Sarasota Memorial Hospital, Sarasota, FL, USA.
J Oncol Pharm Pract. 2021 Dec;27(8):1821-1828. doi: 10.1177/1078155220970266. Epub 2020 Nov 11.
Immune checkpoint inhibitors (ICI) are novel oncolytic therapies associated with various immune related adverse events (irAEs) affecting multiple organ systems, which may have a delayed presentation. Identification of irAEs and prompt initiation of appropriate treatment represents a challenge to clinicians. The purpose of this study was to evaluate the effectiveness of a pharmacy consult service in identification and management of irAEs. This was a single center, retrospective study. Patients included were: ≥18 years old, admitted as inpatients, and reported a history of cancer treatment within the last year. A pharmacy consult was developed and implemented for patients who reported a history of ICI therapy within the last year. Education regarding the consult service was provided to select physicians, nurses, and all pharmacists. Primary outcome: percent of admitted patients reporting ICI therapy within the last year, who required pharmacist intervention for an irAE. Secondary outcomes: types of interventions performed, percentage of recommendation acceptance, pharmacist time spent.
Fifty-one patients received a pharmacy immunotherapy consult. Seventeen patients (33%) met the primary outcome. Thirty-three separate recommendations were made by pharmacists for these 17 patients. The secondary outcomes of interventions made and percentage accepted (n; % accepted): Initiation/adjustment of steroid therapy (20; 40%), placement of a consult for oncology or other specialist (10; 70%), other therapeutic interventions (3; 67%). Average time spent by pharmacist on initial consultations (SD): 29 minutes (15).
A pharmacy consult service may help to increase identification of patients receiving immune checkpoint inhibitors and initiate timely interventions.
免疫检查点抑制剂（ICI）是一种新型的肿瘤治疗药物，与影响多个器官系统的各种免疫相关不良事件（irAE）有关，这些事件可能会延迟出现。识别 irAE 并及时启动适当的治疗是临床医生面临的挑战。本研究旨在评估药学咨询服务在识别和管理 irAE 方面的有效性。这是一项单中心、回顾性研究。纳入的患者标准为：年龄≥18 岁，住院患者，且在过去一年中报告有癌症治疗史。为过去一年报告有 ICI 治疗史的患者开发并实施了药学咨询。向选定的医生、护士和药剂师提供有关咨询服务的教育。主要结果：报告过去一年接受过 ICI 治疗的住院患者比例，这些患者因 irAE 需要药剂师干预。次要结果：实施的干预类型、建议接受率、药剂师花费的时间。
51 名患者接受了药学免疫治疗咨询。17 名患者（33%）符合主要结局标准。药师针对这 17 名患者提出了 33 项不同的建议。干预措施和建议接受率（n；%接受）的次要结果为：开始/调整类固醇治疗（20；40%）、安排肿瘤学或其他专科会诊（10；70%）、其他治疗干预（3；67%）。药师进行初始咨询的平均时间（SD）：29 分钟（15）。
药学咨询服务可能有助于增加识别接受免疫检查点抑制剂治疗的患者，并及时进行干预。
