Charra Florent, Philippe Michael, Herledan Chloé, Caffin Anne-Gaëlle, Larbre Virginie, Baudouin Amandine, Schwiertz Vérane, Vantard Nicolas, Labussiere-Wallet Hélène, Ducastelle-Leprêtre Sophie, Barraco Fiorenza, Balsat Marie, Larcher Marie Virginie, Salles Gilles, Rioufol Catherine, Ranchon Florence
Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France.
University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France.
J Oncol Pharm Pract. 2021 Mar 8:10781552211000115. doi: 10.1177/10781552211000115.
This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.
本研究旨在评估对异基因造血干细胞移植（HSCT）患者实施专业临床药学项目对其出院后免疫抑制治疗依从性的影响。采用前瞻性开放干预设计并设立回顾性对照组。干预措施基于药学咨询：第一次咨询在HSCT病房出院前一天进行，后续咨询在日间护理随访期间（出院后第2周和第4周）进行。在出院处方前，根据完整的用药清单进行主动用药核对。向患者解释了总结在个性化用药时间表上的出院处方。向患者解释了最佳依从性的重要性以及与自我用药相关的潜在问题。通过使用钙调神经磷酸酶抑制剂血清水平的直接方法评估免疫抑制药物的依从性。研究了对急性移植物抗宿主病（GvHD）和感染的潜在影响。26例患者纳入专业临床药学项目，35例患者作为对照组。干预组进行了79次药学咨询，第一次咨询平均持续25分钟，后续咨询平均持续16分钟。干预组治疗目标范围内的血清水平更高（61.5%对53.0%，p = 0.07），个体内差异更大（p = 0.005）。急性GvHD（53.8%对50.3%，p = 0.85）或感染（26.9对22.8%，p = 0.72）方面，组间无显著差异。对接受异基因HSCT的患者实施专业临床药学项目似乎有利于免疫抑制药物的依从性；目前这需要在涉及更多患者的多中心研究中得到证实。
