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Thomboprophylaxis In Multiple Myeloma Patients Treated With Lenalidomide or Thalidomide
Poster Presentations of diabetes, rheumatoid arthritis and psychiatric disorders were associated with an increase in opioid use, whereas hospitalisation (versus ambulatory surgery), high level of preoperative pain and psychiatric disorders were found to be associated with an increase in antineuropathic drug use. Conclusions: This study revealed that around 1 out of 3 patients undergoing carpal tunnel surgery had persistent and even increased use of opioids and antineuropathics drugs more than two months after surgery, in relation with possible chronic postoperative pain. Considering the incidence of carpal tunnel syndrome, the risks associated with persistent opioid use in this population should be further monitored.
Thomboprophylaxis In Multiple Myeloma Patients Treated With Lenalidomide or Thalidomide A. Palmaro1; F. Despas1; and M. Lapeyre-Mestre1,2 Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Toulouse, France; and 2 Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, Toulouse, France Background: Immunomoduladory drugs IMiDs (lenalidomide and thalidomide) have contributed to improve patients’ survival in multiple myeloma. However, they increase the risk of thromboembolic events and often require a concomitant thromboprophylaxis based on treatment received and level of risk. Strategy of prophylaxis is still debated, while international guidelines tend to recommend either aspirin or low weight molecular heparin (LWMH). The aim of this study was to describe strategy of thromboprophylaxis in a cohort of multiple myeloma patients during their first imid-based regimen. Material and Methods: A retrospective cohort study of French beneficiaries from the main health insurance scheme database -SNIIRAM (Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France, 2.8 million inhabitants). Multiple myeloma patients were identified through hospital diagnosis or long-term conditions. Beneficiaries with at least 1 dispensing record for lenalidomide or thalidomide in hospital pharmacy from January 2010 to March 2014 were included. Patients’ characteristics, previous and current treatment line together with thromboprophylatic drugs were described. Results: Among the 271 multiple myeloma patients (62% male, 60% > 65 y) starting an imid-based regimen: 21% (n = 58) received thalidomide alone or thalidomide-dexamethasone (T-TD), 14% (n = 38) bortezomib-thalidomide-dexamethasone (VTD), 25% (n = 68) melphalan-prednisone-thalidomide (MPT) and 40% (n = 107) had lenalidomide-dexamethasone (RD) therapy. Forty-eight percent were at first-line therapy, 42% in second-line therapy and 10% in third-line therapy. Around 85% (n = 230) of the patients received > 1 drug for thromboprophylaxis after starting their imid regimen: 63% aspirin (n = 198), 36% unfractionated heparin or LWMH (n = 98), 15% vitamin K antagonists (n = 42). No prophylaxis was retrieved for 15% of the patients (n = 41). Further analyses are currently implemented to describe thromboprophylaxis in high risk cases: radiotherapy, previous thromboembolism, current use of biphosphonates, or hormonal treatments. Conclusions: These preliminary results revealed a great variability in the implementation of thromboprophylaxis strategy in real-life, even in high risk treatment lines with chemotherapy or dexamethasone in which thromboprophylaxis should be systematically applied.
1
August 2015
Prospective clinical study of fosfomycin efficacy in the treatment of complicated urinary tract infections caused by e. Coli and k. Pneumoniae producing extended spectrum beta lactamases L. Bielen1; and R. Likic1,2 University of Zagreb School of Medicine, Zagreb, Croatia; and 2 University Clinical Hospital Center Zagreb, Croatia Introduction: In the era of rising antibiotic resistance rates, treatment of complicated urinary tract infections (cUTIs) caused by bacterial strains producing extended spectrum beta lactamases (ESBL) represents a major therapeutic problem. Hence, there is a growing interest in the investigation of older antibiotics like fosfomycin, especially due to its rapid bactericidal activity, oral route of administration, low resistance rates and low cost. Material and Methods: One hundred forty-five urinary isolates of ESBL producing E. coli and K. pneumoniae from ambulatory patients were prospectively in vitro tested to fosfomycin and other routinely used antibiotics. Those patients with isolates sensitive to fosfomycin and fulfilling inclusion and exclusion criteria then received on average 3.7 doses of fosfomycin. Fosfomycin was administered orally, every 2 days. Patients on average had 2.3 complicating factors (most commonly recurrent UTIs, diabetes mellitus and chronic kidney disease). Microbiological cure was evaluated 7 to 9 days after completion of treatment by means of urinary culture. Results: All E. coli ESBL isolates (n = 81) were in vitro sensitive to fosfomycin, which was statistically different from all other tested orally administered antibiotics, P < 0.001 (nitrofurantoin 73%, ceftibuten 66%, amoxicillin clavulanate 51%, trimethoprim sulfamethoxazole 20%, ciprofloxacin 11%). Thirty-three of 64 K. pneumoniae ESBL isolates were in vitro sensitive to fosfomycin (52%), which was statistically different from trimethoprim sulfamethoxazole (32%) and ciprofloxacin (11%), P < 0.05, and similar to ceftibuten (55%) and amoxicillin clavulanate (39%). Eradication of ESBL strain was achieved in 29 of the 44 patients with cUTIs (66%), while clinical improvement was achieved in all patients, at least temporarily. Conclusions: In vitro sensitivity of E. coli ESBL to fosfomycin is excellent while that of K. pneumoniae ESBL is much lower. Fosfomycin administered orally in several doses represents a potentially attractive oral therapeutic option for cUTIs caused by ESBL producing strains. 1
Randomized Pragmatic Clinical Trial On The Duration Of Antimicrobial Treatment For Enterobacteriaceae Bacteremia In Adult Patients (Shorten Study) C. Rosso-Fernández1; B. Solano1; L. Lavín-Alconero1; Y. Borrego2; J.M. Cisneros1; A. Valiente4; C. Natera5; and J. Molina1 1 Hospital UniversitarioVirgen del Rocío, Seville, Spain; 2 Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain; 4Hospital Universitario Virgen Macarena, Seville, Spain; and 5Hospital Universitario Reina Sofía, Córdoba, Spain Background: The antimicrobiAQ2al crisis is a major problem as resistant bacteria infections have increased and the availability of effective antibiotics have been reduced. Gram-negative bacilli are responsible for frequent and potentially severe bloodstream infections, among which up to 47% can be produced by Enterobacteria (EB).The optimal duration of antibiotic treatment in this clinical setting is unknown, as no clinical trials (CT) have been designed to answer this question. Moreover, the role of biomarkers such as procalcitonine (PCT) in this setting has not been established.
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Thomboprophylaxis In Multiple Myeloma Patients Treated With Lenalidomide or Thalidomide A. Palmaro1; F. Despas1; and M. Lapeyre-Mestre1,2 Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Toulouse, France; and 2 Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, Toulouse, France Background: Immunomoduladory drugs IMiDs (lenalidomide and thalidomide) have contributed to improve patients’ survival in multiple myeloma. However, they increase the risk of thromboembolic events and often require a concomitant thromboprophylaxis based on treatment received and level of risk. Strategy of prophylaxis is still debated, while international guidelines tend to recommend either aspirin or low weight molecular heparin (LWMH). The aim of this study was to describe strategy of thromboprophylaxis in a cohort of multiple myeloma patients during their first imid-based regimen. Material and Methods: A retrospective cohort study of French beneficiaries from the main health insurance scheme database -SNIIRAM (Système National d'Information Inter-Régime de l'Assurance Maladie) was designed in the Midi-Pyrénées area (South West France, 2.8 million inhabitants). Multiple myeloma patients were identified through hospital diagnosis or long-term conditions. Beneficiaries with at least 1 dispensing record for lenalidomide or thalidomide in hospital pharmacy from January 2010 to March 2014 were included. Patients’ characteristics, previous and current treatment line together with thromboprophylatic drugs were described. Results: Among the 271 multiple myeloma patients (62% male, 60% > 65 y) starting an imid-based regimen: 21% (n = 58) received thalidomide alone or thalidomide-dexamethasone (T-TD), 14% (n = 38) bortezomib-thalidomide-dexamethasone (VTD), 25% (n = 68) melphalan-prednisone-thalidomide (MPT) and 40% (n = 107) had lenalidomide-dexamethasone (RD) therapy. Forty-eight percent were at first-line therapy, 42% in second-line therapy and 10% in third-line therapy. Around 85% (n = 230) of the patients received > 1 drug for thromboprophylaxis after starting their imid regimen: 63% aspirin (n = 198), 36% unfractionated heparin or LWMH (n = 98), 15% vitamin K antagonists (n = 42). No prophylaxis was retrieved for 15% of the patients (n = 41). Further analyses are currently implemented to describe thromboprophylaxis in high risk cases: radiotherapy, previous thromboembolism, current use of biphosphonates, or hormonal treatments. Conclusions: These preliminary results revealed a great variability in the implementation of thromboprophylaxis strategy in real-life, even in high risk treatment lines with chemotherapy or dexamethasone in which thromboprophylaxis should be systematically applied.
1
August 2015
Prospective clinical study of fosfomycin efficacy in the treatment of complicated urinary tract infections caused by e. Coli and k. Pneumoniae producing extended spectrum beta lactamases L. Bielen1; and R. Likic1,2 University of Zagreb School of Medicine, Zagreb, Croatia; and 2 University Clinical Hospital Center Zagreb, Croatia Introduction: In the era of rising antibiotic resistance rates, treatment of complicated urinary tract infections (cUTIs) caused by bacterial strains producing extended spectrum beta lactamases (ESBL) represents a major therapeutic problem. Hence, there is a growing interest in the investigation of older antibiotics like fosfomycin, especially due to its rapid bactericidal activity, oral route of administration, low resistance rates and low cost. Material and Methods: One hundred forty-five urinary isolates of ESBL producing E. coli and K. pneumoniae from ambulatory patients were prospectively in vitro tested to fosfomycin and other routinely used antibiotics. Those patients with isolates sensitive to fosfomycin and fulfilling inclusion and exclusion criteria then received on average 3.7 doses of fosfomycin. Fosfomycin was administered orally, every 2 days. Patients on average had 2.3 complicating factors (most commonly recurrent UTIs, diabetes mellitus and chronic kidney disease). Microbiological cure was evaluated 7 to 9 days after completion of treatment by means of urinary culture. Results: All E. coli ESBL isolates (n = 81) were in vitro sensitive to fosfomycin, which was statistically different from all other tested orally administered antibiotics, P < 0.001 (nitrofurantoin 73%, ceftibuten 66%, amoxicillin clavulanate 51%, trimethoprim sulfamethoxazole 20%, ciprofloxacin 11%). Thirty-three of 64 K. pneumoniae ESBL isolates were in vitro sensitive to fosfomycin (52%), which was statistically different from trimethoprim sulfamethoxazole (32%) and ciprofloxacin (11%), P < 0.05, and similar to ceftibuten (55%) and amoxicillin clavulanate (39%). Eradication of ESBL strain was achieved in 29 of the 44 patients with cUTIs (66%), while clinical improvement was achieved in all patients, at least temporarily. Conclusions: In vitro sensitivity of E. coli ESBL to fosfomycin is excellent while that of K. pneumoniae ESBL is much lower. Fosfomycin administered orally in several doses represents a potentially attractive oral therapeutic option for cUTIs caused by ESBL producing strains. 1
Randomized Pragmatic Clinical Trial On The Duration Of Antimicrobial Treatment For Enterobacteriaceae Bacteremia In Adult Patients (Shorten Study) C. Rosso-Fernández1; B. Solano1; L. Lavín-Alconero1; Y. Borrego2; J.M. Cisneros1; A. Valiente4; C. Natera5; and J. Molina1 1 Hospital UniversitarioVirgen del Rocío, Seville, Spain; 2 Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain; 4Hospital Universitario Virgen Macarena, Seville, Spain; and 5Hospital Universitario Reina Sofía, Córdoba, Spain Background: The antimicrobiAQ2al crisis is a major problem as resistant bacteria infections have increased and the availability of effective antibiotics have been reduced. Gram-negative bacilli are responsible for frequent and potentially severe bloodstream infections, among which up to 47% can be produced by Enterobacteria (EB).The optimal duration of antibiotic treatment in this clinical setting is unknown, as no clinical trials (CT) have been designed to answer this question. Moreover, the role of biomarkers such as procalcitonine (PCT) in this setting has not been established.
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