd

Lees abstract

Use of incretin agents and risk of pancreatic cancer: a population-based cohort study

OBJECTIVE

To determine the association between the use of incretin agents and the risk of pancreatic cancer. Incretins (dipeptidyl peptidase 4 [DPP-4] inhibitors and glucacon-like peptide 1 [GLP-1] receptor analogues) are effective new agents for the treatment of type 2 diabetes mellitus (T2DM). Incretins have been associated with pancreatic cancer, but evidence is limited and conflicting.

DESIGN AND METHODS

A retrospective population-based cohort study was conducted using data from the UK Clinical Practice Research Datalink (CPRD, 2007-2012). 182,428 adult patients with at least one non-insulin antidiabetic drug (NIAD) prescription were matched to non-diabetic controls. Multivariable Cox proportional hazard ratios (HRa) and 95% confidence intervals (CI95) were used to estimate the risk of pancreatic cancer in incretin users (N = 28,370) as compared to controls and to other NIAD users. Adjustments were made for lifestyle, disease and drug history. In a sensitivity analysis, a new user design was used.

RESULTS

The main duration of follow up was 4.1 years for incretin users. Current NIAD use was associated with a 4-fold increased risk of pancreatic cancer and this risk almost doubled among current incretin users as compared to controls. Incretin use was not associated with pancreatic cancer when compared to diabetic controls (HRa 1.36; CI95 0.94-1.96). However, the new user design did show an association between incretin use and pancreatic cancer.

CONCLUSION

Incretin use was not associated with pancreatic cancer after adjustment for the severity of the underlying T2DM. The presence of confounding by disease severity and the lack of duration of use relationship do not support a causal explanation for the association between incretin agents and pancreatic cancer.

Rubriek: Korte bijdrage
Identificatie: 2016;1:a1627
Datum: 27 september 2016

Medicatie minderen bij ouderen: meningen van patiënt, apotheker en huisarts vergeleken

R.J. van Marum ab*, S. van Marum b, S. van Driesten b, S. Verdoorn cd, A. Boxman c en A. Grossklaus c

Lees abstract

Deprescribing for the elderly: comparing opinions of patients, pharmacists and doctors

OBJECTIVE

To study the opinion of elderly patients with polypharmacy regarding their medication and to study the differences in valuation of this medication between patient, community pharmacist and general practitioner (GP).

DESIGN

Interviews and questionnaires.

METHODS

Patients with 7 or more chronically used drugs were interviewed with the Patient’s Attitudes Towards Deprescribing questionnaire. Furthermore patients were asked to name their medication by heart, to rate the assumed importance of each currently used drug on a numeric rating scale (0-10) and to name three drugs they wanted to continue as well as three drugs they would prefer to stop. These last two questions were also presented to their GPs and community pharmacists.

RESULTS

40 patients (mean age 79 years, average 11 drugs) were interviewed. The median number of drugs spontaneously recalled by name by the patient was 2. Though 85% of the patients believes all used drugs are necessary, 98% of them stated they would like to stop drugs if the GP said it was possible. Patients scored the importance of their drugs slightly higher than pharmacists or GPs (mean score: 7,5 versus 6,7 versus 6,9). Rating of importance for all groups seemed not to be based on comparison of numbers needed to treat.

CONCLUSION

Patients consider their current medication useful and necessary, but almost all of them are willing to stop some drugs. Their spontaneous knowledge of the drugs used seems low. Before performing medication reviews, GPs and pharmacists should test the patients’ knowledge and provide them with information necessary for making the right decisions.

Rubriek: Oorspronkelijk artikel
Identificatie: 2016;1:a1626
Datum: 20 september 2016

Contact

Redacteur / secretaris
Arjan Polderman

(070) 373 73 14 npfo@npfo.nl